-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, Rmx6rinbx27yUiQSX2hQwLhtl5xFKyPd6czCoZUuigZktlMtG4ZYGS6/3dHgcRS8 FFMEYVirdy5D2msQvWrJ5Q== 0001019687-08-003027.txt : 20080714 0001019687-08-003027.hdr.sgml : 20080714 20080711175712 ACCESSION NUMBER: 0001019687-08-003027 CONFORMED SUBMISSION TYPE: 10-K PUBLIC DOCUMENT COUNT: 10 CONFORMED PERIOD OF REPORT: 20080331 FILED AS OF DATE: 20080714 DATE AS OF CHANGE: 20080711 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Integrated Healthcare Holdings Inc CENTRAL INDEX KEY: 0001051488 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOSPITALS [8060] IRS NUMBER: 870412182 STATE OF INCORPORATION: NV FISCAL YEAR END: 0331 FILING VALUES: FORM TYPE: 10-K SEC ACT: 1934 Act SEC FILE NUMBER: 000-23511 FILM NUMBER: 08949689 BUSINESS ADDRESS: STREET 1: 1301 N. TUSTIN AVENUE CITY: SANTA ANA STATE: CA ZIP: 92705 BUSINESS PHONE: 714-434-9191 MAIL ADDRESS: STREET 1: 1301 N. TUSTIN AVENUE CITY: SANTA ANA STATE: CA ZIP: 92705 FORMER COMPANY: FORMER CONFORMED NAME: Integrated Healthcare Holdings DATE OF NAME CHANGE: 20040816 FORMER COMPANY: FORMER CONFORMED NAME: FIRST DELTAVISION INC DATE OF NAME CHANGE: 19971216 10-K 1 ihh_10k-033108.txt ANNUAL REPORT ================================================================================ UNITED STATES SECURITIES 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 March 31, 2008; or [ ] Transition Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 Commission File Number 0-23511 ---------------- INTEGRATED HEALTHCARE HOLDINGS, INC. (EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER) Nevada 87-0573331 (STATE OF INCORPORATION) (I.R.S. EMPLOYER IDENTIFICATION NO.) 1301 North Tustin Avenue, Santa Ana, California 92705 (ADDRESS OF PRINCIPAL EXECUTIVE OFFICES) (ZIP CODE) Registrant's telephone number, including area code: (714) 953-3503 Securities registered pursuant to Section 12(b) of the Act: None Securities registered pursuant to Section 12(g) of the Act: Common Stock, $.001 par value (TITLE OF CLASS) ---------------- Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes[ ] No[X] Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes[ ] No[X] Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes [X] No [ ] Indicate by check mark if disclosure of delinquent filers pursuant to Item 405 of Regulation S-K is not contained herein, and will not be contained, to the best of registrant's knowledge, in definitive proxy or information statements incorporated by reference in Part III of this Form 10-K or any amendment to this Form 10-K. [ ] Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, or a non-accelerated filer. See definition of "accelerated filer and large accelerated filer" in Rule 12b-2 of the Exchange Act. (Check one): Large accelerated filer [ ] Accelerated filer [ ] Non-accelerated filer [ ] Smaller reporting company [X] Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Act). Yes [ ] No [X] The aggregate market value of voting stock held by non-affiliates of the registrant was $3,596,300 as of September 28, 2007 (computed by reference to the last sale price of a share of the registrant's common stock on that date as reported by the Over the Counter Bulletin Board). For purposes of this computation, it has been assumed that the shares beneficially held by directors and officers of registrant were "held by affiliates"; this assumption is not to be deemed to be an admission by such persons that they are affiliates of registrant. There were 137,095,716 shares outstanding of the registrant's common stock as of June 16, 2008. DOCUMENTS INCORPORATED BY REFERENCE: No portions of other documents are incorporated by reference into this Annual Report. ================================================================================ INTEGRATED HEALTHCARE HOLDINGS, INC. FORM 10-K ANNUAL REPORT FOR THE YEAR ENDED MARCH 31, 2008 TABLE OF CONTENTS PART I.........................................................................3 ITEM 1. BUSINESS............................................................3 ITEM 1A. RISK FACTORS......................................................19 ITEM 2. PROPERTIES.........................................................25 ITEM 3. LEGAL PROCEEDINGS..................................................26 ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS................27 PART II.......................................................................28 ITEM 5. MARKET FOR REGISTRANT'S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES....28 ITEM 6. SELECTED FINANCIAL DATA............................................30 ITEM 7. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS........................................31 ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK........49 ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA........................50 ITEM 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE ........................................50 ITEM 9A. CONTROLS AND PROCEDURES...........................................50 ITEM 9B. OTHER INFORMATION.................................................51 PART III......................................................................52 ITEM 10. DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE............52 ITEM 11. EXECUTIVE COMPENSATION............................................56 ITEM 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS ................................61 ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE....................................................63 ITEM 14. PRINCIPAL ACCOUNTANT FEES AND SERVICES............................65 ITEM 15. EXHIBITS AND FINANCIAL STATEMENT SCHEDULES........................66 SIGNATURES....................................................................69 PART I FORWARD-LOOKING INFORMATION This Annual Report on Form 10-K contains forward-looking statements, as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements relate to future events or our future financial performance. In some cases, you can identify forward-looking statements by terminology such as "may," "will," "should," "expects," "plans," "anticipates," "believes," "estimates," "predicts," "potential" or "continue" or the negative of these terms or other comparable terminology. These statements are only predictions and involve known and unknown risks, uncertainties and other factors, including the risks discussed under the caption "Risk Factors" herein that may cause our Company's or our industry's actual results, levels of activity, performance or achievements to be materially different from those expressed or implied by these forward-looking statements. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, levels of activity, performance or achievements. Except as may be required by applicable law, we do not intend to update any of the forward-looking statements to conform these statements to actual results. As used in this report, the terms "we," "us," "our," "the Company," "Integrated Healthcare Holdings" or "IHHI" mean Integrated Healthcare Holdings, Inc., a Nevada corporation, unless otherwise indicated. EXPLANATORY NOTE REGARDING CHANGE IN FISCAL YEAR On December 21, 2006 the Company changed its fiscal year end from December 31 to March 31. Unless specifically indicated otherwise, any reference to "2008" and "2007" or "fiscal 2008" and "fiscal 2007" relate to March 31, 2008 and 2007 and the years then ended, respectively, and any reference to "2005" or "fiscal 2005" relates to December 31, 2005 or the year ended December 31, 2005. The transition period, January 1 to March 31, 2006, is referred to as the "transition period". ITEM 1. BUSINESS BACKGROUND Integrated Healthcare Holdings, Inc. is a predominantly physician owned company that, on March 8, 2005, acquired and began operating the following four hospital facilities in Orange County, California (referred to as the "Hospitals"): o 282-bed Western Medical Center in Santa Ana o 188-bed Western Medical Center in Anaheim o 178-bed Coastal Communities Hospital in Santa Ana o 114-bed Chapman Medical Center in Orange Together we believe that the Hospitals represent approximately 12.2% of all hospital available beds in Orange County, California (based on the most recent data on the Office of Statewide Health Planning and Development for California web site as of June 15, 2008) Prior to March 8, 2005, we were primarily a development stage company with no material operations. On November 18, 2003, members of our current and former executive management purchased a controlling interest in the Company and redirected its focus towards acquiring and operating hospitals and healthcare facilities that are financially distressed and/or underperforming. On September 29, 2004, the Company entered into a definitive agreement to acquire the four Hospitals from subsidiaries of Tenet Healthcare Corporation ("Tenet"), and the transaction closed on March 8, 2005. The transaction included operations of four licensed general acute care hospitals with a total of 762 beds. All four hospitals are accredited by the Joint Commission on Accreditation of Healthcare Organizations and other appropriate accreditation agencies that accredit specific programs. All properties are in Orange County California, and operate as described below. 3 WESTERN MEDICAL CENTER - SANTA ANA. Western Medical Center - Santa Ana, located at 1001 North Tustin Avenue, Santa Ana, CA 92705, is Orange County's first hospital, founded over 100 years ago. The hospital is one of IHHI's two hospitals in Santa Ana, which are the only two general acute care hospitals in this city of 350,000 people. The hospital has 282 beds and provides quaternary, tertiary and secondary services. It serves the entire county as one of only three designated trauma centers in Orange County along with other tertiary services such as burn center, kidney transplantation, emergency and scheduled neurosurgical care, cardiac surgical services, a paramedic base station and receiving center. The hospital also maintains Intensive Care Units for adults and pediatrics, and a Neonatal Intensive Care Unit. Additionally the hospital offers telemetry, neurosurgical definitive observation, geriatric, psychiatric, medical, surgical, pediatric and obstetric inpatient services. Supporting these services the hospital offers operating and recovery rooms, radiology services, respiratory therapy services, clinical laboratories, pharmacy, physical and occupational therapy services on an inpatient and most on an outpatient basis. The hospital has approximately 175 active physicians and 535 employee nurses, and hospital staff. WESTERN MEDICAL CENTER - ANAHEIM. Western Medical Center - Anaheim, located at 1025 South Anaheim Boulevard, Anaheim, CA 92805, offers a full range of acute medical and psychiatric care services serving northern Orange County and providing tertiary services to Riverside County residents. The hospital offers special expertise in the tertiary services of The Heart and Vascular Institute, and Behavioral Health Services. Additionally, the hospital provides the Women and Children Health Services, and 24-hour Emergency Services. Supporting these services the hospital offers critical care, medical, surgical and psychiatric services supported by operating and recovery rooms, radiology services, respiratory therapy services, clinical laboratories, pharmacy, physical and occupational therapy services on an inpatient and most on an outpatient basis. The hospital has approximately 75 active physicians and 295 employee nurses, and hospital staff. COASTAL COMMUNITIES HOSPITAL - SANTA ANA. Coastal Communities Hospital, located in Santa Ana at 2701 South Bristol Street, Santa Ana, CA 92704, has served the community for more than 30 years, providing comprehensive medical and surgical services in a caring and compassionate environment. The hospital is one of IHHI's two hospitals in Santa Ana, which are the only two general acute care hospitals in this city of 350,000 people. The hospital has tailored its services to meet the changing needs of the community. The hospital's staff reflects the cultural diversity of the community and is particularly responsive and sensitive to diverse healthcare needs. While services continue to expand, the 178-bed facility is small enough to retain the family atmosphere associated with a community hospital. The hospital offers critical care, medical, surgical obstetric, psychiatric and sub acute services supported by operating and recovery rooms, radiology services, respiratory therapy services, clinical laboratories, pharmacy, physical and occupational therapy services on an inpatient and most on an outpatient basis. The hospital has approximately 55 active physicians and 260 employee nurses, and hospital staff. CHAPMAN MEDICAL CENTER - ORANGE. Founded in 1969, Chapman Medical Center is a 114-bed acute care facility located at 2601 East Chapman Avenue, Orange, CA 92869. The hospital's advanced capabilities position the facility as a leader in specialty niche programs, including the following centers: Chapman Center for Obesity (surgical weight loss program); Center for Heartburn and Swallowing; Chapman Lung Center; Chapman Family Health Center; Doheny Eye Center; House Ear Clinic; Center for Senior Mental Health; and Positive Action Center (Adult and Adolescent Chemical Dependency Program). Supporting these services the hospital offers critical care, medical, surgical and geriatric psychiatric services supported by operating and recovery rooms, radiology services, respiratory therapy services, clinical laboratories, pharmacy, physical and occupational therapy services on an inpatient and most on an outpatient basis. The hospital has approximately 45 active physicians and 115 employee nurses, and hospital staff. On March 8, 2005, the Company assumed management responsibility and control over the Hospitals. All primary systems and controls have been successfully transitioned to our Company for the effective management of the Hospitals. 4 EMPLOYEES AND MEDICAL STAFF At March 31, 2008, the Company had approximately 3,075 employees. Of these employees, approximately 620 are represented by two labor unions, the California Nurses Association and SIEU-United Healthcare Workers, who are covered by collective bargaining agreements. We believe that our relations with our employees are good. The Company also had approximately 170 individuals from contracting agencies at March 31, 2008, consisting primarily of nursing staff. Our hospitals are fully staffed by physicians and other independently practicing medical professionals licensed by the state, who have been admitted to the medical staff of the individual hospital. Under state laws and licensing standards, hospitals' medical staffs are self-governing organizations subject to ultimate oversight by the hospital's local governing board. None of these physicians are employees of the hospitals. Physicians are not limited to medical staff membership at our hospitals, and many are on staff at our other hospitals, or hospitals not owned or operated by us. Physicians on our medical staffs are free to terminate their membership on our medical staffs and admit their patients to other hospitals, owned, or not owned by us. Non-physician staff, including nurses, therapists, technicians, finance, registration, maintenance, clerical, housekeeping, and administrative staff are generally employees of the hospital, unless the service is provided by a third party contracted entity. We are subject to federal minimum wage and hour laws and various state labor laws and maintain an employee benefit plan. Our hospitals' operations depend on the abilities, efforts, experience and loyalty of our employees and physicians, most of who have no long-term contractual relationship. Our ongoing business relies on our attraction of skilled, quality employees, physicians and other healthcare professionals in all disciplines. We strive to successfully attract and retain key employees, physicians and healthcare professionals. Our operations, financial position and cash flows could be materially adversely affected by the loss of key employees or sufficient numbers of qualified physicians and other healthcare professionals. The relations we have with our employees, physicians, and other healthcare professionals are key to our success and they are a priority in our management philosophy. Nursing can have a significant effect on our labor costs. The national nursing shortage continues and is serious in California. The nursing shortage is a significant issue for hospitals, as it is for us. The result has been an increase in the cost of nursing personnel, thus affecting our labor expenses. Additionally, California instituted mandatory nurse staffing ratios, thus setting a high level of nurses to patients, but also requiring nursing staff ratios be maintained at all times even when on breaks or lunch. These requirements in the environment of a severe nursing shortage may cause the limiting of patient admissions with an adverse effect on our revenues. The vast majority of hospitals in California, including ours, are not at all times meeting the state mandated nurse staffing ratios. Our plan is to improve compliance and reduce the cost of contract labor needed to achieve the nurse staffing ratios. 5 COMPETITION Hospital competition is a community issue and unique to each facility. The first factor is the services the hospital offers and the other hospitals in the area offering the same or similar service. The hospital is dependent on the physicians to admit the patients to the hospital. The number of physicians around the hospital, their specialties, and the quality of medicine they practice will have a major impact on the hospital competition. The ability of the hospital to employ and retain qualified nurses, other healthcare professionals, and administrative staff will affect the hospitals' competitiveness in the market place. A hospital's reputation and years of service to the community affects its competitiveness with patients, physicians, employees, and contracting health plans. Southern California is a highly competitive managed healthcare market therefore the contracting relationships with managed care organizations is a key factor in a hospital's competitiveness. The hospital's location, the community immediately surrounding it and the access to the hospital will affect the hospital's competitiveness. Other hospitals or healthcare organizations serving the same locations determine the intensity of the competition. The condition of the physical plant and the ability to invest in new equipment and technology can affect the communities and physicians desire to use the facility. The amount the hospital charges for services is also a factor in the hospital's competitiveness. The funding sources of the competition can also be a factor if a competitor is tax exempt; it has advantages not available to our Hospitals, such as endowments, chartable contributions, tax-exempt financing, and exemptions from taxes. Since these factors are individual to each hospital, each hospital must develop its own strategies, to address the competitive factors in its local. OUR STRATEGY Our goal is to provide high quality healthcare services in a community setting that are responsive to the needs of the communities that we serve. To accomplish our mission in the complex and competitive healthcare industry, our operating strategies are to (1) improve the quality of care provided at our hospitals by identifying best practices and implementing those best practices, (2) improve operating efficiencies and reduce operating costs while maintaining or improving the quality of care provided, (3) improve patient, physician and employee satisfaction, and (4) improve recruitment and retention of nurses and other employees. We continue to integrate and efficiently operate the four Hospitals in order to achieve profitability from operations. We may also seek additional acquisitions of hospitals or health facilities in the future when opportunities for profitable growth arise. HEALTHCARE REGULATION CERTAIN BACKGROUND INFORMATION. Health care, as one of the largest industries in the United States, continues to attract much legislative interest and public attention. Changes in the Medicare and Medicaid programs and other government healthcare programs, hospital cost containment initiatives by public and private payers, proposals to limit payments and healthcare spending, and industry wide competitive factors greatly impact the healthcare industry. The industry is also subject to extensive federal, state and local regulation relating to licensure, conduct of operations, ownership of facilities, physician relationships, addition of facilities and services, and charges and effective reimbursement rates for services. The laws, rules and regulations governing the healthcare industry are extremely complex, and the industry often has little or no regulatory or judicial interpretation for guidance. Compliance with such regulatory requirements, as interpreted and amended from time to time, can increase operating costs and thereby adversely affect the financial viability of our business. Failure to comply with current or future regulatory requirements could also result in the imposition of various civil and criminal sanctions including fines, restrictions on admission, denial of payment for all or new admissions, the revocation of licensure, decertification, imposition of temporary management or the closure of a facility. 6 MEDICARE GENERALLY. Each of the Hospitals participates in the Medicare program. Healthcare providers have been and will continue to be affected significantly by changes that have occurred in the last several years in federal healthcare laws and regulations pertaining to Medicare. The purpose of much of the recent statutory and regulatory activity has been to reduce the rate of increase in Medicare payments and to make such payments more accurately reflect patient resource use at hospitals. In addition, important amendments to the Medicare law were made by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 ("MMA") and the Deficit Reduction Act of 2005 ("DRA"). Although the most significant provisions of MMA relate to an expansion of Medicare's coverage for pharmaceuticals and changes intended to expand managed care under the Medicare program, MMA also made many changes in the laws that are relevant to how Medicare makes payments to hospitals, some of which could have an adverse impact on the Hospitals' Medicare reimbursement. One focus of the DRA, which may affect the Hospitals, is the requirement for hospitals to increase quality of care reporting and an increased penalty for hospitals that fail to properly submit quality data. INPATIENT OPERATING COSTS. Medicare pays acute care hospitals, such as the Hospitals, for most services provided to inpatients under a system known as the Prospective Payment System ("PPS") pursuant to which hospitals are paid for services based on predetermined rates. Medicare payments under PPS are based on the Diagnosis Related Group ("DRG") to which each Medicare patient is assigned. The DRG is determined by the patient's primary diagnosis and other factors for each particular Medicare inpatient stay. The amount to be paid for each DRG is established prospectively by the Centers for Medicare and Medicaid Services ("CMS"). The DRG amounts are not related to a hospital's actual costs or variations in service or length of stay. Therefore, if a hospital incurs costs in treating Medicare inpatients that exceed the DRG level of reimbursement plus any outlier payments, then that hospital will experience a loss from such services, which will have to be made up from other revenue sources. Payment limitations implemented by other third party payers may restrict the ability of a hospital to engage in such "cost-shifting." In October 2006, CMS implemented significant changes to the Medicare program's inpatient acute care PPS that (1) altered the way that DRG weights are calculated, abandoning the charge-based weight system in favor of a cost-based weight system and (2) expanded the number of DRGs so that the severity of a given illness is taken into account for purposes of payment. Such systemic changes took affect for discharges occurring on and after October 1, 2006 and are being phased in over a three year period through federal fiscal year ("FFY") 2008 which began on October 1, 2007. CMS determined that hospitals would respond to the new MS DRG system with improvements in documentation and coding procedures that would result in a 4.8% national increase in payments (the impact on individual hospitals could not be determined as it would vary based on the services provided by the hospital). To offset this, the FFY 2008 final rule included reductions in payments of 1.2% for FFY 2008, 1.8% for FFY 2009, and 1.8% for FFY 2010. CMS has proposed an adjustment to the reduction for FFY 2009 from 1.8% to 0.9% in their proposed FFY 2009 PPS rules, published April 30, 2008 in the Federal Register. At this time, it is not known if the proposed reduction will be adopted, or if adopted, what the affect will be on the Hospitals. For certain Medicare beneficiaries who have unusually costly hospital stays (also known as "outliers"), CMS currently provides additional payments above those specified for the DRG. To determine whether a case qualifies for outlier payments, hospital-specific cost-to-charge ratios are applied to the total covered charges for the case. Operating and capital costs for the case are calculated separately by applying separate operating and capital cost-to-charge ratios and combining these costs to compare them with a defined fixed-loss outlier threshold for the specific DRG. PPS payments are adjusted annually using an inflation index, based on the change in a "market basket" of hospital costs of providing healthcare services. There can be no assurance that future updates in PPS payments will keep pace with inflation or with the increases in the cost of providing hospital services. It is also possible that the prospective payment for capital costs at a Hospital will not be sufficient to cover the actual capital-related costs of the Hospital allocable to Medicare patients' stays. 7 OUTPATIENT SERVICES. All services paid under the outpatient PPS are classified into groups called Ambulatory Payment Classifications ("APC"). Services in each APC are similar clinically and in terms of the resources they require. A payment rate is established for each APC. Depending on the services provided, hospitals may be paid for more than one APC for an encounter. CMS will make additional payment adjustments under outpatient PPS, including "outlier" payments for services where the hospital's cost exceeds 2.5 times the APC rate for that service. In addition, certain other changes have reduced coinsurance payments below what they would have originally been under outpatient PPS. MEDICARE BAD DEBT. Medicare beneficiaries have a coinsurance payment and annual deductible for most inpatient and outpatient hospital services. Hospitals must first seek payment of any such coinsurance and deductible amounts from the Medicare beneficiary. If, after reasonable collection efforts, a hospital is unable to collect these coinsurance and deductible amounts, Medicare currently reimburses hospitals 70 percent of the uncollected coinsurance and deductible amount (known as "Medicare bad debt"). The President's fiscal year 2009 proposed budget would phase out the reimbursement of most Medicare bad debt. It is not possible to determine at this time whether such changes will be adopted by Congress as proposed. MEDICARE CONDITIONS OF PARTICIPATION. Hospitals must comply with provisions called "Conditions of Participation" in order to be eligible for Medicare reimbursement. CMS is responsible for ensuring that hospitals meet these regulatory Conditions of Participation. Under the Medicare rules, hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations ("JCAHO") are deemed to meet the Conditions of Participation. The Hospitals are each currently accredited by JCAHO and are therefore deemed to meet the Conditions of Participation. MEDICARE AUDITS. Medicare participating hospitals are subject to audits and retroactive audit adjustments with respect to reimbursement claimed under the Medicare program. Medicare regulations also provide for withholding Medicare payments in certain circumstances. Any such withholding with respect to the Hospitals could have a material adverse effect on the Company. In addition, contracts between hospitals and third party payers often have contractual audit, setoff and withhold language that may cause substantial, retroactive adjustments. Medicare requires certain financial information be reported on a periodic basis, and with respect to certain types of classifications of information, penalties are imposed for inaccurate reports. As these requirements are numerous, technical and complex, there can be no assurance that the Company will avoid incurring such penalties. Such penalties could materially and adversely affect the Company. MEDICARE MANAGED CARE. The Medicare program allows various managed care plans, now known as Medicare Advantage Plans, offered by private companies to engage in direct managed care risk contracting with the Medicare program. Under the Medicare Advantage program, these private companies agree to accept a fixed, per-beneficiary payment from the Medicare program to cover all care that the beneficiary may require. Generally, in order to engage in risk contracting, a Medicare Advantage Plan must be licensed at the state level. In recent years, many private companies have discontinued their Medicare Advantage Plans. The result has been that the beneficiaries who were covered by the now-discontinued Medicare plan have been shifted back into the Medicare fee-for-service program or into a Medicare cost plan. Also, the decrease in the number of Medicare beneficiaries enrolled in the Medicare Advantage program has not gone unnoticed by Congress and CMS. Congress has recently increased payments to such plans and made other changes to Medicare managed care to encourage beneficiary enrollment in managed care plans. Future legislation or regulations may be created that attempt to increase participation in the Medicare Advantage program. The effect of these recent changes and any future legislation/regulation is unknown but could materially and adversely affect the Company. 8 MEDI-CAL (CALIFORNIA'S MEDICAID PROGRAM) FEE-FOR-SERVICE PROGRAM. The Medi-Cal program is a joint federal/state program that provides healthcare services to certain persons who are financially needy. Each of the Hospitals participates in the Medi-Cal program. The Medi-Cal program includes both a fee-for-service component and a managed care component. Inpatient hospital services under the fee-for-service component are reimbursed primarily under the Selective Provider Contracting Program ("SPCP"), which are negotiated by the California Medical Assistance Commission ("CMAC"). The SPCP and CMAC system for payments to hospitals are designed to pay hospitals below their costs of services to Medi-Cal beneficiaries. The Company is located in an area which is currently a "closed area" under the SPCP. In SPCP closed areas, private hospitals must hold a contract with the Medi-Cal program in order to be paid for their inpatient services (other than services performed in an emergency to stabilize a patient so that they can be transferred to a contracting hospital and additional care rendered to emergency patients who cannot be so stabilized for transfer or where no contracting hospital accepts the patient). Contracting hospitals are generally paid for these services on the basis of all inclusive per diem rates they negotiate under their SPCP/CMAC contracts. Outpatient hospital services under the fee-for service-component are paid for on the basis of a fee schedule, and it is not necessary for hospitals to hold SPCP/CMAC contracts in order to be paid for their outpatient services. Each Hospital currently has an SPCP/CMAC contract in which it is contractually bound to continue until November 26, 2009, and there can be no assurance that the Hospital will maintain SPCP status thereafter or that the current Medi-Cal payment arrangements will continue. There can be no assurance that the SPCP/CMAC contract rates paid to the Hospitals will cover each Hospital's cost of providing care. The Medi-Cal payment rates for outpatient services cover only a small portion of a Hospital's cost of providing care. MEDI-CAL MANAGED CARE. In addition to the fee-for-service component of Medi-Cal, Orange County, California (where the Hospitals are located) participates in the Medi-Cal managed care program. Many Medi-Cal beneficiaries in Orange County are covered under Medi-Cal managed care, and not under fee-for-service Medi-Cal. Medi-Cal managed care in Orange County is provided through a County Organized Health System known as CalOptima. An Orange County hospital that wants to participate in Medi-Cal managed care on a capitated basis must contract with CalOptima, and is typically paid a capitated amount each month to provide, or arrange for the provision of, specified services to CalOptima members assigned to the hospital. The capitated hospital is financially responsible for a predetermined list of services, whether those services are provided at the capitated hospital or another service provider, provided during the term of the contract, including allowable claims received after contract termination. Western Medical Center - Santa Ana had a capitated contract with CalOptima which terminated as of June 2006. Coastal Communities Hospital had a capitated contract with CalOptima which terminated in April 2007. There can be no assurance that the capitated payments received by Western Medical Center - Santa Ana and Coastal Communities Hospital were adequate to reimburse its costs of providing care under its CalOptima contract, or that the capitated payments that have been received will be adequate to cover its costs of providing care under its capitated contract. Mid-year 2006, CalOptima began entering into contracts with hospitals on a fee-for-services basis for managed care Medi-Cal enrollees managed directly by CalOptima and CalOptima's capitated hospitals. The rates in these contracts are based on the greater of an Orange County average SPCP/CMAC rate or the individual hospital's SPCP/CMAC rate. Chapman Medical Center, Coastal Communities Hospital, Western Medical Center - Anaheim and Western Medical Center - Santa Ana entered into these CalOptima fee for service contracts effective June 2006. A hospital which does not have a contract with CalOptima may provide covered services. However, there are ongoing disputes between CalOptima and hospitals in Orange County concerning the amount CalOptima is obligated to pay for emergency services furnished by non-contracting hospitals. An amendment to the federal Medicaid Act which became effective January 1, 2007, appears to set reimbursement from Medi-Cal managed care plans, like CalOptima, to hospital providers of emergency services that do not have contracts with those plans at an average SPCP/CMAC contracted rate for general acute care hospitals or the average contract rate for tertiary hospitals. The State of California has not established a definition differentiating general acute care hospitals from tertiary hospitals or the mechanism for determining the rates specified in the amendment. It is unclear how this amendment will ultimately be interpreted and applied. There can be no assurance that the amount paid to any of the Hospitals for services covered under CalOptima which are covered or not covered under a contract between CalOptima and the Hospital will be adequate to reimburse a Hospital's costs of providing care. 9 MEDI-CAL DSH PAYMENTS. Some of the Hospitals receive substantial additional Medi-Cal reimbursement as a disproportionate share ("DSH") hospital from the DSH Replacement Fund and the Private Hospital Supplemental Fund. Hospitals qualify for this additional funding based on the proportion of services they provide to Medi-Cal beneficiaries and other low-income patients. Payments to a hospital from the State's DSH Replacement Fund are determined on a formula basis set forth in California law and the Medi-Cal State Plan. Hospitals receive funds from the Private Hospital Supplemental Fund pursuant to amendments to their SPCP contracts negotiated with CMAC. The Medi-Cal funding for DSH hospitals, however, is dependent on state general fund appropriations, and there can be no assurance that the state will fully fund the Medi-Cal DSH payment programs. There also can be no assurance that the Hospitals which qualify for DSH will be able to negotiate SPCP contract amendments for Private Hospital Supplemental Fund Payments, although state law currently provides that a qualifying hospital may not receive less from the Private Hospital Supplemental Fund than it received from predecessor funds in the State's 2002-03 fiscal year. The state programs under which special payments are made to DSH hospitals are set to expire as of June 30, 2010. There can be no assurance the programs will be extended or replaced by similar programs. In addition, the federal government has recently proposed regulations which could have a significant negative affect on DSH reimbursement to California hospitals, including the Hospitals, if they become effective. Such changes could materially and adversely affect the Company. WORKERS' COMPENSATION REIMBURSEMENT FEE SCHEDULES. A portion of the Hospitals' revenues are expected to come from Workers' Compensation program reimbursements. As part of an effort in 2003 to control costs under the Workers' Compensation program, the California legislature enacted Labor Code Section 5307.1, which sets reimbursement for hospital inpatient and outpatient services, including outpatient surgery services, at a maximum of 120% of the current Medicare fee schedule for hospitals. The Administrative Director of the Division of Workers' Compensation is authorized to develop and, after public hearings, to adopt a fee schedule for outpatient surgery services, but this schedule may not be more than 120% of the current Medicare fee schedule for hospitals. This fee limitation limits the amount that the Hospitals will be paid for their services provided to Workers' Compensation patients. PROVIDER NETWORKS. Under California law, employers may establish medical provider networks for Workers' Compensation patients and may restrict their employees' access to medical services to providers that are participants in those networks. Employers are free to choose which providers will and will not participate in their networks, and employers pay participating providers on the basis of negotiated rates that may be lower than those that would otherwise be provided for by the Workers' Compensation fee schedules. Employers may also choose to contract with licensed Health Maintenance Organizations ("HMO") and restrict access by their employees to participating providers of these HMOs. The Hospitals are participating providers in several Workers' Compensation networks, and to the extent that the Hospitals are required to negotiate and accept lower reimbursement rates to participate in these networks, there may be an adverse financial impact on the Company. Also, network providers are required to provide treatment in accordance with utilization controls to be established by the Department of Workers' Compensation. Therefore, as network participants, such utilization controls may limit the services for which the Hospital is reimbursed, which would have an adverse financial impact on the Company. FURTHER REFORM. There will likely continue to be substantial activity in the California Workers' Compensation reform area. In the past, the legislature has considered a number of bills, some of which would further reduce the maximum reimbursement for medical services, including hospital services. It is expected that any revisions to the Workers' Compensation fee schedule, when and if implemented, will reduce the fees the Hospitals receive for Workers' Compensation patients. The impact of such possible future fee schedule changes cannot be estimated at this time. It is also possible that the profitability of the Company could be impacted by other future Workers' Compensation cost control efforts. 10 COMMERCIAL INSURANCE Many private insurance companies contract with hospitals on a "preferred" provider basis, and many insurers have introduced plans known as preferred provider organizations ("PPO"). Under preferred provider plans, patients who use the services of contracted providers are subject to more favorable copayments and deductibles than apply when they use non-contracted providers. In addition, under most HMOs, private payers limit coverage to those services provided by selected hospitals. With this contracting authority, private payers direct patients away from nonselected hospitals by denying coverage for services provided by them. The Hospitals currently have several managed care contracts. If the Company's managed care contract rates are unfavorable or are reduced in the future, this may negatively impact the Company's profitability. EMTALA In response to concerns regarding inappropriate hospital transfers of emergency patients based on the patient's inability to pay for the services provided, Congress enacted the Emergency Medical Treatment and Labor Act ("EMTALA") in 1986. This so-called "anti-dumping" law imposes certain requirements on hospitals with Medicare provider agreements to (1) provide a medical screening examination for any individual who comes to the hospital's emergency department, (2) provide necessary stabilizing treatment for emergency medical conditions and labor, and (3) not transfer a patient until the individual is stabilized, unless the benefits of transfer outweigh the risks or the patient gives informed consent to the transfer. Since the Hospitals must provide emergency services without regard to a patient's ability to pay, complying with EMTALA could have an adverse impact on the profitability of the Hospitals, depending upon the number of patients treated in or through the emergency room who are unable to pay. Failure to comply with the law can result in exclusion of the physician from the Medicare and/or Medicaid programs or termination of the hospital's Medicare provider agreements, as well as civil penalties. ANTI-KICKBACK, FRAUD AND SELF-REFERRAL REGULATIONS FEDERAL ANTI-KICKBACK LAW. The Social Security Act's illegal remuneration provisions (the "Anti-kickback Statute") prohibit the offer, payment, solicitation or receipt of remuneration (including any kickback, bribe or rebate), directly or indirectly, overtly or covertly, in cash or in kind, for (a) the referral of patients or arranging for the referral of patients to receive services for which payment may be made in whole or in part under a federal healthcare program, which includes Medicare, Medicaid and TRICARE (formerly CHAMPUS, which provides benefits to dependents of members of the uniformed services) and any state healthcare program, or (b) the purchase, lease, order, or arranging for the purchase, lease or order of any good, facility, service or item for which payment may be made under the above payment programs. The Anti-kickback Statute contains both criminal and civil sanctions, which are enforced by the Office of Inspector General ("OIG") of Department of Health & Human Services ("DHHS") and the United States Department of Justice. The criminal sanctions for a conviction under the Anti-kickback Statute are imprisonment for not more than five years, a fine of not more than $50,000 for each offense, or both, with higher penalties potentially being imposed under the federal Sentencing Guidelines. In addition to the imposition of criminal sanctions, the Secretary of DHHS may exclude any person or entity that commits an act described in the Anti-kickback Statute from participation in the Medicare program and direct states to also exclude that person from participation in state healthcare programs. The Secretary of DHHS can exercise this authority based on an administrative determination, without obtaining a criminal conviction. The burden of proof for the exclusion would be one that is customarily applicable to administrative proceedings, which is a lower standard than that required for a criminal conviction. In addition, violators of the Anti-kickback Statute may be subjected to civil money penalties of $50,000 for each prohibited act and up to three times the total amount of remuneration offered, paid, solicited, or received, without regard to whether a portion of such remuneration was offered, paid, solicited, or received for a lawful purpose. 11 There is ever-increasing scrutiny by federal and state law enforcement authorities, OIG, DHHS, the courts, and Congress of arrangements between healthcare providers and potential referral sources to ensure that the arrangements are not designed as a mechanism to exchange remuneration for patient care referrals and opportunities. The law enforcement authorities, the courts, and Congress have also demonstrated a willingness to look behind the formalities of an entity's structure to determine the underlying purpose of payments between healthcare providers and potential referral sources. Enforcement actions have been increased and, generally, the courts have broadly interpreted the scope of the Anti-kickback Statute and have held, for example, that the Anti-kickback Statute may be violated if merely one purpose of a payment arrangement is to induce referrals. In addition, the OIG has long been on record that it believes that physician investments in healthcare companies can violate the Anti-kickback Statute and the OIG has demonstrated an aggressive attitude toward enforcement of the Anti-kickback Statute in the context of ownership relationships. The OIG has issued regulations specifying certain payment practices that will not be treated as a criminal offense under the Anti-kickback Statute and that will not provide a basis for exclusion from the Medicare or Medicaid programs (the "Safe Harbor Regulations"). These regulations include, among others, safe harbors for certain investments in both publicly traded and non-publicly traded companies. However, investments in the Company will not be protected by either of these safe harbor regulations. Nevertheless, the fact that a specific transaction does not meet all of the criteria of a "safe harbor" does not mean that such transaction constitutes a violation of the Anti-kickback Statute, and the OIG has indicated that any arrangement that does not meet all of the elements of a safe harbor will be evaluated on its specific facts and circumstances to determine whether the Anti-kickback Statute has been violated and, thus, if prosecution is warranted. The OIG is authorized to issue advisory opinions which interpret the Anti- kickback Statute and has issued several advisory opinions addressing investments by physicians in healthcare businesses. Based upon those opinions, it appears unlikely that the OIG would be willing to issue an advisory opinion protecting physician investments in the Company, and no such opinion has been requested by the Company. The Company nevertheless believes, based upon a federal court decision involving physician investments in clinical laboratories, that investments in it by physicians are not automatically prohibited by the Anti- kickback Statute, depending upon the circumstances surrounding such investment. The Company has reviewed the terms of the purchase of ownership interests in the Company by Orange County Physician Investment Network, LLC ("OC-PIN") (which is owned by physicians that refer patients to the Hospitals) and has determined that the purchase should not violate the Anti-kickback Statute. The OIG also has identified many hospital-physician compensation arrangements that are potential violations of the Anti-kickback Statute, including: (a) payment of any incentive for the referral of patients; (b) use of free or discounted office space or equipment; (c) provision of free or discounted services, such as billing services; (d) free training; (e) income guarantees; (f) loans which are not fair market value or which may be forgiven; (g) payment for services which require few, if any substantive duties by the physician or payment for services in excess of fair market value of the services; and (h) purchasing goods or services from physicians at prices in excess of fair market value. The Company has reviewed many of its compensation relationships with physicians, and on-going reviews are occurring, in an effort to ensure that such relationships do not violate the Anti-kickback Statute. 12 CALIFORNIA ANTI-KICKBACK PROHIBITIONS. California law prohibits remuneration of any kind in exchange for the referral of patients regardless of the nature of the payer of such services, and is therefore broader in this regard than is the federal statute. Nevertheless, this statute specifically provides that a medically necessary referral is not illegal solely because the physician that is making the referral has an ownership interest in the healthcare facility to which the referral is made if the physician's return on investment is based upon the amount of the physician's capital investment or proportional ownership and such ownership is not based upon the number or value of patients referred. Further, opinions of the California Attorney General indicate that distributions paid to physicians who invest in entities that conduct health related businesses generally do not violate California's anti-kickback law when the entity conducts a bona fide business, services performed are medically needed, and profit distributions are based upon each investor's proportional ownership interest, rather than the relative volume of each investor's utilization of the entity's business. California has a separate anti-kickback statute which applies only under the Medi-Cal program and which largely parallels the prohibitions of the federal Anti-kickback Statute. The Company believes that analysis under this Medi-Cal anti-kickback statue will be the same as under the federal Anti-kickback Statute discussed above. FALSE AND OTHER IMPROPER CLAIMS. The federal government is authorized to impose criminal, civil, and administrative penalties on any person or entity that files a false claim for payment from the Medicare or Medi-Cal programs. In addition to other federal criminal and civil laws which punish healthcare fraud, the federal government, over the past several years, has accused an increasing number of healthcare providers of violating the federal Civil False Claims Act. The False Claims Act imposes civil liability (including substantial monetary penalties and damages) on any person or corporation which (1) knowingly presents a false or fraudulent claim for payment to the federal government; (2) knowingly uses a false record or statement to obtain payment; or (3) engages in a conspiracy to defraud the federal government to obtain allowance for a false claim. False claims allegations could arise, for example, with respect to the Hospital's billings to the Medicare program for its services or the submission by the Hospital of Medicare cost reports. Specific intent to defraud the federal government is not required to act with knowledge. Instead, the False Claims Act defines "knowingly" to include not only actual knowledge of a claim's falsity, but also reckless disregard for or intentional ignorance of the truth or falsity of a claim. Because the Hospitals perform hundreds of procedures a year for which they are paid by Medicare, and there is a relatively long statute of limitations, a billing error or cost reporting error could result in significant civil or criminal penalties. Under the qui tam, or whistleblower, provisions of the False Claims Act, private parties may bring actions on behalf of the federal government. These private parties, often referred to as relators, are entitled to share in any amounts recovered by the government through trial or settlement. Both direct enforcement activity by the government and whistleblower lawsuits have increased significantly in recent years and have increased the risk that a healthcare company, like us, will have to defend a false claims action, pay fines or be excluded from the Medicare and Medicaid programs as a result of an investigation resulting from a whistleblower case. Although the Company intends that the operations of the Hospitals will materially comply with both federal and state laws related to the submission of claims, there can be no assurance that a determination that we have violated these claims-related laws will not be made, and any such determination would have a material adverse effect on the Company. In addition to the False Claims Act, federal civil monetary penalties provisions authorize the imposition of substantial civil money penalties against an entity which engages in activities including, but not limited to, (1) knowingly presenting or causing to be presented, a claim for services not provided as claimed or which is otherwise false or fraudulent in any way; (2) knowingly giving or causing to be given false or misleading information reasonably expected to influence the decision to discharge a patient; (3) offering or giving remuneration to any beneficiary of a federal healthcare program likely to influence the selection of a particular provider, practitioner or supplier for the ordering or receipt of reimbursable items or services; (4) arranging for reimbursable services with an entity which is excluded from participation from a federal healthcare program; (5) knowingly or willfully soliciting or receiving remuneration for a referral of a federal healthcare program beneficiary; or (6) using a payment intended for a federal healthcare program beneficiary for another use. The 13 Secretary of DHHS, acting through the OIG, also has both mandatory and permissive authority to exclude individuals and entities from participation in federal healthcare programs pursuant to this statute. Also, it is a criminal federal healthcare fraud offense to: (1) knowingly and willfully execute or attempt to execute any scheme to defraud any healthcare benefit program, including any private or governmental program; or (2) to obtain, by means of false or fraudulent pretenses, any property owned or controlled by any healthcare benefit program. Penalties for a violation of this federal law include fines and/or imprisonment, and a forfeiture of any property derived from proceeds traceable to the offense. In addition, if an individual is convicted of a criminal offense related to participation in the Medicare program or any state healthcare program, or is convicted of a felony relating to healthcare fraud, the Secretary of DHHS is required to bar the individual from participation in federal healthcare programs and to notify the appropriate state agencies to bar the individuals from participation in state healthcare programs. While the criminal statutes are generally reserved for instances of fraudulent intent, the federal government is applying its criminal, civil, and administrative penalty statutes in an ever-expanding range of circumstances. For example, the government has taken the position that a pattern of claiming reimbursement for unnecessary services violates these statutes if the claimant merely should have known the services were unnecessary, even if the government cannot demonstrate actual knowledge. The government has also taken the position that claiming payment for low-quality services is a violation of these statutes if the claimant should have known that the care was substandard. In addition, some courts have held that a violation of the Stark Law or the Anti-kickback Statute can result in liability under the federal False Claims Act. Noncompliance with other regulatory requirements can also lead to liability under the False Claims Act if it can be established that compliance with those requirements is necessary in order for a hospital to be paid for its services. Claims filed with private insurers can also lead to criminal and civil penalties under federal law, including, but not limited to, penalties relating to violations of federal mail and wire fraud statutes and of the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations ("HIPAA") provisions which have made the defrauding of any healthcare insurer, whether public or private, a crime. The Hospitals are also subject to various state insurance statutes and regulations that prohibit the Hospitals from submitting inaccurate, incorrect or misleading claims. The Company intends that the Hospitals will comply with all state insurance laws and regulations regarding the submission of claims. IHHI cannot assure, however, that each Hospital's insurance claims will never be challenged or that the Hospitals will in all instances comply with all laws regulating its claims. If a Hospital were found to be in violation of a state insurance law or regulation, the Hospital could be subject to fines and criminal penalties, which would have an adverse effect on IHHI's business and operating results. FEDERAL PHYSICIAN SELF-REFERRAL LAW. Provisions of the Social Security Act commonly referred to as the Stark Law prohibit referrals by a physician of Medicare patients to providers for a broad range of health services if the physician (or his or her immediate family member) has an ownership or other financial arrangement with the provider, unless an exception applies. The "designated health services" to which the Stark Law applies include all inpatient and outpatient services provided by hospitals. Hospitals cannot bill for services they provide as a result of referrals that are made in violation of the Stark Law. In addition, a violation of the Stark Law may result in a denial of payment, require refunds to patients and to the Medicare program, civil monetary penalties of up to $15,000 for each violation, civil monetary penalties of up to $100,000 for certain "circumvention schemes" and exclusion from participation in Medicare, Medicaid, and other federal programs. Violations of the Stark Law may also be actionable as violations of the federal False Claims Act. 14 Notwithstanding the breadth of the Stark Law's general prohibition, the law contains an exception which protects ownership interests held by physicians in hospitals where the referring physician is authorized to perform services at the hospital and the physician's ownership is in the hospital itself, and not merely in a subdivision of the hospital. The Hospitals intend to rely upon this exception to protect the ownership interests that physicians hold in them. Although the Company does not believe that any of its Hospital's will be considered to be "specialty hospitals", changes in this area of the law that would affect the classification of the Hospitals as "specialty hospitals" may affect the Company's operations. Furthermore, in the fiscal year 2009 Inpatient Prospective Payment System proposed rule issued on April 14, 2008, CMS proposed to require hospitals to disclose to patients whether they are owned in part or in whole by physicians, and if so, to make available the names of the physician owners. In addition, CMS proposed that as a condition of continued medical staff membership, physicians would be required to inform patients of their ownership interests in a hospital at the time they refer patients to that hospital. However, because similar disclosure requirements are already imposed by California law (see "Disclosure of Financial Interests" section below), it is unlikely that CMS' implementation of such requirement would have a material affect on the Company's operations. Also, CMS will require hospitals to disclose information concerning physician investment and compensation arrangements, and by July 2007, approximately 500 hospitals will be required to complete a Financial Relationship Disclosure Report ("Report") and submit the information to CMS for review. CMS has indicated that it may implement a regular mandatory disclosure process that will apply to all Medicare participating hospitals. The Company is unaware of whether any of its Hospitals will be required to submit such Reports, however, the Company does not anticipate that any such reporting requirements will materially affect the Company's operations. In addition to physician ownership, the Hospitals have arrangements by which they compensate various physicians for services. Payments by the Company to such physicians will constitute financial relationships for purposes of the Stark Law. Exemptions exist under the Stark Law and its implementing regulations for various types of compensation relationships. The Company will endeavor to ensure that all of its financial relationships qualify for one or more exemptions under the Stark Law. However, there can be no assurance that the Company will be successful in structuring all of its relationships with physicians so as to qualify for protection under one or more of the Stark Law's exceptions. CALIFORNIA PHYSICIAN SELF-REFERRAL LAW RESTRICTIONS. Restrictions on financial relationships between physicians and businesses to which they refer patients for specified types of services, including some services which will be provided by the Hospitals, also exist under California law. As is the case under federal law, the California self-referral restrictions can be triggered by financial relationships other than ownership. However, these laws contain a broad exemption permitting referrals to be made to a hospital so long as the referring physician is not compensated by the hospital for the referral and any equipment lease between the hospital and the physician satisfies certain requirements. An additional requirement imposed by California's self-referral laws is that any non-emergency imaging services performed for a Workers' Compensation patient with equipment that, when new, had a value of $400,000 or more must be pre-approved by the Workers' Compensation insurer or self-insured employer. This provision may require that preauthorization be obtained for MRI services ordered by the Hospitals' physician owners and others who have financial relationships with the Company. It is possible that insurers may refuse to provide any required preauthorizations in connection with referrals of Workers' Compensation patients made to the Hospitals by physicians who have financial relationships with it. However, given that MRI services for Workers' Compensation patients are not anticipated to represent a material portion of the Hospitals' services, the Company does not believe that any such refusals to provide required preauthorizations would have a material impact upon it. 15 LICENSING Health facilities, including the Hospitals, are subject to numerous legal, regulatory, professional, and private licensing, certification, and accreditation requirements. These include requirements relating to Medicare participation and payment, state licensing agencies, private payers and the Joint Commission on Accreditation of Healthcare Organizations ("Joint Commission"). Renewal and continuance of certain of these licenses, certifications and accreditations are based on inspections, surveys, audits, investigations or other reviews, some of which may require or include affirmative action or response by the Company. These activities generally are conducted in the normal course of business of health facilities. Nevertheless, an adverse determination could result in a loss or reduction in a Hospital's scope of licensure, certification or accreditation, or could reduce the payment received or require repayment of amounts previously remitted. Any failure to obtain, renew or continue a license, certification or accreditation required for operation of a Hospital could result in the loss of utilization or revenues, or the loss of the Company's ability to operate all or a portion of a Hospital, and, consequently, could have a material and adverse effect on the Company. DISCLOSURE OF FINANCIAL INTERESTS California law provides that it is unlawful for a physician to refer a patient to an organization in which the physician or the physician's immediate family has a significant beneficial interest unless the physician first discloses in writing to the patient that there is such an interest and advises the patient regarding alternative services, if such services are available. A "significant beneficial interest" means any financial interest equal to or greater than the lesser of five percent of the total beneficial interest or $5,000. This disclosure requirement may be satisfied by the posting of a conspicuous sign likely to be seen by all patients who use the facility or by providing patients with written disclosure statements. Physicians must also make disclosure of entities in which they hold significant financial interests to a patient's payer upon the request of the payer (not to be made more than once a year). A violation of this disclosure requirement constitutes "unprofessional conduct," and is grounds for the suspension or revocation of the physician's license. Further, it is deemed a misdemeanor punishable by imprisonment not to exceed six months, or by a fine not to exceed $2,500. In addition, California's general self-referral laws require that any physician who refers a person to, or seeks consultation from an organization in which the physician has a financial interest, must disclose the financial interest to the patient, or the parent or legal guardian of the patient, in writing, at the time of the referral or request for consultation. This requirement applies regardless of whether the financial interest is otherwise protected by one of the exemptions under the self-referral law. There is no minimum threshold of ownership required in order for this disclosure requirement to be triggered, and this disclosure requirement cannot be satisfied by the posting of a sign. A violation of this disclosure requirement may be subject to civil penalties of up to $5,000 for each offense. Physician investors in the Company will be individually responsible for complying with these disclosure requirements with respect to their referrals to the Hospital. The obligation of physicians with financial interests in the Company to make such disclosures or the effect of such disclosures on patients may have an adverse impact on the Company. HIPAA HIPAA mandated the adoption of standards for the exchange of health information in an effort to encourage overall administrative simplification and enhance the effectiveness and efficiency of the healthcare industry. Under HIPAA, healthcare providers and other "covered entities" such as health insurance companies and other third-party payers, must adopt uniform standards for the electronic transmission of billing statements and insurance claims forms. These standards require the use of standard data formats and code sets when electronically transmitting information in connection with health claims and equivalent encounter information, healthcare payment and remittance advice and health claim status. If we or our payers are unable to exchange information in connection with the specified transactions because of an inability to comply fully with the regulations, we are required to exchange the information using paper. If we are forced to submit paper claims to payers, it will significantly increase our costs associated with billing and could delay payment of claims. 16 On January 23, 2004, DHHS published a final rule that adopted the National Provider Identifier ("NPI") as the standard unique health identifier for healthcare providers. When the NPI is implemented, healthcare providers, including our Hospitals, must use only the NPI to identify themselves in connection with electronic transactions. Legacy numbers, such as Medicaid numbers, CHAMPUS numbers, and Blue Cross-Blue Shield numbers, will not be permitted. Healthcare providers will no longer have to keep track of multiple numbers to identify themselves in the standard electronic transactions with one or more health plans. The NPI is a 10-digit all numeric number that will be assigned to eligible healthcare providers, including our hospitals, by the National Provider System ("NPS"), an independent government contractor. Our hospitals have obtained and are using NPIs in connection with the standard electronic transactions. DHHS also has promulgated security standards and privacy standards which are aimed, in part, at protecting the confidentiality, availability and integrity of health information by health plans, healthcare clearinghouses and healthcare providers that receive, store, maintain or transmit health and related financial information in electronic form, regardless of format. The privacy standards require compliance with rules governing the use and disclosure of patient health and billing information. They create new rights for patients in their health information, such as the right to amend their health information, and they require us to impose these rules, by contract, on any business associate to which we disclose such information to perform functions on our behalf. These provisions required us to implement expensive computer systems, employee training programs and business procedures to protect the privacy and security of each patient health information and enable electronic billing and claims submissions consistent with HIPAA. The security standards require us to maintain reasonable and appropriate administrative, technical, and physical safeguards to ensure the integrity, confidentiality and the availability of electronic health and related financial information. The security standards were designed to protect electronic information against reasonably anticipated threats or hazards to the security or integrity of the information and to protect the information against unauthorized use or disclosure. HIPAA provides both criminal and civil fines and penalties for covered entities that fail to comply. Violations of the privacy or security standards could result in civil penalties of up to $25,000 per violation in each calendar year and criminal penalties of up to $250,000 per violation. In addition, the Hospitals are also subject to state privacy laws, which in some cases are more restrictive than HIPAA and impose additional penalties. Compliance with the HIPAA privacy, security and electronic transmission regulations will require significant changes in information and claims processing practices utilized by healthcare providers, including the Company. Estimates vary widely on the economic cost of implementing these provisions of HIPAA. DHHS estimates the total nationwide cost of compliance with the privacy rule alone at approximately five billion dollars; the Blue Cross and Blue Shield Association estimated that the nationwide cost of compliance may exceed forty billion dollars. As such, the future financial effect of these regulations on the Company is uncertain at this time. CORPORATE PRACTICE OF MEDICINE California has laws that prohibit non-professional corporations and other entities from employing or otherwise controlling physicians or that prohibits certain direct and indirect payment arrangements between healthcare providers. Although we intend to exercise care in structuring our arrangements with healthcare providers to comply with relevant California law, and we believe that such arrangements will comply with applicable laws in all material respects, we cannot give you any assurance that governmental officials charged with responsibility for enforcing these laws will not assert that the Company, or certain transactions that we are involved in, are in violation of such laws, or that the courts will ultimately interpret such laws in a manner consistent with our interpretations. 17 CERTAIN ANTITRUST CONSIDERATIONS The addition of physician-investors in the Company could affect competition in the geographic area in which its Hospitals operate in various ways. Such effects on competition could give rise to claims that the Hospitals, their arrangements with consumers and business entities or with physicians violate federal and state antitrust and unfair competition laws under a variety of theories. Accordingly, there can be no assurance that the activities or operations of the Hospitals will comply with federal and state antitrust or unfair competition laws, or that the Federal Trade Commission, the Antitrust Division of the Department of Justice, or any other party, including a physician participating in the Company's business, or a physician denied participation in the Company's business, will not challenge or seek to delay or enjoin the activities of the Company on antitrust or other grounds. If such a challenge is made, there can be no assurance that such challenge would be unsuccessful. We have not obtained an analysis of any possible antitrust implications of the activities of the Company or of the continuing arrangements and anticipated operations of the Hospitals. ENVIRONMENTAL REGULATIONS Our healthcare operations generate medical waste that must be disposed of in compliance with federal, state, and local environmental laws, rules, and regulations. Our operations, as well as our purchases and sales of facilities, also are subject to compliance with various other environmental laws, rules, and regulations. Remediation costs relating to toxic substances, if encountered during construction, could be material to the Company. CORPORATE HISTORY The Company was originally incorporated under the laws of the State of Utah on July 31, 1984 under the name "Aquachlor Marketing Inc." On December 23, 1988, the Company reincorporated in the State of Nevada. From 1989 until 2003, the Company was a development stage company with no material assets, revenues or business operations. On November 18, 2003, a group of investors purchased a controlling interest in the Company (then known as First Deltavision) with the objective of transforming the Company into a leading provider of high quality, cost-effective health care through the acquisition and management of financially distressed and/or underperforming hospitals and other healthcare facilities. On September 29, 2004, the Company entered into a definitive agreement to acquire the four Hospitals from Tenet and the transaction closed on March 8, 2005 In the first quarter of 2004, the Company changed its fiscal year end from June 30 to December 31, and changed the Company's name to "Integrated Healthcare Holdings, Inc." On December 21, 2006, the Company changed its fiscal year end from December 31 to March 31. Our principal executive offices are located at 1301 North Tustin Avenue, Santa Ana, California 92705, and our telephone number is (714) 953-3503. ITEM 1A. RISK FACTORS An investment in our common stock involves a high degree of risk. You should consider carefully the following information about these risks, together with the other information contained in this report. Our business is subject to a number of risks and uncertainties - many of which are beyond our control - that may cause our actual operating results or financial performance to be materially different from our expectations. You should consider carefully the following information about these risks, together with the other information contained in this report, before you decide to buy our common stock. The risks and uncertainties described below are not the only ones we face. Additional risks and uncertainties not presently known to us or that we currently deem immaterial may also impair our operations. If any of the following risks actually occur, our business would likely suffer and our results could differ materially from those expressed in any forward-looking statements contained in this Annual Report on Form 10-K including our consolidated financial statements and related notes. In such case, the trading price of our common stock could decline, and shareholders could lose all or part of their investment. WE MUST OBTAIN ADDITIONAL CAPITAL WHICH, IF AVAILABLE, WILL LIKELY RESULT IN SUBSTANTIAL DILUTION TO OUR CURRENT SHAREHOLDERS. We will require additional capital to fund our business. If we raise additional funds through the issuance of common or preferred equity, warrants or convertible debt securities, these securities will likely substantially dilute the equity interests and voting power of our current shareholders, and may have rights, preferences or privileges senior to those of the rights of our current shareholders. We cannot predict whether additional financing will be available to us on favorable terms or at all. WE ARE CURRENTLY INVOLVED IN LITIGATION WITH VARIOUS CURRENT AND FORMER MEMBERS OF OUR BOARD OF DIRECTORS AND A SIGNIFICANT SHAREHOLDER. On May 14, 2007, IHHI filed suit in Orange County Superior Court against three of the six members of its Board of Directors (as then constituted) and also against IHHI's largest shareholder, OC-PIN. Among other things, the suit alleges that the defendants breached fiduciary duties owed to IHHI by putting their own economic interests above those of IHHI, its other shareholders, creditors, employees and the public-at-large. The suit also alleges that the defendants' attempt to change IHHI's management and control of the existing Board could trigger an "Event of Default" under the express terms of IHHI's existing credit agreements with its secured lender. 18 On May 17, 2007, OC-PIN filed a separate suit against IHHI in Orange County Superior Court. Both actions have been consolidated so they can be heard before one judge. This litigation is ongoing, and is discussed in further detail below under "Item 3. Legal Proceedings." The circumstances underlying this litigation have been a significant distraction to Company management and the Board of Directors, and may have prevented the Company from pursuing a successful restructuring of its business and other profitable business opportunities. A trial date has been set for January 26, 2009, and the parties are currently moving forward with discovery. On June 19, 2008 the Company received a demand from OC-PIN requesting that it provide notice of a special shareholders meeting by no later than June 26, 2008, with the meeting to occur on a date during the week of July 21-25, 2008. OC PIN stated that the business to be conducted at the special shareholders meeting is to (1) repeal the amendment to the Company's bylaws on June 3, 2008 establishing a procedure for nominating candidates for election as director, (2) remove the entire Board of Directors of the Company, and (3) nominate and elect a new slate of individuals to the Board of Directors. On June 24, 2008, OC-PIN's counsel sent the Company an additional letter demanding that the Company immediately close its stock transfer books or immediately set the Record Date for the requested special shareholders meeting, and waive the record search required under Rule 14a-13(a)(3) of the Securities and Exchange Commission. On June 26, 2008, the Company sent OC-PIN a letter indicating that the Company could not comply with this demand because, among other reasons, OC-PIN has not furnished the consent of the Company's principal lender, which consent is required under the Company's Credit Agreements, aggregating up to $140.7 million, prior to taking any of the actions proposed to be taken by OC-PIN at the special shareholders meeting. In the absence of the lender's consent, the actions proposed by OC-PIN would entitle the lender to certain remedies which would have a material adverse effect on the Company and its shareholders. Further, OC-PIN had not followed the procedures contained in the Company's bylaws for nominating and electing directors of the Company, making the demand defective under the bylaws. Regarding the setting of a record date, the Company is obligated under Rule 14a-13(a)(3) to provide at least 20 business days prior notice to all banks, brokers and other "street name" holders of its stock in advance of the record date for any shareholder meeting at which the Company intends to solicit proxies or consents, and the Company would be in violation of this requirement if it acceded to the demand of OC-PIN's counsel to waive this requirement. The Company believes its positions are justified, and intends to vigorously oppose any attempt by OC-PIN to force the Company to take actions that would put it in default with its lender or cause it to violate the federal securities laws. On July 8, 2008, in a separate action, OC-PIN filed a complaint against the Company in Orange County Superior Court alleging causes of action for breach of contract, specific performance, reformation, fraud, negligent misrepresentation and declaratory relief. The complaint alleges that the Stock Purchase Agreement that the Company executed with OC-PIN on January 28, 2005 "inadvertently omitted" an anti-dilution provision (the "Allegedly Omitted Provision") which would have allowed OC-PIN a right of first refusal to purchase common stock of the Company on the same terms as any other investor in order to maintain OC-PIN's holding at no less than 62.4% of the common stock on a fully diluted basis. The complaint further alleges that the Company has issued stock options under a Stock Incentive Plan and warrants to its lender in violation of the Allegedly Omitted Provision. The complaint further alleges that the issuance of warrants to purchase the Company's stock to Dr. Kali P. Chaudhuri and William Thomas, and their exercise of a portion of those warrants, were improper under the Allegedly Omitted Provision. The Company believes that this lawsuit is wholly without merit and intends to contest these claims vigorously. However, at this early stage, the Company is unable to determine the cost of defending this lawsuit or the impact, if any, that this lawsuit may have on the Company's results of operations or financial condition. WE HAVE INCURRED A SIGNIFICANT LOSS IN OPERATIONS TO DATE. IF OUR SUBSTANTIAL LOSSES CONTINUE, THE MARKET VALUE OF OUR COMMON STOCK WILL LIKELY DECLINE FURTHER AND WE MAY LACK THE ABILITY TO CONTINUE AS A GOING CONCERN. As of March 31, 2008, we had an accumulated deficit of $104,553,000. We incurred a net loss of $ 39,163,000 for the year ended March 31, 2008. A component of this loss relating to warrants, totaling $25,677,000, was reclassified in accordance with generally accepted accounting principles from a liability to equity, so its impact on our stockholders' deficiency was zero. This loss, among other things, has had a material adverse effect on our stockholders' equity and working capital. We are attempting to improve our operating results and financial condition through a combination of contract negotiations, expense reductions, and new issues of equity. However, new issues of equity are encumbered by warrant anti-dilution provisions and there can be no assurance that we will achieve profitability in the future. The Company's $50.0 million Revolving Credit Agreement provides an estimated additional liquidity as of March 31, 2008 of $27.4 million based on eligible receivables, as defined. If we are unable to achieve and maintain profitability, the market value of our common stock will likely decline further, and we will lack the ability to continue as a going concern. 19 WE HAVE A HIGH DEGREE OF LEVERAGE AND SIGNIFICANT DEBT SERVICE OBLIGATIONS. The debt service requirements on our $96 million in debt amount (as of March 31, 2008) to approximately $0.9 million per month. Our relatively high level of debt and debt service requirements have several effects on our current and future operations, including the following: (i) we will need to devote a significant portion of our cash flow to service debt, reducing funds available for operations and future business opportunities and increasing our vulnerability to adverse economic and industry conditions and competition; (ii) our leveraged position increases our vulnerability to competitive pressures; (iii) the covenants and restrictions contained in agreements relating to our indebtedness restrict our ability to borrow additional funds, dispose of assets, issue additional equity or pay dividends on or repurchase common stock; and (iv) funds available for working capital, capital expenditures, acquisitions and general corporate purposes are limited. Any default under the documents governing our indebtedness could have a significant adverse effect on our business and the market value of our common stock. THE SUCCESS OF THE COMPANY WILL DEPEND ON PAYMENTS FROM THIRD PARTY PAYERS, INCLUDING GOVERNMENT HEALTH CARE PROGRAMS. IF THESE PAYMENTS ARE REDUCED OR DELAYED, OUR REVENUE WILL DECREASE. We are largely dependent upon private and governmental third party sources of payment for the services provided to patients in the Hospitals. The amount of payment a hospital receives for the various services it renders will be affected by market and cost factors, perhaps adversely, as well as other factors over which we have no control, including political concerns over the cost of medical care, Medicare and Medicaid regulations, and the cost containment and utilization decisions of third party payers. Any meaningful reduction in the amounts paid by these third party payers for services rendered at the Hospitals will have a material adverse effect on our revenues and cash flows. IF WE ARE UNABLE TO ENTER INTO MANAGED CARE PROVIDER ARRANGEMENTS ON ACCEPTABLE TERMS, OR IF WE HAVE DIFFICULTY COLLECTING FROM MANAGED CARE PAYERS, OUR RESULTS OF OPERATIONS COULD BE ADVERSELY AFFECTED. It would harm our business if we were unable to enter into managed care provider arrangements on acceptable terms. Any material reductions in the payments that we receive for our services, coupled with any difficulties in collecting receivables from managed care payers, could have a material adverse effect on our financial condition, results of operations or cash flows. CHANGES IN THE MEDICARE AND MEDICAID PROGRAMS OR OTHER GOVERNMENT HEALTH CARE PROGRAMS COULD HAVE A MATERIAL ADVERSE EFFECT ON OUR BUSINESS. The Medicare and Medicaid programs are subject to statutory and regulatory changes, administrative rulings, interpretations and determinations concerning patient eligibility requirements, funding levels and the method of calculating payments or reimbursements, among other things; requirements for utilization review; and federal and state funding restrictions, all of which could materially increase or decrease payments from these government programs in the future, as well as affect the cost of providing services to our patients and the timing of payments to our facilities. We are unable to predict the effect of future government health care funding policy changes on our operations. If the rates paid by governmental payers are reduced, if the scope of services covered by governmental payers is limited or if we, or one or more of our subsidiaries' hospitals, are excluded from participation in the Medicare or Medicaid program or any other government health care program, there could be a material adverse effect on our business, financial condition, results of operations or cash flows. OUR BUSINESS CONTINUES TO BE ADVERSELY AFFECTED BY A HIGH VOLUME OF UNINSURED AND UNDERINSURED PATIENTS. Like other organizations in the health care industry, we continue to provide services to a high volume of uninsured patients and more patients than in prior years with an increased burden of co-payments and deductibles as a result of changes in their health care plans. We continue to experience a high level of uncollectible accounts, and, unless our business mix shifts toward a greater number of insured patients or the trend of higher co-payments and deductibles reverses, we anticipate this high level of uncollectible accounts to continue. 20 COST CONTAINMENT, PAY FOR PERFORMANCE, AND OTHER PROGRAMS IMPOSED BY THIRD-PARTY PAYERS, INCLUDING GOVERNMENT HEALTH CARE PROGRAMS, MAY DECREASE THE COMPANY'S REVENUE. The health care industry is currently undergoing significant changes and is regularly subject to regulatory and political intervention. We expect to derive a considerable portion of the Company's revenue through the Hospitals from government-sponsored health care programs and third-party payers (such as employers, private insurers, HMOs or preferred provider organizations). The health care industry is experiencing a trend toward cost containment as government and private third-party payers seek to impose lower payment and utilization rates and negotiate reduced payment schedules with service providers. The Company believes that these trends will continue to result in a reduction from historical levels in per-patient revenue for hospitals. It is distinctly possible that reimbursement from government and private third-party payers for many procedures performed at the Hospital may be reduced in the future. Further reductions in payments or other changes in reimbursement for health care services could have a material adverse effect on the Company's business, financial condition and/or results of operations. Further, rates paid by private third-party payers are generally higher than Medicare, Medicaid and HMO payment rates. Any decrease in the relative number of patients covered by private insurance would have a material adverse effect on the Company's revenues and operations. PROVIDING QUALITY MEDICAL SERVICES FROM TALENTED PHYSICIANS IS CRITICAL TO OUR BUSINESS. Our business depends, in large part, upon the efforts and success of the physicians who will perform services at the Hospitals and the strength of our relationships with these physicians. Any failure of these physicians to maintain the quality of medical care provided or to otherwise adhere to professional guidelines at the Hospitals, or any damage to the reputation of a key physician or group of physicians, could damage the Company's and the Hospitals' reputations in the medical marketplace and may subject us to liability and significantly reduce our revenue and increase our costs. Like many hospitals, we face a growing shortage of primary care and specialty physicians. Should this shortage continue or worsen, the utilization of our hospitals may be adversely impacted. This could have a negative impact on our revenues and profitability. MEDICAL STAFF The primary relationship between a hospital and physicians who practice in it is through the hospital's organized medical staff. Medical staff bylaws, rules and policies establish the criteria and procedures at acute care hospitals, by which a physician may have his or her privileges, participation or membership curtailed, denied or revoked. Physicians who are denied medical staff membership or certain clinical privileges, or who have such membership, participation or privileges curtailed, denied or revoked often file legal actions against hospitals. Such actions may include a wide variety of claims, some of which could result in substantial uninsured damages to a hospital. In addition, failure of the governing body to adequately oversee the conduct of its medical staff may result in hospital liability to third parties. NURSING SHORTAGE Health care providers depend on qualified nurses to provide quality service to patients. There is currently a nationwide shortage of qualified nurses. This shortage and the more stressful working conditions it creates for those remaining in the profession are increasingly viewed as a threat to patient safety and may trigger the adoption of state and federal laws and regulations intended to reduce that risk. For example, California has adopted legislation and regulations mandating a series of specific minimum patient-to-nurse ratios in all acute care hospital nursing units. Any failure by the Hospital to comply with nurse staff ratios could result in action by licensure authorities and may constitute evidence of negligence per se in the event any patient is harmed as the result of inadequate nurse staffing. The vast majority of hospitals in California, including ours, are not at all times meeting the state mandated nurse staffing ratios. 21 In response to the shortage of qualified nurses, health care providers have increased-and could continue to increase-wages and benefits to recruit or retain nurses; many providers have had to hire expensive contract nurses. The shortage could also limit the operations of healthcare providers by limiting the number of patient beds available. The Company has likewise increased and is likely to have to continue to increase-wages and benefits to recruit and retain nurses. The Company may also need to engage expensive contract nurses until permanent staff nurses can be hired to replace any departing nurses. UNION CONTRACTS HAVE BEEN RENEWED BUT THERE CAN BE NO ASSURANCE THAT THE CONTRACTS WILL BE RENEWED IN THE FUTURE. Approximately 20% of the Company's employees are represented by labor unions as of March 31, 2008. On December 31, 2006, the Company's collective bargaining agreements with the California Nurses Association ("CNA") covering certain of our nursing staff and with the Service Employee International Union ("SEIU") expired. Negotiations with both the SEIU and CNA led to agreements being reached on May 9, 2007, and October 16, 2007, for the respective unions. Both contracts were ratified by their respective memberships. The new SEIU Agreement will run until December 31, 2009, and the Agreement with the CNA will run until February 28, 2011. Both Agreements have "no strike" provisions and compensation caps which provide the Company with long term compensation and workforce stability. We do not anticipate the new agreements will have a material adverse effect on our results of operations. Both unions filed grievances under the prior collective bargaining agreements, in connection with allegations the agreements obligated the Company to contribute to Retiree Medical Benefit Accounts. The Company does not agree with this interpretation of the agreements but has agreed to submit the matters to arbitration. Under the new agreements negotiated this year, the Company has agreed to meet with each Union to discuss how to create a vehicle which would have the purpose of providing a retiree medical benefit, not to exceed one percent (1%) of certain employee's payroll. CNA has also filed grievances related to the administration of increases at one facility, change in pay practice at one facility and several wrongful terminations. Those grievances are still pending as of this date, but the Company does not anticipate resolution of the arbitrations will have a material adverse effect on our results of operations. IF EITHER THE COMPANY OR THE HOSPITALS FAIL TO COMPLY WITH APPLICABLE LAWS AND REGULATIONS, WE MAY SUFFER PENALTIES OR BE REQUIRED TO MAKE SIGNIFICANT CHANGES TO OUR OPERATIONS. The health care industry is required to comply with extensive and complex laws and regulations at the federal, state and local government levels relating to, among other things: o Hospital billing practices and prices for services; o Relationships with physicians and other referral sources; o Adequacy of medical care and quality of medical equipment and services; o Ownership of facilities; o Qualifications of medical and support personnel; o Confidentiality, maintenance and security issues associated with health-related information and patient records; o The screening, stabilization and transfer of patients who have emergency medical conditions; o Licensure and accreditation of our facilities; o Operating policies and procedures; and o Construction or expansion of facilities and services. Among these laws are the False Claims Act, HIPAA, the federal anti-kickback statute and the Stark Law. These laws, and particularly the anti-kickback statute and the Stark Law, impact the relationships that we may have with physicians and other referral sources. We have a variety of financial relationships with physicians who refer patients to our facilities. We also provide financial incentives, including minimum revenue guarantees, to recruit physicians into communities served by our hospitals. The OIG has enacted safe harbor regulations that outline practices that are deemed protected from prosecution under the anti-kickback statute. A number of our current arrangements, including financial relationships with physicians and other referral sources, may not qualify for safe harbor protection under the anti-kickback statute. While the failure to meet a safe harbor does not mean that the arrangement necessarily violates the anti-kickback statute, the arrangement may be subject to greater scrutiny. We cannot assure that practices that are outside of a safe harbor will not be found to violate the anti-kickback statute. 22 These laws and regulations are extremely complex and, in some cases, we do not have the benefit of definitive interpretations by either regulators or courts. In the future, it is possible that different interpretations or enforcement of these laws and regulations could subject our current or past practices to allegations of impropriety or illegality or could require us to make changes in our facilities, equipment, personnel, services, capital expenditure programs and operating expenses. A finding that we have violated one or more of these laws or regulations, or even public announcement that we are being investigated for possible violations could have a material adverse effect on our business and our business reputation could suffer significantly. Additionally, we cannot predict with any certainty whether new legislation or regulation, at either the state or federal level, will be implemented and whether those developments will impact our operations or finances. THE COMPANY CONDUCTS ON-GOING REVIEWS OF ITS COMPLIANCE WITH VARIOUS LAWS RELATED TO PHYSICIAN ARRANGEMENTS, WHICH MAY REVEAL VIOLATIONS THAT COULD SUBJECT THE COMPANY TO FINES OR PENALTIES. The Company and the Hospitals have entered into a variety of relationships with physicians. In an increasingly complex legal and regulatory environment, these relationships may pose a variety of legal or business risks. The Company conducts reviews of its compliance with the federal Anti-kickback Statute, Stark law and other applicable laws as they relate to the Company's relationships with referring physicians. The Company's largest shareholder, OC-PIN, is owned and controlled by physicians who also refer to and practice at the Hospitals. OC-PIN may receive dividends as a shareholder. In addition, one of the members of OC-PIN serves as Chairman of the Board of Directors of the Company. As a director, he receives payment from the Company for his service as Chairman. In addition, the Hospitals have various relationships with physicians who are not owners of the Company, as well as with OC-PIN physicians, including medical directorships, sharing in risk pools and service arrangements. The Company entered into a sale leaseback transaction for substantially all of the real estate with Pacific Coast Holdings Investment, LLC ("PCHI") whereby the Company leases substantially all of the real property of the acquired Hospitals from PCHI. PCHI is owned by two LLC's, namely West Coast and Ganesha; which are co-managed by physician investors. The Company has undertaken a review of its agreements with physicians and has a review process in place to ensure that such agreements are in writing and comply with applicable laws. Although there may have been arrangements in the past with physicians that may not have been memorialized in a written agreement or may have expired and not been timely renewed or may have been entered into after services commenced, each of which may have lead to violations of the Stark law, the Company's current review process should prevent such occurrences. Additionally, the Company has reviewed the terms of the purchase of ownership interests in the Company by OC-PIN (which is owned by physicians that refer patients to the Hospitals) and has determined that the purchase should be determined to be permissible under applicable law. The Company has also reviewed certain related party transactions, such as director fees for physician directors and payment of the employment severance package to Dr. Anil Shah, an OC-PIN member. If the Company or the Hospitals are not in compliance with federal and state fraud and abuse laws and physician self-referral laws, the Company could be subject to repayment obligations, fines, penalties, exclusive from participation in federal health care programs, and other sanctions which would have a material adverse effect on the Company's profitability. LICENSING, SURVEYS, INVESTIGATIONS AND AUDITS Health facilities, including the Hospitals, are subject to numerous legal, regulatory, professional and private licensing, certification and accreditation requirements. These include requirements relating to Medicare and Medi-Cal participation and payment, state licensing agencies, private payers and the Joint Commission. Renewal and continuance of certain of these licenses, certifications and accreditations are based on inspections, surveys, audits, investigations or other reviews, some of which may require or include affirmative action or response by the Company. These activities generally are conducted in the normal course of business of health facilities. Nevertheless, an adverse determination could result in a loss or reduction in a Hospital's scope of licensure, certification or accreditation, or could reduce the payment received or require repayment of amounts previously remitted. Any failure to obtain, renew or continue a license, certification or accreditation required for operation of a Hospital could result in the loss of utilization or revenues, or the loss of the Company's ability to operate all or a portion of a Hospital, and, consequently, could have a material and adverse effect on the Company. 23 EARTHQUAKE SAFETY COMPLIANCE The Hospitals are located in an area near active and substantial earthquake faults. The Hospitals carry earthquake insurance with a policy limit of $50 million. A significant earthquake could result in material damage and temporary or permanent cessation of operations at one or more of the Hospitals. In addition, the State of California has imposed new hospital seismic safety requirements. Under these new requirements, the Hospitals must meet stringent seismic safety criteria in the future, and, must complete one set of seismic upgrades to each facility by January 1, 2013. This first set of upgrades is expected to require the Company to incur substantial seismic retrofit expenses. In addition, there could be other remediation costs pursuant to this seismic retrofit. The State of California has introduced a new seismic review methodology known as HAZUS. The HAZUS methodology may preclude the need for some structural modifications. Three of the four Hospitals have requested HAZUS review and one of them has already received a favorable notice pertaining to structural reclassification. There are additional requirements that must be complied with by 2030. The costs of meeting these requirements have not yet been determined. Compliance with seismic ordinances will be a costly venture and could have a material adverse effect on our cash flow. WE FACE INTENSE COMPETITION IN OUR BUSINESS. The healthcare industry is highly competitive. We compete with a variety of other organizations in providing medical services, many of which have greater financial and other resources and may be more established in their respective communities than we are. Competing companies may offer newer or different centers or services than we do and may thereby attract patients or customers who are presently patients, customers or are otherwise receiving our services. Some of the hospitals that compete with our hospitals are owned by government agencies or not-for-profit organizations. Tax-exempt competitors may have certain financial advantages not available to our facilities, such as endowments, charitable contributions, tax-exempt financing, and exemptions from sales, property and income taxes. In certain states, including California, some not-for-profit hospitals are permitted by law to directly employ physicians while for-profit hospitals are prohibited from doing so. We also face increasing competition from physician-owned specialty hospitals and freestanding surgery, diagnostic and imaging centers for market share in high margin services and for quality physicians and personnel. If competing health care providers are better able to attract more patients, recruit and retain physicians, expand services or obtain favorable managed care contracts at their facilities, we may continue to experience a decline in patient volume levels. A SIGNIFICANT PORTION OF OUR BUSINESS IS CONCENTRATED IN CERTAIN MARKETS AND THE RESPECTIVE ECONOMIC CONDITIONS OR CHANGES IN THE LAWS AFFECTING OUR BUSINESS IN THOSE MARKETS COULD HAVE A MATERIAL ADVERSE EFFECT ON THE COMPANY. We receive all of our inpatient services revenue from operations in Orange County, California. The economic condition of this market could affect the ability of our patients and third-party payers to reimburse us for our services, through its effect on disposable household income and the tax base used to generate state funding for Medicaid programs. An economic downturn, or changes in the laws affecting our business in our market and in surrounding markets, could have a material adverse effect on the Company. WE MAY BE LIABLE FOR LOSSES NOT COVERED BY OR IN EXCESS OF OUR INSURANCE. An increasing trend in malpractice litigation claims, rising costs of malpractice litigation, losses associated with these malpractice lawsuits and a constriction of insurers have caused many insurance carriers to raise the cost of insurance premiums or refuse to write insurance policies for hospital facilities. Accordingly, we have increased on retention limits and our estimated reserves may not be adequate. ITEM 1B. UNRESOLVED STAFF COMMENTS None. 24 ITEM 2. PROPERTIES In March 2005, the Company completed the acquisition of the Hospitals and their associated real estate from Tenet. At the closing of the acquisition, the Company transferred all of the fee interests in the acquired real estate to PCHI, a company owned indirectly by two of the Company's largest shareholders. The Company entered into a Triple Net Lease dated March 7, 2005 (amended and restated as of October 1, 2007) under which it leased back from PCHI all of the real estate that it transferred to PCHI. Additionally, the Company leases property from other lessors. As of March 31, 2008, the Company's principal facilities are listed in the following table:
APPROXIMATE AGGREGATE SQUARE LEASE INITIAL LEASE PROPERTY FOOTAGE RATE EXPIRATION -------- ------- ---- ---------- Western Medical Center-Santa Ana 360,000 See note 1. February 28, 2030 1001 North Tustin Avenue Santa Ana, CA 92705 Administrative Building 40,000 See note 1. February 28, 2030 1301 N. Tustin Avenue Santa Ana, CA Western Medical Center-Anaheim 132,000 See note 1. February 28, 2030 1025 South Anaheim Boulevard Anaheim, CA 92805 Coastal Communities Hospital 115,000 See note 1. February 28, 2030 2701 South Bristol Street Santa Ana, CA 92704 Chapman Medical Center 140,000 See note 2. December 31, 2023 2601 East Chapman Avenue Orange, CA 92869
1. Effective October 1, 2007, the Company entered into an amended and restated lease with PCHI. The amended lease terminates on the 25-year anniversary of the original lease (March 8, 2005), grants the Company the right to renew for one additional 25-year period, and requires annual base rental payments of $8.3 million. However, until the Company refinances its $50.0 million Revolving Line of Credit Loan with a stated interest rate less than 14% per annum or PCHI refinances the $45.0 million Term Note, the annual base rental payments are reduced to $7.1 million. In addition, the Company may offset against its rental payments owed to PCHI interest payments that it makes to the Lender under certain of its indebtedness discussed above. The amended lease also gives PCHI sole possession of the medical office buildings located at 1901/1905 North College Avenue, Santa Ana, California that are unencumbered by any claims by or tenancy of the Company. Lease payments to PCHI are eliminated in consolidation. 2. Leased from an unrelated party. Monthly lease payments are approximately $112,000. The State of California has established standards intended to ensure that all hospitals in the state withstand earthquakes and other seismic activity without collapsing or posing the threat of significant loss of life. The Hospitals are located in an area near active and substantial earthquake faults. The Hospitals carry earthquake insurance with a policy limit of $50 million. A significant earthquake could result in material damage and temporary or permanent cessation of operations at one or more of the Hospitals. In addition, the State of California has imposed new hospital seismic safety requirements. Under these new requirements, the Hospitals must meet stringent seismic safety criteria in the future, and, must complete one set of seismic upgrades to each facility by January 1, 2013. This first set of upgrades is expected to require the Company to incur substantial seismic retrofit expenses. In addition, there could be other remediation costs pursuant to this seismic retrofit. The State of California has introduced a new seismic review methodology known as HAZUS. The HAZUS methodology may preclude the need for some structural modifications. Three of the four Hospitals have requested HAZUS review and one of them has already received a favorable notice pertaining to structural reclassification. 25 There are additional requirements that must be complied with by 2030. The costs of meeting these requirements have not yet been determined. Compliance with seismic ordinances will be a costly venture and could have a material adverse effect on our cash flow. The Company believes that its current leased space is adequate for its current purposes and for the next fiscal year. ITEM 3. LEGAL PROCEEDINGS From time to time, health care facilities receive requests for information in the form of a subpoena from licensing entities, such as the Medical Board of California, regarding members of their medical staffs. Also, California state law mandates that each medical staff is required to perform peer review of its members. As a result of the performance of such peer reviews, action is sometimes taken to limit or revoke an individual's medical staff membership and privileges in order to assure patient safety. In August 2007, the Company received such a subpoena from the Medical Board of California concerning a member of the medical staff of one of the Company's facilities. The facility has responded to the subpoena and is in the process of reviewing the matter. Approximately 20% of the Company's employees are represented by labor unions as of September 30, 2007. On December 31, 2006, the Company's collective bargaining agreements with SEIU and CNA expired. Negotiations with both the SEIU and CNA led to agreements being reached on May 9, 2007, and October 16, 2007, for the respective unions. Both contracts were ratified by their respective memberships. The new SEIU Agreement will run until December 31, 2009, and the Agreement with the CNA will run until February 28, 2011. Both Agreements have "no strike" provisions and compensation caps which provide the Company with long term compensation and workforce stability. Both unions filed grievances under the prior collective bargaining agreements, in connection with allegations the agreements obligated the Company to contribute to Retiree Medical Benefit Accounts. The Company does not agree with this interpretation of the agreements but has agreed to submit the matters to arbitration. Under the new agreements negotiated this year, the Company has agreed to meet with each Union to discuss how to create a vehicle which would have the purpose of providing a retiree medical benefit, not to exceed one percent (1%) of certain employee's payroll. CNA has also filed grievances related to the administration of increases at one facility, change in pay practice at one facility, change in medical benefits at two facilities, and several wrongful terminations. Those grievances are still pending as of this date, but the Company does not anticipate resolution of the arbitrations will have a material adverse effect on our results of operations. On May 14, 2007, the Company filed suit in Orange County Superior Court against three of the six members of its Board of Directors (as then constituted) and also against the Company's largest shareholder, OC-PIN. The suit sought damages, injunctive relief and the appointment of a provisional director. Among other things, the Company alleges the defendants breached fiduciary duties owed to the Company by putting their own economic interests above those of the Company, its other shareholders, creditors, employees and the public-at-large. The suit further alleges the defendants' then threatened attempts to change the composition of the Company's management and Board (as then constituted) threatened to trigger multiple "Events of Default" under the express terms of the Company's existing credit agreements with its secured Lender. On May 17, 2007, OC-PIN filed a separate suit against the Company in Orange County Superior Court. OC-PIN's suit sought injunctive relief and damages. OC-PIN alleges the management issue referred to above, together with issues related to monies claimed by OC-PIN, needed to be resolved before completion of the Company's then pending refinancing of its secured debt. OC-PIN further alleges that the Company's President failed to call a special shareholders' meeting, thus denying OC-PIN the opportunity to elect a new member to the Company's Board of Directors. 26 Both actions have since been consolidated before one judge. On July 11, 2007, the Company's motion seeking the appointment of an independent provisional director to fill a vacant seventh Board seat was granted. On the same date, OC-PIN's motion for a mandatory injunction forcing the Company's President to notice a special shareholders meeting was denied. All parties to the litigation thereafter consented to the Court's appointment of the Hon. Robert C. Jameson, retired, as a member of the Company's Board. In December 2007, the Company entered into a mutual dismissal and tolling agreement with OC-PIN. The consolidation suits between the Company, on the one hand, and three members of its former Board are still pending. On April 16, 2008, the Company filed an amended complaint, alleging that the defendant directors' failure to timely approve a refinancing package offered by the Company's largest lender caused the Company to default on its then-existing loans. Also on April 16, 2008, these directors filed cross-complaints against the Company for alleged failures to honor its indemnity obligations to them in this litigation. Given the favorable rulings on July 11, 2007 and other factors, the Company continues to prosecute its original action in hopes of recouping all, or at least a substantial portion, of the economic losses caused by the defendants' alleged multiple breaches of fiduciary duty and other wrongful conduct. A trial date has been set for January 26, 2009, and the parties are currently moving forward with discovery. The Company does not anticipate the resolution of these ongoing claims for damages will have a material adverse effect on its results of operations. On June 19, 2008 the Company received a demand from OC-PIN requesting that it provide notice of a special shareholders meeting by no later than June 26, 2008, with the meeting to occur on a date during the week of July 21-25, 2008. OC PIN stated that the business to be conducted at the special shareholders meeting is to (1) repeal the amendment to the Company's bylaws on June 3, 2008 establishing a procedure for nominating candidates for election as director, (2) remove the entire Board of Directors of the Company, and (3) nominate and elect a new slate of individuals to the Board of Directors. On June 24, 2008, OC-PIN's counsel sent the Company an additional letter demanding that the Company immediately close its stock transfer books or immediately set the Record Date for the requested special shareholders meeting, and waive the record search required under Rule 14a-13(a)(3) of the Securities and Exchange Commission. On June 26, 2008, the Company sent OC-PIN a letter indicating that the Company could not comply with this demand because, among other reasons, OC-PIN has not furnished the consent of the Company's principal lender, which consent is required under the Company's Credit Agreements, aggregating up to $140.7 million, prior to taking any of the actions proposed to be taken by OC-PIN at the special shareholders meeting. In the absence of the lender's consent, the actions proposed by OC-PIN would entitle the lender to certain remedies which would have a material adverse effect on the Company and its shareholders. Further, OC-PIN had not followed the procedures contained in the Company's bylaws for nominating and electing directors of the Company, making the demand defective under the bylaws. Regarding the setting of a record date, the Company is obligated under Rule 14a-13(a)(3) to provide at least 20 business days prior notice to all banks, brokers and other "street name" holders of its stock in advance of the record date for any shareholder meeting at which the Company intends to solicit proxies or consents, and the Company would be in violation of this requirement if it acceded to the demand of OC-PIN's counsel to waive this requirement. The Company believes its positions are justified, and intends to vigorously oppose any attempt by OC-PIN to force the Company to take actions that would put it in default with its lender or cause it to violate the federal securities laws. On July 8, 2008, in a separate action, OC-PIN filed a complaint against the Company in Orange County Superior Court alleging causes of action for breach of contract, specific performance, reformation, fraud, negligent misrepresentation and declaratory relief. The complaint alleges that the Stock Purchase Agreement that the Company executed with OC-PIN on January 28, 2005 "inadvertently omitted" an anti-dilution provision (the "Allegedly Omitted Provision") which would have allowed OC-PIN a right of first refusal to purchase common stock of the Company on the same terms as any other investor in order to maintain OC-PIN's holding at no less than 62.4% of the common stock on a fully diluted basis. The complaint further alleges that the Company has issued stock options under a Stock Incentive Plan and warrants to its lender in violation of the Allegedly Omitted Provision. The complaint further alleges that the issuance of warrants to purchase the Companys stock to Dr. Kali P. Chaudhuri and William Thomas, and their exercise of a portion of those warrants, were improper under the Allegedly Omitted Provision. The Company believes that this lawsuit is wholly without merit and intends to contest these claims vigorously. However, at this early stage, the Company is unable to determine the cost of defending this lawsuit or the impact, if any, that this lawsuit may have on the Company's results of operations or financial condition. We and our subsidiaries are involved in various other legal proceedings most of which relate to routine matters incidental to our business. We do not believe that the outcome of these matters is likely to have a material adverse effect on the Company. 27 ITEM 4. SUBMISSION OF MATTERS TO A VOTE OF SECURITY HOLDERS Our 2007 annual meeting of stockholders was held on September 5, 2007. Of the 137,095,716 shares eligible to vote, 128,537,092 appeared in person or by proxy and established a quorum for the meeting. The matters listed in the table below were approved by the requisite votes. ELECTION OF DIRECTORS VOTES FOR VOTES WITHHELD NOT VOTED --------- --------- -------------- --------- Maurice J. DeWald 69,436,662 2,000 59,098,430 Hon. C. Robert Jameson 69,437,662 1,000 59,098,430 Ajay Meka, M.D. 69,436,662 2,000 59,098,430 Michael Metzler 69,437,662 1,000 59,098,430 Bruce Mogel 69,436,662 2,000 59,098,430 J. Fernando Niebla 69,436,662 2,000 59,098,430 William E. Thomas 69,437,662 1,000 59,098,430 RATIFICATION OF THE APPOINTMENT OF BDO SEIDMAN, LLP AS INDEPENDENT REGISTERED PUBLIC ACCOUNTING FIRM FOR THE YEAR ENDING MARCH 31, 2008 VOTES FOR VOTES AGAINST VOTES WITHHELD NOT VOTED --------- ------------- -------------- --------- 123,265,903 3,089 5,268,100 0 PART II ITEM 5. MARKET FOR REGISTRANT'S COMMON EQUITY, RELATED STOCKHOLDER MATTERS AND ISSUER PURCHASES OF EQUITY SECURITIES The Company's common stock is listed for trading on the OTC Bulletin Board under the symbol "IHCH.OB." The trading market for the Company's common stock has been extremely thin. In view of the extreme thinness of the trading market, the prices reflected on the chart below as reported on the OTC Bulletin Board may not be indicative of the price at which any prior or future transactions were or may be effected in the Company's common stock. Stockholders are cautioned against drawing any conclusions from the data contained herein, as past results are not necessarily indicative of future stock performance. The following table sets forth the quarterly high and low bid price for the Company's common stock for each quarter for the period from April 1, 2006 through March 31, 2008, as quoted on the Over-the-Counter Bulletin Board. Such Over-the-Counter market quotations reflect inter dealer prices, without retail mark-up, mark-down or commission, and may not necessarily represent actual transactions. - --------------------- ------------------- ------------------- PERIOD HIGH LOW ------ ---- --- - --------------------- ------------------- ------------------- Apr 2006 - Jun 2006 $0.40 $0.15 - --------------------- ------------------- ------------------- Jul 2006 - Sep 2006 $0.25 $0.08 - --------------------- ------------------- ------------------- Oct 2006 - Dec 2006 $0.50 $0.10 - --------------------- ------------------- ------------------- Jan 2007 - Mar 2007 $0.40 $0.20 - --------------------- ------------------- ------------------- Apr 2007 - Jun 2007 $0.32 $0.12 - --------------------- ------------------- ------------------- Jul 2007 - Sep 2007 $0.23 $0.12 - --------------------- ------------------- ------------------- Oct 2007 - Dec 2007 $0.33 $0.14 - --------------------- ------------------- ------------------- Jan 2008 - Mar 2008 $0.25 $0.10 - --------------------- ------------------- ------------------- As of the date of this report, there were approximately 223 record holders of the Company's common stock; this number does not include an indeterminate number of stockholders whose shares may be held by brokers in street name. The Company has not paid and does not expect to pay any dividends on its shares of common stock for the foreseeable future, as any earnings will be retained for use in the business. 28 The following table provides summary information concerning the Company's equity compensation plan as of March 31, 2008.
Equity Compensation Plan Information - ------------------------------------------------------------------------------------------------------------ Plan Category Number of Securities to Weighted-average Number of securities be issued upon exercise exercise price of remaining available for of outstanding options, outstanding options, future issuance under warrants and rights warrants and rights equity compensation plans (excluding securities reflected in column (a)) (a) (b) (c) - ------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------ Equity compensation plans approved by 7,445,000 $ 0.24 5,925,957 security holders - ------------------------------------------------------------------------------------------------------------ Equity compensation plans not approved by - - - security holders - ------------------------------------------------------------------------------------------------------------ - ------------------------------------------------------------------------------------------------------------ Total 7,445,000 $ 0.24 5,925,957 - ------------------------------------------------------------------------------------------------------------
STOCK PERFORMANCE TABLE The following table shows the cumulative, five year, split adjusted total return for our Common Stock (including trading in our Common Stock under our current name and under our previous name, First Deltavision, Inc.), compared to two major indices. The Standard & Poor's 500 Stock Index includes 500 companies representing all major industries. The Dow Jones US Healthcare Providers measures owners and operators of providers of health care. Performance data assumes that $100.00 was invested on March 31, 2003 in our Common Stock and each of the indices. The data assumes the reinvestment of all cash dividends and the cash value of other distributions. Stock price performance shown in the table is not necessarily indicative of future stock price performance. S&P500 Close Index - ------ ----- ----- 31-Mar-03 848.18 100.00 31-Mar-04 1,126.21 132.78 31-Mar-05 1,180.59 139.19 31-Mar-06 1,302.89 153.61 31-Mar-07 1,422.53 167.72 31-Mar-08 1,322.70 155.95 IHHI Stock Price - ---------------- 31-Mar-03 $ 0.40 100.00 31-Mar-04 $ 0.72 180.00 31-Mar-05 $ 1.07 267.50 31-Mar-06 $ 0.30 75.00 31-Mar-07 $ 0.32 80.00 31-Mar-08 $ 0.12 30.00 Dow Jones US Healthcare Providers - --------------------------------- 31-Mar-03 239.91 100.00 31-Mar-04 328.35 136.86 31-Mar-05 445.67 185.77 31-Mar-06 528.08 220.12 31-Mar-07 553.04 230.52 31-Mar-08 446.71 186.20 29 ITEM 6. SELECTED FINANCIAL DATA The following selected condensed consolidated financial information should be read in conjunction with "Item 7 - Management's Discussion and Analysis of Financial Condition and Results of Operations" and the consolidated financial statements and notes included elsewhere in this Form 10-K. We had no material business operations prior to the fiscal year ended December 31, 2005.
AS OF OR FOR THE PERIOD ENDED ($ in 000's except per share amounts) Year ended Year ended Year ended Year ended Year ended ---------- ---------- ---------- ---------- ---------- March 31, 2008 March 31, 2007 December 31, 2005 December 31, 2004 December 31, 2003 -------------- -------------- ----------------- ----------------- ----------------- SELECTED BALANCE SHEET DATA: Net working capital $ (12,719) $ (90,307) $ 8,063 $ (12,132) $ 149 Property and equipment 56,917 58,172 59,431 57 47 Other assets 759 - 1,141 11,187 156 Long term debt 85,700 - 70,331 - - Warrant liability - non current - - 21,065 - - Capital lease obligations 6,375 5,834 4,961 - - Minority interest 1,150 1,716 3,342 - - Stockholders' equity (deficiency) (48,268) (39,685) (31,064) (888) 353 SELECTED INCOME STATEMENT DATA: Net operating revenue $ 368,229 $ 350,672 $ 283,698 $ - $ - Salaries and benefits (209,680) (194,865) (153,574) - - Supplies (50,126) (49,577) (39,250) - - Provision for doubtful accounts (30,958) (35,169) (37,349) - - Other operating expenses (69,027) (66,652) (58,716) (1,840) (28) Warrant expense (11,404) (693) (17,604) - - Depreciation and amortization (3,134) (2,495) (2,178) - - Interest expense (13,209) (12,092) (9,925) - - Provision for income taxes (28) (5) (5) - - Net loss before minority interest (37,689) (21,131) (46,833) (1,840) (28) Net loss attributable to common stock $ (39,163) $ (20,538) $ (45,175) $ (1,840) $ (28) PER SHARE DATA: Net loss: Basic and fully diluted $ (0.30) $ (0.23) $ (0.50) $ (0.09) $ (0.01) Weighted average number of common shares outstanding: 131,869 90,291 90,330 19,987 3,471
Long term debt as of March 31, 2008 resulted from the Company's refinancing effective October 9, 2007. Effective December 31, 2007, all warrant liability was reclassified to equity. Long term debt and warrant liability - non current as of March 31, 2007 were $0 because all notes and warrants were due in less than one year. On March 8, 2005 the Company completed the acquisition and commenced operation of the Hospitals. Prior to that time the Company reported activity as a development stage enterprise. The operating results data presented above are not necessarily indicative of our future results of operations. Reasons for this include, but are not limited to: changes in Medicare regulations; Medicaid funding levels set by the State of California and the County of Orange; levels of malpractice expense and settlement trends; availability of trained healthcare personnel and changes in occupancy levels and patient volumes. Factors that affect patient volumes and, thereby, our results of operations at our hospitals and related healthcare facilities include, but are not limited to: (1) unemployment levels; (2) the business environment of local communities; (3) the number of uninsured and underinsured individuals in local communities treated at our hospitals; (4) seasonal cycles of illness; (5) climate and weather conditions; (6) physician recruitment, retention and attrition; (7) local healthcare competitors; (8) managed care contract negotiations or terminations; and (9) factors relating to the timing of elective procedures. 30 ITEM 7. MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS. FORWARD-LOOKING INFORMATION This Annual Report on Form 10-K contains forward-looking statements, as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements relate to future events or our future financial performance. In some cases, you can identify forward-looking statements by terminology such as "may," "will," "should," "expects," "plans," "anticipates," "believes," "estimates," "predicts," "potential" or "continue" or the negative of these terms or other comparable terminology. These statements are only predictions and involve known and unknown risks, uncertainties and other factors, including the risks discussed under the caption "Risk Factors" herein that may cause our Company's or our industry's actual results, levels of activity, performance or achievements to be materially different from those expressed or implied by these forward-looking statements. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee future results, levels of activity, performance or achievements. Except as may be required by applicable law, we do not intend to update any of the forward-looking statements to conform these statements to actual results. As used in this report, the terms "we," "us," "our," "the Company," "Integrated Healthcare Holdings" or "IHHI" mean Integrated Healthcare Holdings, Inc., a Nevada corporation, unless otherwise indicated. Unless otherwise indicated, all amounts included in this Item 7 are expressed in thousands (except per share amounts). OVERVIEW On March 8, 2005, the Company completed its acquisition (the "Acquisition") of four Orange County, California Hospitals and associated real estate, including: (i) 282-bed Western Medical Center - Santa Ana, CA; (ii) 188-bed Western Medical Center - Anaheim, CA; (iii) 178-bed Coastal Communities Hospital in Santa Ana, CA; and (iv) 114-bed Chapman Medical Center in Orange, CA (collectively, the "Hospitals") from Tenet Healthcare Corporation ("Tenet"). The Hospitals were assigned to four wholly owned subsidiaries of the Company formed for the purpose of completing the Acquisition. The Company also acquired the following real estate, leases and assets associated with the Hospitals: (i) a fee interest in the Western Medical Center at 1001 North Tustin Avenue, Santa Ana, CA, a fee interest in the administration building at 1301 North Tustin Avenue, Santa Ana, CA, certain rights to acquire condominium suites located in the medical office building at 999 North Tustin Avenue, Santa Ana, CA, and the business known as the West Coast Breast Cancer Center; (ii) a fee interest in the Western Medical Center at 1025 South Anaheim Blvd., Anaheim, CA; (iii) a fee interest in the Coastal Communities Hospital at 2701 South Bristol Street, Santa Ana, CA, and a fee interest in the medical office building at 1901 North College Avenue, Santa Ana, CA; (iv) a lease for the Chapman Medical Center at 2601 East Chapman Avenue, Orange, CA, and a fee interest in the medical office building at 2617 East Chapman Avenue, Orange, CA; and (v) equipment and contract rights. At the closing of the Acquisition, the Company transferred all of the fee interests in the acquired real estate (the "Hospital Properties") to Pacific Coast Holdings Investment, LLC ("PCHI"), a company owned indirectly by two of the Company's largest shareholders. SIGNIFICANT CHALLENGES COMPANY - Our Acquisition involved significant cash expenditures, debt incurrence and integration expenses that has seriously strained our financial condition. If we are required to issue equity securities to raise additional capital, existing stockholders will likely be substantially diluted, which could affect the market price of our stock. INDUSTRY - Our Hospitals receive a substantial portion of their revenues from Medicare and Medicaid. The healthcare industry is experiencing a strong trend toward cost containment, as the government seeks to impose lower reimbursement and resource utilization group rates, limit the scope of covered services and negotiate reduced payment schedules with providers. These cost containment measures generally have resulted in a reduced rate of growth in the reimbursement for the services that we provide relative to the increase in our cost to provide such services. 31 Changes to Medicare and Medicaid reimbursement programs have limited, and are expected to continue to limit, payment increases under these programs. Also, the timing of payments made under the Medicare and Medicaid programs is subject to regulatory action and governmental budgetary constraints resulting in a risk that the time period between submission of claims and payment could increase. Further, within the statutory framework of the Medicare and Medicaid programs, a substantial number of areas are subject to administrative rulings and interpretations which may further affect payments. Our business is subject to extensive federal, state and, in some cases, local regulation with respect to, among other things, participation in the Medicare and Medicaid programs, licensure and certification of facilities, and reimbursement. These regulations relate, among other things, to the adequacy of physical property and equipment, qualifications of personnel, standards of care, government reimbursement and operational requirements. Compliance with these regulatory requirements, as interpreted and amended from time to time, can increase operating costs and thereby adversely affect the financial viability of our business. Because these regulations are amended from time to time and are subject to interpretation, we cannot predict when and to what extent liability may arise. Failure to comply with current or future regulatory requirements could also result in the imposition of various remedies including (with respect to inpatient care) fines, restrictions on admission, denial of payment for all or new admissions, the revocation of licensure, decertification, imposition of temporary management or the closure of a facility or site of service. We are subject to periodic audits by the Medicare and Medicaid programs, which have various rights and remedies against us if they assert that we have overcharged the programs or failed to comply with program requirements. Rights and remedies available to these programs include repayment of any amounts alleged to be overpayments or in violation of program requirements, or making deductions from future amounts due to us. These programs may also impose fines, criminal penalties or program exclusions. Other third-party payer sources also reserve rights to conduct audits and make monetary adjustments in connection with or exclusive of audit activities. The healthcare industry is highly competitive. We compete with a variety of other organizations in providing medical services, many of which have greater financial and other resources and may be more established in their respective communities than we are. Competing companies may offer newer or different centers or services than we do and may thereby attract patients or customers who are presently patients, customers or are otherwise receiving our services. An increasing trend in malpractice litigation claims, rising costs of malpractice litigation, losses associated with these malpractice lawsuits and a constriction of insurers have caused many insurance carriers to raise the cost of insurance premiums or refuse to write insurance policies for hospital facilities. Also, a tightening of the reinsurance market has affected property, auto and excess liability insurance carriers. Accordingly, the costs of all insurance premiums have increased. We receive all of our inpatient services revenue from operations in Orange County, California. The economic condition of this market could affect the ability of our patients and third-party payers to reimburse us for our services, through its effect on disposable household income and the tax base used to generate state funding for Medicaid programs. An economic downturn, or changes in the laws affecting our business in our market and in surrounding markets, could have a material adverse effect on our financial position, results of operations and cash flows. 32 LIQUIDITY AND CAPITAL RESOURCES The accompanying consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and settlement of obligations in the normal course of business. The Company incurred a net loss of $39.2 million and reported net cash used in operating activities of $11.3 million during the year ended March 31, 2008 and the Company had a working capital deficit of $12.7 million at March 31, 2008. A component of this loss, totaling $25.7 million relating to warrants, was reclassified from liability to equity, thus having no impact on our stockholders' deficiency. The Company refinanced its outstanding debt in October 2007, see "REFINANCING." Notwithstanding the refinancing, these factors, among others, raise substantial doubt about the Company's ability to continue as a going concern and indicate a need for the Company to take action to continue to operate its business as a going concern. There is no assurance that the Company will be successful in improving reimbursements or reducing operating expenses. Management has also been working on improvements in several areas that the Company believes will improve cash flow from operations: 1. Net operating revenues: Due primarily to the impact of improved contracts, commercial, managed care and other patient revenues improved $17.6 million during the year ended March 31, 2008 compared to fiscal 2007. Net collectible revenues (net operating revenues less provision for doubtful accounts) for the year ended March 31, 2008 and 2007 were $337.1 million and $315.5 million, respectively. During the year ended March 31, 2008 and 2007, the Company received $4.8 million and $3.5 million lump sum awards from the State Medi-Cal unit, respectively. Adjusting for this, revenues grew by 4.7%. The Hospitals serve a disproportionate number of indigent patients and receive governmental revenues and subsidies in support of care for these patients. Governmental revenues include payments for Medicaid, Medicaid DSH, and Orange County, CA (CalOptima). Governmental revenues increased $14.2 million for the year ended March 31, 2008 compared to the same period in fiscal year 2007. Inpatient admissions increased by 0.7% to 28,004 for the year ended March 31, 2008 compared to 27,806 for the year ended March 31, 2007. 2. Operating expenses: Management is working aggressively to reduce costs without reduction in service levels. These efforts have in large part been offset by inflationary pressures. Operating expenses before interest and warrants for the year ended March 31, 2008 were $366.8 million, or 2.1%, higher than for the same period in fiscal year 2007. The most significant improvement was the $4.1 million reduction in the Provision for Doubtful Accounts due to improved collection experience. The Company also replaced the Accounts Purchase Agreement with a revolving credit agreement (see "REFINANCING"). As a result, the Loss on Sale of Accounts Receivable decreased by $6.3 million. This was partially offset by increased labor costs of $14.8 million (resulting from wage increases, union settlements and severance agreement). Financing costs: The Company completed the Acquisition of the Hospitals with a high level of debt financing. Effective October 9, 2007, the Company entered into new financing arrangements with Medical Capital Corporation and its affiliates (see "REFINANCING"). The terms of the new financing are expected to reduce the Company's cost of capital by $4.5 million in the first year of the new financing. Additionally, the $50.0 million Revolving Credit Agreement provides an estimated additional liquidity as of March 31, 2008 of $27.4 million based on eligible receivables, as defined. The foregoing analysis presumes that capital expenditures to replace equipment can be kept to an immaterial amount in the short term. REFINANCING - Effective October 9, 2007, the Company and affiliates of Medical Capital Corporation, namely Medical Provider Financial Corporation I, Provider Financial Corporation II, and Medical Provider Financial Corporation III (collectively, the "Lender") executed agreements to refinance the Lender's credit facilities with the Company aggregating up to $140.7 million in principal amount (the "New Credit Facilities"). The New Credit Facilities replaced the Company's previous credit facilities with the Lender, which matured on March 2, 2007. The Company had been operating under an Agreement to Forbear with the Lender with respect to the previous credit facilities. 33 The New Credit Facilities consist of the following instruments: o An $80.0 million credit agreement, under which the Company issued a $45.0 million Term Note bearing a fixed interest rate of 9% in the first year and 14% after the first year, which was used to repay amounts owing under the Company's existing $50.0 million real estate term loan. o A $35.0 million Non-Revolving Line of Credit Note issued under the $80.0 million credit agreement, bearing a fixed interest rate of 9.25% per year and an unused commitment fee of 0.50% per year, which was used to repay amounts owing under the Company's existing $30.0 million line of credit, pay the origination fees on the other credit facilities and for working capital. o A $10.7 million credit agreement, under which the Company issued a $10.7 million Convertible Term Note bearing a fixed interest rate of 9.25% per year, which was used to repay amounts owing under the Company's existing $10.7 million loan. The $10.7 million Convertible Term Note is convertible into common stock of the Company at $0.21 per share during the term of the note. o A $50.0 million revolving credit agreement, under which the Company issued a $50.0 million Revolving Line of Credit Note bearing a fixed interest rate of 24% per year (subject to reduction to 18% if the $45.0 million Term Loan is repaid prior to its maturity) and an unused commitment fee of 0.50% per year, which was used to finance the Company's accounts receivable and is available for working capital needs. Each of the above credit agreements and notes (i) required a 1.5% origination fee due at funding, (ii) matures in three years, (iii) requires monthly payments of interest and repayment of principal upon maturity, (iv) are collateralized by all of the assets of the Company and its subsidiaries and the real estate underlying the Company's hospital facilities (which are owned by PCHI and leased to the Company), and (v) are guaranteed by Orange County Physicians Investment Network, LLC ("OC-PIN") and West Coast Holdings, LLC ("West Coast"), a member of PCHI, pursuant to separate Guaranty Agreements in favor of the lender. Concurrently with the execution of the New Credit Facilities, the Company issued new and amended warrants, see "NEW WARRANTS." The refinancing did not meet the requirements for a troubled debt restructuring in accordance with SFAS 15, "Accounting by Debtors and Creditors for Troubled Debt Restructuring." Under SFAS 15, a debtor must be granted a concession by the creditor for a refinancing to be considered a troubled debt restructuring. Although the New Credit Facilities have lower interest rates than the previous credit facilities, the fair value of the New Warrants (see "NEW WARRANTS") resulted in the effective borrowing rate of the New Credit Facilities to significantly exceed the effective rate of the previous credit facilities. The nondetachable conversion feature of the $10.7 million Convertible Term Note is out-of-the-money on the Effective Date. Pursuant to EITF 05-2, "The Meaning of 'Conventional Convertible Debt Instrument' in Issue No. 00-19," the $10.7 million Convertible Term Note is considered conventional for purposes of applying EITF 00-19, "Accounting for Derivative Financial Instruments Indexed to, and Potentially Settled in, a Company's Own Stock." The New Credit Facilities (excluding the $50.0 million Revolving Credit Agreement, which did not modify or exchange any prior debt) meet the criteria of EITF 06-6 for debt extinguishment accounting since the $10.7 million Convertible Term Note includes a substantive conversion option compared to the previous financing facilities. As a result, pursuant to EITF 96-19, related loan origination fees were expensed in the year ended March 31, 2008, and legal fees and other expenses are being amortized over three years. Based on eligible receivables, as defined, the Company had approximately $27.4 million of additional availability under its Revolving Line of Credit at March 31, 2008. The Company's New Credit Facilities are subject to certain financial and restrictive covenants, as amended, including debt service coverage ratio, minimum cash collections, dividend restrictions, mergers and acquisitions, and other corporate activities common to such financing arrangements. Effective for the period from January 1, 2008 through June 30, 2009, the Lender amended the New Credit Facilities whereby the minimum fixed charge coverage ratio, as defined, was reduced from 1.0 to 0.4. The Company was in compliance with all covenants, as amended, at March 31, 2008. 34 Concurrently with the execution of the New Credit Facilities, the Company issued to an affiliate of the Lender a five-year warrant to purchase the greater of 16.9 million shares of the Company's common stock or up to 4.95% of the Company's common stock equivalents, as defined, at $0.21 per share (the "4.95% Warrant"). In addition, the Company and the Lender entered into Amendment No. 2 to Common Stock Warrant, originally dated December 12, 2005, which entitles an affiliate of the Lender to purchase the greater of 26.1 million shares of the Company's common stock or up to 31.09% of the Company's common stock equivalents, as defined, at $0.21 per share (the "31.09% Warrant"). Concurrently with the execution of the Amended Lease, the Company, PCHI, Ganesha Realty, LLC, and West Coast entered into a Settlement Agreement and Mutual Release (the "Settlement Agreement") whereby the Company agreed to pay to PCHI $2.5 million as settlement for unpaid rents specified in the Settlement Agreement, relating to the medical office buildings located at 1901/1905 North College Avenue, Santa Ana, California (the "College Avenue Property"), and for compensation relating to the medical office buildings located at 999 North Tustin Avenue in Santa Ana, California, under a previously executed Agreement to Compensation. As a result of the Company's refinancing, the remaining 24.9 million warrants held by Dr. Chaudhuri and Mr. Thomas became exercisable on the October 9, 2007 effective date of the refinancing (See "RESTRUCTURING WARRANTS"). LONG TERM LEASE COMMITMENT WITH VARIABLE INTEREST ENTITY - Concurrent with the closing of the Acquisition as of March 8, 2005, the Company entered into a sale leaseback type agreement with a related party entity, PCHI. The Company leases substantially all of the real estate of the acquired Hospitals and medical office buildings from PCHI. As a condition of the New Credit Facilities (see "REFINANCING"), the Company entered into an Amended Lease with PCHI. The Amended Lease terminates on the 25-year anniversary of the original lease (March 8, 2005), grants the Company the right to renew for one additional 25-year period, and requires annual base rental payments of $8.3 million. However, until the Company refinances its $50.0 million Revolving Line of Credit Loan with a stated interest rate less than 14% per annum or PCHI refinances the $45.0 million Term Note, the annual base rental payments are reduced to $7.1 million. In addition, the Company may offset against its rental payments owed to PCHI interest payments that it makes to the Lender under certain of its indebtedness discussed above. The Amended Lease also gives PCHI sole possession of the College Avenue Property that is unencumbered by any claims by or tenancy of the Company. This lease commitment with PCHI is eliminated in consolidation. The Company remains primarily liable under the $45.0 million Term Note notwithstanding its guarantee by PCHI, and this note is cross collateralized by substantially all of the Company's assets and all of the real property of the Hospitals. All of the Company's operating activities are directly affected by the real property that was sold to PCHI. Given these factors, the Company has indirectly guaranteed the indebtedness of PCHI. The Company is standing ready to perform on the $45.0 million Term Note should PCHI not be able to perform and has undertaken a contingent obligation to make future payments if those triggering events or conditions occur. ACCOUNTS PURCHASE AGREEMENT - In March 2005, the Company entered into an Accounts Purchase Agreement (the "APA") for a minimum of two years with Medical Provider Financial Corporation I, an unrelated party (the "Buyer"). The Buyer is an affiliate of the Lender. The APA provided for the sale of 100% of the Company's eligible accounts receivable, as defined, without recourse. The APA required the Company to provide billing and collection services, maintain the individual patient accounts, and resolve any disputes that arose between the Company and the patient or other third party payer for no additional consideration. Effective October 9, 2007, the APA was terminated and the Company repurchased the remaining outstanding accounts that been sold, totaling $6.8 million in addition to the release of security reserve funds and deferred purchase price receivables (See "REFINANCING"). 35 From inception of the APA through October 9, 2007 (date of termination) the Buyer advanced $639.6 million to the Company through the APA. In addition, the Company received $56.9 million in reserve releases from inception through October 9, 2007. Payments posted on sold receivables from inception approximated $671.3 million. Advances net of payment and adjustment activity, cumulatively through October 9, 2007 (date of termination) and March 31, 2007 were $(5.4) million and $7.0 million, respectively. Transaction Fees incurred for the same periods (from inception) were $11.7 and $9.3 million, respectively. NEW WARRANTS - Concurrently with the execution of the New Credit Facilities (see "REFINANCING"), the Company issued to an affiliate of the Lender a five-year warrant to purchase the greater of 16.9 million shares of the Company's common stock or up to 4.95% of the Company's common stock equivalents, as defined, at $0.21 per share (the "4.95% Warrant"). In addition, the Company and the Lender entered into Amendment No. 2 to Common Stock Warrant, originally dated December 12, 2005, which entitles an affiliate of the Lender to purchase the greater of 26.1 million shares of the Company's common stock or up to 31.09% of the Company's common stock equivalents, as defined, at $0.21 per share (the "31.09% Warrant"). Amendment No. 2 to the 31.09% Warrant extended the expiration date of the Warrant to October 9, 2017, removed the condition that it only be exercised if the Company is in default of its previous credit agreements, and increased the exercise price to $0.21 per share unless the Company's stock ceases to be registered under the Securities Exchange Act of 1934, as amended. The 4.95% Warrant and the 31.09% Warrant are collectively referred to herein as the "New Warrants." The New Warrants were exercisable as of October 9, 2007, the effective date of the New Credit Facilities (the "Effective Date"). Accordingly, as of the Effective Date, the Company recorded warrant expense, and a related warrant liability, of $10.2 million relating to the New Warrants. In accordance with SFAS No. 133 and EITF 00-19, the Restructuring Warrants were accounted for as liabilities and were revalued at each reporting date, and the changes in fair value were recorded as change in fair value of warrant liability in the Company's consolidated statements of operations. RESTRUCTURING WARRANTS - The Company entered into a Rescission, Restructuring and Assignment Agreement with Dr. Kali Chaudhuri and Mr. William Thomas on January 27, 2005 (the "Restructuring Agreement"). Pursuant to the Restructuring Agreement, the Company issued warrants to purchase up to 74.7 million shares of the Company's common stock (the "Restructuring Warrants") to Dr. Chaudhuri and Mr. Thomas (not to exceed 24.9% of the Company's fully diluted capital stock at the time of exercise). In addition, the Company amended the Real Estate Option to provide for Dr. Chaudhuri's purchase of a 49% interest in PCHI for $2.45 million. The Restructuring Warrants were exercisable beginning January 27, 2007 and expire on July 27, 2008. The exercise price for the first 43.0 million shares purchased under the Restructuring Warrants is $0.003125 per share, and the exercise or purchase price for the remaining 31.7 million shares is $0.078 per share if exercised between January 27, 2007 and July 26, 2007, $0.11 per share if exercised between July 27, 2007 and January 26, 2008, and $0.15 per share thereafter. In accordance with SFAS No. 133 and EITF 00-19, the Restructuring Warrants were accounted for as liabilities and were revalued at each reporting date, and the changes in fair value were recorded as change in fair value of warrant liability in the Company's consolidated statements of operations. During February 2007, Dr. Chaudhuri and Mr. Thomas submitted an exercise under these warrants to the Company. At March 31, 2007 the Company recorded the issuance of 28.7 million net shares under this exercise following resolution of certain legal issues relating thereto. The issuance of these shares resulted in an addition to paid in capital and to common stock totaling $9.2 million. These shares were issued to Dr. Chaudhuri and Mr. Thomas on July 2, 2007. The shares pursuant to this exercise were recorded as issued and outstanding at March 31, 2007. Additionally, the remaining liability was revalued at March 31, 2007 in the amount of $4.2 million relating to potential shares (20.8 million shares) which could be issued, if the December Note warrant was to become issuable, which occurred on June 13, 2007 upon receipt of a notice of default from the Lender. On July 2, 2007, the Company accepted, due to the default and subsequent vesting of the December Note Warrant, an additional exercise under the anti dilution provisions the Restructuring Warrant Agreement by Dr. Chaudhuri and Mr. Thomas. The exercise resulted in additional shares issuable of 20.8 million shares for consideration of $576 in cash. The effect of this exercise resulted in additional warrant expense for the year ended March 31, 2007 of $693, which was accrued based on the transaction as of March 31, 2007. The related warrant liability of $4.2 million (as of March 31, 2007) was reclassified to additional paid in capital when the 20.8 million shares were issued to Dr. Chaudhuri and Mr. Thomas in July 2007. 36 Upon the Company's refinancing (see "REFINANCING") and the issuance of the New Warrants, the remaining 24.9 million Restructuring Warrants held by Dr. Chaudhuri and Mr. Thomas became exercisable on the Effective Date. Accordingly, as of the Effective Date, the Company recorded warrant expense, and a related warrant liability, of $1.2 million relating to the Restructuring Warrants. RECLASSIFICATION OF WARRANTS - On December 31, 2007, the Company amended its Articles of Incorporation to increase its authorized shares of common stock from 250 million to 400 million. This gave the Company sufficient authorized shares to establish that the outstanding warrants, options, and conversion rights were within its control. Accordingly, effective December 31, 2007, the Company revalued the 24.9 million Restructuring Warrants and the New Warrants resulting in a change in the fair value of derivative of $2.9 million and $11.4 million, respectively, and reclassified the combined warrant liability balance of $25.7 million to additional paid in capital in accordance with EITF 00-19. The Company recorded common stock warrant expense of $11.4 million, $693, and $17.6 million during the years ended March 31, 2008 and 2007, and December 31, 2005, respectively. There was no common stock warrant expense recorded during the three months ended March 31, 2006. The Company recorded a change in the fair value of warrant liability of $14.3 million, $(133.0), $3.5 million, and $(8.2) million for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. COMMITMENTS AND CONTINGENCIES - The State of California has imposed new hospital seismic safety requirements. The Company operates four hospitals located in an area near active earthquake faults. Under these new requirements, the Company must meet stringent seismic safety criteria in the future, and, must complete one set of seismic upgrades to the facilities by January 1, 2013. This first set of upgrades is expected to require the Company to incur substantial seismic retrofit costs. There are additional requirements that must be complied with by 2030. The Company is currently estimating the costs of meeting these requirements; however a total estimated cost has not yet been determined. TABULAR DISCLOSURE OF CONTRACTUAL OBLIGATIONS - =========================================================================================== Payments due by period =========================================================================================== Less than More than Contractual obligations Total 1 year 1-3 years 3-5 years 5 years =========================================================================================== Debt obligations $ 95,579 $ 9,879 $ 85,700 $ - $ - =========================================================================================== Capital lease obligations 13,776 1,240 2,459 2,078 7,999 =========================================================================================== Operating lease obligations 23,593 1,549 2,552 2,529 16,963 =========================================================================================== Purchase obligations 13,404 3,663 6,677 3,064 - =========================================================================================== =========================================================================================== Total $ 146,352 $ 16,331 $ 97,388 $ 7,671 $ 24,962 ===========================================================================================
The above table excludes future payments based on existing arrangements totaling approximately $156 million between the Company and PCHI, its variable interest entity. These payments are eliminated in consolidation. CASH FLOW - Net cash provided by (used in) operating activities for the years ended March 31, 2008 and 2007 and December 31, 2005 was $(11.3) million, $2.5 million, and $(15.2) million, respectively, including net losses, adjusted for depreciation and other non-cash items (excludes provision for doubtful accounts and minority interest) of $10.0 million, $16.6 million, and $21.1 million, respectively. The Company used $1.3 million and produced $19.1 million and $5.9 million in working capital for the years ended March 31, 2008 and 2007 and December 31, 2005, respectively. Net cash used in working capital activities primarily reflects increases in accounts receivable (including security reserve fund and deferred purchase price receivable) including the cost of repurchasing accounts receivable partially offset by the increases in accounts payable and accrued liabilities . Cash produced by growth in accounts payable, accrued compensation and benefits and other current liabilities was $4.7 million, $11.1 million, and $54.1 million for the years ended March 31, 2008 and 2007 and December 31, 2005, respectively. Cash used in accounts receivable, including security reserve fund and deferred purchase price receivable (net of provision for doubtful accounts), was $6.9 million, $0.9 million, and $39.5 million for the years ended March 31, 2008 and 2007 and December 31, 2005, respectively. The $6.9 million used for the year ended March 31, 2008 primarily reflects the return of the Advance Rate Amount, net, and payment of transaction fees in connection with the repurchase of accounts receivable and termination of the APA. 37 Net cash provided by (used in) investing activities during the years ended March 31, 2008 and 2007 and December 31, 2005 was $4.0 million, $(0.6) million, and $(63.7) million, respectively. In the years ended March 31, 2008 and 2007, the Company invested $0.9 million and $0.6 million in cash, respectively, in new equipment. In the year ended December 31, 2005, the Company used $63.2 million to complete the acquisition of four hospitals. During the year ended March 31, 2008, $4.9 million in restricted cash was released to the Company. Net cash provided by financing activities for the years ended March 31, 2008 and 2007 and December 31, 2005 was $2.5 million, $1.0 million, and $92.8 million, respectively. The increase in net cash provided by financing activities for the years ended March 31, 2008 and 2007 and December 31, 2005 was primarily represented by $5.7 million, $2.0 million, and $77.8 million, respectively, in proceeds from credit facilities. RESULTS OF OPERATIONS AND FINANCIAL CONDITION FISCAL YEAR ENDED MARCH 31, 2008 COMPARED TO FISCAL YEAR ENDED MARCH 31, 2007 The following table sets forth, for the years ended March 31, 2008 and 2007, our consolidated statements of operations expressed as a percentage of net operating revenues. Years ended March 31, ---------------------------- 2008 2007 ------------ ------------ Net operating revenues 100% 100% Operating expenses 100% 102% ------------ ------------ Operating income (loss) 0% (2%) ------------ ------------ Other expense: Interest expense, net (4%) (4%) Common stock warrant expense (3%) 0% Change in fair value of warrant liability (4%) 0% ------------ ------------ Other expense, net (11%) (4%) ------------ ------------ Loss before provision for income taxes and minority interest (11%) (6%) Provision for income taxes (0%) 0% Minority interest in variable interest entity (0%) 0% ------------ ------------ Net loss (11%) (6%) ============ ============ NET OPERATING REVENUES - Net operating revenues for the year ended March 31, 2008 increased 5.0% compared to the same period in fiscal year 2007 from $350.7 million to $368.2 million. During the years ended March 31, 2008 and 2007, the Company was granted $4.8 million and $3.5 million, respectively, for indigent care. Admissions for the year ended March 31, 2008 increased 0.7% compared to the same period in fiscal year 2007. Revenue per admission improved by 4.3% during the year ended March 31, 2008 as a result of negotiated managed care and governmental payment rate increases. Based on average revenue for comparable services from all other payers, revenues foregone under the charity policy, including indigent care accounts, for the years ended March 31, 2008 and 2007 were $7.4 million and $8.1 million, respectively. Essentially all net operating revenues come from external customers. The largest payers are the Medicare and Medicaid programs accounting for 67% and 65% of the net operating revenues for the years ended March 31, 2008 and 2007, respectively. 38 Although not a GAAP measure, the Company defines "Net Collectable Revenues" as net operating revenues less provision for doubtful accounts. This eliminates the distortion caused by the changes in patient account classification. Net Collectable Revenues were $337.3 million (net revenues of $368.2 million less $30.9 million in provision for doubtful accounts) and $315.5 million (net revenues of $350.7 million less $35.2 million in provision for doubtful accounts) for the years ended March 31, 2008 and 2007, respectively, an increase of $21.8 million, or 6.1% per admission. In addition to the payment rate increases to revenue referred to above, this was the result of 6.3% improvement in collection. OPERATING EXPENSES - Operating expenses for the year ended March 31, 2008 increased to $367.0 million from $359.1 million, an increase of $7.9 million or 2.2% compared to the same period in fiscal year 2007. The increase in operating expenses was primarily the result of the increase in admissions of 0.7%. Operating expenses expressed as a percentage of net operating revenues for the years ended March 31, 2008 and 2007 were 99.7% and 102.3%, respectively. This improvement is substantially a result of the improvement in revenues. On a per admission basis operating expenses increased only 1.6%. Salaries and benefits increased $14.8 million (7.6%) for the year ended March 31, 2008 compared to the same period in fiscal year 2007, primarily due to wage increases, bonuses and union settlements of $0.7 million and severance agreement of $0.5 million during the year ended March 31, 2008. Other operating expenses relative to net operating revenues for the year ended March 31, 2008 were substantially unchanged compared to the same period in fiscal year 2007. The provision for doubtful accounts for the year ended March 31, 2008 decreased to $30.9 million from $35.2 million, or 12.2%, compared to the same period in fiscal year 2007. The decrease in the provision for doubtful accounts for the year ended March 31, 2008 is primarily due to improvements in recoveries of bad debt and a reduction in unfunded patients compared to the same period in fiscal year 2007. The loss on sale of accounts receivable for the years ended March 31, 2008 and 2007 was $4.1 million and $10.4 million, respectively. The decrease is primarily due to the Company's termination of the APA on October 11, 2007 and repurchase of previously sold receivables in connection with its refinancing (see "REFINANCING"). OPERATING INCOME (LOSS) - Operating income for the year ended March 31, 2008 was $1.2 million compared to a loss of $8.5 million for the year ended March 31, 2007. The increase in income in fiscal year 2008 is primarily due to the increase in revenues, decrease in the provision for doubtful accounts, termination of the APA, and repurchase of previously sold receivables in connection with the refinancing. OTHER INCOME (EXPENSE) - For the year ended March 31, 2008 there was a $14.4 million increase in the change in fair value of warrant liability compared to the comparable period in fiscal year 2007. For the year ended March 31, 2008 there was a $10.7 million increase in common stock warrant expense compared to the comparable period in fiscal year 2007. Interest expense for the year ended March 31, 2008 was $1.1 million more than the same period in fiscal year 2007 due to $1.6 million in loan origination fee expense and amortization of loan fees which was partially offset by a reduction in interest rates under the new financing arrangements. NET LOSS - Net loss for the year ended March 31, 2008 was $39.2 million compared to a net loss of $20.5 million for the same period in fiscal year 2007. 39 FISCAL YEAR ENDED MARCH 31, 2007 COMPARED TO FISCAL YEAR ENDED DECEMBER 31, 2005 The following table sets forth, for the years ended March 31, 2007 and December 31, 2005, our consolidated statements of operations expressed as a percentage of net operating revenues. The year ended December 31, 2005 reflects only the 299 days of operations from the Acquisition date. Years ended ---------------------------- March 31, December 31, 2007 2005 ------------ ------------ Net operating revenues 100% 100% Operating expenses 102% 106% ------------ ------------ Operating loss (2%) (6%) ------------ ------------ Other expense: Interest expense, net (4%) (4%) Common stock warrant expense 0% (6%) Change in fair value of warrant liability 0% (1%) ------------ ------------ Other expense, net (4%) (11%) ------------ ------------ Loss before provision for income taxes and minority interest (6%) (17%) Provision for income taxes 0% 0% Minority interest in variable interest entity 0% 1% ------------ ------------ Net loss (6%) (16%) ============ ============ NET OPERATING REVENUES - Net operating revenues less provision for doubtful accounts increased approximately 28.1% to approximately $315.5 million during the fiscal year ended March 31, 2007 from approximately $246.3 million during the fiscal year ended December 31, 2005. The increase is primarily due to an increase in volumes. Adjusted patient days increased approximately 20.9% and adjusted admissions increased approximately 21.9%. The increased volumes are due to a 22.1% increase in the number of operating days during the fiscal year ended March 31, 2007, as the acquisition of Hospitals occurred on March 8, 2005. Also contributing to the increase in net operating revenues less provision for doubtful accounts is negotiated contract increases executed during the latter part of fiscal 2005 and fiscal 2007 and an increase in bad debt recoveries during fiscal 2007. 40 OPERATING EXPENSES - Operating expenses less provision for doubtful accounts as a percentage of net operating revenues less provision for doubtful accounts decreased by approximately 3.7% during fiscal 2007 compared to fiscal 2005. The reduction is primarily due to cost reductions and improved efficiencies. Salaries and benefits decreased approximately 0.6% as a percentage of net operating revenues less provision for doubtful accounts during fiscal 2007 compared to fiscal 2005. Salaries and benefits percentage increases due to wage increases and associated with bringing certain previously contracted services in house were offset by decreases due to labor and staffing efficiencies realized. Remaining operating expenses as a percentage of net operating revenues less provision for doubtful accounts decreased by approximately 2.9% during fiscal 2007 compared to fiscal 2005. The decrease is primarily due to reductions in contract service expenses, including reductions caused by bringing certain services in house, to other operating cost reductions and to improved efficiencies realized during fiscal 2007. OPERATING LOSS - Loss from operations as a percentage of net revenues less provision for doubtful accounts decreased by approximately 3.7% during fiscal 2007 compared to fiscal 2005. The decrease is due to increases in negotiated contract rates and bad debt recoveries in addition to increased cost efficiencies realized during fiscal 2007. OTHER INCOME (EXPENSE) - Other income (expense), net changed primarily as a result of the changes in common stock warrant expense. As described more fully in our Annual Report on Form 10-K for the year ended December 31, 2005, warrants were initially valued and expensed during fiscal 2005, resulting in a valuation and expense of approximately $21.1 million at December 31, 2005 and for the year then ended, respectively. During and subsequent to fiscal 2007, as described more fully in Note 11 and Note 18 to the Consolidated Financial Statements contained in this Annual Report on Form 10-K, certain exercises of warrants occurred. The warrant transactions resulted in the Company recognizing a gain of approximately $133 related to the change in fair value of derivative and additional warrant expense of approximately $693 for the year ended March 31, 2007. Net interest expense increased to approximately $12.1 million in fiscal 2007 from approximately $9.9 million in fiscal 2005. Net interest expense amounted to approximately 4% of net operating revenues less provision for doubtful accounts during fiscal 2007 and fiscal 2005. NET LOSS - Net loss for the year ended March 31, 2007 was $20.5 million compared to a net loss of $45.2 million for the year ended December 31, 2005. The decrease in net loss in fiscal 2007 was primarily due to a decrease in warrant expense of approximately $16.9 million and a decrease in operating losses of approximately $7.4 million offset by an increase in interest expense of approximately $2.2 million. 41 THREE MONTHS ENDED MARCH 31, 2006 [AUDITED] COMPARED TO THREE MONTHS ENDED MARCH 31, 2005 [UNAUDITED] The following table sets forth, for the three months ended March 31, 2006 and 2005, our consolidated statements of operations expressed as a percentage of net operating revenues. The three months ended March 31, 2005 reflects only the 24 days of operations from the Acquisition date. Three months ended March 31, -------------------------------- 2006 2005 --------------- ------------- Net operating revenues 100% 100% Operating expenses 103% 105% --------------- ------------- Operating loss (3%) (5%) --------------- ------------- Other income (expense): Interest expense, net (4%) (3%) Common stock warrant expense 0% (79%) Change in fair value of warrant liability 9% 0% --------------- ------------- Other income (expense), net 5% (82%) --------------- ------------- Income (loss) before provision for income taxes and minority interest 2% (87%) Provision for income taxes 0% (4%) Minority interest in variable interest entity 0% 0% --------------- ------------- Net income (loss) 2% (91%) =============== ============= NET OPERATING REVENUES - Consolidated net operating revenues, on a calendar day basis (using 24 days for the three months ended March 31, 2005 - "Acquisition" days), increased 5.7% during the three months ended March 31, 2006 as a result of contract rate increases. Average daily census remained unchanged. OPERATING EXPENSES - Operating expenses decreased as a percent of revenues by 1.7% during the three months ended March 31, 2006 which equates to inflationary increases (net of efficiencies) of 4.8%. The provision for doubtful accounts as a percentage of revenue decreased to 9.6% for the three months ended March 31, 2006 from 14.4% in the comparable period in 2005, more than offsetting the $2.8 million loss on sale of accounts receivable incurred during the three months ended March 31, 2006. Salaries and benefits (adjusted for Acquisition days) increased $2.0 million or 4.3% during the three months ended March 31, 2006, slightly under the average wage increase which ranged from 5-6%. Supplies increased $0.6 million or 5.8% during the three months ended March 31, 2006 primarily due to inflationary pressures. Remaining operating expenses (adjusted for Acquisition days) increased approximately $4.6 million during the three months ended March 31, 2006. The most significant increases in other operating expenses related to medical fees for emergency coverage, data processing fees for system conversions and medical equipment repairs. OPERATING LOSS - Loss from operations as a percent of revenue improved by 1.7% during the three months ended March 31, 2006 due to rate improvements in excess of cost increases. 42 OTHER INCOME (EXPENSE), NET - Other income (expense), net, changed primarily as a result of the changes in fair value of warrants. The initial valuation of warrants issued in the first quarter of 2005 was $17.2 million. As described more fully in our Annual Report on Form 10-K for the year ended December 31, 2005, this was revalued to $17.6 million on December 12, 2005 and subsequently increased to $21.1 million as of December 31, 2005. As of March 31, 2006, the fair value of these warrants had decreased to $12.9 million, resulting in a gain of $8.2 million during the three months ended March 31, 2006. Interest costs of 3.7% of revenue during the three months ended March 31, 2006 and 3.1% of revenue during the three months ended March 31, 2005 were relatively consistent between the periods as a percentage of revenue. PROVISION FOR INCOME TAXES - The provision for income taxes for the three months ended March 31, 2006 was $5 compared to $0.9 million for the comparable period in 2005. The provision for income taxes during the three months ended March 31, 2005 was reversed in the subsequent quarter as a result of the impact of the implementation of the Accounts Purchase Agreement. NET INCOME (LOSS) - Net income for the three months ended March 31, 2006 was $2.4 million compared to a net loss of $19.9 million for the three months ended March 31, 2005. The decrease in the loss in 2006 was primarily due to the decrease in Common stock expense of $17.2 million and the increase in the fair value of derivative of $8.2 million. CRITICAL ACCOUNTING POLICIES AND ESTIMATES REVENUE RECOGNITION - Net operating revenues are recognized in the period in which services are performed and are recorded based on established billing rates (gross charges) less estimated discounts for contractual allowances, principally for patients covered by Medicare, Medicaid, managed care and other health plans. Gross charges are retail charges. They are not the same as actual pricing, and they generally do not reflect what a hospital is ultimately paid and therefore are not displayed in the consolidated statements of operations. Hospitals are typically paid amounts that are negotiated with insurance companies or are set by the government. Gross charges are used to calculate Medicare outlier payments and to determine certain elements of payment under managed care contracts (such as stop-loss payments). Because Medicare requires that a hospital's gross charges be the same for all patients (regardless of payer category), gross charges are also what the Hospitals charge all other patients prior to the application of discounts and allowances. Revenues under the traditional fee-for-service Medicare and Medicaid programs are based primarily on prospective payment systems. Discounts for retrospectively cost based revenues and certain other payments, which are based on the Hospitals' cost reports, are estimated using historical trends and current factors. Cost report settlements for retrospectively cost-based revenues under these programs are subject to audit and administrative and judicial review, which can take several years until final settlement of such matters are determined and completely resolved. Estimates of settlement receivables or payables related to a specific year are updated periodically and at year end and at the time the cost report is filed with the fiscal intermediary. Typically no further updates are made to the estimates until the final Notice of Program Reimbursement is received, at which time the cost report for that year has been audited by the fiscal intermediary. There could be a one to two year time lag between the submission of a cost report and receipt of the Final Notice of Program Reimbursement. Since the laws, regulations, instructions and rule interpretations governing Medicare and Medicaid reimbursement are complex and change frequently, the estimates recorded by the Hospitals could change by material amounts. The Company has established settlement payables of $12 and settlement receivables of $909 as of March 31, 2008 and 2007, respectively. Outlier payments, which were established by Congress as part of the diagnosis-related groups ("DRG") prospective payment system, are additional payments made to Hospitals for treating Medicare patients who are costlier to treat than the average patient in the same DRG. To qualify as a cost outlier, a hospital's billed (or gross) charges, adjusted to cost, must exceed the payment rate for the DRG by a fixed threshold established annually by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services ("CMS"). Under Sections 1886(d) and 1886(g) of the Social Security Act, CMS must project aggregate annual outlier payments to all prospective payment system Hospitals to be not less than 5% or more than 6% of total DRG payments 43 ("Outlier Percentage"). The Outlier Percentage is determined by dividing total outlier payments by the sum of DRG and outlier payments. CMS annually adjusts the fixed threshold to bring expected outlier payments within the mandated limit. A change to the fixed threshold affects total outlier payments by changing (1) the number of cases that qualify for outlier payments, and (2) the dollar amount Hospitals receive for those cases that still qualify. The most recent change to the cost outlier threshold that became effective on October 1, 2007 was a decrease from $24.485 to $22.185. CMS projects this will result in an Outlier Percentage that is approximately 5.1% of total payments. The Medicare fiscal intermediary calculates the cost of a claim by multiplying the billed charges by the cost-to-charge ratio from the hospital's most recent filed cost report. The Hospitals received new provider numbers in 2005 and, because there was no specific history, the Hospitals were reimbursed for outliers based on published statewide averages. If the computed cost exceeds the sum of the DRG payment plus the fixed threshold, a hospital receives 80% of the difference as an outlier payment. Medicare has reserved the option of adjusting outlier payments, through the cost report, to a hospital's actual cost-to-charge ratio. Upon receipt of the current payment cost-to-charge ratios from the fiscal intermediary, any variance between current payments and the estimated final outlier settlement are examined by the Medicare fiscal intermediary. The Company recorded $755 and $1,919 in Final Notice of Program Reimbursement settlements during the years ended March 31, 2008 and 2007, respectively. There were no adjustments for Final Notice of Program Reimbursement received during the year ended December 31, 2005 and the three months ended March 31, 2006. As of March 31, 2008 and 2007, the Company recorded reserves for excess outlier payments due to the difference between the Hospitals actual cost to charge rates and the statewide average in the amount of $1,678 and $1,831, respectively. These reserves are combined with third party settlement estimates and are included in due to government payers as a net payable of $1,690 and $922 as of March 31, 2008 and 2007, respectively. The Hospitals receive supplemental payments from the State of California to support indigent care (Medi-Cal Disproportionate Share Hospital payments or "DSH") and from the California Medical Assistance Commission ("CMAC"). The Hospitals received supplemental payments of $16,175, $24,526, and $11,022, and $575 during the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. The related revenue recorded for the years ended March 31, 2008 and 2007 and December 31, 2005, and for the three months ended March 31, 2006 was $19,675, $17,897, $13,943, and $4,240, respectively. As of March 31, 2008 and 2007, estimated DSH receivables of $4,877 and $1,378 are included in due from governmental payers in the accompanying consolidated balance sheets. Revenues under managed care plans are based primarily on payment terms involving predetermined rates per diagnosis, per-diem rates, discounted fee-for-service rates and/or other similar contractual arrangements. These revenues are also subject to review and possible audit by the payers. The payers are billed for patient services on an individual patient basis. An individual patient's bill is subject to adjustment on a patient-by-patient basis in the ordinary course of business by the payers following their review and adjudication of each particular bill. The Hospitals estimate the discounts for contractual allowances utilizing billing data on an individual patient basis. At the end of each month, the Hospitals estimate expected reimbursement for patients of managed care plans based on the applicable contract terms. These estimates are continuously reviewed for accuracy by taking into consideration known contract terms as well as payment history. Although the Hospitals do not separately accumulate and disclose the aggregate amount of adjustments to the estimated reimbursements for every patient bill, management believes the estimation and review process allows for timely identification of instances where such estimates need to be revised. The Company does not believe there were any adjustments to estimates of individual patient bills that were material to its net operating revenues. 44 The Hospitals provide charity care to patients whose income level is below 300% of the Federal Poverty Level. Patients with income levels between 300% and 350% of the Federal Poverty Level qualify to pay a discounted rate under AB774 based on various government program reimbursement levels. Patients without insurance are offered assistance in applying for Medicaid and other programs they may be eligible for, such as state disability, Victims of Crime, or county indigent programs. Patient advocates from the Hospitals' Medical Eligibility Program ("MEP") screen patients in the hospital and determine potential linkage to financial assistance programs. They also expedite the process of applying for these government programs. Based on average revenue for comparable services from all other payers, revenues foregone under the charity policy, including indigent care accounts, were $7.4 million, $8.1 million, $2.9 million, and $1.5 million for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. Receivables from patients who are potentially eligible for Medicaid are classified as Medicaid pending under the MEP, with appropriate contractual allowances recorded. If the patient does not qualify for Medicaid, the receivables are reclassified to charity care and written off, or they are reclassified to self-pay and adjusted to their net realizable value through the provision for doubtful accounts. Reclassifications of Medicaid pending accounts to self-pay do not typically have a material impact on the results of operations as the estimated Medicaid contractual allowances initially recorded are not materially different than the estimated provision for doubtful accounts recorded when the accounts are reclassified. All accounts classified as pending Medicaid, as well as certain other governmental receivables, over the age of 180 days were fully reserved in contractual allowances as of March 31, 2008 and 2007. In June 2007, the Company evaluated its historical experience and changed to a graduated reserve percentage based on the age of governmental accounts. The impact of the change was not material. The Company is not aware of any material claims, disputes, or unsettled matters with any payers that would affect revenues that have not been adequately provided for in the accompanying consolidated financial statements. PROVISION FOR DOUBTFUL ACCOUNTS - The Company provides for accounts receivable that could become uncollectible by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Hospitals estimate this allowance based on the aging of their accounts receivable, historical collections experience for each type of payer and other relevant factors. There are various factors that can impact the collection trends, such as changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients, volume of patients through the emergency department, the increased burden of co-payments to be made by patients with insurance and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and the estimation process. The Company's policy is to attempt to collect amounts due from patients, including co-payments and deductibles due from patients with insurance, at the time of service while complying with all federal and state laws and regulations, including, but not limited to, the Emergency Medical Treatment and Labor Act ("EMTALA"). Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, until the legally required medical screening examination is complete and stabilization of the patient has begun, services are performed prior to the verification of the patient's insurance, if any. In non-emergency circumstances or for elective procedures and services, it is the Hospitals' policy, when appropriate, to verify insurance prior to a patient being treated. MEDICAL CLAIMS INCURRED BUT NOT REPORTED - The Company was contracted with CalOptima, which is a county sponsored entity that operates similarly to an HMO, to provide healthcare services to indigent patients at a fixed amount per enrolled member per month. Through April 2007, the Company received payments from CalOptima based on a fixed fee multiplied by the number of enrolled members at the Hospitals ("Capitation Fee"). The Company recognizes these Capitation Fees as revenues on a monthly basis. 45 In certain circumstances, members would receive healthcare services from hospitals not owned by the Company. In these cases, the Company records estimates of patient member claims incurred but not reported ("IBNR") for services provided by other healthcare institutions. IBNR claims are estimated using historical claims patterns, current enrollment trends, hospital pre-authorizations, member utilization patterns, timeliness of claims submissions, and other factors. There can, however, be no assurance that the ultimate liability will not exceed estimates. Adjustments to the estimated IBNR claims are recorded in the Company's results of operations in the periods when such amounts are determinable. Per guidance under SFAS No. 5, the Company accrues for IBNR claims when it is probable that expected future healthcare costs and maintenance costs under an existing contract have been incurred and the amount can be reasonably estimated. The Company records a charge related to these IBNR claims against its net operating revenues. The Company's net revenues from CalOptima capitation, net of third party claims and estimates of IBNR claims, for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006 were $0.35 million, $1.3 million, $3.2 million, and $1.4 million, respectively. IBNR claims accruals at March 31, 2008 and 2007 were $1.5 and $4.1 million, respectively. The Company's direct cost of providing services to patient members is included in the Company's normal operating expenses. INSURANCE - The Company accrues for estimated general and professional liability claims, to the extent not covered by insurance, when they are probable and reasonably estimable. The Company has purchased as primary coverage a claims-made form insurance policy for general and professional liability risks. Estimated losses within general and professional liability retentions from claims incurred and reported, along with IBNR claims, are accrued based upon projections and are discounted to their net present value using a weighted average risk-free discount rate of 5%. To the extent that subsequent claims information varies from estimates, the liability is adjusted in the period such information becomes available. As of March 31, 2008 and 2007, the Company had accrued $9.9 million and $4.9 million, respectively, which is comprised of $3.0 million and $1.4 million, respectively, in incurred and reported claims, along with $6.9 million and $3.5 million, respectively, in estimated IBNR. The Company has also purchased occurrence coverage insurance to fund its obligations under its workers' compensation program. The Company has a "guaranteed cost" policy, under which the carrier pays all workers' compensation claims, with no deductible or reimbursement required of the Company. The Company accrues for estimated workers' compensation claims, to the extent not covered by insurance, when they are probable and reasonably estimable. The ultimate costs related to this program include expenses for deductible amounts associated with claims incurred and reported in addition to an accrual for the estimated expenses incurred in connection with IBNR claims. Claims are accrued based upon projections and are discounted to their net present value using a weighted average risk-free discount rate of 5%. To the extent that subsequent claims information varies from estimates, the liability is adjusted in the period such information becomes available. As of March 31, 2008 and 2007, the Company had accrued $710 and $1,000, respectively, comprised of $169 and $200, respectively, in incurred and reported claims, along with $541 and $800, respectively, in estimated IBNR. Effective May 1, 2007, the Company initiated a self-insured health benefits plan for its employees. As a result, the Company has established and maintains an accrual for IBNR claims arising from self-insured health benefits provided to employees. The Company's IBNR accrual at March 31, 2008 was based upon projections. The Company determines the adequacy of this accrual by evaluating its limited historical experience and trends related to both health insurance claims and payments, information provided by its insurance broker and third party administrator and industry experience and trends. The accrual is an estimate and is subject to change. Such change could be material to the Company's consolidated financial statements. As of March 31, 2008, the Company had accrued $1.7 million in estimated IBNR. The Company believes this is the best estimate of the amount of IBNR relating to self-insured health benefit claims at March 31, 2008. Since the Company's self-insured health benefits plan was initiated in May 2007, the Company has not yet established historical trends which, in the future, may cause costs to fluctuate with increases or decreases in the average number of employees, changes in claims experience, and changes in the reporting and payment processing time for claims. The Company has also purchased umbrella liability policies with aggregate limits of $25 million. The umbrella policies provide coverage in excess of the primary layer and applicable retentions for insured liability risks such as general and professional liability, auto liability, and workers compensation (employers liability). 46 The Company finances various insurance policies at interest rates ranging from 4.23% to 6.35% per annum. The Company incurred finance charges relating to such policies of $123, $248, $89, and $1 during the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. VARIABLE INTEREST ENTITY - Concurrent with the close on the Acquisition, and pursuant to an agreement dated September 28, 2004, as amended and restated on November 16, 2004, Dr. Chaudhuri and Dr. Shah exercised their option to purchase all of the equity interests in PCHI, which simultaneously acquired title to substantially all of the real property acquired by the Company in the Acquisition. The Company received $5.0 million and PCHI guaranteed the Company's Acquisition Loan (the Acquisition Loan was refinanced on October 9, 2007 with a $45.0 million Term Note). The Company remains primarily liable under the $45.0 million Term Note notwithstanding its guarantee by PCHI, and this note is cross collateralized by substantially all of the Company's assets and all of the real property of the Hospitals. All of the Company's operating activities are directly affected by the real property that was sold to PCHI. Given these factors, the Company has indirectly guaranteed the indebtedness of PCHI. The Company is a guarantor on the $45.0 million Term Note should PCHI not be able to perform and has undertaken a contingent obligation to make future payments if those triggering events or conditions occur. PCHI is a related party entity that is affiliated with the Company through common ownership and control. It is owned 51% by West Coast Holdings, LLC (Dr. Shah and investors) and 49% by Ganesha Realty, LLC (Dr. Chaudhuri and Mr. Thomas). Under FIN 46R, a company is required to consolidate the financial statements of any entity that cannot finance its activities without additional subordinated financial support, and for which one company provides the majority of that support through means other than ownership. Effective March 8, 2005, the Company determined that it provided the majority of financial support to PCHI through various sources including lease payments, remaining primarily liable under the $45.0 million Term Note, and cross collateralization of the Company's non-real estate assets to secure the $45.0 million Term Note. Accordingly, the Company included the net assets of PCHI, net of consolidation adjustments, in its consolidated financial statements at March 31. RECENT ACCOUNTING STANDARDS In September 2006, the FASB issued SFAS No. 157, "Fair Value Measurements." This Statement establishes a single authoritative definition of fair value, sets out a framework for measuring fair value, and requires additional disclosures about fair value measurements. SFAS No. 157 applies only to fair value measurements that are already required or permitted by other accounting standards. The statement is effective for financial statements for fiscal years beginning after November 15, 2007, with earlier adoption permitted. The Company is evaluating the impact, if any, that the adoption of this statement will have on its consolidated results of operations and financial position. On February 14, 2008, the FASB issued FASB Staff Position No. FAS 157-1, "Application of FASB Statement No. 157 to FASB Statement No. 13 and Other Accounting Pronouncements That Address Fair Value Measurements for Purposes of Lease Classification or Measurement under Statement 13" ("FSP FAS 157-1"). This Statement does not apply under FASB Statement No. 13, "Accounting for Leases," and other accounting pronouncements that address fair value measurements for purposes of lease classification or measurement under Statement 13. This scope exception does not apply to assets acquired and liabilities assumed in a business combination that are required to be measured at fair value under SFAS 141 or SFAS 141R, regardless of whether those assets and liabilities are related to leases. 47 On February 12, 2008, the FASB issued FASB Staff Position No. FAS 157-2, "Effective Date of FASB Statement No. 157" ("FSP FAS 157-2"). With the issuance of FSP FAS 157-2, the FASB agreed to: (a) defer the effective date in SFAS No. 157 for one year for certain nonfinancial assets and nonfinancial liabilities, except those that are recognized or disclosed at fair value in the financial statements on a recurring basis (at least annually), and (b) remove certain leasing transactions from the scope of SFAS No. 157. The deferral is intended to provide the FASB time to consider the effect of certain implementation issues that have arisen from the application of SFAS No. 157 to these assets and liabilities. In December 2007, the FASB issued SFAS No. 141(R) "Business Combinations" ("SFAS 141R"). The statement retains the purchase method of accounting for acquisitions, but requires a number of changes, including changes in the way assets and liabilities are recognized in the purchase accounting as well as requiring the expensing of acquisition-related costs as incurred. Furthermore, SFAS 141R provides guidance for recognizing and measuring the goodwill acquired in the business combination and determines what information to disclose to enable users of the financial statements to evaluate the nature and financial effects of the business combination. SFAS 141R is effective for fiscal years beginning on or after December 15, 2008. Earlier adoption is prohibited. The Company is evaluating the impact, if any, that the adoption of this statement will have on its consolidated results of operations and financial position. In February 2007, the FASB issued SFAS No. 159, "The Fair Value Option for Financial Assets and Financial Liabilities-Including an amendment of FASB Statement No. 115." SFAS No. 159 permits entities to choose to measure many financial instruments and certain other items at fair value. Most of the provisions of SFAS No. 159 apply only to entities that elect the fair value option; however, the amendment to SFAS No. 115, "Accounting for Certain Investments in Debt and Equity Securities," applies to all entities with available for sale and trading securities. The statement is effective for financial statements for fiscal years beginning after November 15, 2007. The Company is evaluating the impact, if any, that the adoption of this statement will have on its consolidated results of operations and financial position. In December 2007, the FASB issued SFAS No. 160, "Noncontrolling Interests in Consolidated Financial Statements -- An Amendment of ARB No. 51" ("SFAS 160"). SFAS 160 requires all entities to report noncontrolling(minority) interests in subsidiaries as equity in the consolidated financial statements. Also, SFAS 160 is intended to eliminate the diversity in practice regarding the accounting for transactions between an equity and noncontrolling interests by requiring that they be treated as equity transactions. SFAS 160 is effective for fiscal years beginning on or after December 15, 2008. Earlier adoption is prohibited. SFAS 160 must be applied prospectively as of the beginning of the fiscal year in which it is initially applied, except for the presentation and disclosure requirements, which must be applied retrospectively for all periods presented. The Company has not yet evaluated the impact that SFAS 160 will have on its consolidated results of operations or financial position. 48 In March 2008, the FASB issued SFAS No. 161, "Disclosures about Derivative Instruments and Hedging Activities" ("SFAS 161"). SFAS 161 is intended to improve financial reporting of derivative instruments and hedging activities by requiring enhanced disclosures to enable financial statement users to better understand the effects of derivatives and hedging on an entity's financial position, financial performance and cash flows. The provisions of SFAS 161 are effective for interim periods and fiscal years beginning after November 15, 2008. The Company does not anticipate that the adoption of SFAS No. 161 will have a material impact on its consolidated results of operations or financial position. May 9, 2008, the FASB issued FASB Staff Position No. APB 14-1, "Accounting for Convertible Debt Instruments That May Be Settled in Cash upon Conversion (Including Partial Cash Settlement)" ("FSP APB 14-1"). FSP APB 14-1 clarifies that convertible debt instruments that may be settled in cash upon conversion (including partial cash settlement) are not addressed by paragraph 12 of APB Opinion No. 14, "Accounting for Convertible Debt and Debt Issued with Stock Purchase Warrants." Additionally, FSP APB 14-1 specifies that issuers of such instruments should separately account for the liability and equity components in a manner that will reflect the entity's nonconvertible debt borrowing rate when interest cost is recognized in subsequent periods. FSP APB 14-1 is effective for financial statements issued for fiscal years beginning after December 15, 2008, and interim periods within those fiscal years. The Company has not yet evaluated the impact that FSP APB 14-1 will have on its consolidated results of operations or financial position. OFF BALANCE SHEET ARRANGEMENTS As of March 31, 2008 the Company had no off-balance sheet arrangements. ITEM 7A. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK As of March 31, 2008, we did not have any investment in or outstanding liabilities under market rate sensitive instruments. We do not enter into hedging instrument arrangements. 49 ITEM 8. FINANCIAL STATEMENTS AND SUPPLEMENTARY DATA The following consolidated financial statements are filed as a part of this report beginning on page F-1: ------ ------------------------------------------------------------------- PAGE DESCRIPTION ------ ------------------------------------------------------------------- F-1 Report of Independent Registered Public Accounting Firm ------ ------------------------------------------------------------------- F-2 Report of prior Independent Registered Public Accounting Firm ------ ------------------------------------------------------------------- F-3 Consolidated Balance Sheets as of March 31, 2008 and 2007 ------ ------------------------------------------------------------------- F-4 Consolidated Statements of Operations for the years ended March 31, 2008 and 2007 and December 31, 2005 and the three months ended March 31, 2006 ------ ------------------------------------------------------------------- F-5 Consolidated Statements of Stockholders' Deficiency for the years ended March 31, 2008 and 2007 and December 31, 2005 and the three months ended March 31, 2006 ------ ------------------------------------------------------------------- F-6 Consolidated Statements of Cash Flows for the years ended March 31, 2008 and 2007 and December 31, 2005 and the three months ended March 31, 2006 ------ ------------------------------------------------------------------- F-7 Notes to Consolidated Financial Statements ------ ------------------------------------------------------------------- F-41 Schedule II - Valuation and Qualifying Accounts for the years ended March 31, 2008 and 2007 and December 31, 2005 and the three months ended March 31, 2006 ITEM 9. CHANGES IN AND DISAGREEMENTS WITH ACCOUNTANTS ON ACCOUNTING AND FINANCIAL DISCLOSURE None ITEM 9A(T). CONTROLS AND PROCEDURES Management's Report on Internal Control Over Financial Reporting - Management of Integrated Healthcare Holdings, Inc. is responsible for the preparation, integrity and fair presentation of its published consolidated financial statements. The financial statements have been prepared in accordance with U.S. generally accepted accounting principles and, as such, include amounts based on judgments and estimates made by management. The Company also prepared the other information included in the annual report and is responsible for its accuracy and consistency with the consolidated financial statements. Management is also responsible for establishing and maintaining effective internal control over financial reporting. The Company's internal control over financial reporting includes those policies and procedures that pertain to the Company's ability to record, process, summarize and report reliable financial data. The Company maintains a system of internal control over financial reporting, which is designed to provide reasonable assurance to the Company's management and board of directors regarding the preparation of reliable published financial statements and safeguarding of the Company's assets. The system includes a documented organizational structure and division of responsibility, established policies and procedures, including a code of conduct to foster a strong ethical climate, which are communicated throughout the Company, and the careful selection, training and development of our people. The Board of Directors, acting through its Audit Committee, is responsible for the oversight of the Company's accounting policies, financial reporting, and internal control. The Audit Committee of the Board of Directors is comprised entirely of outside directors who are independent of management. The Audit Committee is responsible for the appointment and compensation of the independent registered public accounting firm. It meets periodically with management, the independent registered public accounting firm, and the internal auditors to ensure that they are carrying out their responsibilities. The Audit Committee is also responsible for performing an oversight role by reviewing and monitoring the financial, accounting and auditing procedures of the Company in addition to reviewing the Company's financial reports. Internal auditors monitor the operation of the internal control system and report findings and recommendations to management and the Audit Committee. Corrective actions are taken to address control deficiencies and other opportunities for improving the internal control system as they are identified. The independent registered public accounting firm and the internal auditors have full and unlimited access to the Audit Committee, with or without management, to discuss the adequacy of internal control over financial reporting, and any other matters which they believe should be brought to the attention of the Audit Committee. 50 Management recognizes that there are inherent limitations in the effectiveness of any system of internal control over financial reporting, including the possibility of human error and the circumvention or overriding of internal control. Accordingly, even effective internal control over financial reporting can provide only reasonable assurance with respect to financial statement preparation and may not prevent or detect misstatements. Further, because of changes in conditions, the effectiveness of internal control over financial reporting may vary over time. The Company assessed its internal control system as of March 31, 2008 in relation to criteria for effective internal control over financial reporting described in "Internal Control - Integrated Framework" issued by the Committee of Sponsoring Organizations of the Treadway Commission. Based on its assessment, the Company has determined that, as of March 31, 2008, its system of internal control over financial reporting was effective. This annual report does not include an attestation report of the Company's registered public accounting firm regarding internal control over financial reporting. Management's report was not subject to attestation by the Company's registered public accounting firm pursuant to temporary rules of the Securities and Exchange Commission that permit the Company to provide only management's report in this annual report. ITEM 9B. OTHER INFORMATION On June 10, 2008, the Company and Medical Provider Financial Corporation I entered into Amendment No. 1 to $50 Million Revolving Credit Agreement. The Amendment is effective for the period from January 1, 2008 through June 30, 2009, and reduced the minimum fixed charge coverage ratio, as defined in the $50 Million Revolving Credit Agreement, from 1.0 to 0.4. A copy of the Amendment is filed as Exhibit 10.11.1 to this Report. On June 20, 2008, the Company and Medical Provider Financial Corporation III entered into Amendment No. 2 to $50 Million Revolving Credit Agreement. The Amendment replaced in its entirety the definition of Material Adverse Effect. A copy of the Amendment is filed as Exhibit 10.11.2 to this Report. 51 PART III ITEM 10. DIRECTORS, EXECUTIVE OFFICERS AND CORPORATE GOVERNANCE The following table contains certain information concerning our directors and executive officers as of March 31, 2008:
---------------------------- ------ --------------------------------------- ---------------------- NAME AGE POSITION WITH COMPANY DATE BECAME DIRECTOR ---------------------------- ------ --------------------------------------- ---------------------- Ajay G. Meka, M.D. 57 Chairman of the Board September 28, 2006 ---------------------------- ------ --------------------------------------- ---------------------- Maurice J. DeWald 68 Director August 1, 2005 ---------------------------- ------ --------------------------------------- ---------------------- Hon. C. Robert Jameson 68 Director July 11, 2007 ---------------------------- ------ --------------------------------------- ---------------------- Michael Metzler 62 Director September 5, 2007 ---------------------------- ------ --------------------------------------- ---------------------- Bruce Mogel 50 Director, Chief Executive Officer & November 18, 2003 President ---------------------------- ------ --------------------------------------- ---------------------- J. Fernando Niebla 68 Director August 1, 2005 ---------------------------- ------ --------------------------------------- ---------------------- William E. Thomas 59 Director September 5, 2007 ---------------------------- ------ --------------------------------------- ---------------------- Steven R. Blake 55 Chief Financial Officer & Executive Vice President, Finance ---------------------------- ------ --------------------------------------- ---------------------- Daniel J. Brothman 53 Chief Operating Officer ---------------------------- ------ --------------------------------------- ---------------------- Jeremiah R. Kanaly 61 Chief Accounting Officer & Treasurer ---------------------------- ------ --------------------------------------- ----------------------
AJAY G. MEKA, M.D has been Chairman of the Board of Directors of the Company since September 28, 2006. Dr. Meka has been a licensed physician in California for the past 23 years. He is a board certified physician practicing in Orange County, California. Dr. Meka received his medical degree from Guntur Medical College in Gunter, India. He performed his postgraduate training at Brooklyn Jewish Hospital and Coney Island Hospital, both in Brooklyn, New York. MAURICE J. DEWALD has served as a member of the Board of Directors of the Company since August 1, 2005 and sits on the Audit Committee, Compensation Committee, Finance Committee and Special Committee. Mr. DeWald is Chairman and Chief Executive Officer of Verity Financial Group, Inc., a private investment firm that he founded in 1992. From 1962-1991, Mr. DeWald was with KPMG LLP, one of the world's largest international accounting and tax consulting firms, where he served at various times as director and as the Managing Partner of the Chicago, Orange County and Los Angeles Offices. Mr. DeWald is a director of Mizuho Corporate Bank of California, Advanced Materials Group, Inc., NNN Healthcare/Office REIT, Inc., and FileScan, Inc., and is a former director of Tenet Healthcare Corporation and Quality Systems, Inc. He also sits on the Advisory Council of the University of Notre Dame Mendoza School of Business. Mr. DeWald is a past Chairman and director of United Way of Greater Los Angeles. Mr. DeWald received a B.B.A. from the University of Notre Dame in 1962. He is also a Certified Public Accountant. HON. C. ROBERT JAMESON has been a director of the Company since July 11, 2007. Judge Jameson is a retired Orange County Superior judge now affiliated with Judicate West, handling complex alternative dispute resolution matters. Before leaving the bench, he was Presiding Judge of the Orange County Superior Court Appellate Division. Judge Jameson obtained his B.A. degree in Political Science from the University of Southern California in 1963 and his Juris Doctor degree at the University of California, Hastings College of the Law in 1966. He served as a judge from 1984-2005 and also was President of the Banyard Inn of Court and an Adjunct Professor of Law at Whittier Law School during his tenure. Judge Jameson was awarded "Judge of the Year" nine times over the course of his career by organizations such as: the Orange County Bar Association Business Litigation section, Orange County Trial Lawyers, the American Board of Trial Advocates and the Consumer Attorneys of California. 52 MICHAEL METZLER has served as President and Chief Executive Officer of the Santa Ana Chamber of Commerce since January 1983. Mr. Metzler directs and controls all activities of this multi-million dollar organization and its subsidiaries, including SACPAC, the chamber's political action committee, and the Greater Santa Ana Vitality Foundation, the chamber's charitable foundation. He has led numerous community initiatives and campaigns that have grown the local economy and advanced the prosperity of business, including a $145 million local school bond campaign in 1999, a $100+ million private development initiative in 2005, and a new career-oriented technical high school in 2006. He also founded the chamber's nationally award-winning 73,000-circulation newspaper, CityLine, in 1996, for which he serves as its publisher. Mr. Metzler has served on numerous community boards, city commissions and county, regional, state, and national task forces, and currently serves as Chairman of the Board of Trustees of Coastal Communities Hospital. Metzler also was a founder of the Santa Ana Business Bank and sits on its Board of Directors. Mr. Metzler is a graduate of California State University, Fullerton, and attended Loyola University School of Law and the Peter F. Drucker Graduate School of Management at Claremont University. BRUCE MOGEL has served Chief Executive Officer and director of the Company since November 18, 2003. Mr. Mogel has over 25 years of experience in operational management and has held several lead executive roles in the healthcare field. Most recently, from 1999-2002, Mr. Mogel served as Executive Vice President of Operations for Doctors' Community Healthcare Corp, where he was responsible for the operations and profitability of five acute care hospitals and one psychiatric hospital, and managed a team of six hospital CEOs and other senior management members. Mr. Mogel earned his Bachelor's degree from The State University of New York at Buffalo with a degree in English. J. FERNANDO NIEBLA has served as a member of the Board of Directors of the Company since August 1, 2005 and sits on the Audit Committee, Compensation Committee, Finance Committee and Special Committee. He has served as President of International Technology Partners, LLC, an information technology and business consulting services company based on Orange County, California since August 1998. He is also a founder of Infotec Development Inc. and Infotec Commercial Systems, two national information technology firms. He currently serves on the Boards of Directors of Union Bank of California, Pacific Life Corp. and Granite Construction Corp., the Board of Trustees of the Orange County Health Foundation, and is the Chairman of the California Advisory Committee to Nacional Financiera, a Mexican Government agency similar to the U.S. Government Small Business Administration office. Mr. Niebla holds a B.S. degree in Electrical Engineering from the University of Arizona and an M.S. QBA from the University of Southern California. WILLIAM E. THOMAS is the Executive Vice President and General Counsel of Strategic Global Management, Inc., a healthcare ventures firm in Riverside, California. Mr. Thomas has served in such capacity since October of 1998. Prior to that Mr. Thomas was a founding and managing partner of a law firm in Riverside, California specializing in business, real estate, and other transactional matters. Mr. Thomas graduated from the University of California at Santa Barbara with a Bachelor of Arts degree in History and Political Science. He holds a Juris Doctor degree from the University of California, Hastings College of the Law, and a Master of Laws degree from New York University. He is a member of the California Bar Association. STEVEN R. BLAKE has served as Chief Financial Officer of the Company since July 1, 2005 and Executive Vice President, Finance since March 21, 2008. He is a California licensed Certified Public Accountant. Mr. Blake came to the Company with over 20 years of experience in multi-hospital financial management. He also has extensive experience serving in financial roles with public companies. Most recently, he served as Regional Vice President of Finance for Tenet Healthcare Corporation ("Tenet"), a position he held for over 17 years. In this position, Mr. Blake was responsible for the financial management of numerous Tenet assets covering five western states (California, Arizona, Washington, Nebraska and Texas). Mr. Blake's strong hospital financial background combined with his knowledge of public company requirements made him a strong addition to the Company's corporate team. 53 DANIEL J. BROTHMAN has served as Chief Operating Officer since May 6, 2008 and as Chief Executive Officer of Western Medical Center - Santa Ana since March 8, 2005. Mr. Brothman also served as Senior Vice President, Operations of the Company from March 8, 2005 to May 6, 2008. Mr. Brothman is an experienced single and multi-hospital operations executive. Since 1999, prior to the acquisition of the Hospitals by the Company he helped build the Western Medical Center in Santa Ana for Tenet. Mr. Brothman also ran Columbia Healthcare's Utah Division from 1996 to 1998. Mr. Brothman has in excess of 30 years experience in hospital administration. Mr. Brothman earned his Bachelor of Arts degree from Washington University at St. Louis and his Master's in Health Care Administration from the University of Colorado at Denver. JEREMIAH R. KANALY has served as Chief Accounting Officer and Treasurer of the Company since September 2007. Mr. Kanaly has over 30 years experience in financial management. Mr. Kanaly is a former partner with KPMG LLP and has served as Chief Financial Officer of several companies including ViewSonic Corporation and Saleen Inc., and as a consultant with Resources Global. Mr. Kanaly is a graduate of the Anderson School of Management at the University of California at Los Angeles and California State University at Northridge. He is a California licensed Certified Public Accountant. Directors DeWald, Metzler, and Niebla constitute the Audit Committee of the Board of Directors. The Company does not have a Nominating Committee as the entire Board of Directors performs the functions of this committee and this process has been adequate to handle the Board nomination process to date. Directors DeWald, Meka, Metzler, and Niebla each satisfy the definition of "independent director" established in the NASDAQ listing standards. The Board of Directors has determined that Director DeWald is an "audit committee financial expert" as defined in the SEC rules. Directors are elected at our annual meeting and serve until the following annual meeting. SECTION 16(a) BENEFICIAL OWNERSHIP REPORTING COMPLIANCE Section 16(a) of the Securities Exchange Act of 1934 requires our officers and directors, and persons who own more than 10% of a registered class of our equity securities, to file reports of ownership and changes in ownership with the SEC. Officers, directors and greater than 10% stockholders are required by SEC regulation to furnish us with copies of all Section 16(a) reports they file. Based solely upon the copies of Section 16(a) reports which we received from such persons or written representations from them regarding their transactions in our common stock, we believe that, during the year ended March 31, 2008, all such forms were filed in a timely fashion. 54 CODE OF ETHICS We have adopted a Code of Business Conduct and Ethics that applies to our employees (including our principal executive officer, principal financial officer, principal accounting officer, and controller) and our directors. Our Code of Business Conduct and Ethics can be obtained free of charge by sending a request to our Corporate Secretary at the following address: Integrated Healthcare Holdings, Inc., Attn: J. Scott Schoeffel, 1301 North Tustin Avenue, Santa Ana, California 92705. STOCKHOLDER RECOMMENDATION OF NOMINEES While there are no formal procedures for stockholders to recommend nominations, the Board of Directors will consider stockholder recommendations. Such recommendations should be addressed to the Corporate Secretary at the address listed above. STOCKHOLDER COMMUNICATIONS In order to facilitate communications with the Board of Directors, or any individual members or any committees of the Board of Directors, stockholders should direct all communication in writing to our General Counsel at Integrated Healthcare Holdings, Inc., 1301 North Tustin Avenue, Santa Ana, California 92705, who will forward all such correspondence to the Board of Directors, individual members of the Board of Directors or applicable chairpersons of any committee of the Board of Directors, as appropriate and as directed in the communication. AUDIT COMMITTEE The Audit Committee of the Board of Directors was formed in August 2005 and consists of three of our independent directors, Maurice DeWald and J. Fernando Niebla, who joined the Board of Directors in August 2005, and Michael Metzler, who joined the Board of Directors in September 2007. The Board of Directors has determined that Maurice DeWald is an "audit committee financial expert" as defined in the rules and regulations of the SEC. The Audit Committee of the Board of Directors preapproves all audit and permissible non-audit services to be performed by the independent auditors. The Audit Committee will also advise management on the engagement of experts with sufficient expertise to advise on accounting and financial reporting of complex financial transactions. Mr. DeWald and Mr. Niebla attended all 7 Audit Committee meetings held during fiscal 2008; Mr. Metzler attended all 3 meetings in fiscal 2008 that were held subsequent to his appointment to the Audit Committee. The Audit Committee Charter was filed previously as APPENDIX A to the Company's Proxy Statement dated November 14, 2006. Management is responsible for the Company's internal controls and financial reporting process. The independent registered public accounting firm is responsible for performing an independent audit of the Company's consolidated financial statements in accordance with the standards of the Public Company Accounting Oversight Board (United States) and to issue a report on these consolidated financial statements. The Audit Committee's responsibility is to oversee these activities. In this context, the Audit Committee has met and held discussions with management and the independent registered public accounting firm. Management represented to the Audit Committee that the Company's consolidated financial statements were prepared in accordance with accounting principals generally accepted in the United States and the Audit Committee has reviewed and discussed the consolidated financial statements with management and the independent registered public accounting firm. The Audit Committee also discussed with the independent registered public accounting firm matters required to be discussed by Statement on Auditing Standards No. 114, "Communication with Audit Committees," as modified or supplemented, including the auditor's judgment about the quality, as well as the acceptability, of our accounting principles as applied in the financial reporting. Our independent registered public accounting firm also provided to the Audit Committee the written disclosures required by the Independence Standards Board Standard No. 1 (Independence Discussions with Audit Committees), and the Audit Committee discussed with the independent registered public accounting firm that firm's independence as well as internal quality control procedures. Based on the Audit Committee's discussions with management and the independent registered public accounting firm and the Audit Committee's review of the representations of management and the report of the independent registered public accounting firm to the Audit Committee, the Audit Committee recommended to the Board of Directors, and the Board has approved, that the audited consolidated financial statements be included in the Company's Annual Report on Form 10-K for the year ended March 31, 2008 for filing with the Securities and Exchange Commission. This report was submitted by Mr. DeWald, Chair, and Messrs. Metzler and Niebla. 55 ITEM 11. EXECUTIVE COMPENSATION The Compensation Committee of the Board of Directors was formed in October 2005 and consists of three directors, Mr. Maurice DeWald, Mr. J. Fernando Niebla, chair, and Mr. William E. Thomas. In our fiscal year ended March 31, 2008, the Compensation Committee held twelve meetings. The Compensation Committee is responsible for overseeing the administration of the Company's executive compensation programs, establishing and interpreting the Company's compensation policies and approving all compensation paid to executive officers, including the named executive officers listed in the Summary Compensation Table. The following table sets forth summary information regarding compensation to (i) our Chief Executive Officer and our Chief Financial Officer during the fiscal year ended March 31, 2008; (ii) each of our other most highly compensated executive officers employed by us as of March 31, 2008 whose salary and bonus for the fiscal year ended March 31, 2008 was in excess of $100,000 for their services rendered in all capacities to us; and (iii) one additional individual for whom disclosure would be required to be provided but for the fact that the individual was not serving as an executive officer at March 31, 2008. The listed individuals are referred to as the "Named Executive Officers." SUMMARY COMPENSATION TABLE Option All other Name and Salary Bonus awards compensation Total Principal Position Year ($) ($)(6) ($)(7) ($) ($) - ------------------------------------- ---------- ------------ ------------ ------------ -------------- ------------- Bruce Mogel 2008 438,154 70,000 - 67,578 575,732 Chief Executive Officer (1) 2007 360,050 - - 17,244 377,294 Steven R. Blake 2008 350,000 46,375 - 46,206 442,581 Chief Financial Officer & 2007 284,519 - - 18,978 303,497 Executive Vice President, Finance (2) Daniel J. Brothman 2008 377,692 46,375 21,000 19,248 464,315 Chief Operating Officer (3) 2007 351,089 - - 23,169 374,258 Jeremiah R. Kanaly 2008 142,788 18,188 - 9,341 170,317 Chief Accounting Officer & 2007 - - - - - Treasurer (4) Larry B. Anderson 2008 525,231 30,000 - 145,102 700,333 President (5) 2007 360,000 - - 23,892 383,892 (Former)
(1) All other compensation for 2008 includes auto allowance of $16,000, Manager's Time Off (MTO) pay out of $40,385 for accrued and untaken vacation hours and the balance is Company contribution to the 401(k) plan. (2) All other compensation for 2008 includes auto allowance of $12,000, MTO pay out of $25,375 for accrued and untaken vacation hours and the balance is Company contribution to the 401(k) plan. (3) All other compensation for 2008 includes auto allowance of $12,000 and the balance is Company contribution to the 401(k) plan. (4) Salary commenced on September 10, 2007. All other compensation includes auto allowance of $7,000 and the balance is Company contribution to the 401(k) plan. (5) All other compensation for 2008 includes auto allowance of $17,000, a MTO pay out of $55,385 for accrued and untaken vacation hours, and $60,000 in consulting fees paid to Mr. Anderson under the Consulting Agreement executed between Mr. Anderson and the Company on December 31, 2007. (6) During the year ended March 31, 2008, the Company implemented the Corporate Team Bonus Plan for 2007/2008. Under this discretionary plan, eligible employees could receive bonuses based on the Company's performance and individual performances. For the year ended March 31, 2008, in June 2008, the Company awarded eligible employees an aggregate of $494,669 in discretionary bonuses, which was approved by the Company's Board of Directors. Of such amount, the Named Executive Officers, Bruce Mogel, Steven Blake, Daniel Brothman, and Jeremiah Kanaly received $30,000, $26,375, $26,375, and $17,188, respectively. All bonuses under the plan were paid on June 6, 2008. Remaining amounts relate to discretionary bonuses for calendar year 2007 that were paid in December 2007. (7) Values in this column represent the amounts expensed by the Company in 2008 for portions of awards granted in 2008. These amounts do not represent the intrinsic or market value of the awards on the date of grant, at year end or at present. For grant date values of all outstanding options at March 31, 2008, please see table entitled "Outstanding Equity Awards at Fiscal Year-End." 56 The following table sets forth summary information regarding stock options the Company has granted to the Named Executive Officers as of March 31, 2008 under the Company's 2006 Stock Incentive Plan.
OUTSTANDING EQUITY AWARDS AT FISCAL YEAR-END Equity incentive plan awards: Number of Number of Number of securities securities securities underlying underlying underlying Option Grant date unexercised unexercised unexercised exercise Option fair value Grant options options unearned price expiration per share Name date exercisable unexercisable options ($) date ($) - -------------------- ------------------- -------------- --------------- -------------- ----------- ----------------- ------------ Bruce Mogel - - - - - - - Steven R. Blake (1) August 6, 2007 - 300,000 300,000 0.26 August 6, 2014 0.03 Daniel J. Brothman (2) August 6, 2007 1,000,000 - - 0.26 August 6, 2014 0.02 Jeremiah R. Kanaly (1) December 13, 2007 - 200,000 200,000 0.30 December 13, 2014 0.09
(1) 1/3 of the shares vest on the twelve month anniversary of the grant date, and an additional 1/12 of the shares vest on each subsequent fiscal quarter-end of the Company following such twelve month anniversary. (2) Vesting retroactively commenced on March 8, 2005, all options were fully vested as of March 31, 2008. 57 EMPLOYMENT CONTRACTS, SEVERANCE AGREEMENTS AND CHANGE OF CONTROL ARRANGEMENTS We have amended employment agreements with Messrs. Mogel, Brothman, and Blake, and entered into an employment agreement with Mr. Kanaly. On November 15, 2007, the Company amended the employment agreement with its CEO, Bruce Mogel, to increase his base salary from $360,000 per year to $525,000 per year. The agreement also specifies that he is eligible to receive performance based incentive compensation up to $97,500 for the year ended March 31, 2008 and $195,000 each year thereafter. Mr. Mogel's auto allowance was increased from $1,000 to $2,000 per month. Mr. Mogel's agreement also provides for stock options (none of which were granted as of March 31, 2008), medical and dental insurance, and up to four weeks vacation annually. Effective March 21, 2008, the Company amended the employment agreement with its CFO, Steven Blake, to increase his base salary from $350,000 per year to $422,000 per year. The agreement also specifies that he is eligible to receive performance based incentive compensation during each fiscal year as determined by the Company's Board of Directors and CEO. Mr. Blake's agreement also provides for stock options (300,000 options were granted as of March 31, 2008), auto allowance ($1,000 per month), medical and dental insurance, and up to four weeks vacation annually. Effective May 6, 2008, the Company amended the employment agreement with its COO, Daniel Brothman, to increase his base salary from $350,000 per year to $422,000 per year. The agreement also specifies that he is eligible to receive performance based incentive compensation during each fiscal year as determined by the Company's Board of Directors and CEO. Mr. Brothman's agreement also provides for stock options (1,000,000 options were granted as of March 31, 2008), auto allowance ($1,000 per month), medical and dental insurance, and up to four weeks vacation annually. Effective September 10, 2007, the Company entered into an employment agreement with its CAO & Treasurer, Jeremiah Kanaly. The agreement specifies that Mr. Kanaly's base salary is $275,000 per year and that he is eligible to receive performance based incentive compensation during each fiscal year as determined by the Company's Board of Directors and CEO. Mr. Kanaly's agreement also provides for stock options (200,000 options were granted as of March 31, 2008), auto allowance ($1,000 per month), medical and dental insurance, and up to four weeks vacation annually. On December 31, 2007, the Company entered into a Severance Agreement With Mutual Releases ("Severance Agreement") and a Consulting Agreement with Larry B. Anderson. Under the Severance Agreement, Mr. Anderson terminated his employment as President of the Company by mutual agreement, effective December 31, 2007. Under the Severance Agreement, Mr. Anderson could receive consideration currently valued at approximately $465,000. The Company will pay Mr. Anderson compensation equivalent to fourteen equal monthly installments. The amount of each monthly installment shall be the sum of Mr. Anderson's base monthly salary, net of required deductions, plus the monthly value of his health and dental insurance, plus the monthly value of his automobile allowance. The schedule of payments is as follows: (i) one lump sum upfront payment equivalent to eight monthly installments, and (ii) the remaining six equal installments shall be paid to him on or before the first business day of each month, commencing on September 1, 2008. In addition, the Company paid a year end (December 31, 2007) bonus of $30,000 to Mr. Anderson. The Severance Agreement also includes mutual releases, specific waivers and releases, nondisclosure of confidential information, return of property, future cooperation, non-disparagement, and general provisions customary in such agreements. Under the terms of the Consulting Agreement, which is effective from January 1, 2008 through June 30, 2008, the Company will pay Mr. Anderson $180,000 consisting of one upfront payment of $60,000 and four equal monthly installments of $30,000 each, commencing April 1, 2008, with the last payment due on July 1, 2008. As additional compensation for special projects, such as his services relating to the then-proposed acquisition of a specifically identified hospital by the Company, Mr. Anderson would be entitled to receive 0.5% of the total value of the purchase, minus $30,000, or an estimated $310,000 if the acquisition was consummated at the then-proposed price. Such acquisition was not consummated by the Company. The Consulting Agreement contains other provisions customary to such agreements. Pension benefits and Nonqualified Deferred Compensation tables are not included as there are no items to report. 58 POTENTIAL PAYMENTS UPON TERMINATION Each of the Company's Named Executive Officers have employment agreements which provide, generally, for payments in the event of resignation for cause. Cause includes, among other items, changes in job duties, reporting relationships, bankruptcy of the Company or change in shareholders of over 50% of the stock. Each Named Executive Officer would be entitled to twelve months salary, benefits and health insurance, but not any additional accruals of paid time off, vacation or sick pay. The following table provides information concerning the estimated payments and benefits that would be provided in the circumstances described above for each of the Named Executive Officers. Payments and benefits are estimated assuming that the triggering event took place on the last business day of fiscal 2008 (March 31, 2008), and the price per share of the Company's common stock is the closing price on the OTCBB as of that date ($0.12). There can be no assurance that a triggering event would produce the same or similar results as those estimated below if such event occurs on any other date or at any other price, of if any other assumption used to estimate potential payments and benefits is not correct. The amounts which would be due the Named Executive Officers as of year end, if they resigned for cause is as follows.
PAYMENTS DUE UPON TERMINATION Name and Employee Principal Health Car Other Position Salary Insurance Allowance Benefits Total -------- --------- --------- --------- -------- ----- Bruce Mogel $ 787,500 $ 24,612 $ 36,000 - $ 848,112 Chief Executive Officer(1) Steven R. Blake $ 422,000 $ 16,408 $ 12,000 - $ 450,408 Chief Financial Officer & Executive Vice President, Finance(2) Daniel J. Brothman $ 350,000 $ 16,408 $ 12,000 - $ 378,408 Senior Vice President, Operations(2) Jeremiah R. Kanaly $ 275,000 $ 8,704 $ 12,000 - $ 295,704 Chief Accounting Officer & Treasurer(2)
(1) Represents payments for 18 months per employment agreement. (2) Represents payments for 12 months per employment agreement. 59 COMPENSATION OF DIRECTORS The following table provides information concerning the compensation of our non-management directors during the fiscal year ended March 31, 2008.
DIRECTOR COMPENSATION Fees earned Stock or paid in cash options Total Name ($) ($) ($) - --------------------------- ------------------ ------------------ ------------------ Ajay G. Meka, M.D. 15,125 8,000 23,125 Maurice J. DeWald 112,750 13,033 125,783 Hon. C. Robert Jameson 17,750 3,100 20,850 Michael Metzler 17,250 3,100 20,350 J. Fernando Niebla 106,500 13,033 119,533 William E. Thomas 23,000 3,100 26,100
Our current compensation and reimbursement policy for Directors is as follows: i. Cash - Each non-employee Director receives an annual fee of $30,000 and an attendance fee of $1,500 for each Board meeting attended, and a separate $1,000 fee for each committee meeting attended. Committee Chairmen receive an additional annual retainer of $5,000. ii. Stock - Options were granted to Directors during the year ended March 31, 2008. Values for stock options represent the amounts expensed by the Company in 2008. These amounts do not represent the intrinsic or market value of the awards on the date of grant, at year end or at present. iii. Travel Reimbursement - All travel and related expenses incurred by Directors to attend Board meetings, committee meetings and other IHHI activities are reimbursed by IHHI. Employee directors receive no compensation for Board service and the Company does not provide any retirement benefits to non-employee directors. Director Mogel is not included above as all compensation paid to him is included in the Summary Compensation Table. COMPENSATION COMMITTEE INTERLOCKS AND INSIDER PARTICIPATION The compensation committee consists of three of the Company's independent directors, Mr. Niebla, Mr. DeWald and Mr. Thomas. There are no interlocks between our executive officers and the members of the Compensation Committee. 60 ITEM 12. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT AND RELATED STOCKHOLDER MATTERS For a discussion of securities authorized for issuance under equity compensation plans, please refer to Item 5 above. SECURITY OWNERSHIP OF CERTAIN BENEFICIAL OWNERS AND MANAGEMENT The following table sets forth information known to us with respect to the beneficial ownership of our common stock as of June 16, 2008, unless otherwise noted, by: o each shareholder known to us to own beneficially more than 5% of our common stock; o each of our directors and each of our executive officers at March 31, 2008; and o all of our current directors and executive officers as a group. Except as otherwise noted below, the address of each person or entity listed on the table is 1301 North Tustin Avenue, Santa Ana, California 92705. The address of Dr. Kali Chaudhuri and William E. Thomas is 6800 Indiana Avenue, Suite 130, Riverside, CA 92506. BENEFICIAL PERCENTAGE OF NAME OWNERSHIP (1) TOTAL (2) - -------------------------------------------------------------------------------- DIRECTORS AND EXECUTIVE OFFICERS Ajay G. Meka, M.D. 166,666 (3) * Maurice J. DeWald 283,332 (4) * Hon. C. Robert Jameson 50,000 (5) * Michael Metzler 50,000 (6) * Bruce Mogel 54,903,786 (7) 40.0% J. Fernando Niebla 283,332 (8) * William E. Thomas 14,694,210 (9) 10.3% Steven R. Blake - - Daniel J. Brothman 1,000,000 (10) * Jerry Kanaly - - - -------------------------------------------------------------------------------- All current directors and executive officers as a group (10 persons) 61,682,828 45.0% PRINCIPAL STOCKHOLDERS (other than those named above) Orange County Physicians Investment Network, LLC 59,098,430 43.1% Kali P. Chaudhuri, M.D. 59,772,290 (12) 38.1% Healthcare Financial Management & Acquisitions, Inc. 124,174,203 (13) 47.5% Medical Provider Financial Corporation III 50,952,381 (14) 27.1% * Less than 1% (1) Beneficial ownership is determined in accordance with the rules of the Securities and Exchange Commission and generally includes voting or investment power with respect to securities. Shares of Common Stock subject to options, warrants and convertible instruments that are exercisable or convertible currently or within 60 days of June 16, 2008 are deemed outstanding for computing the percentage of the person holding such option, warrant or convertible instrument, but are not deemed outstanding for computing the percentage of any other person. Except as reflected in the footnotes or pursuant to applicable community property laws, the persons named in the table have sole voting and investment power with respect to all shares of Common Stock beneficially owned. (2) Percentages are based on 137,095,716 shares of Common Stock outstanding as of June 16, 2008, which does not include up to 12,000,000 shares of Common Stock which may be issued under the Company's 2006 Stock Incentive Plan. (3) Consists of a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008, pursuant to the Company's 2006 Stock Incentive Plan. Dr. Meka is a member of Orange County Physicians Investment Network, LLC ("OC-PIN") and disclaims beneficial ownership of shares held by OC-PIN except to the extent of his pecuniary interest therein. (4) Consists of a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. 61 (5) Consists of a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. (6) Consists of a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. (7) Includes shares held by Dr. Kali P. Chaudhuri (39,789,788) and William E Thomas (9,748,498), each of whom has entered into separate irrevocable proxies expiring in July 2009 providing Mr. Mogel with limited voting rights over all of their shares with respect to certain matters that may be voted on by stockholders. Accordingly, all shares held by Dr. Kali P. Chaudhuri and William E Thomas are deemed beneficially owned by Bruce Mogel, although Mr. Mogel has no pecuniary interest in any such shares. Mr. Mogel holds 5,365,500 shares in his name or affiliated entity. (8) Consists of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. (9) Consists of 9,748,498 issued and outstanding shares, 4,895,712 shares which may be acquired upon exercise of a warrant which expires in July 2008, and a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. (10) Consists of a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. (11) Consists of a portion of a stock option award approved by the Board of Directors which is exercisable within 60 days of June 16, 2008 pursuant to the Company's 2006 Stock Incentive Plan. (12) Consists of 39,789,788 issued and outstanding shares plus 19,982,502 shares which may be acquired upon exercise of a warrant which expires in July 2008. (13) Healthcare Financial Management & Acquisitions, Inc., which is affiliated with the Company's principal lender, Medical Capital Corporation, holds two warrants to acquire 31.09% and 4.95% of the outstanding shares of Common Stock of the Company. (14) Medical Provider Financial Corporation III, which is affiliated with the Company's principal lender, Medical Capital Corporation, holds a convertible term note in the principal amount of $10.7 million convertible into Common Stock of the Company at the rate of $0.21 per share. ITEM 13. CERTAIN RELATIONSHIPS AND RELATED TRANSACTIONS, AND DIRECTOR INDEPENDENCE TRANSACTIONS WITH RELATED PARTIES On July 2, 2007, the Company issued an aggregate of 49,538,286 shares of its common stock upon exercise of outstanding warrants of the Company. The Company issued 39,789,788 shares of common stock to Kali P. Chaudhuri, M.D. and 9,748,498 shares of common stock to William E. Thomas pursuant to the exercise of warrants, dated January 31, 2005, held by each of them. Of these shares, an aggregate of 28,746,857 shares of common stock were issued to Messrs. Chaudhuri and Thomas pursuant to the "net exercise" provisions of their warrants, effective February 6, 2007. An aggregate of 20,791,429 shares were issued pursuant to the cash exercise provisions of their warrants effective July 2, 2007. Payment for the "net exercise" shares consisted of cancellation of warrants to acquire an aggregate of 283,499 shares of common stock. Payment for the cash exercise shares consisted of an aggregate of $575,755 in cash received by the Company from Messrs. Chaudhuri and Thomas. 62 The above issuances of securities were not registered under the Securities Act of 1933, as amended (the "Act"). The securities were issued in private transactions exempt from registration pursuant to Section 4(2) of the Act and Regulation D promulgated thereunder. Effective October 9, 2007, the Company and Medical Capital Corporation and its affiliates (collectively, "MedCap"), which own beneficially more than 5% of our outstanding stock, executed agreements to refinance MedCap's credit facilities with the Company aggregating up to $140.7 million in principal amount (the "New Credit Facilities"). The New Credit Facilities replaced the Company's previous credit facilities with MedCap (the "Prior Debt"), which matured on March 2, 2007. The Company had been operating under an Agreement to Forbear with MedCap with respect to the Prior Debt. Each of the following Credit Agreements and Notes (i) required a 1.5% origination fee due at funding, (ii) matures in three years, (iii) requires monthly payments of interest and repayment of principal upon maturity, (iv) are collateralized by all of the assets of the Company and its subsidiaries and the real estate underlying the Company's hospital facilities (which are owned by PCHI, a company owned indirectly by two of the Company's largest shareholders, and leased to the Company), and (v) are guaranteed by Orange County Physicians Investment Network, LLC and West Coast Holdings, LLC ("West Coast") pursuant to separate Guaranty Agreements in favor of the lender. West Coast is a member of PCHI. PCHI, West Coast, Ganesha, and OC-PIN are credit parties to the New Credit Facilities. The New Credit Facilities consist of the following instruments: o An $80.0 million Credit Agreement, under which the Company issued a $45.0 million Term Note bearing a fixed interest rate of 9% in the first year and 14% after the first year, which was used to repay amounts owing under the Company's existing $50.0 million real estate term loan. o A $35.0 million Non-Revolving Line of Credit Note issued under the $80.0 million Credit Agreement, bearing a fixed interest rate of 9.25% per year, which was used to repay amounts owing under the Company's existing $30.0 million line of credit, pay the origination fees on the other credit facilities and for working capital. o A $10.7 million Credit Agreement, under which the Company issued a $10.7 million Convertible Term Note bearing a fixed interest rate of 9.25% per year, which was used to repay amounts owing under the Company's existing $10.7 million loan. The $10.7 million Convertible Term Note is convertible into common stock of the Company at $0.21 per share during the term of the Note. o A $50.0 million Revolving Credit Agreement, under which the Company issued a $50.0 million Revolving Line of Credit Note bearing a fixed interest rate of 24% per year (subject to reduction to 18% if the $45.0 million Real Estate Term Loan is repaid prior to its maturity) and an unused commitment fee of 0.50% per year, which was used to finance the Company's accounts receivable. The $50.0 million Revolving Line of Credit did not modify or exchange any Prior Debt. From October 9, 2007, the date of refinancing, through March 31, 2008, the Company incurred interest expense related to the New Credit Facilities of approximately $5.0 million. For the period from April 1, 2007 through October 8, 2007, the Company incurred interest expense on the Prior Debt of approximately $5.8 million. The highest aggregate amount of outstanding principal during the year ended March 31, 2008 was approximately $100.9 million on January 31, 2008 (approximately $95.8 million was outstanding on May 31, 2008). With the exception of recurring principal payments (and advances) on the $50.0 million Revolving Line of Credit and the refinancing on October 9, 2007, the Company did not make any principal payments during the year ended March 31, 2008. Debt issuance costs of approximately $2.9 million were incurred in connection with the New Credit Facilities, of which $1.6 million was expensed as of March 31, 2008, and approximately $1.3 million will be amortized over the remaining term of the New Credit Facilities. 63 Concurrently with the execution of the New Credit Facilities, the Company issued to an affiliate of MedCap a five-year warrant to purchase the greater of 16,880,484 shares of the Company's common stock or up to 4.95% of the Company's common stock equivalents, as defined, at $0.21 per share (the "4.95% Warrant"). In addition, the Company and MedCap entered into Amendment No. 2 to Common Stock Warrant, originally dated December 12, 2005, which entitles an affiliate of MedCap to purchase the greater of 26,097,561 shares of the Company's common stock or up to 31.09% of the Company's common stock equivalents (the "31.09% Warrant"). Amendment No. 2 to the 31.09% Warrant extended the expiration date of the Warrant to October 9, 2012, removed the condition that it only be exercised if the Company is in default of its previous credit agreements, and increased the exercise price to $0.21 per share unless the Company's stock ceases to be registered under the Securities Exchange Act of 1934, as amended. As a condition of the New Credit Facilities, the Company entered into an Amended and Restated Triple Net Hospital Building Lease with PCHI (the "Amended Lease"). The Amended Lease terminates on the 25-year anniversary of the original lease (March 8, 2005) (and grants the Company the right to renew for one additional 25-year period) and requires annual base rental payments of $8.3 million (but until the Company refinances its $50.0 million Revolving Line of Credit Loan with a stated interest rate less than 14% per annum or PCHI refinances the Real Estate Loan, the annual base rental payments are reduced to $7.1 million). In addition, the Company may offset against its rental payments owed to PCHI interest payments that it makes to MedCap under certain of its indebtedness discussed above. The Amended Lease also gives PCHI sole possession of the medical office buildings located at 1901/1905 North College Avenue, Santa Ana, California (the "Kindred Property") that are unencumbered by any claims by or tenancy of the Company. Concurrently with the execution of the Amended Lease, the Company, PCHI, Ganesha, and West Coast entered into a Settlement Agreement and Mutual Release (the "Settlement Agreement") whereby the Company agreed to pay to PCHI $2.5 million as settlement for unpaid rents specified in the Settlement Agreement, relating to the Kindred Property, and for compensation relating to the medical office buildings located at 999 North Tustin Avenue in Santa Ana, California, under a previously executed Agreement to Compensation. REVIEW, APPROVAL OR RATIFICATION OF TRANSACTIONS WITH RELATED PARTIES The Company's human resource written policies and procedures provide guidance for conflicts of interest and their relation to the standards of ethical behavior expected of employees. The policies specifically require immediate written disclosure of any business, financial, or other relationship that either creates, or is perceived to create a conflict of interest. The Corporate Compliance Officer is responsible for monitoring compliance with this policy. As part of the quarterly disclosure control procedures, the Chief Financial Officer and Chief Executive Officer for each hospital disclose or certify that employees or officers have not acted in a manner inconsistent with the Company policy related to Conflict of Interest. The CFO and Director of Internal Audit monitor certifications for potential disclosure events. Company policy requires the General Counsel to review and approve all contracts involving related parties, including contracts with related parties who are considered potential referral sources. The Audit Committee has requested that the General Counsel provide periodic updates of such transactions to the Committee. During the acquisition, the Company entered into agreements with the Medical Executive committee ("MEC") at the largest hospital, Western Medical Center - Santa Ana ("WMC-SA") requiring MEC's advance consent for all agreements involving hospital operations with related parties, excluding the lease arrangements between the Company and PCHI. The same agreement was subsequently offered to each of the other hospitals' medical staffs, but not ultimately executed by them. Notwithstanding this fact, the Company applies the disclosure provisions applicable to WMC-SA to all of its facilities. DIRECTOR INDEPENDENCE Directors DeWald, Meka, Metzler, and Niebla each satisfy the definition of "independent director" as established in the NASDAQ listing standards. Directors DeWald, Metzler, and Niebla constitute the Audit Committee of the Board of Directors. The Company does not have a Nominating Committee as the entire Board of Directors performs the functions of this committee and this process has been adequate to handle the Board nomination process to date. The Board of Directors has determined that Director DeWald is an "audit committee financial expert" as defined in the SEC rules. 64 ITEM 14. PRINCIPAL ACCOUNTING FEES AND SERVICES The following table sets forth the aggregate fees that we incurred for audit and non-audit services provided by BDO Seidman, LLP, which acted as our independent registered public accounting firm for the years ended March 31, 2008 and 2007, and performed audit services for us during those periods. The audit fees include only fees that are customary under generally accepted auditing standards and are the aggregate fees that we incurred for professional services rendered for the years ended March 31, 2008 and 2007. For the year ended March 31, ---------------------------- 2008 2007 ------------ ------------ Audit fees (financial) $ 1,293,000 $ 1,400,000 Audit related fees - - Tax fees - - All other - - ------------ ------------ Total fees $ 1,293,000 $ 1,400,000 ============ ============ The Audit Committee of the Board of Directors pre-approves all audit and permissible non-audit services to be performed by the independent auditors. The Board of Directors of the Company considered that the provision of the services and the payment of the fees described above are compatible with maintaining the auditors' independence. 65 ITEM 15. EXHIBITS; FINANCIAL STATEMENT SCHEDULES Exhibits required to be filed are listed below and except where incorporated by reference, immediately follow the Financial Statements. Each document filed with this report is marked with an asterisk (*). References to the "Commission" mean the U.S. Securities and Exchange Commission. - -------------- ----------------------------------------------------------------- Exhibit Number Description - ------ ----------- - -------------- ----------------------------------------------------------------- 3.1 Amended and Restated Articles of Incorporation (incorporated by reference to Appendix A to the Registrant's Report on Form 14C filed on December 10, 2007). - -------------- ----------------------------------------------------------------- 3.2 Amended and Restated Bylaws (incorporated by reference to Exhibit 3.1 to the Registrant's Current Report on Form 8-K filed with the Commission on June 9, 2008). - -------------- ----------------------------------------------------------------- 4.1 Integrated Healthcare Holdings, Inc. 2006 Stock Incentive Plan (incorporated by reference to Appendix B to the Registrant's Definitive Proxy Statement on Schedule 14A filed by the Registrant on November 14, 2006). - -------------- ----------------------------------------------------------------- 4.2 Form of Notice of Stock Option Award and Stock Option Agreement. (incorporated herein by reference from Exhibit 4.5 to the Registrant's Registration Statement under the Securities and Exchange Act of 1933 on Form S-8 filed with the Commission on February 2, 2007). - -------------- ----------------------------------------------------------------- 10.1 Triple Net Hospital and Medical Office Building Lease dated March 7, 2005, as amended by Amendment No. 1 To Triple Net Hospital and Medical Office Building Lease (incorporated herein by reference from Exhibit 99.9 to the Registrant's Current Report on Form 8-K filed with the Commission on March 14, 2005). - -------------- ----------------------------------------------------------------- 10.1.1 Amended and Restated Triple Net Hospital Building Lease (incorporated by reference to Exhibit 99.10 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.1.2 Settlement Agreement and Mutual Release (incorporated by reference to Exhibit 99.11 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.2 Employment Agreement with Bruce Mogel dated February 25, 2005 (incorporated herein by reference from Exhibit 10.16 to the Registrant's Annual Report on Form 10-KSB filed with the Commission on March 31, 2005). - -------------- ----------------------------------------------------------------- 10.2.1 Amended Employment Agreement of Bruce Mogel, dated as of November 15, 2007 (incorporated by reference to Exhibit 99.1 to the Registrant's Report on Form 8-K filed on November 19, 2007). - -------------- ----------------------------------------------------------------- 10.3 Employment Agreement with Larry B. Anderson dated February 25, 2005 (incorporated herein by reference from Exhibit 10.17 to the Registrant's Annual Report on Form 10-KSB filed with the Commission on March 31, 2005). - -------------- ----------------------------------------------------------------- 10.3.1 Severance Agreement with Mutual Releases of Larry B. Anderson, as of December 31, 2007 (incorporated by reference to Exhibit 99.1 to the Registrant's Report on Form 8-K filed on January 7, 2008). - -------------- ----------------------------------------------------------------- 10.3.2 Consulting Agreement of Larry B. Anderson, as of December 31, 2007(incorporated by reference to Exhibit 99.2 to the Registrant's Report on Form 8-K filed on January 7, 2008). 66 - -------------- ----------------------------------------------------------------- 10.4 Employment Agreement with Daniel J. Brothman dated December 31, 2005 (incorporated herein by reference from Exhibit 10.21 to the Registrant's Annual Report on Form 10-KSB filed with the Commission on March 31, 2005). - -------------- ----------------------------------------------------------------- 10.4.1 Amended Employment Agreement between Integrated Healthcare Holdings, Inc. and Daniel J. Brothman(incorporated by reference to Exhibit 99.2 to the Registrant's Report on Form 8-K filed on May 23, 2008). - -------------- ----------------------------------------------------------------- 10.5 Employment Agreement with Steve R. Blake dated March 21, 2005 (incorporated herein by reference from Exhibit 10.22 to the Registrant's Annual Report on Form 10-KSB filed with the Commission on March 31, 2005). - -------------- ----------------------------------------------------------------- 10.5.1 Letter of Amendment to Employment Agreement of Steven R. Blake, dated as of February 14, 2007 (incorporated herein by reference from Exhibit 99.1 to the Registrant's Current Report on Form 8-K filed with the Commission on February 21, 2007). - -------------- ----------------------------------------------------------------- 10.5.2 Amendment #2 to Employment Agreement between Integrated Healthcare Holdings, Inc. and Steve Blake (incorporated by reference to Exhibit 99.1 to the Registrant's Report on Form 8-K filed on April 8, 2008). - -------------- ----------------------------------------------------------------- 10.5.3 Amended Employment Agreement between Integrated Healthcare Holdings, Inc. and Steven R. Blake(incorporated by reference to Exhibit 99.1 to the Registrant's Report on Form 8-K filed on May 23, 2008). - -------------- ----------------------------------------------------------------- 10.6 Employment Agreement between Integrated Healthcare Holdings, Inc. and Jeremiah R. Kanaly, dated as of September 10, 2007 (incorporated by reference to Exhibit 99.1 to the Registrant's Report on Form 8-K filed on September 13, 2007). - -------------- ----------------------------------------------------------------- 10.7 Agreement to Forbear executed June 18, 2007. (incorporated herein by reference from Exhibit 99.1 to the Registrant's Current Report on Form 8-K filed with the Commission on June 19, 2007). - -------------- ----------------------------------------------------------------- 10.7.1 Amendment No. 1 to Forbearance Agreement executed June 18, 2007. (incorporated herein by reference from Exhibit 99.1 to the Registrant's Current Report on Form 8-K filed with the Commission on June 19, 2007). - -------------- ----------------------------------------------------------------- 10.8 $80,000,000 Credit Agreement, dated October 9, 2007 (incorporated by reference to Exhibit 99.1 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.9 $45,000,000 Term Note, dated October 9, 2007 (incorporated by reference to Exhibit 99.2 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.10 $35,000,000 Non Revolving Line of Credit Note, dated October 9, 2007 (incorporated by reference to Exhibit 99.3 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.11 $50,000,000 Revolving Credit Agreement, dated October 9, 2007 (incorporated by reference to Exhibit 99.4 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.11.1 Amendment No. 1 to $50,000,000 Revolving Credit Agreement, dated June 10, 2008 * - -------------- ----------------------------------------------------------------- 10.11.2 Amendment No. 2 to $50,000,000 Revolving Credit Agreement, dated June 20, 2008 * 67 - -------------- ----------------------------------------------------------------- 10.12 $50,000,000 Revolving Line of Credit Note, dated October 9, 2007 (incorporated by reference to Exhibit 99.5 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.13 $10,700,000 Credit Agreement, dated October 9, 2007 (incorporated by reference to Exhibit 99.6 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.14 $10,700,000 Convertible Term Note, dated October 9, 2007 (incorporated by reference to Exhibit 99.7 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.15 4.95% Common Stock Warrant, dated October 9, 2007 (incorporated by reference to Exhibit 99.8 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 10.16 31.09% Common Stock Warrant, dated December 12, 2005 (incorporated by reference to Exhibit 99.4 to the Registrant's Report on Form 8-K filed on December 20, 2005). - -------------- ----------------------------------------------------------------- 10.16.1 Amendment No. 1 to 31.09% Common Stock Warrant, dated April 26, 2006 * - -------------- ----------------------------------------------------------------- 10.16.2 Amendment No. 2 to 31.09% Common Stock Warrant, dated October 9, 2007 (incorporated by reference to Exhibit 99.9 to the Registrant's Report on Form 8-K filed on October 15, 2007). - -------------- ----------------------------------------------------------------- 21.1 The subsidiaries of the Registrant are WMC-SA, Inc., a California corporation, WMC-A, Inc., a California corporation, Chapman Medical Center, Inc., a California corporation, Coastal Communities Hospital, Inc., a California corporation, and Mogel Management, Inc., a Nevada corporation. - -------------- ----------------------------------------------------------------- 23.1 Consent of BDO Seidman, LLP * - -------------- ----------------------------------------------------------------- 23.2 Consent of Ramirez International * - -------------- ----------------------------------------------------------------- 31.1 Certification of Chief Executive Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 * - -------------- ----------------------------------------------------------------- 31.2 Certification of Chief Financial Officer Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002 * - -------------- ----------------------------------------------------------------- 32.1 Certification of Chief Executive Officer Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002 * - -------------- ----------------------------------------------------------------- 32.2 Certification of Chief Financial Officer Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002 * - -------------- ----------------------------------------------------------------- 68 SIGNATURES Pursuant to the requirements of Section 13 or 15(d) of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized. INTEGRATED HEALTHCARE HOLDINGS, INC. Dated: July 11, 2008 /s/ Bruce Mogel ---------------------------------------- Bruce Mogel Chief Executive Officer (Principal Executive Officer) Pursuant to the requirements of the Securities Exchange Act of 1934, this Report has been signed below by the following persons on behalf of the Registrant and in the capacities and on the dates indicated. Dated: July 11, 2008 /s/ Bruce Mogel ---------------------------------------- Bruce Mogel Chief Executive Officer and Director (Principal Executive Officer) Dated: July 11, 2008 /s/ Steven R. Blake ---------------------------------------- Steven R. Blake Chief Financial Officer (Principal Financial Officer) Dated: July 11, 2008 /s/ Jeremiah R. Kanaly ---------------------------------------- Jeremiah R. Kanaly Chief Accounting Officer and Treasurer (Principal Accounting Officer) Dated: July 11, 2008 /s/ Ajay Meka, M.D. ---------------------------------------- Ajay Meka, M.D Chairman of the Board of Directors Dated: July 11, 2008 /s/ Maurice J. DeWald ---------------------------------------- Maurice J. DeWald Director Dated: July 11, 2008 /s/ Hon. C. Robert Jamison ---------------------------------------- Hon. C. Robert Jamison Director Dated: July 11, 2008 /s/ Michael Metzler ---------------------------------------- Michael Metzler Director Dated: July 11, 2008 /s/ J. Fernando Niebla ---------------------------------------- J. Fernando Niebla Director Dated: July 11, 2008 /s/ William E. Thomas ---------------------------------------- William E. Thomas Director 69 Report of Independent Registered Public Accounting Firm Board of Directors and Stockholders Integrated Healthcare Holdings, Inc. Santa Ana, California We have audited the accompanying consolidated balance sheets of Integrated Healthcare Holdings, Inc. and consolidated entities (the "Company") as of March 31, 2008 and 2007 and the related consolidated statements of operations, stockholders' deficiency, and cash flows for each of the two years then ended and for the three month period ended March 31, 2006. We have also audited the schedule as listed in the accompanying index (Item 8). These consolidated financial statements and schedule are the responsibility of the Company's management. Our responsibility is to express an opinion on these financial statements and schedule based on our audits. We conducted our audits in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. The Company is not required to have, nor were we engaged to perform, an audit of its internal control over financial reporting. Our audits included consideration of internal control over financial reporting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Company's internal control over financial reporting. Accordingly, we express no such opinion. An audit also includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements, assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the consolidated financial statements referred to above present fairly, in all material respects, the financial position of Integrated Healthcare Holdings, Inc. at March 31, 2008 and 2007, and the results of its operations and its cash flows for each of the two years then ended and for the three month period ended March 31, 2006, in conformity with accounting principles generally accepted in the United States of America. Also in our opinion, the schedule as listed in the accompanying index presents fairly, in all material respects, the information set forth therein for the years ended March 31, 2008 and 2007 and for the three month period ended March 31, 2006. The accompanying consolidated financial statements have been prepared assuming that the Company will continue as a going concern. As discussed in Note 1 to the consolidated financial statements, the Company has suffered recurring losses, has a significant working capital deficit and a net stockholders' deficiency at March 31, 2008. These factors raise substantial doubt about the Company's ability to continue as a going concern. Management's plans in regard to these matters are also described in Note 1. The consolidated financial statements do not include any adjustments that might result from the outcome of this uncertainty. As discussed in Note 1 to the consolidated financial statements, effective April 1, 2007 the Company adopted Financial Accounting Standards Board Interpretation No. 48, "Accounting for Uncertainty in Income Taxes - an interpretation of FASB No. 109" and effective April 1, 2006, adopted Statement of Financial Accounting Standards No. 123R, "Share-Based Payment." /s/ BDO Seidman, LLP Costa Mesa, California July 11, 2008 F-1 Report of Independent Registered Public Accounting Firm The Board of Directors of Integrated Healthcare Holdings, Inc.: We have audited the accompanying consolidated statements of operations, stockholders' equity (deficiency) and cash flows of Integrated Healthcare Holdings, Inc. and consolidated entities (the "Company") for the year ended December 31, 2005. These consolidated financial statements are the responsibility of the Company's management. Our responsibility is to express an opinion on these statements based on our audit. We conducted our audit in accordance with the standards of the Public Company Accounting Oversight Board (United States). Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion, based on our audit, the consolidated financial statements referred to above present fairly, in all material respects, the results of operations and cash flows of the Company for the year ended December 31, 2005, in conformity with generally accepted accounting principles in the United States of America. The accompanying financial statements have been prepared assuming that the Company will continue as a going concern. As shown in the financial statements, the Company has incurred net losses and, as of December 31, 2005, had a substantial stockholders' deficiency. Further, the Company had substantial balances of notes payable which, under the terms of the agreements, were scheduled to mature during 2006 and early in 2007. The Company had not identified alternate sources of capital to meet its refinancing requirements. These factors raise substantial doubt about the Company's ability to continue as a going concern. The financial statements do not include any adjustments that might be necessary if the Company is unable to continue as a going concern. /s/ RAMIREZ INTERNATIONAL Financial & Accounting Services, Inc. July 11, 2006 Irvine, California F-2
INTEGRATED HEALTHCARE HOLDINGS, INC. CONSOLIDATED BALANCE SHEETS (amounts in 000's, except par value) MARCH 31, MARCH 31, 2008 2007 ------------- ------------- ASSETS Current assets: Cash and cash equivalents $ 3,141 $ 7,844 Restricted cash 20 4,968 Accounts receivable, net of allowance for doubtful accounts of $14,383 and $2,355, respectively 57,990 19,370 Security reserve funds - 7,990 Deferred purchase price receivable - 16,975 Inventories of supplies, at cost 5,853 5,944 Due from governmental payers 4,877 1,378 Prepaid insurance 721 5,004 Other prepaid expenses and current assets 5,811 3,093 ------------- ------------- Total current assets 78,413 72,566 Property and equipment, net 56,917 58,172 Debt issuance costs, net 759 - ------------- ------------- Total assets $ 136,089 $ 130,738 ============= ============= LIABILITIES AND STOCKHOLDERS' DEFICIENCY Current liabilities: Revolving line of credit $ 9,879 $ - Debt, current - 72,341 Accounts payable 46,749 41,443 Accrued compensation and benefits 14,701 12,574 Warrant liability, current - 14,906 Due to governmental payers 1,690 922 Accrued insurance retentions 12,332 4,961 Other current liabilities 5,781 15,726 ------------- ------------- Total current liabilities 91,132 162,873 Debt, non current 85,700 - Capital lease obligations, net of current portion of $406 and $251, respectively 6,375 5,834 Minority interest in variable interest entity 1,150 1,716 ------------- ------------- Total liabilities 184,357 170,423 ------------- ------------- Commitments, contingencies, and subsequent events Stockholders' deficiency: Common stock, $0.001 par value; 400,000 and 250,000 shares authorized; 137,096 and 116,304 shares issued and outstanding, respectively 137 116 Additional paid in capital 56,148 25,589 Accumulated deficit (104,553) (65,390) ------------- ------------- Total stockholders' deficiency (48,268) (39,685) ------------- ------------- Total liabilities and stockholders' deficiency $ 136,089 $ 130,738 ============= ============= The accompanying notes are an integral part of these consolidated financial statements. F-3 INTEGRATED HEALTHCARE HOLDINGS, INC. CONSOLIDATED STATEMENTS OF OPERATIONS (amounts in 000's, except per share amounts) FOR THE YEAR ENDED FOR THE THREE ----------------------------------------------------- MONTHS ENDED MARCH 31, MARCH 31, DECEMBER 31, MARCH 31, 2008 2007 2005 2006 --------------- -------------- -------------- ------------- Net operating revenues $ 368,229 $ 350,672 $ 283,698 $ 86,645 --------------- -------------- -------------- ------------- Operating expenses: Salaries and benefits 209,680 194,865 153,574 48,731 Supplies 50,126 49,577 39,250 12,066 Provision for doubtful accounts 30,958 35,169 37,349 8,330 Other operating expenses 69,027 66,652 58,716 16,808 Loss on sale of accounts receivable 4,079 10,388 8,470 2,808 Depreciation and amortization 3,134 2,495 2,178 673 --------------- -------------- -------------- ------------- 367,004 359,146 299,537 89,416 --------------- -------------- -------------- ------------- Operating income (loss) 1,225 (8,474) (15,839) (2,771) --------------- -------------- -------------- ------------- Other income (expense): Interest expense, net (13,209) (12,092) (9,925) (3,120) Warrant expense (11,404) (693) (17,604) - Change in fair value of warrant liability (14,273) 133 (3,460) 8,218 --------------- -------------- -------------- ------------- (38,886) (12,652) (30,989) 5,098 --------------- -------------- -------------- ------------- Income (loss) before provision for income taxes and minority interest (37,661) (21,126) (46,828) 2,327 Provision for income taxes (28) (5) (5) (5) Minority interest net loss (income) in variable interest entity (1,474) 593 1,658 100 --------------- -------------- -------------- ------------- Net income (loss) $ (39,163) $ (20,538) $ (45,175) $ 2,422 =============== ============== ============== ============= Per Share Data: Income (loss) per common share Basic ($0.30) ($0.23) ($0.50) $0.03 Diluted ($0.30) ($0.23) ($0.50) $0.02 Weighted average shares outstanding Basic 131,869 90,291 90,330 84,281 Diluted 131,869 90,291 90,330 127,228 The accompanying notes are an integral part of these consolidated financial statements. F-4 INTEGRATED HEALTHCARE HOLDINGS, INC. CONSOLIDATED STATEMENTS OF STOCKHOLDERS' DEFICIENCY (amounts in 000's) Additional Common Stock Paid-in Accumulated Shares Amount Capital Deficit Total ------------------------------ ------------ --------------- ------------- Balance, December 31, 2004 20,780 $ 20 $ 1,190 $ (2,099) $ (889) Issuance of common stock 63,152 64 14,936 - 15,000 Net loss - - - (45,175) (45,175) - ------------- ------------- ------------ --------------- ------------- Balance, December 31, 2005 83,932 84 16,126 (47,274) (31,064) Issuance of common stock 3,625 3 129 - 132 Exercise of warrants 28,747 29 9,170 - 9,199 Warrants issued to vendor - - 164 - 164 Net income for the three months ended March 31, 2006 - - - 2,422 2,422 Net loss for the year ended March 31, 2007 - - - (20,538) (20,538) ------------- ------------- ------------ --------------- ------------- Balance, March 31, 2007 116,304 116 25,589 (65,390) (39,685) Exercise of warrants 20,792 21 4,761 - 4,782 Issuance of warrants - - 25,677 - 25,677 Share-based compensation - - 121 - 121 Net loss - - - (39,163) (39,163) ------------- ------------- ------------ --------------- ------------- Balance, March 31, 2008 137,096 $ 137 $ 56,148 $ (104,553) $ (48,268) ============= ============= ============ =============== ============= The accompanying notes are an integral part of these consolidated financial statements F-5 INTEGRATED HEALTHCARE HOLDINGS, INC. CONSOLIDATED STATEMENTS OF CASH FLOWS (amounts in 000's) FOR THE YEAR ENDED FOR THE THREE -------------------------------------------------- MONTHS ENDED MARCH 31, MARCH 31, DECEMBER 31, MARCH 31, 2008 2007 2005 2006 --------------- --------------- --------------- -------------- Cash flows from operating activities: Net income (loss) $ (39,163) $ (20,538) $ (45,175) $ 2,422 Adjustments to reconcile net loss to net cash provided by (used in) operating activities: Depreciation and amortization of property and equipment 3,134 2,495 2,133 673 Provision for doubtful accounts 30,958 35,169 37,349 8,330 Amortization of debt issuance costs and intangible assets 236 900 837 241 Common stock warrant expense 11,404 693 17,604 - Change in fair value of warrant liability 14,273 (133) 3,460 (8,218) Minority interest in net income (loss) of variable interest entity 1,474 (593) (1,658) (100) Noncash share-based compensation expense 121 - - - Changes in operating assets and liabilities: Accounts receivable (69,578) (40,212) (53,324) (6,682) Security reserve funds 7,990 6,798 (14,217) (571) Deferred purchase price receivable 23,765 (2,620) (9,338) (5,017) Inventories of supplies 91 (158) 299 (66) Due from governmental payers (3,499) 5,209 (3,025) (3,562) Prepaid insurance, other prepaid expenses and current assets, and other assets 2,063 3,808 (4,215) 247 Accounts payable 5,306 12,710 26,679 1,897 Accrued compensation and benefits 2,127 990 11,733 (949) Due to governmental payers 768 652 - 270 Accrued insurance retentions and other current liabilities (2,729) (2,647) 15,640 2,311 --------------- --------------- --------------- -------------- Net cash provided by (used in) operating activities (11,259) 2,523 (15,218) (8,774) --------------- --------------- --------------- -------------- Cash flows from investing activities: Decrease (increase) in restricted cash 4,948 4 (4,972) - Acquisition of hospital assets - - (63,172) - Proceeds from minority interest in PCHI - - 5,000 - Additions to property and equipment (921) (644) (564) (83) --------------- --------------- --------------- -------------- Net cash provided by (used in) investing activities 4,027 (640) (63,708) (83) --------------- --------------- --------------- -------------- Cash flows from financing activities: Proceeds from revolving line of credit, net 3,090 - - - Proceeds from debt 2,658 2,010 86,031 132 Debt issuance costs (1,493) - (1,933) - Repayments of debt - - (6,264) - Issuance of common stock 576 - 15,000 - Variable interest entity distribution (2,040) (732) - (201) Payments on capital lease obligations (262) (287) (62) (20) --------------- --------------- --------------- -------------- Net cash provided by (used in) financing activities 2,529 991 92,772 (89) --------------- --------------- --------------- -------------- Net increase (decrease) in cash and cash equivalents (4,703) 2,874 13,846 (8,946) Cash and cash equivalents, beginning of period 7,844 4,970 70 13,916 --------------- --------------- --------------- -------------- Cash and cash equivalents, end of period $ 3,141 $ 7,844 $ 13,916 $ 4,970 =============== =============== =============== ============== The accompanying notes are an integral part of these consolidated financial statements F-6
INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 1 - DESCRIPTION OF BUSINESS AND SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES LIQUIDITY AND MANAGEMENT'S PLANS - The accompanying consolidated financial statements have been prepared on a going concern basis, which contemplates the realization of assets and settlement of obligations in the normal course of business. The Company has incurred significant losses to date including a net loss of $39.2 million and experienced negative cash flow from operations of $11.3 million for the year ended March 31, 2008 and has a working capital deficit of $12.7 million and accumulated stockholders' deficiency of $48.3 million at March 31, 2008. The Company refinanced all its outstanding debt in October 2007. The Company's $50.0 million Revolving Credit Agreement provides an estimated additional liquidity as of March 31, 2008 of $27.4 million based on eligible receivables, as defined (Note 5). The Company's liquidity is highly dependent upon the continued availability under this financing. Notwithstanding the refinancing, these factors, among others, raise substantial doubt about the Company's ability to continue as a going concern and indicate a need for the Company to take action to continue to operate its business as a going concern. The Company has negotiated increased reimbursements from governmental payers and managed care over the past year and is aggressively seeking to obtain future increases. The Company is seeking to reduce operating expenses while continuing to maintain service levels. There can be no assurance that the Company will be successful in improving reimbursements or reducing operating expenses. DESCRIPTION OF BUSINESS - The Company was organized under the laws of the State of Utah on July 31, 1984 under the name of Aquachlor Marketing. Aquachlor Marketing never engaged in business activities. In December 1988, Aquachlor Marketing merged with Aquachlor, Inc., a Nevada corporation incorporated on December 20, 1988. The Nevada Corporation became the surviving entity and changed its name to Deltavision, Inc. In March 1997, Deltavision, Inc. received a Certificate of Revival from the State of Nevada using the name First Deltavision, Inc. In March 2004, First Deltavision, Inc. changed its name to Integrated Healthcare Holdings, Inc. In these consolidated financial statements, the Company refers to Integrated Healthcare Holdings, Inc. and its subsidiaries. Prior to March 8, 2005, the Company was a development stage enterprise with no material operations and no revenues from operations. On September 29, 2004, the Company entered into a definitive agreement to acquire four hospitals (the "Hospitals") from subsidiaries of Tenet Healthcare Corporation ("Tenet"), and completed the transaction on March 8, 2005 (the "Acquisition") (Note 2). The Hospitals are: o 282-bed Western Medical Center in Santa Ana, California; o 188-bed Western Medical Center in Anaheim, California; o 178-bed Coastal Communities Hospital in Santa Ana, California; and o 114-bed Chapman Medical Center in Orange, California. The Company enters into agreements with third-party payers, including government programs and managed care health plans, under which rates are based upon established charges, the cost of providing services, predetermined rates per diagnosis, fixed per diem rates or discounts from established charges. During the 24 days ended March 31, 2005, substantially all of Tenet's negotiated rate agreements were assigned to the Hospitals. The Company received Medicare provider numbers in April 2005 and California State Medicaid Program provider numbers were received in June 2005. BASIS OF PRESENTATION - The accompanying consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries. The Company has also determined that Pacific Coast Holdings Investment, LLC ("PCHI") (Note 12), is a variable interest entity as defined in Financial Accounting Standards Board ("FASB") Interpretation Number ("FIN") 46R, and, accordingly, the financial statements of PCHI are included in the accompanying consolidated financial statements. All significant intercompany accounts and transactions have been eliminated in consolidation. Unless otherwise indicated, all amounts included in these notes to the consolidated financial statements are expressed in thousands (except per share amounts, percentages and stock option prices and values). F-7 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 RECLASSIFICATION FOR PRESENTATION - Certain immaterial amounts previously reported have been reclassified to conform to the current period's presentation. CONCENTRATION OF CREDIT RISK - The Company has secured its working capital and its long term debt from the same Lender (Note 5) and, thus, is subject to significant credit risk if they are unable to perform. The Hospitals are subject to licensure by the State of California and accreditation by the Joint Commission on Accreditation of Healthcare Organizations. Loss of either licensure or accreditation would impact the ability to participate in various governmental and managed care programs, which provide the majority of the Company's revenues. Essentially all net operating revenues come from external customers. The largest payers are the Medicare and Medicaid programs accounting for 67%, 65%, 74%, and 73% of the net operating revenues for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. No other payers represent a significant concentration of the Company's net operating revenues. USE OF ESTIMATES - The accompanying consolidated financial statements have been prepared in accordance with generally accepted accounting principles in the United States of America ("U.S. GAAP") and prevailing practices for investor owned entities within the healthcare industry. The preparation of financial statements in conformity with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Management regularly evaluates the accounting policies and estimates that are used. In general, management bases the estimates on historical experience and on assumptions that it believes to be reasonable given the particular circumstances in which its Hospitals operate. Although management believes that all adjustments considered necessary for fair presentation have been included, actual results may materially vary from those estimates. REVENUE RECOGNITION - Net operating revenues are recognized in the period in which services are performed and are recorded based on established billing rates (gross charges) less estimated discounts for contractual allowances, principally for patients covered by Medicare, Medicaid, managed care and other health plans. Gross charges are retail charges. They are not the same as actual pricing, and they generally do not reflect what a hospital is ultimately paid and therefore are not displayed in the consolidated statements of operations. Hospitals are typically paid amounts that are negotiated with insurance companies or are set by the government. Gross charges are used to calculate Medicare outlier payments and to determine certain elements of payment under managed care contracts (such as stop-loss payments). Because Medicare requires that a hospital's gross charges be the same for all patients (regardless of payer category), gross charges are also what the Hospitals charge all other patients prior to the application of discounts and allowances. F-8 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 Revenues under the traditional fee-for-service Medicare and Medicaid programs are based primarily on prospective payment systems. Discounts for retrospectively cost based revenues and certain other payments, which are based on the Hospitals' cost reports, are estimated using historical trends and current factors. Cost report settlements for retrospectively cost-based revenues under these programs are subject to audit and administrative and judicial review, which can take several years until final settlement of such matters are determined and completely resolved. Estimates of settlement receivables or payables related to a specific year are updated periodically and at year end and at the time the cost report is filed with the fiscal intermediary. Typically no further updates are made to the estimates until the final Notice of Program Reimbursement is received, at which time the cost report for that year has been audited by the fiscal intermediary. There could be several years time lag between the submission of a cost report and receipt of the Final Notice of Program Reimbursement. Since the laws, regulations, instructions and rule interpretations governing Medicare and Medicaid reimbursement are complex and change frequently, the estimates recorded by the Hospitals could change by material amounts. The Company has established settlement payables of $12 and settlement receivables of $909 as of March 31, 2008 and 2007, respectively. Outlier payments, which were established by Congress as part of the diagnosis-related groups ("DRG") prospective payment system, are additional payments made to Hospitals for treating Medicare patients who are costlier to treat than the average patient in the same DRG. To qualify as a cost outlier, a hospital's billed (or gross) charges, adjusted to cost, must exceed the payment rate for the DRG by a fixed threshold established annually by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services ("CMS"). Under Sections 1886(d) and 1886(g) of the Social Security Act, CMS must project aggregate annual outlier payments to all prospective payment system Hospitals to be not less than 5% or more than 6% of total DRG payments ("Outlier Percentage"). The Outlier Percentage is determined by dividing total outlier payments by the sum of DRG and outlier payments. CMS annually adjusts the fixed threshold to bring expected outlier payments within the mandated limit. A change to the fixed threshold affects total outlier payments by changing (1) the number of cases that qualify for outlier payments, and (2) the dollar amount Hospitals receive for those cases that still qualify. The most recent change to the cost outlier threshold that became effective on October 1, 2007 was a decrease from $24.485 to $22.185. CMS projects this will result in an Outlier Percentage that is approximately 5.1% of total payments. The Medicare fiscal intermediary calculates the cost of a claim by multiplying the billed charges by the cost-to-charge ratio from the hospital's most recent filed cost report. The Hospitals received new provider numbers in 2005 and, because there was no specific history, the Hospitals were reimbursed for outliers based on published statewide averages. If the computed cost exceeds the sum of the DRG payment plus the fixed threshold, a hospital receives 80% of the difference as an outlier payment. Medicare has reserved the option of adjusting outlier payments, through the cost report, to a hospital's actual cost-to-charge ratio. Upon receipt of the current payment cost-to-charge ratios from the fiscal intermediary, any variance between current payments and the estimated final outlier settlement are examined by the Medicare fiscal intermediary. The Company recorded $755 and $1,919 in Final Notice of Program Reimbursement settlements during the years ended March 31, 2008 and 2007, respectively. There were no adjustments for Final Notice of Program Reimbursement received during the year ended December 31, 2005 and the three months ended March 31, 2006. As of March 31, 2008 and 2007, the Company recorded reserves for excess outlier payments due to the difference between the Hospitals actual cost to charge rates and the statewide average in the amount of $1,678 and $1,831, respectively. These reserves are combined with third party settlement estimates and are included in due to government payers as a net payable of $1,690 and $922 as of March 31, 2008 and 2007, respectively. F-9 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 The Hospitals receive supplemental payments from the State of California to support indigent care (Medi-Cal Disproportionate Share Hospital payments or "DSH") and from the California Medical Assistance Commission ("CMAC") under the SB 1100 and SB 1255 programs. The Hospitals received supplemental payments of $16,175, $24,526, and $11,022, and $575 during the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. The related revenue recorded for the years ended March 31, 2008 and 2007 and December 31, 2005, and for the three months ended March 31, 2006 was $19,375, $17,897, $13,943, and $4,240, respectively. As of March 31, 2008 and 2007, estimated DSH receivables of $4,877 and $1,378 are included in due from governmental payers in the accompanying consolidated balance sheets. The following is a summary of due from and due to governmental payers as of March 31: March 31, March 31, 2008 2007 -------------- -------------- Due from government payers Medicaid $ 4,877 $ 1,378 -------------- -------------- $ 4,877 $ 1,378 ============== ============== Due to government payers Medicare $ 12 $ (909) Outlier 1,678 1,831 -------------- -------------- $ 1,690 $ 922 ============== ============== Revenues under managed care plans are based primarily on payment terms involving predetermined rates per diagnosis, per-diem rates, discounted fee-for-service rates and/or other similar contractual arrangements. These revenues are also subject to review and possible audit by the payers. The payers are billed for patient services on an individual patient basis. An individual patient's bill is subject to adjustment on a patient-by-patient basis in the ordinary course of business by the payers following their review and adjudication of each particular bill. The Hospitals estimate the discounts for contractual allowances utilizing billing data on an individual patient basis. At the end of each month, the Hospitals estimate expected reimbursement for patients of managed care plans based on the applicable contract terms. These estimates are continuously reviewed for accuracy by taking into consideration known contract terms as well as payment history. Although the Hospitals do not separately accumulate and disclose the aggregate amount of adjustments to the estimated reimbursements for every patient bill, management believes the estimation and review process allows for timely identification of instances where such estimates need to be revised. The Company does not believe there were any adjustments to estimates of individual patient bills that were material to its net operating revenues. The Hospitals provide charity care to patients whose income level is below 300% of the Federal Poverty Level. Patients with income levels between 300% and 350% of the Federal Poverty Level qualify to pay a discounted rate under AB774 based on various government program reimbursement levels. Patients without insurance are offered assistance in applying for Medicaid and other programs they may be eligible for, such as state disability, Victims of Crime, or county indigent programs. Patient advocates from the Hospitals' Medical Eligibility Program ("MEP") screen patients in the hospital and determine potential linkage to financial assistance programs. They also expedite the process of applying for these government programs. Based on average revenue for comparable services from all other payers, revenues foregone under the charity policy, including indigent care accounts, were $7.4 million, $8.1 million, $2.9 million, and $1.5 million for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. F-10 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 Receivables from patients who are potentially eligible for Medicaid are classified as Medicaid pending under the MEP, with appropriate contractual allowances recorded. If the patient does not qualify for Medicaid, the receivables are reclassified to charity care and written off, or they are reclassified to self-pay and adjusted to their net realizable value through the provision for doubtful accounts. Reclassifications of Medicaid pending accounts to self-pay do not typically have a material impact on the results of operations as the estimated Medicaid contractual allowances initially recorded are not materially different than the estimated provision for doubtful accounts recorded when the accounts are reclassified. All accounts classified as pending Medicaid, as well as certain other governmental receivables, over the age of 180 days were fully reserved in contractual allowances as of March 31, 2008 and 2007. In June 2007, the Company evaluated its historical experience and changed to a graduated reserve percentage based on the age of governmental accounts. The impact of the change was not material. The Company is not aware of any material claims, disputes, or unsettled matters with any payers that would affect revenues that have not been adequately provided for in the accompanying consolidated financial statements. PROVISION FOR DOUBTFUL ACCOUNTS - The Company provides for accounts receivable that could become uncollectible by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Hospitals estimate this allowance based on the aging of their accounts receivable, historical collections experience for each type of payer and other relevant factors. There are various factors that can impact the collection trends, such as changes in the economy, which in turn have an impact on unemployment rates and the number of uninsured and underinsured patients, volume of patients through the emergency department, the increased burden of copayments to be made by patients with insurance and business practices related to collection efforts. These factors continuously change and can have an impact on collection trends and the estimation process. The Company's policy is to attempt to collect amounts due from patients, including copayments and deductibles due from patients with insurance, at the time of service while complying with all federal and state laws and regulations, including, but not limited to, the Emergency Medical Treatment and Labor Act ("EMTALA"). Generally, as required by EMTALA, patients may not be denied emergency treatment due to inability to pay. Therefore, until the legally required medical screening examination is complete and stabilization of the patient has begun, services are performed prior to the verification of the patient's insurance, if any. In nonemergency circumstances or for elective procedures and services, it is the Hospitals' policy, when appropriate, to verify insurance prior to a patient being treated. TRANSFERS OF FINANCIAL ASSETS - Prior to the refinancing (Note 5) effective October 9, 2007 (when the Company terminated its Accounts Purchase Agreement (Note 3) and repurchased all its previously sold receivables), the Company sold substantially all of its billed accounts receivable to a financial institution. The Company accounted for its sale of accounts receivable in accordance with SFAS No. 140, "Accounting for Transfers and Servicing of Financial Assets and Extinguishments of Liabilities - A replacement of SFAS No. 125." A transfer of financial assets in which the Company had surrendered control over those assets was accounted for as a sale to the extent that consideration other than beneficial interests in the transferred assets was received in exchange. Control over transferred assets was surrendered only if all of the following conditions were met: 1. The transferred assets have been isolated from the transferor (i.e., they are beyond the reach of the transferor and its creditors); 2. Each transferee has the unconditional right to pledge or exchange the transferred assets it received; and 3. The Company does not maintain effective control over the transferred assets either (a) through an agreement that entitles and obligates the transferor to repurchase or redeem the transferred assets before their maturity or (b) through the ability to unilaterally cause the holder to return specific assets, other than through a cleanup call. If a transfer of financial assets did not meet the criteria for a sale as described above, the Company and transferee accounted for the transfer as a secured borrowing with pledge of collateral and, accordingly, the Company was prevented from derecognizing the transferred financial assets. Where derecognizing criteria were met and the transfer was accounted for as a sale, the Company removed financial assets from the consolidated balance sheet and a net loss was recognized in income at the time of sale. F-11 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 CASH AND CASH EQUIVALENTS - The Company considers all highly liquid debt investments purchased with a maturity of three months or less to be cash equivalents. At times, cash balances held at financial institutions are in excess of federal depository insurance limits. The Company has not experienced any losses on cash and cash equivalents. As of March 31, 2008, cash and cash equivalents includes $3.0 million deposited in lock box accounts that are swept daily by the Lender under various credit agreements (Note 5). Cash held in the Company's bank accounts as of March 31, 2007, collected on behalf of the buyer of accounts receivable, is not included in the Company's cash and cash equivalents. Such amounts are treated as part of the security reserve funds in connection with the Accounts Purchase Agreement (Note 3). LETTERS OF CREDIT - At March 31, 2008, the Company has two outstanding standby letters of credit totaling $1.4 million. These letters of credit were issued by the Company's Lender and correspondingly reduce the Company's borrowing availability under its credit agreements with the Lender (Note 5). RESTRICTED CASH - As of March 31, 2007, restricted cash consists of amounts deposited in short term time deposits with a commercial bank to collateralize the Company's obligations pursuant to certain agreements. As of March 31, 2008, this collateral is no longer needed. INVENTORIES OF SUPPLIES - Inventories of supplies are valued at the lower of weighted average cost or market. PROPERTY AND EQUIPMENT - Property and equipment are stated at cost, less accumulated depreciation and any impairment write-downs related to assets held and used. Additions and improvements to property and equipment are capitalized at cost. Expenditures for maintenance and repairs are charged to expense as incurred. Capital leases are recorded at the beginning of the lease term as property and equipment and a corresponding lease liability is recognized. The value of the property and equipment under capital lease is recorded at the lower of either the present value of the minimum lease payments or the fair value of the asset. Such assets, including improvements, are amortized over the shorter of either the lease term or their estimated useful life, where applicable. The Company uses the straight-line method of depreciation for buildings and improvements, and equipment over their estimated useful lives of 25 years and 3 to 15 years, respectively. F-12 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 LONG-LIVED ASSETS - The Company evaluates its long-lived assets for possible impairment whenever circumstances indicate that the carrying amount of the asset, or related group of assets, may not be recoverable from estimated future cash flows. However, there is an evaluation performed at least annually. Fair value estimates are derived from established market values of comparable assets or internal calculations of estimated future net cash flows. The estimates of future net cash flows are based on assumptions and projections believed by the Company to be reasonable and supportable. These assumptions take into account patient volumes, changes in payer mix, revenue, and expense growth rates and changes in legislation and other payer payment patterns. The Company believes there has been no impairment in the carrying value of its property and equipment at March 31, 2008. DEBT ISSUANCE COSTS - This deferred charge consists of the $750.0 origination fee for the Company's $50.0 million Revolving Line of Credit (new debt) and $742.6 in legal and other expenses incurred in connection with the Company's refinancing paid to third parties (Note 5). These amounts are amortized over the financing agreements' three year life using the straight-line method, which approximates the effective interest method. Other credit agreements (Note 5) entered into on the October 9, 2007 effective date of the $50.0 million Revolving Line of Credit were accounted for as extinguishment of existing debt in accordance with EITF 96-19, "Debtor's Accounting for a Modification or Exchange of Debt Instruments," and EITF 06-6. "Debtor's Accounting for a Modification (or Exchange) of Convertible Debt Instruments." Accordingly, debt issuance costs consisting of loan origination fees of $1.4 million paid to the Lender associated with those credit agreements were expensed as an interest charge during the year ended March 31, 2008. Debt issuance costs of $236.3, $899.6, $836.7, and $241.6 were amortized during the years ended March 31, 2008 and 2007, December 31, 2005, and the three months ended March 31, 2006, respectively. At March 31, 2008 and 2007, prepaid expenses and other current assets in the accompanying consolidated balance sheets included $497.5 and $0, respectively, as the current portion of the debt issuance costs. MEDICAL CLAIMS INCURRED BUT NOT REPORTED - The Company was contracted with CalOptima, which is a county sponsored entity that operates similarly to an HMO, to provide healthcare services to indigent patients at a fixed amount per enrolled member per month. Through April 2007, the Company received payments from CalOptima based on a fixed fee multiplied by the number of enrolled members at the Hospitals ("Capitation Fee"). The Company recognizes these Capitation Fees as revenues on a monthly basis. In certain circumstances, members would receive healthcare services from hospitals not owned by the Company. In these cases, the Company records estimates of patient member claims incurred but not reported ("IBNR") for services provided by other healthcare institutions. IBNR claims are estimated using historical claims patterns, current enrollment trends, hospital pre-authorizations, member utilization patterns, timeliness of claims submissions, and other factors. There can, however, be no assurance that the ultimate liability will not exceed estimates. Adjustments to the estimated IBNR claims are recorded in the Company's results of operations in the periods when such amounts are determinable. Per guidance under SFAS No. 5, the Company accrues for IBNR claims when it is probable that expected future healthcare costs and maintenance costs under an existing contract have been incurred and the amount can be reasonably estimated. The Company records a charge related to these IBNR claims against its net operating revenues. The Company's net revenues from CalOptima capitation, net of third party claims and estimates of IBNR claims, for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006 were $0.35 million, $1.3 million, $3.2 million, and $1.4 million, respectively. IBNR claims accruals at March 31, 2008 and 2007 were $1.5 and $4.1 million, respectively. The Company's direct cost of providing services to patient members is included in the Company's normal operating expenses. F-13 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 STOCK-BASED COMPENSATION - SFAS No. 123R, "Share Based Payment," requires companies to measure compensation cost for stock-based employee compensation plans at fair value at the grant date and recognize the expense over the employee's requisite service period. Effective April 1, 2006, the Company adopted SFAS No. 123R (Note 9). FAIR VALUE OF FINANCIAL INSTRUMENTS - The Company's financial instruments recorded in the consolidated balance sheets include cash and cash equivalents, restricted cash, receivables, accounts payable, and other liabilities including warrant liability and debt. The recorded carrying value of such financial instruments approximates a reasonable estimate of their fair value. To finance the Acquisition, the Company entered into agreements that contained warrants (Notes 5 and 6), which were subsequently required to be accounted for as derivative liabilities. A derivative is an instrument whose value is derived from an underlying instrument or index such as a future, forward, swap, or option contract, or other financial instrument with similar characteristics, including certain derivative instruments embedded in other contracts ("embedded derivatives") and for hedging activities. As a matter of policy, the Company does not invest in separable financial derivatives or engage in hedging transactions. However, the Company may engage in complex transactions in the future that also may contain embedded derivatives. Derivatives and embedded derivatives, if applicable, are measured at fair value and marked to market through earnings. WARRANTS - In connection with its Acquisition of the Hospitals and credit agreements, the Company entered into complex transactions that contain warrants requiring accounting treatment in accordance with SFAS No. 133, SFAS No. 150 and EITF No. 00-19 (Notes 5 and 6). INCOME (LOSS) PER COMMON SHARE - Income (loss) per share is calculated in accordance with SFAS No. 128, "Earnings per Share." Basic income (loss) per share is based upon the weighted average number of common shares outstanding (Note 11). Due to the net losses incurred by the Company, the anti-dilutive effects of warrants and stock options have been excluded in the calculations of diluted loss per share for those periods presented in the accompanying consolidated statements of operations with net losses. SUPPLEMENTAL CASH FLOW INFORMATION - Interest paid during the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006 was $11.3 million, $12.2 million, $9.2 million, and $2.6 million, respectively. The Company made cash payments for taxes of $3 during the year ended March 31, 2008, $5 during the year ended March 31, 2007 and the three months ended March 31, 2006, and $1.4 million during the year ended December 31, 2005. The $1.4 million in taxes paid during the year ended December 31, 2005 was fully refunded to the Company during the year ended March 31, 2007. The Company entered into new capital lease obligations of $958, $749 and $5,109 during the years ended March 31, 2008 and 2007 and December 31, 2005, respectively. The Company revised its initial estimate of a capital lease obligation by $437 during the three months ended March 31, 2006. The Company rescinded a secured promissory note for the return of a deposit on hospital assets of $10.0 million during the year ended December 31, 2005. During the year ended March 31, 2008, the Company reclassified warrant liability of $25,677 to equity (Note 6). The Company had non cash exercises of warrants of $4,206 and $9,199 during the years ended March 31, 2008 and 2007, respectively. During the year ended March 31, 2007 the Company recorded the non cash issuance of warrants to a vendor with a value of $164. Effective October 9, 2007, in conjunction with the Company's refinancing (Note 5), the Accounts Purchase Agreement was terminated and the Company repurchased the remaining outstanding accounts that been sold, for $6.8 million (funded through the initial advance on the $50.0 million Revolving Line of Credit) in addition to the release of security reserve funds and deferred purchase price receivables. INCOME TAXES - The Company accounts for income taxes in accordance with SFAS No. 109, "Accounting for Income Taxes," which requires the liability approach for the effect of income taxes. Under SFAS No. 109, deferred income tax assets and liabilities are determined based on the differences between the book and tax basis of assets and liabilities and are measured using the currently enacted tax rates and laws. The Company assesses the realization of deferred tax assets to determine whether an income tax valuation allowance is required. The Company has recorded a 100% valuation allowance on its deferred tax assets. F-14 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 On July 13, 2006, the FASB issued FIN 48, "Accounting for Uncertainty in Income Taxes - an interpretation of FASB Statement No. 109," which clarifies the accounting and disclosure for uncertain tax positions. This interpretation is effective for fiscal years beginning after December 15, 2006 and the Company has implemented this interpretation as of April 1, 2007. FIN 48 prescribes a recognition threshold and measurement attribute for recognition and measurement of a tax position taken or expected to be taken in a tax return. FIN 48 also provides guidance on de-recognition, classification, interest and penalties, accounting in interim periods, disclosure and transition. Under FIN 48, evaluation of a tax position is a two-step process. The first step is to determine whether it is more-likely-than-not that a tax position will be sustained upon examination, including the resolution of any related appeals or litigation based on the technical merits of that position. The second step is to measure a tax position that meets the more-likely-than-not threshold to determine the amount of benefit to be recognized in the financial statements. A tax position is measured at the largest amount of benefit that is greater than 50 percent likely of being realized upon ultimate settlement. Tax positions that previously failed to meet the more-likely-than-not recognition threshold should be recognized in the first subsequent period in which the threshold is met. Previously recognized tax positions that no longer meet the more-likely-than-not criteria should be de-recognized in the first subsequent financial reporting period in which the threshold is no longer met. The adoption of FIN 48 at April 1, 2007 did not have a material effect on the Company's financial position. The Company and its subsidiaries file income tax returns in the U.S. federal jurisdiction and California. The Company is no longer subject to U.S. federal and state income tax examinations by tax authorities for years before December 31, 2003 and December 31, 2002, respectively. Certain tax attributes carried over from prior years continue to be subject to adjustment by taxing authorities. Penalties or interest, if any, arising from federal or state taxes are recorded as a component of the income tax provision. SEGMENT REPORTING - The Company operates in one line of business, the provision of healthcare services through the operation of general hospitals and related healthcare facilities. The Company's Hospitals generated substantially all of its net operating revenues during the periods since the Acquisition. The Company's four general Hospitals and related healthcare facilities operate in one geographic region in Orange County, California. The region's economic characteristics, the nature of the Hospitals' operations, the regulatory environment in which they operate, and the manner in which they are managed are all similar. This region is an operating segment, as defined by SFAS No. 131. In addition, the Company's general Hospitals and related healthcare facilities share certain resources and benefit from many common clinical and management practices. Accordingly, the Company aggregates the facilities into a single reportable operating segment. RECENTLY ENACTED ACCOUNTING STANDARDS - In September 2006, the FASB issued SFAS No. 157, "Fair Value Measurements." This Statement establishes a single authoritative definition of fair value, sets out a framework for measuring fair value, and requires additional disclosures about fair value measurements. SFAS No. 157 applies only to fair value measurements that are already required or permitted by other accounting standards. The statement is effective for financial statements for fiscal years beginning after November 15, 2007, with earlier adoption permitted. The Company is evaluating the impact, if any, that the adoption of this statement will have on its consolidated results of operations and financial position. On February 14, 2008, the FASB issued FASB Staff Position No. FAS 157-1, "Application of FASB Statement No. 157 to FASB Statement No. 13 and Other Accounting Pronouncements That Address Fair Value Measurements for Purposes of Lease Classification or Measurement under Statement 13" ("FSP FAS 157-1"). This Statement does not apply under FASB Statement No. 13, "Accounting for Leases," and other accounting pronouncements that address fair value measurements for purposes of lease classification or measurement under Statement 13. This scope exception does not apply to assets acquired and liabilities assumed in a business combination that are required to be measured at fair value under SFAS 141 or SFAS 141R, regardless of whether those assets and liabilities are related to leases. F-15 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 On February 12, 2008, the FASB issued FASB Staff Position No. FAS 157-2, "Effective Date of FASB Statement No. 157" ("FSP FAS 157-2"). With the issuance of FSP FAS 157-2, the FASB agreed to: (a) defer the effective date in SFAS No. 157 for one year for certain nonfinancial assets and nonfinancial liabilities, except those that are recognized or disclosed at fair value in the financial statements on a recurring basis (at least annually), and (b) remove certain leasing transactions from the scope of SFAS No. 157. The deferral is intended to provide the FASB time to consider the effect of certain implementation issues that have arisen from the application of SFAS No. 157 to these assets and liabilities. In December 2007, the FASB issued SFAS No. 141(R) "Business Combinations" ("SFAS 141R"). The statement retains the purchase method of accounting for acquisitions, but requires a number of changes, including changes in the way assets and liabilities are recognized in the purchase accounting as well as requiring the expensing of acquisition-related costs as incurred. Furthermore, SFAS 141R provides guidance for recognizing and measuring the goodwill acquired in the business combination and determines what information to disclose to enable users of the financial statements to evaluate the nature and financial effects of the business combination. SFAS 141R is effective for fiscal years beginning on or after December 15, 2008. Earlier adoption is prohibited. The Company is evaluating the impact, if any, that the adoption of this statement will have on its consolidated results of operations and financial position. In February 2007, the FASB issued SFAS No. 159, "The Fair Value Option for Financial Assets and Financial Liabilities-Including an amendment of FASB Statement No. 115." SFAS No. 159 permits entities to choose to measure many financial instruments and certain other items at fair value. Most of the provisions of SFAS No. 159 apply only to entities that elect the fair value option; however, the amendment to SFAS No. 115, "Accounting for Certain Investments in Debt and Equity Securities," applies to all entities with available for sale and trading securities. The statement is effective for financial statements for fiscal years beginning after November 15, 2007. The Company is evaluating the impact, if any, that the adoption of this statement will have on its consolidated results of operations and financial position. In December 2007, the FASB issued SFAS No. 160, "Noncontrolling Interests in Consolidated Financial Statements -- An Amendment of ARB No. 51" ("SFAS 160"). SFAS 160 requires all entities to report noncontrolling(minority) interests in subsidiaries as equity in the consolidated financial statements. Also, SFAS 160 is intended to eliminate the diversity in practice regarding the accounting for transactions between an equity and noncontrolling interests by requiring that they be treated as equity transactions. SFAS 160 is effective for fiscal years beginning on or after December 15, 2008. Earlier adoption is prohibited. SFAS 160 must be applied prospectively as of the beginning of the fiscal year in which it is initially applied, except for the presentation and disclosure requirements, which must be applied retrospectively for all periods presented. The Company has not yet evaluated the impact that SFAS 160 will have on its consolidated results of operations or financial position. In March 2008, the FASB issued SFAS No. 161, "Disclosures about Derivative Instruments and Hedging Activities" ("SFAS 161"). SFAS 161 is intended to improve financial reporting of derivative instruments and hedging activities by requiring enhanced disclosures to enable financial statement users to better understand the effects of derivatives and hedging on an entity's financial position, financial performance and cash flows. The provisions of SFAS 161 are effective for interim periods and fiscal years beginning after November 15, 2008. The Company does not anticipate that the adoption of SFAS No. 161 will have a material impact on its consolidated results of operations or financial position. May 9, 2008, the FASB issued FASB Staff Position No. APB 14-1, "Accounting for Convertible Debt Instruments That May Be Settled in Cash upon Conversion (Including Partial Cash Settlement)" ("FSP APB 14-1"). FSP APB 14-1 clarifies that convertible debt instruments that may be settled in cash upon conversion (including partial cash settlement) are not addressed by paragraph 12 of APB Opinion No. 14, "Accounting for Convertible Debt and Debt Issued with Stock Purchase Warrants." Additionally, FSP APB 14-1 specifies that issuers of such instruments should separately account for the liability and equity components in a manner that will reflect the entity's nonconvertible debt borrowing rate when interest cost is recognized in subsequent periods. FSP APB 14-1 is effective for financial statements issued for fiscal years beginning after December 15, 2008, and interim periods within those fiscal years. The Company has not yet evaluated the impact that FSP APB 14-1 will have on its consolidated results of operations or financial position. F-16 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 2 - ACQUISITION On March 8, 2005, the Company completed the Acquisition of its Hospitals. The Hospitals were assigned to four wholly owned subsidiaries of the Company formed for the purpose of completing the Acquisition. The Company also acquired the following real estate, leases and assets associated with the Hospitals: i. a fee interest in the Western Medical Center at 1001 North Tustin Avenue, Santa Ana, CA, a fee interest in the administration building at 1301 North Tustin Avenue, Santa Ana, CA, certain rights to acquire condominium suites located in the medical office building at 999 North Tustin Avenue, Santa Ana, CA, and the business known as the West Coast Breast Cancer Center; ii. a fee interest in the Western Medical Center at 1025 South Anaheim Blvd., Anaheim, CA; iii. a fee interest in the Coastal Communities Hospital at 2701 South Bristol Street, Santa Ana, CA, and a fee interest in the medical office building at 1901 North College Avenue, Santa Ana, CA; iv. a lease for the Chapman Medical Center at 2601 East Chapman Avenue, Orange, CA, and a fee interest in the medical office building at 2617 East Chapman Avenue, Orange, CA; and v. equipment and contract rights. Subsequently, the Company entered into a sale leaseback transaction for substantially all of the real estate with PCHI (Note 12). The operating results of the Hospitals have been included in the Company's consolidated statements of operations from the date of acquisition (March 8, 2005). The purchase price, after all purchase price adjustments, of the Acquisition amounted to $66,247. The fair value of the assets acquired and related costs consisted of the following: Property and equipment $55,834 Inventories 6,019 Prepaid expenses 2,461 ------- 64,314 Debt issuance costs 1,933 ------- $66,247 ======= The Company financed the Acquisition and related financing costs (Note 5) by obtaining a $50 million Acquisition Loan, drawing $3.0 million on a working capital line of credit, selling shares of the Company's common stock for $10.1 million, and receiving $5.0 million in proceeds from minority investments in PCHI. The following unaudited supplemental pro forma information represents the Company's consolidated results of operations as if the Acquisition had occurred on January 1, 2005 and after giving effect to certain adjustments including interest expense, depreciation expense, and related tax effects. In addition, the following unaudited pro forma information includes the nonrecurring items related to the issuance of 74,700 common stock warrants (Note 6), which resulted in an expense of $17,604 that the Company recorded during the year ended December 31, 2005 and restructuring charges of $3,147 incurred by Tenet during the three months ended March 31, 2005. Such unaudited pro forma information does not purport to be indicative of operating results that would have been reported had the Acquisition occurred on January 1, 2005 or future operating results. Pro forma (unaudited) For the year ended December 31, 2005 Net operating revenues $ 338,994 Net loss $ (59,464) Per share data: Basic and fully diluted loss per common per common share $ (0.71) Weighted average shares outstanding 83,817 F-17 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 3 - ACCOUNTS RECEIVABLE In March 2005, the Company entered into an Accounts Purchase Agreement (the "APA") for a minimum of two years with Medical Provider Financial Corporation I, an unrelated party (the "Buyer"). The Buyer is an affiliate of the Lender (Note 5). The APA provided for the sale of 100% of the Company's eligible accounts receivable, as defined, without recourse. The APA required the Company to provide billing and collection services, maintain the individual patient accounts, and resolve any disputes that arose between the Company and the patient or other third party payer for no additional consideration. Effective October 9, 2007, in conjunction with the Company's refinancing (Note 5), the APA was terminated and the Company repurchased the remaining outstanding accounts that been sold, for $6.8 million (funded through the initial advance on the $50.0 million Revolving Line of Credit) in addition to the release of security reserve funds and deferred purchase price receivables. This resulted in a gain on repurchase of accounts receivable of $918 which was offset against the loss on sale of accounts receivable recorded during the year ended March 31, 2008, resulting in a total net loss on the sale of accounts receivable of $4.1 million. From inception of the APA through October 9, 2007 (date of termination) the Buyer advanced $639.6 million to the Company through the APA. In addition, the Company received $56.9 million in reserve releases from inception through October 9, 2007. Payments posted on sold receivables from inception approximated $671.3 million. Advances net of payment and adjustment activity, cumulatively through October 9, 2007 (date of termination) and March 31, 2007 were $(5.4) million and $7.0 million, respectively. Transaction Fees incurred for the same periods (from inception) were $11.7 and $9.3 million, respectively. F-18 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 The Company recorded estimated Transaction Fees and estimated servicing liability related to the sold accounts receivable at the time of sale. The estimated servicing liability was recorded at cost which approximated fair value of providing such services. The loss on sale of accounts receivable is comprised of the following. For the year ended For the three ---------------------------------------------------------- months ended March 31, 2008 March 31, 2007 December 31, 2005 March 31, 2006 ---------------- ----------------- ------------------- ------------------ Transaction Fees deducted from Security Reserve Funds - closed purchases $ 2,395 $ 4,568 $ 3,330 $ 1,394 Change in accrued Transaction Fees - open purchases (712) 262 863 108 ---------------- ----------------- ------------------- ------------------ Total Transaction Fees incurred 1,683 4,830 4,193 1,502 ---------------- ----------------- ------------------- ------------------ Servicing expense for sold accounts receivable - closed purchases 3,186 5,525 3,597 1,231 Change in accrued servicing expense for sold accounts receivable - open purchases (790) 33 680 75 ---------------- ----------------- ------------------- ------------------ Total servicing expense incurred 2,396 5,558 4,277 1,306 ---------------- ----------------- ------------------- ------------------ Loss on sale of accounts receivable $ 4,079 $ 10,388 $ 8,470 $ 2,808 ================ ================= =================== ==================
The related accrued Transaction Fee and accrued servicing liabilities included in other current liabilities on the accompanying consolidated balance sheet as of March 31, 2007 are as follows. Transaction fee liability $ 1,233 Accrued servicing liability $ 789 The accrued servicing liability recorded at March 31, 2007 approximates fair value in accordance with SFAS No. 140. F-19 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 4 - PROPERTY AND EQUIPMENT Property and equipment consists of the following: March 31, March 31, 2008 2007 --------------- --------------- Buildings $ 33,791 $ 33,697 Land and improvements 13,523 13,523 Equipment 10,520 9,694 Assets under capital leases 7,464 6,505 --------------- --------------- 65,298 63,419 Less accumulated depreciation (8,381) (5,247) --------------- --------------- Property and equipment, net $ 56,917 $ 58,172 =============== =============== Essentially all land and buildings are owned by PCHI (Notes 12, 13 and 14). The Hospitals are located in an area near active and substantial earthquake faults. The Hospitals carry earthquake insurance with a policy limit of $50.0 million. A significant earthquake could result in material damage and temporary or permanent cessation of operations at one or more of the Hospitals. In addition, the State of California has imposed new hospital seismic safety requirements. Under these new requirements, the Hospitals must meet stringent seismic safety criteria in the future and must complete one set of seismic upgrades to each facility by January 1, 2013. This first set of upgrades is expected to require the Company to incur substantial seismic retrofit expenses. In addition, there could be other remediation costs pursuant to this seismic retrofit. The State of California has introduced a new seismic review methodology known as HAZUS. The HAZUS methodology may preclude the need for some structural modifications. Three of the four Hospitals have requested HAZUS review and one of them has already received a favorable notice pertaining to structural reclassification. There are additional requirements that must be complied with by 2030. The costs of meeting these requirements have not yet been determined. Compliance with seismic ordinances will be a costly venture and could have a material adverse effect on the Company's cash flow. F-20 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 5 - DEBT The Company's debt payable to affiliates of Medical Capital Corporation, namely Medical Provider Financial Corporation I, Provider Financial Corporation II, and Medical Provider Financial Corporation III (collectively, the "Lender") consists of the following as of March 31. March 31, March 31, 2008 2007 ---------------- ---------------- Current: Secured note $ - $ 10,700 Less derivative - warrant liability, current - (10,700) Secured acquisition loan - 45,000 Secured line of credit, outstanding borrowings - 27,341 Revolving line of credit, outstanding borrowings 9,879 - ---------------- ---------------- $ 9,879 $ 72,341 ================ ================ Non-current: Convertible note $ 10,700 $ - Secured term note 45,000 - Secured non-revolving line of credit, outstanding borrowings 30,000 - ---------------- ---------------- $ 85,700 $ - ================ ================
F-21 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 Effective October 9, 2007, the Company and its Lender executed agreements to refinance the Lender's credit facilities with the Company aggregating up to $140.7 million in principal amount (the "New Credit Facilities"). The New Credit Facilities replaced the Company's previous credit facilities with the Lender, which matured on March 2, 2007. The Company had been operating under an Agreement to Forbear with the Lender with respect to the previous credit facilities. The New Credit Facilities consist of the following instruments: o An $80.0 million credit agreement, under which the Company issued a $45.0 million Term Note bearing a fixed interest rate of 9% in the first year and 14% after the first year, which was used to repay amounts owing under the Company's existing $50.0 million real estate term loan. o A $35.0 million Non-Revolving Line of Credit Note issued under the $80.0 million credit agreement, bearing a fixed interest rate of 9.25% per year and an unused commitment fee of 0.50% per year, which was used to repay amounts owing under the Company's existing $30.0 million line of credit, pay the origination fees on the other credit facilities and for working capital. o A $10.7 million credit agreement, under which the Company issued a $10.7 million Convertible Term Note bearing a fixed interest rate of 9.25% per year, which was used to repay amounts owing under the Company's existing $10.7 million loan. The $10.7 million Convertible Term Note is convertible into common stock of the Company at $0.21 per share during the term of the note. o A $50.0 million Revolving Credit Agreement, under which the Company issued a $50.0 million Revolving Line of Credit Note bearing a fixed interest rate of 24% per year (subject to reduction to 18% if the $45.0 million Term Loan is repaid prior to its maturity) and an unused commitment fee of 0.50% per year, which was used to finance the Company's accounts receivable and is available for working capital needs. Each of the above credit agreements and notes (i) required a 1.5% origination fee due at funding, (ii) matures in three years, at October 8, 2010, (iii) requires monthly payments of interest and repayment of principal upon maturity, (iv) are collateralized by all of the assets of the Company and its subsidiaries and the real estate underlying the Company's hospital facilities (which are owned by PCHI) and leased to the Company), and (v) are guaranteed by Orange County Physicians Investment Network, LLC ("OC-PIN") and West Coast Holdings, LLC ("West Coast"), a member of PCHI, pursuant to separate Guaranty Agreements in favor of the lender. Concurrently with the execution of the New Credit Facilities, the Company issued new and amended warrants (Note 6). The refinancing did not meet the requirements for a troubled debt restructuring in accordance with SFAS 15, "Accounting by Debtors and Creditors for Troubled Debt Restructuring." Under SFAS 15, a debtor must be granted a concession by the creditor for a refinancing to be considered a troubled debt restructuring. Although the New Credit Facilities have lower interest rates than the previous credit facilities, the fair value of the New Warrants (Note 6) resulted in the effective borrowing rate of the New Credit Facilities to significantly exceed the effective rate of the previous credit facilities. The nondetachable conversion feature of the $10.7 million Convertible Term Note is out-of-the-money on the Effective Date. Pursuant to EITF 05-2, "The Meaning of `Conventional Convertible Debt Instrument' in Issue No. 00-19," the $10.7 million Convertible Term Note is considered conventional for purposes of applying EITF 00-19, "Accounting for Derivative Financial Instruments Indexed to, and Potentially Settled in, a Company's Own Stock." F-22 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 The New Credit Facilities (excluding the $50.0 million Revolving Credit Agreement, which did not modify or exchange any prior debt) meet the criteria of EITF 06-6 for debt extinguishment accounting since the $10.7 million Convertible Term Note includes a substantive conversion option compared to the previous financing facilities. As a result, pursuant to EITF 96-19, related loan origination fees were expensed in the year ended March 31, 2008, and legal fees and other expenses are being amortized over three years (Note 1). Based on eligible receivables, as defined, the Company had approximately $27.4 million of additional availability under its $50.0 million Revolving Line of Credit at March 31, 2008. The Company's New Credit Facilities are subject to certain financial and restrictive covenants including debt service coverage ratio, minimum cash collections, dividend restrictions, mergers and acquisitions, and other corporate activities common to such financing arrangements. Effective for the period from January 1, 2008 through June 30, 2009, the Lender amended the New Credit Facilities whereby the minimum fixed charge coverage ratio, as defined, was reduced from 1.0 to 0.4. This Amendment allowed the $85.7 million debt to be classified as non current. The Company was in compliance with all covenants, as amended, at March 31, 2008. As a condition of the New Credit Facilities, the Company entered into an Amended and Restated Triple Net Hospital Building Lease (the "Amended Lease") with PCHI (Note 14). Concurrently with the execution of the Amended Lease, the Company, PCHI, Ganesha Realty, LLC, ("Ganesha"), and West Coast entered into a Settlement Agreement and Mutual Release (Note 14). NOTE 6 - COMMON STOCK WARRANTS NEW WARRANTS - Concurrently with the execution of the New Credit Facilities (Note 5), the Company issued to an affiliate of the Lender a five-year warrant to purchase the greater of approximately 16.9 million shares of the Company's common stock or up to 4.95% of the Company's common stock equivalents, as defined, at $0.21 per share (the "4.95% Warrant"). In addition, the Company and the Lender entered into Amendment No. 2 to Common Stock Warrant, originally dated December 12, 2005, which entitles an affiliate of the Lender to purchase the greater of 26.1 million shares of the Company's common stock or up to 31.09% of the Company's common stock equivalents, as defined, at $0.21 per share (the "31.09% Warrant"). Amendment No. 2 to the 31.09% Warrant extended the expiration date of the Warrant to October 9, 2017, removed the condition that it only be exercised if the Company is in default of its previous credit agreements, and increased the exercise price to $0.21 per share unless the Company's stock ceases to be registered under the Securities Exchange Act of 1934, as amended. The 4.95% Warrant and the 31.09% Warrant are collectively referred to herein as the "New Warrants." The New Warrants were exercisable as of October 9, 2007, the effective date of the New Credit Facilities (the "Effective Date"). As of the Effective Date, the Company recorded warrant expense, and a related warrant liability, of $10.2 million relating to the New Warrants. RESTRUCTURING WARRANTS - The Company entered into a Rescission, Restructuring and Assignment Agreement with Dr. Kali Chaudhuri and Mr. William Thomas on January 27, 2005 (the "Restructuring Agreement"). Pursuant to the Restructuring Agreement, the Company issued warrants to purchase up to 74.7 million shares of the Company's common stock (the "Restructuring Warrants") to Dr. Chaudhuri and Mr. Thomas (not to exceed 24.9% of the Company's fully diluted capital stock at the time of exercise). In addition, the Company amended the Real Estate Option to provide for Dr. Chaudhuri's purchase of a 49% interest in PCHI for $2.45 million. F-23 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 The Restructuring Warrants were exercisable beginning January 27, 2007 and expire on July 27, 2008. The exercise price for the first 43.0 million shares purchased under the Restructuring Warrants is $0.003125 per share, and the exercise or purchase price for the remaining 31.7 million shares is $0.078 per share if exercised between January 27, 2007 and July 26, 2007, $0.11 per share if exercised between July 27, 2007 and January 26, 2008, and $0.15 per share thereafter. In accordance with SFAS No. 133 and EITF 00-19, the Restructuring Warrants were accounted for as liabilities and were revalued at each reporting date, and the changes in fair value were recorded as change in fair value of warrant liability on the consolidated statement of operations. During February 2007, Dr. Chaudhuri and Mr. Thomas submitted an exercise under these warrants to the Company. At March 31, 2007 the Company recorded the issuance of 28.7 million net shares under this exercise following resolution of certain legal issues relating thereto. The issuance of these shares resulted in an addition to paid in capital and to common stock totaling $9.2 million. These shares were issued to Dr. Chaudhuri and Mr. Thomas on July 2, 2007. The shares pursuant to this exercise were recorded as issued and outstanding at March 31, 2007. Additionally, the remaining liability was revalued at March 31, 2007 in the amount of $4.2 million relating to potential shares (20.8 million shares) which could be issued, if the December Note warrant was to become issuable, which occurred on June 13, 2007 upon receipt of a notice of default from the Lender. On July 2, 2007, the Company accepted, due to the default and subsequent vesting of the December Note Warrant, an additional exercise under the anti-dilution provisions the Restructuring Warrant Agreement by Dr. Chaudhuri and Mr. Thomas. The exercise resulted in additional shares issuable of 20.8 million shares for consideration of $576 in cash. The effect of this exercise resulted in additional warrant expense for the year ended March 31, 2007 of $693, which was accrued based on the transaction as of March 31, 2007. The related warrant liability of $4.2 million (as of March 31, 2007) was reclassified to additional paid in capital when the 20.8 million shares were issued to Dr. Chaudhuri and Mr. Thomas in July 2007. Upon the Company's refinancing (Note 5) and the issuance of the New Warrants, the remaining 24.9 million Restructuring Warrants held by Dr. Chaudhuri and Mr. Thomas became exercisable on the Effective Date. Accordingly, as of the Effective Date, the Company recorded warrant expense, and a related warrant liability, of $1.2 million relating to the Restructuring Warrants. RECLASSIFICATION OF WARRANTS - On December 31, 2007, the Company amended its Articles of Incorporation to increase its authorized shares of common stock from 250 million to 400 million. Accordingly, effective December 31, 2007, the Company revalued the 24.9 million Restructuring Warrants and the New Warrants resulting in a change in the fair value of warrant liability of $2.9 million and $11.4 million, respectively, and reclassified the combined warrant liability balance of $25.7 million to additional paid in capital in accordance with EITF 00-19. The Company recorded common stock warrant expense of $11.4 million, $693, and $17.6 million during the years ended March 31, 2008 and 2007, and December 31, 2005. There was no common stock warrant expense recorded during the three months ended March 31, 2006. The Company recorded a change in the fair value of warrant liability of $14.3 million, $(133), $3.5 million, and $(8.2) million for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. F-24 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 To determine the fair value of the underlying shares, the assumptions used in Black-Scholes model were as follows: October 9, 2007 December 31, 2007 - ------------------------------------------ ------------------------------------------- Restructuring Warrants: Risk-free interest rate 4.1% Risk-free interest rate 2.7% Expected volatility 34.8% Expected volatility 26.9% Dividend yield - Dividend yield - Expected life (years) 0.30 Expected life (years) 0.07 Fair value of warrants $ 0.047 Fair value of warrants $ 0.161 Market value per share $ 0.14 Market value per share $ 0.25 New Warrants: 31.09% Warrant Risk-free interest rate 4.7% Risk-free interest rate 4.0% Expected volatility 47.0% Expected volatility 47.4% Dividend yield - Dividend yield - Expected life (years) 10.00 Expected life (years) 9.78 Fair value of warrants $ 0.089 Fair value of warrants $ 0.184 Market value per share $ 0.14 Market value per share $ 0.25 4.95% Warrant Risk-free interest rate 4.4% Risk-free interest rate 3.5% Expected volatility 35.2% Expected volatility 32.9% Dividend yield - Dividend yield - Expected life (years) 5.00 Expected life (years) 4.78 Fair value of warrants $ 0.043 Fair value of warrants $ 0.119 Market value per share $ 0.14 Market value per share $ 0.25
The expected volatility is based on an analysis of the Company's stock and the stock of the following publicly traded companies that own hospitals. Amsurg Inc. (AMSG) Community Health Systems (CYH) HCA Healthcare Company (HCA) Health Management Associates Inc. (HMA) Lifepoint Hospitals Inc. (LPNT) Medcath Corp. (MDTH) Tenet Healthcare Corp. (THC) Triad Hospitals Inc. (TRI) Universal Health Services Inc. Class B (USH) The risk-free interest rate is based on the average yield on U.S. Treasury zero-coupon issues with remaining terms equal to the expected terms of the warrants. The dividend yield reflects that the Company has not paid any cash dividends since inception and does not anticipate paying cash dividends in the foreseeable future. Although the Company believes this was the most reasonable and accurate methodology to determine the Company's volatility, the circumstances affecting volatility of the comparable companies selected may not be an accurate predictor of the Company's volatility. F-25 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 7 - INCOME TAXES The Company accounts for income taxes in accordance with SFAS No. 109 "Accounting for Income Taxes" which requires the liability approach for the effect of income taxes. Under the liability method, deferred tax assets and liabilities are recognized using tax rates for the effect of temporary differences between book and tax basis of recorded assets and liabilities. The provision for income taxes consists of provisions for federal and state income taxes. The preparation of consolidated financial statements in conformity with U.S. GAAP requires the Company to make estimates and assumptions that affect the reported amount of tax-related assets and liabilities and income tax provisions. The Company assesses the recoverability of the deferred tax assets on an ongoing basis. In making this assessment the Company is required to consider all available positive and negative evidence to determine whether, based on such evidence, it is more likely than not that some portion or all of the net deferred assets will be realized in future periods. This assessment requires significant judgment. In addition, the Company has made significant estimates involving current and deferred income taxes, tax attributes relating to the interpretation of various tax laws, historical bases of tax attributes associated with certain tangible and intangible assets and limitations surrounding the realization of the deferred tax assets. The Company does not recognize current and future tax benefits until it is deemed probable that certain tax positions will be sustained. The provision for income taxes consisted of the following:
For the years ended ------------------------------------------------------ For the three months ended March 31, 2008 March 31, 2007 December 31, 2005 March 31, 2006 -------------- ----------------- ----------------- -------------- Current income tax provision Federal $ 23 $ - $ - $ - State 5 5 5 5 -------------- ----------------- ----------------- -------------- 28 5 5 5 -------------- ----------------- ----------------- -------------- Deferred income tax benefit Federal - - - - State - - - - -------------- ----------------- ----------------- -------------- - - - - -------------- ----------------- ----------------- -------------- Income tax provision $ 28 $ 5 $ 5 $ 5 ============== ================= ================= ==============
F-26 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 A reconciliation between the amount of reported income tax expense and the amount computed by multiplying loss from continuing operations before income taxes by the statutory federal income tax rate is as follows: For the years ended ------------------------------------------------------ For the three months ended March 31, 2008 March 31, 2007 December 31, 2005 March 31, 2006 -------------- ----------------- ----------------- -------------- U.S. federal statutory income taxes $ (13,238) $ (7,184) $ (15,358) $ 789 State and local income taxes, net of federal benefits (2,258) (1,226) (2,665) (348) Change in valuation allowance 2,180 14,684 14,841 4,446 Warrants 8,730 45 7,162 (2,794) Enterprise zone credits (4,023) (6,666) (6,580) (1,666) Other 8,637 352 2,605 (422) -------------- ----------------- ----------------- -------------- Income tax provision $ 28 $ 5 $ 5 $ 5 ============== ================= ================= ==============
Deferred income taxes reflect the tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The following table discloses those significant components of deferred tax assets and liabilities, including the valuation allowance at March 31: 2008 2007 -------------- -------------- Deferred tax assets: Allowance for doubtful accounts $ 6,219 $ 1,052 Accrued vacation 2,169 2,542 Tax credits 18,936 14,913 Net operating losses 11,924 12,334 Other (3,343) 2,885 -------------- -------------- 35,905 33,726 Valuation allowance (35,905) (33,726) -------------- -------------- Total deferred tax assets $ - $ - ============== ============== The company has two Hospitals located in the State of California Enterprise Zone which has provided significant state tax credits ($18,936 as of March 31, 2008) which are allowable to reduce California income tax on a dollar-for-dollar basis. The credits, which are not subject to expiration, are granted by a State agency whose issuance can be reviewed by the California Franchise Tax Board. The valuation allowances above were recorded based on an assessment of the realization of deferred tax assets as described below. The Company assesses the realization of deferred tax assets to determine whether an income tax valuation allowance is required. The Company recorded a 100% valuation allowance on its deferred tax based primarily on the following factors: o cumulative losses in recent years; o income/losses expected in future years; o unsettled circumstances that, if unfavorably resolved, would adversely affect future operations and profit levels; o the availability, or lack thereof, of taxable income in prior carryback periods that would limit realization of tax benefits; o the carryforward period associated with the deferred tax assets and liabilities. ACQUISITION - The Acquisition was an asset purchase transaction and the Company will not benefit from the net operating losses of the acquired Hospitals prior to the date of acquisition. In connection with the Company's completion of the Acquisition in March 2005, the Company sold substantially all of the real estate of the acquired hospitals to PCHI. For income tax purposes, the sale of the real estate of the acquired hospitals is subject to review by the Internal Revenue Service. The IRS could require the Company to report dividend and/or interest income. If the Company is required to report dividend and/or interest income in connection with this transaction, the Company would be required to withhold 28% on any deemed dividend or interest income. The Company's sale of real estate to PCHI on March 8, 2005 for $5 million plus the assumption of the Acquisition Loan is a taxable event to the Company. F-27 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 PCHI TAX STATUS - PCHI is a limited liability corporation. PCHI's owners plan to make tax elections for it to be treated as a disregarded entity for tax reporting whereby, in a manner similar to a partnership. PCHI's taxable income or loss will flow through to its owners and be their separate responsibility. Accordingly, the accompanying consolidated financial statements do not include any amounts for the income tax expense or benefit, or liabilities related to PCHI's income or loss. The Company has Net Operating Loss carryfowards which expire as follows: Tax year ended Federal State December 31, amount expiring amount expiring -------------------- ------------------- ------------------- 2016 $ - $ 3,647 2021 $ - $ 8,734 2024 $ 10 $ - 2025 $ 9,818 $ - 2026 $ 20,307 $ - NOTE 8 - COMMON STOCK STOCK PURCHASE AGREEMENT - On January 28, 2005, the Company entered into a Stock Purchase Agreement (the "Stock Purchase Agreement") with OC-PIN a company founded by Dr. Anil V. Shah, a former board member, and owned by a number of physicians practicing at the acquired Hospitals. This agreement was subsequently amended to include the following: Under the First Amendment and the related Escrow Agreement, OC-PIN deposited a total of $12.5 million into the escrow account. However, following receipt of such funds, a disagreement arose between OC-PIN and the third party which provided $11.0 million of the $12.5 million deposited into the escrow account. In order to resolve this matter and to avoid potential litigation involving the Company, the Company agreed to return $11.0 million of these funds and provide OC-PIN with a limited opportunity to provide alternative financing. Therefore, effective October 31, 2005, the Company entered into a Second Amendment to the Stock Purchase Agreement (the "Second Amendment"), pursuant to which the Company and OC-PIN issued escrow instructions to release escrowed funds as of November 2, 2005, terminate the Escrow Agreement and distribute the assets in the escrow account as follows: 1. $1.5 million of the escrowed cash, plus a pro rata portion of the accrued interest, was delivered to the Company for payment of stock. 2. $11.0 million of the escrowed cash, plus a pro rata portion of the accrued interest was delivered to OC-PIN. 3. 5.8 million of the escrowed shares of the Company's common stock were delivered to OC-PIN. 4. 40.6 million of the escrowed shares of the Company's common stock were delivered to the Company. 5. OC-PIN transferred $2.8 million from another account to the Company for which OC-PIN received 10.8 million of the escrowed shares. 6. The Company agreed to issue to OC-PIN 5.4 million shares of its common stock multiplied by the percentage of OC-PIN's payment required to be made under the Stock Purchase Agreement, as amended, which had been made to date. On September 12, 2006, the Company issued 3.2 million of these shares to OC-PIN in full resolution of the Stock Purchase Agreement. F-28 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 9 - STOCK INCENTIVE PLAN The Company's 2006 Stock Incentive Plan (the "Plan"), which is shareholder-approved, permits the grant of share options to its employees and board members for up to a maximum aggregate of 12.0 million shares of common stock. In addition, as of the first business day of each calendar year in the period 2007 through 2015, the maximum aggregate number of shares shall be increased by a number equal to one percent of the number of shares of common stock of the Company outstanding on December 31 of the immediately preceding calendar year. As of March 31, 2008, the maximum aggregate number of shares under the Plan was increased by approximately 1.4 million shares for a total of 13.4 million. The Company believes that such awards better align the interests of its employees with those of its shareholders. In accordance with the Plan, incentive stock options, non-qualified stock options, and performance based compensation awards may not be granted at less than 100 percent of the estimated fair market value of the common stock on the date of grant. Incentive stock options granted to a person owning more than 10 percent of the voting power of all classes of stock of the Company may not be issued at less than 110 percent of the fair market value of the stock on the date of grant. Option awards generally vest based on 3 years of continuous service (1/3 of the shares vest on the twelve month anniversary of the grant date, and an additional 1/12 of the shares vest on each subsequent fiscal quarter-end of the Company following such twelve month anniversary). Certain option awards provide for accelerated vesting if there is a change of control, as defined. The option awards have 7-year contractual terms. On August 6, 2007, the Board of Directors approved the initial granting of options with the right to purchase an aggregate of 4,795 shares of the Company's common stock to eligible employees pursuant to the Plan. The grant price approved on that date is $0.26 per share. For options granted to employees who have been employed by the Company since its March 8, 2005 inception, vesting retroactively commenced on March 8, 2005. Of the total options granted, 3,500 are subject to this retroactive vesting. Vesting of the remaining 1,295 granted options commenced on the August 6, 2007 grant date. On October 10, 2007, the Board of Directors approved the granting of options with the right to purchase an aggregate of 1,750 shares of the Company's common stock to members of the Board pursuant to the Plan. The grant price approved on that date is $0.18 per share. Of the total options granted, 883.33 were subject to immediate vesting on the grant date. Vesting of the remaining 866.67 granted options commenced on the October 10, 2007 grant date. On December 13, 2007, the Company granted options to employees with the right to purchase an aggregate of 210 shares at an exercise prices of $0.30 per share. All options granted on December 13, 2007 commenced vesting on the grant date. On January 8, 2008, the Company granted options to employees with the right to purchase an aggregate of 760 shares at an exercise prices of $0.26 per share. For options granted to employees who have been employed by the Company since its March 8, 2005 inception, vesting retroactively commenced on March 8, 2005. Of the total options granted on January 8, 2008, 130 are subject to retroactive vesting commencing on March 8, 2005. Vesting of the remaining 630 granted options commenced on the January 8, 2008 grant date. When the measurement date is certain, the fair value of each option grant is estimated on the date of grant using the Black-Scholes valuation model and the assumptions noted in the table below. Since there is limited historical data with respect to both pre-vesting forfeiture and post-vesting termination, the expected life of the options was determined utilizing the simplified method described in the SEC's Staff Accounting Bulletin 107 ("SAB 107"). SAB 107 provides guidance whereby the expected term is calculated by taking the sum of the vesting term plus the original contractual term and dividing that quantity by two. The expected volatility is based on an analysis of the Company's stock and the stock of the following publicly traded companies that own hospitals. Amsurg Inc. (AMSG) Community Health Systems (CYH) HCA Healthcare Company (HCA) Health Management Associates Inc. (HMA) Lifepoint Hospitals Inc. (LPNT) Medcath Corp. (MDTH) Tenet Healthcare Corp. (THC) Triad Hospitals Inc. (TRI) Universal Health Services Inc. Class B (USH) F-29 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 The risk-free interest rate is based on the average yield on U.S. Treasury zero-coupon issues with remaining terms equal to the expected terms of the options. The dividend yield reflects that the Company has not paid any cash dividends since inception and does not anticipate paying cash dividends in the foreseeable future. Expected dividend yield 0.0% Risk-free interest rate 2.8% - 4.4% Expected volatility 30.6% - 37.1% Expected term (in years) 3.5 - 5.8 In accordance with SFAS No. 123R, the Company recorded $120.9 of compensation expense relative to stock options during the year ended March 31, 2008. No options were granted prior to August 6, 2007. A summary of stock option activity for the period from June 30, 2007 through March 31, 2008 is presented as follows (there was no prior stock option activity). Weighted- average Weighted- remaining average contractual Aggregate exercise term intrinsic Shares price (years) value ------------ ------------ ------------ ------------ Outstanding, March 31, 2007 - $ - Granted 7,515 $ 0.24 Exercised - $ - Forfeited or expired (70) $ 0.26 ------------ Outstanding, March 31, 2008 7,445 $ 0.24 6.4 $ - ============ ============ ============ ============ Exercisable at March 31, 2008 4,463 $ 0.24 6.4 $ - ============ ============ ============ ============
No options were exercised during the year ended March 31, 2008. A summary of the Company's nonvested shares as of March 31, 2008, and changes during the year ended March 31, 2008 (there was no prior stock option activity), is presented as follows. Weighted- average grant date Shares fair value ------------- ------------- Nonvested at March 31, 2007 - $ - Granted 7,515 $ 0.04 Vested (4,463) $ 0.03 Forfeited (70) $ 0.08 ------------- ============= Nonvested at March 31, 2008 2,982 $ 0.05 ============= ============= As of March 31, 2008, there was $152.0 of total unrecognized compensation expense related to nonvested share-based compensation arrangements granted under the Plan. That cost is expected to be recognized over a weighted-average period of 2.6 years. F-30 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 10 - RETIREMENT PLAN The Company has a 401(k) plan for its employees. All employees with 90 days of service are eligible to participate, unless they are covered by a collective bargaining agreement which precludes coverage. The Company matches employee contributions up to 3% (5% prior to May 1, 2006) of the employee's compensation, subject to IRS limits. During the years ended March 31, 2008 and 2007, December 31, 2005, and the three months ended March 31, 2006, the Company incurred expenses of $2,982, $3,053, $3,522, and $1,128, respectively, which are included in salaries and benefits in the accompanying consolidated statements of operations. NOTE 11 - INCOME (LOSS) PER SHARE Income (loss) per share has been calculated under SFAS No. 128, "Earnings per Share." SFAS No. 128 requires companies to compute income (loss) per share under two different methods, basic and diluted. Basic income (loss) per share is calculated by dividing the net income (loss) by the weighted average shares of common stock outstanding during the period. Diluted income (loss) per share is calculated by dividing the net income (loss) by the weighted average shares of common stock outstanding during the period and dilutive potential shares of common stock. Dilutive potential shares of common stock, as determined under the treasury stock method, consist of shares of common stock issuable upon exercise of stock warrants or options, net of shares of common stock assumed to be repurchased by the Company from the exercise proceeds. Since the Company incurred losses for the years ended March 31, 2008 and 2007, and December 31, 2005, antidilutive potential shares of common stock, consisting of approximately 200 million, 83 million, and 43 million shares issuable under warrants and stock options, respectively, have been excluded from the calculations of diluted loss per share for those periods. Income per share for the three months ended March 31, 2006 was computed as follows: Numerator: Net income $ 2,422 ============== Denominator: Weighted average common shares 84,281 Warrants 42,947 -------------- Denominator for diluted calculation 127,228 ============== Income per share - basic $ 0.03 Income per share - diluted $ 0.02 The number of shares into which the December Note warrant could convert is not included in the calculation of diluted income per share, as the related December Note was in default and thus the warrant had vested. The inclusion of the warrant on an as converted basis would not change the amount of reported diluted income per share. F-31 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 12 - VARIABLE INTEREST ENTITY Concurrent with the close on the Acquisition, and pursuant to an agreement dated September 28, 2004, as amended and restated on November 16, 2004, Dr. Chaudhuri and Dr. Shah exercised their option to purchase all of the equity interests in PCHI, which simultaneously acquired title to substantially all of the real property acquired by the Company in the Acquisition. The Company received $5.0 million and PCHI guaranteed the Company's Acquisition Loan (the Acquisition Loan was refinanced on October 9, 2007 with a $45.0 million Term Note (Note 5)). The Company remains primarily liable under the $45.0 million Term Note notwithstanding its guarantee by PCHI, and this note is cross-collateralized by substantially all of the Company's assets and all of the real property of the Hospitals. All of the Company's operating activities are directly affected by the real property that was sold to PCHI. Given these factors, the Company has indirectly guaranteed the indebtedness of PCHI. The Company is a guarantor on the $45.0 million Term Note should PCHI not be able to perform and has undertaken a contingent obligation to make future payments if those triggering events or conditions occur. PCHI is a related party entity that is affiliated with the Company through common ownership and control. It is owned 51% by West Coast Holdings, LLC (Dr. Shah and investors) and 49% by Ganesha Realty, LLC (Dr. Chaudhuri and Mr. Thomas). Under FIN 46R (Note 1), a company is required to consolidate the financial statements of any entity that cannot finance its activities without additional subordinated financial support, and for which one company provides the majority of that support through means other than ownership. Effective March 8, 2005, the Company determined that it provided the majority of financial support to PCHI through various sources including lease payments, remaining primarily liable under the $45.0 million Term Note, and cross-collateralization of the Company's non-real estate assets to secure the $45.0 million Term Note. Accordingly, the Company included the net assets of PCHI, net of consolidation adjustments, in its consolidated financial statements at March 31. 2008 2007 -------------- -------------- Total assets $ 45,517 $ 46,464 Total liabilities $ 45,363 $ 45,537 Members' equity $ 154 $ 927 Selected information from PCHI's results of operations for the years ended March 31, 2008 and 2007 and December 31, 2005, and for the three months ended March 31, 2006 is as follows:
Year ended Three months --------------------------------------------------- ended March 31, 2008 March 31, 2007 December 31, 2005 March 31, 2006 -------------- -------------- ----------------- -------------- Net revenues $ 8,965 $ 6,554 $ 7,277 $ 1,545 Net income (loss) $ 1,474 $ (593) $ (1,658) $ (100)
Consolidation adjustments to reflect the effects of the following matters are included in the accompanying consolidated financial statements: The Company's rental income and expense in the Hospitals has been eliminated, consolidating PCHI's ownership of the land and buildings in the accompanying consolidated financial statements. The amount of rent incurred and eliminated for the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006 was $8,965, $6,554, $7,277, and $1,545, respectively. Additionally, a gain of $4,433 arising from the Company's sale of the real property of the Hospitals to PCHI has been eliminated to record the land and buildings at the Company's cost. Essentially all land and buildings in the accompanying consolidated balance sheets are owned by PCHI. F-32 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 PCHI's equity accounts have been classified as a minority interest in a variable interest entity. The Company has a lease commitment to PCHI (Note 14). Based on the existing arrangements, aggregate payments are estimated to be approximately $156.0 million over the remainder of the initial term. Additionally, the Company is responsible for seismic remediation under the terms of the lease agreement (Note 4). NOTE 13 - RELATED PARTY TRANSACTIONS PCHI - The Company leases substantially all of the real property of the acquired Hospitals from PCHI. PCHI is owned by two LLC's, namely West Coast and Ganesha; which are co-managed by Dr. Sweidan and Dr. Chaudhuri, respectively. As the result of the partial exercise of the Restructuring Warrants, Dr. Chaudhuri and Mr. Thomas are constructively the holders of 49.5 million and 28.7 million shares of the outstanding stock of the Company as of March 31, 2008 and 2007, respectively. They are also the owners of the Restructuring Warrants to purchase up to 24.9 million shares of future stock in the Company, issuable as of October 9, 2007 due to an antidilution feature of the warrant (Note 6). As described in Note 12, PCHI is a variable interest entity and, accordingly, the Company has consolidated the financial statements of PCHI in the accompanying condensed financial statements. During the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, the Company paid $5.1 million, $2.2 million, $1.3 million, and $0.6 million, respectively, to a supplier that is also a shareholder of the Company. F-33 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 14 - COMMITMENTS AND CONTINGENCIES OPERATING LEASES - Concurrent with the closing of the Acquisition as of March 8, 2005, the Company entered into a sale leaseback type agreement with a related party entity, PCHI. The Company leases substantially all of the real estate of the acquired Hospitals and medical office buildings from PCHI. As a condition of the New Credit Facilities (Note 5), the Company entered into an Amended Lease with PCHI. The Amended Lease terminates on the 25-year anniversary of the original lease (March 8, 2005), grants the Company the right to renew for one additional 25-year period, and requires annual base rental payments of $8.3 million. However, until the Company refinances its $50.0 million Revolving Line of Credit Loan with a stated interest rate less than 14% per annum or PCHI refinances the $45.0 million Term Note, the annual base rental payments are reduced to $7.1 million. In addition, the Company may offset against its rental payments owed to PCHI interest payments that it makes to the Lender under certain of its indebtedness discussed above. The Amended Lease also gives PCHI sole possession of the medical office buildings located at 1901/1905 North College Avenue, Santa Ana, California (the "College Avenue Property") that are unencumbered by any claims by or tenancy of the Company. This lease commitment with PCHI is eliminated in consolidation (Note 12). Concurrently with the execution of the Amended Lease, the Company, PCHI, Ganesha, and West Coast entered into a Settlement Agreement and Mutual Release (the "Settlement Agreement") whereby the Company agreed to pay to PCHI $2.5 million as settlement for unpaid rents specified in the Settlement Agreement, relating to the College Avenue Property, and for compensation relating to the medical office buildings located at 999 North Tustin Avenue in Santa Ana, California, under a previously executed Agreement to Compensation. This transaction with PCHI is eliminated in consolidation (Note 12). Following is a schedule of the Company's future minimum operating lease payments, excluding the triple net lease with PCHI, that have initial or remaining non-cancelable lease terms in excess of one year as of March 31, 2008: Year ended March 31, --------------- 2009 $ 1,549 2010 1,274 2011 1,278 2012 1,270 2013 1,259 Thereafter 16,963 ------------ Total $ 23,593 ============ Total rental expense for the years ended March 31, 2008 and 2007 and December 31, 2005 was $1,754, $1,839, and $2,276, respectively, and $393 for the three months ended March 31, 2006. The Company received sublease rental income in relation to certain leases of approximately $638, $759, and $536 for the years ended March 31, 2008 and 2007 and December 31, 2005, respectively, and $190 for the three months ended March 31, 2006. F-34 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 CAPITAL LEASES - In connection with the Hospital Acquisition, the Company also assumed the leases for the Chapman facility, which include buildings and land with terms that were extended concurrently with the assignment of the leases to December 31, 2023. The Company leases equipment under capital leases expiring at various dates through January 2013. Assets under capital leases with a net book value of $6,335 and $5,872 are included in the accompanying consolidated balance sheets as of March 31, 2008 and 2007, respectively. Interest rates used in computing the net present value of the lease payments are based on the interest rates implicit in the leases. The following is a schedule of future minimum lease payments under the capitalized leases with the present value of the minimum lease payments as of March 31, 2008: Year ended March 31, - ------------------------ 2009 $ 1,240 2010 1,240 2011 1,219 2012 1,094 2013 984 Thereafter 7,999 ------------------ Total minimum lease payments 13,776 Less amount representing interest (6,995) ------------------ Net present value of net minimum lease payments 6,781 Less current portion (406) ------------------ Noncurrent portion $ 6,375 ================== INSURANCE - The Company accrues for estimated general and professional liability claims, to the extent not covered by insurance, when they are probable and reasonably estimable. The Company has purchased as primary coverage a claims-made form insurance policy for general and professional liability risks. Estimated losses within general and professional liability retentions from claims incurred and reported, along with IBNR claims, are accrued based upon projections and are discounted to their net present value using a weighted average risk-free discount rate of 5%. To the extent that subsequent claims information varies from estimates, the liability is adjusted in the period such information becomes available. As of March 31, 2008 and 2007, the Company had accrued $9.9 million and $4.9 million, respectively, which is comprised of $3.0 million and $1.4 million, respectively, in incurred and reported claims, along with $6.9 million and $3.5 million, respectively, in estimated IBNR. The Company has also purchased occurrence coverage insurance to fund its obligations under its workers' compensation program. Effective May 2006, the Company secured a "guaranteed cost" policy, under which the carrier pays all workers' compensation claims, with no deductible or reimbursement required of the Company. The Company accrues for estimated workers' compensation claims, to the extent not covered by insurance, when they are probable and reasonably estimable. The ultimate costs related to this program include expenses for deductible amounts associated with claims incurred and reported in addition to an accrual for the estimated expenses incurred in connection with IBNR claims. Claims are accrued based upon projections and are discounted to their net present value using a weighted average risk-free discount rate of 5%. To the extent that subsequent claims information varies from estimates, the liability is adjusted in the period such information becomes available. As of March 31, 2008 and 2007, the Company had accrued $710 and $1,000, respectively, comprised of $169 and $200, respectively, in incurred and reported claims, along with $541 and $800, respectively, in estimated IBNR. F-35 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 Effective May 1, 2007, the Company initiated a self-insured health benefits plan for its employees. As a result, the Company has established and maintains an accrual for IBNR claims arising from self-insured health benefits provided to employees. The Company's IBNR accrual at March 31, 2008 was based upon projections . The Company determines the adequacy of this accrual by evaluating its limited historical experience and trends related to both health insurance claims and payments, information provided by its insurance broker and third party administrator and industry experience and trends. The accrual is an estimate and is subject to change. Such change could be material to the Company's consolidated financial statements. As of March 31, 2008, the Company had accrued $1.7 million in estimated IBNR. The Company believes this is the best estimate of the amount of IBNR relating to self-insured health benefit claims at March 31, 2008. Since the Company's self-insured health benefits plan was initiated in May 2007, the Company has not yet established historical trends which, in the future, may cause costs to fluctuate with increases or decreases in the average number of employees, changes in claims experience, and changes in the reporting and payment processing time for claims. The Company has also purchased umbrella liability policies with aggregate limits of $25 million. The umbrella policies provide coverage in excess of the primary layer and applicable retentions for insured liability risks such as general and professional liability, auto liability, and workers compensation (employers liability). The Company finances various insurance policies at interest rates ranging from 4.23% to 6.35% per annum. The Company incurred finance charges relating to such policies of $123, $248, $89, and $1 during the years ended March 31, 2008 and 2007 and December 31, 2005, and the three months ended March 31, 2006, respectively. As of March 31, 2008 and 2007, the accompanying consolidated balance sheets include the following balances relating to the financed insurance policies. March 31, 2008 March 31, 2007 ---------------- ---------------- Prepaid insurance $ 721 $ 5,004 Accrued insurance premiums $ 299 $ 3,808 (Included in other current liabilities) PURCHASE COMMITMENTS - The Company has commitments with two unrelated party service provider vendors extending over one year with two suppliers. Commitments total $3,663, $3,613, $3,064, $3,064, and $0 for the years ending March 31, 2009, 2010, 2011, 2012, and 2013, respectively. BONUSES - During the year ended March 31, 2008, the Company implemented the Corporate Team Bonus Plan for 2007/2008. Under this discretionary plan, eligible employees could receive bonuses based on the Company's performance and individual performances. For the year ended March 31, 2008, the Company awarded eligible employees an aggregate of $494,669, which is included in accrued compensation and benefits in the accompanying consolidated balance sheet as of March 31, 2008. The bonuses were approved by the Company's Board of Directors and were paid in June 2008. SEVERANCE AGREEMENT - On December 31, 2007, the Company entered into a Severance Agreement With Mutual Releases ("Severance Agreement") and a Consulting Agreement with Larry B. Anderson. Under the Severance Agreement, Mr. Anderson terminated his employment as President of the Company by mutual agreement, effective December 31, 2007. Under the Severance Agreement, Mr. Anderson could receive consideration currently valued at approximately $465,000. The Company will pay Mr. Anderson compensation equivalent to fourteen equal monthly installments. The amount of each monthly installment shall be the sum of Mr. Anderson's base monthly salary, net of required deductions, plus the monthly value of his health and dental insurance, plus the monthly value of his automobile allowance. The schedule of payments is as follows: (i) one lump sum upfront payment equivalent to eight monthly installments, and (ii) the remaining six equal installments shall be paid to him on or before the first business day of each month, commencing on September 1, 2008. In addition, the Company paid a year end (December 31, 2007) bonus of $30,000 to Mr. Anderson. The Severance Agreement also includes mutual releases, specific waivers and releases, nondisclosure of confidential information, return of property, future cooperation, non-disparagement, and general provisions customary in such agreements. F-36 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 Under the terms of the Consulting Agreement, which is effective from January 1, 2008 through June 30, 2008, the Company will pay Mr. Anderson $180,000 consisting of one upfront payment of $60,000 and four equal monthly installments of $30,000 each, commencing April 1, 2008, with the last payment due on July 1, 2008. As additional compensation for special projects, such as his services relating to the then-proposed acquisition of a specifically identified hospital by the Company, Mr. Anderson would be entitled to receive 0.5% of the total value of the purchase, minus $30,000, or an estimated $310,000 if the acquisition was consummated at the then-proposed price. Such acquisition was not consummated by the Company. The Consulting Agreement contains other provisions customary to such agreements. CLAIMS AND LAWSUITS - The Company and the Hospitals are subject to various legal proceedings, most of which relate to routine matters incidental to operations. The results of these claims cannot be predicted, and it is possible that the ultimate resolution of these matters, individually or in the aggregate, may have a material adverse effect on the Company's business (both in the near and long term), financial position, results of operations, or cash flows. Although the Company defends itself vigorously against claims and lawsuits and cooperates with investigations, these matters (1) could require payment of substantial damages or amounts in judgments or settlements, which individually or in the aggregate could exceed amounts, if any, that may be recovered under insurance policies where coverage applies and is available, (2) cause substantial expenses to be incurred, (3) require significant time and attention from the Company's management, and (4) could cause the Company to close or sell the Hospitals or otherwise modify the way its business is conducted. The Company accrues for claims and lawsuits when an unfavorable outcome is probable and the amount is reasonably estimable. From time to time, healthcare facilities receive requests for information in the form of a subpoena from licensing entities, such as the Medical Board of California, regarding members of their medical staffs. Also, California state law mandates that each medical staff is required to perform peer review of its members. As a result of the performance of such peer reviews, action is sometimes taken to limit or revoke an individual's medical staff membership and privileges in order to assure patient safety. In August 2007, the Company received such a subpoena from the Medical Board of California concerning a member of the medical staff of one of the Company's facilities. The facility is in the process of responding to the subpoena and is in the process of reviewing the matter. Since the matter is in the early stage, the Company is not able to determine the impact, if any, it may have on the Company's operations or financial position. Approximately 20% of the Company's employees are represented by labor unions as of March 31, 2008. On December 31, 2006, the Company's collective bargaining agreements with SEIU and CNA expired. Negotiations with both the SEIU and CNA led to agreements being reached on May 9, 2007, and October 16, 2007, for the respective unions. Both contracts were ratified by their respective memberships. The new SEIU Agreement will run until December 31, 2009, and the Agreement with the CNA will run until February 28, 2011. Both Agreements have "no strike" provisions and compensation caps which provide the Company with long term compensation and workforce stability. Both unions filed grievances under the prior collective bargaining agreements, in connection with allegations the agreements obligated the Company to contribute to Retiree Medical Benefit Accounts. The Company does not agree with this interpretation of the agreements but has agreed to submit the matters to arbitration. Under the new agreements negotiated this year, the Company has agreed to meet with each Union to discuss how to create a vehicle which would have the purpose of providing a retiree medical benefit, not to exceed one percent of certain employee's payroll. CNA has also filed grievances related to the administration of increases at one facility, change in pay practice at one facility, change in medical benefits at two facilities, and several wrongful terminations. Those grievances are still pending as of this date, but the Company does not anticipate resolution of the arbitrations will have a material adverse effect on our results of operations. F-37 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 On May 14, 2007, the Company filed suit in Orange County Superior Court against three of the six members of its Board of Directors (as then constituted) and also against the Company's largest shareholder, OC-PIN. The suit sought damages, injunctive relief and the appointment of a provisional director. Among other things, the Company alleges the defendants breached fiduciary duties owed to the Company by putting their own economic interests above those of the Company, its other shareholders, creditors, employees and the public-at-large. The suit further alleges the defendants' then threatened attempts to change the composition of the Company's management and Board (as then constituted) threatened to trigger multiple "Events of Default" under the express terms of the Company's existing credit agreements with its secured Lender. On May 17, 2007, OC-PIN filed a separate suit against the Company in Orange County Superior Court. OC-PIN's suit sought injunctive relief and damages. OC-PIN alleges the management issue referred to above, together with issues related to monies claimed by OC-PIN, needed to be resolved before completion of the Company's then pending refinancing of its secured debt. OC-PIN further alleges that the Company's President failed to call a special shareholders' meeting, thus denying OC-PIN the opportunity to elect a new member to the Company's Board of Directors. Both actions have since been consolidated before one judge. On July 11, 2007, the Company's motion seeking the appointment of an independent provisional director to fill a vacant seventh Board seat was granted. On the same date, OC-PIN's motion for a mandatory injunction forcing the Company's President to notice a special shareholders meeting was denied. All parties to the litigation thereafter consented to the Court's appointment of the Hon. Robert C. Jameson, retired, as a member of the Company's Board. In December 2007, the Company entered into a mutual dismissal and tolling agreement with OC-PIN. The consolidation suits between the Company, on the one hand, and three members of its former Board are still pending. On April 16, 2008, the Company filed an amended complaint, alleging that the defendant directors' failure to timely approve a refinancing package offered by the Company's largest lender caused the Company to default on its then-existing loans. Also on April 16, 2008, these directors filed cross-complaints against the Company for alleged failures to honor its indemnity obligations to them in this litigation. Given the favorable rulings on July 11, 2007 and other factors, the Company continues to prosecute its original action in hopes of recouping all, or at least a substantial portion, of the economic losses caused by the defendants' alleged multiple breaches of fiduciary duty and other wrongful conduct. A trial date has been set for January 26, 2009, and the parties are currently moving forward with discovery. The Company does not anticipate the resolution of these ongoing claims for damages will have a material adverse effect on its results of operations. NOTE 15 - SUBSEQUENT EVENTS On June 19, 2008 the Company received a demand from OC-PIN requesting that it provide notice of a special shareholders meeting by no later than June 26, 2008, with the meeting to occur on a date during the week of July 21-25, 2008. OC PIN stated that the business to be conducted at the special shareholders meeting is to (1) repeal the amendment to the Company's bylaws on June 3, 2008 establishing a procedure for nominating candidates for election as director, (2) remove the entire Board of Directors of the Company, and (3) nominate and elect a new slate of individuals to the Board of Directors. On June 24, 2008, OC-PIN's counsel sent the Company an additional letter demanding that the Company immediately close its stock transfer books or immediately set the Record Date for the requested special shareholders meeting, and waive the record search required under Rule 14a-13(a)(3) of the Securities and Exchange Commission. On June 26, 2008, the Company sent OC-PIN a letter indicating that the Company could not comply with this demand because, among other reasons, OC-PIN has not furnished the consent of the Company's principal lender, which consent is required under the Company's Credit Agreements, aggregating up to $140.7 million, prior to taking any of the actions proposed to be taken by OC-PIN at the special shareholders meeting. In the absence of the lender's consent, the actions proposed by OC-PIN would entitle the lender to certain remedies which would have a material adverse effect on the Company and its shareholders. Further, OC-PIN had not followed the procedures contained in the Company's bylaws for nominating and electing directors of the Company, making the demand defective under the bylaws. Regarding the setting of a record date, the Company is obligated under Rule 14a-13(a)(3) to provide at least 20 business days prior notice to all banks, brokers and other "street name" holders of its stock in advance of the record date for any shareholder meeting at which the Company intends to solicit proxies or consents, and the Company would be in violation of this requirement if it acceded to the demand of OC-PIN's counsel to waive this requirement. The Company believes its positions are justified, and intends to vigorously oppose any attempt by OC-PIN to force the Company to take actions that would put it in default with its lender or cause it to violate the federal securities laws. F-38 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 On July 8, 2008, in a separate action, OC-PIN filed a complaint against the Company in Orange County Superior Court alleging causes of action for breach of contract, specific performance, reformation, fraud, negligent misrepresentation and declaratory relief. The complaint alleges that the Stock Purchase Agreement that the Company executed with OC-PIN on January 28, 2005 "inadvertently omitted" an anti-dilution provision (the "Allegedly Omitted Provision") which would have allowed OC-PIN a right of first refusal to purchase common stock of the Company on the same terms as any other investor in order to maintain OC-PIN's holding at no less than 62.4% of the common stock on a fully diluted basis. The complaint further alleges that the Company has issued stock options under a Stock Incentive Plan and warrants to its lender in violation of the Allegedly Omitted Provision. The complaint further alleges that the issuance of warrants to purchase the Company's stock to Dr. Kali P. Chaudhuri and William Thomas, and their exercise of a portion of those warrants, were improper under the Allegedly Omitted Provision. The Company believes that this lawsuit is wholly without merit and intends to contest these claims vigorously. However, at this early stage, the Company is unable to determine the cost of defending this lawsuit or the impact, if any, that this lawsuit may have on the Company's results of operations or financial condition. F-39 INTEGRATED HEALTHCARE HOLDINGS, INC. NOTES TO CONSOLIDATED FINANCIAL STATEMENTS MARCH 31, 2008 NOTE 16 - QUARTERLY RESULTS (UNAUDITED) The following tables contain selected unaudited consolidated statements of operations and income (loss) per share data for each quarter in the years ended March 31, 2008 and 2007: For the three months ended March 31, 2008 December 31, 2007 September 30, 2007 June 30, 2007 ----------------- ----------------- ------------------ ---------------- Net operating revenues $ 97,904 $ 88,158 $ 95,376 $ 86,791 Operating income (loss) $ 2,501 $ (2,558) $ 4,090 $ (2,808) Net income (loss) $ (1,215) $ (33,299) $ 1,126 $ (5,775) Income (loss) per common share Basic $ (0.01) $ (0.24) $ 0.01 $ (0.05) Diluted $ (0.01) $ (0.24) $ 0.01 $ (0.05) Weighted average shares outstanding Basic 137,096 137,096 136,870 116,304 Diluted 137,096 137,096 190,370 116,304 For the three months ended March 31, 2007 December 31, 2006 September 30, 2006 June 30, 2006 ----------------- ----------------- ------------------ ---------------- Net operating revenues $ 87,200 $ 87,137 $ 85,343 $ 90,992 Operating income (loss) $ (402) $ (4,317) $ (4,681) $ 926 Net income (loss) $ (2,320) $ (13,402) $ (7,004) $ 2,188 Income (loss) per common share Basic $ (0.02) $ (0.15) $ (0.08) $ 0.03 Diluted $ (0.02) $ (0.15) $ (0.08) $ 0.02 Weighted average shares outstanding Basic 104,486 87,557 85,013 84,351 Diluted 104,486 87,557 85,013 127,297 F-40 The following financial statement schedule is the only schedule required to be filed under the applicable accounting regulations of the Securities and Exchange Commission. INTEGRATED HEALTHCARE HOLDINGS, INC. SCHEDULE II -- VALUATION AND QUALIFYING ACCOUNTS [amounts in 000's] BALANCE AT BEGINNING OF BALANCE AT PERIOD DESCRIPTION PERIOD ADDITIONS DEDUCTIONS END OF PERIOD - ------ ----------- ------ --------- ---------- ------------- Accounts Receivable: Year ended March 31, 2008 Allowance for doubtful accounts $ 2,355 $ 49,679(1) $ 37,651 $ 14,383 Year ended March 31, 2007 (2) Allowance for doubtful accounts $ 2,463 $ 37,408 $ 37,516 $ 2,355 Three months ended March 31, 2006 Allowance for doubtful accounts $ 3,148 $ 8,330 $ 9,015 $ 2,463 Year ended December 31, 2005 Allowance for doubtful accounts $ - $ 37,349 $ 34,201 $ 3,148 Deferred tax assets: Year ended March 31, 2008 Valuation allowance $ 33,725 $ 2,180 $ - $ 35,905 Year ended March 31, 2007 Valuation allowance $ 19,041 $ 14,684 $ - $ 33,725 Three months ended March 31, 2006 Valuation allowance $ 14,775 $ 4,266 $ - $ 19,041 Year ended December 31, 2005 Valuation allowance $ 800 $ 13,975 $ - $ 14,775 Year ended December 31, 2004 Valuation allowance $ 41 $ 759 $ - $ 800
(1) Includes additions to allowance related to repurchased accounts receivable. (2) Additions and deductions for the year ended March 31, 2007 have been reclassified. Such reclassifications have no effect on the beginning or ending balances. F-41
EX-10.11.1 2 ihh_10k-ex10111.txt AMENDED REVOLVING CREDIT AGREEMENT EXHIBIT 10.11.1 MEDICAL CAPITAL June 10, 2008 VIA U.S. MAIL AND EMAIL Integrated Healthcare Holdings, Inc. 1301 North Tustin Avenue Santa Ana, California 92705 Attn: Bruce Mogel, CEO Re: Amendment No. 1 to $50 Million Revolving Credit Agreement dated October 9, 2007 Borrowers: Integrated Healthcare Holdings, Inc. WMC-A, INC. WMC-SA, INC. Chapman Medical Center, Inc. Coastal Communities Hospital, Inc. Lender: Medical Provider Financial Corporation I Mr. Mogel: Reference is made to the $50 Million Revolving Credit Agreement dated October 9, 2007 ("Credit Agreement") by and between Borrowers and Lender. Capitalized terms not otherwise defined herein shall have the same meaning as set forth in the Credit Agreement. Due to the general decline in economic conditions and other factors, Borrowers have requested that Lender reduce the Minimum Fixed Charge Coverage Ratio set forth in Annex A to the Credit Agreement. Lender has considered Borrower's request and is prepared to amend the Credit Agreement on the following terms and conditions: 1. Effective January 1, 2008 and ending June 30, 2009 ("Reduction Period"), the Minimum Fixed Charge Coverage Ratio set forth in Annex A to the Credit Agreement shall be reduced from 1.0 to 0.4 ("Reduced Coverage Ratio"). 2. The reduction of the Minimum Fixed Charge Coverage Ratio for the Reduction Period shall not be deemed to be nor constitute a waiver of Borrower's rights, duties or obligations under the Credit Agreement, and shall not operate or be construed as a waiver by Lender of any current or future Default or Event of Default, whether of a like or different nature. 2100 South State College Blvd, Anaheim, California 92806 o (800) 824-3700 o (714) 935-3100 o FAX (714) 935-3114 Internet: http://www.medlcalcapital.com The reduction of the Minimum Fixed Charge Coverage Ratio shall be limited solely to the express terms and provisions set forth in this amendment. By making a reduction in the Minimum Fixed Charge Coverage Ratio, Lender does not waive any breach of any representation or warranty of Borrowers under any Loan Document, and all of Lender's claims and rights resulting from any such breach or misrepresentation are specifically reserved. 3. Upon the occurrence and continuation of a Default or Event of Default under the Credit Agreement or any other Loan Document, the Reduced Coverage Ratio and the Reduction Period shall each terminate, expire and have no further force. In said event, the Minimum Fixed Charge Coverage Ratio shall immediately and without further notice be increased from 0.4 to 1.0. 4. Except as amended hereby, the Credit Agreement shall remain in force and effect. In the event of any inconsistency between the Credit Agreement and this Amendment No. 1 to $50 Million Credit Agreement, this Amendment No. 1 to Credit Agreement shall govern and prevail. If Borrowers and Borrower's Representative agree to the foregoing, please cause the appropriate person to affix his signature and date where indicated below and return the original executed version of this letter agreement to me not later than Friday, May 30, 2008. Upon receipt of this letter agreement, without changes or modifications of any kind, executed and dated by each Borrower and the Borrower's Representative, the same shall constitute and shall hereinafter be referred to as "Amendment No. 1 to $50 Million Credit Agreement." Very truly yours, MEDICAL PROVIDER FINANCIAL CORPORATION I /s/ Joseph J. Lampariello Joseph J. Lampariello, President and COO cc: Pacific Coast Holdings Investments, LLC (via U.S. Mail) Ganesha Realty, LLC (via U.S. Mail) West Coast Holdings, LLC (via U.S. Mail) Orange County Physicians Investment Network, LLC (via U.S. Mail) [BORROWER'S SIGNATURE PAGE FOLLOWS] BORROWERS: INTEGRATED HEALTHCARE HOLDINGS, INC., a Nevada corporation, By: /s/ Bruce Mogel Date of Execution: 6/10/08 --------------------------- ---------------- Bruce Mogel, President/CEO WMC-A, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/10/08 --------------------------- ---------------- Bruce Mogel, President/CEO WMC-SA, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/10/08 --------------------------- ---------------- Bruce Mogel, President/CEO COASTAL COMMUNITIES HOSPITAL, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/10/08 --------------------------- ---------------- Bruce Mogel, President/CEO CHAPMAN MEDICAL CENTER, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/10/08 --------------------------- ---------------- Bruce Mogel, President/CEO BORROWER'S REPRESENTATIVE: BRUCE MOGEL By: /s/ Bruce Mogel Date of Execution: 6/10/08 --------------------------- ---------------- Bruce Mogel EX-10.11.2 3 ihh_10k-ex10112.txt AMEND 2 TO CREDIT AGREEMENT EXHIBIT 10.11.2 MEDICAL CAPITAL Medical Provider Financial Corporation III June 20, 2008 VIA U.S. MAIL AND EMAIL - ----------------------- Integrated Healthcare Holdings, Inc. 1301 North Tustin Avenue Santa Ana, California 92705 Attn: Bruce Mogel, President/CEO Re: Amendment No. 2 to $50 Million Revolving Credit Agreement dated October 9, 2007 Borrowers: Integrated Healthcare Holdings, Inc. WMC-A, INC. WMC-SA, INC. Chapman Medical Center, Inc. Coastal Communities Hospital, Inc. Credit Parties: Pacific Coast Holdings Investment, LLC West Coact Holdings, LLC, Ganesha Realty, LLC Orange County Physicians Investment Network, LLC Guarantors: West Coast Holdings, LLC Ganesha Realty, LLC Orange County Physicians Investment Network, LLC Lender: Medical Provider Financial Corporation III Mr. Mogel: Reference is made to the $50 Million Revolving Credit Agreement dated October 9, 2007, as first amended on June 10, 2008 (together, the "Credit Agreement") by and between Borrowers and Lender. Capitalized terms not otherwise defined herein shall have the same meaning as set forth in the Credit Agreement. In connection with the preparation of Borrower's annual reports management requested a clarification concerning that the effect the definition of Material Adverse Effect in the Credit Agreement constitutes a subjective acceleration provision which could require the accountants to treat the Revolving Facility as a short-term obligation rather than a long-term obligation, Borrowers have requested that Lender revise the definition of Material Adverse Effect. Lender has considered Borrower's request and is prepared to amend the Credit Agreement as follows: 1. The definition of Material Adverse Effect, set forth in Annex B to the Credit Agreement, is hereby deleted in its entirety and replaced with the following new definition of Material Adverse Effect: "MATERIAL ADVERSE EFFECT" means any result, occurrence, fact, change, event or effect (whether or not constituting a breach of a representation, warranty or covenant set forth in this Agreement), that, individually or in the aggregate with any such other results, occurrences, facts, changes, events or effects, is or would reasonably be expected to be adverse to any Borrower's or any Credit Party's or any Guarantor's historical or near- term or long-term projected (a) business, (b) operations, (c) assets, (d) liabilities, (e) financial condition, or (f) results of operations (including but not limited to EBITDA or cash flow), in each case, of any Borrower or any Credit Party or any Guarantor taken as a whole, and any one or more of said results, occurrences, facts, changes, events or effects directly or indirectly (i) impairs or causes the impairment of the physical condition of any Collateral, or (ii) impairs or causes the impairment of the value of any Collateral, or (iii) impairs or challenges, or causes the impairment or challenge, of any Borrower's or any Credit Party's or any Guarantor's right to own any Collateral, or (iv) causes any Borrower or any Credit Party or any Guarantor, taken as a whole, to suffer a reduction in annual net income during any fiscal year greater than $12,000,000, or (v) would with the passage of time or giving of notice, or both, result in or cause a Default or Event of Default. 2. Except as amended hereby, the Credit Agreement shall remain in force and effect. In the event of any inconsistency between the Credit Agreement and this Amendment No. 2 to $50 Million Credit Agreement, this Amendment No. 2 to Credit Agreement shall govern and prevail. If Borrowers, Credit Parties and Guarantors agree to the foregoing, please cause the appropriate person to affix his signature and date where indicated below and return the original executed version of this letter agreement to me not later than Thursday, July 3, 2008. Upon receipt of this letter agreement, without changes or modifications of any kind, executed and dated by each Borrower, each Credit Party and each Guarantor, the same shall constitute and shall hereinafter be referred to as "Amendment No. 2 to $50 Million Credit Agreement." Very truly yours, MEDICAL PROVIDER FINANCIAL CORPORATION I /s/ Joseph J. Lampariello Joseph J. Lampariello, President and COO cc: Pacific Coast Holdings Investments, LLC (via U.S. Mail) Ganesha Realty, LLC (via U.S. Mail) West Coast Holdings, LLC (via U.S. Mail) Orange County Physicians Investment Network, LLC (via U.S. Mail) BORROWERS: INTEGRATED HEALTHCARE HOLDINGS, INC., a Nevada corporation, By: /s/ Bruce Mogel Date of Execution: 6/20/08 --------------------------- ---------------- Bruce Mogel, President/CEO WMC-A, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/20/08 --------------------------- ---------------- Bruce Mogel, President/CEO WMC-SA, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/20/08 --------------------------- ---------------- Bruce Mogel, President/CEO COASTAL COMMUNITIES HOSPITAL, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/20/08 --------------------------- ---------------- Bruce Mogel, President/CEO CHAPMAN MEDICAL CENTER, INC., a California corporation, By: /s/ Bruce Mogel Date of Execution: 6/20/08 --------------------------- ---------------- Bruce Mogel, President/CEO CREDIT PARTIES: - --------------- PACIFIC COAST HOLDINGS INVESTMENT, LLC, a California limited liability company, By: Date of Execution: --------------------------- ---------------- By: Date of Execution: --------------------------- ---------------- [SIGNATURE PAGES CONTINUE] WEST COAST HOLDINGS, LLC a California limited liability company, By: Date of Execution: --------------------------- ---------------- GANESHA REALTY, LLC, a California limited liability company, By: Date of Execution: --------------------------- ---------------- ORANGE COUNTY PHYSICIANS INVESTMENT NETWORK, LLC, a Nevada limited liability company, By: Date of Execution: --------------------------- ---------------- GUARANTORS: - ----------- WEST COAST HOLDINGS, LLC, a California limited liability company, By: Date of Execution: --------------------------- ---------------- PACIFIC COAST HOLDINGS INVESTMENT, LLC a California limited liability company, By: Date of Execution: --------------------------- ---------------- ORANGE COUNTY PHYSICIANS INVESTMENT NETWORK, LLC, a Nevada limited liability company, By: Date of Execution: --------------------------- ---------------- EX-10.16.1 4 ihh_10k-10161.txt AMEND TO CS WARRANT Exhibit 10.16.1 INTEGRATED HEALTHCARE HOLDINGS INC. AMENDMENT TO COMMON STOCK WARRANT APRIL 26, 2006 This Amendment to Common Stock Warrant (this "AMENDMENT") is made and entered into as of the date set forth above (the "EFFECTIVE DATE") by and between Integrated Healthcare Holdings, Inc., a Nevada corporation (the "COMPANY"), and Healthcare Financial Management & Acquisitions, Inc., a Nevada corporation (the "HOLDER"). RECITALS A. On December 12, 2005, the Company issued a warrant to subscribe for and purchase a minimum of 26,097,561 shares of Common Stock of the Company subject to the provisions and upon the terms and conditions set forth therein (the "WARRANT"). B. The Warrant, a true and correct copy of which is attached hereto as EXHIBIT A, provides that the number of Shares issuable upon exercise of the Warrant is subject to adjustment from time to time as set forth therein. C. A provision of the Warrant provides for adjustment of the number of Shares issuable upon exercise of the Warrant based on changes in the fair market value of the Shares (the "FMV ADJUSTMENTS"). D. The Company and Holder desire to enter into this Amendment to, among other thing's, amend the provision contained in the Warrant regarding FMV Adjustments. NOW, THEREFORE, in consideration of the foregoing recitals and the mutual promises hereinafter set forth and for other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree to amend the Warrant as set forth herein and agree as follows: AGREEMENT 1. RECITALS. The foregoing Recitals are incorporated by reference as though fully set forth herein. 2. DEFINITIONS. Unless otherwise defined herein, capitalized terms shall have the meanings assigned to such terms in the Warrant. 3. AMENDMENT OF FMV ADJUSTMENTS. The first paragraph of Section 3 of the Warrant is hereby amended to read in its entirety as follows: "ADJUSTMENT TO THE NUMBER OF SHARES ISSUABLE AND/OR THE EXERCISE PRICE. The number of Shares issuable upon the exercise of this Warrant is subject to adjustment from time to time as set forth in this Section 3. Upon each adjustment 1 pursuant to this Section 3, the Holder shall thereafter prior to the Expiration Date be entitled to purchase the adjusted number of Shares of Common Stock at the Exercise Price. Notwithstanding anything to the contrary provided herein, the number of Shares of Common Stock issuable upon the exercise of this Warrant and the payment of the Exercise Price shall be automatically adjusted to be the greater of the following: (1) 26,097,561 Shares of Common Stock (as set forth on page 1 of this Warrant), (2) Shares of Common Stock representing thirty-one and nine one-hundredths percent (31.09%) of all Common Stock Equivalents (as defined hereinbelow) of the Company, or (3) the number of Shares of Common Stock equal to the Outstanding Amount (as defined hereinbelow) divided by the then current fair market value (as determined in Section 1(d) hereof) of each Share of Common Stock; provided , however, that if the number of Shares resulting from such calculation exceeds the aggregate number of shares of authorized but unissued Common Stock and authorized and issued Common Stock held in the Company's treasury then available for issuance upon exercise of this Warrant (such excess number of Shares is referred to herein as the "EXCESS WARRANT SHARES"), then the Company shall pay to the Holder or Holders, upon exercise of this Warrant for all or any portion of the Excess Warrant Shares, an amount equal to the then current fair market value (as determined in Section 1(d) hereof) of each Share of Common Stock multiplied by the number of Excess Warrant Shares for which the Holder or Holders have exercised their right(s) to purchase pursuant to this Warrant. For avoidance of doubt and solely for example purposes, if a) the Outstanding Amount is $5,000,000, b) the aggregate number of shares of authorized but unissued Common Stock and authorized and issued Common Stock held in the Company's treasury then available for issuance upon exercise of this Warrant is 28,000,000, c) the then current fair market value of each Share of Common Stock is $0.15, and d) the total number of shares that the Holder or Holders would be entitled to receive upon exercise of this Warrant in full was 33,333,333 Shares of Common Stock, then upon exercise of this Warrant in full, the Holder or Holders shall receive 28,000,000 Shares of Common Stock, the Excess Warrant Shares would be 5,333,333.33 Shares of Common Stock and the Company shall be obligated to pay the Holder or Holders an aggregate cash payment of $800,000. As used herein, the term "OUTSTANDING AMOUNT" shall mean the amount of that certain $10,700,000 loan (the "LOAN") made with respect to the Credit Agreement that is not repaid at the maturity or default of such Loan plus any accrued and unpaid interest thereon, Lender's fees, costs and expenses, and attorneys' fees, as such Outstanding Amount is determined in the sole and absolute discretion of the Lender. "COMMON STOCK EQUIVALENTS" shall mean, collectively, (i) all shares of Common Stock issued and outstanding, (ii) shares of Common Stock issued or deemed issued as a dividend or distribution, including on any preferred stock, (iii) shares of Common Stock issued or issuable by reason of a dividend, stock split, split-up or other distribution on shares of Common Stock, (iv) shares of Common Stock or Convertible Securities issued or issuable upon the exercise of rights, options or warrants to subscribe for, purchase or otherwise acquire Common Stock or Convertible Securities (as defined hereinbelow) (collectively, "OPTIONS") or shares of Common Stock issued or 2 issuable upon the conversion or exchange of any evidences of indebtedness, shares, preferred stock or other securities directly or indirectly convertible into or exchangeable for Common Stock ("CONVERTIBLE SECURITIES"), pursuant to the terms of such Option or Convertible Security, (v) shares of Common Stock or Convertible Securities issued or issuable to third parties upon the exercise of rights, options, warrants or otherwise, including, without limitation, to suppliers, banks, equipment lessors or other financial institutions, or to real property lessors, pursuant to a debt financing, equipment leasing or real property leasing transaction, and (vi) shares of Common Stock issued or issuable to employees or directors of, or consultants to, the Corporation or any of its subsidiaries pursuant to a plan, agreement or arrangement approved by the Board of Directors of the Company." 4. NET ISSUE EXERCISE. Section 1(c) of the Warrant is hereby amended to read in its entirety as follows: "NET ISSUE EXERCISE. In lieu of exercising this Warrant, the Holder may elect to receive Shares of Common Stock equal to the value of this Warrant (or the portion thereof being canceled) by surrender of this Warrant at the principal office of the Company together with notice of such election, in which event the Company shall issue to the Holder a number of Shares computed using the following formula: X = Y (A-B) ------- A Where X = the number of the Shares to be issued to the Holder. Y = the number of the Shares purchasable under this Warrant. A = the fair market value of one Share on the date of election under this Section 1(c). B = the Exercise Price divided by Y (as adjusted to the date of such calculation)." 5. Section 3(d)(ii) of the Warrant is hereby amended to read in its entirety as follows: "(ii) in the case of the issuance of shares of Common Stock for a consideration in whole or in part other than cash, the consideration other than cash shall be deemed to be the fair market value thereof as determined by the Appraiser, whose determination shall be conclusive." 6. The second sentence of Section 8(a) of the Warrant which reads: 3 "The Warrants may be divided or combined, upon request to the Company by the Holder, into one or more new warrants representing the same aggregate number of Warrants." is hereby amended to read in its entirety as follows: "The Warrant may be divided or combined, upon request to the Company by the Holder, into one or more new warrants representing the same aggregate number of Shares." 7. Section 9(c)(ii) of the Warrant is hereby amended to read in its entirety as follows: "(ii) Each Holder of Shares who participates in a registration pursuant to Section 9 shall indemnify and hold harmless the Company, each of its directors, each of its officers who have signed any such registration statement, and each person, if any, who controls the Company within the meaning of the Securities Act, against any losses, claims, damages or liabilities. to which the Company, or any such director, officer or controlling person may become subject under the Securities Act, the Exchange Act or other federal or state law, insofar as such losses, claims, damages or liabilities (or actions in respect thereof) arise out of, or are based upon, any untrue or alleged untrue statement of any material fact contained in any such registration statement, or final prospectus, or any amendment or supplement thereto, or arise out of or are based upon the omission or the alleged omission to state therein a material fact required to be stated therein or necessary to make the statements therein not misleading, in each case to the extent, but only to the extent, that such untrue statement or alleged untrue statement or omission or alleged omission was made in any such .registration statement, or final prospectus, or any amendment or supplement thereto, in reliance upon and in conformity with written information furnished by such Holder expressly for use in the preparation thereof; and will reimburse any legal or other expenses reasonably incurred by the Company, or any such director, officer or controlling person in connection with investigating or defending against any such loss, claim, damage, liability or action; provided, however, that the indemnity agreement contained in this subparagraph (ii) shall not apply to amounts paid to any claimant in settlement of any suit or claim unless such payment is first approved by such Holder; and, provided further, that the aggregate amount payable by a Holder pursuant to this Section 9(c)(ii) shall not exceed the net proceeds received by such Holder in the registered offering out of which its obligations pursuant to this Section 9(c)(ii) arise." 8. Except as set forth herein, the Warrant shall remain unmodified and in full force and effect. 9. This Amendment may be executed in counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 4 IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Common Stock Warrant as of the date and year first above written. INTEGRATED HEALTHCARE HOLDINGS, INC., A NEVADA CORPORATION BY: /S/ BRUCE MOGEL ------------------------------- Name: Bruce Mogel Title: Chief Executive Officer HEALTHCARE FINANCIAL MANAGEMENT & ACQUISITIONS, INC., A NEVADA CORPORATION By: /s/ Joseph J. Lampariello -------------------------- Name: Joseph J. Lampariello ------------------------- Title: PRESIDENT ---------------------- EX-23.1 5 ihh_10k-ex2301.txt CONSENT EXHIBIT 23.1 Consent of Independent Registered Public Accounting Firm Integrated Healthcare Holdings, Inc. Santa Ana, California We hereby consent to the incorporation by reference in the Registration Statement on Form S-8 pertaining to Integrated Healthcare Holdings, Inc.'s 2006 Stock Incentive Plan, of our report dated July 11, 2008, relating to the consolidated financial statements and schedule of Integrated Healthcare Holdings, Inc. appearing in the Company's Annual Report on Form 10-K for the year ended March 31, 2008. /s/ BDO Seidman, LLP Costa Mesa, California July 11, 2008 EX-23.2 6 ihh_10k-ex2302.txt CONSENT EXHIBIT 23.2 Consent of Independent Registered Public Accounting Firm We consent to the incorporation by reference in the Registration Statement on Form S-8 pertaining to Integrated Healthcare Holdings, Inc.'s 2006 Stock Incentive Plan, of our report dated July 11, 2006 relating to our audit of the consolidated financial statements of Integrated Healthcare Holdings, Inc. for the year ended December 31, 2005, which includes an explanatory paragraph concerning uncertainty about the Company's ability to continue as a going concern, contained in the Company's Annual Report on Form 10-K for the year ended March 31, 2008. /s/ RAMIREZ INTERNATIONAL Financial & Accounting Services, Inc. July 11, 2008 Irvine, California EX-31.1 7 ihh_10k-ex3101.txt CERTIFICATION EXHIBIT 31.1 CERTIFICATION PURSUANT TO RULE 13a-14 AND 15d-14 ------------------------------------------------ UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED ----------------------------------------------------- I, Bruce Mogel, Chief Executive Officer of Integrated Healthcare Holdings, Inc., certify that: 1. I have reviewed this Annual Report on Form 10-K of Integrated Healthcare Holdings, Inc.; 2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; 3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the Registrant as of, and for, the periods presented in this report; 4. The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15 (e) and 15d-15 (e)) for the registrant and have: (a) designed such disclosure controls and procedures to ensure that material information relating to the registrant, including its consolidated, or caused such disclosure controls and procedure to be designed under our supervision, subsidiaries, is made known to us by others within those entities, particularly during the period in which this annual report is being prepared; (b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. (c) evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and (d) disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and; 5. The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent function): (a) all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and (b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal controls over financial reporting. Dated: July 11, 2008 /s/ Bruce Mogel - --------------------------------- Bruce Mogel Chief Executive Officer EX-31.2 8 ihh_10k-ex3102.txt CERTIFICATION EXHIBIT 31.2 CERTIFICATION PURSUANT TO RULE 13a-14 AND 15d-14 ------------------------------------------------ UNDER THE SECURITIES EXCHANGE ACT OF 1934, AS AMENDED ----------------------------------------------------- I, Steven R. Blake, Chief Financial Officer of Integrated Healthcare Holdings, Inc., certify that: 1. I have reviewed this Annual Report on Form 10-K of Integrated Healthcare Holdings, Inc.; 2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; 3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the Registrant as of, and for, the periods presented in this report; 4. The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15 (e) and 15d-15 (e)) for the registrant and have: (a) designed such disclosure controls and procedures to ensure that material information relating to the registrant, including its consolidated, or caused such disclosure controls and procedure to be designed under our supervision, subsidiaries, is made known to us by others within those entities, particularly during the period in which this annual report is being prepared; (b) designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles. (c) evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and (d) disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and; 5. The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent function): (a) all significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and (b) any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal controls over financial reporting. Dated: July 11, 2008 /s/ Steven R. Blake - --------------------------------- Steven R. Blake Chief Financial Officer EX-32.1 9 ihh_10k-ex3201.txt CERTIFICATION EXHIBIT 32.1 CERTIFICATE PURSUANT TO ----------------------- 18 U.S.C. SECTION 1350, ----------------------- AS ADOPTED PURSUANT TO ---------------------- SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002 --------------------------------------------- In connection with the Report of Integrated Healthcare Holdings, Inc. (the "Company") on Form 10-K for the period from April 1, 2007 to March 31, 2008, as filed with the Securities and Exchange Commission (the "Report"), each of the undersigned, in the capacities and on the dates indicated below, hereby certifies pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that: 1) the Report fully complies with the requirements of Section 13(a) or 15(d), as applicable, of the Securities Exchange Act of 1934; and 2) the information contained in the Report fairly presents, in all material respects, the financial condition and result of operations of the Company at the dates and for the period indicated. This Certificate has not been, and shall not be deemed, "filed" with the Securities and Exchange Commission. Dated: July 11, 2008 /s/ Bruce Mogel --------------------------------- Bruce Mogel Chief Executive Officer EX-32.2 10 ihh_10k-ex3202.txt CERTIFICATION EXHIBIT 32.2 CERTIFICATE PURSUANT TO ----------------------- 18 U.S.C. SECTION 1350, ----------------------- AS ADOPTED PURSUANT TO ---------------------- SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002 --------------------------------------------- In connection with the Report of Integrated Healthcare Holdings, Inc. (the "Company") on Form 10-K for the period from April 1, 2007 to March 31, 2008, as filed with the Securities and Exchange Commission (the "Report"), each of the undersigned, in the capacities and on the dates indicated below, hereby certifies pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that: 1) the Report fully complies with the requirements of Section 13(a) or 15(d), as applicable, of the Securities Exchange Act of 1934; and 2) the information contained in the Report fairly presents, in all material respects, the financial condition and result of operations of the Company at the dates and for the period indicated. This Certificate has not been, and shall not be deemed, "filed" with the Securities and Exchange Commission. Dated: July 11, 2008 /s/ Steven R. Blake --------------------------------- Steven R. Blake Chief Financial Officer
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