(State of Incorporation) | (Commission File Number) | (IRS Employer Identification Number) |
Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425) | |||||
Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12) | |||||
Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b)) | |||||
Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c)) |
Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||||||||||||
Item 2.02. | Results of Operations and Financial Condition. |
Item 9.01. | Financial Statements and Exhibits. |
Exhibit No. | Description | |||||||
99.1 | ||||||||
104 | Cover Page Interactive Data File (embedded within the inline XBRL document) |
TENET HEALTHCARE CORPORATION | ||||||||
Date: February 7, 2022 | By: | /s/ R. SCOTT RAMSEY | ||||||
R. Scott Ramsey | ||||||||
Senior Vice President, Controller |
($ in millions, except per share results) | Q4’21 | Q4’20 | FY 2021 | FY 2020 | ||||||||||
Net income available to Tenet common shareholders from continuing operations | $250 | $414 | $915 | $399 | ||||||||||
Net income available to Tenet common shareholders from continuing operations per diluted share | $2.30 | $3.86 | $8.43 | $3.75 | ||||||||||
Adjusted EBITDA excluding grant income | $877 | $832 | $3,278 | $2,247 | ||||||||||
Adjusted EBITDA including grant income | $1,017 | $1,278 | $3,483 | $3,146 | ||||||||||
Adjusted diluted earnings per share from continuing operations | $2.70 | $4.72 | $7.58 | $7.92 | ||||||||||
The table above as well as tables and discussions throughout this earnings release include certain financial measures that are not in accordance with accounting principles generally accepted in the United States of America (GAAP). Reconciliations of GAAP measures to the Adjusted (non-GAAP) measures used are detailed in Tables #1-3 included at the end of this earnings release. Management’s reasoning for the use of these non-GAAP measures and descriptions of the various non-GAAP measures are included in the Non-GAAP Financial Measures section of this earnings release. |
Hospital segment results ($ in millions) | Q4’21 | Q4’20 | FY 2021 | FY 2020 | ||||||||||
Revenues | ||||||||||||||
Net operating revenues (prior to inter-segment eliminations) | $3,910 | $4,065 | $15,982 | $14,790 | ||||||||||
Grant income | $112 | $406 | $142 | $823 | ||||||||||
Same-hospital net patient service revenues (a) | $3,545 | $3,485 | $14,043 | $12,655 | ||||||||||
Same-Hospital Volume Changes versus the Prior-Year Period (a) | ||||||||||||||
Admissions | (3.9) | % | (10.1) | % | (0.1) | % | (11.5) | % | ||||||
Adjusted admissions (b) | — | % | (14.3) | % | 2.4 | % | (15.3) | % | ||||||
Outpatient visits (including outpatient ER visits) | 8.8 | % | (17.7) | % | 15.7 | % | (21.7) | % | ||||||
Emergency Room visits (inpatient and outpatient) | 16.3 | % | (23.8) | % | 8.9 | % | (20.7) | % | ||||||
Hospital surgeries | (1.4) | % | (9.9) | % | 6.1 | % | (14.2) | % | ||||||
Adjusted EBITDA | ||||||||||||||
Adjusted EBITDA excluding grant income | $440 | $431 | $1,789 | $1,088 | ||||||||||
Adjusted EBITDA including grant income | $552 | $837 | $1,931 | $1,911 | ||||||||||
Adjusted EBITDA margin | ||||||||||||||
Adjusted EBITDA margin excluding grant income | 11.3 | % | 10.7 | % | 11.2 | % | 7.4 | % | ||||||
Adjusted EBITDA margin including grant income | 14.1 | % | 20.7 | % | 12.1 | % | 12.9 | % |
Ambulatory segment results ($ in millions) | Q4’21 | Q4’20 | FY 2021 | FY 2020 | ||||||||||
Revenues | ||||||||||||||
Net operating revenues | $742 | $649 | $2,718 | $2,072 | ||||||||||
Grant income excluding equity earnings impact | $26 | $31 | $49 | $59 | ||||||||||
Grant income in equity earnings | $2 | $9 | $14 | $17 | ||||||||||
Same-facility system-wide net patient service revenues (c) | $1,533 | $1,423 | $5,401 | $4,718 | ||||||||||
Volume Changes versus the Prior-Year Period | ||||||||||||||
Same-facility system-wide surgical cases (c) | 4.4 | % | (5.5) | % | 15.6 | % | (15.2) | % | ||||||
Same-facility system-wide surgical cases on same-business day basis (c) | 6.1 | % | (5.5) | % | 16.6 | % | (15.5) | % | ||||||
Adjusted EBITDA, Margins and Noncontrolling Interest (NCI) | ||||||||||||||
Adjusted EBITDA excluding grant income | $343 | $290 | $1,134 | $792 | ||||||||||
Adjusted EBITDA including grant income | $371 | $330 | $1,197 | $868 | ||||||||||
Adjusted EBITDA margin excluding grant income | 46.2 | % | 44.7 | % | 41.7 | % | 38.2 | % | ||||||
Adjusted EBITDA margin including grant income | 50.0 | % | 50.8 | % | 44.0 | % | 41.9 | % | ||||||
Adjusted EBITDA less facility-level NCI excluding grant income | $220 | $193 | $734 | $516 | ||||||||||
Adjusted EBITDA less facility-level NCI | $236 | $214 | $770 | $558 | ||||||||||
Adjusted EBITDA less total NCI excluding grant income (d) | $214 | $187 | $715 | $505 | ||||||||||
Adjusted EBITDA less total NCI (d) | $229 | $207 | $749 | $545 |
Conifer segment results ($ in millions) | Q4’21 | Q4’20 | FY 2021 | FY 2020 | ||||||||||
Net operating revenues | $324 | $344 | $1,267 | $1,306 | ||||||||||
Adjusted EBITDA | $94 | $111 | $355 | $367 | ||||||||||
Adjusted EBITDA margin | 29.0 | % | 32.3 | % | 28.0 | % | 28.1 | % |
($ in millions) | December 31, 2021 | September 30, 2021 | June 30, 2021 | March 31, 2021 | December 31, 2020 | ||||||||||||
Cash and cash equivalents | $2,364 | $2,292 | $2,194 | $2,141 | $2,446 | ||||||||||||
Accounts receivable days outstanding | 57.0 | 56.4 | 55.2 | 55.8 | 55.6 | ||||||||||||
Line-of-credit borrowings outstanding | — | — | — | — | — | ||||||||||||
Ratio of net debt plus Medicare advances liability to Adjusted EBITDA (e) | 4.07 | 3.47 | 4.17 | 4.37 | 4.70 |
($ in millions) | Q4’21 | Q4’20 | FY 2021 | FY 2020 | ||||||||||
Net cash provided by operating activities | $357 | $446 | $1,568 | $3,407 | ||||||||||
Capital expenditures | $(304) | $(166) | $(658) | $(540) | ||||||||||
Free cash flow | $53 | $280 | $910 | $2,867 | ||||||||||
Adjusted free cash flow | $89 | $361 | $1,063 | $3,201 | ||||||||||
Net cash used in investing activities | $(1,516) | $(1,202) | $(714) | $(1,608) | ||||||||||
Net cash provided by (used in) financing activities | $1,231 | $(98) | $(936) | $385 |
CONSOLIDATED ($ in millions except per share amounts) | FY 2022 Outlook | Q1’22 Outlook | |||||||||
Net operating revenues | $19,500 to $19,900 | $4,600 to $4,800 | |||||||||
Income from continuing operations available to Tenet common stockholders | $502 to $677 | $75 to $110 | |||||||||
Adjusted EBITDA | $3,375 to $3,575 | $725 to $775 | |||||||||
Adjusted EBITDA margin | 17.3% to 18.0% | 15.8% to 16.1% | |||||||||
Diluted income per common share from continuing operations | $4.56 to $6.16 | $0.69 to $1.01 | |||||||||
Adjusted net income from continuing operations | $645 to $775 | $100 to $125 | |||||||||
Adjusted diluted earnings per share from continuing operations | $5.86 to $7.05 | $0.92 to $1.15 | |||||||||
Equity in earnings of unconsolidated affiliates | $240 to $260 | $50 to $60 | |||||||||
Depreciation and amortization | $875 to $900 | $210 to $220 | |||||||||
Interest expense | $870 to $880 | $225 to $235 | |||||||||
Net income available to NCI | $590 to $630 | $120 to $140 | |||||||||
Weighted average diluted common shares | ~110 million | ~109 million | |||||||||
NCI cash distributions | $510 to $550 | ||||||||||
Effective tax rate (f) | ~23% | ||||||||||
Net cash provided by operating activities | $1,150 to $1,450 | ||||||||||
Adjusted net cash provided by operating activities | $1,300 to $1,550 | ||||||||||
Capital expenditures | $725 to $775 | ||||||||||
Free cash flow | $425 to $675 | ||||||||||
Free cash flow excluding repayments of Medicare Advance Payments and Deferred Payroll Tax Payments | $1,433 to $1,683 | ||||||||||
Adjusted free cash flow – continuing operations | $575 to $775 | ||||||||||
Adjusted free cash flow – continuing operations, excluding repayments of Medicare Advance Payments and Deferred Payroll Tax Payments | $1,583 to $1,783 |
Hospital Segment ($ in millions) | FY 2022 Outlook | |||||||
Net operating revenues (prior to inter-segment eliminations) | $15,385 to $15,635 | |||||||
Adjusted EBITDA | $1,640 to $1,780 | |||||||
NCI | $30 to $40 | |||||||
Changes versus FY 2020 (g): | ||||||||
Inpatient admissions | Flat to up 2% | |||||||
Adjusted admissions | Up 2% to 4% | |||||||
Ambulatory Segment ($ in millions) | FY 2022 Outlook | |||||||
Net operating revenues | $3,275 to $3,375 | |||||||
Adjusted EBITDA | $1,375 to $1,425 | |||||||
Total NCI (Facility level and Baylor University Medical Center) | $490 to $515 | |||||||
Adjusted EBITDA less total NCI | $885 to $910 | |||||||
Changes versus FY 2020 (g): | ||||||||
Surgical cases volumes | Up 3% to 4% | |||||||
Net revenues per surgical case | Up 2.5% to 3.5% |
Conifer Segment ($ in millions) | FY 2022 Outlook | |||||||
Net operating revenues | $1,325 to $1,375 | |||||||
Adjusted EBITDA | $360 to $370 | |||||||
NCI | $70 to $75 | |||||||
Investor Contact | Media Contact | |||||||
investorrelations@tenethealth.com | Lesley Bogdanow | |||||||
469-893-2387 | 469-893-2640 | |||||||
mediarelations@tenethealth.com |
Description | Page | ||||
Table #4 - Reconciliations of Outlook Net Income to Outlook Adjusted EBITDA | |||||
(Dollars in millions except per share amounts) | Three Months Ended December 31, | |||||||||||||||||||||||||||||||
2021 | % | 2020 | % | Change | ||||||||||||||||||||||||||||
Net operating revenues | $ | 4,856 | 100.0 | % | $ | 4,915 | 100.0 | % | (1.2) | % | ||||||||||||||||||||||
Grant income | 138 | 2.8 | % | 437 | 8.9 | % | (68.4) | % | ||||||||||||||||||||||||
Equity in earnings of unconsolidated affiliates | 77 | 1.6 | % | 66 | 1.3 | % | 16.7 | % | ||||||||||||||||||||||||
Operating expenses: | ||||||||||||||||||||||||||||||||
Salaries, wages and benefits | 2,188 | 45.0 | % | 2,225 | 45.3 | % | (1.7) | % | ||||||||||||||||||||||||
Supplies | 838 | 17.3 | % | 824 | 16.8 | % | 1.7 | % | ||||||||||||||||||||||||
Other operating expenses, net | 1,029 | 21.2 | % | 1,071 | 21.8 | % | (3.9) | % | ||||||||||||||||||||||||
Depreciation and amortization | 201 | 4.1 | % | 233 | 4.7 | % | ||||||||||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | 30 | 0.6 | % | 124 | 2.5 | % | ||||||||||||||||||||||||||
Litigation and investigation costs | 52 | 1.1 | % | 31 | 0.6 | % | ||||||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | (18) | (0.4) | % | (10) | (0.2) | % | ||||||||||||||||||||||||||
Operating income | 751 | 15.5 | % | 920 | 18.7 | % | ||||||||||||||||||||||||||
Interest expense | (221) | (242) | ||||||||||||||||||||||||||||||
Other non-operating expense, net | (2) | (2) | ||||||||||||||||||||||||||||||
Loss from early extinguishment of debt | — | — | ||||||||||||||||||||||||||||||
Income from continuing operations, before income taxes | 528 | 676 | ||||||||||||||||||||||||||||||
Income tax expense | (108) | (130) | ||||||||||||||||||||||||||||||
Income from continuing operations, before discontinued operations | 420 | 546 | ||||||||||||||||||||||||||||||
Discontinued operations: | ||||||||||||||||||||||||||||||||
Loss from operations | (1) | — | ||||||||||||||||||||||||||||||
Loss from discontinued operations | (1) | — | ||||||||||||||||||||||||||||||
Net income | 419 | 546 | ||||||||||||||||||||||||||||||
Less: Net income available to noncontrolling interests | 170 | 132 | ||||||||||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 249 | $ | 414 | ||||||||||||||||||||||||||||
Amounts available (attributable) to Tenet Healthcare Corporation common shareholders | ||||||||||||||||||||||||||||||||
Income from continuing operations, net of tax | $ | 250 | $ | 414 | ||||||||||||||||||||||||||||
Loss from discontinued operations, net of tax | (1) | — | ||||||||||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 249 | $ | 414 | ||||||||||||||||||||||||||||
Earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders: | ||||||||||||||||||||||||||||||||
Basic | ||||||||||||||||||||||||||||||||
Continuing operations | $ | 2.33 | $ | 3.92 | ||||||||||||||||||||||||||||
Discontinued operations | (0.01) | — | ||||||||||||||||||||||||||||||
$ | 2.32 | $ | 3.92 | |||||||||||||||||||||||||||||
Diluted | ||||||||||||||||||||||||||||||||
Continuing operations | $ | 2.30 | $ | 3.86 | ||||||||||||||||||||||||||||
Discontinued operations | (0.01) | — | ||||||||||||||||||||||||||||||
$ | 2.29 | $ | 3.86 | |||||||||||||||||||||||||||||
Weighted average shares and dilutive securities outstanding (in thousands): | ||||||||||||||||||||||||||||||||
Basic | 107,150 | 105,630 | ||||||||||||||||||||||||||||||
Diluted | 108,890 | 107,237 |
(Dollars in millions except per share amounts) | Twelve Months Ended December 31, | |||||||||||||||||||||||||||||||
2021 | % | 2020 | % | Change | ||||||||||||||||||||||||||||
Net operating revenues | $ | 19,485 | 100.0 | % | $ | 17,640 | 100.0 | % | 10.5 | % | ||||||||||||||||||||||
Grant income | 191 | 1.0 | % | 882 | 5.0 | % | (78.3) | % | ||||||||||||||||||||||||
Equity in earnings of unconsolidated affiliates | 218 | 1.1 | % | 169 | 1.0 | % | 29.0 | % | ||||||||||||||||||||||||
Operating expenses: | ||||||||||||||||||||||||||||||||
Salaries, wages and benefits | 8,878 | 45.6 | % | 8,418 | 47.8 | % | 5.5 | % | ||||||||||||||||||||||||
Supplies | 3,328 | 17.1 | % | 2,982 | 16.9 | % | 11.6 | % | ||||||||||||||||||||||||
Other operating expenses, net | 4,206 | 21.6 | % | 4,125 | 23.4 | % | 2.0 | % | ||||||||||||||||||||||||
Depreciation and amortization | 855 | 4.4 | % | 857 | 4.9 | % | ||||||||||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | 85 | 0.4 | % | 290 | 1.6 | % | ||||||||||||||||||||||||||
Litigation and investigation costs | 116 | 0.6 | % | 44 | 0.2 | % | ||||||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | (445) | (2.3) | % | (14) | (0.1) | % | ||||||||||||||||||||||||||
Operating income | 2,871 | 14.7 | % | 1,989 | 11.3 | % | ||||||||||||||||||||||||||
Interest expense | (923) | (1,003) | ||||||||||||||||||||||||||||||
Other non-operating income, net | 14 | 1 | ||||||||||||||||||||||||||||||
Loss from early extinguishment of debt | (74) | (316) | ||||||||||||||||||||||||||||||
Income from continuing operations, before income taxes | 1,888 | 671 | ||||||||||||||||||||||||||||||
Income tax benefit (expense) | (411) | 97 | ||||||||||||||||||||||||||||||
Income from continuing operations, before discontinued operations | 1,477 | 768 | ||||||||||||||||||||||||||||||
Discontinued operations: | ||||||||||||||||||||||||||||||||
Loss from operations | (1) | — | ||||||||||||||||||||||||||||||
Loss from discontinued operations | (1) | — | ||||||||||||||||||||||||||||||
Net income | 1,476 | 768 | ||||||||||||||||||||||||||||||
Less: Net income available to noncontrolling interests | 562 | 369 | ||||||||||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 914 | $ | 399 | ||||||||||||||||||||||||||||
Amounts available (attributable) to Tenet Healthcare Corporation common shareholders | ||||||||||||||||||||||||||||||||
Income from continuing operations, net of tax | $ | 915 | $ | 399 | ||||||||||||||||||||||||||||
Loss from discontinued operations, net of tax | (1) | — | ||||||||||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 914 | $ | 399 | ||||||||||||||||||||||||||||
Earnings (loss) per share available (attributable) to Tenet Healthcare Corporation common shareholders: | ||||||||||||||||||||||||||||||||
Basic | ||||||||||||||||||||||||||||||||
Continuing operations | $ | 8.56 | $ | 3.80 | ||||||||||||||||||||||||||||
Discontinued operations | (0.01) | — | ||||||||||||||||||||||||||||||
$ | 8.55 | $ | 3.80 | |||||||||||||||||||||||||||||
Diluted | ||||||||||||||||||||||||||||||||
Continuing operations | $ | 8.43 | $ | 3.75 | ||||||||||||||||||||||||||||
Discontinued operations | (0.01) | — | ||||||||||||||||||||||||||||||
$ | 8.42 | $ | 3.75 | |||||||||||||||||||||||||||||
Weighted average shares and dilutive securities outstanding (in thousands): | ||||||||||||||||||||||||||||||||
Basic | 106,833 | 105,010 | ||||||||||||||||||||||||||||||
Diluted | 108,571 | 106,263 |
December 31, | December 31, | |||||||||||||
(Dollars in millions) | 2021 | 2020 | ||||||||||||
ASSETS | ||||||||||||||
Current assets: | ||||||||||||||
Cash and cash equivalents | $ | 2,364 | $ | 2,446 | ||||||||||
Accounts receivable | 2,770 | 2,690 | ||||||||||||
Inventories of supplies, at cost | 384 | 368 | ||||||||||||
Assets held for sale | — | 140 | ||||||||||||
Other current assets | 1,557 | 1,503 | ||||||||||||
Total current assets | 7,075 | 7,147 | ||||||||||||
Investments and other assets | 3,254 | 2,534 | ||||||||||||
Deferred income taxes | 65 | 325 | ||||||||||||
Property and equipment, at cost, less accumulated depreciation and amortization | 6,427 | 6,692 | ||||||||||||
Goodwill | 9,261 | 8,808 | ||||||||||||
Other intangible assets, at cost, less accumulated amortization | 1,497 | 1,600 | ||||||||||||
Total assets | $ | 27,579 | $ | 27,106 | ||||||||||
LIABILITIES AND EQUITY | ||||||||||||||
Current liabilities: | ||||||||||||||
Current portion of long-term debt | $ | 135 | $ | 145 | ||||||||||
Accounts payable | 1,300 | 1,207 | ||||||||||||
Accrued compensation and benefits | 896 | 942 | ||||||||||||
Professional and general liability reserves | 254 | 243 | ||||||||||||
Accrued interest payable | 203 | 248 | ||||||||||||
Liabilities held for sale | — | 70 | ||||||||||||
Contract liabilities | 959 | 659 | ||||||||||||
Other current liabilities | 1,362 | 1,333 | ||||||||||||
Total current liabilities | 5,109 | 4,847 | ||||||||||||
Long-term debt, net of current portion | 15,511 | 15,574 | ||||||||||||
Professional and general liability reserves | 791 | 735 | ||||||||||||
Defined benefit plan obligations | 421 | 497 | ||||||||||||
Deferred income taxes | 36 | 29 | ||||||||||||
Contract liabilities - long-term | 15 | 918 | ||||||||||||
Other long-term liabilities | 1,439 | 1,617 | ||||||||||||
Total liabilities | 23,322 | 24,217 | ||||||||||||
Commitments and contingencies | ||||||||||||||
Redeemable noncontrolling interests in equity of consolidated subsidiaries | 2,203 | 1,952 | ||||||||||||
Equity: | ||||||||||||||
Shareholders’ equity: | ||||||||||||||
Common stock | 8 | 7 | ||||||||||||
Additional paid-in capital | 4,877 | 4,844 | ||||||||||||
Accumulated other comprehensive loss | (233) | (281) | ||||||||||||
Accumulated deficit | (1,214) | (2,128) | ||||||||||||
Common stock in treasury, at cost | (2,410) | (2,414) | ||||||||||||
Total shareholders’ equity | 1,028 | 28 | ||||||||||||
Noncontrolling interests | 1,026 | 909 | ||||||||||||
Total equity | 2,054 | 937 | ||||||||||||
Total liabilities and equity | $ | 27,579 | $ | 27,106 |
Twelve Months Ended | ||||||||||||||
(Dollars in millions) | December 31, | |||||||||||||
2021 | 2020 | |||||||||||||
Net income | $ | 1,476 | $ | 768 | ||||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||||||
Depreciation and amortization | 855 | 857 | ||||||||||||
Deferred income tax expense (benefit) | 250 | (128) | ||||||||||||
Stock-based compensation expense | 56 | 44 | ||||||||||||
Impairment and restructuring charges, and acquisition-related costs | 85 | 290 | ||||||||||||
Litigation and investigation costs | 116 | 44 | ||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | (445) | (14) | ||||||||||||
Loss from early extinguishment of debt | 74 | 316 | ||||||||||||
Equity in earnings of unconsolidated affiliates, net of distributions received | (10) | (37) | ||||||||||||
Amortization of debt discount and debt issuance costs | 33 | 38 | ||||||||||||
Pre-tax loss from discontinued operations | 1 | — | ||||||||||||
Other items, net | (33) | (29) | ||||||||||||
Changes in cash from operating assets and liabilities: | ||||||||||||||
Accounts receivable | (197) | 195 | ||||||||||||
Inventories and other current assets | (52) | (145) | ||||||||||||
Income taxes | 68 | 19 | ||||||||||||
Accounts payable, accrued expenses, contract liabilities and other current liabilities | (584) | 1,302 | ||||||||||||
Other long-term liabilities | 28 | 221 | ||||||||||||
Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements | (153) | (333) | ||||||||||||
Net cash used in operating activities from discontinued operations, excluding income taxes | — | (1) | ||||||||||||
Net cash provided by operating activities | 1,568 | 3,407 | ||||||||||||
Cash flows from investing activities: | ||||||||||||||
Purchases of property and equipment | (658) | (540) | ||||||||||||
Purchases of businesses or joint venture interests, net of cash acquired | (1,220) | (1,177) | ||||||||||||
Proceeds from sales of facilities and other assets | 1,248 | 77 | ||||||||||||
Proceeds from sales of marketable securities, long-term investments and other assets | 31 | 59 | ||||||||||||
Purchases of marketable securities and equity investments | (108) | (44) | ||||||||||||
Other items, net | (7) | 17 | ||||||||||||
Net cash used in investing activities | (714) | (1,608) | ||||||||||||
Cash flows from financing activities: | ||||||||||||||
Repayments of borrowings under credit facility | — | (740) | ||||||||||||
Proceeds from borrowings under credit facility | — | 740 | ||||||||||||
Repayments of other borrowings | (3,221) | (3,293) | ||||||||||||
Proceeds from other borrowings | 2,872 | 3,818 | ||||||||||||
Debt issuance costs | (31) | (48) | ||||||||||||
Distributions paid to noncontrolling interests | (423) | (287) | ||||||||||||
Proceeds from sale of noncontrolling interests | 25 | 14 | ||||||||||||
Purchases of noncontrolling interests | (27) | (39) | ||||||||||||
Medicare advances and grants received by unconsolidated affiliates, net of recoupment | (67) | 187 | ||||||||||||
Other items, net | (64) | 33 | ||||||||||||
Net cash provided by (used in) financing activities | (936) | 385 | ||||||||||||
Net increase (decrease) in cash and cash equivalents | (82) | 2,184 | ||||||||||||
Cash and cash equivalents at beginning of period | 2,446 | 262 | ||||||||||||
Cash and cash equivalents at end of period | $ | 2,364 | $ | 2,446 | ||||||||||
Supplemental disclosures: | ||||||||||||||
Interest paid, net of capitalized interest | $ | (937) | $ | (962) | ||||||||||
Income tax payments, net | $ | (92) | $ | (12) |
Three Months Ended | Twelve Months Ended | |||||||||||||||||||||||||
(Dollars in millions) | December 31, | December 31, | ||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net operating revenues (1) : | ||||||||||||||||||||||||||
Hospital Operations and other (prior to inter-segment eliminations) (2) | $ | 3,910 | $ | 4,065 | $ | 15,982 | $ | 14,790 | ||||||||||||||||||
Ambulatory Care | 742 | 649 | 2,718 | 2,072 | ||||||||||||||||||||||
Conifer | ||||||||||||||||||||||||||
Tenet | 120 | 143 | 482 | 528 | ||||||||||||||||||||||
Other clients | 204 | 201 | 785 | 778 | ||||||||||||||||||||||
Total Conifer revenues | 324 | 344 | 1,267 | 1,306 | ||||||||||||||||||||||
Inter-segment eliminations | (120) | (143) | (482) | (528) | ||||||||||||||||||||||
Total | $ | 4,856 | $ | 4,915 | $ | 19,485 | $ | 17,640 | ||||||||||||||||||
Equity in earnings of unconsolidated affiliates: | ||||||||||||||||||||||||||
Hospital Operations and other | $ | 14 | $ | 5 | $ | 25 | $ | 6 | ||||||||||||||||||
Ambulatory Care | 63 | 61 | 193 | 163 | ||||||||||||||||||||||
Total | $ | 77 | $ | 66 | $ | 218 | $ | 169 | ||||||||||||||||||
Adjusted EBITDA (including grant income): | ||||||||||||||||||||||||||
Hospital Operations and other (3) | $ | 552 | $ | 837 | $ | 1,931 | $ | 1,911 | ||||||||||||||||||
Ambulatory Care | 371 | 330 | 1,197 | 868 | ||||||||||||||||||||||
Conifer | 94 | 111 | 355 | 367 | ||||||||||||||||||||||
Total | $ | 1,017 | $ | 1,278 | $ | 3,483 | $ | 3,146 | ||||||||||||||||||
Adjusted EBITDA margins (including grant income): | ||||||||||||||||||||||||||
Hospital Operations and other | 14.1 | % | 20.7 | % | 12.1 | % | 12.9 | % | ||||||||||||||||||
Ambulatory Care | 50.0 | % | 50.8 | % | 44.0 | % | 41.9 | % | ||||||||||||||||||
Conifer | 29.0 | % | 32.3 | % | 28.0 | % | 28.1 | % | ||||||||||||||||||
Total | 20.9 | % | 26.1 | % | 17.9 | % | 17.9 | % | ||||||||||||||||||
Adjusted EBITDA margins (excluding grant income): | ||||||||||||||||||||||||||
Hospital Operations and other | 11.3 | % | 10.7 | % | 11.2 | % | 7.4 | % | ||||||||||||||||||
Ambulatory Care | 46.2 | % | 44.7 | % | 41.7 | % | 38.2 | % | ||||||||||||||||||
Conifer | 29.0 | % | 32.3 | % | 28.0 | % | 28.1 | % | ||||||||||||||||||
Total | 18.1 | % | 17.0 | % | 16.8 | % | 12.8 | % | ||||||||||||||||||
Capital expenditures: | ||||||||||||||||||||||||||
Hospital Operations and other | $ | 283 | $ | 139 | $ | 578 | $ | 467 | ||||||||||||||||||
Ambulatory Care | 17 | 19 | 66 | 51 | ||||||||||||||||||||||
Conifer | 4 | 8 | 14 | 22 | ||||||||||||||||||||||
Total | $ | 304 | $ | 166 | $ | 658 | $ | 540 | ||||||||||||||||||
(1) Net operating revenues include the impact of implicit price concessions and bad debts | ||||||||||||||||||||||||||
(2) Hospital Operations and other revenues includes health plan revenues of $21 million for the twelve months ended December 31, 2020. | ||||||||||||||||||||||||||
(3) Hospital Operations and other Adjusted EBITDA excludes health plan EBITDA of $(1) million and $20 million for the twelve months ended December 31, 2021 and 2020, respectively. |
(Dollars in millions except per share amounts) | Three Months Ended | Twelve Months Ended | ||||||||||||||||||||||||
December 31, | December 31, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 249 | $ | 414 | $ | 914 | $ | 399 | ||||||||||||||||||
Net loss from discontinued operations | (1) | — | (1) | — | ||||||||||||||||||||||
Net income from continuing operations | 250 | 414 | 915 | 399 | ||||||||||||||||||||||
Less: Impairment and restructuring charges, and acquisition-related costs | (30) | (124) | (85) | (290) | ||||||||||||||||||||||
Litigation and investigation costs | (52) | (31) | (116) | (44) | ||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | 18 | 10 | 445 | 14 | ||||||||||||||||||||||
Loss from early extinguishment of debt | — | — | (74) | (316) | ||||||||||||||||||||||
Income (loss) from divested and closed businesses | (1) | 20 | (1) | 20 | ||||||||||||||||||||||
Noncontrolling interest impact | — | 1 | — | 1 | ||||||||||||||||||||||
Tax impact of above items | 21 | 32 | (77) | 172 | ||||||||||||||||||||||
Adjusted net income available from continuing operations to common shareholders | $ | 294 | $ | 506 | $ | 823 | $ | 842 | ||||||||||||||||||
Diluted earnings per share from continuing operations | $ | 2.30 | $ | 3.86 | $ | 8.43 | $ | 3.75 | ||||||||||||||||||
Less: Impairment and restructuring charges, and acquisition-related costs | (0.27) | (1.16) | (0.78) | (2.73) | ||||||||||||||||||||||
Litigation and investigation costs | (0.48) | (0.29) | (1.07) | (0.41) | ||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | 0.17 | 0.09 | 4.10 | 0.13 | ||||||||||||||||||||||
Loss from early extinguishment of debt | — | — | (0.68) | (2.97) | ||||||||||||||||||||||
Income (loss) from divested and closed businesses | (0.01) | 0.19 | (0.01) | 0.18 | ||||||||||||||||||||||
Noncontrolling interest impact | — | 0.01 | — | 0.01 | ||||||||||||||||||||||
Tax impact of above items | 0.19 | 0.30 | (0.71) | 1.62 | ||||||||||||||||||||||
Adjusted diluted earnings per share from continuing operations | $ | 2.70 | $ | 4.72 | $ | 7.58 | $ | 7.92 | ||||||||||||||||||
Weighted average basic shares outstanding (in thousands) | 107,150 | 105,630 | 106,833 | 105,010 | ||||||||||||||||||||||
Weighted average dilutive shares outstanding (in thousands) | 108,890 | 107,237 | 108,571 | 106,263 |
(Dollars in millions) | Three Months Ended | Twelve Months Ended | ||||||||||||||||||||||||
December 31, | December 31, | |||||||||||||||||||||||||
2021 | 2020 | 2021 | 2020 | |||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 249 | $ | 414 | $ | 914 | $ | 399 | ||||||||||||||||||
Less: Net income available to noncontrolling interests | (170) | (132) | (562) | (369) | ||||||||||||||||||||||
Loss from discontinued operations, net of tax | (1) | — | (1) | — | ||||||||||||||||||||||
Income from continuing operations | 420 | 546 | 1,477 | 768 | ||||||||||||||||||||||
Income tax benefit (expense) | (108) | (130) | (411) | 97 | ||||||||||||||||||||||
Loss from early extinguishment of debt | — | — | (74) | (316) | ||||||||||||||||||||||
Other non-operating income (expense), net | (2) | (2) | 14 | 1 | ||||||||||||||||||||||
Interest expense | (221) | (242) | (923) | (1,003) | ||||||||||||||||||||||
Operating income | 751 | 920 | 2,871 | 1,989 | ||||||||||||||||||||||
Litigation and investigation costs | (52) | (31) | (116) | (44) | ||||||||||||||||||||||
Net gains on sales, consolidation and deconsolidation of facilities | 18 | 10 | 445 | 14 | ||||||||||||||||||||||
Impairment and restructuring charges, and acquisition-related costs | (30) | (124) | (85) | (290) | ||||||||||||||||||||||
Depreciation and amortization | (201) | (233) | (855) | (857) | ||||||||||||||||||||||
Income (loss) from divested and closed businesses | (1) | 20 | (1) | 20 | ||||||||||||||||||||||
Adjusted EBITDA | $ | 1,017 | $ | 1,278 | $ | 3,483 | $ | 3,146 | ||||||||||||||||||
Net operating revenues | $ | 4,856 | $ | 4,915 | $ | 19,485 | $ | 17,640 | ||||||||||||||||||
Less: Net operating revenues from closed health plan business | — | 21 | — | 21 | ||||||||||||||||||||||
Adjusted net operating revenues | $ | 4,856 | $ | 4,894 | $ | 19,485 | $ | 17,619 | ||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders as a % of net operating revenues | 5.1 | % | 8.4 | % | 4.7 | % | 2.3 | % | ||||||||||||||||||
Adjusted EBITDA as a % of Adjusted net operating revenues (Adjusted EBITDA margin) | 20.9 | % | 26.1 | % | 17.9 | % | 17.9 | % | ||||||||||||||||||
(Dollars in millions) | 2021 | |||||||||||||
4th Qtr | Full Year | |||||||||||||
Net cash provided by operating activities | $ | 357 | $ | 1,568 | ||||||||||
Purchases of property and equipment | (304) | (658) | ||||||||||||
Free cash flow | 53 | 910 | ||||||||||||
Add back: Medicare Advance Repayments | 186 | 512 | ||||||||||||
Payroll Tax Deferral Payments | 128 | 128 | ||||||||||||
Free cash flow, excluding repayment of Medicare Advances and Deferred Payroll Tax Payments | $ | 367 | $ | 1,550 | ||||||||||
Net cash used in investing activities | $ | (1,516) | $ | (714) | ||||||||||
Net cash provided by (used in) financing activities | $ | 1,231 | $ | (936) | ||||||||||
Net cash provided by operating activities | $ | 357 | $ | 1,568 | ||||||||||
Less: Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements | (37) | (153) | ||||||||||||
Net cash provided by operating activities from discontinued operations | 1 | — | ||||||||||||
Adjusted net cash provided by operating activities from continuing operations | 393 | 1,721 | ||||||||||||
Purchases of property and equipment | (304) | (658) | ||||||||||||
Adjusted free cash flow – continuing operations | 89 | 1,063 | ||||||||||||
Add back: Medicare Advance Repayments | 186 | 512 | ||||||||||||
Payroll Tax Deferral Payments | 128 | 128 | ||||||||||||
Adjusted free cash flow – continuing operations, excluding repayments of Medicare Advances and Deferred Payroll Tax Payments | $ | 403 | $ | 1,703 |
(Dollars in millions) | 2020 | |||||||||||||
4th Qtr | Full Year | |||||||||||||
Net cash provided by operating activities | $ | 446 | $ | 3,407 | ||||||||||
Purchases of property and equipment | (166) | (540) | ||||||||||||
Free cash flow | 280 | 2,867 | ||||||||||||
Less: Medicare Advances | 10 | 1,393 | ||||||||||||
Payroll Tax Deferrals | 260 | 260 | ||||||||||||
Free cash flow excluding Medicare Advances and Payroll Tax Deferrals | $ | 10 | $ | 1,214 | ||||||||||
Net cash used in investing activities | $ | (1,202) | $ | (1,608) | ||||||||||
Net cash (used in) provided by financing activities | $ | (98) | $ | 385 | ||||||||||
Net cash provided by operating activities | $ | 446 | $ | 3,407 | ||||||||||
Less: Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements | (81) | (333) | ||||||||||||
Net cash used in operating activities from discontinued operations | — | (1) | ||||||||||||
Adjusted net cash provided by operating activities from continuing operations | 527 | 3,741 | ||||||||||||
Purchases of property and equipment | (166) | (540) | ||||||||||||
Adjusted free cash flow – continuing operations | 361 | 3,201 | ||||||||||||
Less: Medicare Advances | 10 | 1,393 | ||||||||||||
Payroll Tax Deferrals | 260 | 260 | ||||||||||||
Adjusted free cash flow – continuing operations, excluding Medicare Advances and Payroll Tax Deferrals | $ | 91 | $ | 1,548 |
(Dollars in millions) | Q1’22 | FY 2022 | ||||||||||||||||||||||||
Low | High | Low | High | |||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 75 | $ | 110 | $ | 502 | $ | 677 | ||||||||||||||||||
Less: Net income available to noncontrolling interests | (120) | (140) | (590) | (630) | ||||||||||||||||||||||
Income tax expense | (55) | (70) | (365) | (400) | ||||||||||||||||||||||
Interest expense | (235) | (225) | (880) | (870) | ||||||||||||||||||||||
Loss from early extinguishment of debt(1) | — | — | (33) | (33) | ||||||||||||||||||||||
Other non-operating income (expense), net | — | 5 | — | 10 | ||||||||||||||||||||||
Impairment and restructuring charges, acquisition-related costs, and litigation costs and settlements(2) | (25) | (15) | (125) | (75) | ||||||||||||||||||||||
Depreciation and amortization | (210) | (220) | (875) | (900) | ||||||||||||||||||||||
Loss from divested and closed businesses (i.e., health plan businesses) | (5) | — | (5) | — | ||||||||||||||||||||||
Adjusted EBITDA | $ | 725 | $ | 775 | $ | 3,375 | $ | 3,575 | ||||||||||||||||||
Net operating revenues | $ | 4,600 | $ | 4,800 | $ | 19,500 | $ | 19,900 | ||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders as a % of operating revenues | 1.6 | % | 2.3 | % | 2.6 | % | 3.4 | % | ||||||||||||||||||
Adjusted EBITDA as a % of net operating revenues (Adjusted EBITDA margin) | 15.8 | % | 16.1 | % | 17.3 | % | 18.0 | % |
(Dollars in millions except per share amounts) | Q1’22 | FY 2022 | ||||||||||||||||||||||||
Low | High | Low | High | |||||||||||||||||||||||
Net income available to Tenet Healthcare Corporation common shareholders | $ | 75 | $ | 110 | $ | 502 | $ | 677 | ||||||||||||||||||
Net income from discontinued operations, net of tax | — | — | — | — | ||||||||||||||||||||||
Net income from continuing operations | 75 | 110 | 502 | 677 | ||||||||||||||||||||||
Less: Impairment and restructuring charges, acquisition-related costs, and litigation costs and settlements(1) | (25) | (15) | (125) | (75) | ||||||||||||||||||||||
Loss from early extinguishment of debt(2) | — | — | (33) | (33) | ||||||||||||||||||||||
Loss from divested and closed businesses (i.e., health plan businesses) | (5) | — | (5) | — | ||||||||||||||||||||||
Tax impact of above items | 5 | — | 20 | 10 | ||||||||||||||||||||||
Adjusted net income available from continuing operations to common shareholders | $ | 100 | $ | 125 | $ | 645 | $ | 775 | ||||||||||||||||||
Diluted earnings per share from continuing operations | $ | 0.69 | $ | 1.01 | $ | 4.56 | $ | 6.16 | ||||||||||||||||||
Less: Impairment and restructuring charges, acquisition-related costs, and litigation costs and settlements | (0.23) | (0.14) | (1.14) | (0.68) | ||||||||||||||||||||||
Loss from early extinguishment of debt | — | — | (0.30) | (0.30) | ||||||||||||||||||||||
Loss from divested and closed businesses (i.e., health plan businesses) | (0.05) | — | (0.04) | — | ||||||||||||||||||||||
Tax impact of above items | 0.05 | — | 0.18 | 0.09 | ||||||||||||||||||||||
Adjusted diluted earnings per share from continuing operations | $ | 0.92 | $ | 1.15 | $ | 5.86 | $ | 7.05 | ||||||||||||||||||
Weighted average basic shares outstanding (in thousands) | 107,000 | 107,000 | 108,000 | 108,000 | ||||||||||||||||||||||
Weighted average dilutive shares outstanding (in thousands) | 109,000 | 109,000 | 110,000 | 110,000 |
(Dollars in millions) | FY 2022 | |||||||||||||||||||||||||||||||
Low | High | |||||||||||||||||||||||||||||||
Net cash provided by operating activities | $ | 1,150 | $ | 1,450 | ||||||||||||||||||||||||||||
Purchases of property and equipment – continuing operations | (725) | (775) | ||||||||||||||||||||||||||||||
Free cash flow – continuing operations | 425 | 675 | ||||||||||||||||||||||||||||||
Add back: | ||||||||||||||||||||||||||||||||
Medicare Advance Repayments | 880 | 880 | ||||||||||||||||||||||||||||||
Payroll Tax Deferral Payments | 128 | 128 | ||||||||||||||||||||||||||||||
Free cash flow excluding repayments of Medicare Advances and Deferred Payroll Tax Payments | $ | 1,433 | $ | 1,683 | ||||||||||||||||||||||||||||
Net cash provided by operating activities | $ | 1,150 | $ | 1,450 | ||||||||||||||||||||||||||||
Less: Payments for restructuring charges, acquisition-related costs and litigation costs and settlements(1) | (150) | (100) | ||||||||||||||||||||||||||||||
Net cash used in operating activities from discontinued operations | — | — | ||||||||||||||||||||||||||||||
Adjusted net cash provided by operating activities – continuing operations | 1,300 | 1,550 | ||||||||||||||||||||||||||||||
Purchases of property and equipment – continuing operations | (725) | (775) | ||||||||||||||||||||||||||||||
Adjusted free cash flow – continuing operations(2) | 575 | 775 | ||||||||||||||||||||||||||||||
Add back: | ||||||||||||||||||||||||||||||||
Medicare Advance Repayments | 880 | 880 | ||||||||||||||||||||||||||||||
Payroll Tax Deferral Payments | 128 | 128 | ||||||||||||||||||||||||||||||
Adjusted free cash flow – continuing operations, excluding repayments of Medicare Advances and Deferred Payroll Tax Payments | $ | 1,583 | $ | 1,783 |
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