EX-99.1 2 pressrelease.htm PRESS RELEASE pressrelease.htm
 
Exhibit 99.1
 
Almost Family, Inc.
Steve Guenthner
(502) 891-1000
 
 
The Ruth Group
Investor Relations
Nick Laudico/Zack Kubow
(646) 536-7030/7020
nlaudico@theruthgroup.com
zkubow@theruthgroup.com
 

Almost Family Reports Third Quarter 2009 Results


Recent Company Highlights:
·  
Net service revenues increased 31% to $76.3 million
·  
Visiting Nurse (VN) segment net revenues rose 35% to $65.7 million
·  
Quarterly operating cash flow of $7.8 million – strongest in the Company’s history
·  
Net income increased 31% to $6.2 million
·  
Diluted EPS increased 30% to $0.73 per share
·  
Raised $28 million in the Company’s Equity Distribution Program -- cash on hand plus bank credit facility make $80 million available to fund acquisitions

Louisville, KY, November 4, 2009 – Almost Family, Inc. (Nasdaq: AFAM), a leading regional provider of home health nursing services, announced today its financial results for the three months ended September 30, 2009.

William Yarmuth, Chief Executive Officer, commented, “We’re very pleased to once again report record operating results, especially in what is seasonally a down quarter in our Florida markets.  Despite the immense amount of noise surrounding Federal health care reform activities, our managers have maintained their focus on our patients and referral sources to achieve these results.  Whatever the outcome of the current health care reform efforts might bring, we are positioning our Company to thrive and grow as a major consolidator in the home health care industry.”

Third Quarter Financial Results

Almost Family reported third quarter 2009 net service revenues of $76.3 million, a 31% increase from $58.4 million in the third quarter of 2008.

Net income for the third quarter of 2009 was $6.2 million, or $0.73 per diluted share, compared to $4.7 million, or $0.56 per diluted share, in the third quarter of 2008.  The weighted average shares outstanding for purposes of calculating diluted earnings per share increased 1% between periods.

 

 
 
Almost Family Reports Third Quarter 2009 Results
Page Two
November 4, 2009


Third Quarter Segment Results

Net revenues in the Visiting Nurse segment for the third quarter of 2009 were $65.7 million, a 35% increase from $48.6 million in the third quarter of 2008.  The total revenue growth of $17.1 million came from a 24% organic growth rate plus $7.1 million from acquired operations.  Organic Medicare admissions growth was 11% and organic Medicare Episodic growth was 25%.  Operating income before corporate expense in the VN segment for the third quarter of 2009 was $13.4 million, a 34% increase from $10.0 million in the third quarter of 2008.

Net revenues in the Personal Care (PC) segment for the third quarter of 2009 were $10.6 million, an 8% increase from $9.8 million in the third quarter of 2008.  Operating income before unallocated corporate expense in the PC segment for the third quarter of 2009 was $1.3 million, a 40% increase from $902,000 in the third quarter of 2008.

The Company also noted that its Visiting Nurse segment operations located in Florida normally experience higher admissions during the first quarter and lower admissions during the third quarter than in the other quarters due to seasonal population fluctuations.

Nine Month Period Ended September 30, 2009

Almost Family reported net service revenues for the nine month period ended September 30, 2009 of $219.8 million, a 51% increase from $145.6 million in the same period of 2008.

Net income for the nine month period of 2009 was $17.8 million, or $2.14 per diluted share, compared to $11.1 million, or $1.52 per diluted share, in the nine month period of 2008.

Nine Month Period Segment Results

Net revenues in the Visiting Nurse segment for the nine month period of 2009 were $188.4 million, a 61% increase from $117.3 million in the nine month period of 2008.  The total revenue growth of $71.1 million came from a 32% organic growth rate plus $39.7 million from acquired operations.  Operating income before corporate expense in the VN segment for the nine month period of 2009 was $38.9 million, a 62% increase from $24.0 million in the same period of 2008.

Net revenues in the Personal Care (PC) segment for the nine month period of 2009 were $31.4 million, an 11% increase from $28.3 million in the nine month period of 2008.  Operating income before unallocated corporate expense in the PC segment for the nine month period of 2009 was $3.6 million, a 48% increase from $2.4 million in the nine month period of 2008.

Stock Offering

In the quarter ended September 30, 2009, the Company sold 967,556 shares of its common stock in a series of open market transactions at a weighted average price of $29.71.  Net proceeds of approximately $28 million were used to repay obligations under the Company’s bank credit facility.  As of September 30, 2009, the Company had approximately $10 million in cash on hand.   
 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Three
November 4, 2009


 

Conference Call

A conference call to review the results will begin at 11:00 a.m. ET on November 4, 2009, and will be hosted by William Yarmuth, Chief Executive Officer, and Steve Guenthner, Chief Financial Officer. To participate in the conference call, please dial 1-877-407-0789 (USA) or 1-201-689-8562 (International).  In addition, a dial-up replay of the conference call will be available beginning November 4, 2009 at 2:00 p.m. ET and ending on November 18, 2009. The replay telephone number is 1-877-660-6853 (USA) or 1-201-612-7415 (International). Account Number: 3055 and Passcode: 335866.

A live Web cast of the call will also be available from the Investor Relations section of the corporate Web site at http://www.almostfamily.com. A Web cast replay can be accessed on the corporate Web site beginning November 4, 2009 at approximately 2:00 p.m. ET and will remain available until December 4, 2009.



 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Four
November 4, 2009



 
ALMOST FAMILY, INC. AND SUBSIDIARIES
  
CONSOLIDATED STATEMENTS OF INCOME
  
(UNAUDITED)
  
   
Three months ended September 30,
  
   
2009
    
2008
  
  $ 76,294,375     $ 58,437,365  
 Cost of service revenues
     35,779,006       26,953,672  
 Gross margin
     40,515,369       31,483,693  
 General and administrative expenses:
                
Salaries and benefits
     20,799,942       16,352,793  
 Other
     9,378,248       7,262,549  
 Total general and administrative expenses
     30,178,190       23,615,342  
 Operating income
     10,337,179       7,868,351  
 Interest expense, net
     (156,326 )     (355,077 )
 Income from continuing operations before income taxes
     10,180,853       7,513,274  
 Income tax expense
     (3,985,767 )     (2,729,479 )
 Net income from continuing operations
     6,195,086       4,783,795  
 Discontinued operations, net of tax benefits of $18,384 and $12,759
     (28,624 )     (79,039 )
 Net income
   $ 6,166,462     $ 4,704,756  
                 
                 
 Per share amounts-basic:
                
 Average shares outstanding
     8,282,209       8,137,326  
 Income from continued operations
   $ 0.75     $ 0.59  
 Loss from discontinued operations
     -       (0.01 )
 Net income
   $ 0.75     $ 0.58  
                 
 Per share amounts-diluted:
                
 Average shares outstanding
     8,457,329       8,357,332  
 Income from continued operations
   $ 0.73     $ 0.57  
 Loss from discontinued operations
     -       (0.01 )
 Net income
   $ 0.73     $ 0.56  



 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Five
November 4, 2009



ALMOST FAMILY, INC. AND SUBSIDIARIES
  
CONSOLIDATED STATEMENTS OF INCOME
  
(UNAUDITED)
  
   
Nine months ended September 30,
  
   
2009
    
2008
  
 Net service revenues
   $ 219,828,607     $ 145,621,947  
 Cost of service revenues
     102,494,108       67,995,016  
 Gross margin
     117,334,499       77,626,931  
 General and administrative expenses:
                
 Salaries and benefits
     60,469,972       39,805,479  
 Other
     26,840,565       18,875,416  
 Total general and administrative expenses
     87,310,537       58,680,895  
 Operating income
     30,023,962       18,946,036  
 Interest expense, net
     (673,186 )     (733,833 )
 Income from continuing operations before income taxes
     29,350,776       18,212,203  
 Income tax expense
     (11,488,120 )     (6,996,271 )
 Net income from continuing operations
     17,862,656       11,215,932  
 Discontinued operations, net of tax benefits of $27,061 and $63,661
     (106,999 )     (119,165 )
 Net income
   $ 17,755,657     $ 11,096,767  
                 
                 
 Per share amounts-basic:
                
 Average shares outstanding
     8,164,360       7,111,182  
 Income from continued operations
   $ 2.19     $ 1.58  
 Loss from discontinued operations
     (0.01 )     (0.02 )
 Net income
   $ 2.18     $ 1.56  
                 
 Per share amounts-diluted:
                
 Average shares outstanding
     8,318,411       7,298,718  
 Income from continued operations
   $ 2.15     $ 1.54  
 Loss from discontinued operations
     (0.01 )     (0.02 )
 Net income
   $ 2.14     $ 1.52  


 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Six
 November 4, 2009



 
CONSOLIDATED BALANCE SHEETS
  
   
   
September 30, 2009
        
 ASSETS
  
(UNAUDITED)
    
December 31, 2008
  
 CURRENT ASSETS:
            
 Cash and cash equivalents
   $ 10,072,590     $ 1,301,178  
 Accounts receivable - net
     38,404,378       34,760,021  
 Prepaid expenses and other current assets
     2,930,547       3,113,737  
 Deferred tax assets
     7,098,046       4,437,979  
 TOTAL CURRENT ASSETS
     58,505,561       43,612,915  
                 
 PROPERTY AND EQUIPMENT - NET
     4,095,383       4,199,067  
                 
 GOODWILL
     98,179,505       92,170,091  
                 
 OTHER INTANGIBLE ASSETS
     14,613,918       16,715,369  
                 
 OTHER ASSETS
     576,137       518,317  
    $ 175,970,505     $ 157,215,759  
                 
 LIABILITIES AND STOCKHOLDERS' EQUITY
                
 CURRENT LIABILITIES:
                
 Accounts payable
   $ 5,293,798     $ 5,320,763  
 Accrued other liabilities
     19,502,196       22,436,430  
 Current portion - capital leases and notes payable
     493,210       4,774,249  
 TOTAL CURRENT LIABILITIES
     25,289,204       32,531,442  
                 
 LONG-TERM LIABILITIES:
                
 Revolving credit facility
     -       23,998,428  
 Capital lease obligations
     -       111,002  
 Notes payable
     4,300,000       3,100,000  
 Deferred tax liabilities
     3,218,179       1,215,816  
 Other liabilities
     1,149,412       1,476,843  
 TOTAL LONG-TERM LIABILITIES
     8,667,591       29,902,089  
 TOTAL LIABILITIES
     33,956,795       62,433,531  
                 
 STOCKHOLDERS' EQUITY:
                
 Preferred stock, par value $0.05; authorized
                
 2,000,000 shares; none issued or outstanding
     -       -  
 Common stock, par value $0.10; authorized
                
 25,000,000; 9,146,295 and 8,136,723
                
 issued and outstanding
     914,630       813,672  
 Additional paid-in capital
     94,310,539       64,935,673  
 Retained earnings
     46,788,541       29,032,883  
 TOTAL STOCKHOLDERS' EQUITY
     142,013,710       94,782,228  
    $ 175,970,505     $ 157,215,759  

 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Seven
November 4, 2009



 
CONSOLIDATED STATEMENTS OF CASH FLOWS
  
(UNAUDITED)
  
   
Nine months ended September 30,
  
   
2009
    
2008
  
 Cash flows from operating activities:
            
 Net income
   $ 17,755,657     $ 11,096,767  
 Loss from discontinued operations
     (106,999 )     (119,165 )
 Income from continuing operations
     17,862,656       11,215,932  
 Adjustments to reconcile income from continuing operations to
                
 net cash provided by operating activities:
                
 Depreciation and amortization
     1,752,952       1,151,087  
 Provision for uncollectible accounts
     3,164,030       2,375,792  
 Stock-based compensation
     1,218,909       527,462  
 Deferred income taxes
     (657,704 )     (1,152,716 )
      23,340,843       14,117,557  
 Change in certain net assets, net of the effects of acquisitions:
                
 (Increase) decrease in:
                
 Accounts receivable
     (6,642,774 )     (11,716,548 )
 Prepaid expenses and other current assets
     183,190       (789,821 )
 Other assets
     (57,821 )     (26,455 )
 Increase (decrease) in:
                
 Accounts payable and accrued expenses
     (22,981 )     2,154,591  
 Net cash provided by operating activities
     16,800,457       3,739,324  
                 
 Cash flows from investing activities:
                
 Capital expenditures
     (1,382,133 )     (621,360 )
 Acquisitions, net of cash acquired
     (6,406,358 )     (58,593,323 )
 Net cash used in investing activities
     (7,788,491 )     (59,214,683 )
                 
 Cash flows from financing activities:
                
    Net revolving credit facility (repayments) borrowings
     (23,998,428 )     14,096,873  
 Proceeds from stock option exercises
     78,110       54,876  
 Tax benefit from non-qualified stock option exercises
     211,417       84,448  
 Proceeds from stock offering, net
     27,967,387       41,820,562  
 Principal payments on capital leases and notes payable
     (4,392,041 )     (200,086 )
 Net cash (used in) provided by financing activities
     (133,555 )     55,856,673  
                 
 Cash flows from discontinued operations:
                
 Operating activities
     (106,999 )     (119,165 )
 Investing activities
     -       -  
 Financing activities
     -       -  
 Net cash used in discontinued operations
     (106,999 )     (119,165 )
                 
 Net increase in cash and cash equivalents
     8,771,412       262,149  
 Cash and cash equivalents at beginning of period
     1,301,178       473,222  
 Cash and cash equivalents at end of period
   $ 10,072,590     $ 735,371  
                 
                 
 Summary of non-cash investing and financing activities:
                
 Acquisitions funded by notes payable
   $ 1,200,000     $ 3,000,000  
 Acquisitions funded by stock
   $ -     $ 1,000,000  

 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Eight
 November 4, 2009



 
RESULTS OF OPERATIONS
  
                                     
   
Three months ended September 30,
  
   
2009
          
2008
          
Change
        
   
Amount
    
% Rev
    
Amount
    
% Rev
    
Amount
    
%
  
 Net service revenues:
                                    
 Visiting Nurse
   $ 65,738,993       86.2 %   $ 48,621,039       83.2 %   $ 17,117,954       35.2 %
 Personal Care
     10,555,382       13.8 %     9,816,326       16.8 %     739,056       7.5 %
      76,294,375       100.0 %   $ 58,437,365       100.0 %     17,857,010       30.6 %
 Operating income:
                                                
 Visiting Nurse
     13,418,391       20.4 %   $ 10,000,146       20.6 %     3,418,245       34.2 %
 Personal Care
     1,263,325       12.0 %     901,983       9.2 %     361,342       40.1 %
      14,681,716       19.2 %     10,902,129       18.7 %     3,779,587       34.7 %
 Corporate expenses
     4,344,538       5.7 %     3,033,778       5.2 %     1,310,759       43.2 %
 Operating income
     10,337,178       13.5 %     7,868,351       13.5 %     2,468,828       31.4 %
 Interest expense, net
     (156,326 )     0.2 %     (355,077 )     0.6 %     (198,751 )     -56.0 %
 Income tax expense
     (3,985,767 )     5.2 %     (2,729,479 )     4.7 %     1,256,288       46.0 %
 Net income from continuing operations
   $ 6,195,086       8.1 %   $ 4,783,795       8.2 %   $ 1,411,290       29.5 %
                                                 
 EBITDA from continuing operations
   $ 11,385,337       14.9 %   $ 8,571,218       14.7 %   $ 2,814,119       32.8 %


ALMOST FAMILY, INC. AND SUBSIDIARIES
  
RESULTS OF OPERATIONS
  
                                     
   
Nine months ended September 30,
  
   
2009
          
2008
          
Change
        
   
Amount
    
% Rev
    
Amount
    
% Rev
    
Amount
    
%
  
 Net service revenues:
                                    
 Visiting Nurse
   $ 188,443,726       85.7 %   $ 117,317,207       80.6 %   $ 71,126,519       60.6 %
 Personal Care
     31,384,881       14.3 %     28,304,740       19.4 %     3,080,141       10.9 %
      219,828,607       100.0 %   $ 145,621,947       100.0 %     74,206,660       51.0 %
 Operating income:
                                                
 Visiting Nurse
     38,902,918       20.6 %   $ 24,037,766       20.5 %     14,865,152       61.8 %
 Personal Care
     3,597,234       11.5 %     2,425,635       8.6 %     1,171,599       48.3 %
 Operating income before unallocated
           corporate expenses
     42,500,152       19.3 %     26,463,401       18.2 %     16,036,751       60.6 %
 Corporate expenses
     12,476,189       5.7 %     7,517,365       5.2 %     4,958,824       66.0 %
 Operating income
     30,023,962       13.7 %     18,946,036       13.0 %     11,077,927       58.5 %
 Interest expense, net
     (673,186 )     0.3 %     (733,833 )     0.5 %     (60,647 )     -8.3 %
 Income taxes
     (11,488,120 )     5.2 %     (6,996,271 )     4.8 %     4,491,849       64.2 %
 Net income from continuing operations
   $ 17,862,656       8.1 %   $ 11,215,932       7.7 %   $ 6,646,725       59.3 %
                                                 
 EBITDA from continuing operations
   $ 32,995,823       15.0 %   $ 20,624,585       14.2 %   $ 12,371,238       60.0 %


 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Nine
November 4, 2009



 
 
VISITING NURSE SEGMENT OPERATING METRICS
  
                         
   
Three months ended September 30,
  
   
2009
    
2008
    
Change
        
   
Amount
    
Amount
    
Amount
    
%
  
                         
 Average number of locations
     82       64       18       28.1 %
                                 
 All payors:
                                
 Admissions
     12,878       10,339       2,539       24.6 %
 Billable visits
     416,328       309,183       107,145       34.7 %
                                 
 Medicare statistics:
                                
 Revenue
   $ 59,380,507     $ 43,374,706     $ 16,005,801       36.9 %
 Percentage of total revenues
     90.3 %     89.2 %                
 Billable visits
     360,681       261,426       99,255       38.0 %
 Admissions
     11,616       9,479       2,137       22.5 %
 Episodes started
     19,479       14,562       4,917       33.8 %
                                 
 Revenue per completed episode
   $ 3,002     $ 2,926     $ 76       2.6 %
 Visits per episode
     17.8       17.4       0.4       2.4 %
                                 
 
 
 
ALMOST FAMILY, INC. AND SUBSIDIARIES
  
PERSONAL CARE SEGMENT OPERATING METRICS
  
                                 
   
Three months ended September 30,
  
      2009       2008    
Change
          
   
Amount
    
Amount
    
Amount
    
%
  
 Average number of locations
     23       22       1       4.5 %
                                 
 Admissions
     804       861       (57 )     -6.6 %
 Patient days of care
     152,272       137,878       14,394       10.4 %
 Billable hours
     590,662       544,512       46,150       8.5 %
                                 
 Revenue per billable hours
   $ 17.87     $ 18.03     $ (0.16 )     -0.9 %




 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Ten
November 4, 2009



ALMOST FAMILY, INC. AND SUBSIDIARIES
  
VISITING NURSE SEGMENT OPERATING METRICS
  
                         
   
Nine months ended September 30,
  
   
2009
    
2008
    
Change
        
   
Amount
    
Amount
    
Amount
    
%
  
                         
 Average number of locations
     78       58       20       34.5 %
                                 
 All payors:
                                
 Admissions
     38,532       28,149       10,383       36.9 %
 Billable visits
     1,194,139       737,318       456,821       62.0 %
                                 
 Medicare statistics:
                                
 Revenue
   $ 169,098,518     $ 107,772,323     $ 61,326,195       56.9 %
 Percentage of total revenues
     89.7 %     91.9 %                
 Billable visits
     1,025,210       654,542       370,668       56.6 %
 Admissions
     34,968       25,702       9,266       36.0 %
 Episodes started
     56,703       37,401       19,302       51.6 %
                                 
 Revenue per completed episode
   $ 2,943     $ 2,832     $ 111       3.9 %
 Visits per episode
     17.5       17.2       0.3       1.9 %
                                 
 
 
ALMOST FAMILY, INC. AND SUBSIDIARIES
  
PERSONAL CARE SEGMENT OPERATING METRICS
  
                                 
   
Nine months ended September 30,
  
      2009       2008    
Change
          
   
Amount
    
Amount
    
Amount
    
%
  
 Average number of locations
     22       22       -       -  
                                 
 Admissions
     2,445       2,586       (141 )     -5.5 %
 Patient days of care
     448,331       401,539       46,792       11.7 %
 Billable hours
     1,756,498       1,563,377       193,121       12.4 %
                                 
 Revenue per billable hours
   $ 17.87     $ 18.10     $ (0.23 )     -1.3 %

Non-GAAP Financial Measure
The information provided in the tables in this release includes certain non-GAAP financial measures as defined under Securities and Exchange Commission (SEC) rules.  In accordance with SEC rules, the Company has provided, in the supplemental information and the footnotes to the tables, a reconciliation of those measures to the most directly comparable GAAP measures.


 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Eleven
November 4, 2009


EBITDA:
EBITDA is defined as income before depreciation and amortization, net interest expense and income taxes. EBITDA is not a measure of financial performance under accounting principles generally accepted in the United States of America. It should not be considered in isolation or as a substitute for net income,  operating income,  cash flows from operating, investing or financing activities, or any other measure calculated in accordance with generally accepted accounting principles. The items excluded from EBITDA are significant components in understanding and evaluating financial performance and liquidity. Management routinely calculates and communicates EBITDA and believes that it is useful to investors because it is commonly used as an analytical indicator within our industry to evaluate performance, measure leverage capacity and debt service ability, and to estimate current or prospective enterprise value. EBITDA is also used in certain covenants contained in our credit agreement.

The following tables set forth a reconciliation of Continuing Operations Net Income to EBITDA:


 
RECONCILIATION OF EBITDA
  
             
   
Three months ended September 30,
  
   
2009
    
2008
  
 Net income from continuing operations
   $ 6,195,086     $ 4,783,795  
 Add back:
                
 Interest expense
     156,326       355,077  
 Income tax expense
     3,985,767       2,729,479  
 Depreciation and amortization
     600,936       508,737  
 Amortization of stock-based compensation
     447,222       194,130  
 Earnings before interest, income taxes,
                
 depreciation and amortization (EBITDA)
                
 from continuing operations
   $ 11,385,337     $ 8,571,218  



ALMOST FAMILY, INC. AND SUBSIDIARIES
  
RECONCILIATION OF EBITDA
  
             
   
Nine months ended September 30,
  
   
2009
    
2008
  
 Net income from continuing operations
   $ 17,862,656     $ 11,215,932  
 Add back:
                
 Interest expense
     673,186       733,833  
 Income tax expense
     11,488,120       6,996,271  
 Depreciation and amortization
     1,752,952       1,151,087  
 Amortization of stock-based compensation
     1,218,909       527,462  
 Earnings before interest, income taxes,
                
 depreciation and amortization (EBITDA)
                
 from continuing operations
   $ 32,995,823     $ 20,624,585  


 
About Almost Family
Almost Family, Inc., founded in 1976, is a leading regional provider of home health nursing services, with branch locations in Florida, Kentucky, Connecticut, New Jersey, Ohio, Massachusetts,   Alabama,   Missouri,   Illinois,   Pennsylvania,  and Indiana (in order of revenue significance). Almost Family, Inc. and its subsidiaries operate a Medicare-certified visiting nurse segment and a personal care segment. Altogether, Almost Family operates over 100 branch locations in 11 U.S. states.

 
 
 
Almost Family Reports Third Quarter 2009 Results
Page Twelve
November 4, 2009



Forward Looking Statements
All statements, other than statements of historical facts, included in this news release are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements may be identified by the use of forward-looking terminology such as "may," "will," "expect," "believe," "estimate," "project," "anticipate," "continue," or similar terms, variations of those terms or the negative of those terms. These forward-looking statements are based on the Company's current plans, expectations and projections about future events.

Because forward-looking statements involve risks and uncertainties, the Company's actual results could differ materially from any future results, performance or achievements expressed or implied by such forward-looking statements. The potential risks and uncertainties which could cause actual results to differ materially include: regulatory approvals or third party consents may not be obtained, the impact of further changes in healthcare reimbursement systems, including the ultimate outcome of potential changes to Medicare reimbursement for home health services and to Medicaid reimbursement due to state budget shortfalls; the ability of the Company to maintain its level of operating performance and achieve its cost control objectives; changes in our relationships with referral sources; the ability of the Company to integrate acquired operations; government regulation; health care reform; pricing pressures from Medicare, Medicaid and other third-party payers; changes in, or failure to comply with, laws and interpretations of laws relating to the healthcare industry; and the Company’s self-insurance risks.  For a more complete discussion regarding these and other factors which could affect the Company's financial performance, refer to the Company's various filings with the Securities and Exchange Commission, including its filing on Form 10-K for the year ended December 31, 2008, in particular information under the headings "Special Caution Regarding Forward-Looking Statements" and “Risk Factors.” The Company undertakes no obligation to update or revise its forward-looking statements.