Bank of America Leverage Finance Conference. November 29, 2016
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- Flora Ellen Parker
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1 Bank of America Leverage Finance Conference November 29, 2016
2 FORWARD-LOOKING STATEMENTS Certain statements in this presentation constitute forward-looking statements that is, statements that relate to future, not past, events. In this context, forward-looking statements often address our expected future business and financial performance and financial condition, and often contain words such as expect, assume, anticipate, intend, plan, believe, seek, see, or will. Forward-looking statements by their nature address matters that are, to different degrees, uncertain. Particular uncertainties that could cause our actual results to be materially different than those expressed in our forward-looking statements include, but are not limited to, the factors disclosed under Forward-Looking Statements and Risk Factors in our Form 10-K for the year ended December 31, 2015, Form 10-Q for the quarterly period ended September 30, 2016 and other filings with the Securities and Exchange Commission. Among other things, these factors include the potentially heightened risk of a repeal, modification or other material change in the Patient Protection and Affordable Care Act following the outcome of recent Presidential and Congressional elections. Unless otherwise indicated, all information in this presentation is as of the date of our Quarterly Report on Form 10-Q for the nine months ended September 30, 2016 filed on October 31, We disclaim any obligation to update this information or any forward-looking statement in this presentation, whether as a result of changes in underlying factors, new information, future events or otherwise. NON-GAAP FINANCIAL INFORMATION This presentation contains non-gaap financial measures. Reconciliations of these non-gaap measures to the most comparable GAAP measure are included in the financial tables at the end of this presentation as well as at the end of the Company s press release dated October 31,
3 Business Update
4 Tenet Healthcare Today 79 Acute Care Hospitals 20 Short-Stay Surgical Hospitals 465 Outpatient Facilities* 6 Health Plans** 9 U.K. Hospitals and Clinics 20 Conifer Health Solutions Client Service Centers Conifer Health Clients in 43 States Acute Care: Leading Hospital Operator High-quality, low-cost provider Focused on high-acuity inpatient services #1 or #2 positions in more than two-thirds of markets USPI: Leading Ambulatory Platform in the U.S. Higher-margin, faster-growing, more capital-efficient business Preferred by patients and payers Pioneered three-way partnerships Conifer Health Solutions: Leading Business Process Services Provider Industry leader in growing market Hospital and physician revenue cycle management services Value-based care solutions Map as of November 2016 *Outpatient defined as ambulatory surgery centers, satellite emergency departments, diagnostic imaging centers and urgent care centers **Tenet announced that it is exiting its health plan business in
5 Tenet is Aligned with Key Trends Shaping Healthcare Consumers are actively seeking lower-cost solutions and better value as they assume more responsibility of their healthcare spend Tenet offers patients and payers high-value services through networks of hospitals and outpatient centers Volumes are shifting to outpatient settings due to technology advancements and increased demand for care that is more convenient, affordable and accessible USPI is the largest operator of ASCs in the U.S. The industry is migrating to value-based payment models with government and private payers shifting risk to providers 82% of Tenet s hospitals participate in ACOs and Conifer Health is a leading provider of ACO solutions Consolidation continues across the entire healthcare sector through both traditional M&A as well as joint ventures and partnerships Tenet has achieved regional scale with acquisitions and joint ventures 5
6 ACA How It Has Impacted Tenet We have benefited from the decline in the uninsured beginning in 2014 that resulted from: Commercial insurance exchanges in all states with subsidized premiums and cost sharing for qualifying individuals Exchange volumes only account for approximately 3% of our total same-hospital volumes. However, we estimate that a majority of our Exchange patients previously had other insurance coverage prior to the ACA; Other insurance reforms related to pre-existing conditions; lifetime limits on essential benefits and dependent coverage; and An increase in the number of individuals covered by Medicaid in states that have elected to expand coverage that is substantially federally-funded. 31 states and the District of Columbia have adopted Medicaid expansion. Six of the twelve states in which we operate hospitals have adopted Medicaid expansion. The six states in which we operate hospitals that have not adopted Medicaid expansion are AL, FL, MO, SC, TN and TX. and we have absorbed Medicare payment reductions and quality-related payment adjustments since 2010: Medicare Medicaid Reductions to the Medicare annual market basket payment rate update: o o Market basket reductions that commenced in 2010 and sunset in 2019 under current law; and Productivity reductions that commenced in 2012 and do not sunset. Reductions to Medicare Disproportionate Share Hospital (DSH) payments that commenced in federal fiscal year (FFY) 2014; Payment adjustments related to quality: o Value Based Purchasing (effective FFY 2013) o Readmissions (effective FFY 2013) o Hospital Acquired Conditions (effective FFY 2015) Reductions to federal DSH allotments that commence in FFY
7 Overview of Acute Care Hospitals Operator of 79 hospitals that serve as the hub of Tenet s healthcare delivery system Focus on urban and suburban markets High-quality, patient-centered care at a market-competitive price Licensed Beds by State + Other * 13% TX 24% IL 5% MI 8% Positioning hospitals to gain market share as consumerism and narrow networks grow AL 8% AZ 9% CA 13% FL 17% 79 Hospitals 25 21K 12 Beds + Licensed States Markets 2,000 Employed Physicians 173 Outpatient Facilities ** 82% of Hospitals in ACOs + Includes all hospitals operated by Tenet as of November 2016 * Includes Missouri, South Carolina, Tennessee, Massachusetts and Pennsylvania ** Excludes USPI s facilities and includes Tenet s satellite emergency departments, hospital-based outpatient centers and freestanding urgent care centers that are reported under the Hospital Operations and Other operating segment as of November
8 Committed to Value-Based Care and Delivery Transformation 18 Total ACOs across the Tenet portfolio Tenet recognized Nationally in Top 100 ACOs for 2014, 2015 & K Covered Lives 82 % 15 of Tenet Hospitals are participating in an ACO of 18 (83%) ACOs contracted with private payers 86 % of lives in an open access shared savings model <50,000 covered lives 50,000+ covered lives 100,000+ covered lives 73 % of Tenet markets in at least one Medicare Innovation Program in 2016 $ 50M Tenet Medicare ACO Savings to CMS from Michigan Pioneer ACO recognized by CMS as most successful Pioneer ACO in 2014 for benchmark savings improvement Managing 5.8M lives under Conifer Health Value-Based Care Conifer Health ranked No. 1 among providers of value-based care solutions to Medicare and commercial ACOs (Black Book) $10M Healthcare Innovation Award to Detroit Medical Center to improve healthcare access, quality and efficiency $15.5M Medicare Practice Transformation grants to advance clinically integrated care in underserved communities 11,890 Physicians participating in Tenet ACOs 31 % Primary Care Physicians in Tenet ACOs 8
9 Overview of Conifer Health Solutions A/R Management Clinical Integration Clinical Revenue Integrity Health Plans Consumer Experience Hospitals & Health Systems Employers Physicians National Scale and Scope 800 clients in 43 states 20 Service Centers 14,500 employees Jointly owned with Catholic Health Initiatives Impact: $29 billion in net patient revenue processed annually 24 million patient touch-points 5.8 million managed lives $17 billion medically managed spend No. 1 Black Book ranking for Value-Based Reimbursement, Accountable Care and Revenue Cycle Outsourcing solutions Population Health Financial Risk Management 9
10 Overview of United Surgical Partners International Premier Operator Leading operator of ambulatory surgery centers (ASCs) in U.S. 240 ASCs, 20 short-stay surgical hospitals, 22 imaging centers and 85 urgent care centers* Attractive case mix: over 40% of revenue coming from orthopedics Superior payer mix: over 50% of cases are commercially insured Strategic Partnerships Pioneered three-way partnership model for development of ASCs 50 health system partners and over 4,300 physician partners Provides long-term growth opportunities in the surgical space and other services Creating Value Creates opportunity to expand integrated networks and participation in valuebased care and other risk-based models Delivering enterprise ambulatory solutions *As of November
11 Strong, Integrated Business Model: Well-Positioned for the Future Solid positions in our three operating segments anchored by acute care hospitals Offering solutions to help health systems navigate the rapidly changing healthcare model Growth channels for each segment through M&A and partnership activities Achieving synergies through shared services Greater proportion of EBITDA from higher-growth, higher-margin segments Positioned to deliver long-term value for shareholders Deep bench of management talent across the enterprise 11
12 Financial Overview
13 Q3 16 Financial Highlights Adjusted EBITDA was $570 million Our health plan business lowered Adjusted EBITDA by $5 million this quarter. We are exiting our health plan business. Same-hospital patient revenue grew 5.3% Adjusted admissions increased 1.4% on a same-hospital basis. Admissions increased 0.4% on a same-hospital basis. Revenue per adjusted admission increased 3.9%, continuing the strength from the first half of 2016 and was partly due to growth in higher acuity service lines. Uncompensated care declined 30 basis points to 21.4% of adjusted revenue, down from 21.7% in Q3 15. Hospital segment Adjusted EBITDA was $334 million in 3Q 16, representing an increase of approximately 5% after adjusting for acquisitions, divestitures and an anticipated decline in electronic health record incentives. Note that the results of our health plans are included in our Hospital Operations and other segment. Ambulatory Care same-facility system-wide revenue grew 9.7% Cases increased 4.0% and revenue per case increased 5.5% on a same-facility system-wide basis. Ambulatory Care Adjusted EBITDA was $157 million, up 28.7% from $122 million in Q3 15. Ambulatory Care Adjusted EBITDA less facility-level NCI was $103 million, up 21.2% from $85 million in Q3 15. Conifer s revenue increased 14.7% to $398 million driven by a 29.9% increase in third party revenue Adjusted EBITDA increased 29.5% to $79 million, representing a margin of 19.8%, aided by $9 million of annual customer performance incentives, which were included in our Outlook. Third party revenue growth at Conifer includes business retained from hospitals that Tenet has sold over the past year. Adjusted Free Cash Flow was $368 million in the first nine months 2016 reiterating 2016 Outlook of $400 to $600 million Free Cash Flow was $237 million in the first nine months of
14 Track Record of Financial Performance ($ in millions) Revenue (1) Adjusted EBITDA (3) $24,000 $18,000 $16,615 $18,733 $19,923 $3,200 $2,400 $1,952 $2,276 $2,413 $12,000 $8,654 $9,119 $11,102 $1,600 $1,126 $1,203 $1,342 $6,000 $800 $ /30/16 LTM $ /30/16 LTM Adjusted Net Cash from Operating Activities Continuing Operations (2) Net Debt / Adjusted EBITDA (4) $1, x $1,200 $800 $579 $691 $718 $878 $1,247 $1, x 4.0x 3.7x 4.1x 6.0x 6.0x 5.9x 5.9x $ x $0 0.0x /30/16 LTM /30/2016 Source: Company public filings. 1. Includes equity in earnings of unconsolidated affiliates as reported in each period. 2. Before purchases of property and equipment; excludes payments for restructuring charges, acquisition-related costs, and litigation costs and settlements. 3. Excludes loss from early extinguishment of debt, litigation and investigation costs, impairment of long-lived assets and goodwill, restructuring charges and acquisition-related costs, and gains/losses on sales, consolidation and deconsolidation of facilities. 4. 9/30/2016 pro forma net leverage assumes $475 million drawn on ABL revolver related to Q4, FY2016 working capital and one-time payments. 14
15 Tenet Outlook for 2016 $ in millions, except EPS 2016 Outlook Net Revenue $19,650 - $19,800 Adjusted EBITDA (1) $2,400 - $2,450 Adjusted EBITDA Margin (1) 12.2% % Adjusted diluted E.P.S. from continuing operations (1) $ $1.21 Adjusted Cash Flow from Operations (1) $1,300 - $1,450 Capital Expenditures $850 - $900 Adjusted Free Cash Flow (1) $400 - $600 Assumptions: Bad Debt Ratio 6.75% % Total Hospital Expenses per Adjusted Admission Growth 2.5% - 3.5% Equity in Earnings of Unconsolidated Affiliates $120 - $130 Electronic Health Record Incentives $30 - $35 Depreciation and Amortization $840 - $850 Interest Expense $970 - $980 Effective Tax Rate (2) 22% - 23% Net Income Attributable to Noncontrolling Interests (3) $340 - $360 Fully diluted weighted average shares outstanding 101 (1) Excludes restructuring charges, acquisition-related costs, litigation costs and settlements, discontinued operations, and gains on sales, consolidation and deconsolidation of facilities. (2) In order to estimate Tenet s income tax expense in 2016, the following formula should be used: a) start with pre-tax income, which is estimated to be $590-$620 million; b) subtract GAAP NCI expense, which is estimated to be $340-$360 million in 2016, excluding the extra $18 million of NCI in Q1'16 and $1 million in Q3'16; c) add back permanent differences and nondeductible items, which are estimated to be approximately $35 million in 2016; d) add back approximately $50 million of non-cash NCI expense that Tenet is recognizing related to the portion of USPI that the company does not own; and, e) multiply the result by a 40% tax rate. The result is an effective tax rate of approximately 22%-23% on Tenet s pre-tax income. (3) This represents GAAP NCI expense to be recorded on the income statement, excluding $19 million of NCI recorded by USPI in the nine months ended 9/30/2016 related to $33 million of gains on consolidation of certain businesses and an associated $7 million favorable income tax adjustment. Cash distributions paid to noncontrolling interests are expected to be $220 - $240 million. 15
16 Segment Outlook for 2016 Hospital Operations Ambulatory Conifer and Other Segment Segment Segment 2016 EBITDA $ $1.555 billion 2016 EBITDA $600 - $620 million 2016 EBITDA $265 - $275 million Noncontrolling Interest (1) $30 - $35 million Noncontrolling Interest (1) $260 - $270 million Noncontrolling Interest (1) $50 - $55 million Net Revenue Growth (2) 4% - 5% Net Revenue Growth (2) 9% - 11% Net Revenue Growth (2) 10% - 15% Pro forma EBITDA Growth (3) 3% - 5% EBITDA Growth (3) 20% - 25% EBITDA Growth (3) 4% - 8% Adjusted Admissions Growth (2) 0.0% - 2.0% EBITDA less NCI Growth (3) 10% - 15% Net Revenue per Adjusted Admission (2) 3.0% - 4.0% Case Growth (2) 5.0% - 6.0% Admissions Growth (2) (1.0%) - 0.0% Net Revenue per Case Growth (2) 4.0% - 5.0% (1) Based on GAAP NCI expense. (1) Based on GAAP NCI expense. Cash NCI distributions will be lower. Excludes $19 million of NCI expense recorded by USPI in the nine months ended 9/30/2016 related to a $33 million gain on consolidation and an associated $7 million favorable income tax adjustment. (1) Based on GAAP NCI expense. Cash NCI distributions will be zero. (2) Growth rates on a same hospital basis. (2) Growth rates on a same facility system wide basis. (2) Conifer's revenue growth is benefitting from new customer wins. (3) EBITDA in the hospital segment is expected to decline in 2016 versus the $1.653 billion of reported EBITDA in 2015 as a result of divestitures. (3) EBITDA growth in the ambulatory segment is based on pro forma Ambulatory segment EBITDA of $489 million and EBITDA less NCI of $300 million in The growth rate in 2016 is benefitting from the annualization of acquisitions that were completed in (3) Conifer's EBITDA growth in 2016 is based on $255 million of EBITDA in 2015 after subtracting a non-recurring benefit of approximately $10 million during the first quarter of
17 Summary Adjusted EBITDA was $570 million and would have been at the midpoint of our Outlook range excluding $5 million of negative EBITDA from our health plans Hospital segment delivered solid same-hospital patient revenue growth of 5.3% o Adjusted admissions increased 1.4% o Improved acuity contributed to the 3.9% increase in revenue per adjusted admission Ambulatory Care segment delivered strong same-facility system-wide revenue growth of 9.7%, with cases increasing 4.0%, and EBITDA less facility-level NCI growth of 21.2% Conifer continues to win new customers and expand relationships with existing clients We are exiting our health plan business Adjusted Free Cash Flow was $368 million for the first nine months of 2016 Midpoint of our Adjusted EBITDA Outlook for 2016 was lowered by $25 million, primarily to reflect approximately $20 million of unanticipated losses in our health plans in 2H 16 and the business interruption and additional expenses associated with Hurricane Matthew 17
18 Appendix and Reconciliation of Non-GAAP Financial Measures
19 Hospital Operations & Other Segment < Restated (1) > < As Reported > Q3'14 Q4'14 Q1'15 Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Adjusted Admissions 4.8% 4.3% 5.9% 2.3% 0.7% 0.3% 2.2% 0.5% 1.4% Admissions 3.9% 4.0% 4.9% 1.7% -0.6% -1.8% -0.1% -1.1% 0.4% Revenue Per Adjusted Admission (2) -3.4% 7.1% 2.3% 4.5% 5.8% 0.3% 3.7% 3.9% 3.9% Inpatient Surgeries 0.4% 2.6% 2.4% 1.9% -0.2% -0.9% 0.2% -0.1% 0.2% Outpatient Surgeries -0.3% 0.2% 0.8% 1.2% 1.5% 0.6% 5.6% 2.0% -3.6% Emergency Department Visits 5.1% 7.2% 7.2% 2.4% 1.5% -0.6% 4.8% 0.9% 0.5% Total Outpatient Visits 7.7% 9.2% 6.9% 4.6% 3.0% 3.0% 5.2% 0.8% 0.8% (1) Hospital segment statistics have been restated to exclude the 49 surgery centers and 20 imaging centers that Tenet contributed to the joint venture with United Surgical Partners International (USPI). Prior to the joint venture with USPI, these outpatient revenues and volumes had been included in our hospitals' calculation of adjusted admissions, revenue per adjusted admission, outpatient surgeries and total outpatient visits. (2) Year-over-year metrics from Q3 14 though Q4 15 were impacted by the full year 2014 California Provider revenues not being recorded until Q4 14 due to the timing of the approval of the program. After normalizing for differences related to the timing of the recognition of California Provider Fee revenue in Q4'14, same hospital revenue per adjusted admission increased 3.2% in Q4'15. 19
20 Uncompensated Care Trends $ in millions Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16 Q3 '16 Bad Debt Expense $249 $356 $363 $352 $371 $391 $376 $352 $367 % of revenue before bad debt 5.6% 7.4% 7.6% 7.3% 7.3% 7.2% 6.9% 6.7% 7.0% % of adjusted revenue (1) 4.7% 6.2% 6.4% 6.2% 6.2% 6.1% 5.9% 5.8% 6.0% Charity Care Write-Offs $254 $216 $174 $199 $268 $255 $220 $152 $228 % of adjusted revenue (1) 4.8% 3.8% 3.1% 3.5% 4.5% 4.0% 3.5% 2.5% 3.7% Uninsured Discounts $600 $704 $699 $675 $664 $774 $713 $706 $723 % of adjusted revenue (1) 11.4% 12.3% 12.3% 11.8% 11.1% 12.0% 11.2% 11.6% 11.7% Uncompensated Care (2) $1,103 $1,275 $1,236 $1,226 $1,303 $1,420 $1,309 $1,210 $1,318 Uncompensated Care Percentage (3) 20.9% 22.2% 21.8% 21.4% 21.7% 22.0% 20.6% 19.9% 21.4% (1) Adjusted Revenue equals the sum of: a) Net operating revenues before provision for doubtful accounts, b) Charity Care Write-Offs, and c) Uninsured Discounts. (2) Uncompensated Care equals the sum of: a) Bad debt, b) Charity Care Write-Offs, and c) Uninsured Discounts. (3) The Uncompensated Care Percentage equals: a) Uncompensated Care, divided by b) Adjusted Revenue. 20
21 Ambulatory Care Segment Same-facility system-wide growth (1) Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15 Q1 '16 Q2 '16 Q3 '16 Surgical (ASCs, Surgical Hospitals & Aspen) Revenue 5.1% 8.9% 8.8% 6.7% 9.9% 12.5% 11.0% 11.8% 9.9% Cases 2.9% 2.7% 4.7% 4.8% 5.3% 6.3% 9.0% 5.1% 4.1% Revenue per case 2.2% 6.0% 3.9% 1.8% 4.3% 5.9% 1.9% 6.3% 5.5% Non-Surgical (Imaging & Urgent Care) Revenue % 15.5% 11.5% 10.9% 9.7% 4.2% Visits % 9.5% 9.3% 8.1% 5.4% 3.7% Revenue per visit % 5.5% 2.0% 2.6% 4.2% 0.5% Ambulatory Segment Total Revenue % 10.1% 12.5% 11.0% 11.7% 9.7% Cases % 6.3% 6.9% 8.6% 5.2% 4.0% Revenue per case % 3.5% 5.2% 2.2% 6.1% 5.5% (1) Same-facility system-wide includes the results of both consolidated and unconsolidated facilities. < USPI only (2) > < Pro forma (3) > (2) The growth rates presented for the quarters in calendar year 2014 and Q1'15 are based on the same-facility system-wide growth rates reported by USPI-only and exclude: a) the results of Aspen, b) CareSpot, and c) the surgery and imaging centers that Tenet contributed to the USPI joint venture. (3) The pro forma growth rates for the Ambulatory Segment shown from Q2'15 to Q3'16 include: a) USPI facilities, including its ambulatory surgery centers and surgical hospitals, b) Aspen, c) the surgery and imaging centers that Tenet contributed to the USPI joint venture, and d) CareSpot on a same-facility system-wide basis. Note that CareSpot was acquired by USPI on 12/31/2015 and is included in the growth rates starting in Q1'16. 21
22 Ambulatory Care Segment (continued) $ in millions Q3'14 Q4'14 Q1'15 Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Net operating revenues $287 $308 $295 $322 $329 $397 $429 $442 $448 % growth 13.9% 12.6% 14.6% 28.9% 45.4% 37.3% 36.2% Equity in earnings of unconsolidated affiliates $27 $43 $21 $28 $30 $47 $25 $26 $28 EBITDA $104 $134 $94 $115 $122 $158 $136 $139 $157 % growth 19.0% 4.5% 17.3% 17.9% 44.7% 20.9% 28.7% Net income attributable to noncontrolling interests (1) $32 $33 $27 $31 $37 $48 $46 $52 $54 EBITDA less NCI (prior to Welsh Carson related NCI) (2) $72 $101 $67 $84 $85 $110 $90 $87 $103 % growth 13.6% 2.4% 18.1% 8.9% 34.3% 3.6% 21.2% Net income attributable to Welsh Carson's ownership interest (2)(3)(4)(5) $6 $16 $7 $11 $11 $17 $11 $8 $14 EBITDA less NCI (after Welsh Carson related NCI) (2) $66 $85 $60 $73 $74 $93 $79 $79 $89 % growth 9.1% 2.8% 12.1% 9.4% 31.7% 8.2% 20.3% EBITDA margin 36.2% 43.5% 31.9% 35.7% 37.1% 39.8% 31.7% 31.4% 35.0% EBITDA less NCI Margin (prior to Welsh Carson related NCI) 25.1% 32.8% 22.7% 26.1% 25.8% 27.7% 21.0% 19.7% 23.0% Note: These figures represent the pro forma financial results for Tenet's Ambulatory Care segment, including the results for USPI, Aspen and the surgery and imaging centers contributed by Tenet to the USPI joint venture for all periods shown. (1) Represents subsidiary level NCI expense prior to Tenet recording additional NCI expense related to Welsh Carson's and other USPI shareholders' ownership interest in the USPI joint venture. (2) The amount labeled as Welsh Carson related NCI represents noncontrolling interest expense related to Welsh Carson's and other USPI shareholders' ownership interest in the USPI joint venture; neither Tenet nor USPI intend to make cash distributions to Welsh Carson or other USPI shareholders. (3) Welsh Carson related NCI expense was $37 million in Q4'15, but would have been $17 million excluding one-time gains. These one-time gains increased USPI's net income by $41 million and resulted in a corresponding $20 million increase in net income attributable to noncontrolling interests. The $41 million of additional net income was due to $32 million of gains on the consolidation of certain businesses in the fourth quarter of 2015 and a $9 million favorable tax adjustment; these gains are not included in EBITDA. (4) Welsh Carson related NCI expense was $29 million in Q1'16, but would have been $11 million excluding one-time gains. These one-time gains increased USPI's net income by $36 million and resulted in a corresponding $18 million increase in net income attributable to noncontrolling interests. The $36 million of additional net income was due to $29 million of gains on the consolidation of certain businesses in the first quarter of 2016 and a $7 million favorable tax adjustment; these gains are not included in EBITDA. (5) Welsh Carson related NCI expense was $15 million in Q3'16, but would have been $14 million excluding one-time gains. These one-time gains increased USPI's net income by $3 million and resulted in a corresponding $1 million increase in net income attributable to noncontrolling interests. The $3 million of additional net income was due to $3 million of gains on the consolidation of certain businesses; these gains are not included in EBITDA. 22
23 Conifer Health Solutions Segment Revenue grew 14.7% to $398 million, driven by 30% growth in revenue from non-tenet customers EBITDA grew 29.5% year-over-year to $79 million. The results for the quarter included $9 million of annual customer performance incentives. These incentives were anticipated in our Outlook and may be achieved again in future years, but will not recur at these levels in the fourth quarter of Third party revenue growth at Conifer includes business retained from hospitals that Tenet has sold over the past year. Black Book ranked Conifer Health #1 for End-to-End Revenue Cycle Management Outsourcing Solutions for Large Hospitals and Medical Centers for the fourth year in a row. $ in millions Q3'14 Q4'14 Q1'15 (1) Q2'15 Q3'15 Q4'15 Q1'16 Q2'16 Q3'16 Revenue from Tenet $148 $165 $160 $165 $163 $178 $167 $162 $159 % growth 60.9% 31.0% 14.3% 19.6% 10.1% 7.9% 4.4% -1.8% -2.5% Other Customers $148 $162 $182 $175 $184 $206 $218 $224 $239 % growth 11.3% 17.4% 25.5% 19.0% 24.3% 27.2% 19.8% 28.0% 29.9% Revenue $296 $327 $342 $340 $347 $384 $385 $386 $398 % growth 31.6% 23.7% 20.0% 19.3% 17.2% 17.4% 12.6% 13.5% 14.7% EBITDA $47 $64 $82 $60 $61 $61 $63 $63 $79 % growth 30.6% 77.8% 70.8% 36.4% 29.8% -4.7% -23.2% 5.0% 29.5% EBITDA Margin 15.9% 19.6% 24.0% 17.6% 17.6% 15.9% 16.4% 16.3% 19.8% (1) Conifer's EBITDA in Q1'15 benefitted from approximately $10 million of non-recurring customer incentive revenue. Note: Tenet and Catholic Health Initiatives represented approximately 75% of Conifer's revenue in Q3'16. 23
24 Debt Maturity Profile Debt Maturity Profile (1) ($ in millions) $6,000 $5,000 1,000 $4,000 1,050 $3,000 $2,000 3, ,800 $1,000 $0 1,900 1,900 1,600 1, Senior Secured Notes Second Lien Notes Senior Unsecured Notes ABL Facility (Undrawn) L/C Facility 1. Excludes Capital Leases and Mortgage Notes and Unamortized Note Discounts and Premiums. 24
25 Tenet Adjusted EBITDA Reconciliation ($ in millions) Fiscal Year Ended Dec. 31 LTM /30/2016 Net income (loss) attributable to Tenet common shareholders ($134) $12 ($140) ($210) Less: Net (income) loss attributable to noncontrolling interests (30) (64) (218) (365) Preferred Stock Dividends Loss from discontinued operations, net of tax (11) (22) 2 (2) Income (loss) from continuing operations (93) Income tax benefit (expense) 65 (49) (68) (129) Investment earnings Loss from early extinguishment of debt (348) (24) (1) (1) Interest expense (474) (754) (912) (978) Operating income ,056 1,262 Litigation and investigation costs (31) (25) (291) (515) Gain on sales, consolidations and deconsolidation of facilities Impairment and restructuring charges, and acquisition-related costs (103) (153) (318) (133) Depreciation and amortization (545) (849) (797) (840) Reported Adjusted EBITDA $1,342 $1,952 $2,276 $2,413 Plus: Stock-Based Compensation Expense Adjusted EBITDA $1,378 $2,003 $2,345 $2,483 25
26 Reconciliation of Adjusted EBITDA to Net Income Available (Loss Attributable) to Tenet Healthcare Corporation Common Shareholders (Unaudited) (Dollars in millions) (Unaudited) Three Months Ended Nine Months Ended September 30, September 30, (Dollars in millions) Three Months Ended Nine Months Ended September 30, September 30, Net loss attributable to Tenet Healthcare Corporation common shareholders $ (8) $ (29) $ (113) $ (43) Net loss attributable to Tenet Healthcare Corporation Less: Net income attributable to noncontrolling interests (88) (57) (266) (119) common shareholders $ (8) $ (29) $ (113) $ (43) Net income (loss) from discontinued operations, net of tax 1 (1) (5) (1) Less: Net income attributable to noncontrolling interests (88) (57) (266) (119) Net income (loss) from continuing operations Net income (loss) from discontinued operations, net of tax 1 (1) (5) (1) Income tax benefit (expense) (10) (11) (61) Net income (loss) from continuing operations Investment earnings (losses) (1) 1 2 Income tax benefit (expense) (10) (11) (61) Interest expense (243) (248) (730) (664) Investment earnings (losses) (1) 1 2 Operating income Interest expense (243) (248) (730) (664) Litigation and investigation costs (4) (50) (291) (67) Operating income Gains on sales, consolidation and deconsolidation of facilities Litigation and investigation costs (4) (50) (291) (67) Impairment and restructuring charges, and acquisition-related costs (31) (44) (81) (266) Gains on sales, consolidation and deconsolidation of facilities Depreciation and amortization (205) (185) (632) (589) Impairment and restructuring charges, and acquisition-related costs (31) (44) (81) (266) Adjusted EBITDA $ 570 $ 566 $ 1,800 $ 1,663 Depreciation and amortization (205) (185) (632) (589) Adjusted EBITDA Net operating revenues $ $ 570 4,849 $ $ 566 4,692 $ $ 1,800 14,761 $ $ 1,663 13,608 Net operating revenues Net loss from continuing operations as a % of operating revenues $ 4,849 $ (0.2)% 4,692 $ (0.6)% 14,761 $ (0.7)% 13,608 (0.3)% Net loss from continuing operations as a % of operating revenues Adjusted EBITDA as % of net operating revenues (Adjusted EBITDA margin) (0.2)% 11.8 % (0.6)% 12.1 % (0.7)% 12.2 % (0.3)% 12.2 % Adjusted EBITDA as % of net operating revenues (Adjusted EBITDA margin) 11.8 % 12.1 % 12.2 % 12.2 % 26
27 Reconciliations of Free Cash Flow and Adjusted Free Cash Flow (Unaudited) Three Months Ended Nine Months Ended (Dollars in millions) September 30, September 30, Net cash provided by (used in) operating activities $ 269 $ 482 $ 851 $ 835 Purchases of property and equipment (201) (207) (614) (566) Free cash flow $ 68 $ 275 $ 237 $ 269 Net cash provided by (used in) investing activities $ (204) $ (287) $ (150) $ (1,272) Net cash provided by (used in) financing activities $ (72) $ (44) $ (408) $ 694 Net cash provided by (used in) operating activities $ 269 $ 482 $ 851 $ 835 Less: Payments for restructuring charges, acquisition-related costs, and litigation costs and settlements (33) (71) (132) (157) Net cash provided by (used in) operating activities from discontinued operations 1 (10) 1 (18) Adjusted net cash provided by operating activities continuing operations ,010 Purchases of property and equipment continuing operations (201) (207) (614) (566) Adjusted free cash flow continuing operations $ 100 $ 356 $ 368 $
28
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