UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington D.C. 20549

 

 

FORM 10-Q

 

 

(Mark One)

x

QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2010March 31, 2011

or

 

¨

TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period fromto

Commission File Number: 0-24260

 

 

LOGOLOGO

AMEDISYS, INC.

(Exact Name of Registrant as Specified in its Charter)

 

 

 

Delaware 11-3131700

(State or other jurisdiction of

incorporation or organization)

 

(I.R.S. Employer

Identification No.)

5959 S. Sherwood Forest Blvd., Baton Rouge, LA 70816

(Address of principal executive offices, including zip code)

(225) 292-2031 or (800) 467-2662

(Registrant’s telephone number, including area code)

 

 

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  xþ    No  ¨

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  xþ    No  ¨

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer,” and “smaller reporting company” in Rule 12b-2 of the Exchange Act. (Check one):

 

Large accelerated filer

 

xþ

  

Accelerated filer

 

¨

Non-accelerated filer

 

¨  (Do not check if a smaller reporting company)

  

Smaller reporting company

 

¨

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ¨    No  xþ

The number of shares outstanding of each of the issuer’s classes of common stock, as of the latest practicable date, is as follows: Common stock, $0.001 par value, 29,028,11829,473,568 shares outstanding as of October 21, 2010.April 20, 2011.

 

 

 


TABLE OF CONTENTS

 

SPECIAL CAUTION CONCERNING FORWARD-LOOKING STATEMENTS AND AVAILABLE INFORMATION

   1  

PART I. FINANCIAL INFORMATION

  

ITEM 1.

  

FINANCIAL STATEMENTS (UNAUDITED):

  
  

CONDENSED CONSOLIDATED BALANCE SHEETS AS OF SEPTEMBER 30, 2010MARCH 31, 2011 AND DECEMBER 31, 20092010

   2  
  

CONDENSED CONSOLIDATED INCOME STATEMENTS FOR THE THREE AND NINE-MONTHMONTH PERIODS ENDED SEPTEMBERMARCH 30, 20102011 AND 20092010

   3  
  

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS FOR THE NINE-MONTHTHREE MONTH PERIODS ENDED SEPTEMBER 30,MARCH 31, 2011 AND 2010 AND 2009

   4  
  

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

   5  

ITEM 2.

  

MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

   1413  

ITEM 3.

  

QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

   2520  

ITEM 4.

  

CONTROLS AND PROCEDURES

   2520  

PART II. OTHER INFORMATION

  

ITEM 1.

  

LEGAL PROCEEDINGS

   2621  

ITEM 1A.

  

RISK FACTORS

   2621  

ITEM 2.

  

UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

   2721  

ITEM 3.

  

DEFAULTS UPON SENIOR SECURITIES

   2722  

ITEM 4.

  

RESERVED

   2722  

ITEM 5.

  

OTHER INFORMATION

   2722  

ITEM 6.

  

EXHIBITS

   2823  

SIGNATURES

  3025  

INDEX TO EXHIBITS

   3126  


SPECIAL CAUTION CONCERNING FORWARD-LOOKING STATEMENTS AND AVAILABLE INFORMATION

Special Caution Concerning Forward-Looking Statements

When included in this Quarterly Report on Form 10-Q, or in other documents that we file with the Securities and Exchange Commission (“SEC”), or in statements made by or on behalf of our company, words like “believes,” “belief,” “expects,” “plans,” “anticipates,” “intends,” “projects,” “estimates,” “may,” “might,” “would,” “should” and similar expressions are intended to identify forward-looking statements as defined by the Private Securities Litigation Reform Act of 1995. These forward-looking statements involve a variety of risks and uncertainties that could cause actual results to differ materially from those described therein. These risks and uncertainties include, but are not limited to the following: changes in Medicare and other medical payment levels, our ability to open agencies, acquire additional agencies and integrate and operate these agencies effectively, changes in or our failure to comply with existing Federal and State laws or regulations or the inability to comply with new government regulations on a timely basis, competition in the home health industry, changes in the case mix of patients and payment methodologies, changes in estimates and judgments associated with critical accounting policies, our ability to maintain or establish new patient referral sources, our ability to attract and retain qualified personnel, changes in payments and covered services due to the economic downturn and deficit spending by Federal and State governments, future cost containment initiatives undertaken by third-party payors, our access to financing due to the volatility and disruption of the capital and credit markets, our ability to meet debt service requirements and comply with covenants in debt agreements, business disruptions due to natural disasters or acts of terrorism, our ability to integrate and manage our information systems, changes in or developments with respect to any litigation or investigations relating to the Company, including the United States Senate Committee on Finance inquiry, the SEC investigation and the U.S. Department of Justice Civil Investigative Demand and various other matters, many of which are beyond our control.

Because forward-looking statements are inherently subject to risks and uncertainties, some of which cannot be predicted or quantified, you should not rely on any forward-looking statement as a prediction of future events. We expressly disclaim any obligation or undertaking and we do not intend to release publicly any updates or changes in our expectations concerning the forward-looking statements or any changes in events, conditions or circumstances upon which any forward-looking statement may be based, except as required by law. For a discussion of some of the factors discussed above as well as additional factors, see our Annual Report on Form 10-K for the year ended December 31, 2009,2010, filed with the SEC on February 23, 2010,22, 2011, particularly Part I, Item 1A. – “Risk Factors” therein, which are incorporated herein by reference and Part II, Item 1A. – “Risk Factors” of this Quarterly Report on Form 10-Q. Additional risk factors may also be described in reports that we file from time to time with the SEC.

Available Information

Our company website address is www.amedisys.com. We use our website as a channel of distribution for important company information. Important information, including press releases, analyst presentations and financial information regarding our company, is routinely posted on and accessible on the Investor Relations subpage of our website, which is accessible by clicking on the tab labeled “Investors” on our website home page. We also use our website to expedite public access to time-critical information regarding our company in advance of or in lieu of distributing a press release or a filing with the SEC disclosing the same information. Therefore, investors should look to the Investor Relations subpage of our website for important and time-critical information. Visitors to our website can also register to receive automatic e-mail and other notifications alerting them when new information is made available on the Investor Relations subpage of our website. In addition, we make available on the Investor Relations subpage of our website (under the link “SEC filings”) free of charge our annual reports on Form 10-K, quarterly reports on Form 10-Q, current reports on Form 8-K, ownership reports on Forms 3, 4 and 5 and any amendments to those reports as soon as practicable after we electronically file such reports with the SEC. Further, copies of our Certificate of Incorporation and Bylaws, our Code of Ethical Business Conduct, our Corporate Governance Guidelines and the charters for the Audit, Compensation, Quality of Care and Nominating and Corporate Governance Committees of our Board are also available on the Investor Relations subpage of our website (under the link “Corporate Governance”).

Additionally, our filings can be obtained at the SEC’s Public Reference Room at 100 F Street, NE, Room 1580, Washington, D.C. 20549. Information on the operation of the Public Reference Room may be obtained by calling the SEC at (800) SEC-0330. Our electronically filed reports can also be obtained on the SEC’s internet site at http://www.sec.gov.

PART I. FINANCIAL INFORMATION

ITEM 1. FINANCIAL STATEMENTS

AMEDISYS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED BALANCE SHEETS

(Amounts in thousands, except share data)

(Unaudited)

 

  September 30,
2010
 December 31,
2009
   March 31,
2011
 December 31,
2010
 
ASSETSASSETS     

Current assets:

      

Cash and cash equivalents

  $128,037   $34,485    $148,868   $120,295  

Patient accounts receivable, net of allowance for doubtful accounts of $23,036 and $26,371

   136,450    150,269  

Patient accounts receivable, net of allowance for doubtful accounts of $19,125 and $20,977

   141,923    141,549  

Prepaid expenses

   9,932    10,279     11,605    9,947  

Other current assets

   7,838    23,003     15,701    22,259  
              

Total current assets

   282,257    218,036     318,097    294,050  

Property and equipment, net of accumulated depreciation of $75,954 and $59,780

   117,820    91,919  

Property and equipment, net of accumulated depreciation of $81,300 and $78,074

   144,023    138,554  

Goodwill

   790,409    786,923     791,412    791,412  

Intangible assets, net of accumulated amortization of $15,972 and $11,826

   55,900    57,608  

Intangible assets, net of accumulated amortization of $18,280 and $17,135

   52,248    53,393  

Other assets, net

   17,536    17,865     21,780    22,454  
              

Total assets

  $1,263,922   $1,172,351    $1,327,560   $1,299,863  
              
LIABILITIES AND EQUITYLIABILITIES AND EQUITY     

Current liabilities:

      

Accounts payable

  $19,551   $16,535    $21,290   $20,663  

Payroll and employee benefits

   117,200    119,619     88,322    82,961  

Accrued expenses

   33,746    33,035     69,321    61,254  

Obligations due Medicare

   4,618    4,618  

Current portion of long-term obligations

   39,265    44,254     36,101    37,178  

Current portion of deferred income taxes

   4,247    11,245     12,694    14,285  
              

Total current liabilities

   218,627    229,306     227,728    216,341  

Long-term obligations, less current portion

   153,414    170,899     136,138    144,688  

Deferred income taxes

   36,697    29,399     54,276    52,286  

Other long-term obligations

   6,963    6,412     5,291    6,833  
              

Total liabilities

   415,701    436,016     423,433    420,148  
              

Commitments and Contingencies - Note 6

   

Commitments and Contingencies - Note 5

   

Equity:

      

Preferred stock, $0.001 par value, 5,000,000 shares authorized; none issued or outstanding

   —      —       —      —    

Common stock, $0.001 par value, 60,000,000 shares authorized; 28,953,282 and 28,303,216 shares issued; and 28,318,915 and 28,191,174 shares outstanding

   29    28  

Common stock, $0.001 par value, 60,000,000 shares authorized; 30,084,676 and 29,867,701 shares issued; and 29,445,137 and 29,232,807 shares outstanding

   30    29  

Additional paid-in capital

   398,133    363,670     416,425    407,156  

Treasury stock at cost, 634,367 and 112,042 shares of common stock

   (14,008  (735

Accumulated other comprehensive (loss) income

   (10  114  

Treasury stock at cost, 639,539 and 634,894 shares of common stock

   (14,194  (14,022

Accumulated other comprehensive income

   15    25  

Retained earnings

   462,571    372,089     499,957    484,669  
              

Total Amedisys, Inc. stockholders’ equity

   846,715    735,166     902,233    877,857  

Noncontrolling interests

   1,506    1,169     1,894    1,858  
              

Total equity

   848,221    736,335     904,127    879,715  
              

Total liabilities and equity

  $1,263,922   $1,172,351    $1,327,560   $1,299,863  
              

The accompanying notes are an integral part of these condensed consolidated financial statements.

AMEDISYS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED INCOME STATEMENTS

(Amounts in thousands, except per share data)

(Unaudited)

 

   For the three-
month periods
ended September 30,
  For the nine-month periods
ended September 30,
 
   2010  2009  2010  2009 

Net service revenue

  $404,680   $388,257   $1,239,996   $1,107,987  

Cost of service, excluding depreciation and amortization

   206,312    183,619    619,676    527,096  

General and administrative expenses:

     

Salaries and benefits

   90,354    87,260    267,063    242,340  

Non-cash compensation

   2,636    820    8,317    5,740  

Other

   54,177    43,765    150,624    128,456  

Provision for doubtful accounts

   5,261    4,578    14,069    16,481  

Depreciation and amortization

   8,832    7,481    25,297    20,682  
                 

Operating expenses

   367,572    327,523    1,085,046    940,795  
                 

Operating income

   37,108    60,734    154,950    167,192  

Other (expense) income:

     

Interest income

   197    28    374    161  

Interest expense

   (2,277  (2,682  (7,038  (9,094

Equity in earnings from unconsolidated joint ventures

   788    655    2,310    1,721  

Miscellaneous, net

   (65  324    (1,439  978  
                 

Total other expense, net

   (1,357  (1,675  (5,793  (6,234
                 

Income before income taxes

   35,751    59,059    149,157    160,958  

Income tax expense

   (13,943  (23,033  (58,153  (62,774
                 

Net income

   21,808    36,026    91,004    98,184  

Net income attributable to noncontrolling interests

   (174  (86  (522  (140
                 

Net income attributable to Amedisys, Inc.

  $21,634   $35,940   $90,482   $98,044  
                 

Net income per share attributable to Amedisys, Inc. common stockholders:

     

Basic

  $0.77   $1.31   $3.23   $3.62  
                 

Diluted

  $0.76   $1.29   $3.18   $3.55  
                 

Weighted average shares outstanding:

     

Basic

   28,096    27,340    28,007    27,106  
                 

Diluted

   28,499    27,912    28,490    27,615  
                 

   For the Three-Month Periods
Ended March 31,
 
   2011  2010 

Net service revenue

  $    364,302   $    412,967  

Cost of service, excluding depreciation and amortization

   191,179    204,059  

General and administrative expenses:

   

Salaries and benefits

   85,650    86,967  

Non-cash compensation

   1,910    2,513  

Other

   45,565    45,015  

Provision for doubtful accounts

   3,162    4,345  

Depreciation and amortization

   9,355    8,186  
         

Operating expenses

   336,821    351,085  
         

Operating income

   27,481    61,882  

Other (expense) income:

   

Interest income

   118    85  

Interest expense

   (2,252  (2,411

Equity in earnings from unconsolidated joint ventures

   323    788  

Miscellaneous, net

   (339  33  
         

Total other expense, net

   (2,150  (1,505
         

Income before income taxes

   25,331    60,377  

Income tax expense

   (10,007  (23,547
         

Net income

   15,324    36,830  

Net income attributable to noncontrolling interests

   (36  (184
         

Net income attributable to Amedisys, Inc.

  $15,288   $36,646  
         

Net income per share attributable to Amedisys, Inc. common stockholders:

   

Basic

  $0.54   $1.32  
         

Diluted

  $0.53   $1.29  
         

Weighted average shares outstanding:

   

Basic

   28,366    27,821  
         

Diluted

   28,867    28,359  
         

The accompanying notes are an integral part of these condensed consolidated financial statements.

AMEDISYS, INC. AND SUBSIDIARIES

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Amounts in thousands)

(Unaudited)

 

  For the nine-month periods ended
September 30,
   For the Three-Month Periods Ended
March 31,
 
  2010 2009            2011                    2010           

Cash Flows from Operating Activities:

      

Net income

  $91,004   $98,184    $15,324   $36,830  

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

      

Depreciation and amortization

   25,297    20,682     9,355    8,186  

Provision for doubtful accounts

   14,069    16,481     3,162    4,345  

Non-cash compensation

   8,317    5,740     1,910    2,513  

401(k) employer match

   17,536    13,827     1,403    5,705  

Loss on disposal of property and equipment

   2,314    593     656    171  

Deferred income taxes

   300    11,677     399    1,623  

Equity in earnings of unconsolidated joint ventures

   (2,310  (1,721   (323  (788

Amortization of deferred debt issuance costs

   1,182    1,182     394    394  

Return on equity investment

   1,390    625     240    90  

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

      

Patient accounts receivable

   (250  18,155     (3,536  (4,648

Other current assets

   16,006    1,415     5,112    4,940  

Other assets

   (1,934  1,930     (493  239  

Accounts payable

   2,907    3,572     2,889    3,204  

Accrued expenses

   (3,771  23,885     17,605    8,858  

Other long-term obligations

   551    2,695     (1,543  (625
              

Net cash provided by operating activities

   172,608    218,922     52,554    71,037  
              

Cash Flows from Investing Activities:

      

Proceeds from sale of deferred compensation plan assets

   2,425    956     853    —    

Proceeds from the sale of property and equipment

   —      41  

Purchases of deferred compensation plan assets

   (1,053  (3,064   (219  (54

Purchases of property and equipment

   (37,535  (25,998   (16,580  (9,966

Acquisitions of businesses, net of cash acquired

   (3,121  (31,492   —      (1,969

Acquisitions of reacquired franchise rights

   (2,376  (5,214   —      (2,377
              

Net cash used in investing activities

   (41,660  (64,771   (15,946  (14,366
              

Cash Flows from Financing Activities:

      

Outstanding checks in excess of bank balance

   —      (3,422

Proceeds from issuance of stock upon exercise of stock options and warrants

   1,494    966     96    939  

Proceeds from issuance of stock to employee stock purchase plan

   4,690    4,081     1,578    1,445  

Tax benefit from stock option exercises

   2,427    847     (82  714  

Non-controlling interest distribution

   (185  —    

Proceeds from revolving line of credit

   —      50,200  

Repayments of revolving line of credit

   —      (130,700

Purchase of company stock

   (11,796  —    

Principal payments of long-term obligations

   (34,026  (33,810   (9,627  (12,274
              

Net cash used in financing activities

   (37,396  (111,838   (8,035  (9,176
              

Net increase in cash and cash equivalents

   93,552    42,313     28,573    47,495  

Cash and cash equivalents at beginning of period

   34,485    2,847     120,295    34,485  
              

Cash and cash equivalents at end of period

  $128,037   $45,160    $148,868   $81,980  
              

Supplemental Disclosures of Cash Flow Information:

      

Cash paid for interest

  $7,949   $9,885    $3,490   $3,735  
              

Cash paid for income taxes, net of refunds received

  $49,870   $47,135    $2,793   $14,620  
              

Supplemental Disclosures of Non-Cash Financing and Investing Activities:

      

Notes payable issued for acquisitions

  $750   $8,455    $—     $500  
              

Notes payable issued for software licenses

  $10,801   $—    
       

The accompanying notes are an integral part of these condensed consolidated financial statements.

AMEDISYS, INC. AND SUBSIDIARIES

NOTES TO THE CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

(Unaudited)

1. NATURE OF OPERATIONS, CONSOLIDATION AND PRESENTATION OF FINANCIAL STATEMENTS

Amedisys, Inc., a Delaware corporation, and its consolidated subsidiaries (“Amedisys,” “we,” “us,” or “our”) are a multi-state provider of home health and hospice services with approximately 85% and 88%87% of our revenue derived from Medicare for the three-month periods ended September 30, 2010March 31, 2011 and 2009, respectively and approximately 86% and 88% of our revenue derived from Medicare for the nine-month periods ended September 30, 2010 and 2009, respectively.2010. As of September 30, 2010,March 31, 2011, we had 537489 Medicare-certified home health and 7269 Medicare-certified hospice agencies in 45 states within the United States, the District of Columbia and Puerto Rico.

Basis of Presentation

In our opinion, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting solely of normal recurring adjustments) necessary to present fairly our financial position, our results of operations and our cash flows in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”). Our results of operations for the interim periods presented are not necessarily indicative of results of our operations for the entire year and have not been audited by our independent auditors.

Certain information and footnote disclosures normally included in financial statements prepared in accordance with U.S. GAAP have been condensed or omitted from the interim financial information presented. This report should be read in conjunction with our consolidated financial statements and related notes included in our Annual Report on Form 10-K for the year ended December 31, 20092010 as filed with the Securities and Exchange Commission (“SEC”) on February 23, 201022, 2011 (the “Form 10-K”), which includes information and disclosures not included herein.

Use of Estimates

Our accounting and reporting policies conform with U.S. GAAP. In preparing the unaudited condensed consolidated financial statements, we are required to make estimates and assumptions that impact the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.

Reclassifications and Comparability

Certain reclassifications have been made to prior periods’ financial statements in order to conform them to the current period’s presentation.

As a result of our growth through acquisition and start-up activities, our operating results may not be comparable for the periods that are presented.

Principles of Consolidation

These unaudited condensed consolidated financial statements include the accounts of Amedisys, Inc. and our wholly owned subsidiaries. All significant intercompany accounts and transactions have been eliminated in our accompanying unaudited condensed consolidated financial statements, and business combinations accounted for as purchases have been included in our unaudited condensed consolidated financial statements from their respective dates of acquisition. In addition to our wholly owned subsidiaries, we also have certain equity investments that are accounted for as set forth below.

Equity Investments

We consolidate subsidiaries and/or joint ventures when the entity is a variable interest entity and we are the primary beneficiary or if we have controlling interests in the entity, which is generally ownership in excess of 50%. Third party equity interests in our consolidated joint ventures are reflected as noncontrolling interests in our condensed consolidated financial statements.

For subsidiaries or joint ventures in which we do not have a controlling interest or for which we are not the primary beneficiary, we record such investments under the equity method of accounting.

2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Revenue Recognition

We earn net service revenue through our home health and hospice agencies by providing a variety of services almost exclusively in the homes of our patients. This net service revenue is earned and billed either on an episode of care basis, (on a 60-day episode of care basis for home health services and on a 90-day episode of care basis for the first two hospice episodes of care and on a 60-day episode of care basis for any subsequent hospice episodes), on a per visit basis or on a daily basis depending upon the payment terms and conditions established with each payor for services provided. We refer to home health revenue earned and billed on a 60-day episode of care as episodic-based revenue. For the services we provide, Medicare is our largest payor.

When we record our service revenue, we record it net of estimated revenue adjustments and contractual adjustments to reflect amounts we estimate to be realizable for services provided, as discussed below. We believe, based on information currently available to us and based on our judgment, that changes to one or more factors that impact the accounting estimates (such as our estimates related to revenue adjustments, contractual adjustments and episodes in progress) we make in determining net service revenue, which changes are likely to occur from period to period, will not materially impact our reported consolidated financial condition, results of operations, cash flows or our future financial results.

Home Health Revenue Recognition

Medicare Revenue

Net service revenue is recorded under the Medicare prospective payment programsystem (“PPS”) based on a 60-day episode payment rate that is subject to adjustment based on certain variables including, but not limited to: (a) an outlier payment if our patient’s care was unusually costly (capped at 10% of total reimbursement); (b) a low utilization payment adjustment (“LUPA”) if the number of visits was fewer than five; (c) a partial payment if our patient transferred to another provider or we received a patient from another provider before completing the episode; (d) a payment adjustment based upon the level of therapy services required (thresholds set at 6, 14 and 20 visits); (e) the number of episodes of care provided to a patient, regardless of whether the same home health provider provided care for the entire series of episodes; (f) changes in the base episode payments established by the Medicare Program; (g) adjustments to the base episode payments for case mix and geographic wages; and (h) recoveries of overpayments.

We make adjustments to Medicare revenue on completed episodes to reflect differences between estimated and actual payment amounts, an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. We estimate the impact of such adjustments based on our historical experience, which primarily includes a historical collection rate of over 99% on Medicare claims, and record this estimate during the period in which services are rendered as an estimated revenue adjustment and a corresponding reduction to patient accounts receivable. Therefore, we believe that our reported net service revenue and patient accounts receivable will be the net amounts to be realized from Medicare for services rendered.

In addition to revenue recognized on completed episodes, we also recognize a portion of revenue associated with episodes in progress. Episodes in progress are 60-day episodes of care that begin during the reporting period, but were not completed as of the end of the period. We estimate this revenue on a monthly basis based upon historical trends. The primary factors underlying this estimate are the number of episodes in progress at the end of the reporting period, expected Medicare revenue per episode and our estimate of the average percentage complete based on visits performed. As of September 30,March 31, 2011 and 2010, and 2009, the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and therefore the resulting credits were recorded as a reduction to our outstanding patient accounts receivable in our condensed consolidated balance sheets for such periods.

Non-Medicare Revenue

Episodic-based Revenue.We recognize revenue in a similar manner as we recognize Medicare revenue for episodic-based rates that are paid by other insurance carriers, including Medicare Advantage programs; however, these rates can vary based upon the negotiated terms.

Non-episodic Based Revenue.Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to our established or estimated per-visit rates, as applicable. Contractual adjustments are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third parties and others for services provided and are deducted from gross revenue to determine net service revenue and are also recorded as a reduction to our outstanding patient accounts receivable. In addition, we receive a minimal amount of our net service revenue from patients who are either self-insured or are obligated for an insurance co-payment.

Hospice Revenue Recognition

Hospice Medicare Revenue

Gross revenue is recorded on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are daily or hourly rates for each of the four levels of care we deliver. The four main levels of care we provide are routine care, general inpatient care, continuous home care and respite care. Routine care accounts for 97%98% and 96% of our total net Medicare hospice Medicareservice revenue for the three and nine-monthmonth periods ended September 30,March 31, 2011 and 2010, and 2009.respectively. We make adjustments to Medicare revenue for an inability to obtain appropriate billing documentation or authorizations acceptable to the payor and other reasons unrelated to credit risk. We estimate the impact of these adjustments based on our historical experience, which primarily includes our historical collection rate on Medicare claims, and record it during the period services are rendered as an estimated revenue adjustment and as a reduction to our outstanding patient accounts receivable.

Additionally, as Medicare hospice revenue is subject to an inpatient cap limit and an overall payment cap for each provider number, we monitor our provider numbersthese caps and estimate amounts due back to Medicare if a cap has been exceeded. We record these adjustments as a reduction to revenue and to an increase in other accrued liabilities. As of September 30,We have settled our Medicare hospice reimbursements for all fiscal years through October 31, 2009. For the cap years ended October 31, 2010 and DecemberOctober 31, 2009,2011, we had $1.8have $1.7 million and $0.1$0.5 million, respectively, recorded for estimated amounts due back to Medicare in other accrued liabilities in our accompanying condensed consolidated balance sheets.as of March 31, 2011 and $1.9 million recorded as of December 31, 2010. As a result of our adjustments, we believe our revenue and patients accounts receivable are recorded at amounts that will be ultimately realized.

Hospice Non-Medicare Revenue

We record gross revenue on an accrual basis based upon the date of service at amounts equal to our established rates or estimated per visit rates, as applicable. Contractual adjustments are recorded for the difference between our established rates and the amounts estimated to be realizable from patients, third parties and others for services provided and are deducted from gross revenue to determine our net service revenue and patient accounts receivable.

Patient Accounts Receivable

Our patient accounts receivable are uncollateralized and consist of amounts due from Medicare, Medicaid, other third-party payors and patients. WeThere is no single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables, and thus we believe there is a certain levelare no other significant concentrations of receivables that would subject us to any significant credit risk associated with non-Medicare payors. To provide forin the collection of our non-Medicare patient accounts receivable that could become uncollectible in the future,receivable. We fully reserve for accounts which are aged at 360 days or greater. We write off accounts on a monthly basis once we establishhave exhausted our collection efforts and deem an allowance for doubtful accountsaccount to reduce the carrying amount to its estimated net realizable value. be uncollectible.

We believe the credit risk associated with our Medicare accounts, which represent 72%75% and 77%76% of our net patient accounts receivable at September 30, 2010March 31, 2011 and December 31, 2009,2010, respectively, is limited due to (i) our historical collection rate of over 99% from Medicare and (ii) the fact that Medicare is a U.S. government payor. Accordingly, we do not record an allowance for doubtful accounts for our Medicare patient accounts receivable, which are recorded at their net realizable value after recording estimated revenue adjustments as discussed above. During the three and nine-monthmonth periods ended September 30,March 31, 2011 and 2010, we recorded $2.7$2.4 million and $4.4$0.2 million, respectively, in estimated revenue adjustments to Medicare revenue as compared to $1.9 million and $5.9 million during the three and nine-month periods ended September 30, 2009, respectively. There is no other single payor, other than Medicare, that accounts for more than 10% of our total outstanding patient receivables, and thus werevenue.

We believe there are no other significant concentrationsis a certain level of receivables that would subject us to any significant credit risk associated with non-Medicare payors. To provide for our non-Medicare patient accounts receivable that could become uncollectible in the collection of our patientfuture, we establish an allowance for doubtful accounts receivable.

We fully reserve for accounts which are aged at 360 days or greater. We write off accounts on a monthly basis once we have exhausted our collection efforts and deem an account to be uncollectible.reduce the carrying amount to its estimated net realizable value.

Medicare Home Health

For our home health patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Our Medicare billing begins with a process to ensure that our billings are accurate through the utilization of an electronic Medicare claim review. We submit a RAP for 60% of our estimated payment for the initial episode at the start of care or 50% of the estimated payment for any subsequent episodes of care contiguous with the first episode for a particular patient. The full amount of the episode is billed after the episode has been completed (“final billed”). The RAP received for that particular episode is then deducted from our final payment. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAPs received for that episode will be recouped by Medicare from any other claims in process for that particular provider number. The RAP and final claim must then be re-submitted.

Medicare Hospice

For our hospice patients, our pre-billing process includes verifying that we are eligible for payment from Medicare for the services that we provide to our patients. Once each patient has been confirmed for eligibility, we will bill Medicare on a monthly basis for the services provided to the patient.

Non-Medicare Home Health and Hospice

For our non-Medicare patients, our pre-billing process primarily begins with verifying a patient’s eligibility for services with the applicable payor. Once the patient has been confirmed for eligibility, we will provide services to the patient and bill the applicable payor. We estimate an allowance for doubtful accounts to reduce the carrying amount of the receivables to the amounts we estimate will be ultimately collected. Our review and evaluation of non-Medicare accounts receivable includes a detailed review of outstanding balances and special consideration to concentrations of receivables from particular payors or groups of payors with similar characteristics that would subject us to any significant credit risk. In addition, the amount of the allowance for doubtful accounts is based upon our assessment of historical and expected net collections, business and economic conditions, trends in payment and an evaluation of collectibility based upon the date that the service was provided. Based upon our best judgment, we believe the allowance for doubtful accounts adequately provides for accounts that will not be collected due to credit risk.

Fair Value of Financial Instruments

The following details our financial instruments where the carrying value and fair value differ (amounts in millions):

 

   Fair Value at Reporting Date Using       Fair Value at Reporting Date Using 

Financial Instrument

 As of September 30,
2010
 Quoted Prices in
Active Markets for
Identical Items
(Level 1)
 Significant Other
Observable Inputs
(Level 2)
 Significant
Unobservable Inputs
(Level 3)
   As of March 31,
2011
   Quoted Prices in
Active Markets for
Identical Items
(Level 1)
   Significant Other
Observable Inputs
(Level 2)
   Significant
Unobservable Inputs
(Level 3)
 

Long-term obligations, excluding capital leases

 $192.6   $—     $191.1   $—    

Long-term obligations

  $172.2    $—      $177.3    $—    

The estimates of the fair value of our long-term obligations are based upon a discounted present value analysis of future cash flows. Due to the existing uncertainty in the capital and credit markets, the actual rates that would be obtained to borrow under similar conditions could materially differ from the estimates we have used.

The fair value hierarchy is based on three levels of inputs, of which the first two are considered observable and the last unobservable, that may be used to measure fair value. The three levels of inputs are as follows:

 

Level 1 — Quoted prices in active markets for identical assets and liabilities.

 

Level 2 — Inputs other than Level 1 that are observable, either directly or indirectly, such as quoted prices for similar assets or liabilities; quoted prices in markets that are not active; or other inputs that are observable or can be corroborated by observable market data for substantially the full term of the assets or liabilities.

 

Level 3 — Unobservable inputs that are supported by little or no market activity and are significant to the fair value of the assets or liabilities.

For our other financial instruments, including our cash and cash equivalents, patient accounts receivable, accounts payable and accrued expenses, we estimate the carrying amounts’ approximate fair value due to their short term maturity. Our deferred compensation plan assets are recorded at fair value.

Weighted-Average Shares Outstanding

Net income per share attributable to Amedisys, Inc. common stockholders, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The following table sets forth, for the periods indicated, shares used in our computation of the weighted-average shares outstanding, which are used to calculate our basic and diluted net income per share attributable to Amedisys, Inc. common stockholders (amounts in thousands):

 

   For the three-month periods
ended September 30,
   For the nine-month periods
ended September 30,
 
   2010   2009   2010   2009 

Weighted average number of shares outstanding - basic

   28,096     27,340     28,007     27,106  

Effect of dilutive securities:

        

Stock options

   79     201     143     208  

Non-vested stock and stock units

   324     371     340     301  
                    

Weighted average number of shares outstanding - diluted

   28,499     27,912     28,490     27,615  
                    

   For the Three-Month Periods
Ended March 31,
 
       2011       2010 

Weighted average number of shares outstanding - basic

   28,366     27,821  

Effect of dilutive securities:

    

Stock options

   91     175  

Non-vested stock and stock units

   410     363  
          

Weighted average number of shares outstanding - diluted

   28,867     28,359  
          

For the three and nine-month periodsthree-month period ended September 30, 2010, there were 161,726 and 69,629March 31, 2011 we had no shares respectively, of additional securities that were anti-dilutive compared to 1,209 and 3,8484,222 shares for the three and nine-month periods ended September 30, 2009, respectively.same period in 2010.

3. ACQUISITIONS

We complete acquisitions from time to time in order to pursue our strategy of increasing our market presence by expanding our service base and enhancing our position in certain geographic areas as a leading provider of home health and hospice services. The purchase price paid for acquisitions is negotiated through arm’s length transactions, with consideration based on our analysis of, among other things, comparable acquisitions and expected cash flows for each transaction. Acquisitions are accounted for as purchases and are included in our condensed consolidated financial statements from their respective acquisition dates. Goodwill generated from acquisitions is recognized for the excess of the purchase price over tangible and identifiable intangible assets because of the expected contributions of the acquisitions to our overall corporate strategy.

2010 Acquisitions

On February 1, 2010, we acquired certain assets and liabilities of a home health agency in DeQueen, Arkansas for a total purchase price of $2.5 million ($2.0 million in cash and a $0.5 million promissory note). In connection with the acquisition, we recorded substantially the entire purchase price as goodwill ($2.2 million) and other intangibles ($0.3 million).

On April 5, 2010, we acquired certain assets and liabilities of a hospice agency in Killen, Alabama for a total purchase price of $1.0 million ($0.7 million in cash and a $0.3 million promissory note). In connection with the acquisition, we recorded substantially the entire purchase price as goodwill ($1.1 million), other intangibles ($0.1 million) and other liabilities ($0.2 million).

On July 1, 2010, we acquired certain assets and liabilities of a home health agency in Buckeye, West Virginia for a total purchase price of $0.4 million ($0.4 million in cash). In connection with the acquisition, we recorded substantially the entire purchase price as goodwill ($0.2 million) and other intangibles ($0.2 million).

4. GOODWILL AND OTHER INTANGIBLE ASSETS, NET

The following table summarizes the activity related to our goodwill and our other intangible assets, net, as of and for the nine-monththree-month period ended September 30, 2010March 31, 2011 (amounts in millions):

 

   Goodwill 
   Home Health   Hospice   Total 

Balances at December 31, 2009

  $719.9    $67.0    $786.9  

Additions

   2.4     1.1     3.5  
               

Balances at September 30, 2010

  $722.3    $68.1    $790.4  
               
   Goodwill 
   Home Health   Hospice   Total 

Balances at December 31, 2010

  $723.3    $68.1    $791.4  

Additions

   —       —       —    
               

Balances at March 31, 2011

  $723.3    $68.1    $791.4  
               

 

   Other Intangible Assets, Net 
   Certificates
of Need and
Licenses
  Acquired
Names of
Business
(1)
  Non-Compete
Agreements &
Reacquired
Franchise
Rights (2)
  Total 

Balances at December 31, 2009

   43.4    4.7    9.5    57.6  

Additions

   0.5    0.1    2.7    3.3  

Write-off

   (0.9    (0.9

Amortization

   —      (0.1  (4.0  (4.1
                 

Balances at September 30, 2010

  $43.0   $4.7   $8.2   $55.9  
                 
   Other Intangible Assets, Net 
   Certificates
of Need and
Licenses
   Acquired
Names of
Business
(1)
  Non-Compete
Agreements &
Reacquired
Franchise
Rights (2)
  Total 

Balances at December 31, 2010

  $41.7    $4.7   $7.0   $53.4  

Amortization

   —       (0.1  (1.1  (1.2
                  

Balances at March 31, 2011

  $41.7    $4.6   $5.9   $52.2  
                  

 

(1)

Acquired Names of Business includes $4.4 million of unamortized acquired names and $0.3$0.2 million of amortized acquired names which have a weighted-average amortization period of 2.72.4 years.

(2)

The weighted-average amortization period of our non-compete agreements and reacquired franchise rights is 2.82.4 and 2.42.2 years, respectively.

During the three-month period ended September 30, 2010, we wrote-off $0.9 million in Medicare licenses related to the closing/mergers of the agencies discussed in Note 8.

5.4. LONG-TERM OBLIGATIONS

Long-term obligations, including capital lease obligations, consisted of the following for the periods indicated (amounts in millions):

 

  September 30, 2010 December 31, 2009   March 31, 2011 December 31, 2010 

Senior Notes:

      

$35.0 million Series A Notes; semi-annual interest only payments; interest rate at 6.07% per annum; due March 25, 2013

  $35.0   $35.0    $35.0   $35.0  

$30.0 million Series B Notes; semi-annual interest only payments; interest rate at 6.28% per annum; due March 25, 2014

   30.0    30.0    $30.0    30.0  

$35.0 million Series C Notes; semi-annual interest only payments; interest rate at 6.49% per annum; due March 25, 2015

   35.0    35.0    $35.0    35.0  

$150.0 million Term Loan; $7.5 million principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (1.02% at September 30, 2010); due March 26, 2013

   75.0    97.5  

$150.0 million Term Loan; $7.5 million principal payments plus accrued interest payable quarterly; interest rate at ABR Rate plus applicable percentage or Eurodollar Rate plus the applicable percentage (1.01% at March 31, 2011); due March 26, 2013

  $60.0    67.5  

Promissory notes

   17.6    17.6     12.2    14.4  

Capital leases

   —      0.1  
              
   192.6    215.2     172.2    181.9  

Current portion of long-term obligations

   (39.2  (44.3   (36.1  (37.2
              

Total

  $153.4   $170.9    $136.1   $144.7  
              

Our weighted-average interest rate for our five year Term Loan for the threequarters ended March 31, 2011 and nine-month periods ended September 30, 2010 was 1.1% as compared to 1.3% and 1.8% for the three and nine-month periods ended September 30, 2009, respectively.1.0%.

As of September 30, 2010,March 31, 2011, our total leverage ratio (used to compute the margin and commitment fees, described in more detail in Note 6 of the financial statements included in our Form 10-K) was 0.70.9 and our fixed charge coverage ratio was 1.9.1.5.

As of September 30, 2010,March 31, 2011, our availability under our $250.0 million Revolving Credit Facility was $234.6$232.5 million as we had $15.4$17.5 million outstanding in letters of credit.

See Note 6 of the financial statements included in our Form 10-K for additional details on our outstanding long-term obligations.

6.5. COMMITMENTS AND CONTINGENCIES

Legal Proceedings

In addition to the matters referenced in this note, we are involved in legal actions in the normal course of business, some of which seek monetary damages, including claims for punitive damages. We do not believe that these normal course actions, when finally concluded and determined, will have a material impact on our consolidated financial condition, results of operations or cash flows. We are also involved in the legal actions set forth below.

United States Senate Committee on Finance Inquiry

On May 12, 2010, we received a letter of inquiry from the United States Senate Committee on Finance requesting documents and information relating to our policies and practices regarding home therapy visits and therapy utilization trends. A similar letter was sent to the other major publicly traded home healthcarehealth care companies. We intend to cooperateare cooperating with the Committee with respect to this inquiry. No assurances can be given as to the timing of this inquiry or as to the outcome of this inquiry.

Securities Class Action Lawsuits

On June 7, 2010, a putative securities class action complaint was filed in the United States District Court for the Middle District of Louisiana on behalf of all persons who purchased Amedisys securities between February 23, 2010 and May 13, 2010 against the Company and certain of our current and former senior executives alleging violationsexecutives. Additional putative securities class actions were filed in the United States District Court for the Middle District of Louisiana on July 14, July 16, and July 28, 2010.

On October 22, 2010, the Court issued an order consolidating the putative securities class action lawsuits and the derivative actions (described immediately below) for pre-trial purposes. In the same order, the Court appointed the Public Employees Retirement System of Mississippi and the Puerto Rico Teachers’ Retirement System as co-lead plaintiffs (together, the “Co-Lead Plaintiffs”) for the putative class. On December 10, 2010, the Court also consolidated the ERISA class action lawsuit (described below) with the putative securities class actions and derivative actions for pre-trial purposes.

On January 18, 2011, the Co-Lead Plaintiffs filed an amended, consolidated class action complaint (the “Securities Complaint”) which supersedes the earlier-filed securities class action complaints. The Securities Exchange Act of 1934, as amended, and Rule 10b-5 thereunder. The complaintComplaint alleges that we and certain of our senior executivesthe defendants made false and/or misleading statements as well asand failed to disclose material facts about our business, financial condition, operations and prospects, particularly relating to our policies and practices regarding home therapy visits under the Medicare home health prospective payment system and the related alleged impact on our business, financial condition, operations and prospects. The complaintSecurities Complaint seeks a determination that the action may be maintained as a class action an award of unspecified monetary damages and other unspecified relief. No assurances can be given as to the timing or outcome of this complaint.

Additional putative securities class actions were filed in the United States District Court for the Middle District of Louisiana on July 14, July 16, and July 28, 2010. Those actions make allegations similar those included in the June 7, 2010 complaint described above, except that each purports to assert claims on behalf of a different putative class of purchasers of Amedisys securities.all persons who purchased the Company’s securities between August 2, 2005 and September 28, 2010. All defendants have moved to dismiss the Securities Complaint.

Derivative Actions

On July 2, 2010, an alleged shareholder of the Company filed a derivative lawsuit in the United States District Court for the Middle District of Louisiana, purporting to assert claims on behalf of the Company against certain of our current and former officers and directors. We are named as a nominal defendant in the action. The complaint alleges that our officers and directors breached their fiduciary duties to the Company by making allegedly false statements, and by allegedly failing to establish sufficient internal controls over certain of our home health and Medicare billing practices. The complaint seeks an unspecified amount of damages and an order directing the Company to adopt certain measures purportedly designed to improve its corporate governance and internal procedures. Three similar derivative suits were filed in the United States District Court for the Middle District of Louisiana on July 15, July 21, and August 2, 2010. No assurances can be givenWe are named as a nominal defendant in all of those actions. As noted above, on October 22, 2010, the United States District Court for the Middle District of Louisiana issued an order consolidating the derivative actions with the putative securities class action lawsuits and for pre-trial purposes.

On January 18, 2011, the plaintiffs in the consolidated federal derivative actions filed a consolidated, amended complaint (the “Derivative Complaint”) which supersedes the earlier-filed derivative complaints. The Derivative Complaint alleges that certain of our current and former officers and directors breached their fiduciary duties to the timing or outcomeCompany by making allegedly false statements, by allegedly failing to establish sufficient internal controls over certain of this lawsuit.our home health and Medicare billing practices, by engaging in alleged insider trading, and by committing unspecified acts of waste of corporate assets and unjust enrichment. All defendants in the derivative action, including the Company as a nominal defendant, have moved to dismiss the Derivative Complaint.

On July 23, 2010, a derivative suit was filed in the Nineteenth Judicial District Court, Parish of East Baton Rouge, State of Louisiana. That action also purports to assert claims on behalf of the Company against certain of our current and former officers and directors, and seeks an unspecified amount of damages anddirectors. On December 8, 2010, the Court entered an order directingstaying the Company to adopt unspecified measures to improve its corporate governance and internal procedures. No assurances can be given asaction in deference to the timing or outcome of this lawsuit.earlier-filed derivative actions pending in federal court.

ERISA Class Action Lawsuit

On September 27, 2010 aand October 22, 2010, separate putative class action complaint wascomplaints were filed in the United States District Court for the Middle District of Louisiana against us, certain of our current and former senior executives and current and certain former members of our 401(k) Plan Administrative Committee. The suit allegessuits allege violations of the Employee Retirement Income Security Act (“ERISA”) since January 1, 2006.2006 and July 1, 2007, respectively. The plaintiffplaintiffs brought the complaintcomplaints on behalf of herselfthemselves and a class of similarly situated participants in our 401(k) plan. The plaintiff assertsplaintiffs assert that the defendants breached their fiduciary duties to the 401(k) Plan’s participants by causing the 401(k) plan to offer and hold Amedisys common stock during the respective class periodperiods when it was an allegedly unduly risky and imprudent retirement investment because of our alleged improper business practices. The complaint seekscomplaints seek a determination that the actionactions may be maintained as a class action, an award of unspecified monetary damages and other unspecified relief. No assurances canAs noted above, on December 10, 2010, the Court consolidated the putative ERISA class actions with the putative securities class actions and derivative actions for pre-trial purposes. In addition, on December 10, 2010, the Court appointed interim lead counsel and interim liaison counsel in the ERISA class action.

On March 10, 2011, Wanda Corbin, Pia Galimba and Linda Trammell (the “Co-ERISA Plaintiffs”), filed an amended, consolidated class action complaint (the “ERISA Complaint”), which supersedes the earlier-filed ERISA class action complaints. The ERISA Complaint seeks a determination that the action may be givenmaintained as a class action on behalf of themselves and a class of similarly situated participants in our 401(k) plan from January 1, 2008 through present. All of the defendants have moved to dismiss the timing or outcome of this complaint.ERISA Complaint.

SEC Investigation

On June 30, 2010, we received notice of a formal investigation from the SEC and received a subpoena for documents relating to the matters under review by the United States Senate Committee on Finance and other matters involving our operations. We intend to cooperateare cooperating with the SEC with respect to this investigation. No assurances can be given as to the timing or outcome of this investigation.

U.S. Department of Justice Civil Investigative Demand (“CID”)

On September 27, 2010, we received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act. The CID requires the delivery of a wide range of documents and information to the United States Attorney’s Office for the Northern District of Alabama, relating to the Company’s clinical and business operations, including reimbursement and billing claims submitted to Medicare for home health services, and related compliance activities. The CID generally covers the period from January 1, 2003. We intend to cooperatehave been informed by the Department of Justice that the Company will be receiving another related CID requiring the production of additional documents. We are cooperating with the Department of Justice with respect to this investigation. No assurance can be given as to the timing or outcome of this investigation.

We are unable to assess the probable outcome or reasonably estimate the potential liability, if any, arising from the United States Senate Committee on Finance inquiry, the SEC investigation, the U.S. Department of Justice CID orand the relatedsecurities, shareholder derivative and ERISA litigation described above given the preliminary stage of these matters. The Company intends to continue to vigorously defend itself in the securities, shareholder derivative and ERISA litigation matters. No assurances can be given as to the timing or outcome of the United States Senate Committee on Finance inquiry, the SEC investigation, the U.S. Department of Justice CID or the securities, shareholder derivative and ERISA litigation matters described above or the impact of any of the inquiry, investigation or litigation matters on the Company, its consolidated financial condition, results of operations or cash flows.

We recognize that additional putative securities class action complaints and other litigation could be filed, and that other investigations and actions could be commenced, relating to matters involving our home therapy visits and therapy utilization trends or other matters.

Third Party Audits

We are subject in the ordinary course of our business from time to time to audits under various governmental programs in which third party firms engaged by CMS conduct extensive review of claims data to identify potential improper payments under the Medicare program. In January 2010, our subsidiary that provides home health services in Dayton, Ohio received from a Medicare Program Safeguard Contractor (“PSC”) a request for records regarding 137 claims submitted by the subsidiary paid from January 2, 2008 through November 10, 2009 (the “Claim Period”) to determine whether the underlying services met pertinent Medicare payment requirements. Based on the PSC’s findings, which were extrapolated to all claims for home health services provided by the Dayton subsidiary paid during the Claim Period, on March 9, 2011, the Medicare Administrative Contractor for the subsidiary issued a notice of overpayment seeking recovery from our subsidiary of an alleged overpayment of approximately $5.6 million. We dispute these findings and intend to vigorously seek to have these findings overturned, but no assurances can be given as to the timing or outcome of any appeal.

Insurance

We are obligated for certain costs associated with our insurance programs, including employee health, workers’ compensation and professional liability. While we maintain various insurance programs to cover these risks, we are self-insured for a substantial portion of our potential claims. We recognize our obligations associated with these costs in the period in which a claim is incurred, including with respect to both reported claims and claims incurred but not reported, up to specified deductible limits. These costs have generally been estimated based on historical data of our claims experience. Such estimates, and the resulting reserves, are reviewed and updated by us on a quarterly basis.

Our health insurance has a retention limit of $0.5$0.8 million, our workers’ compensation insurance has a retention limit of $0.4 million and our professional liability insurance has a retention limit of $0.3 million.

7. SHARE REPURCHASE PROGRAM

On August 6, 2010, our Board of Directors authorized a stock repurchase program of up to $60.0 million of our common stock. Purchases may be made through open market and privately negotiated transactions, at times and in such amounts as management deems appropriate, including pursuant to one or more Rule 10b5-1 trading plans. The share repurchase program is scheduled to expire on September 30, 2011.

The timing of any repurchases and the actual number of shares repurchased will depend on a variety of factors, including the price of our common stock, corporate and regulatory requirements, restrictions under our debt obligations and other market and economic conditions. The stock repurchase program does not obligate Amedisys to acquire any particular amount of common stock and may be modified, suspended or discontinued at any time.

During the three months ended September 30, 2010, pursuant to this program, we repurchased 495,815 shares of our common stock at a weighted average price of $23.79 per share and a total cost of approximately $11.8 million. The repurchased shares are classified as treasury shares.

8. EXIT ACTIVITIES

In September 2010, we announced plans to close nine home health agencies and four hospice agencies, consolidate another 23 home health agencies and three hospice agencies into existing locations and discontinue the start-up process associated with 28 prospective home health agencies. In addition to these 67 agencies, we have closed or consolidated an additional 17 home health agencies during the first and second quarters of 2010.

As part of our exit activities associated with these locations, we recorded $5.6 million and $7.1 million in lease liabilities associated with future lease obligations during the three and nine-month period ended September 30, 2010, respectively and recorded $0.4 million in severance costs and $0.9 million for intangible write-offs during the three and nine-month periods ended September 30, 2010. We expect to complete these actions by the end of the fourth quarter of 2010 and incur approximately $2.0 million in additional costs related to these exit activities. However, as a part of our ongoing normal operational review, we may, from time to time, close or consolidate additional agencies.

9.6. SEGMENT INFORMATION

Our operations involve servicing patients through our two reportable business segments: home health and hospice. Our home health segment delivers a wide range of services in the home of individuals who may be recovering from surgery, have a chronic disability or terminal illness or need assistance with the essential activities of daily living. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. The “other” column in the following tables consists of costs relating to corporate support functions that are not directly attributable to a specific segment.

Management evaluates performance and allocates resources based on the operating income of the reportable segments, which exclude corporate expenses, but includes revenues and all other costs directly attributable to the specific segment. Segment assets are not reviewed by the company’s chief operating decision maker and therefore are not disclosed below. The following table summarizes our segment information for the periods indicated (amounts in millions):

 

  For the Three-Month Period Ended September 30, 2010   For the Three-Month Period Ended March 31, 2011 
  Home Health   Hospice   Other Total   Home Health   Hospice   Other Total 

Net service revenue

  $368.5    $36.2    $—     $404.7    $325.5    $38.8    $—     $364.3  

Cost of service, excluding depreciation and amortization

   186.2     20.1     —      206.3     170.8     20.4     —      191.2  

General and administrative expenses

   92.0     9.4     45.8    147.2     76.7     8.1     48.2    133.0  

Provision for doubtful accounts

   5.1     0.2     —      5.3     3.2     —       —      3.2  

Depreciation and amortization

   3.8     0.1     4.9    8.8     3.2     0.1     6.1    9.4  
                              

Operating expenses

   287.1     29.8     50.7    367.6     253.9     28.6     54.3    336.8  
                              

Operating income

  $81.4    $6.4    $(50.7 $37.1    $71.6    $10.2    $(54.3 $27.5  
                              
  For the Three-Month Period Ended September 30, 2009   For the Three-Month Period Ended March 31, 2010 
  Home Health   Hospice   Other Total   Home Health   Hospice   Other Total 

Net service revenue

  $359.4    $28.9    $—     $388.3    $380.5    $32.5    $—     $413.0  

Cost of service, excluding depreciation and amortization

   168.7     14.9     —      183.6     187.0     17.1     —      204.1  

General and administrative expenses

   79.8     6.7     45.3    131.8     86.3     7.8     40.4    134.5  

Provision for doubtful accounts

   4.1     0.5     —      4.6     3.8     0.5     —      4.3  

Depreciation and amortization

   3.5     0.3     3.7    7.5     3.6     0.1     4.5    8.2  
                              

Operating expenses

   256.1     22.4     49.0    327.5     280.7     25.5     44.9    351.1  
                              

Operating income

  $103.3    $6.5    $(49.0 $60.8    $99.8    $7.0    $(44.9 $61.9  
                              
  For the Nine-Month Period Ended September 30, 2010 
  Home Health   Hospice   Other Total 

Net service revenue

  $1,137.0    $103.0    $—     $1,240.0  

Cost of service, excluding depreciation and amortization

   563.9     55.8     —      619.7  

General and administrative expenses

   269.4     25.1     131.5    426.0  

Provision for doubtful accounts

   12.9     1.2     —      14.1  

Depreciation and amortization

   11.3     0.4     13.6    25.3  
               

Operating expenses

   857.5     82.5     145.1    1,085.1  
               

Operating income

  $279.5    $20.5    $(145.1 $154.9  
               
  For the Nine-Month Period Ended September 30, 2009 
  Home Health   Hospice   Other Total 

Net service revenue

  $1,035.6    $72.4    $—     $1,108.0  

Cost of service, excluding depreciation and amortization

   488.5     38.5     —      527.0  

General and administrative expenses

   229.7     17.4     129.5    376.6  

Provision for doubtful accounts

   15.4     1.1     —      16.5  

Depreciation and amortization

   10.0     0.7     10.0    20.7  
               

Operating expenses

   743.6     57.7     139.5    940.8  
               

Operating income

  $292.0    $14.7    $(139.5 $167.2  
               

7. SUBSEQUENT EVENTS

On April 15, 2011, we signed a definitive agreement to acquire Beacon Hospice, Inc (“Beacon”). We have agreed in the definitive agreement to a purchase price of approximately $125 million, subject to customary adjustments. This transaction remains subject to normal closing conditions, including regulatory approvals and is expected to close in May 2011. Beacon operates 23 free-standing locations and one inpatient unit, servicing the states of Massachusetts, Maine, New Hampshire, Rhode Island and Connecticut with revenue of approximately $80 million for 2010.

ITEM 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS

The following discussion and analysis provides information we believe is relevant to an assessment and understanding of our results of operations and financial condition for the three and nine-month periodsmonth period ended September 30, 2010.March 31, 2011. This discussion should be read in conjunction with the condensed consolidated financial statements and notes thereto included herein, and the consolidated financial statements and notes and the related Management’s Discussion and Analysis of Financial Condition and Results of Operations in our Annual Report on Form 10-K for the year ended December 31, 20092010 filed with the Securities and Exchange Commission (“SEC”) on February 23, 201022, 2011 (the “Form 10-K”), which are incorporated herein by this reference.

Unless otherwise provided, “Amedisys,” “we,” “us,” “our” and the “Company” refer to Amedisys, Inc. and our consolidated subsidiaries.

Overview

We are a leading provider of high-quality, low-cost home health services to the chronic, co-morbid, aging American population. Our services include home health and hospice services, and approximately 85% and 88%87% of our revenue was derived from Medicare for the three-month periods ended September 30, 2010March 31, 2011 and 2009, respectively, and approximately 86% and 88% of our revenue was derived from Medicare for the nine-month periods ended September 30, 2010 and 2009, respectively.2010. During the three-month period ended September 30, 2010,March 31, 2011, we had $404.7$364.3 million in net service revenue, earnings per diluted share of $0.76$0.53 and cash flow from operations of $47.2$52.5 million. For

Our operations involve servicing patients through our two reportable business segments: home health and hospice. Our home health segment delivers a wide range of services in the nine-month period ended September 30, 2010,homes of individuals who may be recovering from surgery, have a chronic disability or terminal illness. Our hospice segment provides palliative care and comfort to terminally ill patients and their families. As of March 31, 2011, we had $1.2 billion in net service revenue, earnings per diluted share of $3.18 and cash flow from operations of $172.6 million.

During the three-month period ended September 30, 2010, we incurred certain costs associated with the realignment of operations including severance and legal expenses related to the United States Senate Committee on Finance inquiry and SEC investigation discussed in Note 6 to the condensed consolidated financial statements In addition, for the nine-month period ended September 30, 2010 certain costs include the reversal of accrued bonuses during the second quarter of 2010. We also incurred costs associated with our exit activities for the three-and nine month periods ended September 30, 2010, discussed in Note 8 to the condensed consolidated financial statements. During the three-month period ended September 30, 2010 we settled our Georgia indigent care liability for the years 2007 through 2009 and during the three-month period June 30, 2010 we received the Centers for Medicare and Medicaid Services (“CMS”) bonus payments as the result of the pay for performance demonstration. The following details these items for the three and nine-month periods ended September 30, 2010:

   For the three-month periods ended
September 30, 2010
  For the nine-month periods ended
September 30, 2010
 
   (Income)
Expense
  Net of tax  EPS  (Income)
Expense
  Net of tax  EPS 

Georgia indigent care liability

  $(3.7 $(2.2 $(0.08 $(3.7 $(2.2 $(0.08

CMS bonus payment

   —      —      —      (3.6  (2.2  (0.08

Exit activities

   6.9    4.2    0.15    8.4    5.1    0.18  

Certain costs

   3.1    1.8    0.06    6.4    3.9    0.14  
                         

Total

  $6.3   $3.8   $0.13   $7.5   $4.6   $0.16  
                         

Exit Activities

During September, we announced plans to consolidate 23 operating489 Medicare-certified home health agencies and three69 Medicare-certified hospice agencies (of which four home health agencies were consolidated as of September 2010) with agencies servicing the same markets, close nine operating home health agencies and four operating hospice agencies (of which one hospice agency was closed as of September 2010) and discontinue the start-up process associated with 28 prospective unopened home health locations (of which 17 were discontinued as of September 2010) which were incurring expenses.

In addition to these 67 agencies we have closed or consolidated an additional 17 home health agencies during the first and second quarters of 2010. As part of our exit activities associated with these locations, we recorded $5.6 million and $7.1 million in lease liabilities during the three and nine-month period ended September 30, 2010 associated with future lease obligations and recorded $0.4 million in severance costs and $0.9 million for intangible write-offs during the three and nine month periods ended September 30, 2010. The following details the financial performance of the agencies that we are exiting or consolidating:

   For the three-month period
ended September 30, 2010
  For the nine-month period
ended September 30, 2010
 
   Net Service
Revenue
   Operating
loss(1)
  Net Service
Revenue
   Operating
loss(1)
 

Home Health:

       

Closures

  $1.1    $(0.5 $3.9    $(2.1

Consolidations

   4.6     (0.9  18.4     (3.5

Unopened Startups

   —       (1.9  —       (5.1
                   

Home Health Total

   5.7     (3.3  22.3     (10.7
                   

Hospice:

       

Closures

  $0.4    $(0.2 $1.3    $(0.3

Consolidations

   0.7     0.1    2.0     (0.2

Unopened Startups

   —       (0.1  —       (0.4
                   

Hospice Total

   1.1     (0.2  3.3     (0.9
                   

Total

  $6.7    $(3.5 $25.6    $(11.6
                   

(1)

Excludes the $6.9 million and $8.4 million in exit activity costs for the three and nine-month periods ended September 30, 2010, respectively

The following table summarizes our Medicare-certified agencies, which are located in 45 states within the United States, the District of Columbia and Puerto Rico as of September 30, 2010.detailed below:

 

   Owned and Operated Agencies 
   Home health  Hospice 

At December 31, 2009

   521    65  

Acquisitions

   2    1  

Start-ups

   35    7  

Closed/Consolidated

   (21  (1
         

At September 30, 2010

   537    72  
         
   Owned and Operated Agencies 
   Home health  Hospice 

At December 31, 2010

   486    67  

Start-ups

   4    2  

Closed/Consolidated

   (1  —    
         

At March 31, 2011

   489    69  
         

When we refer to “same store business,” we mean home health and hospice agencies that we have operated for at least the last twelve months; when we refer to “acquisitions,” we mean home health and hospice agencies that we acquired within the last twelve months; and when we refer to “start-ups,” we mean any home health or hospice agency opened by us in the last twelve months. Once an agency has been in operation for a twelve month period, the results for that particular agency are included as part of our same store business from that date forward. When we refer to episodic-based revenue, admissions, recertifications or completed episodes, we mean home health revenue, admissions, recertifications or completed episodes of care for those payors that pay on an episodic-basis, which includes Medicare and other insurance carriers including Medicare Advantage programs.

Recent Developments

Governmental Inquiries and Investigations and Stockholder Litigation

See Note 5 to our condensed consolidated financial statements for a discussion of the recent governmental inquiry, investigations and subsequent stockholder litigation we are involved in. No assurances can be given as to the timing or outcome of these items.

Health Care Reform

In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act (“PPACA”) and the Health Care and Education Reconciliation Act of 2010 (“HCERA”), which amends the PPACA (collectively, the “Health Care Reform Bills”). The Health Care Reform Bills make a number of changes to Medicare payment rates, including the reinstatement of the 3% home health rural add-on, which began on April 1, 2010 (expiring January 1, 2016), and. CMS has recently proposedmade several changes to Medicare home health payments for 2011, as discussed below.

The Health Care Reform Bills also include a systemic rebasing of the amount CMS reimburses for home health services, to be phased in over four years, beginning in 2014. We anticipate that many of the provisions of the Health Care Reform Bills may be subject to further clarification and modification through the rule-making process. It is uncertain at this time the effect the rebasing will have on our future results of operations or cash flows.

Additionally, the Health Care Reform Bills expand health care coverage to many uninsured individuals and expand coverage to those already insured. We do not expect any short term impact on our financial results as a result of these aspects of the legislation. One provision that will impact certain companies significantly is the elimination of the tax deductibility of the Medicare Part D subsidy. This provision does not affect us as we do not provide retiree health benefits.

Payment

In JulyNovember 2010, CMS issued a proposedfinal rule to update and revise Medicare home health rates for calendar year 2011. The proposedfinal rule includes the following changes to the base rate: a 1.4%1.1% market basket increase which includes the 1% reduction mandated by the Health Care Reform Bills, a negative 3.79% case-mix adjustment and a 2.5% reduction to reflect the elimination of the increase in the base reimbursement rate resulting from the outlier cap introduced in 2010. The net effect of these changes decreases the base rate for 2011 by 4.9%5.22% to $2,199.$2,192. The change is effective for all episodes completing during 2011, accordingly, all episodes in progress at December 31, 2010 were impacted.

Face-to-Face and Therapy Requirements

The rule also finalized two provisions of the PPACA: (1) a face-to-face encounter requirement for home health and hospice and (2) changes in the therapy assessment schedule. As a condition for Medicare payment, the PPACA mandates that prior to certifying a patient’s eligibility for the home health benefit, the certifying physician must document that he or she, or an allowed non-physician practitioner, has had a face-to-face encounter with the patient. The encounter must occur in the timeframe of 90 days prior to the start of care or 30 days after the start of care. Documentation regarding these encounters must be present on certifications.

The rule also finalized hospice policy for the implementation of a PPACA provision requiring that a hospice physician or nurse practitioner have a face-to-face encounter with hospice patients during the 30 day period prior to the 180th-day recertification (third benefit period) and each subsequent recertification, and that the certifying hospice physician attest that such a visit took place.

The face-to-face encounter requirement for home health and hospice providers was to become effective January 1, 2011. However, due to concerns that some providers may need additional time to establish operational protocols necessary to comply with face-to-face encounter requirements, CMS has not issued adelayed full enforcement of the requirements until the second quarter of 2011. Beginning with the second quarter, CMS will expect home health and hospices agencies to have fully established such internal processes and have appropriate documentation of required encounters.

In addition, the final rule asimposed important therapy assessment requirements. A professional qualified therapist assessment must take place at least once every 30 days during a therapy patient’s course of treatment. For those qualified patients needing 13 or 19 therapy visits, a qualified therapist must perform the therapy service required, assess the patient, and measure and document effectiveness of the date of this filing. The final rule is expected to be published in October 2010.

In July 2010, CMS issued a notice with comment period to update13th visit and revise the Medicare hospice wage index19th visit for fiscal year 2011. The notice includes a 2.6% increase in the base rate offset by a 0.8% decreaseall therapy disciplines caring for the updated wage index data andpatient. CMS delayed the second year of the 7-year phase out of the budget neutrality adjustment factor. The net effect of the changes increases the base rateeffective date for all therapy provisions until April 1, 2011 by 1.8%. The notice is effective October 1, 2010. We do not expect this change to have a material impact on our future results of operations or financial condition.allow time for home health agencies to take necessary steps to comply.

Results of Operations

During the three-month period ended March 31, 2011, we incurred certain costs of $3.3 million ($2.0 million, net of tax or $0.07 per diluted share) associated with the realignment of operations, acquisition costs, and legal expenses related to the United States Senate Committee on Finance inquiry and SEC and DOJ investigation discussed in Note 5 to the condensed consolidated financial statements and incurred costs associated with agency closings/consolidations we announced in 2010 of $1.1 million ($0.7 million net of tax or $0.02 per diluted share). These costs are included in other operating expenses in our consolidated results of operations.

Consolidated

The following table summarizes our consolidated results of operations (amounts in millions):

   For the Three-Month
Periods Ended March 31,
 
   2011  2010 

Net service revenue

  $364.3   $413.0  

Gross margin

   173.1    208.9  

    % of revenue

   47.5  50.6

Other operating expenses

   145.6    147.0  

    % of revenue

   40.0  35.6
         

Operating income

   27.5    61.9  
         

Income tax expense

   10.0    23.5  

Effective income tax rate

   39.5  39.0
         

Net income attributable to Amedisys, Inc.

  $15.3   $36.6  
         

Net Service Revenue

Our net service revenue decreased $48.7 million from 2010 to 2011 and consisted of a decrease of $55.0 million in home health revenue and an increase of $6.3 million in hospice revenue. The decrease in our home health revenue is primarily due to the 5.2% CMS rate cut, our recent closures and consolidations announced last year and a decline in our recertification volume.

Gross Margin

The decline in our gross margin percentage from 2010 to 2011 is due primarily to the 5.2% CMS rate cut. Our cost of service consists of salaries, taxes and benefits (including health care insurance and workers’ compensation insurance); travel and training expenses (primarily reimbursed mileage at a standard rate); and supplies and services expenses (including payments to contract therapists) incurred by our clinical personnel in our agencies.

Other Operating Expenses

Other operating expenses have decreased from 2010 to 2011 primarily due to a decrease of $1.9 million in salaries and benefits. Additionally, other operating expenses include $0.8 million and $2.5 million in lease terminations and legal costs, respectively.

Depreciation and amortization expense added $1.2 million in additional costs from 2010 to 2011. This increase is primarily due to the implementation of our enterprise resource planning system and the purchase of additional computers and POC tablets for our agencies.

Operating Income

Our operating results may not be comparable forincome decreased $34.4 million from 2010 and is inclusive of $4.4 million in expenses associated with agency closures, legal expenses, and other costs.

Other Expense, Net

Other expense, net increased $0.6 million from 2010 to 2011 primarily due to a $0.5 million increase in loss on the periods presented, primarily as a resultdisposal of our acquisitionproperty and start-up agencies.equipment.

When we refer to “base business,” we mean home health and hospice agencies that we have operated for at least the last twelve months; when we refer to “acquisitions,” we mean home health and hospice agencies that we acquired within the last twelve months; and when we refer to “start-ups,” we mean any home health or hospice agency opened by usIncome Taxes

The increase in the last twelve months. Onceestimated income tax rate from 2010 to 2011 is due to an agency has beenincrease in operation for a twelve month period, the results for that particular agency are included as part of our base business from that date forward. When we refer to episodic-based revenue, admissions, recertifications or completed episodes, we are referring only to data for payors that pay on an episodic-basis, which includes Medicare and other insurance carriers, including Medicare Advantage programs.nondeductible expenses in 2011.

Three-Month Period Ended September 30, 2010March 31, 2011 Compared to the Three-Month Period Ended September 30, 2009March 31, 2010

Net Service RevenueHome Health Division

The following table summarizes our net service revenue growth (amounts in millions):home health segment results of operations:

 

   For the three-month periods ended September 30,    
   2010   2009    
   Base/Start-
ups (2)
  Acquisitions   Total   Total  Variance 

Home health revenue:

        

Medicare revenue

  $305.3   $5.4    $310.7    $313.9   $(3.2

Non-Medicare, episodic-based revenue

   38.4    0.1     38.5     29.0    9.5  
                       

Total episodic-based revenue

   343.7    5.5     349.2     342.9    6.3  

Non-Medicare revenue

   18.4    0.9     19.3     16.5    2.8  
                       
   362.1    6.4     368.5     359.4    9.1  
                       

Hospice revenue:

        

Medicare revenue

   32.7    1.5     34.2     27.0    7.2  

Non-Medicare revenue

   1.9    0.1     2.0     1.9    0.1  
                       
   34.6    1.6     36.2     28.9    7.3  
                       

Total revenue:

        

Medicare revenue

   338.0    6.9     344.9     340.9    4.0  

Non-Medicare revenue

   58.7    1.1     59.8     47.4    12.4  
                       
  $396.7   $8.0    $404.7    $388.3   $16.4  
                       

Internal episodic-based revenue growth (1)

   0.2      18 
              
   For the Three-Month Periods Ended March 31, 
   2011   2010 
   Same Store  Start-ups/
Acquisitions
  Total   Same
Store
  Other (1)  Total 

Financial Information (in millions):

        

Episodic-based revenue

   300.3    6.9    307.2     347.8    13.9    361.7  

Nonepisodic-based revenue

   18.0    0.3    18.3     17.9    0.9    18.8  
                          

Net service revenue

   318.3    7.2    325.5     365.7    14.8    380.5  

Same store episodic-based revenue growth (2)

   (14)%      14  
              

Cost of service

   166.9    3.9    170.8     176.3    10.7    187.0  
                          

Gross margin

   151.4    3.3    154.7     189.4    4.1    193.5  

Other operating expenses

   79.6    3.5    83.1     82.8    10.9    93.7  
                          

Operating income

  $71.8   $(0.2 $71.6    $106.6   $(6.8 $99.8  
                          

Key Statistical Data:

        

Admissions:

        

Episodic-based

   61,158    1,322    62,480     62,445    2,833    65,278  

Nonepisodic-based

   10,504    189    10,693     9,480    512    9,992  
                          

Total admissions

   71,662    1,511    73,173     71,925    3,345    75,270  
                          

Same store episodic-based admission growth (2)

   (2)%      10  
              

Recertifications:

        

Episodic-based

   43,284    447    43,731     48,058    1,657    49,715  

Nonepisodic-based

   4,236    41    4,277     4,785    111    4,896  
                          

Total recertifications

   47,520    488    48,008     52,843    1,768    54,611  
                          

Same store episodic-based recertification growth (2)

   (10)%      (1)%   
              

Completed episodes

   97,941    1,576    99,517     100,913    4,183    105,096  
                          

Visits:

        

Episodic-based

   1,905,098    31,588    1,936,686     2,014,528    76,725    2,091,253  

Nonepisodic-based

   197,308    3,275    200,583     197,426    10,646    208,072  
                          

Total visits

   2,102,406    34,863    2,137,269     2,211,954    87,371    2,299,325  
                          

Cost per visit

  $79.38   $111.34   $79.91    $79.69   $122.36   $81.32  
                          

Average episodic-based revenue per completed episode (3)

  $3,029   $3,007   $3,029    $3,284   $3,216   $3,282  
                          

Episodic-based visits per completed episode (4)

   18.5    17.2    18.5     18.7    17.4    18.6  
                          

 

(1)

Internal episodic-based revenue growth is the percent increase in our base/start-up episodic-based revenueAgencies for the prior period as a percent of the total episodic-based revenue of thewhich are not considered same store agencies (i.e. agencies closed or consolidated in current or prior period.period or unopened startups).

(2)

Our net serviceSame store episodic-based revenue, for our base/start-up agencies of $396.7 million included $9.0 million from our start-up agencies.

Our growth in home health revenue consisted of $7.1 million from our start-up agencies and $6.4 million from our acquisitions, offset by a $4.4 million decline in our base agencies. Included in our home health Medicare revenue is $3.7 million for the settlement of our Georgia indigent care liability for years 2007 through 2009. Excluding the Georgia indigent care settlement, our total episodic-based revenue increased $2.6 millionadmissions or a negative 0.8%. The increase is primarily related to a 3% increase in our revenue per episode offset by a 1% decline in volume. The remainder of the decrease in episodic revenue is due to a lower number of episodes in progress at the beginning of third quarter of 2010 compared to the same period in 2009.

Our average episodic-based revenue per completed episode increased from $3,189 to $3,294 as a result of a 1.8% increase in our base rate effective January 1, 2010, a 3% increase in the base rate on rural episodes (approximately 25% of our episodes) completed subsequent to March 31, 2010, and continued deployment and growth in our therapy intensive specialty programs since June 30, 2009.

Our hospice revenue growth consisted of $3.8 million from our base agencies, $1.9 million from our start-up agencies and $1.6 million from our acquisitions. Hospice revenue is primarily impacted by average daily census, levels of care and payment rates. Overall, our average daily census increased from 2,372 in 2009 to 2,978 in 2010 with 2,962 of our census attributable to our base/start-up agencies during the third quarter of 2010. Our patients’ average length of stay was 83 days for 2009 and 87 days for 2010. Our 2010 revenue was impacted by approximately 1.4% due to the annual hospice rate increase effective October 1, 2009.

Home Health Statistics

The following table summarizes our total home health patient admissions, recertifications and completed episodes:

   For the three-month periods ended September 30,    
   2010   2009    
   Base/Start-
ups
  Acquisitions   Total   Total  Variance 

Admissions:

        

Medicare

   54,474    1,264     55,738     51,897    3,841  

Non-Medicare, episodic-based

   7,714    20     7,734     5,870    1,864  
                       

Total episodic-based

   62,188    1,284     63,472     57,767    5,705  

Non-Medicare

   9,793    619     10,412     8,637    1,775  
                       
   71,981    1,903     73,884     66,404    7,480  
                       

Internal episodic-based admission growth (1)

   8      4 
              

Recertifications:

        

Medicare

   40,215    453     40,668     48,557    (7,889

Non-Medicare, episodic-based

   5,256    7     5,263     4,277    986  
                       

Total episodic-based

   45,471    460     45,931     52,834    (6,903

Non-Medicare

   4,498    96     4,594     5,176    (582
                       
   49,969    556     50,525     58,010    (7,485
                       

Internal episodic-based recertification growth (2)

   (14%)       8 
              

Completed Episodes:

        

Medicare

   91,165    1,654     92,819     95,884    (3,065

Non-Medicare, episodic-based

   12,158    20     12,178     9,223    2,955  
                       
   103,323    1,674     104,997     105,107    (110
                       

(1)

Internal episodic-based admission growth is the percent increase (decrease) in our base/start-upsame store episodic-based revenue, admissions for the period as a percent of the total episodic-based admissions of the prior period.

(2)

Internal episodic-based recertification growth is the percent increase in our base/start-up episodic-basedor recertifications for the period as a percent of the totalsame store episodic-based revenue, admissions or recertifications of the prior period.

Total episodic-based admissions increased approximately 10% with significant improvement in internal admit growth. Our non-Medicare episodic-based admission growth was 32% primarily related to our national agreement with Humana.

We have continued to experience a decline in the number of recertifications over 2009 and expect the trend to continue into the fourth quarter. Our recertifications will vary based on the clinical needs of our patients. The decline is partially due to a lower number of patients on census at the beginning of the third quarter as compared to the same quarter in 2009, which resulted in a fewer number of patients available for recertification.

Cost of Service, Excluding Depreciation and Amortization

Our cost of service consists of the following expenses incurred by our clinical and clerical personnel in our agencies:

salaries and related benefits (including health care insurance and workers’ compensation insurance);

transportation expenses (primarily reimbursed mileage at a standard rate); and

supplies and services expenses (including payments to contract therapists).

The following summarizes our cost of service, visit and cost per visit information:

   For the three-month periods ended September 30,     
   2010   2009     
   Base/Start-
ups
   Acquisitions
   Total   Total   Variance 

Cost of service (amounts in millions):

          

Home health

  $182.9    $3.3    $186.2    $168.7    $17.5  

Hospice

   19.1     1.0     20.1     14.9     5.2  
                         
  $202.0    $4.3    $206.3    $183.6    $22.7  
                         

Home health:

          

Visits during the period:

          

Medicare

   1,788,944     26,258     1,815,202     1,863,213     (48,011

Non-Medicare, episodic-based

   236,861     304     237,165     175,657     61,508  
                         

Total episodic-based

   2,025,805     26,562     2,052,367     2,038,870     13,497  

Non-Medicare

   200,518     7,723     208,241     197,720     10,521  
                         
   2,226,323     34,285     2,260,608     2,236,590     24,018  
                         

Home health cost per visit (1)

  $82.17    $95.96    $82.38    $75.45    $6.93  
                         

Episodic-based visits per completed episode (2)

   19.2     15.3     19.1     18.7     0.4  
                         

(1)(3)

We calculate home health costAverage episodic-based revenue per visit as home health costcompleted episode is the average episodic-based revenue earned for each episodic-based completed episode of service divided by total home health visits during the period.care.

(2)(4)

We calculate episodic-basedEpisodic-based visits per completed episode asis the home health episodic-based visits on completed episodes divided by the home health episodic-based episodes completed during the period.

Net Service Revenue

The increasecomponents of the $55.0 million decline in our home health revenues are the 5.2% CMS rate cut which reduced revenue by $18.0 million, $14.8 million related to agencies we closed or merged in 2010, with the remainder due to declining volumes.

Our revenue per episode decreased 8% due to the 5.2% CMS rate cut and a reduction in the therapy needs of our patients. We also experienced declines in both admissions and recertifications as our same store episodic-based admissions and recertifications declined 2% and 10%, respectively. The decline in recertifications is due to both a decline in our recertification rate and a lower patient census. We expect the decline in our year over year recertification rate to continue into the third quarter of 2011. While we experienced a decline in same store episodic-based admissions over 2010, we did see a sequential improvement from the fourth quarter of 2010.

Cost of Service, excluding Depreciation and Amortization

Our home health cost of service consistsdecreased $16.2 million as we performed 162,056 fewer visits which accounted for $13.2 million of $1.8 million related to the increase in visitsdecrease with the remainder related tofrom the $6.93 increase$1.41 decrease in cost per visit. The increase in visitscost per visit improvement is primarily due to an increase in the numberour portfolio realignment as well as a focus on productivity and conversion of visitssalaried clinicians to our pay per episode. The primary factors contributing to the increasevisit model. In addition, we have experienced sequential improvement in cost per visit were an increase in the percentage of total visits performed by therapists, an increase in the number of clinicians (the majority of which are therapists) that are being paid on a salary basis, and an increase in the ratio of clinical managers per patient census.same store basis.

GeneralOther Operating Expenses

Our other operating expenses decreased $10.6 million in total and Administrative Expenses, Provision for Doubtful Accounts, Depreciation$3.2 million on a same store basis with the primary drivers being a decline in salary and Amortizationbenefits as a result of closures and Other Expense, netmergers and additional cost reductions in our remaining portfolio.

Hospice Division

The following table summarizes our general and administrative expenses, provision for doubtful accounts, depreciation and amortization expense and other expense, net (amounts in millions):hospice segment results of operations:

 

   For the three-month periods
ended September 30,
    
   2010  2009  Variance 

General and administrative expenses:

    

Salaries and benefits

  $90.4   $87.3   $3.1  

Non-cash compensation

   2.6    0.8    1.8  

Rent and utilities

   21.9    14.0    7.9  

Other

   32.3    29.8    2.5  

Provision for doubtful accounts

   5.3    4.6    0.7  

Depreciation and amortization

   8.8    7.5    1.3  

Other expense, net

   (1.4  (1.7  0.3  

The increase in salaries and benefits was primarily due to the addition of field and corporate personnel to support the increase of 40 agencies since the third quarter of 2009. These increases were offset by decreases in severance and bonus expenses.

Rent and utilities increased $7.9 million primarily due to $5.6 million in rent related to the agency closures/consolidations during the quarter. The remainder of the increase was due to additional agencies.

Other general and administrative expenses increased $2.5 million, which included $1.8 million in legal fees incurred as a result of the Senate Finance Committee inquiry, the SEC investigation and related litigation.

Depreciation and amortization expense increased $1.3 million primarily due to the purchase of equipment and furniture and the development of computer software, which are depreciated over three to seven years. Additionally, we wrote-off $0.9 million in intangible assets, primarily Medicare licenses, related to the agency closures during the quarter.

Other expense, net decreased $0.3 million primarily due to a decrease in interest expense as we have reduced our outstanding debt $30.6 million from September 30, 2009 to September 30, 2010.

Income Tax Expense

The following table summarizes our income tax expense and estimated income tax rate (amounts in millions, except for estimated income tax rate):

   For the three-month periods
ended September 30,
    
   2010  2009  Variance 

Income before income taxes

  $35.8   $59.1   $(23.3

Income tax (expense)

   (13.9  (23.0  9.1  

Estimated income tax rate

   39.0  39.0  —    

The decrease in income tax expense of $9.1 million is attributable to a decrease in income before income taxes as our estimated income tax rate remained unchanged from 2009 to 2010.

Nine-Month Period Ended September 30, 2010 Compared to the Nine-Month Period Ended September 30, 2009

Net Service Revenue

The following table summarizes our net service revenue growth (amounts in millions):

  For the nine-month period ended September 30,     For the Three-Month Periods Ended March 31, 
  2010   2009     2011   2010 
  Base/Start- ups (2) Acquisitions   Total   Total Variance   Same
Store
 Start-ups/
Acquisitions
 Total   Same
Store
 Other (1) Total 

Home health revenue:

        

Medicare revenue

  $953.1   $17.7    $970.8    $902.3   $68.5  

Non-Medicare, episodic-based revenue

   109.2    0.2     109.4     82.9    26.5  
                  

Total episodic-based revenue

   1,062.3    17.9     1,080.2     985.2    95.0  

Non-Medicare revenue

   53.9    2.9     56.8     50.4    6.4  
                  
   1,116.2    20.8     1,137.0     1,035.6    101.4  
                  

Hospice revenue:

        

Financial Information (in millions):

        

Medicare revenue

   87.4    9.9     97.3     68.1    29.2    $35.7   $0.8   $36.5    $29.5   $1.3   $30.8  

Non-Medicare revenue

   5.1    0.6     5.7     4.3    1.4     2.3    —      2.3     1.6    0.1    1.7  
                                      

Net service revenue

   38.0    0.8    38.8     31.1    1.4    32.5  

Same store Medicare revenue growth (2)

   21     33  
   92.5    10.5     103.0     72.4    30.6              

Cost of service

   19.6    0.8    20.4     15.8    1.3    17.1  
                                      

Total revenue:

        

Medicare revenue

   1,040.5    27.6     1,068.1     970.4    97.7  

Non-Medicare revenue

   168.2    3.7     171.9     137.6    34.3  

Gross margin

   18.4    —      18.4     15.3    0.1    15.4  

Other operating expenses

   7.4    0.8    8.2     7.3    1.1    8.4  
                                      

Operating income

  $11.0   $(0.8 $10.2    $8.0   $(1.0 $7.0  
  $1,208.7   $31.3    $1,240.0    $1,108.0   $132.0                      
                  

Internal episodic-based revenue growth (1)

   8      20 
            

Key Statistical Data:

        

Hospice admits

   3,088    109    3,197     2,629    164    2,793  

Hospice days

   277,500    6,245    283,745     226,481    10,038    236,519  

Average daily census

   3,083    69    3,153     2,516    112    2,628  

Revenue per day

  $136.84   $134.32   $136.78    $137.22   $139.56   $137.32  

Cost of service per day

  $70.50   $133.46   $71.89    $69.89   $125.70   $72.26  

Average length of stay

   89    48    88     89    61    87  

 

(1)

Internal episodic-basedAgencies for the prior period which are not considered same store agencies (i.e. agencies closed or consolidated in current or prior period or unopened startups).

(2)

Same Store Medicare revenue growth is the percent increase in our base/start-up episodic-basedsame store Medicare revenue for the period as a percent of the total episodic-basedsame store Medicare revenue of the prior period.period

(2)

Our net service revenue for our base/start-up agencies of $1.2 billion included $29.2 million from our start-up agencies.

Net Service Revenue

Our growth in home healthhospice revenue consisted of $55.8increased $6.3 million with $6.9 million from our basesame store agencies, $24.8$0.6 million from our start-up agencies and $20.8$0.2 million from our acquisitions. Included in our home health Medicare revenue is $3.6 million received from CMS for our participation in the pay for performance demonstration and $3.7 million for the settlement of our Georgia indigent care liability for years 2007 through 2009. Excluding the CMS bonus payment and Georgia indigent care settlement, our total episodic-based revenue increased $87.7 million or 9%. The increase is related to a 6% increase in our revenue per episode and a 3% increase in our episode volume. The volume growth consisted of a 11% increase in admissionsacquisitions offset by a 6% decrease in recertifications.

Our average episodic-based revenue per completed episode increased from $3,132 to $3,317 as a result of a 1.8% increase in our base rate effective January 1, 2010, a 3% increase in the base rate on rural episodes (approximately 25% of our episodes) completed subsequent to March 31, 2010, and continued deployment and growth in our therapy intensive specialty programs.

Our hospice revenue growth consisted of $15.7$1.4 million from our base agencies $4.4 million from our start-up agencies and $10.5 million from our acquisitions.we closed or merged in 2010. Hospice revenue is primarily impacted by average daily census, levels of care and payment rates. Overall, our average daily census increased from 2,012 in 2009Our 2011 revenue includes an increase related to 2,816 in 2010 with 2,573 of our census attributable to our base/start-up agencies during 2010. Our patients’ average length of stay was 79 days for 2009 and 87 days for 2010. Our 2010 revenue was impacted by approximately 1.4% due to thean annual hospice rate increase effective October 1, 2009.

Home Health Statistics

The following table summarizes2010, which was approximately 1.8%. Additionally, our total home health patient admissions, recertifications and completed episodes:

   For the nine-month period ended September 30,    
   2010   2009    
   Base/Start-ups  Acquisitions   Total   Total  Variance 

Admissions:

        

Medicare

   163,458    4,405     167,863     154,881    12,982  

Non-Medicare, episodic-based

   23,909    54     23,963     17,207    6,756  
                       

Total episodic-based

   187,367    4,459     191,826     172,088    19,738  

Non-Medicare

   28,535    1,957     30,492     27,071    3,421  
                       
   215,902    6,416     222,318     199,159    23,159  
                       

Internal episodic-based admission growth (1)

   9      5 
              

Recertifications:

        

Medicare

   127,272    1,542     128,814     140,972    (12,158

Non-Medicare, episodic-based

   14,370    32     14,402     12,133    2,269  
                       

Total episodic-based

   141,642    1,574     143,216     153,105    (9,889

Non-Medicare

   13,909    317     14,226     16,471    (2,245
                       
   155,551    1,891     157,442     169,576    (12,134
                       

Internal episodic-based recertification growth (2)

   (8%)       10 
              

Completed Episodes:

        

Medicare

   280,775    5,428     286,203     277,326    8,877  

Non-Medicare, episodic-based

   33,236    74     33,310     26,289    7,021  
                       

Total episodic-based

   314,011    5,502     319,513     303,615    15,898  
                       

(1)

Internal episodic-based admission growth is the percent increase in our base/start-up episodic-based admissions for the period as a percent of the total episodic-based admissions of the prior period.

(2)

Internal episodic-based recertification growth is the percent increase in our base/start-up episodic-based recertifications for the period as a percent of the total episodic-based recertifications of the prior period.

Total episodic-based admissions increased approximately 11% highlighted by significant improvement in internal episodic-based admission growth. Additionally, non-Medicare episodic-based admission growth was 39% as we continue to benefit2011 hospice revenue is net of a $0.4 million hospice cap adjustment, an increase of $0.2 million from our national agreement with Humana.

We have continued to experience a decline in the number of recertifications over 2009 and expect the trend to continue into the fourth quarter. Our recertifications will vary based on the clinical needs of our patients.2010.

Cost of Service Excludingexcluding Depreciation and Amortization

The following summarizes our cost of service, visit and cost per visit information:

   For the nine-month period ended September 30,     
   2010   2009     
   Base/Start-ups   Acquisitions   Total   Total   Variance 

Cost of service (amounts in millions):

          

Home health

  $552.1    $11.8    $563.9    $488.6    $75.3  

Hospice

   49.6     6.2     55.8     38.5     17.3  
                         
  $601.7    $18.0    $619.7    $527.1    $92.6  
                         

Home health:

          

Visits during the period:

          

Medicare

   5,488,321     88,812     5,577,133     5,338,385     238,748  

Non-Medicare, episodic-based

   672,699     1,241     673,940     490,851     183,089  
                         

Total episodic-based

   6,161,020     90,053     6,251,073     5,829,236     421,837  

Non-Medicare

   605,079     24,517     629,596     611,789     17,807  
                         
   6,766,099     114,570     6,880,669     6,441,025     439,644  
                         

Home health cost per visit (1)

  $81.60    $103.06    $81.96    $75.86    $6.10  
                         

Episodic-based visits per completed episode (2)

   19.1     15.1     19.0     18.3     0.7  
                         

(1)

We calculate home health cost per visit as home health cost of service divided by total home health visits during the period.

(2)

We calculate episodic-based visits per completed episode as the home health episodic-based visits on completed episodes divided by the home health episodic-based episodes completed during the period.

Our home healthhospice cost of service increased $75.3$3.3 million on a 439,644 increase in visits. The increase in visits accounted for $33.4 million of the increase with the remainder from the $6.10 increase in cost per visit. The increase in visits is(19%) due to the growth in volume as well as an20% increase in the number of visits per episode. The primary factors contributing to the increase in cost per visit were an increase in the percentage of total visits performed by therapists, an increase in the number ofour average daily census over 2010. Our hospice clinicians (the majority of which are therapists) that are beinggenerally paid on a salarysalaried basis, and anour agencies are staffed based on the average census of the agency.

Other Operating Expenses

Our other operating expenses were relatively flat despite our significant increase in the ratio of clinical managers per patient census.

General and Administrative Expenses, Provision for Doubtful Accounts, Depreciation and Amortization and Other Expense, net

revenue. The following table summarizes our general and administrative expenses, provision for doubtful accounts, depreciation and amortizationhospice division did benefit from a $0.5 million reduction in bad debt expense and other expense, net (amounts in millions):

   For the nine-month periods
ended September 30,
    
   2010  2009  Variance 

General and administrative expenses:

    

Salaries and benefits

  $267.1   $242.3   $24.8  

Non-cash compensation

   8.3    5.7    2.6  

Rent and utilities

   54.3    40.9    13.4  

Other

   96.3    87.6    8.7  

Provision for doubtful accounts

   14.1    16.5    (2.4

Depreciation and amortization

   25.3    20.7    4.6  

Other expense, net

   (5.8  (6.2  0.4  

The increase in salaries and benefits was primarily due to increased personnel costs for our field administrative staff and corporate staff to support the increase of 40 agencies since the third quarter of 2009.

Rent and utilities increased $13.4 million primarily due to $7.1 millionsignificant improvement in rent related to the agency closures/consolidations during the year. The remainder of the increase was due to additional agencies.

Other general and administrative expenses increased $8.7 million, which included $3.6 million in legal fees incurred as a result of the Senate Finance Committee inquiry, the SEC investigation, and related litigation.

Depreciation and amortization expense increased $4.6 million primarily due to the purchase of equipment and furniture and the development of computer software, which are depreciated over three to seven years. Additionally, we wrote-off $0.9 million in intangible assets, primarily Medicare licenses, related to agency closures.

Other expense, net decreased $0.4 million due to a decrease in interest expense of $2.1 million as we have reduced our outstanding debt $30.6 million from September 30, 2009 to September 30, 2010. The $2.1 million decrease in interest expense was offset by a $2.3 million loss on disposals of property and equipment.

Income Tax Expense

The following table summarizes our income tax expense and estimated income tax rate (amounts in millions, except for estimated income tax rate):

   For the nine-month periods
ended September 30,
    
   2010  2009  Variance 

Income before income taxes

  $149.2   $161.0   $(11.8

Income tax (expense)

   (58.2  (62.8  4.6  

Estimated income tax rate

   39.0  39.0  —    

The decrease in income tax expense of $4.6 million is attributable to a decrease in income before income taxes as our estimated income tax rate remained unchanged from 2009 to 2010.cash collections.

LIQUIDITY AND CAPITAL RESOURCES

Cash Flows for the Nine-MonthThree-Month Period Ended September 30, 2010March 31, 2011 Compared to the Nine-MonthThree-Month Period Ended September 30, 2009March 31, 2010

The following table summarizes our cash flows for the periods indicated (amounts in millions):

 

  For the nine-month periods
ended September 30,
     For the Three-Month Periods
Ended March 31,
 
  2010 2009 Variance   2011 2010 

Cash provided by operating activities

  $172.6   $218.9   $(46.3  $52.5   $71.1  

Cash used in investing activities

   (41.7  (64.7  23.0     (15.9  (14.4

Cash used in financing activities

   (37.4  (111.8  74.4     (8.0  (9.2
                 

Net increase in cash and cash equivalents

   93.5    42.4    51.1     28.6    47.5  

Cash and cash equivalents at beginning of period

   34.5    2.8    31.7     120.3    34.5  
                 

Cash and cash equivalents at end of period

  $128.0   $45.2   $82.8    $148.9   $82.0  
                 

Cash provided by operating activities decreased $46.3$18.6 million during 20102011 compared to 2009. This decrease is related to the leveling2010, primarily as a result of our patientchanges in net income, accounts receivable during the nine-month period ended September 30, 2010 compared to the significant improvement in our outstanding patient accounts receivable associated with our 2008 acquisitions during the nine month period ended September 30, 2009 as well as other working capital changes primarily related to the timing of payments. See “Outstanding Patient Accounts Receivable” below for further details on our change in outstanding patient accounts receivable.payable and accrued expenses.

Cash used in investing activities decreased $23.0increased $1.5 million during 20102011 compared to 20092010 primarily due to athe decrease in our acquisition activity offset by an increase in our capital expenditures.purchases of property, plant and equipment.

Cash used in financing activities decreased $74.4$1.2 million during 20102011 compared to 20092010, primarily due to a decrease in draws and repayments on our revolving credit facility offset by $11.8 million in the repurchase of stock under our stock repurchase program.long-term obligations. We have decreased our outstanding long-term obligations net of borrowings by $30.6$9.6 million from September 30, 2009.December 31, 2010.

Liquidity

Typically, our principal source of liquidity is the collection of our patient accounts receivable, primarily through the Medicare program; however, from time to time, we can and do obtain additional sources of liquidity through sales of our equity or by the incurrence of additional indebtedness. As of September 30, 2010,March 31, 2011, we had $128.0$148.9 million in cash and cash equivalents and $234.6$232.5 million in availability under our $250.0 million Revolving Credit Facility.

During the nine-month period ended September 30, 2010,2011, we made $37.5spent $8.5 million in routine capital expenditures, which primarily included equipment, and furniture and computer software and $8.7$8.1 million in capital expenditures related to the implementation of our enterprise resource planning system which is expected to be fully implemented for 2011.and a company-wide refresh of computer hardware. Based on our operating forecasts and our debt service requirements, we believe we will have sufficient liquidity to fund our operations, capital requirements and debt service requirements over the next twelve months and into the foreseeable future.

As we manage our liquidity needs to meet our operating forecasts, debt service requirements and our acquisition and start-up activities, we are monitoring the creditworthiness and solvency of our syndicate of banks that provided the availability of credit under our Revolving Credit Facility as well as the status of the overall equity and credit markets. As of the date of this filing, we do not believe the availability of funds under our Revolving Credit Facility is at risk. If the availability under our current Revolving Credit Facility decreases, we may need to consider adjusting our strategy to meet our operating forecasts, debt service requirements and acquisition and start-up activity needs.

Outstanding Patient Accounts Receivable

Our patient accounts receivable, net decreased $13.8increased $0.4 million from December 31, 20092010 to September 30, 2010March 31, 2011 as our cash collection as a percentage of revenue was 103.6% and 96.0%101.1% for the three-monthsthree-month periods ended September 30, 2010March 31, 2011 and 99.3% for the three-monthsthree-month periods ended December 31, 2009, respectively.2010.

Our patient accounts receivable includes unbilled receivables, which are aged based upon our initial service date. At September 30, 2010,March 31, 2011, the unbilled patient accounts receivable, as a percentage of gross patient accounts receivable, was 22.3%25.1%, or $37.0$42.0 million compared to 19.8%28.3% or $36.7$47.9 million at December 31, 2009.2010. We monitor unbilled receivables on an agency by agency basis to ensure that all efforts are made to bill claims within timely filing deadlines. The timely filing deadlines vary by state for MedicaidMedicaid-reimbursable services and among insurance companies.

Our provision for estimated revenue adjustments (which is deducted from our service revenue to determine net service revenue) and provision for doubtful accounts were as follows for the periods indicated (in millions). We fully reserve for both our Medicare and other patient accounts receivable that are aged over 360 days.

   For the three-month periods
ended September 30,
  For the nine-month periods
ended September 30,
 
   2010  2009  2010  2009 

Provision for estimated revenue adjustments

  $2.7   $1.9   $4.4   $5.9  

Provision for doubtful accounts

   5.3    4.5    14.1    16.4  
                 

Total

  $8.0   $6.4   $18.5   $22.3  
                 

As a percent of revenue

   2.0  1.6  1.5  2.0
                 

   For the Three-Month Periods
Ended March 31,
 
   2011  2010 

Provision for estimated revenue adjustments

  $2.4   $0.2  

Provision for doubtful accounts

   3.2    4.3  
         

Total

  $5.6   $4.5  
         

As a percent of revenue

   1.5  1.1
         

The following schedule details our patient accounts receivable, net of estimated revenue adjustments, by payor class, aged based upon initial date of service (amounts in millions, except days revenue outstanding, net):

 

  0-90   91-180   181-365   Over 365   Total   0-90   91-180   181-365   Over 365   Total 

At September 30, 2010:

          

At March 31, 2011:

          

Medicare patient accounts receivable, net (1)

  $84.9    $13.1    $0.8    $—      $98.8    $86.8    $17.6    $2.2    $—      $106.6  
                                        

Other patient accounts receivable:

                    

Medicaid

   6.1     2.6     2.5     0.5     11.7     5.9     1.9     1.3     0.1     9.2  

Private

   27.5     10.8     8.0     2.7     49.0     27.2     9.6     6.8     1.6     45.2  
                                        

Total

  $33.6    $13.4    $10.5    $3.2    $60.7    $33.1    $11.5    $8.1    $1.7    $54.4  
                                    

Allowance for doubtful accounts (2)

           (23.0           (19.1
                        

Non-Medicare patient accounts receivable, net

          $37.7            $35.3  
                        

Total patient accounts receivable, net

          $136.5            $141.9  
                        

Days revenue outstanding, net (3)

           30.8             34.8  
                        
  0-90   91-180   181-365   Over 365   Total   0-90   91-180   181-365   Over 365   Total 

At December 31, 2009:

          

At December 31, 2010:

          

Medicare patient accounts receivable, net (1)

  $90.1    $20.4    $4.8    $0.2    $115.5    $89.4    $16.4    $1.3    $—      $107.1  
                                        

Other patient accounts receivable:

                    

Medicaid

   6.3     2.7     3.5     2.8     15.3     6.0     2.2     2.0     0.1     10.3  

Private

   20.5     10.6     9.7     5.1     45.9     27.2     9.9     7.0     1.0     45.1  
                                        

Total

  $26.8    $13.3    $13.2    $7.9    $61.2    $33.2    $12.1    $9.0    $1.1    $55.4  
                                    

Allowance for doubtful accounts (2)

           (26.4           (21.0
                        

Non-Medicare patient accounts receivable, net

          $34.8            $34.4  
                        

Total patient accounts receivable, net

          $150.3            $141.5  
                        

Days revenue outstanding, net (3)

           33.9             32.8  
                        

 

(1)

The following table summarizes the activity and ending balances in our estimated revenue adjustments (amounts in millions), which is recorded to reduce our Medicare outstanding patient accounts receivable to their estimated net realizable value, as we do not estimate an allowance for doubtful accounts for our Medicare claims.

 

  For the three-month period ended For the nine-month period ended 
  September 30, 2010 December 31, 2009 September 30, 2010 December 31, 2009 
  For the Three-Month Period
Ended March 31, 2011
 For the Three-Month Period
Ended December 31, 2010
 

Balance at beginning of period

  $6.4   $7.8   $8.7   $7.6    $6.5   $6.3  

Provision for estimated revenue adjustments

   2.7    2.9    4.4    6.7     2.4    2.6  

Write offs

   (2.8  (2.0  (6.8  (5.6   (2.5  (2.4
                    

Balance at end of period

  $6.3   $8.7   $6.3   $8.7    $6.4   $6.5  
                    

Our estimated revenue adjustments were 6.0%5.6% and 7.0%5.7% of our outstanding Medicare patient accounts receivable at September 30, 2010March 31, 2011 and December 31, 2009,2010, respectively.

(2)

The following table summarizes the activity and ending balances in our allowance for doubtful accounts (amounts in millions), which is recorded to reduce only our Medicaid and private outstanding patient accounts receivable to their estimated net realizable value.

  For the three-month period ended For the nine-month period ended 
  September 30, 2010 December 31, 2009 September 30, 2010 December 31, 2009 
  For the Three-Month Period
Ended March 31, 2011
 For the Three-Month Period
Ended December 31, 2010
 

Balance at beginning of period

  $24.5   $28.3   $26.4   $28.7    $21.0   $23.0  

Provision for doubtful accounts

   5.3    3.8    14.1    14.0     3.2    5.1  

Write offs

   (6.8  (5.7  (17.5  (16.3   (5.1  (7.1
                    

Balance at end of period

  $23.0   $26.4   $23.0   $26.4    $19.1   $21.0  
                    

Our allowance for doubtful accounts was 37.9%35.1% and 43.1%37.8% of our outstanding Medicaid and private patient accounts receivable at September 30, 2010March 31, 2011 and December 31, 2009,2010, respectively.

(3)

Our calculation of days revenue outstanding, net is derived by dividing our ending net patient accounts receivable (i.e. net of estimated revenue adjustments and allowance for doubtful accounts) at September 30, 2010March 31, 2011 and December 31, 20092010 by our average daily net patient revenue for the three-month periods ended September 30, 2010March 31, 2011 and December 31, 2009,2010, respectively.

Indebtedness

Our weighted-average interest rate for our five year Term Loan for the threequarters ended March 31, 2011 and nine-month periods ended September 30, 2010 was 1.1% as compared to 1.3% and 1.8% for the three and nine-month periods ended September 30, 2009, respectively.1.0%.

As of September 30, 2010,March 31, 2011, our total leverage ratio (which is required not to exceed 2.5 and is used(used to compute the margin and commitment fees, described in more detail in Note 6 of the financial statements included in our Form 10-K) was 0.70.9 and our fixed charge coverage ratio (which is required to be greater than 1.25) was 1.9.1.5.

As of September 30, 2010,March 31, 2011, our availability under our $250.0 million Revolving Credit Facility was $234.6$232.5 million as we had $15.4$17.5 million outstanding in letters of credit.

See Note 6 of the financial statements included in our Form 10-K for additional details on our outstanding long-term obligations.

Inflation

We do not believe that inflation has significantly impacted our results of operations.

Critical Accounting Policies

See Part II, Item 7 — Critical Accounting Policies and our consolidated financial statements and related notes in Part IV, Item 15 of our Form 10-K, for accounting policies and related estimates we believe are the most critical to understanding our condensed consolidated financial statements, financial condition and results of operations and which require complex management judgment and assumptions, or involve uncertainties. These critical accounting policies include revenue recognition; patient accounts receivable; insurance; goodwill and intangible assets; and income taxes. There have not been any changes to our significant accounting policies or their application, since we filed our Form 10-K.

ITEM 3. QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

Our Revolving Credit Facility and Term Loan carry a floating interest rate which is tied to the Eurodollar rate (i.e. LIBOR) and the Prime Rate and, therefore, our condensed consolidated statements of operations and our condensed consolidated statements of cash flows will be exposed to changes in interest rates. As of September 30, 2010,March 31, 2011, the total amount of outstanding debt subject to interest rate fluctuations was $75.0$60.0 million. A 1.0% interest rate increase would increase interest expense by approximately $0.8$0.6 million annually.

ITEM 4. CONTROLS AND PROCEDURES

Evaluation of Disclosure Controls and Procedures

We have established disclosure controls and procedures designed to ensure that information required to be disclosed in our reports filed under the Securities Exchange Act of 1934 (the “Exchange Act”) is recorded, processed, summarized, disclosed and reported within the time periods specified in the SEC’s rules and forms. This information is also accumulated and communicated to our management and Board of Directors to allow timely decisions regarding required disclosure.

In connection with the preparation of this Quarterly Report on Form 10-Q, as of September 30, 2010,March 31, 2011, under the supervision and with the participation of our management, including our principal executive officer and principal financial officer, we conducted an evaluation of the effectiveness of our disclosure controls and procedures, as such term is defined under Rules 13a-15(e) and 15d-15(e) promulgated under the Exchange Act.

Based on this evaluation, our principal executive officer and principal financial officer concluded that our disclosure controls and procedures were effective as of September 30, 2010,March 31, 2011, the end of the period covered by this Quarterly Report.

Changes in Internal Controls

On January 1, 2011, the Company implemented two modules of a new enterprise resource planning system, PeopleSoft Financials and PeopleSoft Human Capital Management. This implementation was part of our focus on upgrading and enhancing our financial systems and was not in response to any internal control deficiencies. In connection with this system implementation, we are in the process of updating our internal controls over financial reporting, as necessary, to accommodate modifications to our business and accounting processes. We do not believe this implementation will have an adverse affect on our internal controls over financial reporting.

There have beenwere no other changes in our internal control over financial reporting (as defined in Exchange Act Rule 13a-15(f)) that have occurred during the quarter ended September 30, 2010,March 31, 2011, that have materially affected, or are reasonably likely to materially affect, our internal controlcontrols over financial reporting.

Inherent Limitations on Effectiveness of Controls

Our management, including our principal executive officer and principal financial officer, does not expect that our disclosure controls or our internal controls over financial reporting will prevent or detect all errors and all fraud. A control system, no matter how well designed and operated, can provide only reasonable, not absolute, assurance that the control system’s objectives will be met. The design of a control system must reflect the fact that there are resource constraints, and the benefits of controls must be considered relative to their costs. Further, because of the inherent limitations in all control systems, no evaluation of controls can provide absolute assurance that misstatements due to error or fraud will not occur or that all control issues and instances of fraud, if any, have been detected. These inherent limitations include the realities that judgments in decision-making can be faulty and that breakdowns can occur because of simple error or mistake. Controls can also be circumvented by the individual acts of some persons, by collusion of two or more people, or by management override of the controls. The design of any system of controls is based in part on certain assumptions about the likelihood of future events, and there can be no assurance that any design will succeed in achieving its stated goals under all potential future conditions. Projections of any evaluation of controls’ effectiveness to future periods are subject to risks. Over time, controls may become inadequate because of changes in conditions or deterioration in the degree of compliance with policies and procedures.

PART II. OTHER INFORMATION

ITEM 1. LEGAL PROCEEDINGS

See Note 65 to the condensed consolidated financial statements for information concerning our legal proceedings.

ITEM 1A. RISK FACTORS

In addition to the other information set forth in this Quarterly Report on Form 10-Q, you should carefully consider the risk factors included in Part I, “Item 1A. — “Risk Factors” of our Annual Report on Form 10-K. These risk factors could materially impact our business, financial condition and/or operating results. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely impact our business, financial condition and/or operating results. The risk factors listed below supplement the risk factors included in our Annual Report on Form 10-K.

We are the subject of a number of inquiries by the federal government, any of which could result in substantial penalties against us.

We are the subject of a number of inquiries by the federal government. We have received a letter of inquiry from the United States Senate Committee on Finance requesting documents and information relating to our policies and practices regarding home therapy visits and therapy utilization trends. A similar letter was sent to the other major publicly traded home healthcare companies. In addition, we received a notice of formal investigation from the SEC and received a subpoena for documents relating to the matters under review by the United States Senate Committee on Finance and other matters involving our operations. We have also received a CID issued by the U.S. Department of Justice pursuant to the federal False Claims Act, requiring the delivery of a wide range of documents and information relating to our clinical business operations, including reimbursement and billing claims submitted to Medicare for home health services, and related compliance activities. We are cooperating with these investigations and are responding to these requests. However, we cannot predict when these investigations will be resolved, the outcome of these investigations or their impact on our business. An adverse outcome in these investigations could include the commencement of civil and/or criminal proceedings, substantial fines, penalties and/or administrative remedies, including the loss of the right to participate in the Medicare program. In addition, resolution of these matters could involve the imposition of additional and costly compliance obligations. Finally, if these investigations continue over a long period of time, they could divert the attention of management from the day-to-day operations of our business and impose significant administrative burdens on us. These potential consequences, as well as any adverse outcome from these investigations or other investigations initiated by the government at any time, could have a material adverse effect on our business and our consolidated financial condition, results of operations and cash flows.

ITEM 2. UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

The following table provides the information with respect to purchases made by us of shares of our common stock during each of the months during the three-month period ended September 30, 2010:March 31, 2011:

 

Period  (a) Total Number
of Shares
(or Units)
Purchased
  (b) Average
Price Paid
per Share (or
Unit)
   (c) Total Number of
Share (or Units)
Purchased as Part of
Publicly Announced
Plans or Programs
   (d) Maximum Number
(or Approximate Dollar
Value) of Shares (or
Units) that May Yet Be
Purchased Under the
Plans or Programs
 

July 1, 2010 to July 31, 2010

   1,050   $39.34     —       —    

August 1, 2010 to August 31, 2010

   496,165   $23.79     495,815    $48,203,728  

September 1, 2010 to September 30, 2010

   175   $24.96     —       —    
                   

Total

   497,390  (1)  $23.82     495,815    $48,203,728  
                   
Period  (a) Total Number
of Shares
(or Units)
Purchased
  (b) Average
Price Paid
per Share (or
Unit)
   (c) Total Number of
Share (or Units)
Purchased as Part  of
Publicly Announced
Plans or Programs
   (d) Maximum Number
(or Approximate Dollar
Value) of Shares  (or
Units) that May Yet Be
Purchased Under the
Plans or Programs
 

January 1, 2011 to January 31, 2011

   2,111   $33.42     —       —    

February 1, 2011 to February 28, 2011

   2,359   $40.18     —       —    

March 1, 2011 to March 31, 2011

   175   $35.37     —       —    
                   

Total

   4,645  (1)  $36.92     —      $—    
                   

 

(1)

Includes (a) shares of common stock surrendered to us by certain employees to satisfy tax withholding obligations in connection with the vesting of non-vested stock previously awarded to such employees under our 2008 Omnibus Incentive Compensation Plan and (b) shares repurchased through our publicly announced share repurchase program.Plan.

ITEM 3. DEFAULTS UPON SENIOR SECURITIES

None.

ITEM 4. RESERVED

ITEM 5. OTHER INFORMATION

None.

ITEM 6. EXHIBITS

The exhibits marked with the cross symbol (†) are filed and the exhibits marked with the double cross symbol (††) are furnished with this Form 10-Q. Any exhibits marked with the asterisk symbol (*) are management contracts or compensatory plans or arrangements filed pursuant to Item 601(b)(10)(iii) of Regulation S-K.

 

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

   

Exhibit
or Other
Reference

   

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

3.1  

Composite of Certificate of Incorporation of the Company inclusive of all amendments through June 14, 2007

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007

   0-24260     3.1    

Composite of Certificate of Incorporation of the Company inclusive of all amendments through June 14, 2007

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007

  0-24260  3.1
3.2  

Composite of By-Laws of the Company inclusive of all amendments through October 22, 2009

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2009

   0-24260     3.2    

Composite of By-Laws of the Company inclusive of all amendments through October 22, 2009

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2009

  0-24260  3.2
4.1  

Common Stock Specimen

  

The Company’s Registration Statement on Form S-3 filed August 20, 2007

   333-145582     4.8    

Common Stock Specimen

  

The Company’s Registration Statement on Form S-3 filed August 20, 2007

  333-145582  4.8
4.2  

Note Purchase Agreement dated March 25, 2008 among Amedisys, Inc., Amedisys Holding, L.L.C. and the Purchasers identified on Schedule A thereto, relating to the issuance and sale of (a) $35,000,000 aggregate principal amount of their 5.07% Series A Senior Notes due March 25, 2013 (b) $30,000,000 aggregate principal amount of their 6.28% Series B Senior Notes due March 25, 2014 and (c) $35,000,000 aggregate principal amount of their 6.49% Series C Senior Notes due March 25, 2015

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.1    

Note Purchase Agreement dated March 25, 2008 among Amedisys, Inc., Amedisys Holding, L.L.C. and the Purchasers identified on Schedule A thereto, relating to the issuance and sale of (a) $35,000,000 aggregate principal amount of their 5.07% Series A Senior Notes due March 25, 2013 (b) $30,000,000 aggregate principal amount of their 6.28% Series B Senior Notes due March 25, 2014 and (c) $35,000,000 aggregate principal amount of their 6.49% Series C Senior Notes due March 25, 2015

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.1
4.3  

Form of Series A Note due March 25, 2013 (attached as Exhibit 1 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.2    

Form of Series A Note due March 25, 2013 (attached as Exhibit 1 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.2
4.4  

Form of Series B Note due March 25, 2014 (attached as Exhibit 2 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.3    

Form of Series B Note due March 25, 2014 (attached as Exhibit 2 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.3
4.5  

Form of Series C Note due March 25, 2015 (attached as Exhibit 3 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.4    

Form of Series C Note due March 25, 2015 (attached as Exhibit 3 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.4
10.1  

Amended and Restated Employment Agreement dated July 23, 2010 by and among Amedisys, Inc., Amedisys Holdings, L.L.C, and Michael O. Fleming

  

The Company’s Current Report on Form 8-K filed on July 27, 2010

   0-24260     10.1  
10.2  

Amended and Restated Employment Agreement dated July 23, 2010 by and among Amedisys, Inc., Amedisys Holdings, L.L.C, and David R. Bucey

  

The Company’s Current Report on Form 8-K filed on July 27, 2010

   0-24260     10.2  
†10.1*  

Amended and Restated Amedisys, Inc. Employee Stock Purchase Plan effective as of April 1, 2011

      
†31.1  

Certification of William F. Borne, Chief Executive Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

        

Certification of William F. Borne, Chief Executive Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

      
†31.2  

Certification of Dale E. Redman, Chief Financial Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

        

Certification of Dale E. Redman, Chief Financial Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

      
††32.1  

Certification of William F. Borne, Chief Executive Officer, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

        

Certification of William F. Borne, Chief Executive Officer, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

      

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

   

Exhibit
or Other
Reference

 
††32.2  

Certification of Dale E. Redman, Chief Financial Officer, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

      
††101.INS  

XBRL Instance

      
††101.SCH  

XBRL Taxonomy Extension Schema Document

      
††101.CAL  

XBRL Taxonomy Extension Calculation Linkbase Document

      
††101.DEF

XBRL Taxonomy Definition Linkbase Document

††101.LAB  

XBRL Taxonomy Extension Labels Linkbase Document

      
††101.PRE  

XBRL Taxonomy Extension Presentation Linkbase Document

      

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

 

AMEDISYS, INC.

(Registrant)

By:

 

/s/ Dale E. Redman

  
 

      Dale E. Redman

 

      Chief Financial Officer and

      Duly Authorized Officer

DATE: OctoberApril 26, 20102011

EXHIBIT INDEX

The exhibits marked with the cross symbol (†) are filed and the exhibits marked with the double cross symbol (††) are furnished with this Form 10-Q. Any exhibits marked with the asterisk symbol (*) are management contracts or compensatory plans or arrangements filed pursuant to Item 601(b)(10)(iii) of Regulation S-K.

 

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or

Registration

Number

   

Exhibit

or Other

Reference

   

Document Description

  

Report or Registration Statement

  

SEC File or
Registration
Number

  

Exhibit
or Other
Reference

3.1  

Composite of Certificate of Incorporation of the Company inclusive of all amendments through June 14, 2007

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007

   0-24260     3.1    

Composite of Certificate of Incorporation of the Company inclusive of all amendments through June 14, 2007

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended June 30, 2007

  0-24260  3.1
3.2  

Composite of By-Laws of the Company inclusive of all amendments through October 22, 2009

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2009

   0-24260     3.2    

Composite of By-Laws of the Company inclusive of all amendments through October 22, 2009

  

The Company’s Quarterly Report on Form 10-Q for the quarter ended September 30, 2009

  0-24260  3.2
4.1  

Common Stock Specimen

  

The Company’s Registration Statement on Form S-3 filed August 20, 2007

   333-145582     4.8    

Common Stock Specimen

  

The Company’s Registration Statement on Form S-3 filed August 20, 2007

  333-145582  4.8
4.2  

Note Purchase Agreement dated March 25, 2008 among Amedisys, Inc., Amedisys Holding, L.L.C. and the Purchasers identified on Schedule A thereto, relating to the issuance and sale of (a) $35,000,000 aggregate principal amount of their 5.07% Series A Senior Notes due March 25, 2013 (b) $30,000,000 aggregate principal amount of their 6.28% Series B Senior Notes due March 25, 2014 and (c) $35,000,000 aggregate principal amount of their 6.49% Series C Senior Notes due March 25, 2015

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.1    

Note Purchase Agreement dated March 25, 2008 among Amedisys, Inc., Amedisys Holding, L.L.C. and the Purchasers identified on Schedule A thereto, relating to the issuance and sale of (a) $35,000,000 aggregate principal amount of their 5.07% Series A Senior Notes due March 25, 2013 (b) $30,000,000 aggregate principal amount of their 6.28% Series B Senior Notes due March 25, 2014 and (c) $35,000,000 aggregate principal amount of their 6.49% Series C Senior Notes due March 25, 2015

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.1
4.3  

Form of Series A Note due March 25, 2013 (attached as Exhibit 1 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.2    

Form of Series A Note due March 25, 2013 (attached as Exhibit 1 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.2
4.4  

Form of Series B Note due March 25, 2014 (attached as Exhibit 2 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.3    

Form of Series B Note due March 25, 2014 (attached as Exhibit 2 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.3
4.5  

Form of Series C Note due March 25, 2015 (attached as Exhibit 3 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

   0-24260     4.4    

Form of Series C Note due March 25, 2015 (attached as Exhibit 3 to the Note Purchase Agreement Incorporated by reference as Exhibit 4.4 hereto)

  

The Company’s Current Report on Form 8-K filed on April 1, 2008

  0-24260  4.4
10.1  

Amended and Restated Employment Agreement dated July 23, 2010 by and among Amedisys, Inc., Amedisys Holdings, L.L.C, and Michael O. Fleming

  

The Company’s Current Report on Form 8-K filed on July 27, 2010

   0-24260     10.1  
10.2  

Amended and Restated Employment Agreement dated July 23, 2010 by and among Amedisys, Inc., Amedisys Holdings, L.L.C, and David R. Bucey

  

The Company’s Current Report on Form 8-K filed on July 27, 2010

   0-24260     10.2  
†10.1*  

Amended and Restated Amedisys, Inc. Employee Stock Purchase Plan effective as of April 1, 2011

      
†31.1  

Certification of William F. Borne, Chief Executive Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

        

Certification of William F. Borne, Chief Executive Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

      
†31.2  

Certification of Dale E. Redman, Chief Financial Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

        

Certification of Dale E. Redman, Chief Financial Officer, pursuant to Section 302 of the Sarbanes-Oxley Act of 2002

      
††32.1  

Certification of William F. Borne, Chief Executive Officer, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

      

Exhibit

Number

  

Document Description

  

Report or Registration Statement

  

SEC File or


Registration


Number

   

Exhibit


or Other


Reference

 
††32.1

Certification of William F. Borne, Chief Executive Officer, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

††32.2  

Certification of Dale E. Redman, Chief Financial Officer, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002

      
††101.INS  

XBRL Instance

      
††101.SCH  

XBRL Taxonomy Extension Schema Document

      
††101.CAL  

XBRL Taxonomy Extension Calculation Linkbase Document

      
††101.DEF

XBRL Taxonomy Definition Linkbase Document

††101.LAB  

XBRL Taxonomy Extension Labels Linkbase Document

      
††101.PRE  

XBRL Taxonomy Extension Presentation Linkbase Document

      

 

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