Brilliant Acquisition 10-Q 4 Sep 14 2014 Q3 Quarterly report Financial data

Document_and_Entity_Informatio

Document and Entity Information	9 Months Ended
	Jul. 31, 2014	Sep. 03, 2014
Document and Entity Information	'	'
Entity Registrant Name	'BIO REFERENCE LABORATORIES INC	'
Entity Central Index Key	'0000792641	'
Document Type	'10-Q	'
Document Period End Date	31-Jul-14	'
Amendment Flag	'false	'
Current Fiscal Year End Date	'--10-31	'
Entity Well-known Seasoned Issuer	'No	'
Entity Voluntary Filers	'No	'
Entity Current Reporting Status	'Yes	'
Entity Filer Category	'Accelerated Filer	'
Entity Common Stock, Shares Outstanding	'	27,727,644
Document Fiscal Year Focus	'2014	'
Document Fiscal Period Focus	'Q3	'

CONSOLIDATED_BALANCE_SHEETS

CONSOLIDATED BALANCE SHEETS (USD $)	Jul. 31, 2014	Oct. 31, 2013
In Thousands, unless otherwise specified
CURRENT ASSETS:	'	'
Cash and Cash Equivalents	$20,007	$17,952
Accounts Receivable - Net	251,851	206,261
Inventory	19,555	19,095
Other Current Assets	9,570	9,416
Deferred Tax Assets	36,678	42,154
TOTAL CURRENT ASSETS	337,661	294,878
PROPERTY AND EQUIPMENT - AT COST	150,025	133,599
Less: Accumulated Depreciation	-84,185	-67,950
PROPERTY AND EQUIPMENT - NET	65,840	65,649
OTHER ASSETS:	'	'
Investments in Unconsolidated Affiliate	5,241	5,237
Deposits	1,056	1,017
Goodwill - Net	35,185	35,185
Intangible Assets - Net	14,882	16,320
Other Assets	1,365	1,165
Deferred Tax Asset	4,892	2,077
TOTAL OTHER ASSETS	62,621	61,001
TOTAL ASSETS	466,122	421,528
CURRENT LIABILITIES:	'	'
Accounts Payable	69,292	61,614
Accrued Salaries and Commissions Payable	18,327	19,601
Accrued Taxes and Expenses	15,577	18,292
Other Short Term Acquisition Payable	1,897	2,438
Revolving Note Payable - Bank	38,731	26,139
Current Maturities of Long-Term Debt	517	493
Capital Lease Obligations - Short-Term Portion	5,884	5,185
TOTAL CURRENT LIABILITIES	150,225	133,762
LONG-TERM LIABILITIES:	'	'
Capital Lease Obligations - Long-Term Portion	11,997	10,712
Long Term Debt - Net of Current Portion	3,279	3,670
Long Term Acquisition Payable	'	1,789
TOTAL LONG-TERM LIABILITIES	15,276	16,171
SHAREHOLDERS' EQUITY:	'	'
Preferred Stock $.10 Par Value; Authorized 1,666,667 shares, including 3,000 shares of Series A Junior Preferred Stock None Issued	'	'
Common Stock, $.01 Par Value; Authorized 35,000,000 shares: Issued and Outstanding 27,727,644 and 27,683,213 at January 31, 2014 and at October 31, 2013, respectively	277	277
Additional Paid-In Capital	39,979	39,430
Retained Earnings	260,365	231,888
TOTAL SHAREHOLDERS' EQUITY	300,621	271,595
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY	$466,122	$421,528

CONSOLIDATED_BALANCE_SHEETS_Pa

CONSOLIDATED BALANCE SHEETS (Parenthetical) (USD $)	Jul. 31, 2014	Oct. 31, 2013
CONSOLIDATED BALANCE SHEETS	'	'
Preferred Stock, Par Value (in dollars per share)	$0.10	'
Preferred Stock, Authorized shares, including Series A Junior Preferred Stock	3,000	'
Preferred Stock, Authorized shares	1,666,667	1,666,667
Preferred Stock, Issued shares	0	0
Common Stock, Par Value (in dollars per share)	$0.01	$0.01
Common Stock, Authorized shares	35,000,000	35,000,000
Common Stock, Issued shares	27,727,644	27,683,213
Common Stock, Outstanding shares	27,727,644	27,683,213

CONSOLIDATED_STATEMENTS_OF_OPE

CONSOLIDATED STATEMENTS OF OPERATIONS (USD $)	3 Months Ended		9 Months Ended
In Thousands, except Share data, unless otherwise specified	Jul. 31, 2014	Jul. 31, 2013	Jul. 31, 2014	Jul. 31, 2013
CONSOLIDATED STATEMENTS OF OPERATIONS	'	'	'	'
NET REVENUES:	$222,053	$185,427	$604,688	$523,136
COST OF SERVICES:	'	'	'	'
Depreciation and Amortization	5,305	3,981	14,539	11,296
Employee Related Expenses	52,856	43,397	153,532	125,280
Reagents and Lab Supplies	40,743	33,943	116,326	99,421
Other Cost of Services	20,706	18,446	57,145	49,881
TOTAL COST OF SERVICES	119,610	99,767	341,542	285,878
GROSS PROFIT ON REVENUES	102,443	85,660	263,146	237,258
General and Administrative Expenses:	'	'	'	'
Depreciation and Amortization	1,416	1,022	4,116	2,913
Other General and Administrative Expenses	54,282	43,987	154,860	129,441
Bad Debt Expense	18,874	15,592	51,540	43,377
TOTAL GENERAL AND ADMIN. EXPENSES	74,572	60,601	210,516	175,731
OPERATING INCOME	27,871	25,059	52,630	61,527
OTHER (INCOME) EXPENSES:	'	'	'	'
Interest Expense	625	350	1,830	1,077
Other (Income) Expense	-90	-1,046	-4	-52
Interest Income	-22	'	-48	-822
TOTAL OTHER (INCOME) EXPENSES - NET	513	-696	1,778	203
INCOME BEFORE INCOME TAXES	27,358	25,755	50,852	61,324
Provision for Income Taxes	12,108	11,054	22,375	26,620
NET INCOME	$15,250	$14,701	$28,477	$34,704
NET INCOME PER SHARE - BASIC: (in dollars per share)	$0.55	$0.53	$1.03	$1.25
WEIGHTED AVERAGE NUMBER OF SHARES BASIC: (in shares)	27,721,977	27,671,880	27,716,608	27,695,387
NET INCOME PER SHARE - DILUTED: (in dollars per share)	$0.55	$0.53	$1.02	$1.25
WEIGHTED AVERAGE NUMBER OF SHARES - DILUTED: (in shares)	27,864,489	27,841,998	27,854,089	27,861,372

CONSOLIDATED_STATEMENTS_OF_CAS

CONSOLIDATED STATEMENTS OF CASH FLOWS (USD $)	9 Months Ended
In Thousands, unless otherwise specified	Jul. 31, 2014	Jul. 31, 2013
OPERATING ACTIVITIES:	'	'
Net Income	$28,477	$34,704
Adjustments to Reconcile Net Income to Cash Provided by Operating Activities:	'	'
Depreciation and Amortization	18,655	14,209
Deferred Income Taxes (Benefit) Expense	2,661	-4,991
Stock Based Compensation	290	290
(Gain) Loss on Disposal of Fixed Assets	180	301
Undistributed Equity Method (Income) Loss	-4	240
(Increase) Decrease in:	'	'
Accounts Receivable	-32,618	-47,704
Provision for Doubtful Accounts	-12,972	9,153
Inventory	-460	-1,963
Other Current Assets	-154	-1,592
Other Assets	-200	-249
Deposits	-39	-69
Increase (Decrease) in:	'	'
Accounts Payable and Accrued Liabilities	3,689	14,646
NET CASH - OPERATING ACTIVITIES	7,505	16,975
INVESTING ACTIVITIES:	'	'
Acquisition of Equipment and Leasehold Improvements	-11,066	-17,616
Business Acquisitions Related Costs	-2,330	-6,947
NET CASH - INVESTING ACTIVITIES	-13,396	-24,563
FINANCING ACTIVITIES:	'	'
Payments of Long-Term Debt	-367	-345
Payments of Capital Lease Obligations	-4,538	-3,375
Increase (Decrease) in Revolving Line of Credit	12,592	16,576
Common Stock Repurchase	'	2,030
Proceeds from Exercise of Options	259	186
Common Stock Repurchase	'	-2,030
NET CASH - FINANCING ACTIVITIES	7,946	11,012
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	2,055	3,424
CASH AND CASH EQUIVALENTS AT BEGINNING OF PERIODS	17,952	25,143
CASH AND CASH EQUIVALENTS AT END OF PERIODS	20,007	28,567
Cash paid during the period for:	'	'
Interest	1,864	1,010
Income Taxes	23,954	29,387
SUPPLEMENTAL SCHEDULE OF NON-CASH INVESTING AND FINANCING ACTIVITIES:	'	'
Capital Leases	'	3,700
Write-off of property and equipment	'	$3,067

Basis_of_Presentation

Basis of Presentation	9 Months Ended
	Jul. 31, 2014
Basis of Presentation	'
Basis of Presentation	'
	[1] Basis of Presentation
	The accompanying unaudited consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America and the instructions to Form 10-Q and, therefore, do not include all information and footnotes necessary for complete audited financial statements. However, in the opinion of the management of the Company, all adjustments necessary for a fair presentation of the financial position and operating results have been included in these statements. Interim results are not necessarily indicative of results for a full year. Reference is made to the October 31, 2013 audited consolidated financial statements of Bio-Reference Laboratories, Inc.(“BRLI” or the “Company”) contained in its Annual Report on Form 10-K for the year ended October 31, 2013.
	The consolidated financial statements and notes thereto should be read in conjunction with the audited consolidated financial statements and notes for the year ended October 31, 2013 as filed with the Securities and Exchange Commission in the Company’s Annual Report on Form 10-K. Significant accounting policies followed by the Company are set forth in Note 2 to the Company’s 2013 Annual Report on Form 10-K.

Fair_Value_Measurements

Fair Value Measurements	9 Months Ended
	Jul. 31, 2014
Fair Value Measurements	'
Fair Value Measurements	'
	[2] Fair Value Measurements
	As of July 31, 2014, the Company’s financial instruments primarily consist of cash, cash equivalents, short-term trade receivables and payables for which their carrying amounts approximate fair values, and long term debt, for which based on the borrowing rates currently available to the Company for bank loans with similar terms and average maturities, its carrying amount approximates its fair value.

New_Accounting_Pronouncements

New Accounting Pronouncements	9 Months Ended
	Jul. 31, 2014
New Accounting Pronouncements	'
New Accounting Pronouncements	'
	[3] New Accounting Pronouncements
	In May the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2014-09 titled Revenues from Contracts with Customers.  The update calls for a number of revisions in the revenue recognition rules.  The update is effective for annual reporting periods beginning after December 15, 2016, including interim periods within that reporting period. Early application is not permitted.  At this time the company is studying this update and has not yet determined the effect this may have on our consolidated financial statements.

Revenue_Recognition_and_Contra

Revenue Recognition and Contractual Adjustments	9 Months Ended
	Jul. 31, 2014
Revenue Recognition and Contractual Adjustments	'
Revenue Recognition and Contractual Adjustments	'
	[4] Revenue Recognition and Contractual Adjustments
	Service revenues are principally generated from laboratory testing services including chemical diagnostic tests such as blood analysis, urine analysis and genetic testing among others. Service revenues are recognized at the time the testing services are performed and are reported at their estimated net realizable amounts.
	Service revenues before provision for bad debts are determined utilizing gross service revenues net of contractual adjustments and discounts.  Even though it is the responsibility of the patient to pay for laboratory service bills, most individuals in the United States have an agreement with a third party payor such as Medicare, Medicaid or a commercial insurance provider to pay all or a portion of their healthcare expenses; the majority of services provided by BRLI are to patients covered under a third party payor contract.  In certain cases, the individual has no insurance or does not provide insurance information and in other cases tests are performed under contract to a professional organization (such as physicians, hospitals, and clinics) which reimburse BRLI directly; in the remainder of the cases, BRLI is provided the third party billing information and seeks payment from the third party under the terms and conditions of the third party payor for health service providers like BRLI.  Each of these third party payors may differ not only with regard to rates, but also with regard to terms and conditions of payment and providing coverage (reimbursement) for specific tests.  Estimated revenues are established based on a series of highly complex procedures and judgments that require industry specific healthcare experience and an understanding of payor methods and trends. We review our calculations on a monthly basis in order to make certain that we are properly allowing for the uncollectable portion of our gross billings due to the contractual adjustments and discounts and that our estimates remain sensitive to variances and changes within our payor groups.  The contractual allowance calculation is made on the basis of historical allowance rates for the various specific payor groups on a monthly basis with a greater weight being given to the most recent trends; this process is adjusted based on recent changes in underlying contract provisions and shifts in the testing being performed.  This calculation is routinely analyzed by BRLI on the basis of actual allowances issued by payors and the actual payments made to determine what adjustments, if any, are needed.  The table below shows the adjustments made to gross service revenues to arrive at net revenues, the amount reported on our statement of operations.
		($)
		Three Months Ended		Nine Months Ended
		July 31,		July 31,
		[Unaudited]		[Unaudited]
		2014	2013	2014	2013
	Gross Service Revenues	1,100,880	905,713	3,028,379	2,565,929
	Contractual Adjustments and Discounts:
	Medicare/Medicaid Portion	100,630	91,173	284,069	259,433
	All Other Third Party Payors*	762,958	612,769	2,093,337	1,740,265
	Total Contractual Adjustments and Discounts	863,588	703,942	2,377,406	1,999,698
	Service Revenues Net of Contractual Adjustments and Discounts	237,292	201,771	650,973	566,231
	Patient Service Revenue Provision for Bad Debts**	15,239	16,344	46,285	43,095
	Net Revenues	222,053	185,427	604,688	523,136
	* All Other Third Party and Direct Payors consists of almost eight hundred distinct payors, including commercial health insurers and administrators as well as professionally billed accounts such as physicians, hospitals, clinics and other direct billed accounts.
	** Represents the amount of Bad Debt Expense that is required to be presented as a deduction from patient service revenue (net of contractual allowances and discounts) pursuant to ASU No. 2011-7.
	When new business is received by BRLI, service revenues net of contractual adjustments and discounts are calculated by reducing gross service revenues by the estimated contractual allowance. The Patient Service Revenue Provision for Bad Debts represents the amount of bad debt expense expected to occur on patient service revenue based upon our experience.  The remaining bad debt expense is presented as part of operating expenses.  The bad debt expense presented as part of operating expense represents the bad debt expense related to receivables from service revenues determined after taking into account our ability to collect on such revenue.
	BRLI recognized the amounts in subsequent periods for actual allowances/discounts to gross service revenue; bad debt may have been adjusted over the same periods of time to maintain an accurate balance between net revenues and actual revenues. Management has reviewed the allowances/discounts recognized in subsequent periods and believes the amounts to be immaterial. A number of proposals for legislation or regulation continue to be under discussion which could have the effect of substantially reducing Medicare reimbursements for clinical laboratories or introducing cost sharing to beneficiaries. Depending upon the nature of regulatory action, if any, which is taken and the content of legislation, if any, which is adopted, the Company could experience a significant decrease in revenues from Medicare and Medicaid, which could have a material adverse effect on the Company. The Company is unable to predict, however, the extent to which such actions will be taken.

Accounts_Receivable_Allowances

Accounts Receivable Allowances	9 Months Ended
	Jul. 31, 2014
Accounts Receivable Allowances	'
Accounts Receivable Allowances	'
	[5] Accounts Receivable Allowances
	It is typically the responsibility of the patient to pay for laboratory service bills. Most individuals in the United States have an agreement with a third party payor such as Medicare, Medicaid or commercial insurance to pay all or a portion of their healthcare expenses; this represents the major portion of payment for all services provided by BRLI. In certain cases, the individual has no insurance or does not provide insurance information; in the remainder of the cases, BRLI is provided the third party billing information, usually by the referring physician, and seeks payment from the third party under the terms and conditions of the third party payor for health service providers like BRLI. Each of these third party payors may differ not only with regard to rates, but also with regard to terms and conditions of payment and coverage of specific tests. BRLI routinely reviews the reimbursement policies and subsequent payments and collection rates from these different types of payors. Contractual adjustments and discounts are recorded as reductions to gross service revenues and are collectively referred to as the contractual allowance. BRLI has not been required to record an adjustment in a subsequent period related to revenue recorded in a prior period which was material in nature. Aging of accounts receivable is monitored by billing personnel and follow-up activities including collection efforts are conducted as necessary. BRLI writes off receivables against the allowance for doubtful accounts when they are deemed uncollectible. For client billing, accounts are written off when all reasonable collection efforts prove to be unsuccessful. Patient accounts, where the patient is directly responsible for all or a remainder portion of the account after partial payment or denial by a third party payor, are written off after the normal dunning cycle has occurred, although these may be subsequently transferred to a third party collection agency after being written off. Third party payor accounts are written off when they exceed the payer’s timely filing limits. Accounts Receivable on the balance sheet is net of the following amounts for contractual credits and doubtful accounts:
		($)
		[Unaudited]
		July 31,	October 31,
		2014	2013
	Contractual Credits/Discounts	485,840	342,297
	Doubtful Accounts	76,289	89,261
	Total Allowance	562,129	431,558

Intangible_Assets

Intangible Assets	9 Months Ended
	Jul. 31, 2014
Intangible Assets	'
Intangible Assets	'
	[6] Intangible Assets
	The following disclosures present certain information on the Company’s intangible assets as of July 31, 2014 (Unaudited) and October 31, 2013. All intangible assets are being amortized over their estimated useful lives, as indicated below, with no estimated residual value.
	July 31, 2014
	Intangible Asset	Weighted-Average	Cost ($)	Accumulated	Net of Accumulated
		Amortization Period		Amortization ($)	Amortization ($)
		Years
	Customer Lists	20	8,738	3,176	5,562
	Covenants Not-to-Compete	5	11,131	5,443	5,688
	Patents and Licenses	17	5,297	1,665	3,632
	Totals		25,166	10,284	14,882
	October 31, 2013
	Intangible Asset	Weighted-Average	Cost ($)	Accumulated	Net of Accumulated
		Amortization Period		Amortization ($)	Amortization ($)
		Years
	Customer Lists	20	8,738	2,878	5,860
	Covenants Not-to-Compete	5	11,131	4,560	6,571
	Patents and Licenses	17	5,297	1,408	3,889
	Totals		25,166	8,846	16,320
	The aggregate intangible amortization expense for the three months ended July 31, 2014 and 2013 was $479 and $230, respectively.  The aggregate intangible amortization expense for the nine months ended July 31, 2014 and 2013 was $1,438 and $597, respectively.  The estimated intangible asset amortization expense for the remainder of fiscal year ending October 31, 2014 and for the four subsequent years is as follows:
	October 31,	($)
	2014	491
	2015	1,852
	2016	1,540
	2017	1,063
	2018	946
	Thereafter	8,990
	Total	14,882

Revolving_Note_Payable_Bank

Revolving Note Payable - Bank	9 Months Ended
	Jul. 31, 2014
Revolving Note Payable - Bank	'
Revolving Note Payable - Bank	'
	[7] Revolving Note Payable - Bank
	On February 3, 2014, the Company entered into an amended revolving note payable loan agreement with PNC Bank, N.A. (“PNC Bank Credit Line”).  This amendment increased the maximum credit line to $70,000.  The maximum amount of the credit line available to the Company pursuant to the loan agreement is the lesser of (i) $70,000 or (ii) 50% of the Company’s qualified accounts receivable, as defined in the agreement.  The amendment to the Loan and Security Agreement provides for an interest rate on advances to be subject, at the election of the Company, to either the bank’s base rate or the Eurodollar rate of interest plus, in certain instances, an additional interest percentage.  The additional interest percentage charge on bank’s base rate borrowings and on Eurodollar rate borrowings ranges from 1% to 4% and is determined based upon certain financial ratios achieved by the Company.  At July 31, 2014, the Company elected to have all of the total advances outstanding to be subject to the bank’s base rate of interest of 3.50%.  The credit line is collateralized by substantially all of the Company’s assets. The line of credit is available through October 2016 and may be extended for annual periods by mutual consent, thereafter.  The terms of this agreement contain, among other provisions, requirements for maintaining defined levels of capital expenditures and fixed charge coverage, and the prohibition of the payment of cash dividends by the Company. As of July 31, 2014, the Company utilized $38,731 of the available credit under this revolving note payable loan agreement.

LongTerm_Debt_Bank

Long-Term Debt - Bank	9 Months Ended
	Jul. 31, 2014
Long-Term Debt - Bank	'
Long-Term Debt - Bank	'
	[8] Long-Term Debt - Bank
	In December 2010, the Company issued a seven-year term note for $5,408 at the rate of interest of 6.12% per annum for the financing of new equipment.  The note is payable in 84 equal monthly installments commencing on January 29, 2011 of $61 including principal and interest followed by a balloon payment of the principal and interest outstanding on the loan repayment date of December 29, 2017.  The balance on this note as of July 31, 2014 is approximately $3,796.

Provision_for_Income_Taxes

Provision for Income Taxes	9 Months Ended
	Jul. 31, 2014
Provision for Income Taxes	'
Provision for Income Taxes	'
	[9] Provision for Income Taxes
	The provision for income taxes for the three-months ended July 31, 2014 consists of a current tax provision of $15,424 and a deferred tax benefit of $3,316. The provision for income taxes for the nine-months ended July 31, 2014 consists of a current tax provision of $19,714 and a deferred tax provision of $2,661.
	The provision for income taxes for the three-months ended July 31, 2013 consists of a current tax provision of $13,009 and a deferred tax benefit of $1,995. The provision for income taxes for the nine-months ended July 31, 2013 consists of a current tax provision of $31,611 and a deferred tax benefit of $4,991.
	On July31, 2014, the Company had a current deferred tax asset of $36,678 and a long-term deferred tax asset of $4,892 included in other assets.  On July 31, 2013, the Company had a current deferred tax asset of $29,188 and a long-term deferred tax asset of $2,993 included in other assets.

Revenue_Recognition_and_Contra1

Revenue Recognition and Contractual Adjustments (Tables)	9 Months Ended
	Jul. 31, 2014
Revenue Recognition and Contractual Adjustments	'
Schedule of adjustments made to gross service revenues to arrive at net revenues	'
		($)
		Three Months Ended		Nine Months Ended
		July 31,		July 31,
		[Unaudited]		[Unaudited]
		2014	2013	2014	2013
	Gross Service Revenues	1,100,880	905,713	3,028,379	2,565,929
	Contractual Adjustments and Discounts:
	Medicare/Medicaid Portion	100,630	91,173	284,069	259,433
	All Other Third Party Payors*	762,958	612,769	2,093,337	1,740,265
	Total Contractual Adjustments and Discounts	863,588	703,942	2,377,406	1,999,698
	Service Revenues Net of Contractual Adjustments and Discounts	237,292	201,771	650,973	566,231
	Patient Service Revenue Provision for Bad Debts**	15,239	16,344	46,285	43,095
	Net Revenues	222,053	185,427	604,688	523,136
	* All Other Third Party and Direct Payors consists of almost eight hundred distinct payors, including commercial health insurers and administrators as well as professionally billed accounts such as physicians, hospitals, clinics and other direct billed accounts.
	** Represents the amount of Bad Debt Expense that is required to be presented as a deduction from patient service revenue (net of contractual allowances and discounts) pursuant to ASU No. 2011-7.

Accounts_Receivable_Allowances1

Accounts Receivable Allowances (Tables)	9 Months Ended
	Jul. 31, 2014
Accounts Receivable Allowances	'
Schedule of amounts for contractual credits and doubtful accounts	'
		($)
		[Unaudited]
		July 31,	October 31,
		2014	2013
	Contractual Credits/Discounts	485,840	342,297
	Doubtful Accounts	76,289	89,261
	Total Allowance	562,129	431,558

Intangible_Assets_Tables

Intangible Assets (Tables)	9 Months Ended
	Jul. 31, 2014
Intangible Assets	'
Schedule of information on intangible assets	'
	July 31, 2014
	Intangible Asset	Weighted-Average	Cost ($)	Accumulated	Net of Accumulated
		Amortization Period		Amortization ($)	Amortization ($)
		Years
	Customer Lists	20	8,738	3,176	5,562
	Covenants Not-to-Compete	5	11,131	5,443	5,688
	Patents and Licenses	17	5,297	1,665	3,632
	Totals		25,166	10,284	14,882
	October 31, 2013
	Intangible Asset	Weighted-Average	Cost ($)	Accumulated	Net of Accumulated
		Amortization Period		Amortization ($)	Amortization ($)
		Years
	Customer Lists	20	8,738	2,878	5,860
	Covenants Not-to-Compete	5	11,131	4,560	6,571
	Patents and Licenses	17	5,297	1,408	3,889
	Totals		25,166	8,846	16,320
Schedule of estimated amortization expense related to remaining intangible assets	'
	October 31,	($)
	2014	491
	2015	1,852
	2016	1,540
	2017	1,063
	2018	946
	Thereafter	8,990
	Total	14,882

Revenue_Recognition_and_Contra2

Revenue Recognition and Contractual Adjustments (Details) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Jul. 31, 2014	Jul. 31, 2013	Jul. 31, 2014	Jul. 31, 2013
	item
Revenue Recognition and Contractual Adjustments	'	'	'	'
Gross Service Revenues	$1,100,880	$905,713	$3,028,379	$2,565,929
Contractual Adjustments and Discounts:	'	'	'	'
Medicare/Medicaid Portion	100,630	91,173	284,069	259,433
All Other Third Party Payors	762,958	612,769	2,093,337	1,740,265
Total Contractual Adjustments and Discounts	863,588	703,942	2,377,406	1,999,698
Service Revenues Net of Contractual Adjustments and Discounts	237,292	201,771	650,973	566,231
Patient Service Revenue Provision for Bad Debts	15,239	16,344	46,285	43,095
Net Revenues	$222,053	$185,427	$604,688	$523,136
Number of distinct payors included in all other third party and Direct	800	'	'	'

Accounts_Receivable_Allowances2

Accounts Receivable Allowances (Details) (USD $)	Jul. 31, 2014	Oct. 31, 2013
In Thousands, unless otherwise specified
Allowances	'	'
Total Allowance	$562,129	$431,558
Allowance for Contractual Credits Discounts [Member]	'	'
Allowances	'	'
Total Allowance	485,840	342,297
Allowance for Doubtful Accounts [Member]	'	'
Allowances	'	'
Total Allowance	$76,289	$89,261

Intangible_Assets_Details

Intangible Assets (Details) (USD $)	3 Months Ended		9 Months Ended			3 Months Ended	12 Months Ended	3 Months Ended	12 Months Ended	3 Months Ended	12 Months Ended
In Thousands, unless otherwise specified	Jul. 31, 2014	Jul. 31, 2013	Jul. 31, 2014	Jul. 31, 2013	Oct. 31, 2013	Jul. 31, 2014	Oct. 31, 2013	Jul. 31, 2014	Oct. 31, 2013	Jul. 31, 2014	Oct. 31, 2013
						Customer Lists [Member]	Customer Lists [Member]	Noncompete Agreements [Member]	Noncompete Agreements [Member]	Patents and Licenses [Member]	Patents and Licenses [Member]
Intangible assets	'	'	'	'	'	'	'	'	'	'	'
Weighted-Average Amortization Period	'	'	'	'	'	'20 years	'20 years	'5 years	'5 years	'17 years	'17 years
Cost	$25,166	'	$25,166	'	$25,166	$8,738	$8,738	$11,131	$11,131	$5,297	$5,297
Accumulated Amortization	10,284	'	10,284	'	8,846	3,176	2,878	5,443	4,560	1,665	1,408
Net of Accumulated Amortization	14,882	'	14,882	'	16,320	5,562	5,860	5,688	6,571	3,632	3,889
Estimated residual value	0	'	0	'	'	0	'	0	'	0	'
Amortization expenses	479	230	1,438	597	'	'	'	'	'	'	'
Estimated amortization expense related to intangible assets	'	'	'	'	'	'	'	'	'	'	'
2014	491	'	491	'	'	'	'	'	'	'	'
2015	1,852	'	1,852	'	'	'	'	'	'	'	'
2016	1,540	'	1,540	'	'	'	'	'	'	'	'
2017	1,063	'	1,063	'	'	'	'	'	'	'	'
2018	946	'	946	'	'	'	'	'	'	'	'
Thereafter	8,990	'	8,990	'	'	'	'	'	'	'	'
Net of Accumulated Amortization	$14,882	'	$14,882	'	$16,320	$5,562	$5,860	$5,688	$6,571	$3,632	$3,889

Revolving_Note_Payable_Bank_De

Revolving Note Payable - Bank (Details) (USD $)	Jul. 31, 2014	Oct. 31, 2013	Jul. 31, 2014	Feb. 28, 2014	Feb. 28, 2014	Jul. 31, 2014	Feb. 28, 2014	Feb. 28, 2014	Feb. 28, 2014	Feb. 28, 2014	Feb. 28, 2014
In Thousands, unless otherwise specified			Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]	Revolving Credit Facility [Member]
					Debt Instrument, Variable Rate Base Rate [Member]	Debt Instrument, Variable Rate Base Rate [Member]	Debt Instrument, Variable Rate Base Rate [Member]	Debt Instrument, Variable Rate Base Rate [Member]	Debt Instrument, Variable Rate Eurodollar [Member]	Debt Instrument, Variable Rate Eurodollar [Member]	Debt Instrument, Variable Rate Eurodollar [Member]
							Minimum [Member]	Maximum [Member]		Minimum [Member]	Maximum [Member]
Revolving note payable - Bank	'	'	'	'	'	'	'	'	'	'	'
Maximum amount of the credit line available pursuant to the loan agreement	'	'	'	$70,000	'	'	'	'	'	'	'
Maximum credit line available as percentage of accounts receivable	'	'	'	50.00%	'	'	'	'	'	'	'
Variable rate basis	'	'	'	'	'base rate	'	'	'	'Eurodollar rate	'	'
Percentage of additional interest	'	'	'	'	'	'	1.00%	4.00%	'	1.00%	4.00%
Variable rate of interest (as a percent)	'	'	'	'	'	3.50%	'	'	'	'	'
Amount of credit utilized	$38,731	$26,139	$38,731	'	'	'	'	'	'	'	'

LongTerm_Debt_Bank_Details

Long-Term Debt - Bank (Details) (Medium-term Notes [Member], USD $)	1 Months Ended	3 Months Ended
In Thousands, unless otherwise specified	Dec. 31, 2010	Jul. 31, 2014
		item
Medium-term Notes [Member]	'	'
Long-term debt	'	'
Term of debt	'7 years	'
Debt issued	$5,408	'
Debt instrument interest rate (as a percent)	'	6.12%
Number of equal monthly installments	'	84
Monthly installment including principal and interest	'	61
Debt outstanding	'	3,796
Principal repayment for each of the five succeeding fiscal years and thereafter	'	'
Totals	'	$3,796

Provision_for_Income_Taxes_Det

Provision for Income Taxes (Details) (USD $)	3 Months Ended		9 Months Ended
In Thousands, unless otherwise specified	Jul. 31, 2014	Jul. 31, 2013	Jul. 31, 2014	Jul. 31, 2013	Oct. 31, 2013
Provision for Income Taxes	'	'	'	'	'
Current tax provision (benefit)	$15,424	$13,009	$19,714	$31,611	'
Provision for income taxes	'	'	'	'	'
Provision for Income Taxes	12,108	11,054	22,375	26,620	'
Deferred Tax Asset:	'	'	'	'	'
Current Deferred Tax Asset - Net	36,678	29,188	36,678	29,188	42,154
Long Term Deferred Tax Asset - Net	4,892	2,993	4,892	2,993	2,077
Net deferred tax benefit	'	'	'	'	'
Deferred tax provision (benefit)	($3,316)	($1,995)	$2,661	($4,991)	'