UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 10-Q [ X ] Quarterly Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 For the period ended June 30, 1999 ------------------------------------------ or [ ] Transition Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 For the transition period from to ------------- ------------- Commission File Number: 1-12306 ----------------- Integrated Health Services, Inc. ------------------------------------------------------ (Exact name of registrant as specified in its charter) DELAWARE 23-2428312 ------------------------------- ------------------- (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) 910 Ridgebrook Road, Sparks, Maryland 21152 --------------------------------------------------------------- (Address of principal executive offices) (Zip Code) (410) 773-1000 --------------------------------------------------------------- (Registrant's telephone, 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. [ X ] Yes [ ] No Number of shares of common stock of the registrant outstanding as of July 28, 1999: 52,943,909 shares. INTEGRATED HEALTH SERVICES, INC. INDEX Page ---- PART I. FINANCIAL INFORMATION Item 1. - Condensed Financial Statements - Consolidated Balance Sheets June 30, 1999 and December 31, 1998 3 Consolidated Statements of Operations for the three and six months ended June 30, 1999 and 1998 4 Consolidated Statement of Changes in Stockholders' Equity for the six months ended June 30, 1999 5 Consolidated Statements of Cash Flows for the six months ended June 30, 1999 and 1998 6 Notes to Consolidated Financial Statements 7 Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations 14 PART II: OTHER INFORMATION Item 2 Changes in Securities and Use of Proceeds 25 Item 6 Exhibits and Report on Form 8-K 26 Page 2 of 27 INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED BALANCE SHEETS (Dollars In Thousands) June 30, December 31, 1999 1998 ------------ ------------ (Unaudited) Assets Current Assets: Cash and cash equivalents $ 46,036 $ 31,391 Temporary investments 911 12,828 Patient accounts and third-party payor settlements receivable, less allowance for doubtful receivables of $159,965 at June 30, 1999 and $165,260 at December 31, 1998 590,988 649,106 Inventories, prepaid expenses and other current assets 79,180 75,945 Income tax receivable 26,403 39,320 Net assets of discontinued operations - 12,500 ----------- ----------- Total current assets 743,518 821,090 ----------- ----------- Property, plant and equipment, net 1,417,441 1,469,122 Assets held for sale - 7,500 Intangible assets 3,042,963 2,970,163 Other assets 199,990 125,253 ----------- ----------- Total assets $5,403,912 $5,393,128 =========== =========== Liabilities and Stockholders' Equity Current Liabilities: Current maturities of long-term debt $ 22,710 $ 16,760 Accounts payable and accrued expenses 442,810 463,130 ----------- ----------- Total current liabilities 465,520 479,890 ----------- ----------- Long-term Debt: Revolving Credit and Term Loan, less current maturities 1,977,750 1,893,000 Mortgages and other long term debt, less current maturities 204,255 227,269 Subordinated Debt 1,245,908 1,245,908 ----------- ----------- Total long-term debt 3,427,913 3,366,177 ----------- ----------- Other long-term liabilities 164,699 169,099 Deferred gain on sale-leaseback transactions 4,306 4,642 Deferred income tax payable 41,932 41,355 Stockholders' equity: Preferred stock, authorized 15,000,000 shares; no shares issued and outstanding - - Common stock, $0.001 par value. Authorized 150,000,000 shares; issued 53,175,598 at June 30, 1999 and 53,416,527 shares at December 31, 1998 (including 793,920 treasury shares at June 30, 1999 and 602,476 treasury shares at December 31, 1998) 53 53 Additional paid-in capital 1,340,678 1,370,049 Deficit (33,702) (22,483) Treasury stock, at cost (793,920 shares at June 30, 1999 and 602,476 shares at December 31, 1998) (7,487) (15,654) ----------- ----------- Total stockholders' equity 1,299,542 1,331,965 ----------- ----------- Total liabilities and stockholders' equity $5,403,912 $5,393,128 =========== =========== See accompanying Notes to Consolidated Financial Statements Page 3 of 27 INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF OPERATIONS (UNAUDITED) (Dollars in Thousands, Except Per Share Data) Three Months Ended Six Months Ended June 30, June 30, 1999 1998 1999 1998 --------- --------- ---------- ---------- Total revenues $ 624,251 $ 740,754 $1,244,486 $1,502,441 --------- --------- ---------- ---------- Costs and expenses: Operating, general and administrative (including rent) 505,656 572,063 1,013,558 1,171,074 Depreciation and amortization 46,617 36,595 92,991 72,196 Interest, net 74,245 58,187 144,737 118,845 --------- --------- ---------- ---------- Total costs and expenses 626,518 666,845 1,251,286 1,362,115 --------- --------- ---------- ---------- Earnings (loss) from continuing operations before equity in earnings of affiliates and income taxes (2,267) 73,909 (6,800) 140,326 Equity in earnings of affiliates 1,198 184 1,345 454 --------- --------- ---------- ---------- Earnings (loss) from continuing operations before income taxes (1,069) 74,093 (5,455) 140,780 Federal and state income taxes 3,562 30,378 5,764 57,720 --------- --------- ---------- ---------- Earnings (loss) from continuing operations (4,631) 43,715 (11,219) 83,060 Loss from discontinued operations -- (2,217) -- (3,981) --------- --------- ---------- ---------- Net earnings (loss) $ (4,631) $ 41,498 $ (11,219) $ 79,079 ========= ========= ========== ========== Per Common Share - Basic: Earnings (loss) from continuing operations $ (0.09) $ 0.95 $ (0.22) $ 1.86 Net earnings (loss) (0.09) 0.90 (0.22) 1.77 ========= ========= ========== ========== Per Common Share - Diluted: Earnings (loss) from continuing operations $ (0.09) $ 0.80 $ (0.22) $ 1.57 Net earnings (loss) (0.09) 0.76 (0.22) 1.50 ========= ========= ========== ========== See accompanying Notes to Consolidated Financial Statements Page 4 of 27 INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENT OF CHANGES IN STOCKHOLDERS' EQUITY (UNAUDITED) (DOLLARS IN THOUSANDS) ADDITIONAL COMMON PAID-IN TREASURY STOCK CAPITAL DEFICIT STOCK TOTAL ------------------------------------------------------------------------- BALANCE AT DECEMBER 31, 1998 $ 53 1,370,049 (22,483) (15,654) 1,331,965 EXERCISE OF EMPLOYEE STOCK OPTIONS FOR 2,446 COMMON SHARES -- 25 -- -- 25 ISSUANCE OF 95,307 COMMON SHARES IN CONNECTION WITH EMPLOYEE STOCK PURCHASE PLAN -- 734 -- -- 734 ISSUANCE OF 270,856 COMMON SHARES IN CONNECTION WITH 1997 AND 1998 ACQUISITIONS(note 3) -- -- -- -- 0 ISSUANCE OF 326,459 COMMON SHARES IN CONNECTION WITH EMPLOYEE STOCK COMPENSATION LESS UNAMORTIZED COST OF $1,659 -- 177 -- -- 177 ACQUISITION OF 3,607,000 COMMON SHARES OF TREASURY STOCK (AT COST) -- -- -- (24,041) (24,041) ISSUANCE OF 64,003 COMMON SHARES IN CONNECTION WITH DEBT PAYMENTS -- 438 -- -- 438 RE-ISSUANCE OF 3,415,556 COMMON SHARES OF TREASURY STOCK IN CONNECTION WITH EMPLOYEE STOCK COMPENSATION LESS UNAMORTIZED COST OF $11,175 -- (30,745) -- 32,208 1,463 NET LOSS -- -- (11,219) -- (11,219) ------------------------------------------------------------------------- BALANCE AT JUNE 30, 1999 $ 53 1,340,678 (33,702) (7,487) 1,299,542 ========================================================================= See accompanying Notes to Consolidated Financial Statements Page 5 of 27 INTEGRATED HEALTH SERVICES, INC. AND SUBSIDIARIES CONSOLIDATED STATEMENTS OF CASH FLOWS (UNAUDITED) (dollars in thousands) SIX MONTHS ENDED June 30, ------------------------------ 1999 1998 --------- --------- Cash flows from operating activities: Net earnings (loss) $ (11,219) $ 79,079 Adjustments to reconcile net earnings (loss) to net cash provided by operating activities: Loss from discontinued operations -- 3,981 Results of joint ventures (1,198) 389 Depreciation and amortization 92,991 72,196 Deferred income taxes and other non-cash items 5,596 9,734 Amortization of gain on sale-leaseback transactions (336) (355) (Increase) decrease in patient accounts and third-party payor settlements receivable, net 58,720 (127,901) Increase in supplies, inventory, prepaid expenses and other current assets (3,497) (16,413) Decrease in accounts payable and accrued expenses (113,038) (44,742) Decrease in income taxes receivable 12,917 -- Increase in income taxes payable -- 47,536 --------- --------- Net cash provided by operating activities of continuing operations 40,936 23,504 --------- --------- Net cash (used) provided by discontinued operations (13,469) 1,088 --------- --------- Cash flows from financing activities: Proceeds from issuance of capital stock, net 759 55,724 Proceeds from long-term borrowings 318,268 389,735 Repayment of long-term debt (250,775) (373,110) Dividends paid -- (814) Deferred financing costs (9,027) -- Purchase of treasury stock (24,041) -- --------- --------- Net cash provided by financing activities 35,184 71,535 --------- --------- Cash flows from investing activities: Sale of temporary investments 179,636 61,698 Purchase of temporary investments (167,719) (61,169) Business acquisitions (Note 3) (43,883) (95,524) Purchase of property, plant and equipment (112,537) (115,165) Disposition of assets (Notes 4, 7 and 8) 140,298 156,594 Other assets (43,801) (5,603) --------- --------- Net cash used by investing activities (48,006) (59,169) --------- --------- Increase in cash and cash equivalents 14,645 36,958 Cash and cash equivalents, beginning of period 31,391 60,333 --------- --------- Cash and cash equivalents, end of period $ 46,036 $ 97,291 ========= ========= See accompanying Notes to Consolidated Financial Statements Page 6 of 27 NOTES TO CONSOLIDATED FINANCIAL STATEMENTS NOTE 1: BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES The consolidated financial statements included herein do not contain all information and footnote disclosures normally included in financial statements prepared in accordance with generally accepted accounting principles. For further information, such as the significant accounting policies followed by Integrated Health Services, Inc. ("IHS" or the "Company"), refer to the consolidated financial statements and footnotes thereto included in the Company's Annual Report on Form 10-K for the year ended December 31, 1998. In the opinion of management, the consolidated financial statements include all necessary adjustments (consisting of only normal recurring accruals) for a fair presentation of the financial position and results of operations for the interim periods presented. The results of operations for the interim periods presented are not necessarily indicative of the results that may be expected for the full year. NOTE 2: EARNINGS PER SHARE Basic EPS is calculated by dividing net earnings (loss) by the weighted average number of common shares outstanding for the applicable period. Diluted EPS is calculated after adjusting the numerator and the denominator of the basic EPS calculation for the effect of all potential dilutive common shares outstanding during the period. Information related to the calculation of net earnings per share of common stock is summarized as follows: EARNINGS* SHARES PER SHARE (NUMERATOR) (DENOMINATOR) AMOUNT ----------- ------------- ----------- (IN THOUSANDS, EXCEPT PER SHARE AMOUNTS) For The Three Months Ended June 30, 1998: Basic EPS: $ 43,715 46,233 $ 0.95 Adjustment for interest on and incremental shares from assumed conversion of the convertible subordinated debentures: 2,388 8,037 -- Incremental shares from assumed exercise of dilutive options and warrants: -- 3,408 -- -------- ------ ------ Diluted EPS: $ 46,103 57,678 $ 0.80 ======== ====== ====== For The Six Months Ended June 30, 1998: Basic EPS: $ 83,060 44,770 $ 1.86 Adjustment for interest on and incremental shares from assumed conversion of the convertible subordinated debentures: 4,775 8,037 -- Incremental shares from assumed exercise of dilution options and warrants: -- 3,274 -- -------- ------ ------ Diluted EPS: $ 87,835 56,081 $ 1.57 ======== ====== ====== * Represents earnings from continuing operations. For the three and six months ended June 30, 1999, no exercise of options and warrants nor conversion of subordinated debt is assumed since their effect is antidilutive. The weighted average number of common shares is 51,523,079 for the six months ended June 30, 1999 and 51,455,647 for the three months ended June 30, 1999. Page 7 of 27 NOTE 3: NEW ACQUISITIONS Acquisitions during the six months ended June 30, 1999 and the manner of payment are summarized as follows: NOTES PAYABLE AND TOTAL COMMON ACCRUED CASH MONTH TRANSACTION COST STOCK ISSUED LIABILITIES PAID ----- ----------- ---- ------------ ----------- ---- (Dollars in Thousands) Jan. Assets of Suncoast of Manatee, Inc. $ 11,920 -- $ 4,900 $ 7,020 Jan. Assets of Certified Medical 2,760 -- 810 1,950 Associates, Inc. March Stock of Medical Rental Supply, Inc. and Andy Boyd's Inhome Medical/Inhome Medical, Inc. 4,897 -- 1,583 3,314 May Management agreement for Novacare, Inc. 5,548 -- -- 5,548 Various 10 acquisitions, each with total cost of less than $2,000 8,359 -- 1,811 6,548 Various Cash payments of acquisition costs accrued and acquiree accrued liabilities -- -- (19,503) 19,503 -------- ----- ------- -------- $ 33,484 -- $(10,399) $ 43,883 ======== ===== ======= ======== The allocation of the total cost of the 1999 acquisitions to the assets acquired and the liabilities assumed is summarized as follows: Property, Current Plant & Other Intangible Current Total Transaction Assets Equipment Assets Assets Liabilities Cost ----------- ------ --------- ------ ------ ----------- ---- (Dollars in Thousands) Suncoast of Manatee, Inc. -- $ 11,920 -- -- -- $ 11,920 Certified Medical Assoc., Inc. $ 71 77 -- 2,612 -- 2,760 Medical Rental Supply, Inc. and Andy Boyd's Inhome Medical/Inhome Medical, Inc. 270 374 -- 4,253 -- 4,897 Management agreement for Novacare, Inc. -- -- 30,000 85,548 (110,000) 5,548 10 acquisitions, each with total costs of less than $2,000 654 752 (421) 7,505 (131) 8,359 ----- -------- ------- -------- --------- -------- $ 995 $ 13,123 $29,579 $ 99,918 (110,131) $ 33,484 ===== ======== ======= ======== ========= ======== During 1999, the Company issued an additional 162,998, 69,585, 18,097, 9,677 and 10,499 shares to stockholders of Medicare Convalescent Aids of Pinnellas Inc., Hialeah Convalescent Home, Premier Medical, Plateau Medical Equipment and Indian Respiratory Care Inc., respectively, in connection with share price adjustments. Page 8 of 27 NOTE 4: TRANSACTIONS WITH LYRIC HEALTH CARE LLC In 1997, the Company began to explore various options to deleverage the Company without adversely affecting earnings. As part of its delveraging strategy, in each of January and April 1998, (but effective March 31, 1998 in the case of the April 1998 sale) the Company sold five long-term care facilities to Omega Healthcare Investors, Inc. for $44.5 million and $50.5 million, respectively, which facilities were leased back by Lyric Health Care LLC ("Lyric"), a newly formed subsidiary of IHS, at an annual rent of approximately $4.5 million and $4.9 million, respectively. IHS also entered into management and franchise agreements with Lyric. The management and franchise agreements' initial terms are 13 years with two renewal options of 13 years each. The base management fee is 3% of gross revenues, subject to increase if gross revenues exceed $350.0 million. In addition, the agreement provides for an incentive management fee equal to 70% of annual net cash flow (as defined in the management agreement). The duties of IHS as manager include the following: accounting, legal, human resources, operations, materials and facilities management and regulatory compliance. The annual franchise fee is 1% of gross revenues, which grants Lyric the authority to use the Company's trade names and proprietary materials. In a related transaction, TFN Healthcare Investors, Inc. ("TFN") purchased a 50% interest in Lyric for $1.0 million, an amount equal to the Company's initial investment in Lyric and IHS' interest in Lyric was reduced to 50%. Lyric will dissolve on December 31, 2047 unless extended for an additional 12 months. The transactions with Lyric were approved by the disinterested members of the Board of Directors. The Company believes that the terms of the arrangement with Lyric are as advantageous as than could have been obtained from an unrelated third party. The Company believes that the long-term growth of Lyric through facility acquisitions from third parties will allow IHS to increase management fee revenues. On February 1, 1998 Lyric also entered into a five-year employment agreement with Timothy F. Nicholson, the principal stockholder of TFN and a director of the Company. Pursuant to Lyric's operating agreement, Mr. Nicholson will serve as Managing Director of Lyric and will have the day-to-day authority for the management and operation of Lyric and will initiate policy proposals for business plans, acquisitions, employment policy, approval of budgets, adoption of insurance programs, additional service offerings, financing strategy, ancillary service usage, change in material terms of any lease and adoption/amendment of employee health, benefit and compensation plans. As a result of the aforementioned transactions, IHS accounts for its investment in Lyric using the equity method of accounting since IHS no longer controls Lyric. Effective January 1, 1999, as part of its deleveraging strategy, the Company and various wholly owned subsidiaries of the Company (the "Lyric Subsidiaries") sold 32 long-term care facilities to Monarch Properties LP ("Monarch LP") for approximately $135.0 million plus contingent earn-out payments of up to a maximum of $67.6 million. Net proceeds from the sale were approximately $114.3 million. The contingent earn-out payments will be paid to the Company by Monarch LP upon a sale, transfer or refinancing of any or all of the facilities or upon a sale, consolidation or merger of Monarch LP, with the amount of the earn-out payments determined in accordance with a formula described in the Facilities Purchase Agreement among the Company, the Lyric Subsidiaries and Monarch Page 9 of 27 LP. After the sale of the facilities to Monarch LP, the Company transferred the stock of each of the Lyric Subsidiaries to Lyric. Monarch LP then leased all of the facilities back to the Lyric Subsidiaries under the long-term master lease. The Company is managing these facilities for Lyric. Dr. Robert N. Elkins, Chairman of the Board, Chief Executive Officer and President of the Company, beneficially owns 30% of Monarch LP and is the Chairman of the Board of Managers of Monarch Properties, LLP, the parent company of Monarch LP. After the sale of the facilities to Monarch LP, the Company transferred the stock of each of the Lyric Subsidiaries under a long-term master lease. In March 1999, the Company sold, effective April 1, 1999, three additional facilities to Monarch LP for $33 million, which purchase price was paid by a 10% promissory note due March 2000. Monarch LP then leased these facilities to subsidiaries of Lyric. The Company is managing these facilities for Lyric pursuant to the above-described agreements. The transactions with Monarch LP and Lyric were approved by the disinterested members of the Board of Directors. The Company believes that the terms of the arrangements with Monarch LP are as advantageous to the Company as could be obtained from an unrelated third party. The Company deferred an immaterial gain on this transaction. NOTE 5: CREDIT FACILITY AMENDMENT In March 1999, the Company amended its Credit Facility, which amendments loosened the financial convenants, increased interest rates and accelerated the reduction in the availability under the Credit Facility. As amended: o The Term Facility bears interest at a rate equal to, at the option of IHS, either (i) in the case of Eurodollar loans, the sum of (x) between two and three quarters percent and three and one quarter percent (depending on the ratio of the Company's debt) (as defined in the New Credit Facility) to earnings before interest, taxes, depreciation, amortization and rent pro forma for any acquisitions or divestitures during the measurement period (the "Debt/EBITDAR Ratio")) and (y) the interest rate in the London interbank market for loans in an amount substantially equal to the amount of borrowing and for the period of borrowing selected by IHS or (ii) the sum of (a) the higher of (1) Citibank, N.A.'s base rate or (2) one percent plus the latest overnight federal funds rate plus (b) a margin of between one and one half percent and two percent (depending on the Debt/EBITDAR Ratio). o The Additional Term Facility bears interest at a rate equal to, at the option of IHS, either (i) in the case of Eurodollar loans, the sum of (x) between three percent and three and one half percent (depending on the Debt/EBITDAR Ratio) and (y) the interest rate in the London interbank market for loans in an amount substantially equal to the amount of borrowing and for the period of borrowing selected by IHS or (ii) the sum of (a) the higher of (1) Citibank, N.A.'s base rate or (2) one percent plus the latest overnight federal funds rate plus (b) a margin of Page 10 of 27 between one and three quarters percent and two and one quarter percent (depending on the Debt/EBITDAR Ratio). The Term Facility and the Additional Term Facility can be prepaid at any time in whole or in part without penalty. o The Revolving Facility will reduce to $800,000,000 on January 1, 2001, $600,000,000 on January 1, 2002, $500,000,000 on September 30, 2002 and $400,000,000 on January 1, 2003, with a final maturity on September 15, 2003; however, the $100,000,000 letter of credit subfacility and $10,000,000 swing line subfacility will remain at $100,000,000 and $10,000,000, respectively, until final maturity. The Revolving Credit Facility bears interest at a rate equal to, at the option of IHS, either (i) in the case of Eurodollar loans, the sum of (x) between two percent and two and three quarters percent (depending on the Debt/EBITDAR Ratio) and (y) the interest rate in the London interbank market for loans in an amount substantially equal to the amount of borrowing and for the period of borrowing selected by IHS or (ii) the sum of (a) the higher of (1) Citibank, N.A.'s base rate or (2) one percent plus the latest overnight federal funds rate plus (b) a margin of between three quarters of one percent and one and one-half percent (depending on the Debt/EBITDAR Ratio). o The Credit Facility prohibits IHS from purchasing or redeeming IHS stock. The Company acquired certain common shares of treasury stock prior to amending its Credit Facility. NOTE 6: SEGMENT REPORTING After giving effect to the discontinuance of its home health nursing segment, IHS has four primary reportable segments: inpatient services, home respiratory/infusion/DME, diagnostic services and lithotripsy services. Inpatient services include: (a) inpatient facilities which provide basic medical services primarily on an inpatient basis at skilled nursing facilities, as well as hospice services, (b) contract services that provide specialty medical services (e.g., rehabilitation and respiratory services), primarily on an inpatient basis at skilled nursing facilities, (c) contract services that provide specialty medical services under contract to other healthcare providers, and (d) management of skilled nursing Page 11 of 27 facilities owned by third parties. Home respiratory/infusion/DME provides respiratory and infusion therapy, as well as the sale and/or rental of home medical equipment. Diagnostic services provide mobile x-ray and electrocardiogram services on an inpatient basis at skilled nursing facilities. Lithotripsy services is a non-invasive technique that uses shock waves to disintegrate kidney stones, primarily on an outpatient basis. Certain services with similar economic characteristics have been aggregated pursuant to SFAS No. 131. No other individual business segment exceeds the 10% quantitative thresholds of SFAS No. 131. IHS management evaluates the performance of its operating segments on the basis of earnings before interest, income taxes, depreciation and amortization and non-recurring charges. THREE MONTHS ENDED JUNE 30, 1999 HOME INPATIENT RESPIRATORY/ DIAGNOSTIC LITHOTRIPSY SERVICES INFUSION/DME SERVICES SERVICES CONSOLIDATED -------- ------------ -------- -------- ------------ (DOLLARS IN THOUSANDS) Revenues $ 417,816 $ 165,406 $ 25,743 $ 15,286 $ 624,251 Operating, general and administrative expenses (including rent) 353,751 121,226 21,495 9,184 505,656 ---------- ---------- ---------- ---------- ---------- Earnings from continuing operations before non-recurring charges, equity in earnings of affiliates, interest, taxes, depreciation and amortization $ 64,065 $ 44,180 $ 4,248 $ 6,102 $ 118,595 ========== ========== ========== ========== ========== Total Assets $3,315,628 $1,658,310 $ 219,942 $ 210,032 $5,403,912 ========== ========== ========== ========== ========== SIX MONTHS ENDED JUNE 30, 1999 HOME INPATIENT RESPIRATORY/ DIAGNOSTIC LITHOTRIPSY SERVICES INFUSION/DME SERVICES SERVICES CONSOLIDATED -------- ------------ -------- -------- ------------ (DOLLARS IN THOUSANDS) Revenues $ 836,663 $ 324,526 $ 53,852 $ 29,445 $1,244,486 Operating, general and administrative expenses (including rent) 718,025 236,089 42,827 16,617 1,013,558 ---------- ---------- ---------- ---------- ---------- Earnings from continuing operations before non-recurring charges, equity in earnings of affiliates, interest, taxes, depreciation and amortization $ 118,638 $ 88,437 $ 11,025 $ 12,828 $ 230,928 ========== ========== ========== ========== ========== Total Assets $3,315,628 $1,658,310 $ 219,842 $ 210,032 $5,403,912 ========== ========== ========== ========== ========== THREE MONTHS ENDED JUNE 30, 1998 HOME INPATIENT RESPIRATORY/ DIAGNOSTIC LITHOTRIPSY SERVICES INFUSION/DME SERVICES SERVICES CONSOLIDATED -------- ------------ -------- -------- ------------ (DOLLARS IN THOUSANDS) Revenues $ 547,658 $ 152,815 $ 27,018 $ 13,263 $ 740,754 Operating, general and administrative expenses (including rent) 432,616 113,389 18,763 7,295 572,063 ---------- ---------- ---------- ---------- ---------- Earnings from continuing operations before non-recurring charges, equity in earnings of affiliates, interest, taxes, depreciation and amortization $ 115,042 $ 39,426 $ 8,255 $ 5,968 $ 168,691 ========== ========== ========== ========== ========== Total Assets $3,203,188 $1,267,256 $ 215,688 $ 211,011 $4,897,143 ========== ========== ========== ========== ========== SIX MONTHS ENDED JUNE 30, 1998 HOME INPATIENT RESPIRATORY/ DIAGNOSTIC LITHOTRIPSY SERVICES INFUSION/DME SERVICES SERVICES CONSOLIDATED -------- ------------ -------- -------- ------------ (DOLLARS IN THOUSANDS) Revenues $1,115,052 $ 302,450 $ 60,192 $ 24,747 $1,502,441 Operating, general and administrative expenses (including rent) 886,698 225,167 45,564 13,645 1,171,074 ---------- ---------- ---------- ---------- ---------- Earnings from continuing operations before non-recurring charges, equity in earnings of affiliates, interest, taxes, depreciation and amortization $ 228,354 $ 77,283 $ 14,628 $ 11,102 $ 331,367 ========== ========== ========== ========== ========== Total Assets $3,203,188 $1,267,256 $ 215,688 $ 211,011 $4,897,143 ========== ========== ========== ========== ========== There are no material inter-segment revenues or receivables. Revenues derived from Medicare and various state Medicaid reimbursement programs represented 31% and 25%, respectively, Page 12 of 27 for the three and six months ended June 30, 1999 and 37% and 20%, respectively, for the three and six months June 30, 1998. The Company does not evaluate its operations on a geographic basis. NOTE 7: SALE OF OUTPATIENT CLINICS In February 1998, the Company sold its outpatient clinics to Continucare Rehabilitation Services, Inc. for $10.0 million. During the fourth quarter of 1997, the Company wrote down its basis in its outpatient clinics to net realizable value. Accordingly, no gain or loss was recognized by the Company on such sale. NOTE 8: SALE OF FACILITIES In June 1998, the Company sold eleven long-term care facilities for approximately $56.7 million, which approximated the Company's basis. Therefore, the Company recognized no gain or loss during the second quarter of 1998. NOTE 9: DISCONTINUED OPERATIONS In October 1998, the Company adopted a plan to discontinue its home health nursing business segment. Accordingly, during 1998, the operating results of the home health nursing segment have been segregated from continuing operations and reported as a separate line item on the condensed statement of operations. The loss from this discontinued operation of $4.0 million represents the operating loss for the six month period ended June 30, 1998. The operating loss includes the effects of interest expense incurred in connection with acquisition financing. During the six months ended June 30, 1999, the Company sold this business segment for approximately $26.0 million. NOTE 10: SUBSEQUENT EVENTS On August 1, 1999, the Company entered into a lease agreement to lease 14 skilled nursing facilities from Florida Convalescent Centers, Inc. for annual lease payments of $14,300,000. The Company has reached definitive agreements to purchase seven respiratory companies for approximately $11,350,000. There can be no assurance that any of these pending acquisitions will be consummated on the proposed terms, different terms, or at all. Page 13 of 27 MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS Statements in this Quarterly Report on Form 10-Q concerning the Company's business outlook or future economic performance; anticipated profitability, revenues, expenses or other financial items; and business segment growth, together with other statements that are not historical facts, are "forward-looking statements" as that term is defined under Federal Securities Laws. Forward-looking statements are subject to risks, uncertainties and other factors which could cause actual results to differ materially from those stated in such statements. Such risks, uncertainties and factors include, but are not limited to, the Company's substantial indebtedness, growth strategy, capital requirements and recent acquisitions as well as the Company's ability to operate profitably under the newly implemented Medicare Prospective Payment System ("PPS"), competition, government regulation, general economic conditions and the other risks detailed in the Company's filings with the Securities and Exchange Commission, including the Annual Report on Form 10-K for the year ended December 31, 1998. The Company continues to evaluate the impact of the Balanced Budget Act ("BBA") upon future operating results. While the BBA was passed in August 1997, specifics relating to each business line will continue to be released until the year 2000. The assumptions used by the Company to evaluate the BBA are based upon the most accurate information available at each quarter end. At present the Company believes it is reacting to all of the known changes created by the BBA, however, it cannot predict the impact of unforeseen reductions in anticipated rates issued by the government. After giving effect to the discontinuance of its home health nursing segment, IHS has four primary reportable segments: inpatient services, home respiratory/infusion/DME, diagnostic services and lithotripsy services. Inpatient services include: (a) inpatient facilities which provide basic medical services primarily on an inpatient basis at skilled nursing facilities, as well as hospice services, (b) Page 14 of 27 contract services that provide specialty medical services (e.g., rehabilitation and respiratory services), primarily on an inpatient basis at skilled nursing facilities, (c) contracted services that provide specialty medical services under contract to other healthcare providers, and (d) management of skilled nursing facilities owned by third parties. Home respiratory/infusion/DME provides respiratory and infusion therapy, as well as the sale and/or rental of home medical equipment. Diagnostic services provide mobile x-ray and electrocardiogram services on an inpatient basis at skilled nursing facilities. Lithotripsy services is a non-invasive technique that uses shock waves to disintegrate kidney stones, primarily on an outpatient basis. Certain services with similar economic characteristics have been aggregated pursuant to SFAS No. 131. No other individual business segment exceeds the 10% quantitative thresholds of SFAS No. 131. The Company, in an effort to reduce indebtedness, as well as to improve liquidity, is currently exploring the sale of a portion or all of certain business segments. There can, however, be no assurance that a sale will be completed, or that such sale if it were to occur would not have a material adverse affect on the Company. Additionally, the sale of a major segment or a major portion of a segment may require a reevaluation under SFAS 121, "Impairment of Long Lived Assets" of the impact on other business segments including corporate division assets such as computer systems. Finally, the Company is in the process of assessing the impact of the relocation of various business units to the Company's new headquarters campus scheduled for the third and fourth quarter. THREE MONTHS ENDED JUNE 30, 1999 COMPARED TO THREE MONTHS ENDED JUNE 30, 1998 Net revenues for the three months ended June 30, 1999 decreased $116.5 million, or 15.7%, to $624.25 million from the comparable period in 1998. Such decrease was attributable to (i) a $142.78 million decrease from (a) the sale, subsequent to June 30, 1998, of 37 facilities (the "Lyric facilities") to real estate investment trusts, which leased such facilities to Lyric Health Care LLC, which is 50% owned by IHS and which facilities are now managed by IHS, (b) a decrease in the Company's rates for inpatient services provided as a result of the implementation of a BBA mandated prospective payment system ("PPS") for the Company's nursing facilities during the first half of 1999 and (c) a decrease in demand for therapy services Page 15 of 27 in the Company's contract rehabilitation division as a result of PPS, (ii)a decrease of $7.77 million from home respiratory/infusion/DME companies in operations in both periods, (iii) a decrease of $1.28 million from diagnostic services in operations in both periods, partially offset by (iv) an increase of $1.52 million from lithotripsy services in operations in both periods and (v) revenue from companies acquired subsequent to June 30, 1998, including (x) $12.94 million from inpatient services, (y) $20.36 million from home respiratory/infusion/DME, and (z) $500,000 from lithotripsy services. Customers of the Company's contract rehabilitation division are admitting fewer Medicare patients and are reducing utilization of rehabilitation services to a far greater degree than the Company had expected. Operating, general and administrative expense (including rent) decreased $66.41 million, or 11.61%, in the three months ended June 30, 1999 compared to the three months ended June 30, 1998. Such decrease was attributable to (i) a $91.28 million decrease from (a) the sale of the Lyric facilities, (b) a decrease in the Company's inpatient services provided, and (c) a decrease in therapy services in the Company's contract rehabilitation division, and (ii) a $5.73 million decrease from home respiratory/infusion/DME companies in operations in both periods, partially offset by (iii) an increase of $2.73 million from diagnostic services in operations in both periods, (iv) an increase of $1.74 million from lithotripsy services in operations in both periods and (v) increases in expenses from acquisitions subsequent to June 30, 1998, including (x) $12.41 million from inpatient services, (y) $13.57 million from home respiratory/infusion/DME services, and (z) $152,000 from lithotripsy services. In response to the reduced demand for therapy services provided to third parties by the Company's contract rehabilitation division, the Company began in the fourth quarter of 1998 to reduce staff and changed the method of compensation to its remaining therapists. Depreciation and amortization increased to $46.62 million for the three months ended June 30, 1999, a 27.39% increase as compared to $36.60 million in 1998. Of the $10.02 million increase, $1.38 million, or Page 16 of 27 13.78%, was attributable to depreciation and amortization of businesses acquired subsequent to June 30, 1998. The remaining increase was primarily due to depreciation and amortization related to increased routine and capital expenditures at existing facilities and depreciation and amortization of inpatient services and home respiratory companies acquired during the second quarter of 1998 partially offset by the sale of the Lyric facilities. Net interest expense increased $16.06 million, or 27.60%, during the three months ended June 30, 1999. The increase was primarily the result of increased borrowings under the revolving credit facility and other debt assumed related to acquisitions subsequent to June 30, 1998. Earnings (loss) from continuing operations decreased from earnings of $43.72 million in the three months ended June 30, 1998 to a loss of $4.63 million for the three months ended June 30, 1999. The decrease is primarily due to the decrease in therapy services in the Company's contract rehabilitation division within the inpatient services segment. The Company's effective tax rate in 1998 under generally accepted accounting principles was approximately 41% which included certain amortization costs that are not deductible for income tax purposes. The Company's anticipated effective tax rate in 1999 exceeds 100%. Since pre-tax earnings (loss) in 1999 are expected to be substantially less in 1999 compared to 1998 pre-tax earnings, the non-deductibility of these amortization costs will have a much greater impact on the effective tax rate under generally accepted accounting principles. As pre-tax earnings grow, the non-deductibility of certain amortization costs will have a diminishing impact on the effective tax rate. In October 1998, the Company's Board of Directors adopted a plan to discontinue operations of the home health nursing segment. Accordingly, during 1998, the operating results of the home nursing segment have been segregated from continuing operations and reported as a separate line item on the statement of operations. The operating loss (net of tax) during the three months ended June 30, 1998 was $2.22 million. Net loss and loss per share for 1999 were $4.63 million and $0.09 per share, respectively, compared to net earnings and diluted earnings per share for 1998 of $41.5 million and $0.76 per share. Weighted average shares decreased from 57,678,000 (diluted) in 1998 to 51,456,000 in 1999. In 1999, no exercise of options and warrants nor conversion of subordinated debt is assumed since their effect is antidilutive. Subsequent to June 30, 1998, the Company issued an aggregate of 1,315,544 shares of Common Stock, including 746,662 shares for acquisitions 31,927 shares upon exercise of options and 146,493 shares for the employee stock purchase plan and 32,459 shares for current and deferred compensation. During this period, the Company repurchased 4,667,500 shares of its Common Stock and reissued 4,074,380 of such shares. Page 17 of 27 SIX MONTHS ENDED JUNE 30, 1999 COMPARED TO SIX MONTHS ENDED JUNE 30, 1998 Net revenues for the six months ended June 30, 1999 decreased $257.96 million, or 17.17%, to $1,244.49 million from the comparable period in 1998. Such decrease was attributable to (i) a $291.61 million decrease from (a) the sale, subsequent to June 30, 1998, of 37 facilities ("the Lyric facilities") to real estate investment trusts, which leased such facilities to Lyric Health Care LLC, which is 50% owned by IHS and which facilities are now managed by IHS, (b) a decrease in the Company's rates for inpatient services provided as a result of PPS, and (c) a decrease in demand for therapy services in the Company's contract rehabilitation division as a result of PPS, (ii)a decrease of $4.10 million from home respiratory/infusion/DME companies in operations in both periods, (iii) a decrease of $6.34 million from diagnostic services in operations in both periods, partially offset by (iv) an increase of $3.90 million from lithotripsy services in operations in both periods and (v) revenue from acquisitions subsequent to June 30, 1998, including (x) $13.22 million from inpatient services, (y) $26.18 million from home respiratory/infusion/DME, and (z) $804,000 from lithotripsy services. Customers of the Company's contract rehabilitation division are admitting fewer Medicare patients and are reducing utilization of rehabilitation services to a far greater degree than the Company had expected. Page 18 of 27 Operating, general and administrative expense (including rent) decreased $157.52 million, or 13.5%, in the six months ended June 30, 1999 compared to the six months ended June 30, 1998. Such decrease was attributable to (i) a $181.38 million decrease from (a) the sale of the Lyric facilities, (b) a decrease in the Company's inpatient services provided, and (c) a decrease in therapy services in the Company's contract rehabilitation division, (ii) a $6.68 million decrease from home respiratory/infusion/DME companies in operations in both periods, (iii) a $2.74 million decrease from diagnostic services in operations in both periods, partially offset by (iv) an increase of $2.68 million from lithotripsy services in operations in both periods and (v) increases in expenses from acquisitions subsequent to June 30, 1998, including (x) $12.71 million from inpatient services, (y) $17.60 million from home respiratory/infusion/DME services, and (z) $288,000 from lithotripsy services. In response to the reduced demand for therapy services provided to third parties by the Company's contract rehabilitation division, the Company began in the fourth quarter of 1998 to reduce staff and changed the method of compensation to its remaining therapists. Depreciation and amortization increased to $92.99 million for the six months ended June 30, 1999, a 28.80% increase as compared to $72.20 million in 1998. Of the $20.80 million increase, $2.04 million, or 9.80%, was attributable to depreciation and amortization of businesses acquired subsequent to June 30, 1998. The remaining increase was primarily due to depreciation and amortization related to increased routine and capital expenditures at existing facilities and depreciation and amortization of inpatient services and home respiratory companies acquired during the second quarter of 1998 partially offset by the sale of the Lyric facilities. Page 19 of 27 Net interest expense increased $25.89 million, or 21.79%, during the six months ended June 30, 1999. The increase was primarily the result of increased borrowings under the revolving credit facility and other debt assumed related to acquisitions subsequent to June 30, 1998. Earnings (loss) from continuing operations decreased from earnings of $83.06 million in the six months ended June 30, 1998 to a loss of $11.22 million for the six months ended June 30, 1999. The decrease is primarily due to the decrease in therapy services in the Company's contract rehabilitation division. The Company's effective tax rate in 1998 under generally accepted accounting principles was approximately 41% which included certain amortization costs that are not deductible for income tax purposes. The Company's anticipated effective tax rate in 1999 exceeds 100%. Since pre-tax earnings (loss) in 1999 are excepted to be substantially less in 1999 compared to 1998 pre-tax earnings, the non-deductibility of these amortization costs will have a much greater impact on the effective tax rate under generally accepted accounting principles. As pre-tax earnings grow, the non-deductibility of certain amortization costs will have a diminishing impact on the effective tax rate. In October 1998, the Company's Board of Directors adopted a plan to discontinue operations of the home health nursing segment. Accordingly, during 1998, the operating results of the home nursing segment have been segregated from continuing operations and reported as a separate line item on the statement of operations. The operating loss (net of tax) during the six months ended June 30, 1998 was $3.98 million. Net loss and loss per share for 1999 were $11.22 million and $0.22 per share, respectively, compared to net earnings and diluted earnings per share for 1998 of $79.08 million and $1.50 per share. Weighted average shares decreased from 56,081,000 (diluted) in 1998 to 51,523,000 in 1999. In 1999, no exercise of options and warrants nor conversion of subordinated debt is assumed since their effect is antidilutive. Subsequent to June 30, 1998, the Company issued an aggregate of 1,315,544 shares of Common Stock, including 746,662 shares for acquisitions, 31,927 shares upon exercise of options 146,493 shares issued for the employee stock purchase plan and 326,459 shares for current and deferred compensation. During this period, the Company repurchased 4,667,500 shares of its Common Stock and reissued 4,074,380 of such shares. Page 20 of 27 LIQUIDITY AND CAPITAL RESOURCES At June 30, 1999, the Company had working capital of $278.0 million, as compared with $341.2 million at December 31, 1998. The decrease in working capital was primarily due to an increase in cash and cash equivalents and other current assets, a decrease in accounts payable and accrued expenses partially offset by a decrease in patient accounts and third party payor settlements receivable and a decrease in temporary investments and income tax receivable. There were no material capital commitments for capital expenditures as of June 30, 1999. Net patient accounts and third-party payor settlements receivable decreased $58.1 million to $591.0 million at June 30, 1999, as compared to $649.1 million at December 31, 1998. The decrease was primarily attributable to improved cash collections and reduced revenue resulting from lower rates for the Company's inpatient services and decreased demand for contract rehab services provided to third parties. Gross patient accounts receivable were $692.9 million at June 30, 1999, as compared with $735.2 million at December 31, 1998. Net third-party payor settlements receivable from federal and state governments (i.e., Medicare and Medicaid cost reports) was $58.1 million at June 30, 1999, as compared to $79.2 million at December 31, 1998. Net cash provided by operating activities of continuing operations for the six months ended June 30, 1999, was $40.9 million as compared to $23.5 million for the comparable period in 1998. Cash provided by operating activities for the six months ended June 30, 1999 increased compared to the comparable period in 1998 primarily because of a decrease in patient accounts and third party payor settlements receivable, net, partially offset by a net loss in 1999 compared to net earnings in 1998 and a decrease in accounts payable and accrued expenses. The discontinued operation resulted in cash used of $13.5 million for the six months ended June 30, 1999 as compared to cash provided of $1.1 million for the six months ended June 30, 1999. Net cash provided by financing activities was $35.2 million for the six month period in 1999 as compared to $71.5 million provided by financing activities for the comparable period in 1998. In both periods, the Company received net proceeds from long-term borrowings and made repayments on certain debt. During the six months ended June 30, 1999, the Company repurchased 3.6 million shares of its stock for Page 21 of 27 approximately $24.0 million. Net cash used by investing activities was $48.0 million for the six month period ended June 30, 1999 as compared to $59.2 million used by investing activities for the six month period ended June 30, 1998. Cash used for acquisitions was $43.9 million in 1999 as compared to $95.5 million for 1998. Cash used for the purchase of property, plant and equipment was $112.5 million in 1999 and $115.2 million in 1998. Cash used for the purchase of other assets was $43.8 million in 1999 and $5.6 million in 1998. The $43.8 million in cash disbursements for other assets was used primarily for $25.0 million of loans to employees and certain loans to third parties. In the first six months of 1999, the Company received $114.3 million related to the sale of 32 long-term care facilities to Monarch LP (See Note 4). Also during the first six months of 1999, the Company sold its discontinued home nursing segment for approximately $26.0 million. In the first quarter of 1998, the Company received $89.9 million related to the sale of ten long-term care facilities to Omega Healthcare Investors, Inc. (See Note 4). During the first quarter of 1998, the Company sold its outpatient clinics for approximately $10.0 million (See Note 7) and $56.7 million from the sale of eleven long-term care facilities in June 1998 (See Note 8). The net proceeds from such sales were used to repay debt outstanding under the revolving credit facility and other corporate purposes, including acquisitions. As a result of the BBA's implementation of a prospective payment system for home nursing beginning with cost report periods beginning on or after October 1, 1998, contingent payments in respect of the acquisition of First American Health Care of Georgia, Inc. in October 1996, aggregating $155 million, became payable over five years beginning in 2000. The present value of such payments at June 30, 1999 is $122.5 million and is recorded on the balance sheet under the caption other long-term liabilities. IHS' contingent liabilities (other than liabilities in respect of litigation) aggregated approximately $103.0 million as of June 30, 1999. IHS is required, upon certain defaults under the lease, to purchase its Orange Hills facility at a purchase price equal to the greater of $7.1 million or the facility's fair market value. IHS has established several irrevocable standby letters of credit with the Bank of Nova Scotia totaling $29.9 million at June 30, 1999 to secure certain of the Company's workers' compensation obligations, health benefits and Page 22 of 27 other obligations. In addition, IHS has several surety bonds in the amount of $66.0 million to secure certain of the Company's health benefits, patient trust funds and other obligations. In addition, with respect to certain acquired businesses IHS is obligated to make certain contingent payments if earnings of the acquired business increase or earnings targets are met. The Company is obligated to purchase the remaining interests in its lithotripsy partnerships at a defined price in the event legislation is passed or regulations adopted that would prevent the physician partners from owning an interest in the partnership and using the partnership's lithotripsy equipment for the treatment of his or her patients. In addition, IHS has obligations under operating and synthetic leases aggregating approximately $882.06 million at June 30, 1999. The Company anticipates that cash from operations and borrowings under revolving credit facilities will be adequate to cover its scheduled debt payments and future anticipated capital expenditure requirements throughout 2000. The Company continues to explore asset sales to reduce its leverage and provide additional liquidity. YEAR 2000 COMPLIANCE The Company has conducted a comprehensive review of its computer systems to identify the systems that are affected by the "Year 2000" issue and has substantially completed an implementation plan to resolve this issue. This issue affects computer systems that have date sensitive programs that may not properly recognize the year 2000. Systems that do not properly recognize such information could generate erroneous data or cause a system to fail, resulting in business interruption. As part of the Company's Year 2000 Project, the Company has completed its initial evaluation of current computer systems, software and embedded technologies. IHS began implementation of its Year 2000 plan in January 1997 and all business segments have been examined. An inventory of all equipment and systems supported by IHS' Information Technology department has been compiled and compliance has been verified. The Year 2000 Project is approximately 84% complete and it is anticipated that the project will be substantially implemented by September 1999. Periodic meetings are being held with the Board of Directors and senior management to ensure that the project stays on schedule. Page 23 of 27 Through June 30, 1999, expenditures related to the Year 2000 issue totaled approximately $9.2 million. The Company currently estimates that an additional $1.8 million will be spent to complete the project, although additional amounts may be required. The costs will be funded through cash from operations and borrowings under the Revolving Facility and are being expensed as incurred. One of the biggest risks to the Company is that regulatory payors (i.e., Medicare and Medicaid), suppliers and other entities with which the Company has a material relationship will not be compliant by Year 2000 and therefore unable to pay claims. The Company has initiated a program to determine whether the computer programs of its significant payors and suppliers will be upgraded in a timely manner. This program consists of obtaining verification of compliance, arranging contingency pay out agreements, testing electronic transactions and necessary business interruption insurance. The Company has not completed this review; however initial responses indicate that no significant issues are expected to arise. The failure to correct a material Year 2000 problem could result in an interruption in, or a failure of, certain normal business activities or operations. The Company has not established a formal contingency plan to put into effect in the event of a failure to correct a material Year 2000 problem. Due to the general uncertainty inherent in the Year 2000 problem, resulting in part from the uncertainty of the Year 2000 readiness of third party payors and suppliers, there can be no assurance that the Company's assessment is correct or that the assessment of materiality of any failure is correct. Completion of the Year 2000 Project is expected to significantly reduce the Company's level of uncertainty over the Year 2000 issue and the Company believes that upon completion of the Project, the possibility of significant interruptions of normal operations should be minimal. Page 24 of 27 PART II: OTHER INFORMATION Item 2. - Changes in Securities On January 6, 1999 and March 26, 1999, the Company issued 11,872 and 151,126, respectively, shares of Common Stock to the stockholders of Medicare Convalescent Aids of Pinellas, Inc. d/b/a Medaids, RxStat and Prime Medical Services, Inc., which was purchased in February 1998. These shares were issued pursuant to terms in the purchase agreement which require the Company to recalculate the number of shares deliverable based upon the average closing New York Stock Exchange price for IHS shares for the 20 trading day period immediately preceding the first anniversary of the Closing Date. On January 13, 1999, the Company issued 69,585 shares of Common Stock to the stockholders of Hialeah Convalescent Home, which was purchased in June 1998, because the average price of 68,259 shares of Common Stock issued to the Hialeah shareholders at the time of closing of the acquisition (the "Original Shares") was higher than the average price of the Common Stock at the time such shares were registered for resale under the Securities Act. The number of additional shares is equal to the difference between (i) the number of shares determined by dividing the merger consideration of $2.5 million by the average closing price of the Common Stock on the New York Stock Exchange ("NYSE") for the 30 trading days ending on the date immediately preceding the date of the registration statement covering the cost of the Original Shares was declared effective and (ii) the number of shares determined by dividing the merger consideration of $2.5 million by the average closing price of the Common Stock on the NYSE for the 30 trading day period immediately preceding the date which was two trading days prior to the closing date of the acquisition. During the first quarter of 1999, the Company issued 2,446 shares of Common Stock to ex-employees as severance payments. On April 22, 1999, the Company issued 9,677 and 18,097 shares of Common Stock to the stockholders of Plateau Medical Equipment, Inc. and Premier Medical, respectively, which were purchased in August 1997 and October 1997, respectively.These shares were issued pursuant to terms in the purchase agreements that require shares of the Company's Common Stock to be held in escrow for any purchase price adjustments to be made twenty-four (24) months from the acquisition dates. On May 11, 1999, the Company issued 10,499 shares of Common Stock to the stockholders of Indiana Respiratory Care, Inc. which was purchased in November 1998, because the average price of 67,395 shares of Common Stock issued to the Indiana Respiratory Care shareholders at the time of closing of the acquisition (the "Original Shares") was higher than the average price of Common Stock at the time such shares were registered for resale under the Securities Act. The number of additional shares is equal to the difference between (i)the number of shares determined by dividing the merger consideration of $1 million by the average closing price of the Common Stock on the New York Stock Exchange ("NYSE") for the 30 trading day period immediately preceding the date which was two trading days prior to the closing date of the acquisition less $2.00 and (ii) the number of shares determined by dividing the merger consideration of $1 million by the average closing price of the Common Stock on the NYSE for the 30 trading day period immediately preceding the date which was two trading days prior to the closing date of the acquisition. The Common Stock issued by the Company in these transactions was not registered under the Securities Act of 1933, as amended, in reliance upon exemptions contained Page 25 of 27 in Section 4(2) thereof. Each of the stockholders made representations to the effect that (i) the shares were being acquired for its own account and not with a view to, or for sale in connection with, any distribution; (ii) acknowledging that the shares were restricted securities under Rule 144; (iii) that it had knowledge and experience in business matters, was capable of evaluating the merits and risks of the investment, and was able to bear the risk of loss; (iv) had the opportunity to make inquiries of and obtain information from IHS. The Company is obligated to register the Common Stock for resale under the Securities Act of 1933, as amended. Item 3. - Submission of Matters to a Vote of Security Holders (a) The Annual Meeting of Stockholders of Integrated Health Services, Inc. was held on May 28, 1999 (c) (i) The following persons, comprising the entire Board of Directors, were elected at the Annual Meeting pursuant to the following vote tabulations: Votes For Votes Withheld --------- -------------- Robert N. Elkins 41,619,633 1,668,636 Edwin M. Crawford 41,635,262 1,653,007 Kenneth M. Mazik 41,634,562 1,653,707 Robert M. Mitchell 41,446,001 1,842,268 Charles W. Newhall III 41,634,562 1,653,707 Timothy F. Nicholson 41,635,362 1,652,907 John L. Silverman 41,634,862 1,653,407 George H. Strong 41,634,552 1,653,717 Item 4. - Exhibits and Reports on Form 8-K -------------------------------- (a) Exhibits 10.1 Revolver Amendment 27 Financial Data Schedule (b) Reports on Form 8-K None Page 26 of 27 - 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. INTEGRATED HEALTH SERVICES, INC. -------------------------------- By: /s/ Robert N. Elkins ------------------------------------ Robert N. Elkins Chief Executive Officer By: /s/ C. Taylor Pickett ------------------------------------ C. Taylor Pickett Executive Vice President-Chief Financial and Accounting Officer Date: August 13, 1999 Page 27 of 27