Q1 2020 Earnings Call
Asked several weeks for a number of quarters, we've talked a lot about our proprietary transfer center, which we've built out across much of the portfolio over the past two years, we've been able to leverage the transfer center during the pandemic in ways that clearly benefit our hospitals and patients during these unique circumstances.
And the focus on organizational enhancements across our supply chain provided exceptional advantages during a period when supplies were sometimes difficult to source.
The scale of our organization help us with bulk buying the more importantly, we are able to strategically channels supply and equipment inventory across the company's affiliated hospitals based on each markets unique needs.
We have previously made investments into tele health. Unlike other systems, we saw slope consumer adoption now in a matter just weeks the vast majority of affiliated providers on a tele health platform and we're seeing both consumer and provider adoption increase largely out of necessity.
Because of our ability to leverage our investments in work and successfully scale. It rapidly. We're now hosting more than 20000 telehealth visits per week across our affiliated clinics.
This compares to less than 100 per month before the pandemic. This exponential growth in telehealth visits has been astounding and we plan to further develop this important offering as we expect the consumers will continue to want the benefit convenience and value Tele health with the providers going forward.
Because management managing through all of the phases of the culprit 19 pandemic has been such an extraordinary experience. We felt it would be interesting for you to hear directly from one of our regional presidents about our thoughtful phased in coordinated efforts to reopen services for that I'd like to turn the call over to Kevin Stockton, Kevin as the president of our West.
Sure in region, with which includes our operations in Arizona, including our Tucson market, Alaska, and New Mexico Kevin.
Thank you, Tim and Hello, everyone Im pleased to be with you today to talk through some of our planning as we reopened our facilities two additional health care services.
These are strategies, we are leveraging and not only the western region, but across other CHS markets.
Since this is a scalable model.
We develop this plan to be mindful of our safety imperative and the regulations in place in each specific market.
First as early market preparedness, our preparation effort, which started soon after cobot 19 impacted our communities have been vital in identifying and tracking delayed health care opportunities.
While also maintaining focus on current and the potential for future business through the addition of Tele health and digital care options.
These strategies allowed important touch points with our patients who are required to delay care and kept them engaged and readily available for rescheduling.
In addition, our adoption of traditional and new care options will allow patients to conveniently access services in our health systems, where they can be thoughtfully navigated for additional health care needs. These efforts will facilitate the strongest rebound of elective volumes as possible as cobot 19 restrictions or loosened in their markets reopened.
Secondly, we are enhancing safety protocols for bolt patient than staff.
This includes strategies for conservation of personal protective equipment that here into lab testing guidelines and careful cobot 19 screening procedures.
Our work is very centered on keeping patients safe.
Indicate about how we're doing that and creating the best possible patient experiences under these new operating conditions.
To that end, we have created new processes for elective patient testing redesigned waiting and care areas to ensure social distancing adopted universal masking protocols and utilized separate care locations, where available to provide safety and security.
We believe that consumer confidence, we'll build momentum 33 opening phase and we will also infill trust in our systems far into the future.
Third as close collaboration with physicians and medical staff leadership.
This is able to coordinate a return to elective business and maintains compliance with federal state and local requirements.
We have pulled closely partnered with our providers to redesign traditional block scheduling programs and revised surgical scheduling guidelines with expanded hours to ensure the delayed case volume can be accommodated all while continuing to manage ongoing business activities.
Finally, we are optimizing our operations.
Both patient flow in department throughput to help with emerge from the Kobin 19 pandemic, even stronger than before.
Activating our staff in facilities for elected services will be a measured approach, we're taking steps to reduce barriers and adopting technology and processes that will ultimately make a stronger in our care delivery.
This is a valuable opportunity to identify areas, where we can perform even better and make necessary changes for a more efficient and patient focused healthcare delivery system moving forward.
Because of all of our planning and now the execution of our reopening plan I am confident that we are the best physician possible to successfully re open for business and operate effectively in a post coven healthcare environment Tim.
Thank you Kevin as Kevin mentioned, we've been focused on both adaptability and execution.
And while the timing and pace at which healthcare demand will return is difficult to forecast today. We are encouraged by the early reports coming out of the markets that have already begun their reopening phase.
We believe that we are well positioned to meet the current and future healthcare needs of our communities due in large part because of our focus on the strategic advancement of key service lines with capital investments and medical staff recruitment as well as access point development prior to the covet 19 pandemic.
Now turning to the cost management side.
As we've shared on previous earnings calls our management team formalized and began executing upon a strategic margin improvement program back in the third quarter of 2019.
As a reminder, the plan included a detailed analysis of corporate shared services and hospital synergies.
We have continued to deploy our supply chain and vendor spend reduction initiatives as well as thoughtfully reorganize certain non clinical areas implement technology led process improvements and implement other cost reduction efforts system wide.
The progress from these programs was evident in our results through the end of February and we're continuing to execute this strategic margin improvement plan as we move forward.
As we have mentioned on this call there're a number of variables that could impact the timing and extend to which we regain our growth momentum we are continuously analyzing and monitoring a number of scenarios and we are confident in our ability to demonstrate agility as we manage through this unprecedented operating environment and now I'll turn the call over to Kevin.
Tenants.
Thank you, Tim and good morning, everyone.
Due to the unusual circumstances caused by cobot 19 toward the end of first quarter I will not cover all of our typical financial metrics today, instead I would point you to the 8-K in our slide deck for additional details.
When looking at first quarter I believe it is important to highlight the trajectory we were on prior to the impact of Cobot 19.
On a year over year basis through February our net operating revenues have increased approximately 3% our adjusted EBITDA increased 12% and our adjusted EBITDA margins have expanded 200 basis points.
During the first two months for the quarter, we continued to see success from our strategic margin improvement program that began in the second half of 2019.
As a percent of our consolidated net operating revenues, our salaries and benefits decreased 20 basis points supplies decreased 150 basis points and other operating expenses decreased 50 basis points.
As a result, we were off to a strong start for the quarter. We saw continued momentum building in the beginning of March and due to a favorable March calendar, we expected to deliver continued improvement in growth year over year for the month Mark.
Beginning in the middle of March we experienced rapid declines in volumes due to the code 19 pandemic, which we have highlighted throughout today's call. So before moving on to additional details on the first quarter I wanted to provide an update regarding our volumes during the month of April which has been impacted in a similar.
Cash and compared to other national healthcare systems, and the external hospitals survey data.
Looking at the month of April on a year over year and same store basis, the company's inpatient admissions are down approximately 35%.
Adjusted admissions are down approximately 45% surgeries down approximately 70% and ear visits down in approximately 45%.
Obviously, our second quarter will be materially impacted by the totaled 19 pandemic and the uncertainties around the timing of recovery and other factors as we've discussed with that we went through our 2020 financial guidance.
And now I would like to walk through some additional details from the first quarter. During the first quarter net operating revenue came in at 3.025 billion down 3.5% from the prior year on a same store basis, while adjusted EBITDA was 309 million down 21% on a consolidated basis.
Switching to cash flow our cash flows provided by operations were 57 million for the first quarter 2020.
This compares to cash flows from operations of 133 million during the first quarter 2019.
In terms of the year over year decrease there are two items worth noting versus the prior quarter.
We saw higher interest payments in the first quarter of 2020 of approximately 75 million in part due to timing of payments and we paid into escrow $53 million for the settlement of a legal claim that had been accrued for in the fourth quarter 20 Twond.
Turning to Capex, our Capex for the first quarter 2020 was 99 million or 3.3% of net revenue compared to 120 million $121 million were 3.6% of net revenue in the prior year.
It's worth noting that a higher percentage for our planned Capex for 2020 was weighted to the middle and back ended the year.
As we manage through these unusual circumstances, we have the ability to reduce certain non urgent projects. However, we remain committed to investing capital towards high growth opportunities across our markets to be positioned for growth in the future.
As it relates to liquidity at the end of first quarter the company at $246 million of cash on the balance sheet and $239 million of additional borrowing capacity under tavio.
In terms of the carriers Act in April we received approximately 245 million from the first 50 billion allocated by the public health and social services Emergency Fund.
And we received approximately 1.2 billion in Medicare accelerated payments.
That helps support our near term liquidity.
Our expected 2020 divestiture proceeds will also augment our liquidity, we expect currently announced divestitures to provide approximately 400 million of additional cash.
While we continue to receive inbound interest in discuss potential transactions. The divestitures announced today, we'll complete our formalize Divesture plan, which we started back in 2017.
We're very pleased to complete this divestiture program and we look forward to driving growth from the strengthen portfolio as our markets begin to reopen.
In terms of our capital structure, we executed transactions late in 2019 in early 2020, which strengthened our liquidity improved the company's maturity profile and removed our first lien financial covenant.
Most recently in January we extended 1 billion of our 2021 notes and 425 million of our 2023 notes to 2025.
At the end of first quarter, we had approximately $13.5 billion of long term debt and the company has no material near term maturities with its with its next maturity of $231 million not due until February of 2022.
In summary, we are confident that with our current cash on hand proceeds from the signed definitive agreements availability under our ABL and the possibility of additional provider leaf grants under the past cares acting carriers at 3.5, we have ample liquidity to manage through this crisis returned a norm.
No operations and be well positioned for growth moving forward.
Wayne I'll return the call back to you. Thank you Kevin and at this point operator, we're ready to open up for questions. We'll limit everyone to one question. So several you'll have a time on the call, but as always we are available to talk to you anytime you can reach assess the area code 600 467000.
As a reminder, you'll need to press.
One on your telephone to ask a question to withdraw your question, Chris or cash.
In order to allow everyone time for questions.
Thank you please limit yourselves to one question each.
Please stand by what we compiled acuity roster.
Your first question comes from Josh Raskin from from research.
Hi, Thanks, Ed Good morning, and I'll sort of here Mike Thanks for.
The work that the folks at community not hospitals are doing especially the clinical staff.
My question Todd.
Little bit more about is sort of were emerging I feel like every week. It's different just this process of the markets reopening and you talked about some of the at markets. If theyre opening first how do you sort of think about capacity and what that looks like are you able to bring sort of full capacity online or the safety protocols sort of inhibit a little bit at that what percentage of the electives that.
You guys had seen deferred or we scheduled and then how do you prioritize the actual procedures.
What goes first and what types of patients. So you are you seeing early.
So does this is Wayne I think you heard Kevin to give a little bit of a report in terms of higher process is working so I think we're very will organise in terms of how we stage.
Our capacity issues, just as we did in terms of being able to stage our capacity issue the code 19 patients.
So I feel pretty comfortable where we are and also.
I feel pretty comfortable we have a pretty good read on this because of the work we've done around our telehealth program, which were having a huge numbers of calls every week on that but let me turn it to Lynn.
Kind of talk about clinical issues.
Okay claim so I think depends really market by market and.
Their service line focus areas, but many are focusing on a lot of high throughput.
Patient procedures. So again patients that can quickly I have their procedure and be transition tone without necessarily taking up the hospital that are I see that and then some of the limited by capacity by state regulations et cetera. So those are the thing I would add Josh is that we are encouraged by what we see in.
First week in terms of recovery.
Okay.
Your next question comes from Frank Morgan from RBC capital markets.
Good morning.
I hate the color there maybe lynn on that subject.
Yes, Im sure you talked a lot of physicians about this but are you getting any feedback from the they are getting you about class patients.
Receptiveness to actually coming back in from procedures on an inpatient based I understand outpatient should come back fairly quickly, but just any color around that and then maybe for Kevin just how do you want it did accounting treatment for the Cures Act. Thanks.
Yeah. Thanks to obviously, another docs are anxious to get back to work and and what we're saying as long as we can reassure that we have the protocols in place.
That the patients can be seen their screened and they're taking care of safely.
And then also setting up zones within the hospital so they know that.
They're coming in for a non co that procedure that they're in an area taking care of by staff.
That are dedicated to those areas as well so again trying to set a separate areas within the facility for co that care patients and Noncovered care patients.
And I'll add a few things of that Frank This is Tim I'm in terms of the by market approach that the framework that Kevin stock and referenced in the call today, certainly as Lynn said, we want to manage through some state by state guidelines and requirements, but the one thing we've been very focused on his understanding the consumer behavior or concern element of this first of all wanting to do.
The right thing to provide care very safely, but also understanding that there are certain visible things, we could do to reassure patients that we are all about their safety if the country continues to work through the pandemic.
We are we're maintaining a lot of the same visit a restriction, but as patients do enter our health care systems. Instead of just screeners. We also are going to have a certain level of I'll call. It concierge support to help guide them through anything they do within our hospitals and then the other thing that we focused on is where we have outpatient access points that could serve and purposes or in ways.
At our inpatient care facilities concerning the past maybe directing patients more in that way so that they're not exposed to full hospital environment and get increased utilization in our outpatient access points as we reopened.
And then Frank on the accounting question the accelerated Medicare payments will just be a balance sheet item. So theres no income.
Statement impact.
Of that but it is cash flow benefit in terms of the $245 million Grant our expectation right. Now is that that is the second quarter benefit to revenue.
Which will flow through to EBITDA I know the accounting industry is weighing in with the FCC on that and final word hasn't come out but that is everyone's current thinking then the sequestration relief is kind of a prospective PML benefit just an increase.
In reimbursement on the Medicare claims and the payroll tax.
Deferral is also just the balance sheet cash flow item.
Your next question comes from AJ Rice from credit Suisse.
Yes.
Hi, everybody glad to hear ones doing well I'm.
Just maybe to focus in on the labor side, a little bit.
To what extent in those last couple of weeks of mortgage were able to likes labor and was there more has there been more of an opportunity earlier.
Second quarter to do it and then when you think about the procedures coming back.
Sometimes when you have excess procedures, you end up having to pay a lot of overtime or other stuff or do you have enough likes and your workforce. So that you can absorb these.
Procedures and they'll come on.
To you that come back to you at a normalized margin or.
Should we think about some need to pay overtime to get those procedures work through.
Sure, let let me start off here AJ. So if the end of March.
Certainly the pandemic kit very late in the quarter as you're all aware, which gave us less opportunity to deal with expenses.
From a timely basis.
Did have some reduction in premium labor.
Cost call back overtime rates and that sort of thing as volume started to fall off going forward into April we have not had any large scale layoffs or furloughs, it's been more of a market by market decision that we've managed through those cost primarily using reads.
Just work schedules.
A job sharing.
And those sort of levers that we pulled so that we could manage through kind of the labor costs is volumes continued to decline through April and May Jay. This is Tim I will just add to Kevin's comments on we were protective of our staff throughout the crisis for the reasons. Kevin noted we wanted to be ready.
On the other side of this to reactivate our reopening plans and having engaged workforce as such obviously a key to that.
We kind of look at this in terms of how do you do this in some markets there may be a need to go to extended hours. So we've cautioned all of our operators to really be nimble be flexible depending on what the physicians the surgeon than the patients desire, we'll be ready to take the business and open up on extended hours and on weekends, but we kind of deployed.
Ill versus the switch approach here dialing back and forth depending on what's happening in each market from demand, but also from a resurgence of cobot 19 cases should that happen. If if we don't reopen up these communities safely, but at the end today, probably getting back to some of the regular schedules, we saw where we've always had.
A certain amount of overtime weekend scheduling during peak demand seasons like the fourth quarter, we've always been able to manage that influx of incremental business and drive for your really sufficient margin on it.
Your next question comes from Andrew Baum from Barclays.
Hi, good morning, and thanks, everyone in the organization career collective effort during the crisis.
Onto my question now that the formal divestiture program is completed how should we think about ongoing portfolio rationalization. You mentioned in your prepared remarks that you're still generated inbound interest little divestitures still will be an area of focus just not in the formalized plan any comments there would be helpful. Thanks.
I would answer that by saying, we will continue to take inbound interest and consider opportunities if they are strategic in nature.
Or the multiple that's being offered is just something that you know.
Would be in our best interest to consider but Divestures was will not be a primary focus but focus as we go forward I think our portfolio. As we currently have is one that we believe is very strong and that we can grow and has a good trajectory going forward.
Yeah, absolutely, Kevin let me just add to that a little bit.
I just want to acknowledge all the people who have worked really hard owned divestitures well, we're trying to grow the business in trying to do with cobot 19.
Unbelievable work.
In particularly if you look at the rate, we've gotten 10 or 11 times in terms of multiples.
And we've been able to get through this.
Unbelievably quick.
Who is taking a couple of years, but is unbelievably quick in terms of all that so I just want to thank everyone for that but it is it it was a formal job but.
The execution was excellent so.
Right right now and as Kevin said, we've got a great portfolio with opportunity for substantial growth going forward.
Your next question comes from Brian Tim Healy from Jefferies.
Hi, good morning, guys and ER.
Thanks for taking the question yes. The question the have Wayne as we think about your comment about how you guys are trying to.
Maintained your competitive position.
The smaller guide or smaller operators in your market.
Struggling or were already struggling before so they had been.
The government stepping in how do you view that thousands the government really coming in is that sufficient and on the other side of that the competitive dynamic where you are gaining share potentially as you were smaller or inferior competitors struggle.
Let me just start with the government.
Hi can you not be happy if you get $245 million from the government at 1.2 billion.
In terms of the accelerated payments I would say, though that oh all of us into industry have.
I don't recall in absolute concern, but some issues around the calculations.
On how this is being distributed and we're working hard to try to correct. Those issues. We think you know maybe the first 30 billion.
The it could have been the distributed a little different.
But that's part of the first 50, we still have 50 to go in that group and then we've got to 75 coming.
So we're we're very optimistic about.
What we will what will happen in the next.
Distributions out of all these kind of going forward. So I'm I'm real comfortable that look the competitive advantage that we think we have in the markets now are not only just or we will position, but as we've talked about for the last two three years, we've been building and enhancing our markets and trying to figure out ways that we can.
Really gaining market share.
Good example of this I think is our our total non ITSM experience that we just just add here. We now have a 20000 calls.
A month, a week or month, we are weak I'm, sorry, I get excited that hard to imagine. This week 20, then calls a week and look what that does is that save you know we talk about digital marking those kinds of that's a real connection deflation is an opportunity for our doctors to say the somebody ask question earlier about apprehension in terms route.
Turning to hospital inpatient, it's a real opportunity for our doctors say look we've got this we're going to take care. Obviously hospital is save employees are working hard they're safe and we're going to do a good job for you.
I think that those components as well as all the work we've done in terms of the.
Number of physicians locations, a freestanding eightys all the above that we've done in our markets I think really positions us well competitively.
Your next question comes from the line of Ralph Giacobbe from Citi.
Thanks. Good morning, I was hoping you could provide or give some idea differences in underlying volume trends across your markets is there a significant variance around that 35% and anything you can determine around sort of the behaviors are characteristics between the markets and then separately.
If you just give us an idea of how exchange rates compare to commercial rates in any commentary just around the economic implications in your markets be helpful. As well. Thank you.
So you know normally we don't to comment on specific markets. When it's also the but in this instance, what you see is that the number of states are opening up at different times. So you are having a different rates a recovery because of the fact that you know you've got.
I think we have nine markets that are that are open it will be open by the end of the week.
And so you're going to see a different ratio in terms of college is working on Kevin or Tim you want to it did I might I might add a little bit to that in terms of across the portfolio have we seen differences.
Not broad differences, let me answer it that way, but what it did do it certainly highlighted where we're really really strong on partnering with doctors on who's choosing us for elective care.
Some of those stronger markets did perhaps have a little bit more of a volume degradation because at the high elective left it up business that we pull through those markets, but for the most part if you look at it by a region or a market on network perspective at all balanced out pretty consistently and I think that plays out with what you're hearing in public hospital surveys in terms of volume heads.
And what's been reported publicly so far by our peers.
Really really consistent bands yeah. There's one other thing I would add to the medical staffs and the communities. This is across the country not just our hospitals are all eager to get started and are ready to go back to work and they're going to make sure that they do everything we do everything propylene and they do everything appropriately in terms of those patients. So that's a very positive thing in terms of restart giving you some.
Well I think the one thing in terms of the question regarding the margin over the payer mix and those types of things, obviously, we're going to be watchful of any changes and employment trends in our markets alone. So we certainly have a keen on that as well managed care companies have so much money, we're hopeful for rate increase here now.
Uh huh.
Your next question comes from Terry Kim from JP Morgan.
Okay.
Hi, Good morning, Oh, P. Carey today.
Two quick questions if I could actually the first is on the seven definitive agreement it sounds like none of those have closed yet and given the.
Pandemic I guess, if there was ever an opportunity for someone to call a Mac in the contract like represented so just.
Confidence level that that those will actually closed and then.
Second one I mean, you guys sound a little more bullish about it sort of the rate of reopening in recovery then.
Since appears in probably everyday that goes about goes by its helpful in terms of obtaining.
That confidence, but JNJ you know I think it's kind of said sort of market expectations for even the third quarter are still being down 20% to 50% than the fourth quarter being up zero to 15%. So just wondering does that sound too bearish to you too bullish if you just kind of comment.
So on you know sort of what's out there in terms of some people's expectations.
So let me start Gary with the question on the divestitures, so as you've seen.
Number these deals we had one time last week to sign this week.
We've been working closely with the buyers you know much of these negotiations have gone on during this.
Pandemic period, everyone is well aware of kind of the current situations with those markets and we're very comfortable those are going to be completed.
And I think we did really exceptional work kind of getting through those deals maintaining those multiples of in that 10 to 11 times EBITDA.
EBITDA and were again, we're confident that.
Just all that's really left to some final regulatory approvals, but to get those across the finish line, but the deals are signed.
So Gary in terms of trying to predict or.
How how rapid or how quickly all this recovery, it's almost impossible because every state every market is different.
And you have some certainly some bears on when you use these kind of global predictions or you know I would assume they include markets like New York, California. The some of the other big markets that have substantial issues that are going to be very late in terms of returning so I'd say the it would be very difficult, but if we were to go market by.
Market.
We are beginning to see bid indications in our markets in terms of recovery, but it's way too early for us to 19 patients Tim you want to add to the yeah, I think I'm I would say, we're guardedly optimistic as you pointed out Gary everyday we can live a more confident with reports that are coming in from market that are in the early phases of reopening.
In terms of the types of care, however, I'd like to re refer back to Lynns comments that we aren't seeing a lot of inpatient heavy duty surgeries, taking place yet. This is largely ambulatory surgery, which is a very good book of business for US don't get me wrong, but at this point no lot of states are necessarily ready to release those.
Types of services to take place in our hospitals were also mindful of our inventories about PT, our lab testing capability. So we kind of to balance that out with each state's regulations that for the most part again no. One has a crystal ball here, but very very I'm confident that we can get that outpatient business backup and.
Running a little bit quicker than perhaps we initially thought even a week ago.
Your next question comes from Kevin Fischbeck from Bank of America.
Great. Thanks, I guess one of the questions.
We kind of wrestle with this kind of what the.
Absolutely the case should look like post Cove, Ed It sounds like we're going to be in a recession for some time period, obviously deployed 20 baseline going to be you know somewhat disruptive, but you got if you had to normalize 2020, how do you think about communities ability to grow during a recession should we expect seem to be able to grow EBITDA during recessions or is that going.
To be difficult and if it's if you can grow.
That's that's a volume pressure and payer mix. Thanks.
One thing I'd, just point to that I think maybe a little bit different than.
Where the company was positioned say back in 2008 coming out of that recession is with the divestiture program. Our portfolio is much stronger were in markets with with much better demographics.
And so I think we're positioned.
Quite well to continue to grow.
There's also the thought that maybe after this pandemic as there is a.
Population move out of the more urban areas.
Towards the more suburban and rural areas, which we would be positioned to benefit from it if that occurs over the next.
A few years, though there you know sort of unpredictable issue here is unemployment and a number of people will be uninsured kind of going forward and once we get a better handle on that in next few months.
Maybe a little easier to determine that but I I would think that as Kevin said, we're probably about as well positioned as we ever have been in terms of opportunities to grow going forward.
Yeah, I'll tag onto that I think going back to 2008 and contrasting it to today and all the work that we put in over the last several years of transition to portfolio. We've also really growing our ambulatory access point footprint as more care migrates to the outpatient side of things I believe we're very well position in that space, we talked a lot today about our intense focus.
And partnering with doctors and working to be preferred in our communities because we do I'm half the REIT focused consistent application of all of our resources with those doctors to accelerate care and to enhance Karen in each one of our markets I think thats very important for us.
Coming out of this but also well into the future.
In due time, our last question is from Whit Mayo from Tvs.
Hi, Thanks, just had a quick one here can we get the actual dollar amount from.
The the sequester the payroll tax and how much your capital spending plans have changed for the balance of the year. Thanks.
Sure and I think those dollar amounts are on slide 14, and our deck. So.
Western Europe, although that is.
Tom prospective.
The amount, we actually will get will be perspective based on Medicare volume, if you base it on last years.
Run rate it would have been about $40 million on the employer payroll tax deferral that should benefit us from a cash flow standpoint about a 160 million over the remainder of this year than half of that will be paid back in December 21, and half of it in December 22.
And I will now turn the call back over to Mr. Smith for closing comments.
Thank you again for spending time with US today I want express again, how deeply grateful we are to all of our employees physicians nickel stay of regional Presidents Hospital is shipped in hospital support teams.
Corporate support teams, who have been at the forefront of committed into sort of global can.
We are encouraged and strengthened by the dedication and tireless efforts of all these true health care heroes, who remain diligent in fighting this endemic and we'll continue to support their efforts as we look forward to recover. This concludes our call for today, we'll look forward to updating you on all of our progress later in the year. Once again, if you have some questions you can all.
Always reach us at area code six onefive for six or 7000.
Ladies and gentlemen. This concludes today's conference call. Thank you for participation you may now disconnect.
Yeah.
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