LOUISVILLE, Ky., May 04, 2016 (GLOBE NEWSWIRE) -- Almost Family, Inc. (Nasdaq:AFAM), a leading regional provider of home health nursing and personal care services, announced today its financial results for the quarter ended April 1, 2016.
First Quarter Highlights:
- Record net service revenues of approximately $153.7 million with record revenues in all three segments
- Adjusted earnings from home health operations(1) of $6.0 million, $0.59 per diluted share versus $0.51 in the first quarter of 2015 an increase of 16% despite an 8% increase in diluted shares outstanding
- Adjusted EBITDA from home health operations(1) of $13.2 million
- GAAP Net income, including deal and transition costs, attributable to Almost Family, Inc. of $3.9 million, $0.38 per diluted share versus $0.46 in the first quarter of 2015
- Healthcare Innovations segment performed nearly 16,000 in home assessments and has nearly 122,000 ACO beneficiaries through 15 Accountable Care Organizations under contract
- Operating cash flow of $5.6 million
__________________
(1) See Non-GAAP Financial Measures starting on page 8
Management Comments
William Yarmuth, Chairman and Chief Executive Officer, commented: “As we continue through the integration process of a very prolific acquisition pace in late 2015 and early 2016, we are very pleased with the overall performance of our business and the execution of our strategic development and growth plans. We are happy to be reporting record revenues in all three of our business segments and we’re extremely excited and optimistic about our prospects for future growth.”
Steve Guenthner, President added: “During this period of relative regulatory stability, we have been, and are, able to make key investments in all our segments for growth, innovation and improvement in patient care. Both our access to capital and the M&A environment remain positive and we are continuing to work diligently to find, make and carefully integrate acquisitions that meet our stringent investment criteria.”
Yarmuth concluded: “Once again, we welcome the newest members of our growing family of healthcare providers joining us with the Long Term Solutions and Bayonne VNA acquisitions completed during the quarter. We also thank our over 13,000 dedicated employees for their unwavering commitment and intense focus on providing high quality patient care, particularly those dealing with transition and integration of recent acquisitions.”
First Quarter Financial Results
VN segment net revenues increased $10.1 million to a record $109.6 million from $99.5 million in the prior year and total Medicare admissions grew by 6.3% to 25,205 from 23,722 primarily due to home health agencies acquired in late 2015 and early 2016. VN segment contribution increased $2.6 million, or 20.8%, to $15.0 million, from $12.4 million in the prior year period. Contribution margin as a percentage of revenue thus increased to 13.7% from 12.5%. On a same-store basis, Medicare admissions outside of Florida grew organically by 2.5%. Within Florida, same store Medicare admissions in Florida in the first quarter of 2016 were 7.2% below the first quarter of 2015 which was was the Company’s all-time high-water mark for Florida Medicare admissions. Florida Medicare admissions in the first quarter of 2016 were 7.1% higher than the fourth quarter of 2015. Florida accounted for approximately one-fourth of the Company’s Medicare admissions in the first quarter of 2016.
PC segment net revenues increased $10.9 million, or 38.0%, to a record $39.7 million in 2016 from $28.8 million in 2015 primarily due to acquisitions. PC segment contribution increased 29.0% or $0.8 million as compared to the same period of last year.
Healthcare Innovations (HCI) segment net revenues increased $4.3 million to a record $4.4 million, in 2016 from $0.1 million in 2015, as acquired LTS and Ingenios revenues were $4.2 million. The first quarter of the year has historically been seasonally lower than the other three quarters in these assessment businesses. LTS was acquired in January 2016 and Ingenios was acquired in July 2015. The Company continues to expect the HCI segment to be profitable for 2016.
Corporate expenses as a percentage of revenue declined to 5.0%, from 5.4% in the prior year period, while deal, transition and other costs grew to $2.6 million for 2016, primarily as a result of costs related to 2016 and 2015 acquisitions. Borrowings related to acquisition activity in late 2015 and early 2016 also increased interest expense to $1.3 million, from $0.4 million in the prior year period.
Net cash from operating activities of $5.6 million was generated in the first quarter of 2016. Home Health accounts receivable days sales outstanding were 56 at the end of the first quarter of 2016 as compared to 62 at the end of the first quarter of 2015.
The effective tax rate for the first quarter of 2016 and 2015 was 40.5%.
The Company noted that it will continue to pursue quality acquisitions of in-home health care service providers consistent with its stated strategy and the types of services its segments currently provide.
| ALMOST FAMILY, INC. AND SUBSIDIARIES | ||||||||
| CONSOLIDATED STATEMENTS OF INCOME | ||||||||
| (In thousands, except per share data) | ||||||||
| (UNAUDITED) | ||||||||
| Three month period ended | ||||||||
| April 1, 2016 | April 3, 2015 | |||||||
| Net service revenues | $ | 153,698 | $ | 128,399 | ||||
| Cost of service revenues (excluding depreciation & amortization) | 82,232 | 68,327 | ||||||
| Gross margin | 71,466 | 60,072 | ||||||
| General and administrative expenses: | ||||||||
| Salaries and benefits | 41,676 | 36,393 | ||||||
| Other | 19,445 | 15,810 | ||||||
| Deal and transition costs | 2,609 | 406 | ||||||
| Total general and administrative expenses | 63,730 | 52,609 | ||||||
| Operating income | 7,736 | 7,463 | ||||||
| Interest expense, net | (1,332 | ) | (447 | ) | ||||
| Income before income taxes | 6,404 | 7,016 | ||||||
| Income tax expense | (2,677 | ) | (2,987 | ) | ||||
| Net income | 3,727 | 4,029 | ||||||
| Net loss (income) - noncontrolling interests | 190 | 365 | ||||||
| Net income attributable to Almost Family, Inc. | $ | 3,917 | $ | 4,394 | ||||
| Per share amounts-basic: | ||||||||
| Average shares outstanding | 10,089 | 9,353 | ||||||
| Net income attributable to Almost Family, Inc. | $ | 0.39 | $ | 0.47 | ||||
| Per share amounts-diluted: | ||||||||
| Average shares outstanding | 10,260 | 9,521 | ||||||
| Net income attributable to Almost Family, Inc. | $ | 0.38 | $ | 0.46 | ||||
| ALMOST FAMILY, INC. AND SUBSIDIARIES | ||||||||
| CONSOLIDATED BALANCE SHEETS | ||||||||
| (In thousands) | ||||||||
| April 1, 2016 | ||||||||
| (UNAUDITED) | January 1, 2016 | |||||||
| ASSETS | ||||||||
| CURRENT ASSETS: | ||||||||
| Cash and cash equivalents | $ | 7,135 | $ | 7,522 | ||||
| Accounts receivable - net | 94,008 | 92,909 | ||||||
| Prepaid expenses and other current assets | 9,515 | 9,033 | ||||||
| TOTAL CURRENT ASSETS | 110,658 | 109,464 | ||||||
| PROPERTY AND EQUIPMENT - NET | 10,649 | 10,000 | ||||||
| GOODWILL | 315,360 | 277,061 | ||||||
| OTHER INTANGIBLE ASSETS | 66,106 | 64,629 | ||||||
| OTHER ASSETS | 3,885 | 3,615 | ||||||
| TOTAL ASSETS | $ | 506,658 | $ | 464,769 | ||||
| LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||
| CURRENT LIABILITIES: | ||||||||
| Accounts payable | $ | 10,128 | $ | 12,297 | ||||
| Accrued other liabilities | 43,735 | 42,524 | ||||||
| TOTAL CURRENT LIABILITIES | 53,863 | 54,821 | ||||||
| LONG-TERM LIABILITIES: | ||||||||
| Revolving credit facility | 133,211 | 113,790 | ||||||
| Deferred tax liabilities | 15,260 | 13,094 | ||||||
| Seller notes | 12,520 | 6,556 | ||||||
| Other liabilities | 2,968 | 2,608 | ||||||
| TOTAL LONG-TERM LIABILITIES | 163,959 | 136,048 | ||||||
| TOTAL LIABILITIES | 217,822 | 190,869 | ||||||
| NONCONTROLLING INTEREST - REDEEMABLE - | ||||||||
| HEALTHCARE INNOVATIONS | 3,639 | 3,639 | ||||||
| STOCKHOLDERS’ EQUITY: | ||||||||
| Preferred stock, par value $0.05; authorized 2,000 shares; none issued or outstanding | — | — | ||||||
| Common stock, par value $0.10; authorized 25,000; 10,490 and 10,125 issued and outstanding | 1,049 | 1,013 | ||||||
| Treasury stock, at cost, 114 and 103 shares | (3,126 | ) | (2,731 | ) | ||||
| Additional paid-in capital | 138,822 | 127,253 | ||||||
| Noncontrolling interest - nonredeemable | (770 | ) | (730 | ) | ||||
| Retained earnings | 149,222 | 145,456 | ||||||
| TOTAL STOCKHOLDERS’ EQUITY | 285,197 | 270,261 | ||||||
| TOTAL LIABILITIES AND STOCKHOLDERS’ EQUITY | $ | 506,658 | $ | 464,769 | ||||
| ALMOST FAMILY, INC. AND SUBSIDIARIES | ||||||||
| CONSOLIDATED STATEMENTS OF CASH FLOWS | ||||||||
| (UNAUDITED) | ||||||||
| (In thousands) | ||||||||
| April 1, 2016 | April 3, 2015 | |||||||
| Cash flows of operating activities: | ||||||||
| Net income | $ | 3,727 | $ | 4,029 | ||||
| Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||
| Depreciation and amortization | 1,050 | 918 | ||||||
| Provision for uncollectible accounts | 3,845 | 1,865 | ||||||
| Stock-based compensation | 717 | 520 | ||||||
| Deferred income taxes | 2,166 | 1,031 | ||||||
| 11,505 | 8,363 | |||||||
| Change in certain net assets and liabilities, net of the effects of acquisitions: | ||||||||
| Accounts receivable | (3,571 | ) | (11,961 | ) | ||||
| Prepaid expenses and other current assets | (257 | ) | 3,653 | |||||
| Other assets | (334 | ) | 17 | |||||
| Accounts payable and accrued expenses | (1,735 | ) | (3,853 | ) | ||||
| Net cash provided by operating activities | 5,608 | (3,781 | ) | |||||
| Cash flows of investing activities: | ||||||||
| Capital expenditures | (969 | ) | (401 | ) | ||||
| Cost basis investment | - | (1,000 | ) | |||||
| Acquisitions, net of cash acquired | (24,229 | ) | (3,000 | ) | ||||
| Net cash used in investing activities | (25,198 | ) | (4,401 | ) | ||||
| Cash flows of financing activities: | ||||||||
| Credit facility borrowings | 78,011 | 47,813 | ||||||
| Credit facility repayments | (58,590 | ) | (39,161 | ) | ||||
| Debt issuance fees | - | (1,158 | ) | |||||
| Proceeds from stock option exercises | - | 23 | ||||||
| Purchase of common stock in connection with share awards | (396 | ) | (276 | ) | ||||
| Tax impact of share awards | 214 | 88 | ||||||
| Payment of special dividend in connection with share awards | - | (50 | ) | |||||
| Principal payments on notes payable and capital leases | (36 | ) | (23 | ) | ||||
| Net cash provided by (used in) financing activities | 19,203 | 7,256 | ||||||
| Net change in cash and cash equivalents | (387 | ) | (926 | ) | ||||
| Cash and cash equivalents at beginning of period | 7,522 | 6,886 | ||||||
| Cash and cash equivalents at end of period | $ | 7,135 | $ | 5,960 | ||||
| ALMOST FAMILY, INC. AND SUBSIDIARIES | |||||||||||||||||||||||||||
| RESULTS OF OPERATIONS | |||||||||||||||||||||||||||
| (UNAUDITED) | |||||||||||||||||||||||||||
| (In thousands) | |||||||||||||||||||||||||||
| Three months ended | |||||||||||||||||||||||||||
| April 1, 2016 | April 3, 2015 | Change | |||||||||||||||||||||||||
| Amount | % Rev | Amount | % Rev | Amount | % | ||||||||||||||||||||||
| Home Health Operations | |||||||||||||||||||||||||||
| Net service revenues: | |||||||||||||||||||||||||||
| Visiting Nurse | $ | 109,613 | 73.4 | % | $ | 99,535 | 77.6 | % | $ | 10,078 | 10.1 | % | |||||||||||||||
| Personal Care | 39,693 | 26.6 | % | 28,761 | 22.4 | % | 10,932 | 38.0 | % | ||||||||||||||||||
| 149,306 | 100.0 | % | 128,296 | 100.0 | % | 21,010 | 16.4 | % | |||||||||||||||||||
| Operating income before corporate expenses: | |||||||||||||||||||||||||||
| Visiting Nurse | 14,975 | 13.7 | % | 12,400 | 12.5 | % | 2,575 | 20.8 | % | ||||||||||||||||||
| Personal Care | 3,737 | 9.4 | % | 2,898 | 10.1 | % | 839 | 29.0 | % | ||||||||||||||||||
| 18,712 | 12.5 | % | 15,298 | 11.9 | % | 3,414 | 22.3 | % | |||||||||||||||||||
| Healthcare Innovations Operations | |||||||||||||||||||||||||||
| Revenue | 4,392 | 100.0 | % | 103 | 100.0 | % | 4,289 | 4164.1 | % | ||||||||||||||||||
| Operating loss before noncontrolling interest | (673 | ) | -15.3 | % | (517 | ) | -501.9 | % | (156 | ) | 30.2 | % | |||||||||||||||
| Corporate expenses | 7,694 | 5.0 | % | 6,912 | 5.4 | % | 782 | 11.3 | % | ||||||||||||||||||
| Deal, transition and other costs | 2,609 | 1.7 | % | 406 | 0.3 | % | 2,203 | 542.6 | % | ||||||||||||||||||
| Operating income | 7,736 | 5.0 | % | 7,463 | 5.8 | % | 273 | 3.7 | % | ||||||||||||||||||
| Interest expense, net | (1,332 | ) | -0.9 | % | (447 | ) | -0.3 | % | (885 | ) | 198.0 | % | |||||||||||||||
| Income tax expense | (2,677 | ) | -1.7 | % | (2,987 | ) | -2.3 | % | 310 | -10.4 | % | ||||||||||||||||
| Net income | $ | 3,727 | 2.4 | % | $ | 4,029 | 3.1 | % | $ | (302 | ) | -7.5 | % | ||||||||||||||
| Adjusted EBITDA from home health operations (1) | $ | 13,151 | 8.8 | % | $ | 10,203 | 8.0 | % | $ | 2,948 | 28.9 | % | |||||||||||||||
| Adjusted earnings from home health operations (1) | $ | 6,032 | 4.0 | % | $ | 4,825 | 3.8 | % | $ | 1,208 | 25.0 | % | |||||||||||||||
(1) See Non-GAAP Financial Measures starting on page 8.
| VISITING NURSE SEGMENT OPERATING METRICS | |||||||||||||||||||||||||||
| Three months ended | |||||||||||||||||||||||||||
| April 1, 2016 | April 3, 2015 | Change | |||||||||||||||||||||||||
| Amount | % | Amount | % | Amount | % | ||||||||||||||||||||||
| Average number of locations | 164 | 160 | 4 | 2.5 | % | ||||||||||||||||||||||
| All payors: | |||||||||||||||||||||||||||
| Patient months | 91,881 | 80,982 | 10,899 | 13.5 | % | ||||||||||||||||||||||
| Admissions | 28,455 | 26,279 | 2,176 | 8.3 | % | ||||||||||||||||||||||
| Billable visits | 737,871 | 642,592 | 95,279 | 14.8 | % | ||||||||||||||||||||||
| Medicare: | |||||||||||||||||||||||||||
| Admissions | 25,205 | 89 | % | 23,722 | 90 | % | 1,483 | 6.3 | % | ||||||||||||||||||
| Revenue (in thousands) | $ | 103,158 | 94 | % | $ | 95,122 | 96 | % | $ | 8,036 | 8.4 | % | |||||||||||||||
| Revenue per admission | $ | 4,093 | $ | 4,010 | $ | 83 | 2.1 | % | |||||||||||||||||||
| Billable visits | 652,118 | 88 | % | 584,438 | 91 | % | 67,680 | 11.6 | % | ||||||||||||||||||
| Recertifications | 12,273 | 11,927 | 346 | 2.9 | % | ||||||||||||||||||||||
| Payor mix % of Admissions | |||||||||||||||||||||||||||
| Traditional Medicare Episodic | 82.0 | % | 84.1 | % | -2.1 | % | |||||||||||||||||||||
| Replacement Plans Paid Episodically | 4.6 | % | 4.0 | % | 0.6 | % | |||||||||||||||||||||
| Replacement Plans Paid Per Visit | 13.4 | % | 11.9 | % | 1.5 | % | |||||||||||||||||||||
| Non-Medicare: | |||||||||||||||||||||||||||
| Admissions | 3,250 | 11 | % | 2,557 | 10 | % | 693 | 27.1 | % | ||||||||||||||||||
| Revenue (in thousands) | $ | 6,455 | 6 | % | $ | 4,413 | 4 | % | $ | 2,042 | 46.3 | % | |||||||||||||||
| Revenue per admission | $ | 1,986 | $ | 1,726 | $ | 260 | 15.1 | % | |||||||||||||||||||
| Billable visits | 85,753 | 12 | % | 58,154 | 9 | % | 27,599 | 47.5 | % | ||||||||||||||||||
| Recertifications | 1,131 | 427 | 704 | 164.9 | % | ||||||||||||||||||||||
| Payor mix % of Admissions | |||||||||||||||||||||||||||
| Medicaid & other governmental | 32.6 | % | 30.8 | % | 1.8 | % | |||||||||||||||||||||
| Private payors | 67.4 | % | 69.2 | % | -1.8 | % | |||||||||||||||||||||
| PERSONAL CARE SEGMENT OPERATING METRICS | |||||||||||||||||||||||||||
| Three months ended | |||||||||||||||||||||||||||
| April 1, 2016 | April 3, 2015 | Change | |||||||||||||||||||||||||
| Amount | Amount | Amount | % | ||||||||||||||||||||||||
| Average number of locations | 71 | 61 | 10 | 16.4 | % | ||||||||||||||||||||||
| Admissions | 2,446 | 1,427 | 1,019 | 71.4 | % | ||||||||||||||||||||||
| Patient months of care | 39,060 | 22,766 | 16,294 | 71.6 | % | ||||||||||||||||||||||
| Billable hours | 1,821,539 | 1,286,884 | 534,655 | 41.5 | % | ||||||||||||||||||||||
| Revenue per billable hour | $ | 21.79 | $ | 22.35 | $ | (0.56 | ) | -2.5 | % | ||||||||||||||||||
| HEALTHCARE INNOVATIONS SUPPLEMENTAL DATA | ||||||||||||
| Three months ended | ||||||||||||
| April 1, 2016 | April 3, 2015 | Change | ||||||||||
| Amount | Amount | Amount | % | |||||||||
| In-home Assessments | 15,575 | - | 15,575 | NM | ||||||||
| Medicare ACO enrollees under management | 121,881 | 83,133 | 38,748 | 46.6 | % | |||||||
| ACOs under contract | 15 | 11 | 4 | 36.4 | % | |||||||
| Assets | 61,768 | 9,820 | 51,948 | NM | ||||||||
| Liabilities | 5,695 | 246 | 5,449 | NM | ||||||||
| Non-controlling interest - redeemable | 3,639 | 3,639 | - | 0.0 | % | |||||||
| Non-controlling interest - nonredeemable | (151 | ) | (199 | ) | 48 | -24.1 | % | |||||
Non-GAAP Financial Measures
The information provided in some of the tables in this release includes certain non-GAAP financial measures as defined under SEC rules. In accordance with SEC rules, the Company has provided, in the supplemental information, a reconciliation of those measures to the most directly comparable GAAP measures.
Adjusted Earnings from Home Health Operations
Adjusted earnings from home health operations is not a measure of financial performance under accounting principles generally accepted in the United States of America. It should not be considered in isolation or as a substitute for net income, operating income, cash flows from operating, investing or financing activities, or any other measure calculated in accordance with generally accepted accounting principles. The presentation of adjusted earnings from home health operations provides investors with pertinent information to enable comparison of financial performance between periods by excluding certain items that the Company believes are not representative of its ongoing home health operations due to the nature of the items.
The following tables set forth a reconciliation of net income attributable to Almost Family, Inc. to adjusted earnings from home health operations:
| ALMOST FAMILY, INC. AND SUBSIDIARIES | ||||||
| RECONCILIATION OF ADJUSTED EARNINGS | ||||||
| FROM HOME HEALTH OPERATIONS | ||||||
| (In thousands) | ||||||
| Three month period ended | ||||||
| (in thousands) | April 1, 2016 | April 3, 2015 | ||||
| Net income attributable to Almost Family, Inc. | $ | 3,917 | $ | 4,394 | ||
| Addbacks: | ||||||
| Deal, transition and other, net of tax | 1,552 | 242 | ||||
| Adjusted earnings | 5,469 | 4,636 | ||||
| Healthcare Innovations operating loss after NCI, net of tax | 563 | 189 | ||||
| Adjusted earnings from home health operations | $ | 6,032 | $ | 4,825 | ||
| Per share amounts-diluted: | ||||||
| Average shares outstanding | 10,260 | 9,521 | ||||
| Net income attributable to Almost Family, Inc. | $ | 0.38 | $ | 0.46 | ||
| Addbacks: | ||||||
| Deal, transition and other, net of tax | 0.15 | 0.03 | ||||
| Adjusted earnings | 0.53 | 0.49 | ||||
| Healthcare Innovations operating loss after NCI, net of tax | 0.05 | 0.02 | ||||
| Adjusted earnings from home health operations | $ | 0.59 | $ | 0.51 | ||
Adjusted EBITDA from Home Health Operations
Adjusted earnings before interest, income tax, depreciation and amortization, amortization of stock-based compensation, deal, transition and other and Healthcare Innovations operating loss (Adjusted EBTIDA from Home Health Operations) is not a measure of financial performance under accounting principles generally accepted in the United States of America. It should not be considered in isolation or as a substitute for net income, operating income, cash flows from operating, investing or financing activities, or any other measure calculated in accordance with generally accepted accounting principles. The items excluded from Adjusted EBITDA from Home Health Operations are significant components in understanding and evaluating financial performance and liquidity. Management routinely calculates and communicates Adjusted EBITDA from Home Health Operations and believes that it is useful to investors because it provides a common analytical indicator within our industry to evaluate performance, measure leverage capacity and debt service ability, and to estimate current or prospective enterprise value. Adjusted EBITDA is also used in certain covenants contained in our credit agreement.
The following tables set forth a reconciliation of net income from continuing operations to Adjusted EBITDA from Home Health Operations:
| ALMOST FAMILY, INC. AND SUBSIDIARIES | ||||||
| RECONCILIATION OF ADJUSTED EBITDA | ||||||
| FROM HOME HEALTH OPERATIONS | ||||||
| (In thousands) | ||||||
| Three month period ended | ||||||
| (in thousands) | April 1, 2016 | April 3, 2015 | ||||
| Net income | $ | 3,917 | $ | 4,394 | ||
| Add back: | ||||||
| Interest expense | 1,332 | 447 | ||||
| Income tax expense | 2,677 | 2,987 | ||||
| Depreciation and amortization | 985 | 831 | ||||
| Stock-based compensation from home health operations | 717 | 520 | ||||
| Deal and transition costs | 2,609 | 406 | ||||
| Adjusted EBITDA | 12,237 | 9,585 | ||||
| Healthcare Innovations operating loss | 914 | 618 | ||||
| Adjusted EBITDA from home health operations | $ | 13,151 | $ | 10,203 | ||
About Almost Family, Inc.
Almost Family, Inc., founded in 1976, is a leading regional provider of home health nursing services, with branch locations in Florida, Ohio, Tennessee, New York, Connecticut, Kentucky, New Jersey, Massachusetts, Georgia, Pennsylvania, Indiana, Missouri, Illinois, Mississippi and Alabama (in order of revenue significance). Almost Family, Inc. and its subsidiaries operate a Medicare-certified segment, a personal care segment and a healthcare innovations segment. Almost Family operates over 230 branch locations in fifteen U.S. states.
Forward Looking Statements
All statements, other than statements of historical facts, included in this news release are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements may be identified by the use of forward-looking terminology such as “may,” “will,” “expect,” “believe,” “estimate,” “project,” “anticipate,” “continue,” or similar terms, variations of those terms or the negative of those terms. These forward-looking statements are based on the Company's current plans, expectations and projections about future events.
Because forward-looking statements involve risks and uncertainties, the Company's actual results could differ materially from any future results, performance or achievements expressed or implied by such forward-looking statements. The potential risks and uncertainties which could cause actual results to differ materially include: regulatory approvals or third party consents may not be obtained; the impact of further changes in healthcare reimbursement systems, including the ultimate outcome of potential changes to Medicare reimbursement for home health services and to Medicaid reimbursement due to state budget shortfalls; the ability of the Company to maintain its level of operating performance and achieve its cost control objectives; changes in our relationships with referral sources; the ability of the Company to integrate acquired operations including obtaining synergies, integration objectives and anticipated timelines; government regulation; health care reform; pricing pressures from Medicare, Medicaid and other third-party payers; changes in laws and interpretations of laws relating to the healthcare industry; the ability of the Company to integrate, manage and keep secure our information systems; changes in the marketplace and regulatory environment for Health Risk Assessments and the Company’s self-insurance risks. For a more complete discussion regarding these and other factors which could affect the Company's financial performance, refer to the Company's various filings with the Securities and Exchange Commission, including its filing on Form 10-K for the fiscal year ended January 1, 2016, in particular information under the headings "Special Caution Regarding Forward-Looking Statements" and “Risk Factors.” With regard to the Company’s investment in development-stage enterprises in its Healthcare Innovations segment, there can be no assurance that its operational and developmental objectives will be realized or that the Company’s investments will result in future returns. The Company undertakes no obligation to update or revise its forward-looking statements.