Hello, ladies and gentlemen, and welcome to the Addus HomeCare Corporation Fourth Quarter 2020 Earnings Conference Call. At this time, all participants are in a listen-only mode. Later we will conduct a question-and-answer session and instructions will follow at that time. [Operator Instructions] As a reminder, this conference call is being recorded. I would now like to turn the conference over to your host, Dru Anderson. Please, go ahead.

Good morning and welcome to the Addus HomeCare Corporation fourth quarter and 2020 earnings conference call. Today's call is being recorded. To the extent any non-GAAP financial measure is discussed in today's call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP by going to the company's website and reviewing yesterday's news release. This conference call may also contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements, among others regarding Addus' expected quarterly and annual financial performance for 2021 or beyond. For this purpose any statements made during this call that are not statements of historical fact may be deemed to be forward-looking statements. Without limiting the foregoing, discussions of forecasts, estimates, targets, plans, beliefs, expectations and the like are intended to identify forward-looking statements. You are hereby cautioned that these statements may be affected by important factors among others, set forth in Addus' filings with the Securities and Exchange Commission and its fourth quarter and 2020 news release. Consequently actual operations and results may differ materially from the results discussed in the forward-looking statements. The company undertakes no obligation to update any forward-looking statements, whether as a result of new information future events or otherwise. At this time I would like to turn the call over to the company's President and Chief Executive Officer, Mr. Dirk Allison. Please, go ahead, sir.

Thank you, Dru. Good morning and thank you for joining us for our 2020 fourth quarter earnings call. With me today are Brian Poff, our Chief Financial Officer; and Brad Bickham, our Chief Operating Officer. As usual, I will begin with some overall comments and then Brian will discuss the fourth quarter results in more detail. Following our comments we would be happy to respond to any questions. As we've been saying for the past 11 months, a pandemic continues to create many challenges, as we experienced a substantial new surge of COVID cases beginning midway through the fourth quarter of 2020. While I expect the environment to remain operationally challenging over the next several months, we are encouraged by the progress being made with the COVID vaccine rollout and the steady reduction in COVID cases since the peak in late December. We look forward to the time when this pandemic is no longer a significant disruption to our operations. In spite of the ongoing pandemic-related challenges, my optimism about the future of both the home care industry and Addus remains strong. I'm especially proud of our dedicated team of leaders and team members that have demonstrated their ability to meet our mission and execute upon our strategy. This past year has been a unique challenge for our country and I believe all of our Addus team has been a vital part of keeping our elderly citizens safe. As you saw with the financial results we announced yesterday, we continued our solid operating performance in the fourth quarter of 2020. Our revenue for the fourth quarter was $196 million as compared to $192.4 million for the fourth quarter of 2019. Adjusted earnings per diluted share for the fourth quarter of 2020 was $0.82, up from $0.73 for the fourth quarter…

Thank you, Dirk, and good morning, everyone. Addus had another solid financial performance in the fourth quarter of 2020 and for the full year, continuing to demonstrate consistent profitable growth, despite the ongoing challenges and disruptions related to the COVID-19 pandemic. As Dirk noted, total net service revenues for the fourth quarter were $196 million. The revenue breakdown is as follows. Personal Care revenues were $164.4 million or 83.9% of revenue. Hospice care revenues were $27.6 million or 14.1% of revenue and Home Health revenues were $4 million or 2% of revenue. Our revenues for the full year 2020 were $764.8 million, up 17.9% from the prior year with contributions from both organic growth and acquisitions. And we continue to execute our growth strategy with favorable results. Our overall volumes were fairly consistent with the third quarter and continue to trend modestly below pre-COVID levels. However, we have a strong business model in place and believe we are well positioned to meet expected demand, especially as vaccines are more widely distributed, consumers become more confident in a less restrictive environment and volumes return to historical levels. Our results also reflect the incremental benefits of the four acquisitions we completed in 2020, three of which closed in the fourth quarter. Together, acquisitions completed over the past two years have combined annual total revenue of approximately $214 million. We continue to evaluate and pursue additional acquisition opportunities and have a robust pipeline of potential transactions that meet our target criteria. Going forward, we believe the market landscape in 2021 will be advantageous for us to enhance our current operations while looking to complement with clinical services and expansion into select attractive markets. Other financial results for the fourth quarter of 2020 include the following. Our gross margin percentage was 30.2% compared with…

Thank you. [Operator Instructions] Your first response is from Matt Borsch of BMO Capital Markets. Please go ahead.

Yeah. I was hoping that you could talk a little bit more about if you are able to about the contract that you were -- you and other large providers were excluded from. Is there a characteristic to those that either are new or continuing with the program as opposed to those that were shut out? And how do you -- would you have any thoughts on how you think the protest process will go from here?

We don't know of any characteristics. Some of the providers that were selected quite honestly are quite small and have very little business. So it's a little bit of a black box about the formula was undertaken. We have requested information from the state so that we can better understand what went on. We have not yet received that information. As far as the protest, we believe that enough people protests that have not received the contract. There may be an opportunity for the state to relook at how they did it. But for our standpoint, we're not just stopping with the process. We're looking at other things. It's not -- honestly it's not an extremely profitable business for us. In fact it's probably one of our lowest-margin businesses across the country. But it is something, we will continue to look at as an internal team, talk to the state about and see what's the best direction for the company going forward.

That makes sense. Maybe just one more question if I could. On the M&A pipeline, particularly on the personal care side, I think you -- maybe it was across all three segments but highlighting some good opportunities. Is some of that coming out of just the difficulty -- of continuing difficulty of smaller organizations to manage through the pandemic? And maybe that was worsened by what happened with the virus surge in November-December?

Yeah. I think -- Matt, this is Brian. I think we've seen especially in the personal care segment several opportunities of various sizes. I think a couple of factors there. I definitely think, it's been a little challenging for folks to manage through in a smaller setting in this environment. We are also seeing more states, particularly this year moving into EVV, which I think we've talked about in the past. A lot of those folks had kind of moved that can down the road just a bit. But a lot of the states are starting that transition process, which I think is making business for some of the smaller providers a little more difficult and probably a little more likely to be attractive for us.

Got it. Thank you.

Thank you. Your next response is from Brian Tanquilut of Jefferies. Please go ahead.

Hi. Good morning. This is Jack Levine on for Brian. Thanks for taking my questions. First, one on the New York state budget just wanted – we've been getting a lot of questions from investors. Wanted to see, if you guys had any thoughts on the budget overall. What the impacts from that purpose cut could be? And then, also, if you've seen any sort of pass-through or impact from the retroactive cut to the managed care plans?

Yeah. Yes, Jack, we trying to tell you what's come out of the New York budget is really difficult. I am not even sure that everybody understands what is in there even at the state level. Certainly, from the Medicaid standpoint, I think it's talking at a potential 1% additional reduction in Medicaid fees. We'll see, if that comes through. From our standpoint, we are just trying to make sure that in that state we are operating as efficiently as we can because of the challenges we see with the overall status – financial status at the state.

Yeah. This is Brad. We have not seen any impact to the rates currently. Right now, we just recently went through contract renegotiations and payer rates with most of our large providers regarding minimum wage pass-throughs and those went successfully. So we're not exactly sure how that will if it all pass through to us.

Okay. Great. That's helpful. And then one more for me, just on the – the employment market outlook, particularly for personal care. I think over the past couple of years we viewed the rate-limiting factor for growth in the personal care segment is really on the supply side of things. Just wondering, if there's any color you could give on the outlook for that employment market incremental to some of the commentary you gave on what hiring’s looked like recently?

Yes. This is Brad again. Certainly on the – with respect to the employment, we've done a pretty good job recruiting. We saw some significant decline in November and December due to the COVID surge. Numbers started coming back up in January, have continued to increase slightly into February. When we're looking at long term with the elevated unemployment rates, I think there's the potential there. Now, there's going to be some dampening effect of that, if the – with respect to the proposal on the $400 unemployment benefit that's currently out there or currently proposed. So that may in the near-term cause some challenges for us. But I think once that that expires there should be some good opportunities for us to ramp up recruiting.

Great. Thanks, and congrats on a good quarter.

Thank you.

Thank you. Your next response is from Scott Fidel of Stephens. Please go ahead.

Hey, guys. This is Kato Bezel [ph] on for Scott. I'm just wondering, if you could help size the impact from the Illinois rate increases for 2021 on an annualized basis? And then just given that you were able to absorb the minimum wage increases in the second half 2020 without much margin impact, I'm wondering how we should think about the potential margin impact on the rate increase for 2021 given that there is the Chicago minimum wage hike coming in over the summer? So we're just wondering, if this is kind of more net-neutral or if there's a directional margin impact from those two dynamics?

Yeah, Kato, I think we expect – similar to prior years, we've had a similar dynamic in play. When we do get the statewide rate increase keep in mind we saw a higher minimum wage only in our Chicago market. The rate increase we're going to get is going to be statewide. And at that time, we will do our typical negotiations with the union on all the non-Chicago workers on those wage rates. So typically, how we've seen this transpire and how we would expect it to in the next couple of instances in April and then January of next year, is an increase in revenue with a corresponding kind of typical margin that we would see in that market. So we've characterized, I believe in the past that, the rate increase we expect to get in April should be on an annualized basis, just north of $20 million in additional revenue and then some margin on that. So the rate increase expected for January of next year would be similar in profile.

That's it for me. Thanks guys.

Thank you. Our next response is from John Ransom of Raymond James. Please go ahead.

Hey good morning. Dirk I'm just curious where you see market multiples now for particularly home care assets where there just hasn't been a lot of M&A recently.

Yes. John certainly, it's no surprise for anybody that's followed health care services that the multiples for clinical service particularly have been increasing have been quite high. I mean if you look at the hospice multiples they've been 12, 14 or so on an adjusted run rate basis. We suspect that home health is probably near that maybe slightly below. But again there's not been as many quite as many home health deals announced as of this point in time. But certainly the clinical services are in that 12 to 14-plus range at least at this point. Personal care, again personal care has been a little bit quiet the last six to nine months. We have always targeted our personal care the smaller deals at six to seven times; maybe the larger deals eight times, eight and a half times. And our guess is those multiples were probably still pretty common where we think they'll be. We don't think there has been a great uptick in the personal care market as far as valuation at this time.

Great. Second question just on your obviously labor is a perennial issue. I mean it's something you got to manage through every year. Are you able to assist with getting your personal caregivers vaccinations, or are they kind of on their own from that standpoint?

Yes. This is Brad. Great question. We have assisted from the standpoint we've offered a stipend for them to incentivize them to get both doses of the vaccine. That's going pretty well. But as far as being able to schedule for them that's been challenging. What we have done is blasted out information as we get it as to availability of vaccines and how to register and that sort of thing. And I've also put out a fair amount of educational materials to just help them understand the vaccine the safety of it, the efficacy of it. And then in some a couple of markets in New Mexico mainly where we have skilled services that are located -- co-located in the same buildings as the personal care they have participated in some drive-through vaccinations.

And do you have an estimate on what percent of your workforce has been able to be vaccinated?

It's -- I wish the numbers were greater. I mean right now we don't really collect that information until they get that second dose and they submit their verification for payments. So, it's going a little slower than we would like, but at least, we are seeing kind of steady progress.

And I would guess I mean given the not majority but just the prevalence of family-on-family, it's maybe a bit less of an issue in aggregate for you than say for home health I mean personal care versus home health. I'm balling down I'm guessing but less of an issue?

I mean that's probably correct. I mean certainly on the skilled side when you're providing services in a facility setting that's something that they're going to be looking for. So, we have certainly been promoting and encouraging our folks on the skilled side to get vaccinated quickly. They also have the easier opportunities. They're in that first-tier folks to get vaccinated. So, we're seeing a higher percentage in the skilled side. But I agree with you on the personal care side when you're talking about family caregivers it's probably not as I'd say critical until everybody gets vaccinated in the home.

Great. And I know you've got operations everywhere but did the Texas weather issue did it cause any ripples in your operations or hope you guys are all okay and have water and power all that stuff that look terrific. But does that cause any issues this quarter that we should be aware?

Yes. Fortunately in Texas, we have just the skilled services. So, they weren't as impacted from as the personal care would be. That being said Texas certainly got the lion's share of the headlines related to the storm, but we did see some impact in particularly downstate Illinois some of the more rural markets that we serve that also got hit hard with the weather.

Got you. Okay. Thank you. That’s it for me.

[Operator Instructions] Your next response is from Mitra Ramgopal of Sidoti. Please go ahead.

Yes, hi, good morning and thanks for taking the questions. First, the personal care business certainly held up well despite the pandemic. But on the hospice/home health side those lagged a little. I was just wondering, how comfortable or confident you are in terms of resumption of organic growth in those segments as we look out this year and beyond.

Hi Mitra, this is Brad. We certainly saw the more significant impact on the hospice and the home health. And first off, on the home health piece of the business, our assets are primarily located in New Mexico. They got hit pretty hard with the surge. We saw some of the hospitals there curtail elective procedures in the November and particularly more in the December time frame. What we have seen on home health actually is a pretty good bounce back in January and February with admission volume. So feel pretty comfortable on the home health side. With respect to hospice, we've looked at the data several different ways. And even though we've had good admissions, sequential admission growth between Q3 and Q4 and we've actually seen that trend continue into January and February, I think a lot of it is short length-of-stay patients. And when you look at the data, we've seen our length of stay particularly with -- we look at it patients that are in service for less than 30 days. That percentage has increased. But even within that segment, we've seen the average length of stay for those decline a couple of days. And it's going to take a while to -- a little while to see that trend reverse that I think will have an impact on ADC. I can tell you January ADC has stabilized. February ADC has ticked up over January. So we're seeing an encouraging steady increase, but it's going to probably take a little while to get back on track on the hospice side. I would look more to the second half of the year for kind of getting back to normal.

Okay. That's very helpful. Then on the acquisition front Dirk, I know you mentioned you have a really strong pipeline across all the segments. I was just curious if -- is there going to be a greater emphasis in terms of entering new geography so to speak or just -- before to consolidate in terms of the existing markets at this point?

Mitra, our real focus is strengthening the markets in which we currently operate. We have -- if you look at the number of states, I believe its 23. Now, we have left a couple of very small states consolidated that business back into other markets. Our goal going forward it's to take those states which we operate and we want to drive hopefully eventually three levels of care in those markets and try to backfill and do that with our acquisition strategy. Now, it doesn't mean that if we had an opportunity in a substantial way to enter in a new market where we felt, we could then get to two or three levels of care in that market, we would certainly look at that. But you can -- for most of what we're looking at today it's more in the markets than where we are currently operating.

Okay. No that's great. And then finally, just coming back to New York. Do you see that sort of one-off or potentially a risk with maybe some other states adopting similar approaches and leading to potentially being locked out of some of these contracts?

New York has always been special. And from our standpoint, it's the state that is kind of an outlier as it looks at this. We don't anticipate -- we have no -- with everything we know in the other states and we operate, this is not even something they would be looking at. There are some states that are going to more -- adding some self-directed programs which we work very well with as an agency with self-directed care. But as far as a true CDPAP where the patient themselves are the -- really the employer of the caregiver and we're just kind of that fiscal intermediary that is not something we see elsewhere nor think will spread.

Okay. Thanks again for taking the question s.

I am showing no further questions at this time. I would like to turn the call back over to Dirk Allison.

Thank you, operator. And I want to thank you all today for your interest in Addus and for being part of our earnings call today. We hope you have a great week. Thank you.

Ladies and gentlemen, this concludes today's conference. Thank you for your participation. Have a wonderful day and you may all disconnect.