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Tenet Healthcare Corporation (THC)

Q4 2010 Earnings Call· Wed, Jan 12, 2011

$177.07

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Transcript

Operator

Operator

Good day, ladies and gentlemen, and welcome to the Tenet Healthcare conference call to introduce its outlook for 2011 and discuss the company’s strategies and current business trends. My name is Jeff, and I'll be your operator for today. At this time, all participants are in a listen-only mode. Later we will facilitate a question-and-answer session. (Operator instructions) As a reminder, this conference is being recorded for replay purposes. I would now like to turn the conference over to your host for today, Mr. Thomas Rice, Senior Vice President and Head of Investor Relations. Please proceed, Mr. Rice.

Thomas Rice

Management

Thank you, operator. And good morning, everyone. Tenet's management will be making forward-looking statements on this call. These statements are based on management's current expectations and are subject to risk and uncertainties that may cause those forward-looking statements to be materially incorrect. Management cautions you not to rely on and makes no promises to update any of the forward-looking statements. The presentation Tenet is making today includes non-GAAP financial information. A reconciliation of this information to GAAP can be found in the Appendix to the presentation. Finally, we note that Tenet will be filing a proxy statement in connection with its 2011 Annual Meeting of Shareholders and urge shareholders to read these materials once filed with the SEC. During the question-and-answer portion of the call, callers are requested to limit themselves to one question and one follow-up question. At this time, I would turn the call over to Trevor Fetter, Tenet's President and CEO. Trevor?

Trevor Fetter

Management

Thank you, Tom. And good morning, everyone, and thanks for joining us. We decided to hold this call, instead of attending the JP Morgan Conference, in order to have sufficient time to cover more topics. We also wanted to allow the analyst community to ask questions. To those of you on the West Coast, I‘m sorry to hold the call so early, but since we are issuing preliminary results for 2010 and an EBITDA outlook for 2011 and beyond, we wanted to complete the call before the market opens. Before I start with our results and outlook, I want to briefly address the unsolicited proposal we received in November from Community Health. As you know, in December, our Board of Directors unanimously determined that the Community Health proposal of $6 per share in cash and stock grossly undervalued Tenet and was not in the best interests of Tenet or its stockholders. The Tenet Board believes that Community Health‘s proposal does not reflect the value of our compelling growth prospects and that Tenet‘s stockholders, not Community‘s stockholders, deserve to benefit from Tenet‘s growth. At the conclusion of my prepared remarks today, my colleagues and I are happy to take your questions. Let‘s now turn to the presentation. The slides we are using are at both tenethealth.com and streetevents.com. Many of you know us very well. But for those of you who are new to the Tenet story, let me take just a minute to provide some background. I‘d like to start with some brief comments about our industry, so please turn to slide three. With large barriers to entry, a lack of foreign competition, and limited risk of substitution, this has always been viewed as a stable industry. The industry has suffered a bit during the recession, but is now at…

Operator

Operator

Thank you. (Operator instructions) It looks like our first question comes from the line of Tom Gallucci with Lazard Capital. Please proceed. Tom Gallucci – Lazard Capital: Good morning. Thanks for all the color, Trevor. I guess my question would really just be a little bit more about the MPI. I think that one of the ideas behind the proposed acquisition was improving the standardization across the platform. You showed some of the earnings numbers that you expect from MPI in the next few years. Can you just remind us where you are actually in the rollout of that physically and how me hospitals is it in? How does that piece of the equation progress as we look forward?

Trevor Fetter

Management

Yes. So, Tom, thank you. Why don’t I ask Steve Newman to describe the rollout and then Biggs to just remind the audience what we have assumed in terms of results from MPI going forward? Steve?

Steve Newman

Analyst

Tom, we’ve rolled MPI out to 36 hospitals to date. Each of those hospitals is working on five DRGs. We anticipate that the remainder of our hospitals will be touched by MPI by the end of this first quarter.

Biggs Porter

Analyst

Just to expand that thought and to talk about $50 million that we’ve assumed from MPI and all the related initiatives we’ve put into that bucket for this presentation, put in context, we achieved $30 million in 2010 from the partial year effects. We’re just looking at five DRGs at 36 hospitals. Savings on those will grow on just those DRGs as physician adoption grows, but also from achieving a full year run rate on those initial implementations. To point out these with the DRGs with the greatest losses, but they are not necessarily low-hanging fruit. So there’s lots of opportunities going forward, even a profitable DRG can also be made better. So we expand the number of hospitals, we expand the number of DRGs as we going forward. We are adding the remainder of our hospitals this quarter and adding DRGs over time, and there is about probably over 100 DRGs with significant volume at each of our hospitals. There is lots of runway from here. Now the other things we put under the MPI umbrella are productivity in length of stay initiatives, which we have and would expect to continuously improve over time, and we have better tools available to us now with more internal consulting resources, also we’ve added that than ever before. We are also focusing more on education, the middle of frontline managers, which is really where the day-to-day decisions are made on those fronts. And we demonstrated improvements on all of these things, and as I said in 2010, and expect with all the runway ahead of us that we can achieve what we’ve put into the forecast of $50 million a year at the middle range. I’d just add one more thought to it. Clinical standardization and our advanced systems will also enhance this effort.

Operator

Operator

All right. Our next question comes from the line of Adam Feinstein. Please proceed. Adam Feinstein – Barclays Capital: Yes. Thank you. Good morning, everyone. I guess, just wanted to get some more color. In the long-term outlook you gave, you gave volume growth assumptions of flat to positive. Just want to get some more color and clarity there as you are thinking about that. Is that assuming growth in all payer – or flat to positive growth in all payer classes? And just as you think about the swing factors there, when you say flat to positive, I guess just to get to the positive level in relative to the flat level, maybe just talk about as you guys think about the swing factors. So just want to once again get a better understanding of the volume assumptions throughout the 2010 to 2015.

Trevor Fetter

Management

Adam, I just need to clarify something, which was flat to down 1%. So it was flat to negative.

Biggs Porter

Analyst

In 2011, it’s flat to negative. It’s zero to negative 1%. Then over the five-year period, we assume volumes grow only slightly. You may recall on the inpatient utilization charge that Trevor showed earlier, we just go from – just go up 200 basis points, which is equivalent of about 4% aggregate inpatient volume growth over the five-year period. So that’s not annual number, that’s aggregate cumulative number by the end of the five-year period. So that’s very modest, if you will, volume growth assumed. In terms of payer classes, we are going to stop focusing discretely on commercial volumes, but for the sake of understanding here, Trevor did mention, I think that’s in the slides, there’s $25 million net negative payer shift, adverse mix shift included in our 2011 numbers. What that reflects is a negative 3% year-over-year change in commercial volumes. So we’ve assumed that in 2011, it’s still negative. We assumed in 2012, in fact, that commercial volumes are still negative – at half that rate, a negative 1.5. And then we assume commercial volumes were flat, zero growth rate going forward. So the growth that we’ve assumed is not in commercial, and in fact, commercial is still negative over the next couple of years before going zero. Adam Feinstein – Barclays Capital: Okay, great. And then just a follow-up on the volume, I appreciate all the details here. So, it's interesting on the healthcare reform you gave some assumptions around volume growth. Certainly just from building our own models, we know a lot of work goes into figuring that out. But just once again, as you think about that 7.5% inpatient, 5.0% outpatient growth, just wanted to get more color. Do you guys think that's going to be pretty evenly mixed, or are there certain regions where you think that volume growth is going to be better from healthcare based on the uninsured mix that you have in certain geographies?

Biggs Porter

Analyst

The way we derived it, in fact, would have it vary by region because what we did was we took the CBO – the Congressional Budget Office estimates for the conversion of the uninsured to exchanges in Medicaid and applied those to each of our markets and assumed, meaning the volume of uninsured in each of our markets the populations, the demographics, and assumed the utilization of services of that newly insured was the same as it was of the existing, let’s say, Medicaid and commercial patients. We also assumed that our market share was constant with where it is today. So we basically just assumed we picked up our share in each market of whatever is there in terms of uninsured and charity patients presently, as they can afford into Medicaid or into an exchange status. So it does vary then. So in areas where there are greater populations of the uninsured, then we would assume that there is a greater influx of volume to us there. There’s probably going to be a number of questions on healthcare reform, and just to try to kind of put a pin in it and dress what I think at a level of detail makes sense at this point in time, I’d like to lay out a few things here. In 2015, there’s $140 million net improvement from health reform. And using sort of large round numbers, basically it’s a roughly breakeven scenario before the volume increases we just talked about. It’s about $325 million at that point of cumulative market basket and dish reductions. Offsetting that, there is just over $300 million of bad debt improvement. So, as I said, pretty much a wash before you get to the volume increase. What we expect in terms of revenues on that 7%…

Operator

Operator

(Operator instructions) Our next question comes from the line of Sheryl Skolnick with CRT Capital Group. Please proceed. Sheryl Skolnick – CRT Capital Group: Good morning, gentlemen. Arguably, this is the single most important conference call you've had, given what's at stake, which is the independence and ultimate valuation of the company over the near term, if not the long-term. So presumably, you've done a very good job of – and it sounds as if you've done a very good job of documenting some of the key assumptions and the growth drivers. But right now, the stock is only being valued inclusive of the provider tax fee revenue, however we are going to call that for California, at roughly 5.5 times at the low end of your estimate for next year. And I guess what I would question is, if that's where the market is going to value you at roughly $6.90 a share, what – apart from all you have done to improve operations, to demonstrate the track record, to grow revenues, to operate with integrity, with clarity, with transparency, all the wonderful things you've done and to implement programs that I would argue are unique in the industry, what else can you do to enhance the value of your equity that you haven't already done? And would you be willing to sell the company to the right buyer at the right price? Because I think that's what this all comes down to.

Trevor Fetter

Management

Well, Sheryl, I appreciate certainly a large part of that question. Look, until this morning, much of this information – in fact, I would say the most important information that we’ve put forth in the call was not in the market. There has been an information vacuum since we released third quarter results. So we’ve, this morning, given the market quite a lot to absorb and understand relating to the fourth quarter of 2010 and our performance in that quarter, including the improved trajectory and volumes and the outperformance on the EBITDA line. We’ve given the market a lot to understand in terms of 2011 and just setting aside that provider fee item what the trajectory is for 2011. And then certainly beyond 2011, we’ve given everyone a lot to absorb with respect to our expected trajectory towards 2015 and even what the possible impact of health reform would be. We’ve got several important external items affecting the company, including the convergence from the recession and what that would do to both the industry and Tenet and then the impending implementation of the most important drivers in health reform that Biggs talked about earlier. So I think this is – I think it’s premature to answer the second part of your question. And I think with respect to how the company is valued, I think we’ve certainly provided a level of disclosure and transparency here today that should enable the market to reach a more informed opinion that might have been the case in certainly November and December and even earlier this week. Sheryl Skolnick – CRT Capital Group: Okay. Thank you.

Operator

Operator

Our next question comes from the line of John Ransom with Raymond James. Please proceed. John Ransom – Raymond James: Hi. My question is, if we want to think about free cash flow, taking your numbers in applying free cash flow, is there anything else we need to be thinking about? You've given us the CapEx range and some of the other things. But in thinking about that, what would you estimate, with no acquisitions, kind of the total deleveraging that might occur between now and, say, 2013?

Biggs Porter

Analyst

As you say, we haven’t put cash projections into the information that’s there. However, a couple of important points. The Department of Justice payments that we were making completely retired. We’re complete with that as of the third quarter of last year. So that’s a drag in the past, which is no longer there going forward. On – another key important point is that the NOL we are projecting to protect us from tax payments until 2014 or ’15 time period. So, as a result of that, we think that our EBITDA growth will produce increasing free cash flow from a – that a PC [ph] might not have is from a working capital standpoint, what would we assume. And although we’re not giving cash flow guidance yet for 2011 until we fully analyzed carry-on effects from 2010, we would expect that working capital on an annual basis would have to support higher revenues and would grow maybe in the neighborhood of $50 million to $90 million or $100 million in any particular year. Obviously, the higher revenue growth periods towards the end might require more working capital than the more modest assumptions for first few years. So, something in the range of $50 million to $90 million a year for working capital usage would be the base line. Now having said that, what Conifer has experienced in the past in driving days and receivables down cooperatively with our hospitals and our expectations to continue to be able to work successfully on that, we may be able to do better than that $50 million level going forward. John Ransom – Raymond James: Just a point of clarification. Does your CapEx include the outpatient acquisitions, the 450 to 550?

Biggs Porter

Analyst

Over the next two years, no. They are only in there for the next two years. John Ransom – Raymond James: What I'm saying is, should we factor in additional dollars are outpatient acquisitions? I'm not sure I understood your answer.

Biggs Porter

Analyst

Yes. In 2011, we’d be spending –

Trevor Fetter

Management

What he meant was that –

Biggs Porter

Analyst

About $100 million in 2011 in addition to the CapEx numbers. John Ransom – Raymond James: Yes, okay.

Trevor Fetter

Management

And we haven’t included outpatient acquisition beyond that, John. But we are anticipating at least making them in 2011 at a rate and value similar to what we did in 2010. John Ransom – Raymond James: Okay. Thank you.

Operator

Operator

Our next question comes from the line of Ann Hynes with Caris & Company. Please proceed. Ann Hynes – Caris & Company: Good morning. So, when I look at slide 22, Biggs, I know you touched upon it with an earlier question, but the capacity utilization at 52% by 2015, just when I look at it, it seems very conservative, given what we hope would be an economic recovery and secondly, health reform and your exposure and high uninsured markets. So, I guess my question is, what’s the driver of the conservatism, or maybe I'm just looking at it incorrectly?

Biggs Porter

Analyst

You’re right. It is conservative. I think that the – that number for the 2% growth is really before that health reform add-on or the 7% to be clarity. So it was intended to show what’s happening from sort of an organic status quo basis as opposed to what happened traditionally when we get that 7% volume growth anticipated from healthcare reform. But I go back to you point, I do think it’s conservative even on a status quo kind of basis because we do have a history prior to recession of driving increased volume. We were doing it prior to the recession hitting in 2008. All of our initiatives associated with traditional integration, we believe, will drive volume. We think demographics will drive volume. We think that economic recovery will drive volume. The biggest concern is what is the pace of the economic recovery and how quickly does that take off. So we just chose to be conservative on that point because it’s just one of the harder things to project.

Steve Newman

Analyst

Ann, this is Steve Newman. I just want to add one point to what Biggs said in a reminder that under the MPI umbrella we also have our case management initiative. One of the goals is obviously to cut length of stay. So, as we grow volume and cut length of stay, there is not that one-to-one increase in capacity utilization from a census perspective. Ann Hynes – Caris & Company: All right. And then on that slide you gave, provided $40 million incremental EBITDA for every 1% of total volume, that's assuming your current payer mix. So, if we have a reacceleration of commercial volume, would there be upside to that, given that you’ve been negatively hurt the downturn in the economy and commercial volume versus –?

Biggs Porter

Analyst

Yes. If commercial grows at any point greater than the aggregate growth, then there is upside to our incremental margins. Ann Hynes – Caris & Company: Okay. Great. Thank you.

Operator

Operator

Our next question comes from the line of Doug Simpson with Morgan Stanley. Please proceed. Doug Simpson – Morgan Stanley: Hi. Thanks for all the detail in the slide deck. Just a question on managed care contracting. How would you characterize where you see your rates today looking into 2011? And how much opportunity do you think, relative to some baseline, is there to drive those rates higher? Is there a pretty big dispersion still across the portfolio in terms of your best markets versus your worst markets? Just any color you could give us on how much room you think there is for improvement.

Trevor Fetter

Management

Okay. Thanks, Doug. So I guess the first comment I should make about our managed care pricing is that we are, at this point, 90% contracted for 2011 and 60% for 2012. So we have a very significant degree of visibility into what our rates are over at least the beginning part of this multi-year outlook. As we look at the – across the country at the markets, we still feel that there is plenty of opportunity where we are positioned low relative to primarily the leading not-for-profit competitors in those markets. Those are real competitors when you get down to it on a managed care point of view. And we have worked very hard to create a superior value proposition. As I mentioned in the script, we’re managed care payers. And that consists of a reasonable price, demonstrably high levels of clinical quality on their metrics. I’m not talking about CMS core measures. I’m talking about the Centers of Excellence programs and other designations that the managed care companies put out for – in order to evaluate the hospitals. And then in our revenue cycle, we have a very smooth, low friction revenue cycle operation with respect to managed care. We have very low rates of denials. We have a great high rate of automation. And so, our basic value proposition of managed care is high quality, low cost, ease of doing business, and we do it centralized in a centralized way with the large national managed care companies where we’re able to work with them in order to help them build market share. If they needed pricing concessions in particular market, we can make it up in a different market. It’s a very collaborative type of relationship. So, of all the moving parts in a multi-year forecast like this, managed care pricing is one of the ones that we have a greater degree of visibility into.

Operator

Operator

Our next question comes from the line of Gary Taylor with Citigroup. Please proceed. Gary Taylor – Citigroup: Hi. Can you hear me?

Trevor Fetter

Management

Yes. Gary Taylor – Citigroup: Great. Thanks. Just a couple quick questions on the details, because there is a lot to work through. I thought I heard early in the call a mention around the fourth quarter related to malpractice. And I didn't know if that was a continuation of the favorable trends that you’ve been expecting for most of the year or if there was anything unusual contributing to the 4Q on that front?

Trevor Fetter

Management

There are two – the mention was – I was trying to condense a lot into a short sentence. There are a couple of things going on. We have had a long multi-year trend of improving clinical quality. It also gets back to our targeted growth initiative where part of the strategy and targeted growth was to evaluate malpractice risk as part of our evaluation of certain service lines. And so, over time, we’ve made deliberate effort to improve clinical quality and reduce malpractice that way, but also if there are service lines that are inherently higher risk than others, we’ve taken that into consideration in deemphasizing or exiting those service lines. So we’ve had sort of a real reduction in malpractice experience through improvements in clinical quality. And if you look over time over the last several years, we have fought a headwind in malpractice through reductions in interest rates that reduce the discount rate that’s used to discount the malpractice liability. Now, even with that headwind, due to the improvements we have made in clinical quality, we’ve cut malpractice costs in-house over the past five years on a per patient day basis, which is the best metric for it. In the fourth quarter, as you know, interest rates in general increased. And for a long time we’ve been talking about how – as an interest rate environment started to turn and go higher, one of the effects would be on old discounted liabilities, whether it’s workers’ comp or malpractice, you’d get a little bit of a tailwind from that. So that’s – what I was saying is that in the fourth quarter there is a component of both of those effects, the continued improvement in malpractice experience along with a reduction in the discounted liability or at least an improvement in malpractice expense due to slightly higher discount rates. Gary Taylor – Citigroup: Okay, great. So it sounds like it's going to be relatively consistent with what we've seen with the last several quarters?

Trevor Fetter

Management

We’ll discuss that in more specifics when we do the fourth quarter call. Gary Taylor – Citigroup: Okay, great.

Trevor Fetter

Management

All those drivers. Gary Taylor – Citigroup: Sure. My last question, I just want to make sure I understand this correctly. So, when we look at the 2011 guidance, I know on the slides it says there's $40 million in provider taxes included, which I believe you characterize as what you think the right sort of recurring run rate is. But then also, you had made a comment that suggested the $64 million from California was also included in that guidance. So could you just kind of walk us through, I guess, what your view of sort of recurring EBITDA guidance is, adjusted for both of those?

Biggs Porter

Analyst

Sure. This is Biggs. In 2011, there is both the $64 million carryover, if you will, of the California provider fee that was applicable to 2009 and ’10, but which isn’t going to be recognized in the P&L until 2011. There is also – the majority of that cash is not going to be received until 2011. So that’s in 2011. Additionally, in California, we expect a follow-on program – it won’t be a $64 million level, but we expect a follow-on program applicable to 2011 and we expect provider fees to be a range put in place in Pennsylvania. The aggregate of those is $40 million or better at this point. So in 2011, there is really $104 million in the outlook for provider fees in combination of the carryover plus the expected follow-on or new programs. And then in the sort of, if you will, ’12 and ’13 period, the $64 million doesn’t recur, but we expect $40 million to recur either in the form of continued provider fees, the bulk of which is the fact that the Pennsylvania fees in multi-year program already as it’s been put into place. And then what you see – if we don’t see continued provider fee out of California or otherwise, we expect to see restoration of some of the state supplemental payments or other things, which would keep us from $40 million run rate Medicaid funding increase level in those years relative to what we had in 2010. Gary Taylor – Citigroup: Great. That's perfect. Just the last follow-up. As we are modeling quarterly EBITDA in ‘11, presumably, we have California in the first quarter. But from the Pennsylvania perspective or from that $40 million run rate perspective to I guess avoid the issue of kind of what's in the EBITDA, what's not in the EBITDA, is there – do you think that $40 million runs ratably through the year, or are we just going to have to live with it being lumpier than that?

Biggs Porter

Analyst

Ideally, it would run evenly through the year. It could be a little front-end loaded because California program may be front end loaded. But if we get back to this issue of when is it all approved, when is the point where we can record it, it’s just too subjective right now to say exactly how this will appear quarterly. Maybe we’ll have greater visibility to that by the time we report fourth quarter results more fully in detail in February, and we can give a great review of how the year will unfold at that point. Gary Taylor – Citigroup: Okay. Great. Thank you.

Operator

Operator

Our next question comes from the line of Justin Lake with UBS. Please proceed. Justin Lake – UBS: Thanks. Good morning. Just kind of following up on Gary's question there. As I look at 2011 guidance, I know there's a number of moving parts here, but it looks like you've got a little over $100 million of provider taxes that will run through 2011 that really weren't in the prior years. If you adjust for that in the $40 million of acquired EBITDA, that basically speaks to about 100% of your EBITDA growth guidance, going from 1,050 to 1,200. I'm just curious if that's – in your mind, it would be indicative of a same-store kind of flat EBITDA, ex those two items. Is that a fair way to look at it, or are there some moving parts that I'm missing?

Biggs Porter

Analyst

I’ll try to hit all the big moving parts, and it should get back to some reasonable understanding, which I think you’re pretty close to already. But the big negatives – I'll start with the negatives in 2011 relative to 2010 and I’ll use round numbers. But on HIT initiative, about $15 million growth in expense or net expense in 2011 relative to 2010 – Justin Lake – UBS: That’s $15 million or $50 million, I’m sorry, Biggs?

Biggs Porter

Analyst

$15 million. Justin Lake – UBS: $15 million, got it.

Biggs Porter

Analyst

$15 million. And it’s consistent with what’s on the slides. So you can refer back to there on the number of these points for that matter. The healthcare reform is about $15 million negative effect from the market basket adjustments in 2011 relative to 2010, which again is $15 million. State supplemental payments and Medicaid funding, in general, outside of the provider fees are down $25 million. Within our risk range, we’d say it’s $25 million to $60 million, but let’s just say it’s $25 million for the sake of this. But then, the cost initiatives are worth $50 million to the plus side; outpatient acquisitions, talk about it’s worth $40 million on the plus side; California provider fees, $64 million; the follow-on fees, $40 million. So if you sum all those up, that takes you to about $130 million of net positive. So there’s only about $10 million left for all other factors combined. Okay? Justin Lake – UBS: Got it. So if we were to think about that $10 million, it is about 1% EBITDA growth?

Biggs Porter

Analyst

Yes, the – I think it – Justin Lake – UBS: How do you get from 1% to – I'm sorry, go ahead.

Biggs Porter

Analyst

Well, you have to think in terms of the zero to negative 1% assumption on inpatient value exacerbated by payer mix shift within that a $25 million. So once again, we are choosing to be conservative in terms of our assumption that we do not have volume growth in 2011 at the middle of the range and that we have adverse shift from the continuing declines in commercial in 2011. Now, if you look at just what was happening here in the fourth quarter, November, December, fairly strong, really showing a different trend from what was there previously. We’ve got certainly chance to do better than that. But for purposes of the outlook in the middle of the range, we chose to hold at that level. Justin Lake – UBS: Okay, great. And just last question, the med mal that you talked about just a minute ago, could you put a number around that as far as the benefit in the quarter?

Biggs Porter

Analyst

Well, as far as the – I think, maybe most important is the effect of the discount rate. It was around $10 million. There was some similar effect, smaller on workers’ comp. But to put that in perspective, that pretty much just represents a reversal of the hit we took in the third quarter as discount rates lowered because interest rates lowered. So, for the second half of the year and for the year, the effective discount rates kind of washes out. So it creates some movement in the quarter, but not on an annual basis – at least that’s much smaller on an annual basis. Justin Lake – UBS: Got it. So you feel like the ’10 run rate on med mal is good for ‘11?

Biggs Porter

Analyst

Well, the ’10 – okay. The aggregate run rate – let's just take – forget about reductions, forget about changes quarter-to-quarter and just look at aggregate expense. Our aggregate expense for 2011 compared to ’10, we think, may be pretty similar. Justin Lake – UBS: Okay, great. Thank you very much for all the detail.

Operator

Operator

Our next question comes from the line of A.J. Rice with Susquehanna Financial Group. Please proceed. A.J. Rice – Susquehanna Financial Group: Hello, everybody, and thanks for all the information. Just a point of clarification. On the $400 million year-end cash balance, so some of that – even though none of the $64 million has been recognized, some of it has been obtained and in that cash balance, is that right?

Biggs Porter

Analyst

There is a relatively small amount, only about $10 million net received at 12/31. So the rest of it is carrying over. A.J. Rice – Susquehanna Financial Group: Okay. I guess my broader question would be, in light of the last 30 days and taking into account the growth expectations that you guys are laying out without really much dependence upon acquisition activity, does – and when you think about capital allocations, either short-term or long-term, does doing anything proactively on the share repurchase, maybe taking your leverage up some, looking at even a dividend, I guess, would be another way to do it, either one-time or long-term? Did any of that move up on the radar screen as something worth considering in light of your perception that at least recently the stock has been very undervalued and that maybe is why there was an opportunity for someone to put an opportunistic bid on the table?

Trevor Fetter

Management

A.J., it’s a very good question. And let me answer it this way. Prior to this bid being put on the table, as you put it, we were actively pursuing some not-for-profit acquisitions, hospital acquisitions in our markets. We think that those types of opportunities will be – I would say, abundant is maybe going too far, but they will certainly be more numerous than they had been in the past once that would be interesting to us. With respect to the other types of alternative that you are talking about, I think it’s safe to assume that given the circumstances and given our views on the true underlying value of this company, driven by very concise and well articulated strategies that we are considering a number of alternatives at this point. A.J. Rice – Susquehanna Financial Group: Okay. Any time frame on that or –?

Trevor Fetter

Management

No, I don’t think so. I think – obviously we have taken actions in the past week that will enable shareholders to have some time to see and experience how the market values the company and reach their own conclusions about value for the company. And we will be very prudent and deliberate as we go forward. A.J. Rice – Susquehanna Financial Group: Okay. All right. Thanks a lot.

Operator

Operator

Our final question comes from the line of Shelley Gnall with Goldman Sachs. Please proceed. Shelley Gnall – Goldman Sachs: Thanks very much for fitting me in. I guess just a question. I think I heard your expectations for your larger outlook include stable market share assumptions. Can you just update us? I know you've done some work looking into how your market share has been trending. Do you still have the view that your market share has been stable? Has it been declining in some markets, and have you taken any steps to address that?

Trevor Fetter

Management

Thanks, Shelley. So we made fairly detailed comments about that on the third quarter call. You know that the information to support those comments is not instantly available. I think that’s something we would address more thoroughly on our Q4 call. We need some time to pull that together. But there’s nothing that’s happened in our markets to suggest to us and with our own trends to suggest anything other than stable to growing market share. So we feel pretty comfortable in that respect in here today.

Biggs Porter

Analyst

And Shelley, this is Biggs. My comments on market share were made in the context of how we got to our healthcare reform volume assumptions that we assume the healthcare reform – our market share didn’t change under healthcare reform. So that 7% growth in inpatient and 5% in outpatient was purely a matter of capturing our current market share of the presumed utilization of the uninsured as they get insurance rather than assuming there is any market share change that occurs at that point in time. Certainly, one of our initiatives will be to try to go drive towards increasing share of the good new paying volumes that will be out there. And so strategically, we will work in that direction, but we didn’t reflect it in our assumptions on healthcare reform. Shelley Gnall – Goldman Sachs: Okay. I appreciate the clarity. Thank you.

Trevor Fetter

Management

Okay. Well, thanks, everyone, for participating today. We went a little bit longer – actually a lot longer than I had said we would at the outset. But I appreciate all the questions. If there are further follow-up questions, as I mentioned at the outset of the call, you can reach us later today, throughout the day, by calling our Investor Relations number. Thanks, everyone. Good bye.

Operator

Operator

Ladies and gentlemen, that concludes today’s conference. Thank you for your participation. You may now disconnect. Have a wonderful day.