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Investor Presentation
March 9, 2016
FORWARD-LOOKING STATEMENTS
Certain statements in this presentation constitute forward-looking statements within the meaning of Section 27A of the Securities Act and Section
21E of the Exchange Act. These statements are based on managements current expectations and involve known and unknown risks, uncertainties
and other factors that may cause the Companys actual results to be materially different from those expressed or implied by such forward-looking
statements, including, among others, changes in laws and regulations affecting the healthcare industry; adverse litigation or regulatory
developments, government investigations or litigation, including any significant monetary resolution or other undesirable consequences of the
Clinica de la Mama qui tam action and criminal investigation, the resolution of which could have a material adverse effect on the Companys
business, financial condition, results of operations or cash flows; our success in implementing our business development plans and integrating newly
acquired businesses, including our United Surgical Partners International joint venture; the ability to continue to expand and realize earnings
contributions from the revenue cycle management, health care information management, capitation management, and patient communications
services businesses of our Conifer Health Solutions subsidiary; our ability to identify and execute on measures designed to save or control costs or
streamline operations; and our success in completing recently announced acquisition and disposition transactions. These and other risks and
uncertainties are discussed in the Companys filings with the Securities and Exchange Commission, including the Companys annual report on Form
10-K and quarterly reports on Form 10-Q. All information regarding the Companys 2016 Outlook is as of February 22, 2016, the date of the
Companys earnings release for the fourth quarter of 2015, and has not been updated. The Companys Outlook, including forecasted adjusted free
cash flow, excludes restructuring charges, acquisition-related costs, litigation costs and settlements, and discontinued operations. For information
regarding litigation costs and settlements, which could be material, reference is made to Note 10 of the Consolidated Financial Statements of the
Companys Annual report on Form 10-K for the year ended December 31, 2015. We disclaim any obligation to update any forward-looking statement
in this presentation, whether as a result of changes in underlying factors, new information, future events or otherwise.
Strategic Overview
June
Conifer selected by
prominent health
system (DartmouthHitchcock Health) to
manage hospital and
physician revenue cycle
services (6.4.15)
Sharpened acute
care portfolio
through sale of Saint
Louis University
Hospital (8.31.15)
July
Expanded footprint in
Coachella Valley, CA,
with acquisition of HiDesert Medical Center
(7.15.15)
August
September
October
December
November
Renewed multi-year
agreement with largest Increased scale and
health plan customer strengthened urgent
(Aetna) (12.18.15)
care capabilities with
USPIs acquisition of
CareSpot Express
Healthcare (12.31.15)
$18.6B
$2.276B
12.2%
$405M
Revenue
(Up 12%)
Adjusted EBITDA
(Up 17%)
High-quality, low-cost
provider
Higher-margin, faster-growing,
more capital-efficient business
Focused on high-acuity
inpatient services
#1 or #2 positions in more
than two-thirds of markets
Pioneered three-way
partnerships
Consumers are actively seeking lower-cost solutions and better value as they
assume more responsibility of their healthcare spend
Financial Overview
Adjusted EBITDA
$2,000
11.8%
12.4%
$1,500
$1,000
$500
$434
5.0%
$571
8.4%
8.5%
$687
$701
9.1%
$982
$1,050
12.9%
13.2%
$1,952
12.1%
$1,145
$1,203
$2,276
12.2%
$2,450
16%
14%
12.9%
11.7%
12%
$1,342
10%
$732
8%
6%
6.4%
$0
4%
2004
2005
2006
2007
2008
2009
2010
Adjusted EBITDA
2011
2012
2013
2014
2015 2016F
Ambulatory: 24%
Conifer: 10%
Hospital Operations
& Other: 85%
1.
2.
2016 forecast based on the midpoint of Outlook for net operating revenue and Adjusted EBITDA as issued on February 22, 2016.
2016 forecast based on the segment Outlook for Adjusted EBITDA as issued on February 22, 2016.
Conifer: 11%
11
Hospital Operations
& Other: 65%
Margin
$ Millions
$2,500
USPI JV
6/16/15
Vanguard
Acquisition
10/1/13
$18,800 - $19,200
$2,400 - $2,500
(1)
12.8% - 13.0%
$1.18 - $2.25
$1,300 - $1,450
$850 - $900
$400 - $600
(1)
(1)
Assumptions:
Bad Debt Ratio
Equity in Earnings of Unconsolidated Affiliates
Electronic Health Record Incentives
Depreciation and Amortization
Interest expense
7.0% - 7.5%
$150 - $170
$25 - $35
$810 - $850
$950 - $970
22% - 27%
$310 - $330
102
(2)
(3)
(1) Excludes restructuring charges, acquisition-related costs, litigation costs and settlements, and discontinued operations.
(2) In order to estimate Tenets income tax expense in 2016, the following formula should be used: a) start with pre-tax income, which is estimated to be $580-$740 million; b)
subtract GAAP NCI expense, which is estimated to be $310-$330 million in 2016; c) add back permanent differences and non-deductible items, which are estimated to be
approximately $25-$35 million in 2016; d) add back approximately $50 million of non-cash NCI expense that Tenet is recognizing related to the portion of USPI that the company
does not own; and, e) multiply the result by a 40% tax rate. The result of this calculation is an effective tax rate of 22%-27% on Tenets pre-tax income.
(3) This represents GAAP NCI expense to be recorded on the income statement. Cash distributions paid to noncontrolling interests are expected to be $220 -$240 million.
* As issued on February 22, 2016.
12
Ambulatory Segment
2016 EBITDA
~$585 million
(1)
~$240 million
2016 Noncontrolling Interest
3% - 4%
3% - 5%
0.0% - 2.0%
(2)
5% - 6%
15% - 20%
15% - 20%
(2)
2.0% - 3.0%
(1.0%) - 1.0%
Case Growth
Net Revenue per Case Growth (2)
Conifer Segment
2016 EBITDA
2016 Noncontrolling Interest (1)
Net Revenue Growth (2)
EBITDA Growth (3)
~$265 million
~$50 million
10% - 15%
~4%
2.0% - 3.0%
2.0% - 3.0%
(1) Based on GAAP NCI expense. Cash NCI distributions will be lower.
(1) Based on GAAP NCI expense. Cash NCI distributions will be zero.
Ambulatory Segment
EBITDA less NCI Growth (1)
8% - 10%
(1) Includes growth from acquisitions. EBITDA less NCI in the
Ambulatory segment is expected to grow 5-6% annually excluding
acquisitions.
* As issued on February 22, 2016. Segment-level EBITDA excludes restructuring charges, acquisition-related costs, litigation costs and settlements, and discontinued operations.
13
Conifer Segment
EBITDA Growth
~10%
Fixed Rate Debt with Staggered Maturities Reduces Interest Rate Risk
Over 80% of our debt matures in 2020 or beyond (1)
$4,500
$3,500
$3,000
$2,500
$2,000
$1,041
$1,600
$3,200
$1,900
$2,800
$1,900
$500
$0
$1,000
Floating Rate
Secured
Debt,
$900M(2)
6%
2016
2017
2018
2019
2020
2021
2022
2023
$0
Secured
$430
$1,500
$0
Fixed Rate
Unsecured
Debt,
$7.780B
56%
Fixed Rate
Secured
Debt,
$5.241B(1)
38%
$1,050
$4,000
2031
Unsecured
14
Free cash flow generation expected to be sufficient to self-fund our cash needs, including:
Surgery center acquisition program; anticipate deploying $100 million to $150 million on ambulatory acquisitions each year
Estimated $1.5 billion in payments from 2016 to 2020 to purchase the remaining 49.9% of USPI owned by Welsh Carson and other pre-existing USPI shareholders;
the payment in 2016 is expected to be approximately $127 million
Cash distributions to minority partners
Asset sales are proceeding as expected continue to anticipate $1 billion of net proceeds
To date, generated approximately $500 million in cash through asset sales
Expect to complete Atlanta transaction as early as March 31 and receive approximately $575 million in cash and reduce our indebtedness by approximately $89
million from the elimination of capital lease obligations
15
Hospital Overview
TX 26%
GA 5%
MI 8%
AL 8%
FL 16%
AZ 9%
CA 12%
84
22K
13
30
2,100
173
80%
Hospitals
Licensed
Beds+
States
Markets
Employed
Physicians
Outpatient
Facilities**
of Hospitals
in ACOs
+Includes
17
Organize our portfolio to enhance scale and build strong regional networks through
acquisitions, partnerships and joint ventures
18
19
~10% Neurosurgery
~2% Trauma
Joshua Tree, CA
Acquisition of HiDesert Medical
Center, pairing with
two existing Tenet
hospitals
Dallas/Fort Worth, TX
Joint venture with Baylor Scott &
White Health (five hospitals)
Birmingham, AL
Joint venture with Baptist
Health System (five
hospitals)
Atlanta, GA
Definitive agreement for sale
of facilities to WellStar Health
System (five hospitals)
Enhancing
Throughput (1)
Reduced Medicare Excess Days
by 4% from 2014
Drove 12% increase in
discharges before noon
Emergency Room
Improved patients discharged
<120 minutes by 5%
Reduced time to admit
through ER by 4%
Reduced patients who left
without treatment by 4%
Operating Room
Optimizing Supply
Chain
GPO consolidation effective
2/1/16
Insourcing service line
purchasing experts
Driving Labor
Improvement
Drove 9% YOY reduction in
contract labor utilization in
Q415 (same-store)
Optimized workforce
Matched staff to volume and
acuity
Reduction in overtime
21
(1)
---------------------------->
Q4'14
Q1'15
Adjusted Admissions
0.1%
3.9%
4.8%
4.3%
5.9%
2.3%
0.7%
0.3%
Admissions
-0.9%
2.8%
3.9%
4.0%
4.9%
1.7%
-0.6%
-1.8%
1.7%
-2.8%
-3.4%
7.1%
2.3%
4.5%
5.8%
0.3% (2)
Inpatient Surgeries
-0.8%
-0.9%
0.4%
2.6%
2.4%
1.9%
-0.2%
-0.9%
Outpatient Surgeries
-4.6%
-3.6%
-0.3%
0.2%
0.8%
1.2%
1.5%
0.6%
-0.7%
4.8%
5.1%
7.2%
7.2%
2.4%
1.5%
-0.6%
2.7%
6.5%
7.7%
9.2%
6.9%
4.6%
3.0%
3.0%
(1) Hospital segment statistics have been restated to exclude the 49 surgery centers and 20 imaging centers that Tenet contributed to the joint venture with United
Surgical Partners International (USPI). Prior to the joint venture with USPI, these outpatient revenues and volumes had been included in our hospitals' calculation of
adjusted admissions, revenue per adjusted admission, outpatient surgeries and total outpatient visits.
(2) After normalizing for differences related to the timing of the recognition of California Provider Fee revenue in Q4'14 and Q4'15, same hospital revenue per adjusted
admission increased 3.2% in Q4'15.
22
Q1'13 Q2'13 Q3 '13 Q4 '13 Q1 '14 Q2 '14 Q3 '14 Q4 '14 Q1 '15 Q2 '15 Q3 '15 Q4 '15
$359
8.5%
$391
9.0%
$415
9.5%
$348
8.2%
$380
8.8%
$320
7.3%
$249
5.6%
$356
7.4%
$363
7.6%
$352
7.3%
$371
7.3%
$391
7.2%
7.0%
7.4%
7.8%
6.6%
7.3%
6.1%
4.7%
6.2%
6.4%
6.2%
6.2%
6.1%
$263
5.1%
$229
4.3%
$249
4.7%
$329
6.3%
$221
4.2%
$240
4.6%
$254
4.8%
$216
3.8%
$174
3.1%
$199
3.5%
$268
4.5%
$255
4.0%
$651
$727
$707
$683
$694
$629
$600
$704
$699
$675
$664
$774
% of adjusted revenue
Charity Care Write-Offs
% of adjusted revenue
(1)
(1)
Uninsured Discounts
% of adjusted revenue
(1)
12.6% 13.8% 13.3% 13.0% 13.3% 12.0% 11.4% 12.3% 12.3% 11.8% 11.1% 12.0%
$1,273 $1,347 $1,371 $1,360 $1,295 $1,189 $1,103 $1,275 $1,236 $1,226 $1,303 $1,420
(3)
24.7% 25.5% 25.8% 25.9% 24.8% 22.7% 20.9% 22.2% 21.8% 21.4% 21.7% 22.0%
(1) Adjusted Revenue equals the sum of: a) Net operating revenues before provision for doubtful accounts, b) Charity Care Write-Offs, and c) Uninsured Discounts.
(2) Uncompensated Care equals the sum of: a) Bad debt, b) Charity Care Write-Offs, and c) Uninsured Discounts.
(3) The Uncompensated Care Percentage equals: a) Uncompensated Care, divided by b) Adjusted Revenue.
23
20
BILLION MEDICALLY
MANAGED SPEND
FOR EMPLOYERS
5.7
25
29
14,500+ EMPLOYEES
20 SERVICE CENTERS
800+ CLIENTS IN
40+ STATES
Headquarters
MILLION PATIENT
TOUCH-POINTS
ANNUALLY
Service Centers
25
26
Consumer
Experience
Clinical
Revenue
Integrity
Physicians
Prepare & Collect
A/R
Management
Hospitals
& Health
Systems
Health
Plans
Clinical
Integration
Physician Alignment
Clinical Integration Intelligence
Employers
Population
Health
Management
Financial
Risk
Management
Population/Employee Engagement
Health Management Workflow
Care Coordination/Medical Management
Population Health Intelligence
27
Capture additional share of the revenue cycle management market that is currently
insourced today
Generate new client relationships through opportunities from USPI and acute care
portfolio activities
Expand revenue cycle management and value-based care service offerings through
organic development and small acquisitions
Leverage data from tens of millions of patient interactions to capture new opportunities
and service the value-based care environment to drive competitive differentiation
28
$56
$52
+4% CAGR
$43
Outsourced
$12
+15% CAGR
$20
+10% CAGR
$29
$31
$42
Population
Health
$32
$21
$6
Wellness
Insourced
Consulting
2015
1. Overall market size accounts for hospital and physician RCM
Source: McKinsey & Co.
2020
29
$4
$4
$8
2015
2020
1,600
Tenet
Other
300
$265
250
$203
1,200
Revenue $ in Millions
EBITDA
1,000
$747
$132
$602
800
600
200
150
$105
$515
100
400
$117
$591
200
$371
$666
$404
50
2012
2013
2014
2015
EBITDA Margin %
22%
14%
17%
19%
Cap Ex ($M)
$13
$21
$25
$28
30
EBITDA $ in Millions
1,400
Conifer
Delivered 30% EBITDA growth in 2015
Anticipate approximately $265 million of EBITDA in 2016, up 4% as compared to $255 million of EBITDA in 2015 after adjusting for $10 million of customer
incentive revenues in 1Q15 that are not expected to recur.
Note that $265 million of EBITDA in 2016 represents a 9% increase versus 2H15 annualized EBITDA of $244 million.
Conifer is making investments in 2016 to position the company for additional growth and is also onboarding Dartmouth-Hitchcock, additional Catholic Health
Initiatives hospitals and working on other customer implementations, which will constrain Conifers EBITDA growth in 2016.
Q4'13
$126
29.9%
Q1'14
$140
52.2%
Q2'14
$138
46.8%
Q3'14
$148
60.9%
(1)
Q4'14 Q1'15
Q2'15
$165
$160
$165
31.0% 14.3% 19.6%
Q3'15
$163
10.1%
Q4'15
$178
7.9%
$119
$125
$133
$138
600.0% 594.4% 375.0% 155.6%
$145
21.8%
$147
17.6%
$148
11.3%
$162
17.4%
$182
25.5%
$175
19.0%
$184
24.3%
$206
27.2%
Revenue
% growth
$211
97.2%
$219
102.8%
$225
83.8%
$264
74.6%
$285
35.1%
$285
30.1%
$296
31.6%
$327
23.7%
$342
20.0%
$340
19.3%
$347
17.2%
$384
17.4%
EBITDA
% growth
$32
28.0%
$28
12.0%
$36
50.0%
$36
16.1%
$48
50.0%
$44
57.1%
$47
30.6%
$64
77.8%
$82
70.8%
$60
36.4%
$61
29.8%
$61
-4.7%
EBITDA Margin
15.2%
12.8%
16.0%
13.6%
16.8%
15.4%
15.9%
19.6%
24.0%
17.6%
17.6%
15.9%
$ in millions
Revenue from Tenet
% growth
Other Customers
% growth
Q1'13
$92
2.2%
Q2'13
$94
4.4%
Q3'13
$92
-2.1%
(1) Conifer's EBITDA in Q1'15 benefitted from approximately $10 million of non-recurring customer incentive revenue.
Note: Tenet and Catholic Health Initiatives represented approximately 80% of Conifer's revenue in both Q4'14 and Q4'15.
31
Overview
USPI is an experienced and trusted partner with some of the nations most successful health systems, well positioned
for current and future environments
Trusted
Strategic
Partner
Market
Leader
Disciplined
Operator
Financial
Strength
Industry leader of health system and physician partnerships in short-stay facilities with both local market
strength and a national presence.
Fifteen year history of establishing strategic, exclusive partnerships with leading health systems which yields
additional growth opportunities, both in surgery and other ambulatory services.
History of strategic investments in infrastructure and growth teams that position us to create or react quickly
to opportunities and adapt to environmental changes.
Attractive high quality and high value solutions to those paying for health care; attractive experience and
satisfaction rates for those accessing the system.
Attractive business model with low risk cash flows, reliable payers, high margins and low capital intensity.
The combination with Tenet provides significant opportunities for growth, and value creation through
synergies and expansion of pipeline. Acquisitions at accretive multiples enhance organic growth.
33
Build and expand relationships with health system partners through further
development of ambulatory offerings
34
Key
ASCs
Surgical Hospitals
Imaging Centers
Urgent Care Centers
(1) As of 2/1/2016
35
Financials
Facility
EBITDA
System-wide revenues
$3.6B
margins: 30%
$489M
EBITDA
Pressure
from
EBITDA less NCI
$352M
supply
expense on
more
complex
Average facility
cases + payer
Net revenue
USPI mgmt fee
mix shift
Expense
Facility EBITDA
Bad debt
expense: 2.3%
Average days
(2)
100%
Payer mix
Case mix
% revenue
Revenue
Volume
74%
26%
48%
52%
Commercial
Govt / other
Orthopedic
Spine
GI
Pain Mgmt
General
Ophthalmology
ENT
Gynecology
Urology
Podiatry
Other
Hospitals
Cases / month 15%
25 25 16 66%
IP
11
11
11
32
8
8
7
3
3
3
3
ASCs
85%
700
4%
Operating
1.2M surgeries/year
28 states
74% of revenue is commercial
NR / case
30%
$1,725
EBITDA margin
OP
30%
Labor
NR / case
28%
$6,600
Supplies
NR/case: $2,400
USPI ownership: 31%
Other
EBITDA margin
Average beds: 27 (range: 6 to 68)
(1) Financials represent the 2015 pro forma financials for the Ambulatory segment. All other metrics are USPI-only, and exclude Aspen.
(2) Prior to noncontrolling interest expense related to Welsh Carson and other USPI shareholders.
36
Low risk cash flows from high margin specialties & reliable payers
High margin, elective procedures
o 54% of revenue mix from musculoskeletal procedures
37
Long-lasting existing partnerships as well as a robust pipeline for additional joint ventures and consolidation opportunities
38
Patients
Growing out-of-pocket
costs driving greater
seasonality for
elective utilization
PCP capitation and
network alignment
changing access
Leveraging public and
proprietary tools to
shop for value
Physicians
Health Systems
Payment is migrating
to value-based
systems
Continued pressure
toward employment
Referring providers
bearing risk / in
narrow networks
Population Health is
strategic imperative
Payers pushing
service-line risksharing
Inpatient volumes
under pressure
Tech investment
consuming significant
capital
USPI well-positioned to capture share from savvy shoppers and through alignment of specialists and facilities
with risk-bearing PCPs and health systems
39
Demographics
Co-Morbidities
Aging population
driving joint
replacement
volumes
Osteoarthritis
affecting larger
share of
population
Smoking, diabetes,
obesity correlated with
osteoarthritis
Expected increase in
demand over next 20
years given higher
patient longevity
Increased prevalence of
obesity in hip
replacement patients
complicates outcomes
Weekend warriors
may require eventual
replacements following
arthroscopy
Clinical Innovations
Technology
improvements
driving utilization
Minimally invasive
surgical techniques
key innovation
53%
40%
34%
80%
Population growth
of 65+ year olds
from 2015 to 2030
Rate of osteoarthritis in
adults 65+ years old
Percent of people to
suffer from back pain
in their lifetime
40
2020
Quality
Partnerships
Service lines
New models
41
Outpatient / ambulatory
Health
system
Inpatient
Post-acute
Physicians
* Capabilities today
42
43
Ambulatory Segment
Pro Forma EBITDA by Quarter
$160
-30%
$140
$120
$100
-11%
-22%
-38%
-36%
Q1
Q2
Q3
$80
Q4
$60
$40
$20
$0
2011: USPI Only
Note: Percentages refer to the historical decline in EBITDA from the fourth quarter to the subsequent first quarter.
44
Revenue ($000s)
Systemwide
Growth
GAAP
Growth
2011
2012
2013
2014
2015
USPI Only
USPI Only
USPI Only
USPI Only
$1,975,715
13%
$499,178
5%
$2,203,577
12%
$540,235
8%
$2,329,143
6%
$616,231
14%
$2,523,000
8%
$641,000
4%
$3,579,000
15%
$1,366,000
18%
EBITDA ($000s)
Growth
$263,105
9%
$280,454
7%
$300,193
7%
$308,000
3%
$489,000
15%
$193,938
8%
$207,814
7%
$221,305
6%
$231,000
4%
$352,000
12%
0.6%
5.2%
2.5%
3.1%
-0.4%
1.1%
0.6%
3.9%
7.9%
3.6%
(1) The pro forma growth ra tes for 2015 were ca l cul a ted us i ng the pro forma res ul ts for Tenet's Ambul a tory s egment i n 2014. The pro forma
res ul ts for Tenet's Ambul a tory s egment i n 2015 a nd 2014 i ncl ude the res ul ts for USPI, As pen a nd the s urgery a nd i ma gi ng centers contri buted
by Tenet to the USPI joi nt venture.
(2) Pro forma EBITDA l es s NCI i n 2015 before s ubtra cting noncontrol l i ng i nteres t expens e rel a ted to Wel s h Ca rs on's a nd other pre-exi s ting
USPI s ha rehol ders 49.9% owners hi p i nteres t i n the USPI joi nt venture.
45
(1)
(2)
---------------------->
(3)
----->
Q1 '14
Q2 '14
Q3 '14
Q4 '14
Q1 '15
Q2 '15
Q3 '15
Q4 '15
Revenue
-0.3%
3.1%
5.1%
8.9%
8.8%
6.9%
10.1%
12.5%
Cases
-3.1%
-0.4%
2.9%
2.7%
4.7%
6.8%
6.3%
6.9%
2.9%
3.5%
2.2%
6.0%
3.9%
0.1%
3.5%
5.2%
(1) Same-facility system-wide includes the results of both consolidated and unconsolidated facilities.
(2) The growth rates presented for the quarters in calendar year 2014 and Q1'15 are based on the same-facility system-wide growth rates reported by USPIonly and exclude: a) the results of Aspen, and b) the surgery and imaging centers that Tenet contributed to the USPI joint venture.
(3) The pro forma growth rates shown for Q2'15, Q3'15 and Q4'15 include: a) USPI facilities, b) Aspen, and c) the surgery and imaging centers that Tenet
contributed to the USPI joint venture on a same-facility system-wide basis.
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Q1'14
Q2'14
Q3'14
Q4'14
Q1'15
Q2'15
Q3'15
Q4'15
$259
$286
$287
$308
$295
13.9%
$322
12.6%
$329
14.6%
$397
28.9%
$18
$28
$27
$43
$21
$28
$30
$47
EBITDA
% growth
$79
$110
$104
$134
$94
19.0%
$115
4.5%
$122
17.3%
$158
17.9%
$20
$27
$32
$33
$30
$22
$37
$48
$59
$83
$72
$101
$64
8.5%
$93
12.0%
$85
18.1%
$110
8.9%
$4
$12
$6
$16
$8
$13
$11
$21
$55
$71
$66
$85
$56
1.8%
$80
12.7%
$74
12.1%
$89
4.7%
30.5%
22.8%
38.5%
29.0%
36.2%
25.1%
43.5%
32.8%
31.9%
21.7%
35.7%
28.9%
37.1%
25.8%
39.8%
27.7%
(1)
(2)
(2)
EBITDA margin
EBITDA less NCI Margin (prior to Welsh Carson related NCI)
Note: These figures represent the pro forma financial results for Tenet's Ambulatory Care segment, including the results for USPI, Aspen and the surgery and imaging centers
contributed by Tenet to the USPI joint venture for all periods shown.
(1) Represents subsidiary level noncontrolling interest expense prior to Tenet recording additional noncontrolling interest expense related to Welsh Carson's and other preexisting USPI shareholders' 49.9% ownership interest in the USPI joint venture.
(2) The amount labeled as Welsh Carson related NCI represents noncontrolling interest expense related to Welsh Carson's and other pre-existing USPI shareholders' 49.9%
ownership interest in the USPI joint venture; neither Tenet nor USPI intend to make cash distributions to Welsh Carson or other pre-existing USPI shareholders.
(3) Welsh Carson related NCI expense was $37 million in Q4'15, but would have been $21 million excluding one-time gains. These one-time gains increased USPI's net
income by $32 million and resulted in a corresponding $16 million increase in net income attributable to noncontrolling interests. The $32 million of additional net income
was due to gains on the consolidation and deconsolidation of certain businesses in the fourth quarter of 2015; these gains are not included in EBITDA.
47