SEC Company Response from MEDICORE INC (CIK 0000008643) — Jun 29, 2005
MEDICORE INC (CIK 0000008643)
Date: June 29, 2005 · CIK: 0000008643 · Accession: 0001028212-05-000033
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File numbers found in text: 333-125515
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Medicore, Inc.
2337 West 76th Street
Hialeah, Florida 33016
Telephone: (305) 558-4000
Telecopier: (305) 825-0961
Jim B. Rosenberg
Senior Assistant Chief Accountant
Securities and Exchange Commission
450 Fifth Street
Washington, D.C. 02549
RE: Form 10-K for the fiscal year ended December 31, 2004
Medicore, Inc. (06906)
On June 3, 2004, Medicore, Inc.'s ("Medicore") subsidiary, Dialysis
Corporation of America ("DCA") filed a registration statement on Form S-4
(Registration No. 333-125515, "Registration Statement") with the Securities
and Exchange Commission ("Commission") relating to the merger whereby
Medicore will merge with and into DCA, the surviving company. A Medicore
proxy statement and DCA information statement were included in the
aforementioned Registration Statement as well as financial statements for
each of DCA and Medicore and pro forma financial information. Mr. Zafar
Hasan for Jeffrey Reidler, Assistant Director of the Division of Corporation
Finance ("Division") advised DCA on June 17, 2005, that the Commission was
not conducting a full review of the Form S-4, but will be monitoring for
resolution all issues in connection with a targeted accounting review of
DCA's and Medicore's annual reports on Form 10-K. Mr. Hasan noted the
monitoring of the Registration Statement for the signature of DCA's Chief
Accounting Officer, which signature, we have been advised, will be included
in DCA's pre-effective amendment no.1 to the Registration Statement.
On June 22, 2005, the Division provided comments requiring both DCA and
Medicore to provide information to better understand the disclosure provided
in each company's Form 10-K.
Following are our responses chronologically presented and numbered in
accordance with each of the Division's comments.
Item 7. Management's Discussion and Analysis of Financial Condition and ...
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page 40
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Critical Accounting Policies and Estimates, page 52
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1. Please provide to us the following about your accounting for revenue and
accounts receivable:
Response: DCA accounted for in excess of 98% of Medicore's 2004 sales
revenues. DCA's accounts receivable as of December 31, 2004,
comprised all but $42,000 of accounts receivable. In order to be
consistent with the responses to the Division's comments on the DCA
2004 Form 10-K, Medicore's responses to the Division's comments on
the Medicore 2004 Form 10-K are being addressed from a DCA
perspective in relation to accounts receivable and related items.
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* The steps you take in collecting accounts receivable, including
patient co-payments;
Response: The initial billing for services rendered is generated and
submitted monthly, no later than the 4th business day of the month
following the month in which services were rendered. Upon receipt
of payment from a primary payor, which typically ranges from 15 to
60 days after initial billing, secondary bills are generated, and
submitted to the secondary payor. Upon receipt of payment from the
secondary payor, which typically ranges from 15 to 60 days after
submission of billing to such payor, a third bill may be required
to an additional payor.
Once a patients' insurer has been billed and it has paid its
coverage, a bill will be generated to the patient for any remaining
balance or co-payments. The initial billing to a patient will
occur at any of the stages delineated above, depending on
applicable insurance coverage. Accounts are reviewed monthly. If
payments are not received, the patient will be contacted. An
additional bill along with a collection letter will be sent to the
patient. Unless paid, this process will continue for two
additional months with each communication being progressively
stronger in content. Patient uncollectible accounts will be
submitted to be written off no earlier that 120 days after the date
of the first collection letter.
All receivables are followed-up monthly to insure timely and
accurate payments are received.
On rare occasions, collection agencies are employed when patients
are paid directly by insurers for DCA services and do not forward
the funds to DCA.
* Your policy with respect to determining when a receivable is
recorded as a bad debt and when a write off is recorded, including
any thresholds (amount and age);
Response: Revenue is recognized and receivables recorded in the period
services are rendered.
DCA uses sound business judgment to establish that a receivable is
uncollectible when claimed as worthless and that there is no
likelihood of recovery at any time in the future.
Based on the procedure delineated in the prior response, once it
has been determined that all appropriate parties have been billed
for all covered DCA services and DCA has exhausted and documented
all collection efforts, DCA's collection department will submit
those uncollectible receivables for final approval by the Director
of Accounting and the V.P. of Finance. Upon approval the
uncollectible receivables will be written off.
* State whether your billing system generates contractual adjustments
based on fee schedules for the patient's insurance plan for each
patient encounter or if an estimate of contractual allowances is
made; if an estimate is made, state what factors are considered in
determining the estimate.
Response: DCA's billing system predominantly makes contractual adjustments
based on fee schedules for the patient's insurance plan. On
limited occasions, a patient's insurance plan fee schedule cannot
readily be determined. In those instances, an estimate of the
contractual rates is made. These estimates are based on historical
data using the fee schedule of patients with similar insurance
plans. Once the actual fee schedule for the
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patient in question is obtained, any adjustments to original
contractual rates are immediately made.
2. Please explain to us the following: (a) why your receivable balance at
December 31, 2004 increased substantially higher than your total sales for
2004 (b) why your allowance increased during 2004 and (c) why bad debt
expense decreased during 2003 as compared to 2002, and increased during 2004
as compared to 2003.
Response: (a) In the first half of 2003, the State of Georgia's Medicaid
program had implemented a new computer system and contractor
that created billing and collection delays for all service
providers in that state. As a result, DCA experienced
untimely collection in Georgia from mid-2003 until the end of
2004. This impacted DCA's six dialysis clinics located in
Georgia. As of the second quarter, 2005, DCA has begun to
receive the delayed Georgia Medicaid payments of 2003 and 2004
claims, and there has been improved processing of current
service claims by Georgia Medicaid.
Additionally, development of new dialysis centers temporarily
increases the aging of receivables. It can take up to six
months for a newly operating facility to experience the same
receivable turnover as an existing operation. DCA opened five
new dialysis centers during fiscal 2004.
(b) The provision for doubtful accounts is determined under a
variety of criteria, primarily the aging of the receivables,
historical collection trends, and payor mix. This is generally
a reflection of DCA's collection experience. Although
management believed that the delays relating to the claims (as
discussed in subparagraph (a) above) would be resolved and
payments made (as currently is the case), it determined to
take a conservative approach and include these receivables in
the provision for doubtful accounts. As a result, DCA added
$413,000 to doubtful accounts due to the issues with Georgia
Medicaid.
(c) Bad debt expense in 2003 reflected a Medicare bad debt
recovery of $341,000 as compared to a $52,000 recovery during 2002.
Medicare bad debt recovery amounts are determined based upon the
cost reports generated annually for each of DCA's centers. Before
consideration of Medicare bad debt recoveries, the provision for
doubtful accounts as a % of medical service revenue amounted to 3%
for 2004, 2% for 2003, and 3% for 2002.
3. Please provide to us the following information about your accounts
receivable:
* For each period presented, tell us and quantify the amount of
changes in estimates of prior contractual adjustments that you
recorded during the current period. For example, for 2004, this
amount would represent the amount of the difference between
estimates of contractual adjustments for services provided in 2003
and the amount of the new estimates or settlement amount that was
recorded during 2004.
Response: Contractual adjustments related to 2002 recorded in 2003 were
approximately $59,000 (1.4% of December 31, 2002 accounts
receivable), and contractual adjustments related to 2003 recorded
in 2004 were approximately $508,000 (8.9% of December 31, 2003
accounts receivable). Out of network providers represented the
largest portion of estimate changes. Out of network providers do
not generally provide fee schedules and
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coinsurance information. Historical trends and data provide
information on which to base contractual estimates.
* Explain and quantify the reasonably possible effects that a change
in estimate of unsettled amounts from 3rd party payors as of the
latest balance sheet date could have on financial position and
operations.
Response: With more historical data and newly gained experience with
additional centers in new markets, it is anticipated that a change
in estimates would impact our accounts receivable no more than 5%.
This would not significantly influence the financial position or
operations of DCA.
* Disaggregate self-payors from the commercial insurers and private
payors in your comparative tubular format for payor mix
concentrations and include the related aging of accounts
receivable. The aging schedule may be based on management's own
reporting criteria (i.e., unbilled, less than 30 days, 30 to 60
days etc.) or some other reasonable presentation. At a minimum,
indicate the past due amounts and a breakdown by payor
classification (i.e., Medicare, Medicaid, managed care and other,
and self-pay). We would expect self-pay to be separately
classified from any other grouping. If your billing system does
not have the capacity to provide an aging schedule of your
receivables, explain to us that fact and clarify how this affects
your ability to estimate your allowance for bad debts.
Response: Accounts Receivable Table attached as Schedule A.
* If you have amounts that are pending approval from third party
payors (i.e., Medicaid pending), please provide the balances of
such amounts, where they have been classified in your aging
buckets, and what payor classification they have been grouped with.
If amounts are classified outside of self-pay, tell us why this
classification is appropriate, and provide the historical
percentage of amounts that get reclassified into self-pay.
Response: Currently, there are no approvals pending for third party payors.
* The days sales outstanding for each period presented.
Response: The days sales outstanding is for 70 and 58 for December 31, 2004
and December 31, 2003, respectively.
Item 15(a)(1) and (2) - Financial Statements, page F-1
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Consolidated Statement of Operations, page F-5
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4. Please tell us why it is appropriate for you to include a gain on the sale
of a former subsidiary as part of your continuing operations in this
statement and your consolidated statements of cash flows, when (a) page F-26
apparently indicates that the sale was of your ownership in Techdyne, Inc.
and (b) page 39 apparently indicates that the sale had originally been
included as part of discontinued operations.
Response: This is a contingent gain related to the sale of Medicore's
interest in a former subsidiary for which no items related to the
discontinued operations had been reported in the two most recent
calendar years and for which there were, therefore, no comparative
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discontinued operation items reflected in Medicore's 2004
consolidated statement of operations. The gain was reported as a
separately identifiable item in Medicore's 2004 consolidated
statement of operations and disclosure was provided in the notes to
the consolidated financial statements and elsewhere in the 2004
Form 10-K concerning the nature of the gain.
Medicore considers its presentation of the gain was appropriate
considering that the gain was presented as a non-operating gain
rather than being included as part of income from operations and
detailed disclosure was provided as to its nature.
Consolidated Statements of Stockholders' Equity, page F-6
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5. Please tell us how you account for exercises of subsidiary stock options
and why it is appropriate for you to reduce equity for these exercises. In
so doing, please cite the specific literature (by pronouncement and
paragraph) supporting this.
Response: Medicore owns a majority interest in DCA with the remainder of the
ownership in DCA held by minority shareholders. Medicore and
minority interests represent relative ownership in the equity of
DCA. Exercise of DCA stock options increases the minority interest
ownership % in DCA and decreases Medicore's ownership % in DCA.
The amount by which Medicore's interest in the equity of DCA, its
subsidiary, given up as a result of the decrease in its ownership %
in DCA from subsidiary stock option exercises differs from
Medicore's interest in proceeds from the options exercised and
represents a change in Medicore's interest in the equity of DCA.
This change is reflected as a corresponding change in Medicore's
equity and in the minority interest in DCA presente