Welcome to the second of the eight investor webinars Tenet has planned for This afternoon s call focuses on Conifer Health Solutions.

Transcription

1 Tom Rice: Thank you Jeff, and good afternoon, everyone. Welcome to the second of the eight investor webinars Tenet has planned for This afternoon s call focuses on Conifer Health Solutions. Turning to the slides posted on Tenet s website about half an hour ago, slide #2 summarizes the qualifications regarding forward-looking statements. Please also refer to the note on forwardlooking statements contained in our annual report on Form 10-K. With that, it is now my pleasure to turn the call over to Trevor Fetter, Tenet s President and Chief Executive Officer. Trevor Trevor Fetter: Thank you, Tom, and good afternoon, everyone. We appreciate the positive feedback we received after last month s managed care webinar, and thanks for taking the time to join us today. Be sure to mark your calendars for our next webinar, featuring Kyle Burtnett, Vice President of our Outpatient Services Group. That call is scheduled for Thursday, June 7 th at 11:00 a.m. eastern. Turning to today s topic, I hope you ve had a chance to review the press release we issued a half hour ago regarding Conifer s new relationship with Catholic Health Initiatives. We are tremendously excited about the relationship, and we believe it adds materially to Conifer s contribution to creating shareholder value at Tenet. This new partnership between Tenet, Conifer, and CHI has great strategic value and is a true game changer for Conifer. This goes well beyond the profitability of the 10-year revenue cycle services contract. By adding CHI s 56 hospitals to its existing portfolio of clients, Conifer increases its position as a market leader in the healthcare revenue cycle services business. Catholic Health Initiatives is ideal as a partner and a large customer. They and their leadership are regarded very highly within our industry, which means that potential customers should feel even more confident when making a decision to use Conifer, and finally, CHI has important incentives to work with us to bring even more hospitals and hospital system clients into Conifer.

2 Pro Forma for the addition of CHI, and upon full implementation of the contract, Conifer will provide revenue cycle services to approximately 150 hospitals, and service $18 billion of revenue annually. This volume leverages Conifer s existing capabilities, and provides even greater economies of scale. Over the next half hour, Conifer President Steve Mooney will take you through Conifer s business and strategy. As you listen to his review, it should become clear that this is a business where scale matters, and there are barriers to achieving this scale. Over many years, Tenet has made the investment in Conifer that is necessary to achieve scale, to the tune of about $250 million to date, and we are delighted that CHI has chosen to join us in what should be a very rewarding future. As we have spoken to investors in recent years, we have communicated very clearly Tenet s intent to build on the capabilities that we ve developed through the ownership and management of acute care hospitals, and we are committed to offering these capabilities to third parties in the healthcare sector. We see this as a powerful strategy to both accelerate our growth, and to achieve important diversification of our business profile. To give you greater insight into Conifer s performance on a quarter-by-quarter basis, we plan to start reporting Conifer as a business segment beginning next quarter. While we are not disclosing that level of detail today, I can tell you that we expect to report Conifer s adjusted EBITDA for 2012 in a range of $90 million to $100 million, based on revenues in a range of $385 million to $425 million. The CHI contract is roughly breakeven in 2012 due to typical start-up expenses associated with vendor contracts. This is assumed in the numbers I just mentioned. In 2012, roughly 85 percent of Conifer s EBITDA will come from Tenet, and 15 percent will be generated by providing services to non-tenet, non-chi entities. I m sure you will wonder how this new deal affects our prior 2013 and 2015 Outlooks, which we reconfirmed last week. We re not re-forecasting every line item, but the portion of the Outlooks related to Conifer could now be viewed as conservative. With that, let me turn the call over to today s featured speaker, Conifer President Steve Mooney. Steve? Stephen Mooney Thanks, Trevor. Obviously, today is a very exciting day for Conifer. I would like to thank all of those who helped make this happen. I won t name each person, since the list is long, but I do want to express my appreciation to them all. I also appreciate the opportunity to talk about Conifer and the great things we re doing, not only for Tenet but for healthcare in general.

3 We are making a positive impact on our client hospitals and their patients, and I want to take the next 20 minutes or so to tell you how we are doing that. Just to give you an idea of what s ahead, I first plan to review the details of today s announcement and explain why it s such a game-changer. Then I ll briefly cover Conifer s history. I will focus on how we re operating today, and finally, I will discuss our strategies for further enhancing our leadership position in the industry. Let s start by turning to slide 3 in the presentation deck. I want to add a bit of color to the Catholic Health Initiatives or CHI news we announced this afternoon. We entered into this groundbreaking, 10-year, business process management partnership to manage the revenue cycle for 56 of CHI s hospitals. Conifer will be processing more than $6 billion in annual revenue for CHI, to bringing its approximately 2,500 revenue cycle employees into Conifer over the next eight months. As part of the agreement, CHI will become a minority partner in Conifer. We are excited about this opportunity because it provides visible recognition of Conifer s position in the revenue cycle industry, and further validates the need for this type of support for hospitals and healthcare systems even large ones like CHI. We see this partnership as a game changer for Conifer. This is a processing business, where scale and experience can drive significant advantages in cost efficiencies and operating capabilities. By expanding our volumes by more than 50 percent through this relationship, Conifer has clearly established itself as a leader in the healthcare revenue cycle business. The driving concept behind Conifer is that when each company maintains a tight focus on what it does best, everybody wins. Conifer s mission is to deploy expertise in revenue cycle practices, so its client hospitals can focus on delivering quality care to the patients they serve. This relationship with CHI provides an incredible opportunity to form a strategic partnership that benefits every stakeholder in all three organizations: Conifer, CHI and Tenet. This partnership confirms how important financial performance is to healthcare, and that it makes financial sense for healthcare providers to pursue this shared service business model, as the cost of managing health care continues to rise. So why did CHI select Conifer? Let s turn to slide 4. CHI first looked at its own financial and revenue cycle situation to assess whether it had any challenges or opportunities it needed to address. Once its leaders determined they did, in fact, see a need for revenue cycle performance, they then evaluated whether to make those changes on their own, or bring in outside, expert assistance. At that point, CHI engaged an outside consultant to help determine the scope of the work to be done, and how best to proceed.

4 After a thorough, exhaustive review, CHI weighed all of its options, and determined the best solution available was to partner with Conifer. While they gave us many reasons for their decision, they told us they felt the maturity of our operations, as well as our values, competency, patient-centric approach and transparency, were among the key differentiating factors. They realized we have created a solution that is hard to replicate, even for large healthcare systems. As a result of their decision, they said they now expect significant annual revenue cycle improvements through better management of their patient access, health information management, and patient financial services functions. We will accomplish this by using our more standardized and centralized operating model, which I ll talk about in detail later in this presentation. Moving to slide 5. We, of course, are very happy that CHI chose to partner with us, and we look forward to many years of working together. They are now at a point at which they will be able to focus entirely on their core strengths of patient care, quality and fulfilling their mission to their communities, while Conifer concentrates on improving and sustaining their financial performance to support that focus, in full alignment with their culture and values. Together, we ll develop a truly patient-centric approach that drives positive outcomes for patients, their families and their communities which in turn, will also be good in the long term for Conifer and CHI. Putting together an agreement like this caps about a decade of work for those of us leading our organization, because it was more than nine years ago when the idea for creating the company that would become Conifer was first considered. For those who aren t familiar with Conifer s history, let me quickly take you back to 2003, when we were known as the Patient Financial Services division of Tenet Healthcare Corporation, and tell you how those ideas brought us to where we are today. Please move to slide 6. Back in 2003, Tenet recognized that to address internal factors, like disparate systems and duplicate business offices, and external factors like decreasing reimbursements and changing regulatory environments, it had to improve its financial performance and focus on patient care. Then, it had the foresight to know that making operational improvements in the revenue cycle were critical to achieving both goals. But since there were no full-service revenue cycle providers at the time, Tenet had two choices: create a solution in-house, or buy needed services from consultants to manage dozens of vendors. Tenet chose to build this competency in-house, and once this business model was proven in Tenet s hospitals, we realized the concept and operational structure could improve the industry if other hospitals had access to it.

5 On slide 7 now. We then began putting together what would eventually become Conifer, and in late 2008, Conifer Health Solutions was launched as one of a very few healthcare services companies to provide revenue cycle transformation and patient communications services to hospitals and health systems nationwide. Conifer s strategic business model for driving maximum operational improvement is centered on fully integrating systems and proprietary workflows, as well as centralizing services in our existing operations centers, which we call our centers of excellence. Looking at slide 8, this business model is most successful when we transition our clients revenue cycle employees to Conifer employees, as we can bring to bear the full power of our productivity capabilities, and implement extensive training around our core values, leading to compliance, ethics, and personal and professional accountability. By assuming full operational management of a hospital s revenue cycle, including its people and processes, Conifer can typically achieve a 3 percent to 6 percent improvement in yield from enhanced revenue cycle operational performance. To give you some sense of the difference between 3 percent and 6 percent, when we start working with hospitals that already have a more mature revenue cycle operational model, which may include centralization and standardization, we would expect the yield increase to be more in line with 3 percent. On the other hand, when we work with hospitals that have a decentralized revenue cycle environment using disparate systems, we can achieve up to a 6 percent improvement. Now we re moving to slide 9. As we talk about delivering revenue cycle, or even our other services to hospitals and healthcare systems, I think it would make sense to take a moment and define the scope of our services, not just for revenue cycle offerings, but for all the elements within Conifer Health Solutions. Overall, including CHI, Conifer now provide services to some 380 healthcare entities, such as hospitals, diagnostic imaging centers, clinics, and physician groups. Our services fall into three areas of expertise. The first area is the one we ve talked about already: revenue cycle solutions. Let s go to slide 10. Before reaching agreement with CHI, we had about 100 hospital clients for which we provided some level of revenue cycle service, which includes patient access, revenue

6 integrity, and patient financial services. These hospitals combined represented over $11 billion of patient revenues and 5 million patient accounts processed annually. More specifically, starting on the left side of the slide, our revenue cycle services include, Patient Access includes pre-registration, registration, our medical eligibility program, financial counseling, and quality assurance. Moving to the right, revenue integrity includes charge description master (CDM) and health information management, which includes clinical coding. Patient financial services includes billing, follow-up, denial management, underpayment recovery, customer service, cash applications and clinical denials and appeals for all government and insurance payers, as well as self-pay collections and bad debt management. Among our current clients utilizing these services, in addition to Tenet and now CHI, were Memorial University Medical Center, an academic and medical center in Savannah, Georgia; Trinity Health, a non-profit, faith-based health system headquartered in Novi, Michigan; and the non-profit community hospitals that are in joint ventures with LHP Hospital Group in Plano, Texas. On slide 11 now. Our second operating area within Conifer is patient communications, which also began operating under the Conifer umbrella in Conifer patient communications offers four distinct services: marketing campaign support, scheduling, first-level clinical admission reviews, and post-visit outreach. We currently serve more than 250 healthcare entities from an operations center in Florida. As the only business process management solutions provider that focuses solely on delivering services throughout the entire continuum of patient care, Conifer s patient communications services range from creating a first impression, to facilitating access and follow-up communications, to building lasting customer relationships. On slide 12. Our third service area is capitation management. We have been part of Tenet, managing capitated contract risk, for more than 20 years. In 2011, we began offering cap management services to hospitals and healthcare systems under the Conifer name. Cap management provides capitation management services to risk-bearing healthcare providers, and is positioned to leverage a host of capabilities under healthcare reform. As part of delivering these services, cap management has developed deep actuarial capabilities to assess and manage clients financial risks. This business is assessing, and reassessing, to ensure appropriate care and quality, which will be required for hospitals to receive full funding in the future. We currently manage over 600,000 lives.

7 Now let s move to slide 13. As you do so, I will give you just a moment to compare it with slide 7. Looking more closely at the largest business within Conifer Health, our revenue cycle solutions business, we have grown our company substantially since our launch in In just 3-1/2 years, we have doubled our revenue under management from $9 billion to $18 billion and increased our client base from about 60 to more than 150 hospitals. We have about 3,800 revenue cycle staff members in our operating centers and client hospital locations, and we will add about 2,500 more CHI employees to handle that business. With this expansion in our base in employees we will benefit from scale. We can also provide enhanced career opportunities for our staff. On slide 14. Our training and career development for our staff is the cornerstone of our philosophy, as it truly takes people first, with process and technology right behind, to succeed in serving our hospital clients. As a healthcare service provider, we are a people-intensive business. Without our people, we will fail. We know that if our employees aren t well-trained, engaged, and provided with the proper tools and technology, we can t provide exceptional service to our hospital clients and their patients. Because we understand this, we work hard to ensure that our employees have the resources they need to do the best possible job for our hospital clients. This equates to training, a solid career path, a focus on the community, and an overall culture of unity, shared values, and recognition, all of which supports our patient centric approach. Now, just by way of explanation, I know I ve used the phrase patient-centric a couple of times. Those words are very important to us, as we carry out our mission. Let me define what we mean by this phrase. At Conifer, being patient-centric means putting the patient and his or her needs first. While it might seem obvious that patients are considered first and foremost in healthcare, we don t think it is something that should be left to chance. So we emphasize this point continually to ensure it is a primary focus of every Conifer employee every day. As part of two healthcare systems, Tenet for more than 30 years, and now CHI, we know how important it is to train our employees to be patient-centric in every interaction. We believe this approach is a real differentiator in the marketplace, and we re committed to it in every aspect of our business. In addition to this training, all of our employees participate in a very robust compliance program. Under the direction of Conifer s Chief Compliance Officer, employees and subcontracted vendors providing healthcare services are required to adhere to Conifer s Standards of Conduct and to take Conifer's annual general ethics and compliance training. We

8 also have a cross-functional team of lawyers, regulatory experts and compliance personnel, to ensure timely review of regulatory matters, as well as spearhead our ongoing regulatory monitoring process. Now, as we see on slide 15, beyond having highly skilled and trained employees, we have made significant investments to make sure they have the right tools. Namely, Tenet and Conifer have invested over $250 million in process and technology innovation. So let me review just a few of our tools that we believe differentiate Conifer in the marketplace, starting with patient self-service technologies. One of the keys to enhancing patient satisfaction is enabling the patients to use technology in the healthcare arena, just as they do in so many other aspects of their lives. People use self-service kiosks to purchase food at grocery stores and to check-in at the airport, so we offer similar self-service kiosks to our hospital clients and their patients. Today, Conifer uses kiosks and tablets in 10 hospitals. We are still maturing our self-service capabilities, and we have already measured a 35% reduction in employee time handling patients that checked in and signed forms on a kiosk, versus a completely manual process. As the functionality of our self-service technology grows, we will continue to see improved savings. Reducing the time for administration allows our patient access employees to engage with the patients and make them feel welcome in the hospital, which increases patient satisfaction. In addition to freeing up time for employees, it is also a major green initiative. The average hospital will save well in excess of ½ million pages of printed forms per year. While patients are in the hospital, we use technology extensively in our medical eligibility counseling service program. Using tablet computers, our counselors meet uninsured and under-insured patients to help them secure alternate funding sources to help with the financial aspects of their healthcare. In 2011, we found alternate funding sources for 125,000 of these Tenet patients. Our counselors also help the patients with budgeting for unexpected healthcare costs, understanding their personal out-of-pocket responsibility, and making referrals to financial and social assistance programs, all part of the patient-centric approach I mentioned earlier. Outside of the hospitals, and after receiving treatment, patients like the convenience of being able to pay for their services online using our 24/7 self-service access. Conifer facilitates over 100,000 online payments from patients at Tenet hospitals every year, and unlike many bill pay vendors, our patients have the ability to see the charge, adjustment and payment detail, so they understand the balance due. About 5% of patients elect to use online services to make payments today, and we expect, with our technology solutions, that number will grow significantly.

9 Turning to slide 16 now. While technology has been important for us in our direct dealings with patients, it is even more critical behind the scenes, helping us work more efficiently and effectively. Our revenue cycle management system has over 25 terabytes of active data, can handle thousands of concurrent users, and processes up to 50,000 transactions per second. In addition, Conifer has developed and implemented about 300,000 automated decision points in workflow into this proprietary revenue cycle management over the years. In order to make it easy for our clients to leverage our automation and technology investments, Conifer has created a robust set of integration services that will integrate with any primary vendor system currently used for patient financial services. These include patient accounting systems, clinical systems, and really, any system a hospital would have that would touch the revenue cycle. These workflows are used in all corners of our revenue cycle business, but there is no overall measure of what impact they ve had. We do measure the impact in each individual business area or project. In one study, we introduced a workflow that uses electronic claim status information to help develop better workflows for employees so they aren t manually following up on claims that are already determined to be clean. This generates a 30% reduction in daily workload for that team, and is typical of what we achieve with our workflows throughout the organization. We have a patent-pending proprietary decision engine and process called MicroSegmentation, which is used to match accounts with the optimal collection approach. This process identified 15 data elements as statistically significant based on regression analysis of actual Tenet data, including visit-specific variables, such as emergent vs. non-emergent, insurance coverage, patient address and phone number, and other factors, such as census data and payer variables. Conifer uses regression analytics to predict collectability and determine the optimal collection workflow path, so we know where best to focus our efforts and maximize productivity. We have models that predict the propensity to pay for early out, bad debt, and secondary bad debt collections. We also have models that predict day-to-pay for managed care and Medicaid payers, as well as models to predict co-pays, appeal effectiveness, financial-clearance-related denials, probability for qualifying for a government program or charity program, and probability for having a third-party liability funding source. In the case of our models for use with self-pay patients, they allow us to predict with better than 99% certainty which patients will pay with little intervention, which ones won t or can t pay, no matter how much you intervene, and which ones just need advice and counseling to help them through the payment process.

10 Of course, we also provide extensive training to our staff to ensure they always treat patients appropriately and with compassion, by taking a patient-centric approach and following our Conifer values of integrity, unity, service, innovation, recognition and respect. In addition to using technology as we work with patients, we also rely on it in working with government and commercial payers. In fact, Conifer has developed direct, automated connections with about 25 of our largest payers, including Medicare, United, Aetna, Cigna, and Anthem, who collectively account for about 80% of all volumes. We also have connections through a business partner to reach another 100 payers. Ultimately, all transactions will be automated, but today, this process allows communication from each payer to immediately enter our automated workflow process, which cuts the resolution time and produces better outcomes. Turning to slide 17. Utilizing this intricate combination of people, process and technology is the key to our success. It is a mixture that we have found is difficult to replicate, and a significant barrier to entry for others that might consider moving into this space. We have been very open about what it has taken for us to achieve what we have. Hospitals, healthcare systems and even competitors know what we have put into Conifer, they realize how incredibly difficult it would be to attempt something similar on their own. We have created a leading brand in our industry. It has most recently helped us form our partnership with CHI, and we re confident it will help us with other prospective clients in the future. We don t ask anyone just to take our word for it. Our achievements have been recognized by a couple of very important industry organizations, and we are very proud to have them. First, Conifer s business office management solution has been granted a Peer Reviewed by HFMA designation for two consecutive years. HFMA is the Healthcare Financial Management Association, and has completed a peer review process on Conifer to validate that our services meet the standards for effectiveness, quality, price, value and customer support. Peerreviewed selection focuses on two critical areas of A/R management for healthcare: One area is third-party billing and follow-up for Medicare, Medicaid, and Insurance payers and the other area is self-pay and bad debt collection. Second, Conifer is one of a select few premier corporate partners of the American College of Healthcare Executives, known as ACHE, and is the only revenue cycle management company with such a designation. ACHE chooses its premier partners based on each company s ability to demonstrate a commitment to the future of healthcare leadership and improve healthcare delivery.

11 In Conifer s case, we are able to help ACHE s members take advantage of groundbreaking approaches to improving their financial performance and patient satisfaction simultaneously. In return, ACHE helps us build relationships with healthcare executives to better understand the challenges they face, while sharing with them the latest trends and lessons learned in patient communications and healthcare finance, particularly about revenue cycle management and hospital compliance. Turning to slide 18. As we look to the future, we have the energy and enthusiasm of a 3-1/2 year old company. And we have the experience of a more than 30-year-old healthcare provider organization. What we offer the marketplace are services we literally and candidly developed at Tenet s expense. Being partnered with Tenet for more than three decades has been like working in a laboratory or test environment. We have developed and refined hundreds of thousands of laboratory processes, and built hundreds of millions of dollars worth of proprietary technology. We have created and conducted extensive training for our employees. The services we take to the marketplace are thoroughly tested and ready for implementation. This has allowed us to establish Conifer as one of the market s few sure-play healthcare business process management providers. Unlike most other companies in our space, we aren t developing software for sale or managing IT; and we aren t consultants offering a strategy for someone else to build and manage. We are a healthcare service provider working to improve operational performance for our clients so they can better market to their community, communicate effectively with patients, and support patient financial administration. Our initial service offerings from 2008 have expanded to support health information management and ICD-10, risk and capitation management, ACO and bundled payment processing. We also have an unparalleled focus on efficiency and productivity in what we call a process focused organization. Conifer s approach is to deploy lean manufacturing and six sigma methodologies to bring a level of actionable, real-time information that allows us to measure cycle times, cost per account and fall-out rates, so that we can set goals for each process, in addition to the standard performance metrics. Specialists are dedicated to evaluate process performance, and a job is constantly created to make the most efficient process possible. One example is that we have a behavioral economist on staff researching how we communicate with patients. Among the issues facing hospitals working with the under- and uninsured population and people s apathy and people s confusion about their bills. We have been

12 conducting research studies into consumer motivation around healthcare bills, testing different messaging and measuring the results. We believe if we can find better ways to connect with people, we can get the opportunity to help them qualify for government or charity programs, which helps both the patients and the hospital. As you would expect, these investments can only be justified given the sufficient scale to reap benefits of these process improvements. While Conifer had the scale prior to CHI, the incremental scale gained from the CHI volume will leverage these capabilities to an even greater extent, and widen the competitive distance between Conifer and others striving to establish credibility in the revenue cycle space. Our operations department is then focused on meeting production and quality goals in our centralized operations centers by eliminating the responsibility for process and system issues. Implementing this strategy has produced optimal efficiencies for our team, but more importantly, has helped us continue to produce the financial performance results our hospital clients expect. Following a process-focused organization model allows us to be more proactive, too. Rather than run reports, look for trends and then develop action plans based on history, we can proactively predict cash flow and aging by payer, client or business line. As an example, our system will notify us of changes in payer behavior as soon as a change becomes statistically significant. This allows us to contact a payer earlier than we had before. Lastly, we understand the integral parts of both ACOs and bundled payments. They include: the ability to aggregate clinical data, manage clinical and financial transactions, manage populations with chronic disease in the ambulatory setting, and provide analytical services to caregivers to improve clinical outcomes and the efficiency of care. Our cap management organization is leading the way in this area, and will ensure Conifer is at the forefront of the future of healthcare. Also, we know that doing a good job is the only way hospitals will be rewarded. The new hospital value-based purchasing program implemented as part of the Affordable Care Act assures exactly that. According to CMS, "hospitals that perform well on quality measures relating both to clinical process of care and to patient experience of care or those making improvements in their performance on those measures, would receive higher payments." So if hospitals choose Conifer to comprehensively manage patient access and patient accounting, this will provide their patients with a positive experience required to achieve successful ratings, and give them the ability to focus more time, energy, and financial resources on quality patient care and the overall patient experience. In addition, Conifer s patient

13 communication solutions will give hospitals the ability to strategically administer patient satisfaction and HCAHPS surveys to patients upon discharge. As we look to grow the company in the years ahead, we see a marketplace that is just developing. While the leaders in the revenue cycle industry collectively have hundreds of hospital clients today, in the years ahead, we expect that number to increase substantially. To capture our share of this dynamic and evolving market, and maintain our position as a market leader, we will continue to follow the growth strategies that have served us well. We will keep looking for growth at individual hospitals and healthcare systems, something that has brought us most of our new clients thus far. We have a solid pipeline of potential customers, and we are confident our new agreement with CHI will accelerate that pipeline even greater. We will also seek acquisitions, as we did in late 2010 when we acquired a Health Information Management company to enhance our offerings and give us a competitive advantage. One area we know we need to look at, for example, is in physician revenue cycle management. As more healthcare delivery gets integrated, we need to further develop our solutions that support the full continuum of care. We will keep looking for acquisition opportunities that help maintain and extend our scale advantage, and bring us even better processes or technology for our clients. In closing, let me leave you with the slogan that guides our approach to the work we do: Expert, focused, human. Which means we are experts in providing business process management solutions. We are focused on enhancing financial performance and patient satisfaction. And we deliver services with a caring, human touch. Utilizing our experience and expertise across our service offerings, we know Conifer is well-positioned to lead healthcare business process management in the future. We are also well-positioned around healthcare reform, and are ready to help our clients navigate the financial challenges all hospitals are facing in the current environments. Our new partnership with CHI will help us further demonstrate all of this to the marketplace, as we continue to grow our company by helping hospitals and healthcare systems provide quality care, serving their patients, and fulfilling their missions in their communities. I appreciate everyone taking time this afternoon to allow us to tell you about Conifer. I ll now turn the call back over to Trevor before we start Q & A. Trevor Trevor Fetter: Thank you, Steve.

14 Before starting our Q&A, let me remind listeners that we do not intend to provide additional financial data with regard to this transaction during our Q&A, so please direct your questions to Steve Mooney and his team and keep them focused on the business of Conifer and today s announcement. With that, I ll ask the operator to assemble the queue for questions. Operator ###