UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-Q
(MARK ONE)
☒QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR THE QUARTERLY PERIOD ENDED June 30, 20212022
 OR

☐TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR THE TRANSITION PERIOD FROM _____TO _____

COMMISSION FILE NUMBER 1-11151


U.S. PHYSICAL THERAPY, INC.
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)


NEVADA 76-0364866
(STATE OR OTHER JURISDICTION OF INCORPORATION OR ORGANIZATION) (I.R.S. EMPLOYER IDENTIFICATION NO.)

1300 WEST SAM HOUSTON PARKWAY SOUTH, SUITE 300, HOUSTON, TEXAS
 77042
(ADDRESS OF PRINCIPAL EXECUTIVE OFFICES) (ZIP CODE)

REGISTRANT’S TELEPHONE NUMBER, INCLUDING AREA CODE: (713) 297-7000

Title of each classTrading Symbol(s)Name of each exchange on which registered
Common Stock, $.01 par valueUSPHNew York Stock Exchange

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    ☒  Yes     ☐  No

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted and pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and such files).   ☒  Yes     ☐  No

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer☑Accelerated filer☐
Non-accelerated filer
☐ (Do not check if a smaller reporting company)
Smaller reporting company☐
  Emerging growth company☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    ☐  Yes    ☒  No

Title of each class
Trading
Symbol(s)
Name of each exchange on which registered
Common Stock, $.01 par valueUSPHNew York Stock Exchange

As of August 9, 2021,8, 2022, the number of shares outstanding (issued less treasury stock) of the registrant’s common stock, par value $.01 per share, was: 12,906,932.13,004,245.



PART I—FINANCIAL INFORMATION - UNAUDITED
 
Item 1.
Financial Statements.
3
   
 
Consolidated Balance Sheets as of June 30, 20212022 and December 31, 20202021
3
   
 
Consolidated Statements of Income for the three and six months ended June 30, 20212022 and 20202021
4
Consolidated Statements of Comprehensive Income for the three and six months ended June 30, 2022 and 2021
5
   
 
Consolidated Statements of Cash Flows for the six months ended June 30, 20212022 and 20202021
56
   
 
Consolidated Statements of Changes in Equity for the three months and six months ended June 30, 20212022 and 20202021
67
   
 
Notes to Consolidated Financial Statements
78
   
Item 2.
Management’s Discussion and Analysis of Financial Condition and Results of Operations
2931
   
Item 3.
Quantitative and Qualitative Disclosure About Market Risk
46
   
Item 4.
Controls and Procedures
4647
  
PART II—OTHER INFORMATION 
  
Item 1.
Legal Proceedings
47
  
Item 6.
Exhibits
4849
   
 
Signatures
49
   
 Certifications 


2
Table of ContentsIndex

ITEM 1.FINANCIAL STATEMENTS.

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
(IN THOUSANDS, EXCEPT SHARE DATA)

 June 30, 2021  December 31, 2020  June 30, 2022  December 31, 2021 
ASSETS (unaudited)     (unaudited)    
Current assets:            
Cash and cash equivalents $20,419  $32,918  $48,572  $28,567 
Patient accounts receivable, less allowance for credit losses of $2,435 and $2,008, respectively
  45,144   41,906 
Patient accounts receivable, less allowance for credit losses of $2,948 and $2,768, respectively
  50,549   46,272 
Accounts receivable - other  9,025   9,039   18,915   16,144 
Other current assets  5,111   3,773   3,810   4,183 
Total current assets  79,699   87,636   121,846   95,166 
Fixed assets:                
Furniture and equipment  57,538   55,426   60,379   58,743 
Leasehold improvements  35,986   35,320   41,038   39,194 
Fixed assets, gross  93,524   90,746   101,417   97,937 
Less accumulated depreciation and amortization  71,964   69,081   77,188   74,958 
Fixed assets, net  21,560   21,665   24,229   22,979 
Operating lease right-of-use assets  87,090   81,595   101,274   96,427 
Investment in unconsolidated affiliate
  12,346   12,215 
Goodwill  373,887   345,646   442,761   434,679 
Other identifiable intangible assets, net  59,216   56,280   92,655   86,382 
Other assets  1,506   1,539   1,333   1,578 
Total assets $622,958  $594,361  $796,444  $749,426 
        
LIABILITIES, REDEEMABLE NON-CONTROLLING INTERESTS, USPH SHAREHOLDERS’ EQUITY
AND NON-CONTROLLING INTERESTS
        
LIABILITIES, REDEEMABLE NON-CONTROLLING INTEREST, USPH SHAREHOLDERS’ EQUITY AND NON-CONTROLLING INTEREST        
Current liabilities:                
Accounts payable - trade $1,782  $1,335  $3,793  $3,268 
Accounts payable - due to seller of acquired business
  3,203   3,203 
Accrued expenses  44,720   59,746   41,246   45,705 
Current portion of operating lease liabilities  27,860   27,512   32,083   30,475 
Current portion of notes payable  1,017   4,899 
Current portion of term loan and notes payable  4,780   830 
Total current liabilities  75,379   93,492   85,105   83,481 
Notes payable, net of current portion  821   596   4,258   3,587 
Revolving line of credit  38,000   16,000   0   114,000 
Term Loan, net of current portion and deferred financing costs
  144,631   0 
Deferred taxes  8,281   7,779   19,483   14,385 
Operating lease liabilities, net of current portion  66,887   61,985   77,776   74,185 
Other long-term liabilities  5,442   4,539   4,858   7,345 
Total liabilities  194,810   184,391   336,111   296,983 
                
Redeemable non-controlling interests - temporary equity  143,337   132,340 
Redeemable non-controlling interest - temporary equity  151,400   155,262 
                
Commitments and Contingencies  0   0   
   
 
                
U.S. Physical Therapy, Inc. (“USPH”) shareholders’ equity:                
Preferred stock, $0.01 par value, 500,000 shares authorized, 0 shares issued and outstanding
  0   0   0   0 
Common stock, $0.01 par value, 20,000,000 shares authorized, 15,121,669 and 15,066,282 shares issued, respectively
  151   151 
Common stock, $0.01 par value, 20,000,000 shares authorized, 15,218,982 and 15,126,160 shares issued, respectively
  152   151 
Additional paid-in capital  99,039   95,622   106,801   102,688 
Accumulated other comprehensive loss
  (395)  0 
Retained earnings  216,286   212,015   232,247   224,395 
Treasury stock at cost, 2,214,737 shares
  (31,628)  (31,628)  (31,628)  (31,628)
Total USPH shareholders’ equity  283,848   276,160   307,177   295,606 
Non-controlling interests - permanent equity  963   1,470 
Total USPH shareholders’ equity and non-controlling interests - permanent equity  284,811   277,630 
Total liabilities, redeemable non-controlling interests,        
USPH shareholders’ equity and non-controlling interests - permanent equity $622,958  $594,361 
Non-controlling interest - permanent equity  1,756   1,575 
Total USPH shareholders’ equity and non-controlling interest - permanent equity  308,933   297,181 
Total liabilities, redeemable non-controlling interest,        
USPH shareholders’ equity and non-controlling interest - permanent equity $796,444  $749,426 

See notes to consolidated financial statements.

3
Table of ContentsIndex

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF INCOME
(IN THOUSANDS, EXCEPT PER SHARE DATA)
(unaudited)

 Three Months Ended  For the Six Months Ended  Three Months Ended   Six Months Ended 
 June 30, 2021  June 30, 2020  June 30,2021  June 30, 2020  June 30, 2022  June 30, 2021  June 30,2022  June 30, 2021 
                        
Net patient revenues $113,238  $72,279  $212,492  $172,405 
Other revenues  13,690   11,578   26,804   24,169 
Net revenues  126,928   83,857   239,296   196,574 
Operating costs:                
Net patient revenue $118,196  $113,238  $227,734  $212,492 
Other revenue  22,460   13,690   44,626   26,804 
Net revenue  140,656   126,928   272,360   239,296 
Operating cost:                
Salaries and related costs  68,866   43,429   132,681   112,433   79,939   68,866   155,088   132,681 
Rent, supplies, contract labor and other  22,416   20,311   43,836   43,220   28,345   22,394   57,007   43,851 
Provision for credit losses  1,364   739   2,564   2,100   1,551   1,364   2,856   2,564 
Closure costs - lease and other  (22)  94   15   1,987 
Closure costs - derecognition of goodwill  0   0   0   1,859 
Total operating costs  92,624   64,573   179,096   161,599 
Total operating cost  109,835   92,624   214,951   179,096 
                                
Gross profit  34,304   19,284   60,200   34,975   30,821   34,304   57,409   60,200 
                                
Corporate office costs  12,074   9,022   22,948   20,699   10,741   12,074   22,297   22,948 
Operating income  22,230   10,262   37,252   14,276   20,080   22,230   35,112   37,252 
                                
Other income and expense:                
Relief Funds  0   7,959   0   7,959 
Gain on sale of partnership interest and clinics  0   1,073   0   1,073 
Other income and expense                
Equity in earnings of unconsolidated affiliate  340   0   679   0 
Interest and other income, net  46   4   100   47   679   46   725   100 
Loss on revaluation of put-right liability  (617)  0   (14)  0 
Interest expense - debt and other  (237)  (653)  (483)  (1,080)  (987)  (237)  (1,527)  (483)
Total other income and expense  (191)  8,383   (383)  7,999   (585)  (191)  (137)  (383)
Income before taxes  22,039   18,645   36,869   22,275   19,495   22,039   34,975   36,869 
Provision for income taxes  4,567   3,882   7,511   4,174   4,239   4,567   7,737   7,511 
                                
Net income $17,472  $14,763  $29,358  $18,101  
15,256  
17,472  
27,238  
29,358 
                                
Less: net income attributable to non-controlling interests:                
Redeemable non-controlling interests - temporary equity  (3,611)  (2,996)  (6,064)  (4,792)
Non-controlling interests - permanent equity  (1,425)  (1,535)  (2,685)  (2,061)
Less: net income attributable to non-controlling interest:                
Redeemable non-controlling interest - temporary equity  (2,626)  (3,611)  (5,183)  (6,064)
Non-controlling interest - permanent equity  (1,435)  (1,425)  (2,061)  (2,685)
 $(5,036) $(4,531) $(8,749) $(6,853) 
(4,061) 
(5,036) 
(7,244) 
(8,749)
                                
Net income attributable to USPH shareholders $12,436  $10,232  $20,609  $11,248  $11,195  $12,436  $19,994  $20,609 
                                
Basic and diluted earnings per share attributable to USPH shareholders $0.82  $0.99  $1.03  $1.19  $0.87  $0.82  $1.55  $1.03 
                                
Shares used in computation - basic and diluted  12,902   12,843   12,886   12,820   12,998   12,902   12,968   12,886 
                                
Dividends declared per common share $0.35  $0  $0.70  $0.32  $0.41  $0.35  $0.82  $0.70 

See notes to consolidated financial statements.

4
Table of ContentsIndex
U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME
(IN THOUSANDS, EXCEPT PER SHARE DATA)
(unaudited)

  Three Months Ended  For the Six Months Ended 
  June 30, 2022
  June 30, 2021
  June 30, 2022
  June 30, 2021
 
             
Net income $15,256  $17,472  $27,238  $29,358 
Other comprehensive loss                
Unrealized loss on cash flow hedge  (531)  0   (531)  0 
Tax effect at statutory rate (federal and state) of 25.55%
  136   0   136   0 
Comprehensive income $14,861  $17,472  $26,843  $29,358 
                 
Comprehensive income attributable to non-controlling interest  (4,061)  (5,036)  (7,244)  (8,749)
Comprehensive income attributable to USPH shareholders $10,800  $12,436  $19,599  $20,609 

5
Index
U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
(IN THOUSANDS)
(unaudited)

 Six Months Ended  Six Months Ended 
 June 30, 2021  June 30, 2020  June 30, 2022  June 30, 2021 
OPERATING ACTIVITIES            
Net income including non-controlling interests $29,358  $18,101 
Adjustments to reconcile net income including non-controlling interests to net cash provided by
operating activities:
        
Net income including non-controlling interest and earnings from unconsolidated affiliates, net
 $27,238  $29,358 
Adjustments to reconcile net income including non-controlling interest to net cash provided by operating activities:        
Depreciation and amortization  5,484   5,333   7,298   5,484 
Provision for credit losses  2,564   2,100   2,856   2,564 
Equity-based awards compensation expense  3,405   3,389   3,660   3,405 
Deferred income taxes  3,160   (1,737)  4,307   3,160 
Loss on sale of fixed assets  106   429 
Gain on sale of partnership interest  0   (1,073)
Derecognition (write-off) of goodwill - closed clinics  0   1,859 
Loss on revaluation of put-right liability  14   0 
(Gain) loss on sale of clinics and fixed assets  (614)  106 
Earnings in unconsolidated affiliate
  (679)  0 
Changes in operating assets and liabilities:                
(Increase) decrease in patient accounts receivable  (5,325)  8,880 
Decrease in accounts receivable - other  129   283 
Increase in patient accounts receivable  (7,459)  (5,325)
(Increase) decrease in accounts receivable - other  (2,862)  129 
(Increase) decrease in other assets  (255)  5,969   230   (255)
(Decrease) increase in accounts payable and accrued expenses  (3,672)  4,478 
Increase in other long-term liabilities  602   345 
Decrease in accounts payable and accrued expenses
  (3,891)  (3,672)
(Decrease) increase in other long-term liabilities  (2,587)  602 
Net cash provided by operating activities  35,556   48,356   27,511   35,556 
                
INVESTING ACTIVITIES                
Purchase of fixed assets  (3,301)  (4,628)  (4,569)  (3,301)
Purchase of majority interest in businesses, net of cash acquired  (20,402)  (11,633)  (11,799)  (20,402)
Purchase of redeemable non-controlling interest, temporary equity  (9,536)  (2,388)  (8,648)  (9,536)
Purchase of non-controlling interest, permanent equity  0   (144)  (156)  0 
Proceeds on sale of redeemable non-controlling interest, temporary equity  32   19 
Proceeds on sales of partnership interest, clinics and fixed assets  (168)  695   740   (168)
Distributions from unconsolidated affiliate
  548
   0
 
Proceeds on sales of redeemable non-controlling interest-temporary  344   32 
Net cash used in investing activities  (33,375)  (18,079)  (23,540)  (33,375)
                
FINANCING ACTIVITIES                
Distributions to non-controlling interests, permanent and temporary equity  (9,398)  (5,707)
Distributions to non-controlling interest, permanent and temporary equity  (7,202)  (9,398)
Cash dividends paid to shareholders  (9,028)  (4,110)  (10,659)  (9,028)
Proceeds from revolving line of credit  128,000   99,000   61,000   128,000 
Proceeds from term loan
  150,000   0 
Payments on revolving line of credit  (106,000)  (112,000)  (175,000)  (106,000)
Principal payments on notes payable  (4,207)  (314)  (338)  (4,207)
(Payment) receipt of Medicare Accelerated and Advance Funds  (14,054)  12,861   0   (14,054)
Payment of deferred financing costs
  (1,779)  0 
Other  7   0   12   7 
Net cash used in financing activities  (14,680)  (10,270)  16,034   (14,680)
                
Net (decrease) increase in cash and cash equivalents  (12,499)  20,007 
Net decrease in cash and cash equivalents  20,005   (12,499)
Cash and cash equivalents - beginning of period  32,918   23,548   28,567   32,918 
Cash and cash equivalents - end of period $20,419  $43,555  $48,572  $20,419 
                
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION                
Cash paid during the period for:                
Income taxes $6,967  $57  $4,524  $6,967 
Interest $741  $944 
Interest paid
 $1,319  $741 
Non-cash investing and financing transactions during the period:                
Purchase of businesses - seller financing portion $550  $300  $374  $550 
Purchase of businesses - payable $1,000  $0 
Purchase of redeemable non-controlling interest - notes payable $0  $137 
Purchase of businesses - contingent consideration
 $
0  $
1,000 
Notes payable related to purchase of redeemable non-controlling interest, temporary equity
 $948  $0 
Notes payable due to purchase of non-controlling interest, permanent equity $0  $699  $296  $0 
Note receivables related to sale of partnership interest $287  $386 
Notes receivable related to sale of partnership interest
 $
0  $
287 
Notes receivable related to sale of partnership interest - redeemable non-controlling interest
 $
1,476  $
0 

See notes to consolidated financial statements.

5
6
Table of ContentsIndex

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY
(IN THOUSANDS)
(unaudited)

  U.S.Physical Therapy, Inc.       
 Common Stock  Additional  Retained  Treasury Stock  Total Shareholders’  Non-Controlling    
For the three months ended June 30, 2021
 Shares  Amount  Paid-In Capital  Earnings  Shares  Amount  Equity  Interests  Total 
                            
Balance March 31, 2021  15,111  $151  $97,286  $210,375   (2,215) $(31,628) $276,184  $1,057  $277,241 
Issuance of restricted stock, net of cancellations  10   0   0   0   0   0   0   0   0 
Revaluation of redeemable non-controlling interest, net of tax  0   0   0   (1,897)  -   0   (1,897)  0   (1,897)
Compensation expense - equity-based awards  -   0   1,754   0   -   0   1,754   0   1,754 
Dividends paid to USPT shareholders  -   0   0   (4,514)  -   0   (4,514)  0   (4,514)
Distributions to non-controlling interest partners - permanent equity  -   0   0   0   -   0   0   (1,510)  (1,510)
Other  -   0   (1)  (114)  -   0   (115)  (9)  (124)
Net income attributable to non-controlling interest - permanent equity  -   0   0   0   -   0   0   1,425   1,425 
Net income attributable to USPH shareholders  -   0   0   12,436   -   0   12,436   0   12,436 
Balance June 30, 2021
  15,121  $151  $99,039  $216,286   (2,215) $(31,628) $283,848  $963  $284,811 
  U.S.Physical Therapy, Inc.       
  Common Stock  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Treasury Stock  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
For the three months ended June 30, 2022 Shares  Amount  Shares  Amount 
Balance March 31, 2022 $15,206   151  $105,205   0  $227,243   (2,215) $(31,628) $300,971  $1,245  $302,216 
Issuance of restricted stock, net of cancellations  13   1   0   0   0   0   0   1   0   1 
Revaluation of redeemable non-controlling interest, net of tax  0   0   0   0   116   0   0   116   0   116 
Compensation expense - equity-based awards  -   0   1,814   0   0   -   0   1,814   0   1,814 
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans  -   0   1   0   0   -   0   1   0   1 
Purchase of partnership interests -  non-controlling interest  -   0   (219)  0   0   -   0   (219)  239   20 
Dividends paid to USPH shareholders  -   0   0   0   (5,332)  -   0   (5,332)  0   (5,332)
Distributions to non-controlling interest partners - permanent equity  -   0   0   0   0   -   0   0   (1,163)  (1,163)
Deferred taxes related to redeeemable non-controlling interest - temporary equity  -   0   0   0   (1,486)  -   0   (1,486)  0   (1,486)
Other  -   0   0   0   511   -   0   511   0   511 
Net income attributable to non-controlling interest - permanent equity  -   0   0   0   0   -   0   0   1,435   1,435 
Net income attributable to USPH shareholders  -   0   0   0   11,195   -   0   11,195   0   11,195 
Other comprehensive loss  -   0   0   (395)  0   -   0   (395)  0   (395)
Balance June 30, 2022  15,219   152  $106,801  $(395) $232,247   (2,215) $(31,628) $307,177  $1,756  $308,933 

 U.S.Physical Therapy, Inc.        U.S.Physical Therapy, Inc.       
 Common Stock  Additional  Retained  Treasury Stock  Total Shareholders’  Non-Controlling     Common Stock  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Treasury Stock  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
For the six months ended June 30, 2021
 Shares  Amount  Paid-In Capital  Earnings  Shares  Amount  Equity  Interests  Total 
                           
Balance December 31, 2020
  15,065  $151  $95,622  $212,015   (2,215) $(31,628) $276,160  $1,470  $277,630 
For the six months ended June 30, 2022 Shares  Amount  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Shares  Amount  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
Balance December 31, 2021 $15,126   151   (2,215) $(31,628)
Issuance of restricted stock, net of cancellations  56   0   0   0   0   0   0   0   0   93   1   0   0   0   0   0   1   0   1 
Revaluation of redeemable non-controlling interest, net of tax  -   0   0   (7,310)  -   0   (7,310)  0   (7,310)  -   0   0   0   3   -   0   3   0   3 
Compensation expense - equity-based awards  -   0   3,403   0   -   0   3,403   0   3,403   -   0   3,660   0   0   -   0   3,660   0   3,660 
Dividends paid to USPT shareholders  -   0   0   (9,028)  -   0   (9,028)  0   (9,028)
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans  -   0   707   0   0   -   0   707   0   707 
Purchase of partnership interests - non-controlling interest  -   0   (265)  0   0   -   0   (265)  (95)  (360)
Dividends paid to USPH shareholders  -   0   0   0   (10,659)  -   0   (10,659)  0   (10,659)
Distributions to non-controlling interest partners - permanent equity  -   0   0   0   -   0   0   (3,182)  (3,182)  -   0   0   0   0   -   0   0   (2,471)  (2,471)
Short swing profit settlement  -   0   13   0   -   0   13   0   13 
Deferred taxes related to redeeemable non-controlling interest - temporary equity  -   0   0   0   (1,486)  -   0   (1,486)  0   (1,486)
Other  -   0   1   0   -   0   1   (10)  (9)  -   0   11   0   0   -   0   11   686   697 
Net income attributable to non-controlling interest - permanent equity  -   0   0   0   -   0   0   2,685   2,685   -   0   0   0   0   -   0   0   2,061   2,061 
Net income attributable to USPH shareholders  -   0   0   20,609   -   0   20,609   0   20,609   -   0   0   0   19,994   -   0   19,994   0   19,994 
Balance June 30, 2021
  15,121  $151  $99,039  $216,286   (2,215) $(31,628) $283,848  $963  $284,811 
Other comprehensive loss  -   0   0   (395)  0   -   0   (395)  0   (395)
Balance June 30, 2022  15,219   152  $106,801  $(395) $232,247   (2,215) $(31,628) $307,177  $1,756  $308,933 

 U.S.Physical Therapy, Inc.        U.S.Physical Therapy, Inc.       
 Common Stock  Additional  Retained  Treasury Stock  Total Shareholders’  Non-Controlling     Common Stock  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Treasury Stock  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
For the three months ended June 30, 2020
 Shares  Amount  Paid-In Capital  Earnings  Shares  Amount  Equity  Interests  Total 
                           
Balance March 31, 2020  15,059  $151  $89,756  $182,785   (2,215) $(31,628) $241,064  $1,240  $242,304 
For the three months ended June 30, 2021 Shares  Amount  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Shares  Amount  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
Balance March 31, 2021  15,111   151   (2,215) $(31,628)
Issuance of restricted stock, net of cancellations  (1)  0   0   0   0   0   0   0   0   10   0   0   0   0   0   0   0   0   0 
Revaluation of redeemable non-controlling interest, net of tax  0   0   0   2,466   0   0   2,466   0   2,466   0   0   0   0   (1,897)  0   0   (1,897)  0   (1,897)
Compensation expense - equity-based awards  -   0   1,502   0   -   0   1,502   0   1,502   -   0   1,754   0   0   -   0   1,754   0   1,754 
Dividends paid to USPT shareholders  -   0   0   0   (4,514)  -   0   (4,514)  0   (4,514)
Distributions to non-controlling interest partners - permanent equity  -   0   0   0   -   0   0   (1,313)  (1,313)  -   0   0   0   0   -   0   0   (1,510)  (1,510)
Other  -   0   0   (10)  -   0   (10)  (28)  (38)  -   0   (1)  0   (114)  -   0   (115)  (9)  (124)
Net income attributable to non-controlling interest - permanent equity  -   0   0   0   -   0   0   1,535   1,535   -   0   0   0   0   -   0   0   1,425   1,425 
Net income attributable to USPH shareholders  -   0   0   10,232   -   0   10,232   0   10,232   -   0   0   0   12,436   -   0   12,436   0   12,436 
Balance June 30, 2020
  15,058  $151  $91,258  $195,473   (2,215) $(31,628) $255,254  $1,434  $256,688 
Balance June 30, 2021  15,121   151  $99,039  $0  $216,286   (2,215) $(31,628) $283,848  $963  $284,811 

 U.S.Physical Therapy, Inc.        U.S.Physical Therapy, Inc.       
 Common Stock  Additional  Retained  Treasury Stock  Total Shareholders’  Non-Controlling     Common Stock  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Treasury Stock  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
For the six months ended June 30, 2020
 Shares  Amount  Paid-In Capital  Earnings  Shares  Amount  Equity  Interests  Total 
                           
Balance December 31, 2019  14,989  $150  $87,383  $184,352   (2,215) $(31,628) $240,257  $1,444  $241,701 
For the six months ended June 30, 2021 Shares  Amount  
Additional
Paid-In Capital
  
Accumulated Other
Comprehensive Loss
  
Retained
Earnings
  Shares  Amount  
Total Shareholders’
Equity
  
Non-Controlling
Interests
  Total 
Balance December 31, 2020  15,065   151   (2,215) $(31,628)
Issuance of restricted stock, net of cancellations  69   1   0   0   0   0   1   0   1   56   0   0   0   0   0   0   0   0   0 
Revaluation of redeemable non-controlling interest, net of tax  -   0   0   4,036   -   0   4,036   0   4,036   -   0   0   0   (7,310)  -   0   (7,310)  0   (7,310)
Compensation expense - equity-based awards  -   0   3,389   0   -   0   3,389   0   3,389   -   0   3,403   0   0   -   0   3,403   0   3,403 
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans  -   0   486   0   -   0   486   0   486 
Dividends paid to USPT shareholders  -   0   0   (4,110)  -   0   (4,110)  0   (4,110)  -   0   0   0   (9,028)  -   0   (9,028)  0   (9,028)
Distributions to non-controlling interest partners - permanent equity  -   0   0   0   -   0   0   (2,043)  (2,043)  -   0   0   0   0   -   0   0   (3,182)  (3,182)
Short swing profit settlement  -   0   13   0   0   -   0   13   0   13 
Other  -   0   0   (53)  -   0   (53)  (28)  (81)  -   0   1   0   0   -   0   1   (10)  (9)
Net income attributable to non-controlling interest - permanent equity  -   0   0   0   -   0   0   2,061   2,061   -   0   0   0   0   -   0   0   2,685   2,685 
Net income attributable to USPH shareholders  -   0   0   11,248   -   0   11,248   0   11,248   -   0   0   0   20,609   -   0   20,609   0   20,609 
Balance June 30, 2020
  15,058  $151  $91,258  $195,473   (2,215) $(31,628) $255,254  $1,434  $256,688 
Balance June 30, 2021  15,121   151  $99,039  $0  $216,286   (2,215) $(31,628) $283,848  $963  $284,811 


See notes to consolidated financial statements.

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U.S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
June 30, 20212022
(unaudited)

1.
1.BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

The consolidated financial statements include the accounts of U.S. Physical Therapy, Inc. and its subsidiaries (the “Company”). All significant intercompany transactions and balances have been eliminated.

The Company operates its business through 2 reportable business segments. The Company’s reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. The Company’s physical therapy operations consist of physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic-related disorders, sports-related injuries, preventive care, rehabilitation of injured workers and neurological injuries. Services provided by the industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments. Prior to

During the second quarter2021 year and the six months ended June 30, 2022, the Company completed the acquisitions of 4 multi-clinic practices and 2 industrial injury prevention businesses as detailed below.


Acquisition
 Date Acquired  Clinics 
March 2022 Acquisition
 March 31, 2022  
70
%
  6 
December 2021 Acquisition
 December 31, 2021  
75
%
  3 
November 2021 Acquisition
 November 30, 2021  
70
%
 0
IIPS* 
September 2021 Acquisition
 September 30, 2021  
100
%
 0
IIPS* 
June 2021 Acquisition
 June 30, 2021  
65
%
  8 
March 2021 Acquisition
 March 31, 2021  
70
%
  6 


*
Industrial injury prevention services business



As of June 302020, 2022, the Company operated 608 clinics in 39 states. The Company also manages physical therapy facilities for third parties, primarily hospital and physicians, with 33 third-party facilities under management as a single segment. All prior year segment information has been reclassified to conform toof June 30, 2022.



During the current segment presentation. See Note 11 - Segment Information.six months ended June 30, 2022, the Company closed 3 clinics and sold 5 clinics.


Physical Therapy Operations

The physical therapy operations segment primarily operates through subsidiary clinic partnerships, in which the Company generally owns a 1% general partnership andinterest in the Clinic Partnerships. Our limited partnership interests  typically ranginggenerally range from 49%65% to 99%75% in the Clinic Partnerships. The managing therapist of each clinic owns, directly or indirectly, the remaining limited partnership interest in most of the clinics (hereinafter referred to as “Clinic Partnerships”). To a lesser extent, the Company operates some clinics, through wholly-owned subsidiaries, under profit sharing arrangements with therapists (hereinafter referred to as “Wholly-Owned Facilities”).

The Company continues to seek to attract for employment physical therapists who have established relationships with physicians and other referral sources, by offering these therapists a competitive salary and incentives based on the profitability of the clinic that they manage. For multi-site clinic practices in which a controlling interest is acquired by the Company, the prior owners typically continue on as employees to manage the clinic operations, retainingretain a non-controlling ownership interest in the clinics and receivingreceive a competitive salary for managing the clinic operations. In addition, the Company has developed satellite clinic facilities as part of existing Clinic Partnerships and Wholly-Owned Facilities, with the result that a substantial number of Clinic Partnerships and Wholly-Owned Facilities operate more than 1 clinic location.

On June 30, 2021, the Company acquired a 65% interest in an 8-clinic physical therapy practice with the practice founder retaining 35%. The purchase price was approximately $10.3 million, of which $9.0 million was paid in cash, $1.0 million is payable based on the achievement of certain business criteria and $0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on June 30, 2023.

On 8March 31, 2021, the Company acquired a 70% interest in a 5-clinic physical therapy practice with the practice founder retaining 30%.  When acquired, the practice was developing a sixth clinic which has been completed. The purchase price for the 70% interest was approximately $12.0 million, of which $11.7 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on March 31, 2023.

On November 30, 2020, the Company acquired a 75% interest in a 3-clinic physical therapy practice. The purchase price for the 75% interest was $8.9 million (net of cash acquired), of which $8.6 million was paid in cash and $0.3 million in the form of a note payable that is payable in 2 principal installments totaling $162,500 each. The first principal payment plus accrued interest is due to be paid on November 2021 with the second installment to be paid in November 2022. The note accrues interest at 3.25% per annum.

On September 30, 2020, the Company acquired a 70% interest in an entity which holds 6-management contracts that have been in place for a number of years. The purchase price for the 70% interest was approximately $4.2 million, of which $3.7 million was paid in cash and $0.5 million in the form of two notes payable. One of the notes payable of $0.3 million was paid in November 2020. The remaining note of $0.2 million is payable, with any accrued interest at 5% per annum, on September 30, 2021.

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On February 27, 2020, the Company acquired interests in a 4-clinic physical therapy practice. The 4 clinics are operated in 4 separate partnerships.  The Company’s interests in the 4 partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 4.75% per annum and the principal and interest is payable in February 2022.

During the six months ended June 30, 2021, the Company sold 2 clinics. The aggregate sales price of $0.1 million was paid in cash.

As of June 30, 2021, the Company operated 575 clinics in 39 states. The Company also manages physical therapy facilities for third parties, primarily hospital and physicians, with 39third-party facilities under management as of June 30, 2021.

Clinic Partnerships

For non-acquired Clinic Partnerships, the earnings and liabilities attributable to the non-controlling interests, typically owned by the managing therapist, directly or indirectly, are recorded within the balance sheets as non-controlling interestsinterest – permanent equity and within the income statements as net income attributable to non-controlling interestsinterest – permanent equity.

For acquired Clinic Partnerships with redeemable non-controlling interests,interest, the earnings attributable to the redeemable non-controlling interestsinterest are recorded within the consolidated statements of income line item – net income attributable to non-controlling interestsinterest – redeemable non-controlling interestsinterest – temporary equity and the equity interests areinterest is recorded on the consolidated balance sheet as redeemable non-controlling interestsinterest – temporary equity.  In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is not included in net income but charged directly to retained earnings and is included in the earnings per basic and diluted earnings per share calculation.

Wholly-Owned Facilities

For Wholly-Owned Facilities with profit sharing arrangements, an appropriate accrual is recorded for the amount of profit sharing due to the profit sharing therapists. The amount is expensed as compensation and included in operating costscost – salaries and related costs. The respective liability is included in current liabilities – accrued expenses on the balance sheets.

Industrial Injury Prevention Services

In March 2017, the Company acquired a 55% interest in the initial industrial injury prevention business. On April 30, 2018, the Company acquired a 65% interest in another business in the industrial injury prevention sector. On April 30, 2018, the Company combined the 2 businesses.  After the combination, the Company owned a 59.45% interest in the combined business, Briotix Health, Limited Partnership (“Briotix Health”), the Company’s industrial injury prevention operation.

On April 11, 2019, the Company acquired 100% of a third company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network in 45 states including onsite at 11 client locations. The business was then combined with Briotix Health increasing the Company’s ownership position in the partnership to approximately 76.0%.

Services provided in the industrial injury prevention services segment include onsite services for clients’ employees including injury prevention and rehabilitation, performance optimization, post offer employment testing, functional capacity evaluations, and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. The Company performs these services through Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs).
trainers.

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Basis of Presentation

The accompanying unaudited consolidated financial statements were prepared in accordance with accounting principles generally accepted in the United States of America for interim financial information and in accordance with the instructions for Form 10-Q. However, the statements do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America for complete financial statements. Management believes this report contains all necessary adjustments (consisting only of normal recurring adjustments) to present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented. For further information regarding the Company’s accounting policies, please read the audited financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 20202021 filed with the Securities and Exchange Commission on March 1, 20212022.

The Company believes, and the Chief Executive Officer and Chief Financial Officer and Corporate Controller have certified, that the financial statements included in this report present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented.

Operating results for the three months and six months ended June 30 2021, 2022, are not necessarily indicative of the results the Company expects for the entire year.

Impact of COVID-19

As previously disclosed in a series of filings withIn addition to the SEC and furtherrisk factors described in detail in the Company’s Quarterly Reports on Form 10-Q for the first three quarters of 2020 and our Annual Report on Form 10-K10-K for the year ended December 31, 2020,2021 filed with the Company’s results were negatively impacted by the effectsSEC on March 1, 2022, see Item 1A in Part II of thethis report.

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Index
Impact of COVID-19

pandemic in 2020. For 2021 periods as compared to 2020 periods, the increase in revenuesMedicare Accelerated and expenses are primarily due to the Company returning to pre-pandemic results.Advance Payment Program (“MAAPP Funds”)

The Company has put preparedness plansOn March 27, 2020, in place at our facilities to maintain continuity of operations, while also taking steps to keep employees and patients safe. In line with recommendations to reduce large gatherings and increase social distancing, the Company has continued to allow a large number of office-based employees to work remotely. The Company is monitoring the situation and will adjust work environments accordingly.

In response to the COVID-19COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). In March 2020,The CARES Act provided waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in responseappropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19.

The CARES Act allowed for qualified healthcare providers to receive advanced payments under the MAAPP Funds during the COVID-19 pandemic,pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded the CARES Act was signed into law. The CARES Act provides numerous tax provisions and other stimulus measures, including temporary changes regarding$14.1 million in advance payments received as a liability. During the prior and future utilization of net operating losses, temporary changes to the prior and future limitations on interest deductions, temporary suspension of certain payment requirements for the employer portion of Social Security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property, and the creation of certain payroll tax credits associated with the retention of employees.

In 2020,three months ended March 31, 2021, the Company received a numberrepaid the MAAPP Funds of benefits$14.1 million rather than applying them to future services performed. During the six months ended June 30, 2022, and 2021, the Company did 0t record any income from payments under the CARES Act including, but not limited to:Act.

•
The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payment Program (“MAAPP Funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded these payments as a liability; however, during the first quarter of 2021, the Company repaid the MAAPP Funds of $14.1 million rather than applying them to future services performed.

•
The Company elected to defer depositing the employer’s share of Social Security taxes for payments due from March 27, 2020 through December 31, 2020, interest-free and penalty-free.  As of June 30, 2021 included in accrued liabilities is $4.1 million and in other long-term liabilities is $4.2 million related to these deferred payments.

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•
The CARES Act provided additional waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. In 2020, the Company’s consolidated subsidiaries received approximately $13.5 million in payments under the CARES Act (“Relief Funds”). In accordance with GAAP, these payments were recorded as Other income – Relief Funds. These funds are not required to be repaid upon attestation and compliance with certain terms and conditions, which could change materially based on evolving grant compliance provisions and guidance provided by the U.S. Department of Health and Human Services. Currently, the Company can attest to and comply with the terms and conditions.  The Company will continue to monitor the evolving guidelines and may record adjustments as additional information is released. There were 0 Relief Funds received in the six months ended June 30, 2021.

Significant Accounting Policies

Cash Equivalents

The Company maintains its cash and cash equivalents at financial institutions.  The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents.  The combined account balances at several institutions typically exceed Federal Deposit Insurance Corporation (“FDIC”) insurance coverage and, as a result, there is a concentration of credit risk related on deposits in excess of FDIC insurance coverage. Management believes that the risk is not significant.

Long-Lived Assets

Fixed assets are stated at cost. Depreciation is computed using the straight-line method over the estimated useful lives of the assets. Estimated useful lives for furniture and equipment range from three to eight years and for purchased software from three to seven years. Leasehold improvements are amortized over the shorter of the lease term or estimated useful lives of the assets, which is generally three to five years.

The Company reviews property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances which indicate that the amounts may be impaired. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell.

The Company did 0t note an impairment to long-lived assets during the three and six months ended June 30 2021, 2022.

Goodwill

Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.

Goodwill and other indefinite-lived intangible assets are not amortized but are instead subject to periodic impairment evaluations. The fair value of goodwill and other identifiable intangible assets with indefinite lives are evaluated for impairment at least annually and upon the occurrence of certain events or conditions and are written down to fair value if considered impaired. These events or conditions include but are not limited to: a significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale or disposition of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. The Company evaluates indefinite lived tradenames using the relief from royalty method in conjunction with its annual goodwill impairment test.

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The Company operateshas a 2 operating segment business which is made up of various clinics within partnerships, and the other isan industrial injury prevention services business. The partnerships are components of regions and are aggregated to the operating segment level for the purpose of determining the Company’s reporting units when performing its annual goodwill impairment test (theretest. In 2021 and 2020, there were 6 regions in both 2020 and 2019 in the physical therapy operations segment).regions. In addition to the 6 regions, mentioned prior, the impairment analysis included a separate analysis for the industrial injury prevention services business, as a separate reporting unit.

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As part of the impairment analysis, the Company is first required to assess qualitatively if it can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not impaired, the Company is then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than its carrying amount, the Company considers relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. The Company considers both the income and market approach in determining the fair value of its reporting units when performing a quantitative analysis.

An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the estimated fair value of the reporting unit. The evaluation of goodwill in 20202021 and 20192020 did not result in any goodwill amounts that were deemed impaired.

Based onAs part of the economic conditions and the decline in patient visits due to the COVID-19 pandemic,annual assessment, the Company evaluated whether events or circumstances indicated that it was more likely than not that the fair value of the reporting units were reduced below their carrying value as of June 30, 2021.December 31, 2021. As a result of the assessment, the Company determined that it was not more likely than not that goodwill and tradenames of the reporting units were impaired as of December 31, 2021.
June 30, 2021.

The Company will continue to monitor for any triggering events or other indicators of impairment.  Due to the uncertainty of the current economic conditions resulting from the COVID
-19 pandemic, the Company will continue to review its carrying amounts of goodwill and other intangibles quarterly.

During the six months ended June 30, 2020, the Company derecognized (wrote-off) goodwill in the amount of $1.9 million related to closed clinics due to COVID-19.

Redeemable Non-Controlling InterestsInterest

The non-controlling interests that are reflected as redeemable non-controlling interestsinterest in the consolidated financial statements consist of those that the owners and the Company have certain redemption rights, whether currently exercisable or not, and which currently, or in the future, require that the Company purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met.  The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership agreements.  The redemption rights can be triggered by the owner or the Company at such time as both of the following events have occurred: 1) termination of the owner’s employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement.  The redemption rights are not automatic or mandatory (even upon death) and require either the owner or the Company to exercise its rights when the conditions triggering the redemption rights have been satisfied.

On the date the Company acquires a controlling interest in a partnership, and the limited partnership agreement for such partnership contains redemption rights not under the control of the Company, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption – Redeemable non-controlling interestsinterest – temporary equity.  Then, in each reporting period thereafter until it is purchased by the Company, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial carrying value, based on the predetermined formula defined in the respective limited partnership agreement.  As a result, the value of the non-controlling interest is not adjusted below its initial carrying value.  The Company records any adjustments in the redemption value, net of tax, directly to retained earnings and the adjustments are not reflected in the consolidated statements of income.  Although the adjustments are not reflected in the consolidated statements of income, current accounting rules require that the Company reflects the adjustments, net of tax, in the earnings per share calculation.  The amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statements of net income. Management believes the redemption value (i.e. the carrying amount) and fair value are the same.

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Non-Controlling InterestsInterest

The Company recognizes non-controlling interests,interest, in which the Company has no obligation but the right to purchase the non-controlling interests,interest, as permanent equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interestsinterest is included in consolidated net income on the face of the statements of net income. Changes in a parent entity’s ownership interest in a subsidiary that do not result in deconsolidation are treated as equity transactions if the parent entity retains its controlling financial interest. The Company recognizes a gain or loss in net income when a subsidiary is deconsolidated. Such gain or loss is measured using the fair value of the non-controlling equity investment on the deconsolidation date.

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Index
When the purchase price of a non-controlling interest by the Company exceeds the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital. Additionally, operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner.

Revenue Recognition

Revenues are recognized in the period in which services are rendered. See Note 3- Revenue Recognition, for further discussion of revenue recognition.

Provision for Credit Losses

The Company determines provisions for credit losses based on the specific agings and payor classifications at each clinic. The provision for credit losses is included in operating costscost in the consolidated statements of net income. Net accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and provisions for credit losses, includes only those amounts the Company estimates to be collectible.

Income Taxes

Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.

The Company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount to be recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority.

On March 27, 2020, the CARES Act was enacted. The CARES Act includes changes to certain tax law related to net operating losses and the deductibility of interest expense and depreciation. ASC 740, Income Taxes requires the effects of changes in tax rates and laws on deferred tax balances to be recognized in the period in which the legislation is enacted. The legislation had no effect on the Company’s deferred income taxes and current income taxes payable during the three and six months ended June 30, 20212022.

The Company did 0t have any accrued interest or penalties associated with any unrecognized tax benefits 0r was any interest expense recognized during the three and six months endedJune 30, 2021.2022. The Company records any interest or penalties, if required, in interest and other expense, as appropriate.

Fair Value of Financial Instruments

Fair value is defined as an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement that should be determined based on assumptions that market participants would use in pricing an asset or liability. As a basis for considering such assumptions, a fair value hierarchy has been established that prioritizes the inputs used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurement) and the lowest priority to unobservable inputs (Level 3 measurement).

The three levels of the fair value hierarchy are as follows:
Level 1 – Quoted prices in active markets for identical assets or liabilities;
Level 2 – Quoted prices for similar instruments in active markets; quoted prices for identical or similar instruments in markets that are not active; and model-derived valuations whose significant inputs are observable; and
Level 3 – Unobservable inputs in which there is little or no market data which require the reporting entity to develop its own assumptions.

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Fair Value of Financial Instruments

The carrying amounts reported in the balance sheets for cash and cash equivalents, contingent earn-out payments, accounts receivable, accounts payable and notes payable approximate their fair values due to the short-term maturity of these financial instruments. The carrying amount of the debt under the Third Amended and Restated Credit Agreement and(defined as “Credit Agreement” in Note 9) approximates the redemption value of Redeemable non-controlling interests approximate the respective fair values. The fair value of the Company’s redeemable non-controlling interests is determined based on “Level 3” inputs.value. The interest rate on the debt under the Third Amended and Restated Amended Credit Agreement is tied to the London Interbank OfferedSecured Overnight Financing Rate (“LIBOR”SOFR”).

The redeemable non-controlling interest included on the consolidated balance sheets and the put right associated with the potential future purchase of the separate company in the November 2021 acquisition (as described in Note 2) are both marked to fair value on a recurring basis using Level 3 inputs.  The redemption value of redeemable non-controlling interests approximates the fair value.  The put right associated with the potential future purchase of the separate company in the November 2021 acquisition is determined using a Monte Carlo simulation model utilizing unobservable inputs such as asset volatility and discount rates. The unobservable inputs in the valuation include asset volatility of 25% and a discount rate of 10.49%. Provisions withinSee Note 5 for the agreement currently providechanges in the fair value of redeemable non-controlling interest. The put right increased $0.6 million for the three months ended June 30, 2022 and was valued at $3.5 million on June 30, 2022.

The valuations of the Company’s interest rate derivatives are measured as the present value of all expected future cash flows based on SOFR-based yield curves. The present value calculation uses discount rates that have been adjusted to reflect the credit quality of the Company withand its counterparty which is a Level 2 fair value measurement. The carrying and fair value of the ability to replace LIBOR with a different referenceCompany’s interest rate derivative as of June 30, 2022, was $0.5 million, which is included in current liabilities in the event LIBOR ceases to existCompany’s consolidated balance sheet. See Note 10 for changes in the fair value of the interest rate swap.

Segment Reporting

Operating segments are components of an enterprise for which separate financial information is available that is evaluated regularly by chief operating decision makers in determining the allocation of resources and in assessing performance.  The Company currently operates through 2 segments: physical therapy operations and industrial injury prevention services.

Use of Estimates

In preparing the Company’s consolidated financial statements, management makes certain estimates and assumptions, especially in relation to, but not limited to, goodwill impairment, tradenames and other intangible assets, allocations of purchase price, provision for credit losses, tax provision and contractual allowances, that affect the amounts reported in the consolidated financial statements and related disclosures. Actual results may differ from these estimates.

Self-Insurance Program

The Company utilizes a self-insurance plan for its employee group health insurance coverage administered by a third party. Predetermined loss limits have been arranged with an insurance company to minimize the Company’s maximum liability and cash outlay. Accrued expenses include the estimated incurred but unreported costs to settle unpaid claims and estimated future claims. Management believes that the current accrued amounts are sufficient to pay claims arising from self-insurance claims incurred through June 30, 2021.2022.

Restricted Stock

Restricted stock issued to employees and directors is subject to continued employment or continued service on the board, respectively. Generally, restrictions on the stock granted to employees lapse in equal annual installments on the following four anniversaries of the date of grant. For those shares granted to directors, the restrictions will lapse in equal quarterly installments during the first year after the date of grant. For those granted to officers, the restrictionsrestriction will lapse in equal quarterly installments during the four years following the date of grant. Compensation expense for grants of restricted stock is recognized based on the fair value per share on the date of grant amortized over the vesting period. The Company recognizes any forfeitures as they occur. The restricted stock issued is included in basic and diluted shares for the earnings per share computation.

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Recently Adopted Accounting Guidance

In June 2016,December 2019, the FASB issued ASU 2016-13, Financial Instruments 2019-12, Income Taxes (Topic 740)– Credit Losses, which added a new impairment model (known asSimplifying the current expected credit loss (CECL) model) thatAccounting for Income Taxes (“ASU 2019-12”). The objective of ASU 2019-12 is based on expected losses rather than incurred losses. Underto simplify the new guidance, an entity recognizes as an allowance its estimate of expected credit losses. The CECL model applies to most debt instruments, including trade receivables. The CECL model does not have a minimum thresholdaccounting for recognition of impairment losses and entities will need to measure expected credit losses on assets that have a low risk of loss. The standard is required to be applied using the modified retrospective approach with a cumulative-effect adjustment to retained earnings, if any, upon adoption.

The Company completed the adoption of the standard on January 1, 2020. The financial instruments subject to ASU 2016-13 are the Company’s accounts receivable derived from contracts with customers. A significant portion of the Company’s accounts receivable are from highly-solvent, creditworthy payors including governmental programs such as Medicare and Medicaid, and highly regulated commercial insurers. The Company’s estimate of expected credit losses as of January 1, 2020, using its expected credit loss evaluation process, resulted in no adjustmentsincome taxes by removing certain exceptions to the allowancegeneral principles in Topic 740 and to provide more consistent application to improve the comparability of financial statements. The amendments in this ASU are effective for credit losses and no cumulative-effect adjustment to retained earnings on the adoption date of the standard.

In January 2017, the FASB issued ASU 2017-04, Simplifying the Test for Goodwill Impairment (Topic 350), which eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment charge. ASU 2017-04 is effective prospectively for fiscal years, and the interim periods within those years beginning after December 15, 2019.2020, and early adoption was permitted. The Company completed theadopted this pronouncement as of January 1, 2021. The adoption of the standard effective January 1, 2020 and there was noASU 2020-06 did not have a material impact to goodwill fromon the Company’s adoption of this change.financial statements.

Recently Issued Accounting Guidance

In MarchAugust 2020,, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. This ASU provides temporary optional expedients and exceptions to the guidance on contract modifications and hedge accounting to ease the financial reporting burdens of the expected market transition from LIBOR and other interbank offered rates to alternative reference rates. The new guidance was effective upon issuance, and the Company is allowed to elect to apply the amendments prospectively through December 31, 2022. Borrowings under the Amended Credit Agreement bear interest based on LIBOR or an alternate base rate. Provisions within the agreement currently provide the Company with the ability to replace LIBOR with a different reference rate in the event LIBOR ceases to exist.

In August 2020, the FASB issued ASU 2020-06Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, which simplifies the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. As part of this update, convertible instruments are to be included in diluted earnings per share using the if-converted method, rather than the treasury stock method. Further, contracts which can be settled in cash or shares, excluding liability-classified share-based payment awards, are to be included in diluted earnings per share on an if-converted basis if the effect is dilutive, regardless of whether the entity or the counterparty can choose between cash and share settlement. The share-settlement presumption may not be rebutted based on past experience or a stated policy.

This pronouncement iswas effective for fiscal years, and for interim periods within those fiscal years, beginning after December 15, 2021.2021.The Board specified that an entity should adopt the guidance at the beginning of its annual fiscal year. The Company plans to adoptadopted this pronouncement as of January 1, 2022. The use of either the modified retrospective or fully retrospective method of transition is permitted. The Company is currently evaluating the impact of the adoption of ASU 2020-06 did not have a material impact on the Company’s consolidated financial statements.statements.

Recently Issued Accounting Guidance

14In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. This ASU provides temporary optional expedients and exceptions to the guidance on contract modifications and hedge accounting to ease the financial reporting burdens of the expected market transition from LIBOR and other interbank offered rates to alternative reference rates. The new guidance was effective upon issuance, and the Company has elected to apply the amendments prospectively through December 31, 2022. Borrowings under the Third Amended and Restated Credit Agreement bear interest based on SOFR. The interest rate applicable to the Third Amended and Restated Credit Agreement is tied to SOFR.
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2. ACQUISITIONS OF BUSINESSES

On June 30,March 31, 2022, the Company acquired a 70% interest in a 6-clinic physical therapy practice. The practice’s owners retained 30% of the equity interests. The purchase price for the 70% equity interest was approximately $11.5 million, of which $11.2 million was paid in cash and $0.3 million in the form of a note payable.  The note accrues interest at 3.5% per annum and the principal and interest are payable on March 31, 2024.

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The purchase price for the 2022 acquisition has been preliminarily allocated as follows (in thousands):
   
Physical Therapy
Operations
 
Cash paid, net of cash acquired $11,799 
Seller notes  374 
Contingent payments  100 
Total consideration $12,273 
     
Estimated fair value of net tangible assets acquired:    
Total current assets $466 
Total non-current assets  2,655 
Total liabilities  (2,664)
Net tangible assets acquired  457 
Customer and referral relationships  3,742 
Non-compete agreements  247 
Tradenames  659 
Goodwill  12,114 
Fair value of non-controlling interest (classified as redeemable non-controlling interest)  (4,946)
  $12,273 

On December 31, 2021, the Company acquired a 65%75% interest in an 8-clinica 3-clinic physical therapy practice with the practice founder retaining 35%25%. The purchase price for the 75% interest was approximately $10.3$3.6 million, of which $9.0$3.4 million was paid in cash and $0.2 million in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest are payable on December 31, 2023.

On November 30, 2021, the Company acquired an approximate 70% interest in a leading provider of industrial injury prevention services. The previous owners retained the remaining interest. The purchase price for the approximate 70% equity interest, not inclusive of a $2.0 million contingent payment, was approximately $65.2 million of which $60.7 million was paid in cash and $1.0 million in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on November 30, 2023. As part of the transaction, the Company also agreed to the potential future purchase of a separate company under the same ownership that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The current owners have the right to put this transaction to the Company in approximately five years, with such right having an initial fair value of $3.5 million value on December 31, 2021, as reflected on the Company’s consolidated balance sheet in Other long-term liabilities. The value of this right will be adjusted in future periods, as appropriate, with any change in value reflected in the Company’s consolidated statement of income. The Company does not currently possess any of the controlling interests in this separate company, does not control this company through contract or governance rights and currently does not exercise significant influence over this separate company. Due to these reasons, and based on current accounting guidance, the achievementCompany did not consolidate the separate company through the variable interest or voting interest model. On June 30, 2022, the fair value of certain business criteriathis put right was $3.5 million.  The increase was reflected in the consolidated statement of income in the line item – Loss on revaluation of put-right liability.

On September 30, 2021, the Company acquired a company that specializes in return-to-work and ergonomic services, among other offerings. The Company acquired the company’s assets at a purchase price of approximately $3.3 million (which includes the obligation to pay an amount up to $0.6 million in contingent payment consideration in conjunction with the acquisition if specified future operational objectives are met) and contributed those assets to the industrial injury services business. The initial purchase price, not inclusive of the $0.6 million contingent payment, was approximately $2.7 million, of which $2.4 million was paid in cash, and $0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest are payable on September 30, 2023.

On June 30, 2021, the Company acquired a 65% interest in an 8-clinic physical therapy with the previous owners retaining 35%. The purchase price was approximately $10.7 million, of which $8.6 million was paid in cash, $1.0 million was payable based on the achievement of certain business criteria and $0.3 million is in the form of a note payable. The business criteria were met and accordingly $1.0 million was paid in July 2022. The note accrues interest at 3.25% per annum and the principal and interest are payable on June 30, 2023. Additionally, the Company has an obligation to pay an additional amount up to $0.8 million in contingent payment consideration in conjunction with the acquisition if specified future operational objectives are met. The Company recorded acquisition-date fair value of this contingent liability based on the likelihood of the contingent earn-out payment. The earn-out payment will subsequently be remeasured to fair value each reporting date.

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On March 31, 2021, the Company acquired a 70% interest in a 5-clinic5-clinic physical therapy practice with the practice founderprevious owners retaining 30%. When acquired, the practice was developing a sixth clinic which has been completed. The purchase price for the 70% interest was approximately $12.0$11.6 million, of which $11.7$11.3 million was paid in cash and $0.3$0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest isare payable on March 31, 2023.

The purchase price for the 2021 acquisitions has been preliminarily allocated as follows (in thousands):

     Physical Therapy    
  IIPS*  Operations  Total 
Cash paid, net of cash acquired $63,193  $23,544  $86,737 
Seller notes  1,250   800   2,050 
Contingent payments  2,520   837   3,357 
Other payable  0   1,000   1,000 
Seller put right  3,522   0   3,522 
Total consideration $70,485  $26,181  $96,666 
             
Estimated fair value of net tangible assets acquired:            
Total current assets $5,588  $1,891  $7,479 
Total non-current assets  12,620   7,014   19,634 
Total liabilities  (4,842)  (8,399)  (13,241)
Net tangible assets acquired $13,366  $506  $13,872 
Customer and referral relationships  21,127   7,969   29,096 
Non-compete agreements  500   415   915 
Tradenames  5,141   2,144   7,285 
Goodwill  58,257   27,103   85,360 
Fair value of non-controlling interest (classified as redeemable non-controlling interest)  (27,906)  (11,956)  (39,862)
  $70,485  $26,181  $96,666 


*Industrial injusry prevention services

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

For the 2022 and 2021 acquisitions, a majority of total current assets primarily represents accounts receivable. Total non-current assets are fixed assets and equipment used in the practice.

The purchase priceprices plus the fair value of the non-controlling interests for the acquisitions in 2021 were allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. trade names, referral relationships and non-compete agreements, and liabilities assumed based on the fair values at the acquisition date, with the amount exceeding the fair values being recorded as goodwill.

For the acquisitions in 2021, the values assigned to the customer and referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives. For customer and referral relationships, the weighted-average amortization period was 13.8 years. For non-compete agreements, the weighted-average amortization period was 5.6 years at the end of the year. The values assigned to tradenames are tested annually for impairment.

The consideration paid for each of the acquisitions was derived through arm’s length negotiations. Funding for the cash portions was derived from proceeds from the Company’s revolving credit facility. The results of operations of the acquisitions have been included in the Company’s consolidated financial statements since their respective date of acquisition. Unaudited proforma consolidated financial information for the acquisitions in 2022 and 2021 have not been included, as the results, individually and in the aggregate, were not material to current operations.

The purchase price plus the fair value of the non-controlling interest for the acquisitions in 2022 and those acquired after June 30, 2021 was allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. tradenames, referral relationships and non-compete agreements, and liabilities assumed based on the estimated fair values at the acquisition date, with the amount in excess of fair values being recorded as goodwill. The Company is in the process of completing its formal valuation analysis of the acquisitions, to identify and determine the fair value of tangible and identifiable intangible assets acquired and the liabilities assumed. Thus, the final allocation of the purchase price may differ from the preliminary estimates used aton June 30, 20212022 based on additional information obtained and completion of the valuation of the identifiable intangible assets. Changes in the estimated valuation of the tangible assets acquired, the completion of the valuation of identifiable intangible assets and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.  The purchase price allocation for the March 2021 and the June 2021 Acquisitions have been finalized. The Company continues to evaluate the components for the purchase price allocations for other acquisitions in 2021.

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For the acquisitions in 2021,2022, the estimated values assigned to the customer and referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives. For customer and referral relationships, the weighted-average amortization period is 12.0 years. For non-compete agreements, the weighted-average amortization period is 6.05.0 years.

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

The purchase price for the 2021 acquisitions has been preliminarily allocated as follows (in thousands):

Cash paid, net of cash acquired $20,401 
Seller note  550 
Payable  1,000 
Total consideration $21,951 
     
Estimated fair value of net tangible assets acquired:    
Total current assets $476 
Total non-current assets  505 
Total liabilities  (1,159)
Net tangible assets acquired $(178)
Referral relationships  3,249 
Non-compete  495 
Tradename  1,290 
Goodwill  27,814 
Fair value of non-controlling interest (classified as redeemable non-controlling interests)  (10,719)
  $21,951 

On November 30, 2020, the Company acquired a 75% interest in a 3-clinic physical therapy practice. The purchase price for the 75% interest was $8.9 million (net of cash acquired), of which $8.6 million was paid in cash and $0.3 million in the form of a note payable that is payable in 2 principal installments totaling $162,500 each. The first principal payment plus accrued interest will be paid on November 2021 with the second installment to be paid in November 2022. The note accrues interest at 3.25% per annum.

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On September 30, 2020, the Company acquired a 70% interest in an entity which holds 6-management contracts that have been in place for a number of years. The purchase price for the 70% interest was approximately $4.2 million, of which $3.7 million was paid in cash and $0.5 million in the form of 2 notes payable. One of the notes payable of $0.2 million is payable, with any accrued interest at 5% per annum, on September 30, 2021. The remaining note of $0.3 million was paid in November 2020.

On February 27, 2020, the Company acquired interests in a 4-clinic physical therapy practice. The 4 clinics are in 4 separate partnerships. The Company’s interests in the 4 partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

For the 2021 and 2020 acquisitions, a majority of total current assets primarily represents accounts receivable. Total non-current assets are fixed assets and equipment used in the practice.

The purchase price for the 2020 acquisitions has been allocated as follows (in thousands):

Cash paid, net of cash acquired $23,912 
Seller note  1,121 
Total consideration $25,033 
     
Estimated fair value of net tangible assets acquired:    
Total current assets $1,271 
Total non-current assets  196 
Total liabilities  (555)
Net tangible assets acquired $912 
Referral relationships  4,497 
Non-compete  522 
Tradename  1,557 
Goodwill  28,843 
Fair value of non-controlling interest (classified as redeemable non-controlling interests)  (11,298)
  $25,033 

The Company is in the process of completing its formal valuation analysis of the September 2020 and November 2020 acquisitions, to identify and determine the fair value of tangible and identifiable intangible assets acquired and the liabilities assumed. Thus, the final allocation of the purchase price may differ from the preliminary estimates used at June 30, 2021 based on additional information obtained and completion of the valuation of the identifiable intangible assets. Changes in the estimated valuation of the tangible assets acquired, the completion of the valuation of identifiable intangible assets and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.

The purchase prices plus the fair value of the non-controlling interests for the acquisitions in 2020 were allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. trade names, referral relationships and non-compete agreements, and liabilities assumed based on the fair values at the acquisition date, with the amount exceeding the fair values being recorded as goodwill.
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For the acquisitions in 2020, the values assigned to the referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives.  For referral relationships, the weighted average amortization period was 11.0 years at December 31, 2020.  For non-compete agreements, the weighted average amortization period was 6.0 years at December 31, 2020. The values assigned to tradenames are tested annually for impairment.
impairment.
The consideration paid for each of the acquisitions was derived through arm’s length negotiations. Funding for the cash portions was derived from proceeds from the Company’s revolving credit facility. The results of operations of the acquisitions have been included in the Company’s consolidated financial statements since their respective date of acquisition. Unaudited proforma consolidated financial information for the acquisitions in 2021 and 2020 have not been included, as the results, individually and in the aggregate, were not material to current operations.

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3. REVENUE RECOGNITION

Categories

Revenues are recognized in the period in which services are rendered.

Net patient revenuesrevenue consists of revenuesrevenue for physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic-related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenuesrevenue (patient revenuesrevenue less estimated contractual adjustments) areis recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied. There is an implied contract between us and the patient upon each patient visit. Generally, this occurs as the Company provides physical and occupational therapy services, as each service provided is distinct and future services rendered are not dependent on previously rendered services. The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. The allowance for estimated contractual adjustments is based on terms of payor contracts and historical collection and write-off experience.

Management contract revenues,revenue, which areis included in other revenuesrevenue in the consolidated statements of net income, areis derived from contractual arrangements whereby the Company manages a clinic owned by a third party. The Company does not have any ownership interest in these clinics. Typically, revenues arerevenue is determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for our employees, are recorded when incurred.

RevenuesRevenue from the industrial injury prevention services segment, which are alsois included in other revenuesrevenue in the consolidated statements of net income, areis derived from onsite services the Company provides to clients’ employees including injury prevention, rehabilitation, ergonomic assessments and performance optimization. Revenue from the industrial injury prevention services segment is recognized when obligations under the terms of the contract are satisfied. Revenues areRevenue is recognized at an amount equal to the consideration the Company expects to receive in exchange for providing injury prevention services to its clients. The revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period.

Additionally, other revenues includerevenue includes services the Company provides on-site, such as schools, for physical or occupational therapy services, and fees from athletic trainers. Contract terms and rates are agreed to in advance between the Company and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in advance, revenue is recorded as a liability over the period of the agreement and recognized at the point in time, when the services are performed.

The Company determines allowances for doubtful accountscredit losses based on the specific agings and payor classifications at each clinic. The provision for credit losses is included in clinic operating costscost in the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and provision for credit losses, includes only those amounts the Company estimates to be collectible.

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The following table details the revenue related to the various categories (in thousands):

 Three Months Ended  Six Months Ended 
  June 30, 2021  June 30, 2020  June 30, 2021  June 30, 2020 
Net patient revenues $113,238  $72,279  $212,492  $172,405 
Management contract revenues  2,739   1,592   5,297   3,740 
Other revenues  918   328   1,464   895 
Physical therapy operations $116,895  $74,199  $219,253  $177,040 
Industrial injury prevention services revenues  10,033   9,658   20,043   19,534 
  $126,928  $83,857  $239,296  $196,574 
 Three Months Ended  Six Months Ended 
  June 30, 2022  June 30, 2021  June 30, 2022  June 30, 2021 
Net patient revenue $118,196  $113,238  $227,734  $212,492 
Other revenue  898   918   1,770   1,464 
Physical therapy operations $
119,094  $
114,156  $
229,504  $
213,956 
Management contract revenue 
2,125  
2,739  
4,351  
5,297 
Industrial injury prevention services revenue  19,437   10,033   38,505   20,043 
  $140,656  $126,928  $272,360  $239,296 

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Medicare Reimbursement

The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (“MPFS”). For services provided in 2017 through 2019, a 0.5% increase was applied to the fee schedule payment rates before applying the mandatory budget neutrality adjustment. For services provided in 2020 through 2025 0 adjustment is expected to be applied each year to the fee schedule payment rates, before applying the mandatory budget neutrality adjustment.

In the 2020 MPFS Final Rule, CMSthe Centers for Medicare and Medicaid Services (“CMS”) revised coding, documentation guidelines, and increased the code values for office/outpatient evaluation and management (E/M)(“E/M”) codes and cuts to other codes to maintain budget neutrality of the MPFS beginning in 2021. Under the 2021 MPFS Final Rule, CMS increased the values for the E/M office visit codes and made cuts to other specialty codes to maintain budget neutrality. As a result, reimbursementCMS projected a 9% decrease in fee schedule payment rates for therapy services set to take effect in 2021. However, Congress intervened with passage of the Consolidated Appropriations Act, 2021 and reimbursement for the codes applicable to physical/occupational therapy services provided by our clinics received an estimated 3.5% decrease in the aggregate in payment from Medicare in calendar year 2021 as compared to 2020.

In the 2022 MPFS Final Rule published on November 2, 2021, there was to be an approximately 3.75% reduction to Medicare payments for physical/occupational therapy services. This was due to the expiration of the additional funding to the conversion factor provided by Congress in 2021 under the Consolidated Appropriations Act, 2021. However, this reduction was addressed in the Protecting Medicare and American Farmers from Sequester Cuts Act (“2021 Act”) signed into law on December 10, 2021. Based on various provisions in the 2021 Act, the Company now estimates that the Medicare rate reduction for the full year of 2022 will be approximately 0.75%. The 2021 Act did not address the 15% reduction in Medicare payments for services performed by a physical or occupational therapist assistant, which began on January 1, 2022.

In the 2023 MPFS Proposed Rule published on July 7, 2022, CMS proposed a 4.4% reduction in the Physician Fee Schedule conversion factor.  In addition, the Consolidated Appropriations Act, 2021 included a reduction in Medicare payment rates of approximately 3% in 2024.  These payment reductions are expected to take effect unless regulatory or Congressional action results in modifications to such rates as has occurred in 2021 and 2022.

The Budget Control Act of 2011 increased the federal debt ceiling in connection with deficit reductions over the next ten years, and requires automatic reductions in federal spending by approximately $1.2 trillion. Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap. On April 1, 2013, a 2% reduction to Medicare payments was implemented. The Bipartisan Budget Act of 2015, enacted on November 2, 2015, extended the 2% reductions to Medicare payments through fiscal year 2025. The Bipartisan Budget Act of 2018, enacted on February 9, 2018, extends the 2% reductions to Medicare payments through fiscal year 2027. The CARES Act suspended the 2% payment reduction to Medicare payments for dates of service from May 1, 2020, through December 31, 2020. The Consolidated Appropriations Act, 2021 further suspended the 2% payment reduction until March 31, 2021. On April 14, 2021, additional legislation was enacted that waived the 2% payment reduction for the remainder of calendar 2021. The 2021 Act, which was signed into law on December 10, 2021, included a three-month extension of the 2% sequester relief applied to all Medicare payments through March 31, 2022, followed by three months of 1% sequester relief through June 30, 2022. Sequester relief is scheduled to then end on June 30, 2022.

Beginning in 2021, payments to individual therapists (Physical/Occupational Therapist in Private Practice) paid under the fee schedule may be subject to adjustment based on performance in the Merit Based Incentive Payment System (“MIPS”), which measures performance based on certain quality metrics, resource use, and meaningful use of electronic health records. Therapists eligible to participate in MIPS include only those therapists who are enrolled with Medicare as private practice providers, and does not include therapists in facility-based providers, such as our clinics enrolled as certified rehabilitation agencies. Less than 3% of the Company’s therapist providers currently participate in MIPS. Under the MIPS requirements, a provider’s performance is assessed according to established performance standards each year and then is used to determine an adjustment factor that is applied to the professional’s payment for the corresponding payment year. The provider’s MIPS performance in 2019 will determine the payment adjustment in 2021. For those therapist providers who actually participated in MIPS during 2019, the resulting average payment adjustment was an increase of 1%.

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Each year from 2019 through 2024, professionals who receive a significant share of their revenues through an alternate payment model (“APM”) (such as accountable care organizations or bundled payment arrangements) that involves risk of financial losses and a quality measurement component will receive a Index5% bonus in the corresponding payment year. The bonus payment for APM participation is intended to encourage participation and testing of new APMs and to promote the alignment of incentives across payors.

Under the Middle ClassMiddle-Class Tax Relief and Job Creation Act of 2012 (‘‘MCTRA’’(“MCTRA”), since October 1, 2012, patients who met or exceeded $3,700 in therapy expenditures during a calendar year have been subject to a manual medical review to determine whether applicable payment criteria are satisfied. The $3,700 threshold is applied to Physical Therapy and Speech Language Pathology Services; a separate $3,700 threshold is applied to the Occupational Therapy. The MACRA directed CMS to modify the manual medical review process such that those reviews will no longer apply to all claims exceeding the $3,700 threshold and instead will be determined on a targeted basis based on a variety of factors that CMS considers appropriate.

The Bipartisan Budget Act of 2018 extends the targeted medical review indefinitely but reduces the threshold to $3,000 through December 31, 2027. For 2028, the threshold amount will be increased by the percentage increase in the Medicare Economic Index (“MEI”) for 2028 and in subsequent years the threshold amount will increase based on the corresponding percentage increase in the MEI for such subsequent year.

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CMS adopted a multiple procedure payment reduction (‘‘MPPR’’(“MPPR”) for therapy services in the final update to the MPFS for calendar year 2011. The MPPR applied to all outpatient therapy services paid under Medicare Part B — occupational therapy, physical therapy and speech-language pathology. Under the policy, the Medicare program pays 100% of the practice expense component of the Relative Value Unit (‘‘RVU’’(“RVU”) for the therapy procedure with the highest practice expense RVU, then reduces the payment for the practice expense component for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions. In 2013, the practice expense component for the second and subsequent therapy service furnished during the same day for the same patient was reduced by 50%.

Medicare claims for outpatient therapy services furnished by therapytherapist assistants on or after January 1, 2020 must include a modifier indicating the service was furnished by a therapytherapist assistant. Outpatient therapy services furnished on or after January 1, 2022, in whole or part by a therapytherapist assistant will beare paid at an amount equal to 85% of the payment amount otherwise applicable for the service.

Statutes, regulations, and payment rules governing the delivery of therapy services to Medicare beneficiaries are complex and subject to interpretation. We believeThe Company believes that we arethe Company is in compliance, in all material respects, with all applicable laws and regulations and are not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on the ourCompany’s financial statements as of June 30, 2021.2022. Compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from the Medicare program. For the three months ended June 30, 2021 and 2020, respectively, net patient revenues from Medicare were approximately $35.6 million and $16.9 million, respectively.  For the six months ended June 30, 20212022, and 2020,2021, respectively, net patient revenuesrevenue from Medicare werewas approximately $62.2$74.9 million and $44.4$62.1 million, respectively.

Given the history of frequent revisions to the Medicare program and its reimbursement rates and rules, wethe Company may not continue to receive reimbursement rates from Medicare that sufficiently compensate us for ourthe Company’s services or, in some instances, cover ourthe Company’s operating costs. Limits on reimbursement rates or the scope of services being reimbursed could have a material adverse effect on ourthe Company’s revenue, financial condition and results of operations. Additionally, any delay or default by the federal or state governments in making Medicare and/or Medicaid reimbursement payments could materially and, adversely, affect ourthe Company’s business, financial condition and results of operations.

Contractual Allowances

Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third partythird-party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in Company clinics. The Company estimates contractual allowances based on its interpretation of the applicable regulations, payor contracts and historical calculations. Each month the Company estimates its contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on the Company’s historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow the Company to provide the necessary detail and accuracy with its collectability estimates. However, the services authorized and provided and related reimbursement are subject to interpretation that could result in payments that differ from the Company’s estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. The Company’s billing system does not capture the exact change in its contractual allowance reserve estimate from period to period in order to assess the accuracy of its revenues and hence its contractual allowance reserves. Management regularly compares its cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, historically the difference between net revenues and corresponding cash collections has generally reflected a difference within approximately 1.0% to 1.5% of net revenues.revenue. Additionally, analysis of subsequent periods’ contractual write-offs on a payor basis reflects a difference within approximately 1.0% to 1.5% between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, the Company believes that a change in the contractual allowance reserve estimate would not likely be more than 1.0% to 1.5% aton June 30, 2021.2022.

19
A contract’s transaction price is allocated to each distinct performance obligation and recognized when, or as, the performance obligation is satisfied. To determine the transaction price, the Company includes the effects of any variable consideration, such as the probability of collecting that amount. The Company applies established rates to the services provided, and adjusts for the terms of payor contracts, as applicable. These contracted amounts are different from the Company’s established rates.  The Company has established a “contractual allowance” for this difference. The allowance is based on the terms of payor contracts, historical and current reimbursement information and current experience with the clinic and partners. The Company’s established rates less the contractual allowance is the revenue that is recognized in the period in which the service is rendered. This revenue is deemed the transaction price and stated as “Net Patient Revenue” on the Company’s consolidated statements of income.

20
The Company’s performance obligations are satisfied at a point in time. After the clinic has provided services and satisfied its obligation to the customer for the reimbursement rates stipulated in the payor contracts (i.e. the transaction price), the Company recognizes the revenue, net of contractual allowances, in the period in which the services are rendered. The Company recognizes the full amount of revenue and reports the contractual allowances as a contra (or offset) revenue account to report a net revenue number based on the expected collections.

4. EARNINGS PER SHARE

In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest (see Note 5 – Redeemable Non-Controlling Interest), net of tax, charged directly to retained earnings is included in the earnings per basic and diluted share calculation. The following table provides a detail of the basic and diluted earnings per share computation (in thousands, except per share data).

 Three Months Ended  Six Months Ended 
  June 30, 2021  June 30, 2020  June 30, 2021  June 30, 2020 
Computation of earnings per share - USPH shareholders:            
Net income attributable to USPH shareholders $12,436  $10,232  $20,609  $11,248 
(Charges) credit to retained earnings:                
Revaluation of redeemable non-controlling interest  (2,549)  3,344   (9,819)  5,473 
Tax effect at statutory rate (federal and state) of 25.55% and 26.25%, respectively
  651   (878)  2,508   (1,437)
  $10,538  $12,698  $13,298  $15,284 
                 
Earnings per share (basic and diluted) $0.82  $0.99  $1.03  $1.19 
                 
Shares used in computation:                
Basic and diluted earnings per share - weighted-average shares  12,902   12,843   12,886   12,820 
 Three Months Ended  Six Months Ended 
  June 30, 2022  June 30, 2021  June 30, 2022  June 30, 2021 
Computation of earnings per share - USPH shareholders:            
Net income attributable to USPH shareholders $11,195  $12,436  $19,994  $20,609 
(Charges) credit to retained earnings:                
Revaluation of redeemable non-controlling interest  210   (2,549)  57   (9,819)
Tax effect at statutory rate (federal and state) of 25.55%
  (54)  651   (15)  2,508 
  $11,351  $10,538  $20,036  $13,298 
                 
Earnings per share (basic and diluted) $0.87  $0.82  $1.55  $1.03 
                 
Shares used in computation:                
Basic and diluted earnings per share - weighted-average shares  12,998   12,902   12,968   12,886 

5. REDEEMABLE NON-CONTROLLING INTEREST

Since October 2017, when the Company acquires a majority interest (the “Acquisition”) in a physical therapy clinic business (referred to as “Therapy Practice”), these Acquisitions occur in a series of steps which are described below.

1.Prior to the Acquisition, the Therapy Practice exists as a separate legal entity (the “Seller Entity”). The Seller Entity is owned by one or more individuals (the “Selling Shareholders”) most of whom are physical therapists that work in the Therapy Practice and provide physical therapy services to patients.
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Index
2.In conjunction with the Acquisition, the Seller Entity contributes the Therapy Practice into a newly-formed limited partnership (“NewCo”), in exchange for one hundred percent (100%) of the limited and general partnership interests in NewCo. Therefore, in this step, NewCo becomes a wholly-owned subsidiary of the Seller Entity.
3.
The Company enters into an agreement (the “Purchase Agreement”) to acquire from the Seller Entity a majority (ranges from 50% to 90%) of the limited partnership interest and in all cases 100% of the general partnership interest in NewCo. The Company does not purchase 100% of the limited partnership interest because the Selling Shareholders, through the Seller Entity, want to maintain an ownership percentage. The consideration for the Acquisition is primarily payable in the form of cash at closing and a small, two-year note in lieu of an escrow (the “Purchase Price”). The Purchase Agreement does not contain any future earn-out or other contingent consideration that is payable to the Seller Entity or the Selling Shareholders.
4.The Company and the Seller Entity also execute a partnership agreement (the “Partnership Agreement”) for NewCo that sets forth the rights and obligations of the limited and general partners of NewCo. After the Acquisition, the Company is the general partner of NewCo.

5.As noted above, the Company does not purchase 100% of the limited partnership interests in NewCo and the Seller Entity retains a portion of the limited partnership interest in NewCo (“Seller Entity Interest”).
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6.
In most cases, some or all of the Selling Shareholders enter into an employment agreement (the “Employment Agreement”) with NewCo with an initial term that ranges from three to five years (the “Employment Term”), with automatic one-year renewals, unless employment is terminated prior to the end of the Employment Term. As a result, a Selling Shareholder becomes an employee (“Employed Selling Shareholder”) of NewCo. The employment of an Employed Selling Shareholder can be terminated by the Employed Selling Shareholder or NewCo, with or without cause, at any time. In a few situations, a Selling Shareholder does not become employed by NewCo and is not involved with NewCo following the closing; in those situations, such Selling Shareholders sell their entire ownership interest in the Seller Entity as of the closing of the Acquisition.
7.The compensation of each Employed Selling Shareholder is specified in the Employment Agreement and is customary and commensurate with his or her responsibilities based on other employees in similar capacities within NewCo, the Company and the industry.
8.The Company and the Selling Shareholder (including both Employed Selling Shareholders and Selling Shareholders not employed by NewCo) execute a non-compete agreement (the “Non-Compete Agreement”) which restricts the Selling Shareholder from engaging in competing business activities for a specified period of time (the “Non-Compete Term”). A Non-Compete Agreement is executed with the Selling Shareholders in all cases. That is, even if the Selling Shareholder does not become an Employed Selling Shareholder, the Selling Shareholder is restricted from engaging in a competing business during the Non-Compete Term.
9.
The Non-Compete Term commences as of the date of the Acquisition and  expires on the later of :
a.Two years after the date an Employed Selling Shareholders’ employment is terminated (if the Selling Shareholder becomes an Employed Selling Shareholder) or
b.
Five to six years from the date of the Acquisition, as defined in the Non-Compete Agreement, regardless of whether the Selling Shareholder is employed by NewCo.
10.
The Non-Compete Agreement applies to a restricted region which is a defined as a 15-milemile radius from the Therapy Practice. That is, an Employed Selling Shareholder is permitted to engage in competing businesses or activities outside the 15-mile radiusdefined mileage (after such Employed Selling Shareholder no longer is employed by NewCo) and a Selling Shareholder who is not employed by NewCo immediately is permitted to engage in the competing business or activities outside the 15-mile radius.defined mileage.

The Partnership Agreement contains provisions for the redemption of the Seller Entity Interest, either at the option of the Company (the “Call Right”) or at the option of the Seller Entity (the “Put Right”) as follows:

1.Put Right

a.a)
In the event that any Selling Shareholder’s employment is terminated under certain circumstances prior to a specified date (the “Specified Date”), the Seller Entity thereafter may have an irrevocable right to cause the Company to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest at the purchase price described in “3” below.

b.b)
In the event that any Selling Shareholder is not employed by NewCo as of the Specified Date and the Company has not exercised its Call Right with respect to the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest, Seller Entity thereafter shall have the Put Right to cause the Company to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest at the purchase price described in “3” below.

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Index
c.c)
In the event that any Selling Shareholder’s employment with NewCo is terminated for any reason on or after the Specified Date, the Seller Entity shall have the Put Right, and upon the exercise of the Put Right, the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest shall be redeemed by the Company at the purchase price described in “3” below.

2.Call Right

a.a)
If any Selling Shareholder’s employment by NewCo is terminated prior to the Specified Date, the Company thereafter shall have an irrevocable right to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest, in each case at the purchase price described in “3” below.

b.b)
In the event that any Selling Shareholder’s employment with NewCo is terminated for any reason on or after Specified Date, the Company shall have the Call Right, and upon the exercise of the Call Right, the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest shall be redeemed by the Company at the purchase price described in “3” below.

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3.
For the Put Right and the Call Right, the purchase price is derived from a formula based on a specified multiple of NewCo’s trailing twelve months of earnings before interest, taxes, depreciation, amortization, and the Company’s internal management fee, plus an Allocable Percentage of any undistributed earnings of NewCo (the “Redemption Amount”). NewCo’s earnings are distributed monthly based on available cash within NewCo.; Therefore, the undistributed earnings amount is small, if any.

4.
The Purchase Price for the initial equity interest purchased by the Company is, in almost all cases, also based on the same specified multiple of the trailing twelve-month earnings that is used in the Put Right and the Call Right noted above.

5.
The Put Right and the Call Right do not have an expiration date, and the Seller Entity Interest is not required to be purchased by the Company or sold by the Seller Entity unless either the Put Right or the Call Right is exercised.

6.
The Put Right and the Call Right never apply to Selling Shareholders who do not become employed by NewCo, since the Company requires that such Selling Shareholders sell their entire ownership interest in the Seller Entity at the closing of the Acquisition.

ProgressiveHealth Acquisition

On November 30, 2021, the Company acquired a majority interest in ProgressiveHealth Companies, LLC (“Progressive”), which owns a majority interest in certain subsidiaries (“Progressive Subsidiaries”) that operate in the industrial injury prevention and therapy services businesses.  The Progressive transaction was completed in a series of steps which are described below.


1.Prior to the acquisition, the Progressive Subsidiaries were owned by a legal entity (“Progressive Parent”) controlled by its individual owners (the “Progressive Selling Shareholders”), who work in and manage the Progressive business.

2.In conjunction with the acquisition, the Selling Shareholders caused the Progressive Parent to transfer its ownership of the Progressive Subsidiaries into a newly-formed limited liability company (“Progressive NewCo”), in exchange for one hundred percent (100%) of the membership interests in NewCo. Therefore, in this step, NewCo became wholly-owned by the Selling Shareholders.

3.The Company entered into an agreement (the “Progressive Purchase Agreement”) to acquire from the Selling Shareholders a majority of the membership interest in NewCo. The consideration for the acquisition is primarily payable in the form of cash at closing, a relatively small portion paid in cash after the closing contingent on certain performance criteria, and a small note in lieu of an escrow (the “Progressive Purchase Price”).
22

4.The Company and the Selling Shareholders also executed an operating agreement (the “Progressive Operating Agreement”) for NewCo that sets forth the rights and obligations of the members of NewCo.

5.As noted above, the Company did not purchase 100% of the membership interests in NewCo and the Selling Shareholders retained a portion of the membership interest in NewCo (“Progressive Selling Shareholders’ Interest”).

6.The Company and the Selling Shareholders executed a non-compete agreement (the “Progressive Non-Compete Agreement”) which restricts the Selling Shareholders from competing for a specified period of time (the “Progressive Non-Compete Term”).

7.
The Non-Compete Term commences as of the date of the Acquisition and expires on the later of:

a.Two years after the date a Selling Shareholder no longer is involved in the management of NewCo or

b.Seven years from the date of the acquisition.

8.The Non-Compete Agreement applies to the entire United States.

9.The Put Right (as defined below) and the Call Right (as defined below) do not have an expiration date.

The Operating Agreement contains provisions for the redemption of the Selling Shareholder’s Interest, either at the option of the Company (the “Progressive Call Right”) or at the option of the Selling Shareholder (the “Progressive Put Right”) as follows:


1.Put Right

a.Each of the Selling Shareholders has the right to sell 30% of their respective residual interests on each of the 4th and 5th anniversaries of the acquisition closing, and then 10% on each of the 6th and 7th anniversaries
b.
In the event that any Selling Shareholder terminates his management relationship with NewCo for any reason on or after the seventh anniversary of the Closing Date, the Selling Shareholder has the Put Right, and upon the exercise of the Put Right, the Selling Shareholder’s Interest shall be redeemed by the Company at the purchase price described in “3” below.

2.Call Right

a.
If any Selling Shareholder’s ceases to perform management services on behalf of NewCo, the Company thereafter shall have an irrevocable right to purchase from such Selling Shareholder his Interest, in each case at the purchase price described in “3” below.
3.
For the Put Right and the Call Right, the purchase price is derived from a formula based on a specified multiple of NewCo’s trailing twelve months of earnings before interest, taxes, depreciation, amortization, and the Company’s internal management fee, plus an Allocable Percentage of any undistributed earnings of NewCo (the “Redemption Amount”). NewCo’s earnings are distributed monthly based on available cash within NewCo; therefore, the undistributed earnings amount is small, if any.
4.
The Purchase Price for the initial equity interest purchased by the Company is also based on the same specified multiple of the trailing twelve-month earnings that is used in the Put Right and the Call Right noted above.
5.
The Put Right and the Call Right do not have an expiration date.


Neither the Operating Agreement nor the Non-Compete Agreement contain any provision to escrow or “claw back” the equity interest in NewCo held by the Selling Shareholders, in the event of a breach of the operating agreement or non-compete terms, or the management services agreement pursuant to which the Selling Shareholders perform services on behalf of NewCo. The Company’s only recourse against the Selling Shareholder for breach of any of these agreements is to seek damages and other legal remedies under such agreements. There are no conditions in any of the arrangements with a Selling Shareholder that would result in a forfeiture of the equity interest in NewCo held by a Selling Shareholder.

An Employed Selling Shareholder’s ownership of his or her equity interest in the Seller Entity predates the Acquisition and the Company’s purchase of its partnership interest in NewCo. The Employment Agreement and the Non-Compete Agreement do not contain any provision to escrow or “claw back” the equity interest in the Seller Entity held by such Employed Selling Shareholder, nor the Seller Entity Interest in NewCo, in the event of a breach of the employment or non-compete terms. More specifically, even if the Employed Selling Shareholder is terminated for “cause” by NewCo, such Employed Selling Shareholder does not forfeit his or her right to his or her full equity interest in the Seller Entity and the Seller Entity does not forfeit its right to any portion of the Seller Entity Interest. The Company’s only recourse against the Employed Selling Shareholder for breach of either the Employment Agreement or the Non-Compete Agreement is to seek damages and other legal remedies under such agreements. There are no conditions in any of the arrangements with an Employed Selling Shareholder that would result in a forfeiture of the equity interest held in the Seller Entity or of the Seller Entity Interest.

23
For the three and six months ended June 30, 2021 and 2020,dates indicated, the following table details the changes in the carrying amount (fair value) of the redeemable non-controlling interestsinterest (in thousands):

 Three Months Ended  Six Months Ended  Three Months Ended  Six Months Ended 
 June 30, 2021  June 30, 2020  June 30, 2021  June 30, 2020  June 30, 2022  June 30, 2021  June 30, 2022  June 30, 2021 
                        
Beginning balance $138,924  $140,498  $132,340  $137,750  $158,008  $138,924  $155,262  $132,340 
Operating results allocated to redeemable non-controlling interest partners  3,611   2,996   6,064   4,792   2,626   3,611   5,183   6,064 
Distributions to redeemable non-controlling interest partners  (2,622)  (2,054)  (6,216)  (3,665)  (2,328)  (2,622)  (4,731)  (6,216)
Changes in the fair value of redeemable non-controlling interest  2,549   (3,344)  9,819   (5,473)  (210)  2,549   (57)  9,819 
Purchases of redeemable non-controlling interest  (4,707)  (1,372)  (9,536)  (3,224)  (7,138)  (4,707)  (9,596)  (9,536)
Acquired interest  5,556   0   10,719   6,471   0   5,556   4,946   10,719 
Sales of redeemable non-controlling interest - temporary equity  0   564   319   564   2,187   0   2,187   319 
Notes receivable related to sales of redeemable non-controlling interest - temporary equity  0   (545)  (287)  (545)  (1,843)  0   (1,843)  (287)
Adjustments in notes receivable related to the the sales of redeemable non-controlling interest - temporary equity  26   (15)  115   58   98   26   49   115 
Ending balance $143,337  $136,728  $143,337  $136,728  $151,400  $143,337  $151,400  $143,337 

The following table categorizes the carrying amount (fair value) of the redeemable non-controlling interestsinterest (in thousands):

 
June 30, 2021
  
June 30, 2020
 
       
Contractual time period has lapsed but holder's employment has not been terminated $73,915  $72,815 
Contractual time period has not lapsed and holder's employment has not been terminated  69,422   63,913 
Holder's employment has terminated and contractual time period has expired  0   0 
Holder's employment has terminated and contractual time period has not expired  0   0 
  $143,337  $136,728 
 
 Six Months Ended 
 
 June 30, 2022  June 30, 2021 
 
      
Contractual time period has lapsed but holder’s employment has not terminated
 
$
73,204
  
$
73,915
 
Contractual time period has not lapsed and holder’s employment has not terminated
  
78,196
   
69,422
 
Holder’s employment has terminated and contractual time period has expired
  
0
   
0
 
Holder’s employment has terminated and contractual time period has not expired
  
0
   
0
 
 
 
$
151,400
  
$
143,337
 

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6. GOODWILL

The changes in the carrying amount of goodwill consisted of the following (in thousands):

 
Six Months Ended
  Year Ended  Six Months Ended  Year Ended 
 June 30, 2021  December 31, 2020  June 30, 2022  December 31, 2021 
            
Beginning balance $345,646  $317,676  $434,679  $345,646 
Goodwill acquired  27,814   28,540   12,114   89,746 
Goodwill derecognition (write-off) related to closed clinics  0   (1,859)
Goodwill adjustments for purchase price allocation of businesses acquired in prior year  427   1,289   (4,032)  (713)
Ending balance $373,887  $345,646  $442,761  $434,679 

The derecognition (write-off) of goodwill in the amount of $1.9million was related to certain clinics that have been permanently closed.

7. INTANGIBLE ASSETS, NET

Intangible assets, net as of June 30, 20212022, and December 31, 20202021 consisted of the following (in thousands) thousands):

 June 30, 2021  December 31, 2020 
Tradenames $32,836  $32,317 
Referral relationships, net of accumulated amortization of $16,082 and $14,522, respectively
  24,707   22,119 
Non-compete agreements, net of accumulated amortization of $6,170 and $5,993, respectively
  1,673   1,844 
  $59,216  $56,280 
 June 30, 2022  December 31, 2021 
Tradenames $39,838  $38,790 
Customer and referral relationships, net of accumulated amortization of $20,772 and $17,762, respectively
  51,047   45,643 
Non-compete agreements, net of accumulated amortization of $6,717 and $6,450, respectively
  1,770   1,949 
  $92,655  $86,382 

24
Tradenames, referral relationships and non-compete agreements are related to the businesses acquired. The value assigned to tradenames has an indefinite life and is tested at least annually for impairment using the relief from royalty method in conjunction with the Company’s annual goodwill impairment test. The value assigned to referral relationships is being amortized over their respective estimated useful lives which range from six to thirteenfourteen years. Non-compete agreements are amortized over the respective term of the agreements which range from five to six years.

The following table details the amount of amortization expense recorded for intangible assets for the three and six months ended June 30, 20212022, and 20202021 (in thousands) thousands):

 Three Months Ended  Six Months Ended  Three Months Ended  Six Months Ended 
 June 30, 2021  June 30, 2020  June 30, 2021  June 30, 2020  June 30, 2022  June 30, 2021  June 30, 2022  June 30, 2021 
Referral relationships $778  $836  $1,561  $1,449 
Customer and referral relationships $1,339  $778  $3,011  $1,561 
Non-compete agreements  138   87   177   264   120   138   267   177 
 $916  $923  $1,738  $1,713  $1,459  $916  $3,278  $1,738 

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Table of Contents
Based on the balance of referral relationships and non-compete agreements as of June 30, 2021,2022, the expected amount to be amortized in 20212022 and thereafter by year is as follows (in thousands):

Referral Relationships Non-Compete Agreements 
Years Annual Amount Years Annual Amount 
Ending December 31,   Ending December 31,   
2021 (excluding the six months ended June 30, 2021)
$1,626 2021 (excluding the six months ended June 30, 2021)$281 
2022$3,203 2022$406 
2023$3,096 2023$336 
2024$2,932 2024$279 
2025$2,788 2025$213 
Thereafter$11,062 Thereafter$158 
Customer and Referral Relationships
  Non-Compete Agreements 
Years Annual Amount  Years  Annual Amount 
Ending December 31,    Ending December 31,    
2022 (excluding the six months ended June 30, 2022)
 $2,745  
2022 (excluding the six months ended June 30, 2022)
  $267 
2023 $5,393  2023
  $477 
2024 $5,228  2024
  $421 
2025 $5,084  2025
  $355 
2026 $4,616  2026
  $216 
Thereafter $27,981  Thereafter  $34 

8. ACCRUED EXPENSES

Accrued expenses as of June 30, 20212022 and December 31, 20202021 consisted of the following (in thousands):

 June 30, 2021  December 31, 2020  June 30, 2022  December 31, 2021 
Salaries and related costs $24,378  $24,646  $19,524  $23,569 
Credit balances due to patients and payors  5,638   5,756   7,875   6,649 
Group health insurance claims  2,316   2,113   2,038   1,984 
Closure costs  844   1,333   285   498 
Federal income taxes payable  4,547   5,715 
MAAPP funds payable  0   14,054 
Deferred employer payroll taxes - CARES ACT  4,547   4,170 
Federal taxes payable  1,754   2,716 
Contingent payments related to acquisition
  1,000   1,000 
Settlement of a legal matter
  0   2,750 
Other  2,450   1,959   8,770   6,539 
Total $44,720  $59,746  $41,246  $45,705 

See Note – 1 BasisIn January 2022, to avoid the legal fees and discovery costs in defending a legal matter and the uncertainty of Presentation and Significant Accounting Policies – Impactprotracted litigation, the Company entered into a settlement agreement. The Company admitted no liability or wrongdoing. Under the terms of COVID-19 for a discussionthe settlement, the Company agreed to make payments which amounted to $2.75 million, of CARES Act and MAAPP funds. Closure costs consist primarily of remaining lease commitments related to closed clinics.which $2.6 million was recorded as an expense in 2021.

9. NOTES PAYABLE AND AMENDED CREDIT AGREEMENT

Amounts outstanding under the Amended Credit Agreement (as defined below) and notes payable as of June 30, 2021 and December 31, 2020 consisted of the following (in thousands):

 June 30, 2021  December 31, 2020 
Credit Agreement average effective interest rate of 2.6% for both June 30, 2021 and December 31, 2020, (inclusive of unused fee)
 $38,000  $16,000 
Various notes payable with $1,017 plus accrued interest due in the next year, interest accrues in the range of 3.25% through 5.50% per annum
  1,838   5,495 
  $39,838  $21,495 
Less current portion  (1,017)  (4,899)
Long term portion $38,821  $16,596 

Effective December 5,2013, the Company entered into an Amended and Restated Credit Agreement with a commitment for a $125.0$125.0 million revolving credit facility. This agreement was amended and/or restated in August 2015, January 2016, March 2017, November 2017, January and January 2021 (hereafter referred to as “Amended(“Amended Credit Agreement”). The

On June 17,2022, the Company entered into the Third Amended and Restated Credit Agreement is unsecured(the “Credit Agreement”) among Bank of America, N.A., as administrative agent (“Administrative Agent”) and has loan covenants, including requirements that the Company comply with a consolidated fixed charge coverage ratio and consolidated leverage ratio. Proceedslenders from the Amended Credit Agreement may be used for working capital, acquisitions, purchases of the Company’s common stock, dividend payments to the Company’s common stockholders, capital expenditures and other corporate purposes. The pricing grid is based on the Company’s consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.25% to 2.0% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Feestime-to-time party thereto.

25
Index
Amounts outstanding under the Amended Credit Agreement include an unused commitment feeand Credit Agreement (as defined above) and notes payable as of 0.3%June 30,2022 and December 31,2021 consisted of the following (in thousands):

  
June 30, 2022
  
December 31, 2021
 
  
Principal
Amount
  
Unamortized discount
and debt issuance cost
  Net Debt  
Principal
Amount
  
Unamortized discount
and debt issuance cost
  Net Debt 
Revolving Facilitiy $0  $0  $0  $114,000  $0  $114,000 
Term Facility  150,000   2,027   147,973   0   0   0 
Other Debt  5,696   0   5,696   4,417   0   4,417 
Total Debt $155,696  $2,027  $153,669  $118,417  $0  $118,417 
Less: Current portion of long-term debt  5,188   408  $4,780   830   0   830 
Total long-term debt, net of current portion $150,508  $1,619  $148,889  $117,587  $0  $117,587 

The Credit Agreement, which matures on June 17, 2027, provides for loans in an aggregate principal amount of funds outstanding under$325 million. Such loans were made available through the Amendedfollowing facilities (collectively, the “Senior Credit Agreement.Facilities”):

1)Revolving Facility: $175 million, five-year, revolving credit facility (“Revolving Facility”), which includes a $12 million sublimit for the issuance of standby letters of credit and a $15 million sublimit for swingline loans (each, a “Swingline Loan”).

25
2)
Term Facility: $150 million term loan facility (the “Term Facility”). The Term Facility amortizes in quarterly installments of: (a) 0.625% in each of the firsttwo years, (b) 1.250% in the third and fourth year, and (c) 1.875% in the fifth year of the Credit Agreement. The remaining outstanding principal balance of all term loans is due on the maturity date.

The January 2021 amendment toproceeds of the Amended Credit Agreement allows the cash and noncash consideration thatRevolving Facility shall be used by the Company could pay with respectfor working capital and other general corporate purposes of the Company and its subsidiaries, including to fund future acquisitions permittedand invest in growth opportunities. The proceeds of the Term Facility were used by the Company to refinance the indebtedness outstanding under the Amended Credit Agreement, to $50,000,000pay fees and expenses incurred in connection with the transactions involving the loan facilities, for any fiscal year,working capital and the amountother general corporate purposes of the Company may pay in cash dividendsand its subsidiaries.

The Company is permitted to its shareholdersincrease the Revolving Facility and/or add one or more tranches of term loans in an aggregate amount not to exceed $50,000,000 in any fiscal year. The commitment remains at $125the sum of (i) $100 million howeverplus (ii) an unlimited additional amount, provided that (in the accordion featurecase of clause (ii)), after giving effect to such increases, the pro forma Consolidated Leverage Ratio (as defined in the agreement was expandedCredit Agreement) would not exceed 2.0:1.0, and the aggregate amount of all incremental increases under the Revolving Facility does not exceed $50,000,000.

The interest rates per annum applicable to providethe Senior Credit Facilities (other than in respect of Swingline Loans) will be Term SOFR (as defined in the Credit Agreement) plus an applicable margin or, at the option of the Company, an alternate base rate plus an applicable margin. Each Swingline Loan shall bear interest at the base rate plus the applicable margin. The applicable margin for capacity upTerm SOFR borrowings ranges from 1.50% to $150 million,2.25%, and has a maturitythe applicable margin for alternate base rate borrowings ranges from 0.50% to 1.25%, in each case, based on the Consolidated Leverage Ratio of the Company and its subsidiaries. Interest is payable at the end of the selected interest period but no less frequently than quarterly and on the date of November 30, 2025. maturity.

The AmendedCompany will also pay to the Administrative Agent, for the account of each lender under the Revolving Facility, a commitment fee equal to the actual daily excess of each lender’s commitment over its outstanding credit exposure under the Revolving Facility (“unused fee”). Such unused fee will range between 0.25% and 0.35% per annum and is also based on the Consolidated Leverage Ratio of the Company and its subsidiaries. The Company may prepay and/or repay the revolving loans and the term loans, and/or terminate the revolving loan commitments, in whole or in part, at any time without premium or penalty, subject to certain conditions.
The Credit Agreement is unsecuredcontains customary covenants limiting, among other things, the incurrence of additional indebtedness, the creation of liens, mergers, consolidations, liquidations and dissolutions, sales of assets, dividends and other payments in respect of equity interests, acquisitions, investments, loans and guarantees, subject, in each case, to customary exceptions, thresholds and baskets. The Credit Agreement includes certain financial covenants which include a consolidated fixed charge coverage ratiothe Consolidated Fixed Charge Coverage Ratio, and a consolidated leverage ratio,the Consolidated Leverage Ratio, as defined in the agreement.Credit Agreement. The Credit Agreement also contains customary events of default.
26
The Company’s obligations under the Credit Agreement are guaranteed by its wholly-owned material domestic subsidiaries (each, a “Guarantor”), and the obligations of the Company and any Guarantors are secured by a perfected first priority security interest in substantially all of the existing and future personal property of the Company and each Guarantor, subject to certain exceptions.
As of June 30,, 2021,2022, $38.0150.0 million million was outstanding on the AmendedSenior Credit Agreement,Facilities, resulting in $87.0175.0 million million of availability. As of June 30, 2021,2022, the Company was in compliance with all of the covenants contained in the Amended Credit Agreement.

The Company generally enters into various notes payable as a means of financing a portion of its acquisitions and purchasing of non-controlling interests. In conjunction with these transactions in 20202022 and 2021, the Company entered into notes payable in the aggregate amount of $1.64.9 million of which an aggregate principal payment of $0.50.8 million is due in 2021,2022, $0.64.1 million is due in 2022 and $0.5 million is due in 2023. Interest accrues in the range of 3.25% to 5.50%3.50% per annum and is payable with each principal installment.

10.DERIVATIVE INSTRUMENTS

The balanceCompany is exposed to certain market risks during the ordinary course of business due to adverse changes in interest rates. The exposure to interest rate risk primarily results from the Company’s variable-rate borrowing. The Company may elect to use derivative financial instruments to manage risks from fluctuations in interest rates. The Company does not purchase or hold derivatives for trading or speculative purposes. Fluctuations in interest rates can be volatile and the Company’s risk management activities do not eliminate these risks.

Interest Rate Swap

In May 2022, the Company entered into an interest rate swap agreement, effective on June 30, 2022, with Bank of America, N.A, which has a $150 million notional value, and a maturity date of June 30, 2027. Beginning in July 2022, the Company receives 1-month SOFR, and pays a fixed rate of interest of 2.815% on 1-month SOFR on a quarterly basis. The total interest rate in any period will also include an applicable margin based on the Company’s consolidated leverage ratio.

In connection with the swap, no cash was exchanged between the Company and the counterparty.

The Company designated its interest rate swap as a cash flow hedge and structured it to be highly effective. Consequently, unrealized gains and losses related to the fair value of the various notes payable entered into priorinterest rate swap are recorded to 2020 was $0.2 million which will be paidaccumulated other comprehensive income (loss), net of tax.

The impacts of the Company’s derivative instruments on the accompanying Consolidated Statements of Comprehensive Income for the three months and six months ended June 30, 2022 are presented in the last six months in 2021.

Subsequent aggregate annual payments of principal required pursuant to the Amended Credit Agreement and outstanding notes payable at June 30, 2021 are as followstable below (in thousands):

During the twelve months ended June 30, 2022 $1,017 
During the twelve months ended June 30, 2023  821 
During the twelve months ended June 30, 2026  38,000 
  $39,838 
  Three Months Ended  For the Six Months Ended 
  June 30, 2022  June 30, 2021  June 30, 2022  June 30, 2021 
Unrealized loss on cash flow hedge  
(531
)
  
0
   
(531
)
  
0
 
Tax effect at statutory rate (federal and state) of 25.55%
  
136
   
0
   
136
   
0
 
Other Comprehensive loss 
$
(395
)
 
$
0
  
$
(395
)
 
$
0
 

The outstanding amounts undervaluations of the Amended Credit Agreement facility (balance at June 30, 2021Company’s interest rate derivatives are measured as the present value of $38.0 million) mature all expected future cash flows based on November 30, 2025.
SOFR-based yield curves. The present value calculation uses discount rates that have been adjusted to reflect the credit quality of the Company and its counterparty which is a Level 2 fair value measurement.

10.27
The carrying and fair value of the Company’s interest rate derivatives (included in current liabilities) were as follows:

  June 30, 2022  June 30, 2021 
       
Interest rate swap 
$
(531
)
 
$
0
 

11. LEASES

The Company has operating leases for its corporate offices and operating facilities. The Company determines if an arrangement is a lease at the inception of a contract. Effective January 1, 2019, right- of-use assets and operating lease liabilities are included in the consolidated balance sheet. Right-of-use assets represent the Company’s right to use an underlying asset during the lease term and operating lease liabilities represent net present value of the Company’s obligation to make lease payments arising from the lease. Right-of-use assets and operating lease liabilities are recognized at commencement date based on the net present value of the fixed lease payments over the lease term. The Company’s operating lease terms are generally five years or less. The Company’s lease terms include options to extend or terminate the lease when it is reasonably certain that the option will be exercised. As most of the Company’s operating leases do not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating fixed lease expense is recognized on a straight-line basis over the lease term.

In accordance with ASC 842, the Company records on its consolidated balance sheet leases with a term greater than 12 months. The Company has elected, in compliance with current accounting standards, not to record leases with an initial termsterm of 12 months or less in the consolidated balance sheet. ASC 842 requires the separation of the fixed lease components from the variable lease components. The Company has elected the practical expedient to account for separate lease components of a contract as a single lease cost thus causing all fixed payments to be capitalized. Non-lease and variable cost components are not included in the measurement of the right-of-use assets or operating lease liabilities. The Company also elected the package of practical expedients permitted within ASC 842, which among other things, allows the Company to carry forward historical lease classification. Variable lease payment amounts that cannot be determined at the commencement of the lease such as increases in lease payments based on changes in index rates or usage are not included in the right-of- use assets or operating lease liabilities. These are expensed as incurred and recorded as variable lease expense.

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For the three months and six months ended June 30, 2021,2022, the components of lease expense were as follows (in thousands):

 Three Months Ended  Six Months Ended  Three Months Ended  Six Months Ended 
 
June 30, 2021
  
June 30, 2020
  
June 30, 2021
  
June 30, 2020
  
June 30, 2022
  
June 30, 2021
  
June 30, 2022
  
June 30, 2021
 
Operating lease cost $7,895  $7,815  $15,624  $15,627  $8,700  $7,895  $17,104  $15,624 
Short-term lease cost  361   215   729   509   259   361   580   729 
Variable lease cost  1,628   1,514   3,239   3,046   1,994   1,628   3,926   3,239 
Total lease cost * $9,884  $9,544  $19,592  $19,182  $10,953  $9,884  $21,610  $19,592 

*Sublease income was immaterial

Lease cost is reflected in the consolidated statement of net income in the line item – rent, supplies, contract labor and other.

Supplemental information related to leases was as follows (in thousands):

 Three Months Ended  Six Months Ended  Three Months Ended  Six Months Ended 
 June 30, 2021  June 30, 2020  
June 30, 2021
  
June 30, 2020
  June 30, 2022  June 30, 2021  
June 30, 2022
  
June 30, 2021
 
                        
Cash paid for amounts included in the measurement of operating lease liabilities (in thousands) $8,258  $6,555  $16,370  $14,345  $8,940  $8,258  $17,557  $16,370 
                                
Right-of-use assets obtained in exchange for new operating lease liabilities (in thousands) $12,976  $7,535  $20,873  $19,075  $15,595  $12,976  $21,606  $20,873 

28
Index
The aggregate future lease payments for operating leases as of June 30, 20212022 were as follows (in thousands):

Fiscal Year Amount  Amount 
2021 (excluding the six months ended June 30, 2021)
 $15,765 
2022  28,048 
2022 (excluding the six months ended June 30, 2022)
 $17,829 
2023  22,301   31,725 
2024  15,724   25,292 
2025  9,460   18,060 
2026 and therafter
  9,374 
2026  11,613 
2027 and therafter
  11,135 
Total lease payments $100,672  $115,654 
Less: imputed interest  5,925   5,795 
Total operating lease liabilities $94,747  $109,859 

Average lease terms and discount rates were as follows:

 Three Months Ended  Six Months Ended 
  June 30, 2021  June 30, 2020  
June 30, 2021
  
June 30, 2020
 
Weighted-average remaining lease term - Operating leases 4.11 Years  4.21 Years  
4.11 Years
  
4.21 Years
 
             
Weighted-average discount rate - Operating leases  3.0%  3.2%  3.0%  3.2%
 Three Months Ended  Six Months Ended 
  June 30, 2022  June 30, 2021  
June 30, 2022
  
June 30, 2021
 
Weighted-average remaining lease term - Operating leases 4.19 Years  4.11 Years  
4.19 Years
  
4.11 Years
 
             
Weighted-average discount rate - Operating leases  2.48%  3.0%  2.48%  3.0%

11.12. SEGMENT INFORMATION

The Company’s reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. IncludedAlso included in the physical therapy operations segment are revenues from management contract services and other services which include services the Company provides on-site, such as schools for athletic trainers for schools.trainers.

The Company evaluates performance of the segments based on gross profit. The Company has provided additional information regarding its reportable segments which contributes to the understanding of the Company and provides useful information.

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The following table summarizes selected financial data for the Company’s reportable segments. Prior year results presented herein have been changed to conform to the current presentation.

 Three Months Ended June 30,  Six Months Ended June 30,  Three Months Ended June 30,  Six Months Ended June 30, 
 2021  2020  2021  2020  2022  2021  2022  2021 
                        
Net operating revenues:            
Net operating revenue:            
Physical therapy operations $116,895  $74,199  $219,253  $177,040  $121,219  $116,895  $233,855  $219,253 
Industrial injury prevention services  10,033   9,658   20,043   19,534   19,437   10,033   38,505   20,043 
Total Company $126,928  $83,857  $239,296  $196,574  $140,656  $126,928  $272,360  $239,296 
                                
Gross profit:                                
Physical therapy operations (excluding closure costs) $31,739  $16,199  $54,950  $33,978 
Physical therapy operations
 $26,698  $31,761  $49,135  $54,935 
Industrial injury prevention services  2,543   3,179   5,265   4,843   4,123   2,543   8,274   5,265 
 $34,282  $19,378  $60,215  $38,821 
Physical therapy operations - closure costs  (22)  94   15   3,846 
Gross profit $34,304  $19,284  $60,200  $34,975  $30,821  $34,304  $57,409  $60,200 
                                
Total Assets:                                
Physical therapy operations         $578,985  $534,238  

  

  $414,172  $545,449 
Industrial injury prevention services          43,973   50,780   
   
   382,272   203,977 
Total Company         $622,958  $585,018  

  

  $796,444  $749,426 

13. INVESTMENT IN UNCONSOLIDATED AFFILIATE

12. RELATED PARTY TRANSACTIONS

SettlementThrough one of Short Swing Profit Claim

In March 2021,the subsidiaries, the Company recorded approximately $12.8 thousand relatedhas a 49% joint venture interest in a company which provides physical therapy services for patients at hospitals. Since the Company is deemed to the short swing profit settlement remitted bynot have a shareholder of our company under Section 16(b) of the Securities Exchange Act of 1934, as amended. The Company recognized the proceeds as an increase to additional paid-in capitalcontrolling interest in the consolidatedjoint venture, the Company’s investment is accounted for using the equity method of accounting. The investment balance sheetsof this joint venture as of June 30, 2021 and consolidated statements of stockholders’ equity, as well as in cash provided by financing activities included in Other, in the consolidated statements of cash flows, for2022, is $12.3 million. For the six months ended June 30, 2021.
2022, the earnings amounted to$679 thousand and $548 thousand was distributed to the Company.

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Index
14. COMMON STOCK

From September 2001 through December 31, 2008, the Board authorized the Company to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of the Company’s common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of its common stock (“March 2009 Authorization”). The Amended Credit Agreement permits share repurchases of up to $15,000,000, subject to compliance with covenants. The Company is required to retire shares purchased under the March 2009 Authorization.

Under the March 2009 Authorization, the Company has purchased a total of 859,499 shares. There is no expiration date for the share repurchase program. There are currently an additional estimated 129,455137,363 shares (based on the closing price of $115.87$109.20 on June 30, 2021)2022) that may be purchased from time to time in the open market or private transactions depending on price, availability and the Company’s cash position. The Company did 0t purchase any shares of its common stock during the three and six months ended June 30, 2021.
2022.

14.
15. RECLASSIFICATION OF PRIOR PERIOD PRESENTATION

Certain prior yearperiod amounts have been reclassified for consistency with the current yearperiod presentation. These reclassifications had no effect on the reported results of operations.

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Table of ContentsIndex
Item 2.MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS.

The following is a discussion of our historical consolidated financial condition and results of operations, and should be read in conjunction with (i) our historical consolidated financial statements and accompanying notes thereto included elsewhere in this Quarterly Report on Form 10-Q; (ii) our Annual Report on Form 10-K for the year ended December 31, 20202021 filed with the Securities and Exchange Commission (the “SEC”) on March 1, 2022 (“2021 (“2020 Annual Report”); and (iii) our management’s discussion and analysis of financial condition and results of operations included in our 20202021 Annual Report. This discussion includes forward-looking statements that are subject to risk and uncertainties. Actual results may differ substantially from the statements we make in this section due to a number of factors that are discussed in “Forward-Looking Statements” herein and in Part II, Item 1A. Risk Factors of this report.

References to “we,” “us,” “our” and the “Company” shall mean U.S. Physical Therapy, Inc. and its subsidiaries.

EXECUTIVE SUMMARY

Our Business

We operate outpatient physical therapy clinics that provide pre- and post-operative care and treatment for a variety of orthopedic-related disorders and sports-related injuries, neurologically-related injuries and rehabilitation of injured workers. We also operate an industrial injury prevention services (“IIPS”) business which includes onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments services.

Business Update Related to COVID-19

As previously disclosed in a series of filings with the SEC and further described in detail in our Quarterly Reports on Form 10-Q for the first three quarters of 2020 and the 2020 Annual Report, our results were negatively impacted by the effects of the COVID-19 pandemic in 2020. For 2021 periods as compared to 2020 periods, the increase in revenues and expenses are primarily due to the Company returning to pre-pandemic volumes.

We have put preparedness plans in place at our facilities to maintain continuity of operations, while also taking steps to keep employees and patients safe. In line with recommendations to reduce large gatherings and increase social distancing, we continue to allow a large number of office-based employees to work remotely. The Company is monitoring the situation and will adjust work environments accordingly.

In response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The CARES Act was signed into law in March 2020. The CARES Act provides numerous tax provisions and other stimulus measures, including temporary changes regarding the prior and future utilization of net operating losses, temporary changes to the prior and future limitations on interest deductions, temporary suspension of certain payment requirements for the employer portion of Social Security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property, and the creation of certain payroll tax credits associated with the retention of employees.

In 2020, we received benefits under the CARES Act including, but not limited to:

•
The CARES Act allowed for qualified healthcare providers to receive advanced payments under the Medicare Accelerated and Advance Payment Program (“MAAPP Funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. We applied for and received approval fromCenters for Medicare & Medicaid Services (“CMS”) in April 2020. We recorded the $14.1 million in advance payments received as a liability. During the 2021 First Quarter, we repaid the MAAPP Funds of $14.1 million rather than applying them to future services performed.

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We elected to defer depositing the employer’s share of Social Security taxes for payments due from March 27, 2020 through December 31, 2020, interest-free and penalty-free.  As of June 30, 2021, included in each of accrued liabilities was $4.1 million and in other long-term liabilities is $4.2 million related to these deferred payments.

The CARES Act provided additional waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. Through December 31, 2020, our consolidated subsidiaries received approximately $13.5 million of payments under the CARES Act (“Relief Funds”). Under the our accounting policy, these payments have been recorded as Other income – Relief Funds. These funds are not required to be repaid upon attestation and compliance with certain terms and conditions, which could change materially based on evolving grant compliance provisions and guidance provided by the U.S. Department of Health and Human Services. Currently, we can attest and comply with the terms and conditions.  We will continue to monitor the evolving guidelines and may record adjustments as additional information is released.  There were no Relief Funds received in the six months ended June 30, 2021.

Selected Operating and Financial Data

Our reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. Our physical operations consist of physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic-related disorders, sports-related injuries, preventive care, rehabilitation of injured workers and neurological injuries. Services provided by industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments.

At June 30, 2021,2022, we operated 575608 clinics in 39 states.  In addition to our ownership and operation of outpatient physical therapy clinics, we also manage physical therapy facilities for third parties, such as physicians and hospitals, with 3933 such third-party facilities under management as of June 30, 2021.2022.

In March 2017,During the 2021 year and for the six months ended June 30, 2022, we acquired a 55% interest in an initialcompleted the acquisitions of four multi-clinic practices and two industrial injury prevention business. On April 30, 2018, we made a second acquisition and subsequently combined the two businesses.   After the combination, we owned a 59.45% interest in the combined business, Briotix Health, Limited Partnership (“Briotix Health”). Services provided include onsite injury and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. We perform these services through businesses as detailed below.

Acquisition
 Date Acquired Clinics
March 2022 Acquisition
 March 31, 2022 70% 6
December 2021 Acquisition
 December 31, 2021 75% 3
November 2021 Acquisition
 November 30, 2021 70% IIPS*
September 2021 Acquisition
 September 30, 2021 100% IIPS*
June 2021 Acquisition
 June 30, 2021 65% 8
March 2021 Acquisition
 March 31, 2021 70% 6

*Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs). On April 11, 2019, we acquired a third company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network in 45 states including onsite at eleven client locations. The acquired business was then combined with Briotix Health increasing our ownership position in the partnership to approximately 76.0%.

On June 30, 2021, we acquired a 65% interest in an eight-clinic physical therapy practice with the practice founder retaining 35%. The purchase price was approximately $10.3 million, of which $9.0 million was paid in cash, $1.0 million is payable based on the achievement of certain business criteria and $0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on June 30, 2023.
On March 31, 2021, we acquired a 70% interest in a five-clinic physical therapy practice with the practice founder retaining 30%. When acquired, the practice was developing a sixth clinic which has been completed.  The purchase price was approximately $12.0 million, of which $11.7 million was paid in cash and a $0.3 million note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on March 31, 2023.
On November 30, 2020, we acquired a 75% interest in a three-clinic physical therapy practice. The purchase price for the 75% interest was $8.9 million (net of cash acquired), of which $8.6 million was paid in cash and $0.3 million in the form of a note payable that is payable in two principal installments totaling $162,500 each. The first principal payment plus accrued interest is due to be paid in November 2021 with the second installment to be paid in November 2022. The note accrues interest at 3.25% per annum.

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On September 30, 2020, we acquired a 70% interest in an entity which holds six-management contracts that have been in place for a number of years. Currently, these contracts have a five year term. The purchase price for the 70% interest was approximately $4.2 million, with $3.7 million payable in cash and $0.5 million in two notes payable. One of the notes payable of $0.2 million is payable, with any accrued interest at 5% per annum, on September 30, 2021.  The remaining note of $0.3 million was paid in November 2020.

On February 27, 2020, we acquired interests in a four-clinic physical therapy practice. The four clinics are in four separate partnerships.  Our interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The purchase price was $11.9 million, of which $11.6 million was paid in cash and a $0.3 million note payable.  The note accrues interest at 4.75% per annum and the principal and interest is payable in February 2022.

During the six months ended June 30, 2020,2022, we closed three clinics and sold twofive clinics.  The aggregate sales price was $0.1 million.

Employees

Our strategy is to acquire physical therapy practices, develop outpatient physical therapy clinics as satellites within existing partnerships, acquire industrial injury prevention services businesses, and to continue to support the growth of our existing businesses requires a talented workforce that can grow with us. As of June 30, 2021,2022 we employed approximately 5,1785,809 people nationwide, of which approximately 2,7553,158 were full-time employees.

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It is crucial that we continue to attract and retain top talent. To attract and retain talented employees, we strive to make our corporate office and all of our practices and businesses a diverse and healthy workplace, with opportunities for our employees to receive continuing education, skill development, encouragement to grow and develop their career, all supported by competitive compensation, incentives, and benefits. Our clinical professionals are all licensed and a vast majority have advanced degrees. Our operational leadership teams have long-standing relationships with local and regional universities, professional affiliations, and other applicable sources that provide our practices with a talent pipeline.

We provide competitive compensation and benefits programs to help meet our employees'employees’ needs in the practices and communities in which they serve. These programs (which can vary by practice and employment classification) include incentive compensation plans, a 401(k) plan, healthcare and insurance benefits, health savings and flexible spending accounts, paid time off, family leave, education assistance, mental health, and other employee assistance benefits.

We invest resources to develop the talent needed to support our business strategy. Resources include a multitude of training and development programs delivered internally and externally, online and instructor-led, and on-the-job learning formats.

We expect to continue adding personnel in the future as we focus on potential acquisition targets and organic growth opportunities.

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RESULTS OF OPERATIONS

Summary of 2022 Second Quarter Compared to the 2021 Second Quarter and Six Months Results

For the three months ended June 30, 2022 (“2022 Second Quarter”), our net income attributable to our shareholders was $11.2 million as compared to $12.4 million for the three months ended June 30, 2021 (“2021 Second Quarter”), our net income attributable to diluted shareholders was $12.4 million, as compared to $10.2 million for the three months ended June 30, 2020 (“2020 Second Quarter”) and $14.6 million for the three months ended June 30, 2019 (“2019 Second Quarter”), which includes a $5.8 million gain on the sale of the Company’s interest in a physical therapy partnership on June 30, 2019.  For the six months ended June 30, 2021 (“2021 Six Months”), our net income attributable to diluted shareholders was $20.6 million, as compared to $11.2 million for the six months ended June 30, 2020 (“2020 Six Months”) and $23.1 million for the six months ended June 30, 2019 (“2019 Six Months”).  Inclusive of the charge or credit for revaluation of non-controlling interest, net of taxes, used to compute diluted earnings per diluted share in accordance with GAAP, the amount is $10.5 million, or $0.82 per diluted share, for the 2021 Second Quarter as compared to $12.7 million, or $0.99 per diluted share, for the 2020 Second Quarter, and $10.8 million, or $0.85 per diluted share, for the 2019 Second Quarter.  Inclusive of the charge or credit for revaluation of redeemable non-controlling interest, net of taxes, used to compute diluted earnings per diluted share in accordance with GAAP, the amount is $13.3 million, or $1.03 per diluted share, for the 2021 Six Months  as compared to $15.3 million, or $1.19 per diluted share, for the 2020 Six Months, and $15.8 million, or $1.24 per diluted share, for the 2019 Six Months.  In accordance with current accounting guidance,Generally Accepted Accounting Principles (“GAAP”), the revaluation of redeemable non-controlling interest, net of taxes, is not included in net income but charged directly to retained earnings; however, the charge or credit for this change is included in the earnings per basic and diluted share calculation. SeeInclusive of the table belowcharge for revaluation of non-controlling interest, net of taxes, the amount is $11.4 million, or $0.87 per diluted share, for the computation of diluted earnings2022 Second Quarter, and $10.5 million, or $0.82 per diluted share.  In 2020,share, for the valuation of redeemable non-controlling interests decreased due to the results associated with the pandemic, therefore resulting in a credit to retained earnings. In 2021 and 2019, the valuations increased therefore there was a charge to retained earnings.Second Quarter.

For the 20212022 Second Quarter, our Operating Results, a non-GAAP measure, was $11.7 million, or $0.90 per diluted share, the second highest quarterly amount in our Company’s history, as compared to $12.4 million, or $0.96 per diluted diluted share, as compared to $9.5 million (inclusive of Relief Funds), or $0.74 per diluted diluted share, for the 20202021 Second Quarter, the highest quarterly amount in our Company’s history.

For the six months ended June 30, 2022 (“2022 Six Months”), our net income attributable to our shareholders was $20.0 million and $10.3was $20.6 million for the six months ended June 30, 2022 (“2021 Six Months”).  Inclusive of the charge for revaluation of non-controlling interest, net of taxes, the amount is $20.0 million, or $0.81$1.55 per diluted share, for the 2019 Second Quarter.  2022 Six Months, and $13.3 million, or $1.03 per diluted share, for the 2021 Six Months.

For the 20212022 Six Months, our Operating Results, a non-GAAP measure, was $20.0 million, or $1.54 per diluted share, a decrease of 3.0%, as compared to $20.6 million, or $1.60 per diluted diluted share, as compared to $13.4 million, or $1.04 per diluted diluted share, for the 2020 Six Months, and $18.8 million, or $1.47 per diluted share, for the 2019 Six Months.2021 Second Quarter.

We believe providing Operating Results is useful to investors for comparing our period-to-period results and for comparing with other similar businesses since most do not have redeemable instruments and therefore have different equity structures. We use Operating Results, which eliminates certain items described above that can be subject to volatility and unusual costs, as one of the principal measures to evaluate and monitor financial performance.
Operating Results is not a non-Generally Accepted Accounting Principles (“GAAP”) measure equalsof financial performance under GAAP and should not be considered in isolation or as an alternative to, or substitute for, net income attributable to our diluted shareholders perpresented in the consolidated statements of income less gain on sale of partnership interests and clinics plus charges incurred for clinic closure costs and expenses related to CFO transition, all net of taxes. Earnings per diluted share from Operating Results also excludes the impact of the revaluation of redeemable non-controlling interest and the associated tax impact.
financial statements.

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The table below provides a calculationfollowing tables provide detail of the diluted earnings per share computation and reconcile net income attributable to our shareholders calculated in accordance with GAAP to Operating Results (in thousands, except per share data):

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
EARNINGS PER SHARES AND OPERATING RESULTS
(IN THOUSANDS, EXCEPT PER SHARE DATA)
(unaudited)
  Three Months Ended June 30, 
  2022  2021 
Computation of earnings per share - USPH shareholders:      
Net income attributable to USPH shareholders $11,195  $12,436 
Credit (charges) to retained earnings:        
Revaluation of redeemable non-controlling interest  210   (2,549)
Tax effect at statutory rate (federal and state) of 25.55%  (54)  651 
  $11,351  $10,538 
         
Earnings per share (basic and diluted) $0.87  $0.82 
         
Adjustments:        
Change in revaluation of put-right liability  617   - 
Revaluation of redeemable non-controlling interest  (210)  2,549 
Tax effect at statutory rate (federal and state)  (104)  (651)
Operating Results (a non-GAAP measure) $11,654  $12,436 
         
Basic and diluted Operating Results per share (a non-GAAP measure) $0.90  $0.96 
         
Shares used in computation - basic and diluted  12,998   12,902 

 Three Months Ended June 30, 
  2021  2020  2019 
Computation of earnings per share - USPH shareholders:         
Net income attributable to USPH shareholders $12,436  $10,232  $14,620 
Credit (charges) to retained earnings:            
Revaluation of redeemable non-controlling interest  (2,549)  3,344   (5,169)
Tax effect at statutory rate (federal and state) of 25.55% and 26.25%, respectively  651   (878)  1,356 
  $10,538  $12,698  $10,807 
             
Earnings per share (basic and diluted) $0.82  $0.99  $0.85 
             
Adjustments:            
Closure costs  (22)  94   - 
Expenses related to CFO transition  -   -   - 
Gain on sale of partnership interest and clinics  -   (1,073)  (5,823)
Relief Funds  -   (7,958)  - 
Allocation to non-controlling interest  -   1,900   - 
Revaluation of redeemable non-controlling interest  2,549   (3,344)  5,169 
Tax effect at statutory rate (federal and state) of 25.55%, 26.25% and 26.25%, respectively  (651)  2,725   172 
Operating Results (excluding Relief Funds) $12,414  $5,042  $10,325 
             
Relief Funds  -   7,958   - 
Allocation to non-controlling interest  -   (1,900)  - 
Tax effect at statutory rate (federal and state) of 25.55%, 26.25% and 26.25%, respectively  -   (1,590)  - 
Operating Results (including Relief Funds) $12,414  $9,510  $10,325 
             
Basic and diluted Operating Results (without Relief Funds) per share $0.96  $0.39  $0.81 
Basic and diluted Operating Results (including Relief Funds) per share $0.96  $0.74  $0.81 
             
Shares used in computation - basic and diluted  12,902   12,843   12,767 
  Six Months Ended June 30, 
  2022  2021 
Computation of earnings per share - USPH shareholders:      
Net income attributable to USPH shareholders $19,994  $20,609 
Credit (charges) to retained earnings:        
Revaluation of redeemable non-controlling interest  57   (9,819)
Tax effect at statutory rate (federal and state) of 25.55%  (15)  2,508 
  $20,036  $13,298 
         
Earnings per share (basic and diluted) $1.55  $1.03 
         
Adjustments:        
Change in revaluation of put-right liability  14   - 
Revaluation of redeemable non-controlling interest  (57)  9,819 
Tax effect at statutory rate (federal and state)  11   (2,508)
Operating Results (a non-GAAP measure) $20,004  $20,609 
         
Basic and diluted Operating Results per share (a non-GAAP measure) $1.54  $1.60 
         
Shares used in computation - basic and diluted  12,968   12,886 

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 Six Months Ended June 30, 
  2021  2020  2019 
Computation of earnings per share - USPH shareholders:         
Net income attributable to USPH shareholders $20,609  $11,248  $23,063 
Credit (charges) to retained earnings:            
Revaluation of redeemable non-controlling interest  (9,819)  5,473   (9,830)
Tax effect at statutory rate (federal and state) of 25.55%, 26.25% and 26.25%, respectively  2,508   (1,437)  2,580 
  $13,298  $15,284  $15,813 
             
Earnings per share (basic and diluted) $1.03  $1.19  $1.24 
             
Adjustments:            
Closure costs  15   3,846   - 
Expenses related to CFO transition  -   133   - 
Gain on sale of partnership interest and clinics  -   (1,073)  (5,823)
Relief Funds  -   (7,958)  - 
Allocation to non-controlling interest  -   1,900   - 
Revaluation of redeemable non-controlling interest  9,819   (5,473)  9,830 
Tax effect at statutory rate (federal and state) of 25.55%, 26.25% and 26.25%, respectively  (2,508)  2,264   (1,052)
Operating Results (excluding Relief Funds) $20,624  $8,923  $18,768 
             
Relief Funds  -   7,958   - 
Allocation to non-controlling interest  -   (1,900)  - 
Tax effect at statutory rate (federal and state) of 25.55%, 26.25% and 26.25%, respectively  -   (1,590)  - 
Operating Results (including Relief Funds) $20,624  $13,391  $18,768 
             
Basic and diluted Operating Results (without Relief Funds) per share $1.60  $0.70  $1.47 
Basic and diluted Operating Results (including Relief Funds) per share $1.60  $1.04  $1.47 
             
Shares used in computation - basic and diluted  12,886   12,820   12,738 

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Three Months Ended June 30, 2021 Compared to the Three Months Ended June 30, 2020

The following table summarizes financial data by segment for the periods indicated and reconciles the data to our consolidated financial statements (in thousands):

 Three Months Ended June 30,  Three Months Ended June 30, 
 2021  2020  2022 2021 
           
Net operating revenues:      
Net operating revenue:     
Physical therapy operations $116,895  $74,199  $121,219 $116,895 
Industrial injury prevention services  10,033   9,658   19,437  10,033 
Total Company $126,928  $83,857  $140,656 $126,928 
             
Gross profit:             
Physical therapy operations (excluding closure costs) $31,739  $16,199 
Physical therapy operations $26,698 $31,761 
Industrial injury prevention services  2,543   3,179   4,123  2,543 
 $34,282  $19,378 
Physical therapy operations - closure costs  (22)  94 
Gross profit $34,304  $19,284  $30,821 $34,304 
             
Total Assets:             
Physical therapy operations $578,888  $534,238  $414,172 $545,449 
Industrial injury prevention services  44,070   50,780   382,272  203,977 
Total Company $622,958  $585,018  $796,444 $749,426 

RevenuesRevenue

Reported net revenuestotal revenue for the 2022 Second Quarter was $140.7 million, an increase of 10.8% as compared to $126.9 million for the 2021 Second Quarter was $126.9 million, an increase of 51.4% as compared to $83.9 million for the 2020 Second Quarter.SeeQuarter.  See table below for a detail of reported net revenuestotal revenue (in thousands):

 Three Months Ended 
  June 30, 2021  June 30, 2020 
Revenue related to Mature Clinics $105,223  $69,567 
Revenue related to 2021 Clinic Additions  2,458   - 
Revenue related to 2020 Clinic Additions  5,531   1,952 
Revenue from clinics sold or closed in 2021  24   102 
Revenue from clinics sold or closed in 2020  2   658 
Net patient revenue from physical therapy operations.  113,238   72,279 
Other revenue  918   328 
Physical therapy operations $114,156  $72,607 
Management contract revenue  2,739   1,592 
Industrial injury prevention services  10,033   9,658 
Total Revenue $126,928  $83,857 
  Three Months Ended 
  June 30, 2022  June 30, 2021 
Revenue related to Mature Clinics $108,582  $110,105 
Revenue related to 2022 Clinic Additions  3,117   - 
Revenue related to 2021 Clinic Additions  6,191   2,414 
Revenue from clinics sold or closed in 2022  306   592 
Revenue from clinics sold or closed in 2021  -   127 
Net patient revenue from physical therapy operations  118,196   113,238 
Other revenue  898   918 
Revenue from physical therapy operations  119,094   114,156 
Revenue - Management contracts  2,125   2,739 
Revenue - Industrial injury prevention services  19,437   10,033 
Total Revenue $140,656  $126,928 

Net patient revenuesRevenue from physical therapy operations increased $41.0$4.9 million, or 56.7%4.3%, to $113.2$119.1 million for the 2022 Second Quarter from $114.2 million for the 2021 Second Quarter from $72.3 million for the 2020 Second Quarter. Included in net patient revenues are revenues related to clinics sold or closed in 2021 and 2020 of $26,000 for 2021 Second Quarter and $0.8 million for the 2020 Second Quarter. During the full year of 2020, the Company sold its interest in 14 clinics and closed 34 clinics.  For comparison purposes, adjusted for revenue from the clinics sold or closed, net patient revenues from physical therapy operations was approximately $113.2 million for Second Quarter 2021, inclusive of $8.0 million related to clinics opened or acquired in the 2021 Second Quarter  (“2021 Clinic Additions”) and 2020 year (“2020 Clinic Additions”), together referred to as (“Clinic Additions”), and $71.5 million for the Second Quarter 2020, inclusive of $2.0 million for 2020 Clinic Additions. Net patient revenuesrevenue related to clinics opened or acquired prior to 20202021 and still in operations atoperation on June 30, 20212022 (“Mature Clinics”) increased $35.7decreased $1.5 million, or 1.4%, to $108.6 million for the 2022 Second Quarter compared to $110.1 million for the 2021 Second Quarter, due mostly to the decrease in average net patient revenue per visit. Visits for Mature Clinics (same store) for the 2022 Second Quarter decreased slightly (0.2%) as compared to the 20202021 Second Quarter.

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The average net patient revenue per visit was $103.18 for the 2022 Second Quarter as compared to $104.46 for the 2021 Second Quarter as compared to $106.97 for the 2020 Second Quarter, including all clinics operational during such periods.Quarter. Total patient visits increased 60.4%5.7% to 1,145,554 for the 2022 Second Quarter from 1,084,070 for the 2021 Second Quarter from 675,701 for the 2020 Second Quarter. Net patient revenues arerevenue is based on established billing rates less allowances for patients covered by contractual programs and workers’ compensation. Net patient revenues arerevenue is determined after contractual and other adjustments relating to patient discounts from certain payors. Payments received under contractual programs and workers’ compensation are based on predetermined rates and are generally less than the established billing rates.

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Revenue from physical therapythe industrial injury prevention services business increased 93.7% to $19.4 million for the 2022 Second Quarter as compared to $10.0 million for the 2021 Second Quarter.  Excluding $6.8 million of revenue related to the IIPS acquisition in November 2021, IIPS revenue increased 25.5% in the 2022 Second Quarter as compared to the 2021 Second Quarter.

Revenue from management contracts increased 72.0%decreased 22.4% to $2.1 million for the 2022 Second Quarter as compared to $2.7 million for the 2021 Second Quarter due to the termination of five management contracts.

Operating Cost

Total operating cost was $109.8 million for the 2022 Second Quarter, or 78.1% of total revenue, as compared to $1.6$92.6 million, or 73.0% of total revenue, for the 20202021 Second Quarter. Other miscellaneous revenue was $0.9Operating cost related to Mature Clinics increased by $4.0 million or 5.0%, for the 2022 Second Quarter compared to the 2021 Second Quarter. In addition, operating cost related to the IIPS business increased by $7.8 million of which $5.7 million related to our November 2021 IIPS acquisition. Physical therapy total operating costs were $81.09 per visit in the 2022 Second Quarter as compared to $76.50 per visit in the 2021 Second Quarter, and $0.3 million in the 2020 Second Quarter.  Other miscellaneous revenue includes a varietyan increase of services, including athletic trainers provided for schools and athletic events.

Revenue from the industrial injury prevention business increased 3.9% to $10.0 million for the 2021 Second Quarter as compared to $9.7 million for the 2020 Second Quarter.

Operating Costs

Total operating costs, excluding closure costs, were $92.6 million for the 2021 Second Quarter, or 73.0% of net revenues, an improvement of 390 basis points as compared to $64.5 million for the 2020 Second Quarter, or 76.9% of net revenues. Included in operating costs for the 2021 Second Quarter was $7.0 million related to Clinic Additions.  Operating costs for Mature Clinics increased by $22.2 million for the 2021 Second Quarter compared to the 2020 Second Quarter.  In addition, operating costs related to the industrial injury prevention business increased by $1.0 million.6.0%.  See table below for a detail of operating costs, excluding closure costscost (in thousands):

 Three Months Ended 
  June 30, 2021  June 30, 2020 
Operating costs related to Mature Clinics $75,988  $53,767 
Operating costs related to 2021 Clinic Additions  2,019   - 
Operating costs related to 2020 Clinic Additions  4,934   1,513 
Operating costs related to clinics sold or closed in 2021  (2)  132 
Operating costs related to clinics sold or closed in 2020  14   1,425 
Physical therapy operations $82,953  $56,837 
Physical therapy management contracts  2,202   1,163 
Industrial injury prevention services  7,491   6,479 
  $92,646  $64,479 
  Three Months Ended 
  June 30, 2022  June 30, 2021 
Operating cost related to Mature Clinics $84,216  $80,205 
Operating cost related to 2022 Clinic Additions  2,692   - 
Operating cost related to 2021 Clinic Additions  5,996   2,063 
Operating cost related to clinics sold or closed in 2022  324   555 
Operating cost related to clinics sold or closed in 2021  -   107 
Operating cost related to physical therapy operations  92,898   82,930 
Operating cost related to management contracts  1,622   2,203 
Operating cost related to industrial injury prevention services  15,315   7,491 
Total operating cost $109,835  $92,624 

Each component of operating costscost is discussed below:

Operating Costs—Cost—Salaries and Related Costs

Salaries and related costs, including physical therapy operations and the industrial injury prevention services business, were 54.3%was 56.8% of net revenuesrevenue for the 20212022 Second Quarter versus 51.8%54.3% for the 20202021 Second Quarter. Salaries and related costs for the physical therapy operations werewas $66.7 million in the 2022 Second Quarter, or 56.1% of physical therapy operations revenue, as compared to $60.6 million in the 2021 Second Quarter, or 53.1% of physical therapy operations revenues, as compared to $36.9 million in the 2020 Second Quarter, or 50.9% of physical therapy operations revenues.revenue. Included in salaries and related costs for the physical therapy operations for the 20212022 Second Quarter was $4.9 million related to 20212022 and 20202021 Clinic Additions.  Adjusted for the salaries and related costs for clinics closed or sold in 2022 and 2021 of $0.2 million in the Second Quarter and 2020,$0.4 million in 2021 Second Quarter, salaries and related costs forrelated to Mature Clinics increased by $20.1$2.7 million in the 20212022 Second Quarter compared to the 20202021 Second Quarter.  Physical therapy salaries and related costs were $58.29 per visit in the 2022 Second Quarter as compared to $55.95 per visit in the Second Quarter 2021, an increase of 4.2%. Salaries and related costs related to management contracts increaseddecreased by $0.9$0.4 million for the 20212022 Second Quarter.

Salaries and related costs for the industrial injury prevention services business werewas $11.6 million in the 2022 Second Quarter, or 59.9% of industrial injury prevention services revenue, as compared to $6.2 million in the 2021 Second Quarter, or 62.2% of industrial injury prevention services revenues, as compared to $5.5 million in the 2020 Second Quarter, or 56.9% of net industrial injury prevention services revenues.revenue.

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Operating Costs—Cost—Rent, Supplies, Contract Labor and Other

Rent, supplies, contract labor and other costs, including physical therapy operations and the industrial injury prevention servicesIIPS business, were 17.7%was 20.2% of net revenuesrevenue in the 20212022 Second Quarter versus 24.2%17.6% in the 20202021 Second Quarter. Rent, supplies, contract labor and other costs for the physical therapy operations werewas $24.7 million in the 2022 Second Quarter, or 20.7% of physical therapy operations revenue, as compared to $20.9 million in the 2021 Second Quarter, or 16.8%18.3% of physical therapy operations revenues, as compared to $19.2 million in the 2020 Second Quarter, or 26.4% of physical therapy operations revenues.revenue. Included in rent, supplies, contract labor and other costs related to physical therapy operations for the 20212022 Second Quarter was $2.0$2.7 million related to 20212022 and 20202021 Clinic Additions.  Adjusted for the rent, supplies, contract labor and other costs for clinics related to the clinics closed or sold in 20212022 and 20202021 of $0.1 million in the 20212022 Second Quarter and $1.0$0.2 million in the 20202021 Second Quarter, rent, supplies, contract labor and other costs for Mature Clinics increased by $1.3$1.9 million in the 20212022 Second Quarter compared to the 20202021 Second Quarter.  Rent, supplies, contract labor and other costs, related to management contracts decreased $0.9$0.1 million in the 20212022 Second Quarter.

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Rent, supplies, contract labor and other costs for the industrial injury prevention services business werewas $3.5 million in the 2022 Second Quarter, or 18.2% of industrial injury prevention services revenue, as compared to $1.2 million in the 2021 Second Quarter, or 12.5% of industrial injury prevention services revenues, as compared to $0.9 million in the 2020 Second Quarter, or 10.2% of net industrial injury prevention services revenues.revenue.

Operating Costs—Cost—Provision for Credit Losses

The provision for credit losses as a percentage of net revenue was 1.1% in the 20212022 Second Quarter and 0.9% for the comparable period in 2020.2021.

Our provision for credit losses for patient accounts receivable as a percentage of total patient accounts receivable was 5.1% at5.51% on June 30, 2021,2022, as compared to 4.5% at5.64% on December 31, 2020.2021. Our days’ sales outstanding werewas 33 days on June 30, 2022 and 32 days at both June 30, 2021 andon December 31, 2020.2021.

Gross Profit

Gross profit for the 20212022 Second Quarter, excluding closure costs, was $34.3$30.8 million, an increasea decrease of $14.9$3.5 million, or approximately 76.9%10.2%, as compared to $19.4$34.3 million for the 20202021 Second Quarter. The gross profit percentage excluding closure costs, was 27.0%21.9% of nettotal revenue for the 20212022 Second Quarter an increase of 390 basis points as compared to 23.1%27.0% for the 20202021 Second Quarter. The gross profit percentage for the Company’s our
physical therapy clinics, excluding closure costs,operations was 27.3%22.0% for the 2022 Second Quarter as compared to 27.4% for the 2021 Second Quarter, an improvement of 560 basis points as compared to 21.7% for the 2020 Second Quarter. The gross profit percentage on physical therapy management contracts was 23.7% for the 2022 Second Quarter as compared to 19.6% for the 2021 Second Quarter, a decrease of 730 basis points as compared to 26.9% for the 2020 Second Quarter.

The gross profit percentage for the industrial injury prevention services business was 21.2% for the 2022 Second Quarter as compared to 25.3% for the 2021 Second Quarter, a decreaseQuarter. The IIPS margin in 2022 has been impacted by the lower margin profile of 760 basis points as compared to 32.9% for the 2020 Second Quarter.

Company’s November 2021 IIPS acquisition The table below details the gross profit excluding closure costs (in thousands):

 Three Months Ended  Three Months Ended 
 June 30, 2021  June 30, 2020  June 30, 2022 June 30, 2021 
Gross profit, excluding closure costs:      
      
Physical therapy operations $31,203  $15,770  $26,196  $31,226 
Management contracts  536   429  503  536 
Industrial injury prevention services  2,543   3,179   4,122   2,542 
Gross profit, excluding closure costs $34,282  $19,378 
        
Physical therapy operations - closure costs  (22)  94 
Gross profit $34,304  $19,284  $30,821  $34,304 

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Corporate Office Costs

Corporate office costs were $10.7 million for the 2022 Second Quarter compared to $12.1 million for the 2021 Second Quarter compared to $9.0 million for the 2020 Second Quarter. Corporate office costs were 9.5%7.6% of net revenuestotal revenue for the 20212022 Second Quarter as compared to 10.8%9.5% for the 20202021 Second Quarter.  The increase in costsdecrease was primarily due to higher salaries and benefits forlower estimated bonus expense in the 20212022 Second Quarter compared to the 20202021 Second Quarter.  The 2020 Second Quarter included salary reductions and furloughs related to the pandemic.

Operating Income

Operating income for the 20212022 Second Quarter was $22.2$20.1 million an increase of  $12.0 million, or 116.6%, as compared to $10.3and $22.2 million for the 20202021 Second Quarter. Operating income as a percentage of nettotal revenue increased by 530 basis points from 12.2%was 14.3% for the 2020 period2022 Second Quarter as compared to 17.5% for the 2021 period.Second Quarter.

Interest ExpenseLoss on Revaluation of Put-Right Liability

Interest expenseThe loss on revaluation of put-right liability was $237,000 for$617,000.  As part of the IIPS business acquisition on November 30, 2021, Second Quarter and $653,000 forwe also agreed to the 2020 Second Quarter due to reduced borrowingspotential future purchase of a separate company under the Company’s revolving credit line. Atsame ownership that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to us in approximately five years, with such right having a $3.5 million value at June 30, 2021, $38.0 million was outstanding under2022, as reflected on our Amended Credit Agreement (as defined below). See “—Liquidity and Capital Resources” below for a discussionconsolidated balance sheet in Other long-term liabilities. The value of the terms of our Amended Credit Agreement.this right will continue to be adjusted in future periods, as appropriate.

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Provision for Income Taxes

The provision for income tax was $4.2 million for the 2022 Second Quarter and $4.6 million for the 2021 Second Quarter and $3.9 million for the 2020 Second Quarter. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest (effective tax rate) was 27.5% for the 2022 Second Quarter and 26.9% for the 2021 Second Quarter and 27.5% for the 2020 Second Quarter. See table below ($ in thousands):

See table below detailing calculation of the provision for income taxes as a percentage of income before taxes less net income attributable to non-controlling interest ($ in thousands):

 Three Months Ended 
  June 30, 2021  June 30, 2020 
       
Income before taxes $22,039  $18,645 
         
Less: net income attributable to non-controlling interests:        
Redeemable non-controlling interests - temporary equity  (3,611)  (2,996)
Non-controlling interests - permanent equity  (1,425)  (1,535)
  $(5,036) $(4,531)
         
Income before taxes less net income attributable to non-controlling interests $17,003  $14,114 
         
Provision for income taxes $4,567  $3,882 
         
Effective tax rate  26.9%  27.5%
         
  Three Months Ended 
  June 30, 2022  June 30, 2021 
Income before taxes $19,495  $22,039 
         
Less: net income attributable to non-controlling interest:        
Redeemable non-controlling interest - temporary equity  (2,626)  (3,611)
Non-controlling interest - permanent equity  (1,435)  (1,425)
  $(4,061) $(5,036)
         
Income before taxes less net income attributable to non-controlling interest $15,434  $17,003 
         
Provision for income taxes $4,239  $4,567 
         
Percentage  27.5%  26.9%

Net Income Attributable to Non-controlling InterestsInterest

Net income attributable to redeemable non-controlling interestsinterest (temporary equity) was $2.6 million for the 2022 Second Quarter and $3.6 million for the 2021 Second Quarter and $3.0 million for the 2020 Second Quarter.  Net income attributable to non-controlling interestsinterest (permanent equity) was $1.4 million for the 20212022 Second Quarter and $1.5 million for the 20202021 Second Quarter.

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2022 Six Months Ended June 30, 2021 Compared to the2021 Six Months Ended June 30, 2020

The following table summarizes financial data by segment for the periods indicated and reconciles the data to our consolidated financial statements (in thousands):

 Six Months Ended June 30,  Six Months Ended June 30, 
 2021  2020  2022 2021 
           
Net operating revenues:      
Net operating revenue:     
Physical therapy operations $219,253  $177,040  $233,855 $219,253 
Industrial injury prevention services  20,043   19,534   38,505  20,043 
Total Company $239,296  $196,574  $272,360 $239,296 
             
Gross profit:             
Physical therapy operations (excluding closure costs) $54,950  $33,978 
Physical therapy operations $49,135 $54,935 
Industrial injury prevention services  5,265   4,843   8,274  5,265 
 $60,215  $38,821 
Physical therapy operations - closure costs  15   3,846 
Gross profit $60,200  $34,975  $57,409 $60,200 
             
Total Assets:             
Physical therapy operations $578,985  $534,238  $414,172 $545,449 
Industrial injury prevention services  43,973   50,780   382,272  203,977 
Total Company $622,958  $585,018  $796,444 $749,426 

Revenues
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Revenue

Reported net revenuestotal revenue for the 20212022 Six Months increased $42.7was $272.4 million, or 21.7%an increase of 13.8% as compared to $239.3 million as compared to $196.6 million for the 20202021 Six Months.  See table below for a detail of reported net revenuestotal revenue (in thousands):

 For the Six Months Ended 
  June 30, 2021  June 30, 2020 
Revenue related to Mature Clinics $199,068  $165,277 
Revenue related to 2021 Clinic Additions  2,549   - 
Revenue related to 2020 Clinic Additions  10,732   2,930 
Revenue from clinics sold or closed in 2021  141   333 
Revenue from clinics sold or closed in 2020  2   3,865 
Net patient revenue from physical therapy operations. $212,492  $172,405 
Other revenue  1,464   895 
Physical therapy operations $213,956  $173,300 
Management contract revenue  5,297   3,740 
Industrial injury prevention services  20,043   19,534 
Total Revenue $239,296  $196,574 
  For the Six Months Ended 
  June 30, 2022  June 30, 2021 
Revenue related to Mature Clinics $211,215  $208,531 
Revenue related to 2022 Clinic Additions  3,312   - 
Revenue related to 2021 Clinic Additions  12,346   2,465 
Revenue from clinics sold or closed in 2022  861   1,104 
Revenue from clinics sold or closed in 2021  -   392 
Net patient revenue from physical therapy operations  227,734   212,492 
Other revenue  1,770   1,464 
Revenue from physical therapy operations  229,504   213,956 
Revenue - Management contracts  4,351   5,297 
Revenue - Industrial injury prevention services  38,505   20,043 
Total Revenue $272,360  $239,296 

Net patient revenuesRevenue from physical therapy operations increased $40.1$15.5 million, or 23.3%7.3%, to $212.5$229.5 million for the 2022 Six Months from $214.0 million for the 2021 Six Months from $172.4 million for the 2020 Six Months. Included in net patient revenues are revenues related to clinics sold or closed in 2021 and 2020 of $13.3 million for the 2021 Six Months and $2.9 million for the 2020 Six Months.  During the 2021 Six Months, the Company sold its interest in 2 clinics and closed 1 clinic. During the full year of 2020, the Company sold its interest in 14 clinics and closed 34 clinics. For comparison purposes, adjusted for revenue from the clinics sold or closed, net patient revenues from physical therapy operations was approximately $212.3 million for the Six Months 2021, inclusive of $13.3 million related Clinic Additions and $168.2 million for the 2021 Six Months, inclusive of $3.0 million for 2020 Clinic Additions. Net patient revenues related to Mature Clinics increased $33.8 million for the 2021 Six Months compared to the 2020 Six Months.

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The average net patient revenue per visit was $103.09 for the 2022 Six Months as compared to $104.58 for the 2021 Six Months as compared to $104.70 for the 2020 Six Months, including all clinics operational during such periods.Months. Total patient visits wereincreased 8.7% to 2,209,073 for the 2022 Six Months from 2,031,858 for the 2021 Six Months and 1,646,724 for the 2020 Six Months, an increase of 23.4%.Months. Net patient revenues arerevenue is based on established billing rates less allowances for patients covered by contractual programs and workers’ compensation. Net patient revenues arerevenue is determined after contractual and other adjustments relating to patient discounts from certain payors. Payments received under contractual programs and workers’ compensation are based on predetermined rates and are generally less than the established billing rates.

Revenue from physical therapy management contracts was $5.3Net patient revenue related to Mature Clinics increased $2.7 million, or 1.3%, to $211.2 million for the 2022 Six Months compared to $208.5 million for the 2021 Six Months. Visits for Mature Clinics (same store) for the 2022 Six Months an increase of 41.6%,increased 3.0% as compared to $3.7 million for the 20202021 Six Months. The increase in visits was partially offset by a reduction in the net patient revenue per visit.

Revenue from the industrial injury prevention services business increased 2.6%92.1% to $38.5 million for the 2022 Six Months as compared to $20.0 million for the 2021 Six Months.  Excluding $13.7 million of revenue related to the IIPS acquisition in November 2021, IIPS revenue increased 24.0% in the 2022 Six Months as compared to $19.5 million for the 20202021 Six Months.

Other miscellaneousRevenue from management contract revenue was $1.5decreased 17.9% to $4.4 million for the 2022 Six Months as compared to $5.3 million for the 2021 Six Months and $0.9 million fordue to the 2020 Six Months.  Other miscellaneous revenue includes a varietytermination of services, including athletic trainers provided for schools and athletic events.certain management contracts.

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Operating CostsCost

Total operating costs, excluding closure costs, werecost was $215.0 million for the 2022 Six Months, or 78.9% of total revenue, as compared to $179.1 million, or 74.8% of total revenue, for the 2021 Six Months, or 74.8% of net revenues, an improvement of 550 basis points as comparedMonths. Operating cost related to $157.8Mature Clinics increased by $10.1 million for the 2020 Six Months, or 80.3% of net revenues. Included in operating costs for the 2021 Six Months was $11.7 million related to Clinic Additions, of which $9.6 million is associated with 2020 Clinic Additions.  Operating costs for Mature Clinics decreased by $15.4 million for the 20212022 Six Months compared to the 20202021 Six Months.  In addition, operating costscost related to the industrial injury prevention services business decreasedincreased by $0.1 million.$15.5 million of which $11.3 million related to the recent IIPS acquisition.  See table below for a detail of operating costs, excluding closure costscost (in thousands):

 For the Six Months Ended 
  June 30, 2021  June 30, 2020 
Operating costs related to Mature Clinics $147,975  $132,591 
Operating costs related to 2021 Clinic Additions  2,161   - 
Operating costs related to 2020 Clinic Additions  9,569   2,272 
Operating costs related to clinics sold or closed in 2021  154   395 
Operating costs related to clinics sold or closed in 2020  (4)  4,829 
Physical therapy operations $159,855  $140,087 
Physical therapy management contracts  4,448   2,975 
Industrial injury prevention services  14,778   14,691 
  $179,081  $157,753 
  Six Months Ended 
  June 30, 2022  June 30, 2021 
Operating cost related to Mature Clinics $166,468  $156,321 
Operating cost related to 2022 Clinic Additions  3,083   - 
Operating cost related to 2021 Clinic Additions  11,466   2,128 
Operating cost related to clinics sold or closed in 2022  251   979 
Operating cost related to clinics sold or closed in 2021  
-
   442 
Operating cost related to physical therapy operations  181,268   159,870 
Operating cost related to management contracts  3,453   4,448 
Operating cost related to industrial injury prevention services  30,230   14,778 
Total operating cost $214,951  $179,096 

Each component of operating costscost is discussed below:

Operating Costs—Cost—Salaries and Related Costs

Salaries and related costs, including physical therapy operations and the industrial injury prevention services business, were 55.4%was 56.9% of net revenuesrevenue for the 20212022 Six Months versus 57.2%55.4% for the 20202021 Six Months. Salaries and related costs for the physical therapy operations were $116.3was $129.2 million in the 2022 Six Months, or 56.3% of physical therapy operations revenue, as compared to $116.2 million in the 2021 Six Months, or 54.3% of physical therapy operations revenues, as compared to $97.5 million in the 2020 Six Months, or 56.3% of physical therapy operations revenues.revenue. Included in salaries and related costs for the physical therapy operations for the 20212022 Six Months was $8.2$8.1 million related to 2022 and 2021 Clinic Additions.  Adjusted for the salaries and related costs for clinics closed or sold in 2022 and 2021 of $0.1 million in the 2022 Six Months and 2020,$0.9 million in 2021 Six Months, salaries and related costs forrelated to Mature Clinics increased by $14.6$6.6 million in the 20212022 Six Months compared to the 20202021 Six Months.  Salaries and related costs related to management contracts increaseddecreased by $1.4$0.8 million for the 20212022 Six Months.

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Salaries and related costs for the industrial injury prevention services business werewas $22.7 million in the 2022 Six Months, or 59.0% of industrial injury prevention services revenue, as compared to $12.5 million in the 2021 Six Months,or 62.3% of industrial injury prevention services revenues, as compared to $12.4 million in the 2020 Six Months, or 63.6% of net industrial injury prevention services revenues.revenue.

Operating Costs—Cost—Rent, Supplies, Contract Labor and Other

Rent, supplies, contract labor and other costs, including physical therapy operations and the industrial injury prevention services business, were 18.3%was 20.9% of net revenuesrevenue in the 20212022 Six Months versus 22.0%18.3% in the 20202021 Six Months. Rent, supplies, contract labor and other costs for the physical therapy operations werewas $49.3 million in the 2022 Six Months, or 21.5% of physical therapy operations revenue, as compared to $41.0 million in the 2021 Six Months, or 19.2% of physical therapy operations revenues, as compared to $40.5 million in the 2020 Six Months, or 23.4% of physical therapy operations revenues.revenue. Included in rent, supplies, contract labor and other costs related to physical therapy operations for the 20212022 Six Months was $3.4$4.7 million related to 2022 and 2021 Clinic Additions.  Adjusted for the rent, supplies, contract labor and other costs for clinics related to the clinics closed or sold in 2022 and 2021 of $0.3 million in the 2022 Six Months and 2020,$0.5 million in the 2021 Six Months, rent, supplies, contract labor and other costs for Mature Clinics increased by $0.3$4.6 million in the 20212022 Six Months compared to the 20202021 Six Months.  Rent, supplies, contract labor and other costs, related to management contracts increased $48,000decreased $0.2 million in the 20212022 Six Months.

Rent, supplies, contract labor and other costs for the industrial injury prevention services business werewas $7.4 million in the 2022 Six Months, or 19.1% of industrial injury prevention services revenue, as compared to $2.3 million in the 2021 Six Months, and the 2020 Six Months, or 11.4% and 11.6%, respectively, of net industrial injury prevention services revenues.revenue.

Operating Costs—Cost—Provision for Credit Losses

The provision for credit losses as a percentage of net revenue was 1.0% in the 2022 Second Quarter and 1.1% for the comparable period in both the 2021 Six Months and 2020 Six Months.2021.

Our provision for credit losses for patient accounts receivable as a percentage of total patient accounts receivable was 5.1%5.51% at June 30, 2021,2022, as compared to 4.5%5.64% at December 31, 2020.2021. Our days’ sales outstanding were 32was 33 days at June 30, 20212022 and 32 days at December 31, 2020.2021.

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Gross Profit

Gross profit for the 20212022 Six Months, excluding closure costs, was $60.2$57.4 million, an increasea decrease of $21.4$2.8 million, or approximately 55.1%4.6%, as compared to $38.8$60.2 million for the 20202021 Six Months. The gross profit percentage excluding closure costs, was 25.2%21.1% of nettotal revenue for the 20212022 Six Months an increase of 550 basis points as compared to 19.7%25.2% for the 20202021 Six Months. The gross profit percentage for the Company’sour physical therapy clinics, excluding closure costs,operations was 21.0% for the 2022 Six Months as compared to 25.3% for the 2021 Six Months, an improvement of 610 basis points as compared to 19.2% for the 2020 Six Months. The gross profit percentage on physical therapy management contracts was 20.6% for the 2022 Six Months as compared to 16.0% for the 2021 Six Months, a decrease of 450 basis points as compared to 20.5% for the 2020 Six Months.

The gross profit percentage for the industrial injury prevention businessservices was 21.5% for the 2022 Six Months as compared to 26.3% for the 2021 Six Months, an improvementMonths. The IIPS margin in 2022 has been impacted by the lower margin profile of 150 basis points as compared to 24.8% for the 2020 Six Months.

our November 2021 IIPS acquisition. The table below details the gross profit excluding closure costs (in thousands):

 For the Six Months Ended  Six Months Ended 
 June 30, 2021  June 30, 2020  June 30, 2022 June 30, 2021 
Gross profit, excluding closure costs:      
      
Physical therapy operations $54,101  $33,213  $48,236  $54,086 
Management contracts  849   765  898  849 
Industrial injury prevention services  5,265   4,843   8,275   5,265 
Gross profit, excluding closure costs $60,215  $38,821 
        
Physical therapy operations - closure costs  15   3,846 
Gross profit $60,200  $34,975  $57,409  $60,200 

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Corporate Office Costs

Corporate office costs were $22.3 million for the 2022 Six Months compared to $22.9 million for the 2021 Six Months compared to $20.7 million for the 2020 Six Months. Corporate office costs were 9.6%8.2% of net revenuestotal revenue for the 20212022 Six Months as compared to 10.5%9.6% for the 20202021 Six Months. The increase in costsdecrease was primarily due to higher salaries and benefits forlower estimated bonus expense in the 2022 Six Months than the 2021 Six Months compared to the 2020 Six Months.  The 2020 Six Months included salary reductions and furloughs related to the COVID-19 pandemic.

Operating Income

Operating income for the 20212022 Six Months waswere $35.1 million and $37.3 million an increase of  $23.0 million, or 160.9%, as compared to $14.3 million for the 20202021 Six Months. Operating income as a percentage of nettotal revenue increased by 830 basis points from 7.3%was 12.9% for the 2020 period2022 Six Months as compared to 15.6% for the 2021 period.Six Months.

Interest ExpenseLoss on Revaluation of Put-Right Liability

Interest expenseThe loss on revaluation of the put-right liability was $483,000 for$14,000.  As part of the IIPS business acquisition on November 30, 2021, Six Months and $1.1 million forwe also agreed to the 2020 Six Months due to reduced borrowingspotential future purchase of a separate company under the Company’s revolving credit line. Atsame ownership that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to us in approximately five years, with such right having a $3.5 million value at June 30, 2021, $38.0 million was outstanding under2022, as reflected on our Amended Credit Agreement (as defined below). See “—Liquidity and Capital Resources” below for a discussionconsolidated balance sheet in Other long-term liabilities. The value of the terms of our Amended Credit Agreement.this right will continue to be adjusted in future periods, as appropriate.

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Provision for Income Taxes

The provision for income tax was $7.7 million for the 2022 Six Months and $7.5 million for the 2021 Six Months and $4.2 million for the 2020 Six Months. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest (effective tax rate) was 27.9% for the 2022 Six Months and 26.7% for the 2021 Six Months and 27.1% for the 2020 Six Months.

See table below detailing calculation of the provision for income taxes as a percentage of income before taxes less net income attributable to non-controlling interest ($ in thousands):

 Six Months Ended 
  June 30, 2021  June 30, 2020 
       
Income before taxes $36,869  $22,275 
         
Less: net income attributable to non-controlling interests:        
Redeemable non-controlling interests - temporary equity  (6,064)  (4,792)
Non-controlling interests - permanent equity  (2,685)  (2,061)
  $(8,749) $(6,853)
         
Income before taxes less net income attributable to non-controlling interests $28,120  $15,422 
         
Provision for income taxes $7,511  $4,174 
         
Effective tax rate  26.7%  27.1%
  Six Months Ended 
  June 30, 2022  June 30, 2021 
Income before taxes $34,975  $36,869 
         
Less: net income attributable to non-controlling interest:        
Redeemable non-controlling interest - temporary equity  (5,183)  (6,064)
Non-controlling interest - permanent equity  (2,061)  (2,685)
  $(7,244) $(8,749)
         
Income before taxes less net income attributable to non-controlling interest $27,731  $28,120 
         
Provision for income taxes $7,737  $7,511 
         
Percentage  27.9%  26.7%

Net Income Attributable to Non-controlling InterestsInterest

Net income attributable to redeemable non-controlling interestsinterest (temporary equity) was $6.6$5.2 million for the 20212022 Six Months and $4.8$6.1 million for the 20202021 Six Months.  Net income attributable to non-controlling interestsinterest (permanent equity) was $2.1 million for the 2022 Six Months and $2.7 million for the 2021 Six Months and $2.1 million for the 2020 Six Months.

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Other Comprehensive Loss

TableConcurrently with the Credit Agreement (as defined below), we entered into an interest rate swap agreement in May 2022, which has a $150 million notional value, a maturity date of ContentsJune 30, 2027 and was effective on June 30, 2022. Beginning in July 2022, we pay a fixed rate of interest of 2.815% on 1-month SOFR on a quarterly basis. The total interest rate in any period will also include an applicable margin based on our consolidated leverage ratio. Currently, our interest rate including the applicable margin is 4.665%.  Unrealized gains and losses related to the fair value of the interest rate swap are recorded to accumulated other comprehensive income (loss), net of tax. The fair value of the interest rate swap at June 30, 2022, was $0.5 million, which has been included within current liabilities in the accompanying Consolidated Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statement of Comprehensive Income for the three and six months ended June 30, 2022 was an unrealized loss of $0.4 million, net of tax.

LIQUIDITY AND CAPITAL RESOURCES

We believe that our business has sufficient cash to allow us to meet our short-term cash requirements. At June 30, 20212022 and December 31, 2020,2021, we had $20.4$48.6 million and $32.9$28.6 million, respectively, in cash.  We believe that our cash and cash equivalents and availability under our revolving credit facilityCredit Facilities are sufficient to fund the working capital needs of our operating subsidiaries through at least June 30, 2022.2023.

Cash and cash equivalents decreasedincreased by $12.5$20.4 million from December 31, 20202021 to June 30, 2021.2022.  During the 20212022 Six Months, $35.6$27.5 million was provided by operations and $22.0$211.0 million from proceeds on our Amended Credit Agreement (described below). The major uses of cash for investing and financing activities included: repayment of MAAPP fundspayments on our Revolving Facility ($14.1175.0 million), distributions to non-controlling interests inclusive of those classified as redeemable non-controlling interestsinterest ($9.47.2 million), cash dividends paid to our shareholders ($9.010.7 million), purchase of business and non-controlling interestsinterest ($29.920.4 million), principal payments on notes payable ($4.2 million) and purchase of fixed assets ($3.34.6 million).

Effective December 5, 2013,On June 17, 2022, we entered into anthe Third Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended and/or restated in August 2015, January 2016, March 2017, November 2017(the “Credit Agreement”) among Bank of America, N.A., as administrative agent (“Administrative Agent”) and January 2021 (hereafter referred to as “Amended Credit Agreement”). the lenders from time-to-time party thereto.

The Amended Credit Agreement, is unsecured and has loan covenants, including requirements that we comply with a consolidated fixed charge coverage ratio and consolidated leverage ratio. Proceeds fromwhich matures on June 17, 2027, provides for loans in an aggregate principal amount of $325 million. Such loans will be available through the Amendedfollowing facilities (collectively, the “Senior Credit Agreement mayFacilities”):


1)Revolving Facility: $175 million, five-year, revolving credit facility (“Revolving Facility”), which includes a $12 million sublimit for the issuance of standby letters of credit and a $15 million sublimit for swingline loans (each, a “Swingline Loan”).

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2)Term Facility: $150 million term loan facility (the “Term Facility”). The Term Facility amortizes in quarterly installments of: (a) 0.625% in each of the first two years, (b) 1.250% in the third and fourth year, and (c) 1.875% in the fifth year of the Credit Agreement. The remaining outstanding principal balance of all term loans is due on the maturity date.

The proceeds of the Revolving Facility shall be used by us for working capital acquisitions, purchases of our common stock, dividend payments to  our common stockholders, capital expenditures and other general corporate purposes. The pricing grid is based on our consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.25% to 2.0% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Fees under the Amended Credit Agreement include an unused commitment fee of 0.3%purposes of the amountCompany and its subsidiaries, including to fund future acquisitions and invest in growth opportunities. The proceeds of fundsthe Term Facility were used by us to refinance the indebtedness outstanding under the Second Amended Credit Agreement.

The 2021 amendment to the Amendedand Restated Credit Agreement, allowsto pay fees and expenses incurred in connection with the loan facilities transactions, for cashworking capital and noncash consideration for acquisitionsother general corporate purposes of our Company and its subsidiaries.

We will be permitted underto increase the Amended Credit AgreementRevolving Facility and/or add one or more tranches of up to $50,000,000 for any fiscal year, and allows for payments in cash dividends to  shareholdersterm loans in an aggregate amount not to exceed $50,000,000the sum of (i) $100 million plus (ii) an unlimited additional amount, provided that (in the case of clause (ii)), after giving effect to such increases, the pro forma Consolidated Leverage Ratio (as defined in any fiscal year.  the Credit Agreement) would not exceed 2.0:1.0, and the aggregate amount of all incremental increases under the Revolving Facility does not exceed $50,000,000.

The commitment remains at $125 million, howeverinterest rates per annum applicable to the accordion featureSenior Credit Facilities (other than in respect of Swingline Loans) will be Term SOFR as defined in the agreement was expanded to provide for capacity up to $150 million,plus an applicable margin or, at our option, an alternate base rate plus an applicable margin. Currently, our interest rate including the applicable margin is 4.665%. Interest is payable at the end of the selected interest period but no less frequently than quarterly and has a maturityon the date of November 30, 2025.maturity.

We will also pay to the Administrative Agent, for the account of each lender under the Revolving Facility, a commitment fee equal to the actual daily excess of each lender’s commitment over its outstanding credit exposure under the Revolving Facility (“unused fee”). The AmendedCompany may prepay and/or repay the revolving loans and the term loans, and/or terminate the revolving loan commitments, in whole or in part, at any time without premium or penalty, subject to certain conditions.

The Credit Agreement is unsecuredcontains customary covenants limiting, among other things, the incurrence of additional indebtedness, the creation of liens, mergers, consolidations, liquidations and dissolutions, sales of assets, dividends and other payments in respect of equity interests, acquisitions, investments, loans and guarantees, subject, in each case, to customary exceptions, thresholds and baskets. The Credit Agreement includes certain financial covenants which include a consolidated fixed charge coverage ratiothe Consolidated Fixed Charge Coverage Ratio and a consolidated leverage ratio,the Consolidated Leverage Ratio, as defined in the agreement.Credit Agreement. The Credit Agreement also contains customary events of default.

Our obligations under the Credit Agreement are guaranteed by its wholly-owned material domestic subsidiaries (each, a “Guarantor”), and the obligations of the Company and any Guarantors are secured by a perfected first priority security interest in substantially all of the existing and future personal property of the Company and each Guarantor, subject to certain exceptions.

On June 30, 2021, $38.02022, $150.0 million was outstanding on the Amended Credit AgreementTerm Loan and the Revolving Facility remains available resulting in $87.0$175.0 million of availability. As of June 30, 2021,2022, we were in compliance with all of the covenants thereunder.

On June 30,March 31, 2022, we acquired a 70% interest in a six-clinic physical therapy practice. The practice’s owners retained 30% of the equity interests. The purchase price for the 70% equity interest was approximately $11.5 million, of which $11.2 million was paid in cash and $0.3 million is in the form of a note payable.  The note accrues interest at 3.5% per annum and the principal and interest are payable on March 31, 2024.

On December 31, 2021, we acquired a 65%75% interest in an eight-clinica three-clinic physical therapy practice with the practice founder retaining 35%25%. The purchase price for the 75% interest was approximately $10.3$3.7 million, of which $9.0$3.5 million was paid in cash and $0.2 million in the form of a note payable.  The note accrues interest at 3.25% per annum and the principal and interest are payable on December 31, 2023.

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On November 30, 2021, we acquired an approximate 70% interest in a leading provider of industrial injury prevention services. The previous owners retained the remaining interest. The initial purchase price for the 70% equity interest, not inclusive of the $2.0 million contingent payment in conjunction with the acquisition if specified future operational objectives are met, was approximately $63.2 million, of which $62.2 million was paid in cash, and $1.0 million is in the form of a note payable. The note accrues interest at 3.25% and the principal and interest is payable basedon November 30, 2023. The business generates approximately $27.0 million in annual revenue at a margin of approximately 20%. As part of the transaction, we also agreed to the future purchase of a separate company under the same ownership that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area.  The current owners have the right to put this transaction to us in approximately five years, with such put right having an initial $3.5 million fair value on June 30, 2022, as reflected on the achievementCompany’s consolidated balance sheet in Other long-term liabilities.  The value of certainthis right will be adjusted in future periods, as appropriate, with any change in fair value reflected in the Company’s consolidated statement of income.

On September 30, 2021, the Company acquired a company that specializes in return-to-work and ergonomic services, among other offerings. The business criteriagenerates more than $2.0 million in annual revenue. We acquired the company’s assets at a purchase price of approximately $3.3 million (which includes the obligation to pay an amount up to $0.6 million in contingent payment consideration in conjunction with the acquisition if specified future operational objectives are met) and contributed those assets to industrial injury prevention services subsidiary. The initial purchase price, not inclusive of the $0.6 million contingent payment, was approximately $2.7 million, of which $2.4 million was paid in cash, and $0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest are payable on September 30, 2023.

On June 30, 2021, the Company acquired a 65% interest in an eight-clinic physical therapy practice with the practice founders retaining 35%. The purchase price was approximately $10.3 million, of which $9.0 million was paid in cash, $1.0 million was payable based on the achievement of certain business criteria and $0.3 million is in the form of a note payable. The business criteria were met and accordingly $1.0 million was paid in July 2022. The note accrues interest at 3.25% per annum and the principal and interest are payable on June 30, 2023. Additionally, the Company has an obligation to pay an additional amount up to $0.8 million in contingent payment consideration in conjunction with the acquisition if specified future operational objectives are met. The Company recorded acquisition-date fair value of this contingent liability based on the likelihood of the contingent earn-out payment. The earn-out payment will subsequently be remeasured to fair value each reporting date.

On March 31, 2021, the Company acquired a 70% interest in a five-clinic physical therapy practice with the practice founderfounders retaining 30%.  When acquired, the practice was developing a sixth clinic which has been completed. The purchase price for the 70% interest was approximately $12.0 million, of which $11.7 million was paid in cash and $0.3 million is in the form of a note payable.  The note accrues interest at 3.25% per annum and the principal and interest isare payable on March 31, 2023.

On November 30,March 27, 2020, we acquired a 75% interest in a three-clinic physical therapy practice. response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The purchase priceCARES Act provided waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the 75% interest was $8.9Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19.

The CARES Act allowed for qualified healthcare providers to receive advanced payments under the MedicareAccelerated and Advance Payment Program (“MAAPP Funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval fromCenters for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded the $14.1 million (netin advance payments received as a liability. During the 2021 First Quarter, the Company repaid the MAAPP Funds of $14.1 million rather than applying them to future services performed.

Historically, we have generated sufficient cash from operations to fund our development activities and to cover operational needs. We plan to continue developing new clinics and making additional acquisitions. We have from time to time purchased the non-controlling interests of limited partners in our Clinic Partnerships. We may purchase additional non-controlling interests in the future. Generally, any acquisition or purchase of non-controlling interests is expected to be accomplished using a combination of cash acquired), of which $8.6 million was paid in cash and $0.3 million in the form of a note payable that is payable in two principal installments totaling $162,500 each. The first principal payment plus accrued interest is due to be paid on November 2021 with the second installment to be paid in November 2022. The note accrues interest at 3.25% per annum.

On September 30, 2020, we acquired a 70% interest in an entity which holds six-management contracts that have been in place for a number of years. Currently, these contracts have a five year term. The purchase price for the 70% interest was approximately $4.2 million, with $3.7 million payable in cash and $0.5 million in two notes payable.  One of the notes payable of $0.2 million is payable, with any accrued interest at 5% per annum, on September 30, 2021.  The remaining note of $0.3 million was paid in November 2020.financing. Any large acquisition would likely require financing.

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On February 27, 2020, we acquired interests in a four-clinic physical therapy practice. The four clinics are in four separate partnerships.  Our interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in a note payable.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.

We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts, in a consistent manner for all payor types. Claims are submitted to payors daily, weekly or monthly in accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time consuming and typically involves the submission of claims to multiple payors whose payment of claims may be dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting Medicare Rehab Agency statuspayor credentialing approval initially may be delayed for a relatively short transition period. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor type receivables, the write-off generally occurs after the accounts receivable has been outstanding for at least 120 days.

We generally enter into various notes payable as a means of financing our acquisitions. Our outstanding notes payable as of June 30, 20212022 relate to certain of the acquisitions of businesses and purchases of redeemable non-controlling interestsinterest that occurred in 2018 through June 2021.2022. Typically, the notes are payable over two years plus any accrued and unpaid interest. Interest accrues at various interest rates ranging from 3.25% to 5.5% per annum, subject to adjustment. At June 30, 2021,2022, the balance on these notes payable was $1.8$5.7 million.  In addition, we assumed leases with remaining terms of 1 month to 6 years for the operating facilities.

In conjunction with the above mentionedabove-mentioned acquisitions, in the event that a limited minority partner’s employment ceases at any time after a specified date that is typically between three and five years from the acquisition date, we have agreed to certain contractual provisions which enable such minority partners to exercise their right to trigger our repurchase of that partner’s non-controlling interest at a predetermined multiple of earnings before interest and taxes.

As of June 30, 2021,2022, we have accrued $5.6$7.9 million related to credit balances due to patients and payors.  This amount is expected to be paid in the next twelve months.

From September 2001 through December 31, 2008, our Board of Directors (“Board”) authorized us to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of our common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of our common stock (“March 2009 Authorization”). Our Amended Credit Agreement permits share repurchases of up to $15,000,000, subject to compliance with covenants. We are required to retire shares purchased under the March 2009 Authorization.

There is no expiration date for the share repurchase program. As of June 30, 2021,2022, there are currently an additional estimated  129,455137,363 shares (based on the closing price of $115.87$109.20 on June 30, 2021)2022) that may be purchased from time to time in the open market or private transactions depending on price, availability and our cash position. We did not purchase any shares of our common stock during the threesix months ended June 30, 2021.2022.

FACTORS AFFECTING FUTURE RESULTS

The risks related to our business and operations include:

the multiple effects of the impact of public health crises and epidemics/pandemics, such as the novel strain of COVID-19 and its variants, for which the total financial magnitude cannot be currently estimated;
changes as the result of government enacted national healthcare reform;
changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status;status;
revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction;reduction;
business and regulatory conditions including federal and state regulations;

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governmental and otherchanges in reimbursement rates or payment methods from third party payor inspections, reviews, investigationspayors including government agencies, and audits, which may resultchanges in sanctions or reputational harmthe deductibles and increased costs;co-pays owed by patients;
compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply;
changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients;
revenue and earnings expectations;
legal actions, which could subject us to increased operating costs and uninsured liabilities;
general economic conditions;
availability and cost of qualified physical therapists;
personnel productivity and retaining key personnel;comply;
competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets;assets;
the impact of COVID-19 related vaccination and/or testing mandates at the federal, state and/or local level, which could have an adverse impact on staffing, revenue, costs and the results of operations;
changes as the result of government enacted national healthcare reform;
business and regulatory conditions including federal and state regulations;
governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs;

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revenue and earnings expectations;
legal actions, which could subject us to increased operating costs and uninsured liabilities;
general economic conditions, including but not limited to inflationary and recessionary periods;
availability and cost of qualified physical therapists;
personnel productivity and retaining key personnel;
competitive environment in the industrial injury prevention services business, which could result in the termination or non-renewalnonrenewal of contractual service arrangements and other adverse financial consequences for that service line;
acquisitions, and the successful integration of the operations of the acquired businesses;
impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non controlling interestsnon-controlling interest (minority interests);
maintaining our information technology systems with adequate safeguards to protect against cyber-attacks;cyber-attacks;
a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act;
maintaining clients for which we perform management and other services, as a breach or termination of those contractual arrangements by such clients could cause operating results to be less than expected;
maintaining adequate internal controls;
maintaining necessary insurance coverage;coverage;
availability, terms, and use of capital;capital; and
weather and other seasonal factors.

See alsoIn addition to the above, see Risk Factors in Part 2 - Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2020.2021 and the additional risk factor below:

Our debt and financial obligations could adversely affect our financial condition, our ability to obtain future financing, and our ability to operate our business.
We have outstanding debt obligations that could adversely affect our financial condition and limit our ability to successfully implement our business strategy. Furthermore, from time to time, we may need additional financing to support our business and pursue our business strategy, including strategic acquisitions. Our ability to obtain additional financing, if and when required, will depend on investor demand, our operating performance, the condition of the capital markets, and other factors. We cannot assure that additional financing will be available to us on favorable terms when required, or at all.
Our loan agreements contain certain restrictions and requirements that among other things:
require us to maintain a quarterly fixed charge coverage ratio and minimum working capital ratio;
limit our ability to obtain additional financing in the future for working capital, capital expenditures and acquisitions, to fund growth or for general corporate purposes;
limit our future ability to refinance our indebtedness on terms acceptable to us or at all;
limit our flexibility in planning for or reacting to changes in our business and market conditions or in funding our strategic growth plan; and
impose on us financial and operational restrictions.

Our ability to meet our debt service obligations will depend on our future performance, which will be affected by the other risk factors described in our Annual Report on Form 10-K filed on March 1, 2022. If we do not generate enough cash flow to pay our debt service obligations, we may be required to refinance all or part of our existing debt, sell our assets, borrow more money or raise equity. There is no guarantee that we will be able to take any of these actions on a timely basis, on terms satisfactory to us, or at all.

If we fail to satisfy our debt service obligations or the other restrictions and requirements in our loan agreements, we could be in default. Unless cured or waived, a default would permit lenders to accelerate the maturity of the debt under the credit agreement and to foreclose upon the collateral securing the debt.

Our outstanding loans bear interest at variable rates. In response to the variable rates, we entered into entered into an interest rate swap agreement.  See above for further discussion of this swap agreement.

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Forward-Looking Statements

We make statements in this report that are considered to be forward-looking statements within the meaning given such term under Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). These statements contain forward-looking information relating to the financial condition, results of operations, plans, objectives, future performance and business of our Company. These statements (often using words such as “believes”, “expects”, “intends”, “plans”, “appear”, “should” and similar words) involve risks and uncertainties that could cause actual results to differ materially from those we project. Included among such statements are those relating to opening new clinics, availability of personnel and the reimbursement environment.  The forward-looking statements are based on our current views and assumptions and actual results could differ materially from those anticipated in such forward-looking statements as a result of certain risks, uncertainties, and factors, which include, but are not limited to the risks listed above.

Many factors are beyond our control. Given these uncertainties, you should not place undue reliance on our forward-looking statements. Please see the other sections of this report and our other periodic reports filed with the Securities and Exchange Commission (the “SEC”) for more information on these factors. Our forward-looking statements represent our estimates and assumptions only as of the date of this report. Except as required by law, we are under no obligation to update any forward-looking statement, regardless of the reason the statement may no longer be accurate.

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ITEM 3.QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK.

WeThe Company is exposed to certain market risks during the ordinary course of business due to adverse changes in interest rates. The exposure to interest rate risk primarily results from the Company’s variable-rate borrowing. The Company may elect to use derivative financial instruments to manage risks from fluctuations in interest rates. The Company does not purchase or hold derivatives for trading or speculative purposes. Fluctuations in interest rates can be volatile and the Company’s risk management activities do not maintain any derivative instruments,eliminate these risks.

In May 2022, we entered into an interest rate swap arrangements, hedging contracts, futures contracts or the like. Our primary market risk exposure is the changesagreement, effective on June 30, 2022, which has a $150 million notional value, and a maturity date of June 30, 2027. Beginning in July 2022, we receive 1-month SOFR, and pay a fixed rate of interest rates obtainableof 2.815% plus an additional margin on a quarterly basis. The total interest rate in any period will also include an applicable margin based on our Amended Credit Agreement. The interest on our Amended Credit Agreement is based on a variable rate. At June 30, 2021, $38.0 million was outstanding under our Amended Credit Agreement. Based on the balance of the Amended Credit Agreement at June 30, 2021, any change inConsolidated Leverage Ratio.

We designated the interest rate swap as a cash flow hedge and structured it to be highly effective. Consequently, unrealized gains and losses related to the fair value of 1% would yield a decrease or increase in annualthe interest expenserate swap are recorded to accumulated other comprehensive income (loss), net of $380,000.tax.

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ITEM 4.CONTROLS AND PROCEDURES.

(a)Evaluation of Disclosure Controls and Procedures

As of the end of the period covered by this report, the Company’s management completed an evaluation, under the supervision and with the participation of our principal executive officer and principal financial officer, of the effectiveness of our disclosure controls and procedures. Based on this evaluation, our principal executive officer and principal financial officer concluded (i) that our disclosure controls and procedures are designed to ensure that information required to be disclosed in the reports that we file or submit under the Securities Exchange Act of 1934, as amended, is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to our management, including our principal executive officer and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure and (ii) that our disclosure controls and procedures are effective.

(b)Changes in Internal Control over Financial Reporting

There have been no changes in our internal control over financial reporting during the period covered by this report that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

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Table of Contents
PART II—OTHER INFORMATION

ITEM 1.LEGAL PROCEEDINGS.

We are a party to various legal actions, proceedings, and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of our business. We cannot predict the ultimate outcome of pending litigation, proceedings, and regulatory and other governmental audits and investigations. These matters could potentially subject us to sanctions, damages, recoupments, fines, and other penalties. The Department of Justice, CMS, or other federal and state enforcement and regulatory agencies may conduct additional investigations related to our businesses in the future that may, either individually or in the aggregate, have a material adverse effect on our business, financial position, results of operations, and liquidity.

Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. We are and have been a defendant in these cases in the past and may be named as a defendant in similar cases from time to time in the future.

Florida Litigation
ITEM 1A.RISK FACTORS.

On August 19, 2019, we received notice of a qui tam lawsuit filed by a relator on behalf of the United States, titled U.S. ex rel. Bonnie Elsdon, v. U.S. Physical Therapy, Inc., U.S. Physical Therapy, Ltd., Rehab Partners #2, Inc., The Hale Hand Center, Limited Partnership (the “Hale Partnership”),Our debt and Suzanne Hale.   This whistleblower lawsuit was filed in the U.S. District Court for the Southern District of Texas, seeking damagesfinancial obligations could adversely affect our financial condition, our ability to obtain future financing, and civil penalties under the federal False Claim Act.  This lawsuit was originally filed under seal by a former employee of The Hale Hand Center, Limited Partnership (“Hale Partnership”), a majority-owned subsidiary of the Company, on May 25, 2018.  The U.S Government declinedour ability to intervene in the case and unsealed the Complaint on July 17, 2019.  The plaintiff - relator served the Complaint on us and the other named defendants on August 19, 2019.operate our business.

The Complaint alleges that the Hale Partnership engaged in conduct to purposely “upcode” its billings for services provided to Medicare patients. The plaintiff - relator points to three dates of service and provides examples of what it alleges are inflated billings by the Hale Partnership; the relator then claims that similar false claims must have occurred on other days and at other Company-owned partnerships.

On October 3, 2019, we filed Motions to Dismiss based on numerous grounds on behalf of each of the named defendants. On October 29, 2019, the plaintiff-relator dismissed three of the named defendants, Rehab Partners #2, Inc., U.S. Physical Therapy, Ltd., and Suzanne Hale. The Motions to Dismiss were denied on November 30, 2020.

We have engaged counseloutstanding debt obligations that could adversely affect our financial condition and fully investigatedlimit our ability to successfully implement our business strategy. Furthermore, from time to time, we may need additional financing to support our business and pursue our business strategy, including strategic acquisitions. Our ability to obtain additional financing, if and when required, will depend on investor demand, our operating performance, the matter,condition of the capital markets, and believeother factors. We cannot provide assurances that the allegationsadditional financing will be available to us on favorable terms when required, or at all.

Our loan agreements contain certain restrictions and requirements that among other things:
require us to maintain a quarterly fixed charge coverage ratio and minimum working capital ratio;
limit our ability to obtain additional financing in the Complaint have no merit. We intendfuture for working capital, capital expenditures and acquisitions, to vigorously defend this action, butfund growth or for general corporate purposes;
limit our future ability to refinance our indebtedness on terms acceptable to us or at this time we are unableall;
limit our flexibility in planning for or reacting to predict the timingchanges in our business and outcome of the matter.market conditions or in funding our strategic growth plan; and
impose on us financial and operational restrictions.

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Our ability to meet our debt service obligations will depend on our future performance, which will be affected by the other risk factors described in our Annual Report on Form 10-K filed on March 1, 2022. If we do not generate enough cash flow to pay our debt service obligations, we may be required to refinance all or part of our existing debt, sell our assets, borrow more money or raise equity. There is no guarantee that we will be able to take any of these actions on a timely basis, on terms satisfactory to us, or at all.

If we fail to satisfy our debt service obligations or the other restrictions and requirements in our loan agreements, we could be in default. Unless cured or waived, a default would permit lenders to accelerate the maturity of the debt under the credit agreement and to foreclose upon the collateral securing the debt.

Our outstanding loans bear interest at variable rates. In response to the variable rates, we entered into entered into an interest rate swap agreement.  See above for further discussion of this swap agreement.

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ITEM 6.EXHIBITS.

Exhibit
Number
Description
  
10.1
+
First Amendment to SecondThird Amended and Restated Credit AgreemelyAgreement dated as of January 9, 2021June 17, 2022 among the Company, as the borrower, and Bank of America, N.A., as AdminstrativeAdministrative Agent, Regions Capital Markets as Syndication Agent, BofA Securities Inc. and Regions Capital Markets as Joint Load Arrangers, BofA Securities Inc., as Sole Bookrunner and the lenders named therein. [incorporated by reference to Exhibit 10.1 to the CompanyCompany's Current Report on Form 8-K10-Q filed with the SEC on February 4, 2021.June 21, 2022.]
10.2+
U.S. Physical Therapy, Inc. Objective Long-Term Incentive Plan for Senior Management for 2021, effective March 17, 2021. [incorporated by reference to Exhibit 99.1 to the Company Current Report on Form 8-K filed with the SEC on March 16, 2021.]
10.3+
U.S. Physical Therapy, Inc. Discretionary Long-Term Incentive Plan for Senior Management for 2021, effective March 17, 2021. [incorporated by reference to Exhibit 99.2 to the Company Current Report on Form 8-K filed with the SEC on March 16, 2021.]
10.4+
U.S. Physical Therapy, Inc. Objective Cash/RSA Bonus Plan for Senior Management for 2021, effective March 17, 2021. [incorporated by reference to Exhibit 99.3 to the Company Current Report on Form 8-K filed with the SEC on March 16, 2021.]
10.5+
U.S. Physical Therapy, Inc. Objective Cash/RSA Bonus Plan for Senior Management for 2021, effective March 17, 2021. [incorporated by reference to Exhibit 99.4 to the Company Current Report on Form 8-K filed with the SEC on March 16, 2021.]
99.1
2021 Letter to Shareholders [incorporated by reference to Exhibit 99.1 to the Company Current Report on Form 8-K filed with the SEC on April 5, 2021.]
31.1*
Rule 13a-14(a)/15d-14(a) Certification of Chief Executive Officer.
31.2*
Rule 13a-14(a)/15d-14(a) Certification of Chief Financial Officer.
31.3*
Rule 13a-14(a)/15d-14(a) Certification of Corporate Controller.
32*
Certification Pursuant to 18 U.S.C 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS*XBRL Instance Document
101.SCH*XBRL Taxonomy Extension Schema Document
101.CAL*XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF*XBRL Taxonomy Extension Definition Linkbase Document
101.LAB*XBRL Taxonomy Extension Label Linkbase Document
101.PRE*XBRL Taxonomy Extension Presentation Linkbase Document

*Filed herewith


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Table of Contents

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on our behalf by the undersigned thereunto duly authorized.

 U.S. PHYSICAL THERAPY, INC.
   
Date: August 9, 20218, 2022By:/s/ CAREY HENDRICKSON
  Carey Hendrickson
  Chief Financial Officer
  (principalPrincipal financial and accounting officer)
   
By: /s/ JON C. BATES
Jon C. Bates
Vice President/Corporate Controller


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