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UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, DC 20549

FORM 10-Q/A10-Q

Amendment No. 1

QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended SeptemberJune 30, 20212022

OR

TRANSITION REPORT PURSUANT TO SECTION 13 OR

 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

Commission File Number: 001-39391

img230333197_0.jpg 

CareMax, Inc.

(Exact Name of Registrant as Specified in its Charter)

Delaware

85-0992224

( State or other jurisdiction of

incorporation or organization)

(I.R.S. Employer
Identification No.)

1000 NW 57 Court, Suite 400

Miami, FL,

33126

(Address of principal executive offices)

(Zip Code)

Registrant’s telephone number, including area code: (786) 360-4768

Securities registered pursuant to Section 12(b) of the Act:

Title of each class

Trading

Symbol(s)

Name of each exchange on which registered

Class A common stock, par value $0.0001 per share

CMAX

The Nasdaq Stock Market LLC

Warrants, each whole warrant exercisable for one share of Class A common stock, each at an exercise price of $11.50 per share

CMAXW

The Nasdaq Stock Market LLC

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 pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, 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

 

Non-accelerated filer

 

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 pursuant 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

Indicate by check mark whether the registrant has filed all documents and reports required to be filed by Sections 12, 13 or 15(d) of the Securities Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court. Yes No ☐

As of November 15, 2021,August 5, 2022, the registrant had 87,073,98587,396,972 shares of Class A common stock, $0.0001 par value per share, and 0 shares of Class B common stock, $0.0001 par value per share issued and outstanding.


EXPLANATORY NOTE

 

CareMax, Inc. (the “Company”) is filing this Amendment No. 1 on Form 10-Q/A for the quarter ended September 30, 2021 (this “Form 10-Q/A”).

This Form 10-Q/A amends the Company’s Quarterly Report on Form 10-Q for the quarterly period ended September 30, 2021, as filed with the Securities and Exchange Commission (“SEC”) on November 15, 2021 (the “Original Filing”).This Form 10-Q/A is being filed to restate the Company’s unaudited Condensed Consolidated Financial Statements for the three and nine months ended September 30, 2021. The restatement reflects the reclassification of the contingent share earnout related to the Company’s business combination from stockholders’ equity to a liability for the period from the closing of the business combination on June 8, 2021 to the satisfaction of the triggering event relating to the first earnout on July 9, 2021. See Note 2 to the unaudited Condensed Consolidated Financial Statements included in this Form 10-Q/A for further information regarding the restatement.

The Company is filing this Form 10-Q/A to amend and restate the Original Filing with modification as necessary to reflect the restatement. The following items have been amended to reflect the restatement:

Part I, Item 1: Financial Information

Part I, Item 2: Management's Discussion and Analysis of Financial Condition and Results of Operations

Part I, Item 4: Controls and Procedures

Part II, Item 6: Exhibits

In addition, the Company’s Chief Executive Officer and Chief Financial Officer have provided new certifications dated as of the date of this Form 10-Q/A (Exhibits 31.1, 31.2, 32.1 and 32.2).

Except as described above and set forth in this Form 10-Q/A, this Form 10-Q/A does not amend or update any other information contained in the Original Filing. This Form 10-Q/A does not purport to reflect any information or events subsequent to the Original Filing, except as expressly described herein.


CareMax, Inc.

Quarterly Report on Form 10-Q/A10-Q

For the Quarter Ended SeptemberJune 30, 20212022

Table of Contents

PART I. FINANCIAL INFORMATION

Item 1

Condensed Consolidated Balance Sheets

1

Condensed Consolidated Statements of Operations

2

Condensed Consolidated Statements of Changes in Stockholders'/Members' Equity

3

Condensed Consolidated Statements of Cash Flows

4

Notes to Condensed Consolidated Financial Statements

6

Item 2.

Management’s Discussion and Analysis of Financial Condition and Results of Operations

3319

Item 3.

Quantitative and Qualitative DisclosureDisclosures About Market Risk

5435

Item 4.

Controls and Procedures

5536

PART II. OTHER INFORMATION

5737

Item 1.

Legal Proceedings

5737

Item 1A.

Risk Factors

5737

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

5738

Item 3.

Defaults Upon Senior Securities

5738

Item 4.

Mine Safety Disclosures

5738

Item 5.

Other Information

5738

Item 6.

Exhibits

5838


PART I.I – FINANCIAL INFORMATION

CAREMAX, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

(in thousands, except share and per share data)

ITEM 1. FINANCIAL STATEMENTS

CAREMAX, INC.

 

 

September 30,
2021
(As Restated, Note 2)

 

 

December 31,
2020

 

ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT ASSETS

 

 

 

 

 

 

Cash

 

$

80,451

 

 

$

4,934

 

Accounts receivable, net

 

 

33,624

 

 

 

9,395

 

Inventory

 

 

398

 

 

 

15

 

Prepaid expenses

 

 

17,926

 

 

 

183

 

Risk settlements due from providers

 

 

464

 

 

 

80

 

Due from related parties

 

 

-

 

 

 

274

 

Total Current Assets

 

 

132,863

 

 

 

14,881

 

 

 

 

-

 

 

 

 

Property and equipment, net

 

 

16,163

 

 

 

4,796

 

Goodwill

 

 

451,908

 

 

 

10,068

 

Intangible assets, net

 

 

61,575

 

 

 

8,575

 

Deferred debt issuance costs

 

 

2,084

 

 

 

-

 

Other assets

 

 

1,109

 

 

 

183

 

  Total Assets

 

$

665,701

 

 

$

38,503

 

 

 

 

 

 

 

 

LIABILITIES AND STOCKHOLDERS'/MEMBERS' EQUITY

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT LIABILITIES

 

 

 

 

 

 

Accounts payable

 

$

5,677

 

 

$

1,044

 

Accrued expenses

 

 

8,346

 

 

 

2,572

 

Accrued interest payable

 

 

-

 

 

 

149

 

Risk settlements due to providers

 

 

171

 

 

 

643

 

Current portion of long-term debt

 

 

6,279

 

 

 

1,004

 

Due to related parties

 

 

-

 

 

 

39

 

Other current liabilities

 

 

2,831

 

 

 

-

 

  Total Current Liabilities

 

 

23,304

 

 

 

5,451

 

 

 

 

-

 

 

 

 

Derivative warrant liabilities

 

 

17,110

 

 

 

-

 

Long-term debt, less current portion

 

 

112,890

 

 

 

26,325

 

Other liabilities

 

 

6,032

 

 

 

-

 

Total Liabilities

 

 

159,336

 

 

 

31,776

 

COMMITMENTS AND CONTINGENCIES (Note 14)

 

 

-

 

 

 

 

STOCKHOLDERS'/MEMBER'S EQUITY

 

 

-

 

 

 

 

Class A common stock ($0.0001 par value; 250,000,000 shares
  authorized;
87,073,985 shares issued and outstanding at September 30,
  2021)

 

 

9

 

 

 

-

 

Additional paid-in-capital

 

 

502,751

 

 

 

-

 

Retained Earnings

 

 

3,605

 

 

 

-

 

Member units (0 par value, 200 authorized, issued and outstanding at
  December 31, 2020)

 

 

-

 

 

 

223

 

Members' equity

 

 

-

 

 

 

6,504

 

  Total Stockholders'/Members' Equity

 

 

506,365

 

 

 

6,727

 

 

 

 

 

 

 

 

  Total Liabilities and Stockholders'/Members' Equity

 

$

665,701

 

 

$

38,503

 

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

(in thousands, except share and per share data)

 

 

June 30,
2022

 

 

December 31,
2021

 

ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Assets

 

 

 

 

 

 

Cash

 

$

68,130

 

 

$

47,917

 

Accounts receivable, net

 

 

72,633

 

 

 

41,998

 

Inventory

 

 

915

 

 

 

550

 

Prepaid expenses

 

 

22,169

 

 

 

17,040

 

Risk settlements due from providers

 

 

500

 

 

 

539

 

Total Current Assets

 

 

164,347

 

 

 

108,044

 

 

 

 

 

 

 

 

Property and equipment, net

 

 

17,332

 

 

 

15,993

 

Goodwill

 

 

464,846

 

 

 

464,566

 

Intangible assets, net

 

 

51,885

 

 

 

59,811

 

Deferred debt issuance costs

 

 

2,309

 

 

 

1,972

 

Other assets

 

 

8,260

 

 

 

2,706

 

Total Assets

 

$

708,979

 

 

$

653,092

 

 

 

 

 

 

 

 

LIABILITIES AND STOCKHOLDERS' EQUITY

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Liabilities

 

 

 

 

 

 

Accounts payable

 

$

9,156

 

 

$

3,110

 

Accrued expenses

 

 

14,250

 

 

 

8,690

 

Risk settlements due to providers

 

 

176

 

 

 

196

 

Current portion of long-term debt

 

 

18

 

 

 

6,275

 

Other current liabilities

 

 

3,514

 

 

 

3,687

 

Total Current Liabilities

 

 

27,113

 

 

 

21,959

 

 

 

 

 

 

 

 

Derivative warrant liabilities

 

 

4,520

 

 

 

8,375

 

Long-term debt, less current portion

 

 

181,501

 

 

 

110,960

 

Other liabilities

 

 

7,717

 

 

 

6,428

 

Total Liabilities

 

 

220,852

 

 

 

147,722

 

COMMITMENTS AND CONTINGENCIES (Note 13)

 

 

 

 

 

 

STOCKHOLDERS' EQUITY

 

 

 

 

 

 

Preferred stock (1,000,000 authorized and 0 outstanding as of June 30, 2022 and December 31, 2021)

 

 

-

 

 

 

-

 

Class A common stock ($0.0001 par value; 250,000,000 shares authorized; 87,467,972 and 87,367,972 shares issued and outstanding as of June 30, 2022 and December 31, 2021, respectively)

 

 

9

 

 

 

9

 

Additional paid-in-capital

 

 

514,262

 

 

 

505,327

 

Retained (deficit) earnings

 

 

(26,144

)

 

 

33

 

Total Stockholders' Equity

 

 

488,127

 

 

 

505,370

 

 

 

 

 

 

 

 

Total Liabilities and Stockholders' Equity

 

$

708,979

 

 

$

653,092

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.

(1)


CAREMAX, INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

(Unaudited)

(in thousands, except share and per share data)

Three Months Ended
September 30,

 

Three Months Ended
September 30,

 

Nine Months Ended
September 30,

 

Nine Months Ended
September 30,

 

 

Three Months Ended June 30,

 

 

Six Months Ended June 30,

 

2021
(As Restated, Note 2)

 

2020

 

2021
(As Restated, Note 2)

 

2020

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Revenue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medicare risk-based revenue

$

76,428

 

$

24,242

 

$

142,005

 

$

75,083

 

 

$

143,664

 

 

$

37,761

 

 

$

251,410

 

 

$

65,577

 

Medicaid risk-based revenue

 

20,884

 

0

 

26,333

 

0

 

 

 

19,896

 

 

 

5,449

 

 

 

40,062

 

 

 

5,449

 

Other revenue

 

7,308

 

 

64

 

 

9,118

 

 

251

 

 

 

8,719

 

 

 

1,709

 

 

 

17,727

 

 

 

1,811

 

Total revenue

 

104,620

 

24,306

 

177,456

 

75,334

 

 

 

172,279

 

 

 

44,919

 

 

 

309,199

 

 

 

72,837

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Operating expenses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

External provider costs

 

73,329

 

17,304

 

127,023

 

49,110

 

 

 

120,348

 

 

 

35,535

 

 

 

213,204

 

 

 

53,694

 

Cost of care

 

21,602

 

4,341

 

34,822

 

12,244

 

 

 

30,364

 

 

 

7,867

 

 

 

57,712

 

 

 

13,220

 

Sales and marketing

 

1,274

 

311

 

2,340

 

811

 

 

 

2,299

 

 

 

775

 

 

 

5,600

 

 

 

1,066

 

Corporate, general and administrative

 

13,589

 

1,885

 

24,264

 

4,626

 

 

 

18,063

 

 

 

8,881

 

 

 

37,041

 

 

 

10,676

 

Depreciation and amortization

 

5,176

 

359

 

7,127

 

1,072

 

 

 

4,903

 

 

 

1,437

 

 

 

9,965

 

 

 

1,951

 

Acquisition related costs

 

879

 

 

0

 

 

1,028

 

 

0

 

 

 

2,789

 

 

 

149

 

 

 

3,055

 

 

 

149

 

Total operating expenses

 

115,849

 

 

24,200

 

 

196,603

 

 

67,863

 

 

 

178,767

 

 

 

54,643

 

 

 

326,577

 

 

 

80,755

 

Operating (loss) income

 

(11,229

)

 

106

 

 

(19,147

)

 

7,471

 

 

 

(6,488

)

 

 

(9,724

)

 

 

(17,378

)

 

 

(7,918

)

Interest (expense), net

 

(1,291

)

 

(387

)

 

(2,587

)

 

(1,117

)

Nonoperating (expenses) income

 

 

 

 

 

 

 

 

 

 

 

 

Interest expense

 

 

(3,896

)

 

 

(792

)

 

 

(5,624

)

 

 

(1,296

)

Gain on remeasurement of warrant liabilities

 

10,227

 

0

 

12,022

 

0

 

 

 

7,391

 

 

 

1,795

 

 

 

3,855

 

 

 

1,795

 

(Loss) gain on remeasurement of contingent earnout liabilities

 

(11,625

)

 

0

 

5,794

 

0

 

Gain on extinguishment of debt, net

 

279

 

0

 

1,637

 

0

 

Other expense, net

 

(840

)

 

0

 

 

(840

)

 

0

 

Gain on remeasurement of contingent earnout liabilities

 

 

-

 

 

 

17,420

 

 

 

-

 

 

 

17,420

 

Gain (loss) on extinguishment of debt, net

 

 

(6,172

)

 

 

1,358

 

 

 

(6,172

)

 

 

1,358

 

Other income (expense), net

 

 

(45

)

 

 

-

 

 

 

(507

)

 

 

-

 

 

 

(2,722

)

 

 

19,781

 

 

 

(8,448

)

 

 

19,277

 

(Loss) income before income tax

 

(14,479

)

 

(281

)

 

(3,120

)

 

6,354

 

 

 

(9,210

)

 

 

10,057

 

 

 

(25,826

)

 

 

11,359

 

Income tax provision

 

0

 

 

0

 

 

0

 

 

0

 

 

 

(171

)

 

-

 

 

 

(351

)

 

-

 

Net (loss) income

$

(14,479

)

$

(281

)

$

(3,120

)

$

6,354

 

 

$

(9,381

)

 

$

10,057

 

 

$

(26,178

)

 

$

11,359

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income attributable to non-controlling interest

 

0

 

 

34

 

 

0

 

 

26

 

Net (loss) income attributable to controlling interest

$

(14,479

)

$

(315

)

$

(3,120

)

$

6,328

 

 

 

 

 

 

 

 

 

Net (loss) income attributable to CareMax, Inc. Class A common stockholders

$

(14,479

)

$

(315

)

$

(3,120

)

$

6,328

 

Weighted average basic shares outstanding

 

82,552,520

 

10,796,069

 

40,847,294

 

10,796,069

 

Weighted average diluted shares outstanding

 

82,552,520

 

10,796,069

 

40,847,294

 

10,796,069

 

Weighted-average basic shares outstanding

 

 

87,422,917

 

 

 

28,404,759

 

 

 

87,395,596

 

 

 

19,649,057

 

Weighted-average diluted shares outstanding

 

 

87,422,917

 

 

 

30,906,859

 

 

 

87,395,596

 

 

 

20,907,019

 

Net (loss) income per share

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Basic

$

(0.18

)

$

(0.03

)

$

(0.08

)

$

0.59

 

 

$

(0.11

)

 

$

0.35

 

 

$

(0.30

)

 

$

0.58

 

Diluted

$

(0.18

)

$

(0.03

)

$

(0.08

)

$

0.59

 

 

$

(0.11

)

 

$

0.33

 

 

$

(0.30

)

 

$

0.54

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.

(2)


CAREMAX, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS'/MEMBERS' EQUITY

(Unaudited)

(in thousands, except share data)

 

Class A Common Stock

 

 

Additional

 

 

Total

 

 

 

 

 

Noncontrolling

 

 

Total

 

 

Shares

 

 

Amount

 

 

Paid-in-capital
(As Restated, Note 2)

 

 

Controlling Interest

 

 

Retained Earnings
(As Restated, Note 2)

 

 

Interest

 

 

Equity

 

BALANCE - DECEMBER 31, 2019

 

-

 

 

$

-

 

 

$

-

 

 

$

5,160

 

 

$

-

 

 

$

(214

)

 

$

4,946

 

Net income (loss)

 

-

 

 

 

-

 

 

 

-

 

 

 

3,261

 

 

 

-

 

 

 

(90

)

 

 

3,171

 

Purchase of non-controlling interest

 

-

 

 

 

-

 

 

 

-

 

 

 

(400

)

 

 

-

 

 

 

-

 

 

 

(400

)

Change in ownership due to change in non-controlling interest

 

-

 

 

 

-

 

 

 

-

 

 

 

(44

)

 

 

-

 

 

 

44

 

 

 

-

 

BALANCE- MARCH 31, 2020

 

-

 

 

 

-

 

 

 

-

 

 

 

7,977

 

 

 

-

 

 

 

(260

)

 

 

7,717

 

Net income

 

-

 

 

 

-

 

 

 

-

 

 

 

3,382

 

 

 

-

 

 

 

82

 

 

 

3,464

 

Change in ownership due to change in non-controlling interest

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

Distributions

 

-

 

 

 

-

 

 

 

-

 

 

 

(81

)

 

 

-

 

 

 

-

 

 

 

(81

)

BALANCE- JUNE 30, 2020

 

-

 

 

 

-

 

 

 

-

 

 

 

11,278

 

 

 

-

 

 

 

(178

)

 

 

11,100

 

Net (loss) income

 

-

 

 

 

-

 

 

 

-

 

 

 

(315

)

 

 

-

 

 

 

34

 

 

 

(281

)

Change in ownership due to change in non-controlling interest

 

-

 

 

 

-

 

 

 

-

 

 

 

(42

)

 

 

-

 

 

 

42

 

 

 

-

 

Distributions

 

-

 

 

 

-

 

 

 

-

 

 

 

(63

)

 

 

-

 

 

 

-

 

 

 

(63

)

BALANCE- SEPTEMBER 30, 2020

 

-

 

 

$

-

 

 

$

-

 

 

$

10,858

 

 

$

-

 

 

$

(102

)

 

$

10,756

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BALANCE - DECEMBER 31, 2020

 

-

 

 

$

-

 

 

$

-

 

 

$

6,727

 

 

$

-

 

 

$

-

 

 

$

6,727

 

Net income

 

-

 

 

 

-

 

 

 

-

 

 

 

1,302

 

 

 

-

 

 

 

-

 

 

 

1,302

 

Distributions

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

BALANCE- MARCH 31, 2021

 

-

 

 

 

-

 

 

 

-

 

 

 

8,029

 

 

 

-

 

 

 

-

 

 

 

8,029

 

Activity prior to the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Additional paid-in-capital

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

  Net loss

 

 

 

 

-

 

 

 

 

 

 

(6,487

)

 

 

 

 

 

 

 

 

(6,487

)

Effects of the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

  Reverse recapitalization

 

28,780,819

 

 

 

3

 

 

 

(186,632

)

 

 

(1,542

)

 

 

1,542

 

 

 

-

 

 

 

(186,629

)

  Equity consideration issued to acquire IMC

 

10,412,023

 

 

 

1

 

 

 

155,346

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

155,347

 

  Shares issued for holdback

 

55,000

 

 

 

-

 

 

 

821

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

821

 

  Proceeds from the sale of Class A Common stock, net of offering costs

 

41,000,000

 

 

 

4

 

 

 

397,525

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

397,529

 

Activity after the business combination:

 

 

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

-

 

  Net income

 

-

 

 

 

-

 

 

 

-

 

 

 

 

 

 

16,543

 

 

 

-

 

 

 

16,543

 

  Equity consideration issued to acquire SMA

 

384,615

 

 

 

-

 

 

 

5,027

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

5,027

 

BALANCE- JUNE 30, 2021

 

80,632,457

 

 

 

8

 

 

 

372,088

 

 

 

-

 

 

 

18,085

 

 

 

-

 

 

 

390,181

 

  Equity consideration issued to acquire DNF

 

2,741,528

 

 

 

-

 

 

 

26,072

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

26,072

 

  Reverse recapitalization

 

-

 

 

 

-

 

 

 

(104

)

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(104

)

  Contingently issuable stock to CMG Sellers and IMC Parent - First Share Price Trigger on Earnout Shares

 

3,200,000

 

 

 

1

 

 

 

39,109

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

39,110

 

  Reclassification of contingent consideration previously liability classified

 

 

 

 

 

 

 

45,088

 

 

 

 

 

 

 

 

 

 

 

 

45,088

 

  Proceeds from the sale of Class A Common stock, net of offering costs

 

500,000

 

 

 

-

 

 

 

6,650

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

6,650

 

  Stock compensation expense

 

-

 

 

 

-

 

 

 

966

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

966

 

  Series A Warrants issued under the Advisory Agreement

 

-

 

 

 

-

 

 

 

12,883

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

12,883

 

  Net loss

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(14,479

)

 

 

-

 

 

 

(14,479

)

BALANCE- SEPTEMBER 30, 2021

 

87,073,985

 

 

$

9

 

 

$

502,751

 

 

$

-

 

 

 

3,605

 

 

$

-

 

 

$

506,365

 

 

 

Three Months Ended

 

 

 

Class A Common Stock

 

 

Preferred

 

 

Additional

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

Shares

 

 

Amount

 

 

Stock

 

 

Paid-in-capital

 

 

Members' units

 

 

Member's Equity

 

 

Retained Earnings
(Deficit)

 

 

Equity

 

BALANCE - MARCH 31, 2021

 

 

-

 

 

$

-

 

 

$

-

 

 

$

-

 

 

$

223

 

 

$

7,805

 

 

$

-

 

 

$

8,029

 

Activity prior to the Business Combination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(6,487

)

 

 

-

 

 

 

(6,487

)

Effects of the Business Combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

Reverse recapitalization

 

 

28,780,819

 

 

 

3

 

 

 

-

 

 

 

(186,632

)

 

 

(223

)

 

 

(1,319

)

 

 

1,542

 

 

 

(186,629

)

Equity consideration issued to acquire IMC

 

 

10,412,023

 

 

 

1

 

 

 

-

 

 

 

155,346

 

 

-

 

 

-

 

 

-

 

 

 

155,347

 

Shares issued for holdback

 

 

55,000

 

 

-

 

 

 

-

 

 

 

821

 

 

-

 

 

-

 

 

-

 

 

 

821

 

Proceeds from the sale of Class A common stock, net of offering costs

 

 

41,000,000

 

 

 

4

 

 

 

-

 

 

 

397,525

 

 

-

 

 

-

 

 

-

 

 

 

397,529

 

Activity after the Business Combination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

-

 

 

-

 

 

 

-

 

 

-

 

 

 

-

 

 

 

 

 

 

16,543

 

 

 

16,543

 

Equity consideration issued to acquire SMA

 

 

384,615

 

 

-

 

 

 

-

 

 

 

5,027

 

 

-

 

 

-

 

 

-

 

 

 

5,027

 

BALANCE - JUNE 30, 2021

 

 

80,632,457

 

 

$

8

 

 

$

-

 

 

$

372,088

 

 

$

-

 

 

$

-

 

 

$

18,085

 

 

$

390,181

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BALANCE - MARCH 31, 2022

 

 

87,367,972

 

 

$

9

 

 

$

-

 

 

$

508,945

 

 

$

-

 

 

$

-

 

 

$

(16,763

)

 

$

492,190

 

Stock-based compensation expense

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,787

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,787

 

Issuance of shares upon vesting of stock-based compensation awards

 

 

100,000

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

Vesting of Series B Warrants under Advisory Agreement

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,530

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,530

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(9,381

)

 

 

(9,381

)

BALANCE - JUNE 30, 2022

 

 

87,467,972

 

 

$

9

 

 

$

-

 

 

$

514,262

 

 

$

-

 

 

$

-

 

 

$

(26,144

)

 

$

488,127

 

 

 

Six Months Ended

 

 

 

Class A Common Stock

 

 

Preferred

 

 

Additional

 

 

 

 

 

 

 

 

 

 

 

Total

 

 

 

Shares

 

 

Amount

 

 

Stock

 

 

Paid-in-capital

 

 

Members' units

 

 

Member's Equity

 

 

Retained Earnings
(Deficit)

 

 

Equity

 

BALANCE - DECEMBER 31, 2020

 

 

-

 

 

$

-

 

 

$

-

 

 

$

-

 

 

$

223

 

 

$

6,504

 

 

$

-

 

 

$

6,727

 

Activity prior to the Business Combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(5,185

)

 

 

-

 

 

 

(5,185

)

Effects of the Business Combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reverse recapitalization

 

 

28,780,819

 

 

 

3

 

 

 

-

 

 

 

(186,632

)

 

 

(223

)

 

 

(1,319

)

 

 

1,542

 

 

 

(186,629

)

Equity consideration issued to acquire IMC

 

 

10,412,023

 

 

 

1

 

 

 

-

 

 

 

155,346

 

 

-

 

 

-

 

 

-

 

 

 

155,347

 

Shares issued for holdback

 

 

55,000

 

 

-

 

 

 

-

 

 

 

821

 

 

-

 

 

-

 

 

-

 

 

 

821

 

Proceeds from the sale of Class A common stock, net of offering costs

 

 

41,000,000

 

 

 

4

 

 

 

-

 

 

 

397,525

 

 

-

 

 

-

 

 

-

 

 

 

397,529

 

Activity after the Business Combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

16,543

 

 

 

16,543

 

Equity consideration issued to acquire IMC

 

 

384,615

 

 

-

 

 

 

-

 

 

 

5,027

 

 

-

 

 

-

 

 

-

 

 

 

5,027

 

BALANCE - JUNE 30, 2021

 

 

80,632,457

 

 

$

8

 

 

$

-

 

 

$

372,088

 

 

$

-

 

 

$

-

 

 

$

18,085

 

 

$

390,181

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BALANCE - DECEMBER 31, 2021

 

 

87,367,972

 

 

$

9

 

 

$

-

 

 

$

505,327

 

 

$

-

 

 

$

-

 

 

$

33

 

 

$

505,370

 

Stock-based compensation expense

 

 

-

 

 

 

-

 

 

 

-

 

 

 

3,875

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

3,875

 

Issuance of shares upon vesting of stock-based compensation awards

 

 

100,000

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

Vesting of Series B Warrants under Advisory Agreement

 

 

-

 

 

 

-

 

 

 

-

 

 

 

5,060

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

5,060

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(26,178

)

 

 

(26,178

)

BALANCE - JUNE 30, 2022

 

 

87,467,972

 

 

$

9

 

 

$

-

 

 

$

514,262

 

 

$

-

 

 

$

-

 

 

$

(26,144

)

 

$

488,127

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.

(3)


CAREMAX, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(Unaudited)

(in thousands)

 

 

Nine Months Ended
September 30,

 

 

Nine Months Ended
September 30,

 

 

 

2021
(As Restated, Note 2)

 

 

2020

 

CASH FLOWS FROM OPERATING ACTIVITIES

 

 

 

 

 

 

Net (Loss)/Income

 

$

(3,120

)

 

$

6,354

 

Adjustments to reconcile net (loss)/income to net cash

 

 

 

 

 

 

(Used in)/provided by operating activities:

 

 

 

 

 

 

Depreciation expense

 

 

1,657

 

 

 

626

 

Amortization expense

 

 

5,488

 

 

 

448

 

Amortization of debt issuance costs

 

 

522

 

 

 

52

 

Stock compensation expense

 

 

966

 

 

 

0

 

Change in fair value of warrant liabilities

 

 

(12,022

)

 

 

0

 

Change in fair value of contingent earnout liabilities

 

 

(5,794

)

 

 

0

 

Gain on extinguishment of debt

 

 

(1,637

)

 

 

0

 

Changes in operating assets and liabilities:

 

 

 

 

 

 

Accounts receivable

 

 

4,296

 

 

 

(583

)

Inventory

 

 

67

 

 

 

(3

)

Prepaid expenses

 

 

(1,371

)

 

 

55

 

Risk settlements due from/due to providers

 

 

(384

)

 

 

(92

)

Due to/from related parties

 

 

235

 

 

 

(141

)

Other assets

 

 

(312

)

 

 

12

 

Accounts payable

 

 

1,583

 

 

 

(347

)

Accrued expenses

 

 

(3

)

 

 

(381

)

Other liabilities

 

 

1,178

 

 

 

0

 

Accrued interest

 

 

(149

)

 

 

0

 

Net Cash (Used In)/Provided by Operating Activities

 

 

(8,801

)

 

 

5,998

 

 

 

 

 

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES

 

 

 

 

 

 

Purchase of property and equipment

 

 

(2,967

)

 

 

(1,789

)

Acquisition of businesses

 

 

(298,344

)

 

 

(2,656

)

Asset Purchase Agreement Holdback Payment

 

 

0

 

 

 

(333

)

Purchase of noncontrolling interest ownership

 

 

0

 

 

 

(316

)

Net Cash Used in Investing Activities

 

 

(301,311

)

 

 

(5,094

)

 

 

 

 

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES

 

 

 

 

 

 

Borrowings under revolving loan commitment

 

 

0

 

 

 

2,467

 

Loan from Paycheck Protection Program

 

 

0

 

 

 

2,164

 

Proceeds from issuance of Class A common stock

 

 

415,000

 

 

 

0

 

Issuance costs of Class A common stock

 

 

(12,471

)

 

 

0

 

Reverse recapitalization

 

 

(108,386

)

 

 

0

 

Proceeds from borrowings on long-term debt and credit facilities

 

 

125,000

 

 

 

0

 

Principal payments on long-term debt

 

 

(26,143

)

 

 

(251

)

Payment of deferred financing costs

 

 

(6,883

)

 

 

0

 

Payment of debt prepayment penalties

 

 

(487

)

 

 

0

 

Distributions to members

 

 

0

 

 

 

(144

)

Net Cash Provided by Financing Activities

 

 

385,630

 

 

 

4,236

 

 

 

 

 

 

 

 

NET INCREASE IN CASH

 

 

75,518

 

 

 

5,140

 

Cash - Beginning of Period

 

 

4,934

 

 

 

4,438

 

CASH - END OF PERIOD

 

$

80,451

 

 

$

9,578

 

 

 

Six Months Ended June 30,

 

 

 

2022

 

 

2021

 

CASH FLOWS FROM OPERATING ACTIVITIES

 

 

 

 

 

 

Net (loss)/income

 

$

(26,178

)

 

$

11,359

 

Adjustments to reconcile net (loss)/income to net cash

 

 

 

 

 

 

Depreciation and amortization expense

 

 

9,965

 

 

 

1,961

 

Amortization of debt issuance costs

 

 

753

 

 

 

135

 

Stock-based compensation expense

 

 

3,875

 

 

 

-

 

Gain on remeasurement of warrant liabilities

 

 

(3,855

)

 

 

(1,795

)

Gain on remeasurement of contingent earnout liabilities

 

 

-

 

 

 

(17,420

)

Loss (gain) on extinguishment of debt

 

 

6,172

 

 

 

(1,358

)

Non-cash interest expense

 

 

1,078

 

 

 

-

 

Other non-cash, net

 

 

411

 

 

 

-

 

Changes in operating assets and liabilities:

 

 

 

 

 

 

Accounts receivable

 

 

(29,976

)

 

 

1,267

 

Inventory

 

 

(365

)

 

 

-

 

Prepaid expenses

 

 

(139

)

 

 

(1,322

)

Risk settlements due to/(due from) providers

 

 

19

 

 

 

(208

)

Due to/from related parties

 

 

-

 

 

 

235

 

Other assets

 

 

(105

)

 

 

(275

)

Accounts payable

 

 

5,273

 

 

 

(2,113

)

Accrued expenses

 

 

4,910

 

 

 

6,453

 

Other liabilities

 

 

764

 

 

 

99

 

Net Cash used in Operating Activities

 

 

(27,398

)

 

 

(2,983

)

 

 

 

 

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES

 

 

 

 

 

 

Purchase of property and equipment

 

 

(2,893

)

 

 

(1,527

)

Acquisition of businesses

 

 

-

 

 

 

(210,252

)

Net Cash used in Investing Activities

 

 

(2,893

)

 

 

(211,779

)

 

 

 

 

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES

 

 

 

 

 

 

Proceeds from issuance of Class A common stock

 

 

-

 

 

 

410,000

 

Issuance costs of Class A common stock

 

 

-

 

 

 

(12,471

)

Recapitalization transaction

 

 

-

 

 

 

(108,799

)

Proceeds from borrowings

 

 

184,000

 

 

 

125,000

 

Principal payments on long-term debt

 

 

(121,881

)

 

 

(24,496

)

Payments of debt issuance costs

 

 

(6,174

)

 

 

(6,883

)

Long-term debt extinguishment costs

 

 

-

 

 

 

(487

)

Collateral for letters of credit

 

 

(5,439

)

 

 

-

 

Net Cash provided by Financing Activities

 

 

50,505

 

 

 

381,864

 

 

 

 

 

 

 

 

NET INCREASE IN CASH AND RESTRICTED CASH

 

 

20,214

 

 

 

167,102

 

Cash - Beginning of Period

 

 

47,917

 

 

 

4,934

 

CASH AND RESTRICTED CASH - END OF PERIOD

 

$

68,130

 

 

$

172,036

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.

(4)


CAREMAX, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Continued)

(Unaudited)

(in thousands)

SUPPLEMENTAL DISCLOSURES OF NONCASH INVESTING AND
FINANCING ACTIVITIES:

 

Nine Months Ended September 30,

 

 

Nine Months Ended September 30,

 

 

 

2021
(As Restated, Note 2)

 

 

2020

 

Equity consideration issued in acquisitions

 

$

187,266

 

 

$

0

 

Contingent consideration issued in business combination

 

 

72,571

 

 

 

0

 

Purchase of non-controlling interest through accounts payable

 

 

0

 

 

 

183

 

Payroll Protection Program loan forgiveness

 

 

2,164

 

 

 

0

 

Equity/Warrant consideration issued to The Related Companies, L.P.

 

 

14,533

 

 

 

0

 

SUPPLEMENTAL DISCLOSURES OF CASH ACTIVITIES:

 

 

 

 

 

 

Cash paid for interest

 

 

2,317

 

 

 

815

 

Acquisition of business financed through deferred consideration

 

 

0

 

 

 

450

 

Purchase of non-controlling interest financed through accounts payable

 

 

0

 

 

 

83

 

 

 

Six Months Ended June 30,

 

 

 

2022

 

 

2021

 

CASH AT END OF PERIOD RECONCILIATION

 

 

 

 

 

 

Cash

 

 

68,130

 

 

 

170,080

 

Restricted cash

 

 

 

 

 

1,956

 

Cash and restricted cash - end of period

 

 

68,130

 

 

 

172,036

 

 

 

 

 

 

 

 

SUPPLEMENTAL SCHEDULE OF NON-CASH ACTIVITIES:

 

 

 

 

 

 

Vesting of Series B Warrants under Advisory Agreement

 

 

5,060

 

 

 

 

Equity consideration issued in acquisitions

 

 

 

 

 

161,193

 

Contingent consideration issued in business combination

 

 

 

 

 

72,571

 

Payroll Protection Program loan forgiveness

 

 

 

 

 

2,164

 

Additions to construction in progress funded through accounts payable

 

 

773

 

 

 

565

 

Non-cash interest expense

 

 

1,078

 

 

 

 

SUPPLEMENTAL CASH FLOW INFORMATION:

 

 

 

 

 

 

Cash paid for interest

 

 

3,769

 

 

 

941

 

The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.

(5)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)(Unaudited)

Note 1. DESCRIPTION of business

CareMax, Inc. (“CareMax” or the “Company”), f/k/a Deerfield Healthcare Technology Acquisitions Corp. (“DFHT”), a Delaware corporation, was originally formed in July 2020 as a publicly traded special purpose acquisition company for the purpose of effecting a merger, capital stock exchange, asset acquisition, stock purchase, reorganization, or similar business combination involving one or more businesses. CareMax is a technology-enabled care platform providing high-quality, value-based care and chronic disease management through physicians and health care professionals committed to the overall health and wellness continuum of care for its patients. TheAs of June 30, 2022, the Company currently operatesoperated 4048 wholly owned, multi-specialty medical centers in Florida, Tennessee and New York, that offer a comprehensive suite of healthcare and social services, and a proprietary software and services platform that provides data, analytics, and rules-based decision tools/workflows for physicians across the United States.

The Business Combination and Acquisitions

On December 18, 2020, DFHT entered into a Business Combination Agreement (the “Business Combination Agreement”) with CareMax Medical Group, L.L.C., a Florida limited liability company (“CMG”), the entities listed in Annex I to the Business Combination Agreement (the “CMG Sellers”), IMC Medical Group Holdings, LLC, a Delaware limited liability company (“IMC”), IMC Holdings, LP, a Delaware limited partnership (“IMC Parent”) and Deerfield Partners, L.P. (“Deerfield Partners”). The Business Combination (as defined below) was approved by DFHT’s stockholders and closed on June 8, 2021 (the “Closing Date”), whereby DFHT acquired 100% of the equity interests of CMG and 100% of the equity interests in IMC, with CMG and IMC becoming wholly owned subsidiaries of DFHT. Immediately upon completion (the “Closing”) of the transactions contemplated by the Business Combination Agreement and the related financing transactions (the “Business Combination”), the name of the combined company was changed to CareMax, Inc.

At the Closing, the CMG Sellers and IMC Parent were paid consideration valued in the aggregate at approximately $364 million and $250 million respectively, less repayment of net debt and further subject to the purchase price adjustments set forth in the Business Combination Agreement (the “Closing Consideration”). The net Closing Consideration was comprised of 68% ($229.4 million) and 45% ($85.2 million) in cash for the CMG Sellers and IMC Parent, respectively, with the remainder of the Closing Consideration comprised of 10,796,069 and 10,412,023 shares of Class A common stock of the Company, par value $0.0001 per share (“Class A Common Stock”), issued to the CMG Sellers and IMC Parent, respectively, at a reference price of $10.00 per share. The Business Combination Agreement also provides that an additional 3,500,000 and 2,900,000 shares of Class A Common Stock (the “Earnout Shares”) are payable after the Closing to the CMG Sellers and IMC Parent, respectively, upon the satisfaction of certain conditions (see Note 8 – Stockholders' Equity).

 

Also at the Closing, DFHT, DFHTA Sponsor LLC (the “Sponsor”), O.M. Investment Group, Inc. (“O.M.”), in its capacity as representative of the CMG Sellers, and Continental Stock Transfer & Trust Company, in its capacity as escrow agent ( “Continental”), entered into an escrow agreement (the “CMG Escrow Agreement”), and DFHT, the Sponsor, IMC Parent and Continental entered into an escrow agreement (the “IMC Escrow Agreement” and together with the CMG Escrow Agreement, the “Escrow Agreements”). Pursuant to the terms of the CMG Escrow Agreement and the IMC Escrow Agreement, DFHT deposited $0.5 million and $1.0 million, respectively, into adjustment escrow accounts (the “Adjustment Escrow Amounts”) for the purpose of securing certain post-closing adjustment obligations of the CMG Sellers and IMC Parent, respectively. Of such $0.5 million securing the post-closing adjustment obligations of the CMG Sellers, 68% ($340,000) was in cash and 32% was in 16,000 shares of Class A Common Stock, and of such $1.0 million securing the post-closing adjustment obligations of IMC Parent, 45% ($450,000) was in cash and 55% was in 55,000 shares of Class A Common Stock (such shares collectively, the “Adjustment Escrow Shares”). Following the date on which the Closing Consideration is finally determined pursuant to the Business Combination Agreement, all or a portion of the applicable Adjustment Escrow Amounts and Adjustment Escrow Shares will either be released to the CMG Sellers or to IMC Parent, as applicable, or to the Company in accordance with certain adjustment mechanisms in the Business Combination Agreement.

Immediately following the Closing, all of the 3,593,750 issued and outstanding shares of Class B common stock of the Company, par value $0.0001 per share (“Class B Common Stock”), automatically converted, on a one-for-one basis, into shares of Class A Common Stock in accordance with DFHT’s second amended and restated certificate of incorporation.

Contingent Consideration Common Shares

(6)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Pursuant to the Business Combination Agreement, the CMG Sellers and IMC Parent, who received Class A Common Stock in connection with the Business Combination, are entitled to receive earn-out consideration to be paid out in the form of Class A Common Stock. Up to an additional 3.5 million and 2.9 million Earnout Shares are payable after the Closing to the CMG Sellers and IMC Parent, respectively: (i) if within the first year after the Closing, the volume weighted average trading price of Class A Common Stock equals or exceeds $12.50 per share on any 20 trading days in any 30-day trading period (the “First Share Price Trigger”), then 1.75 million and 1.45 million Earnout Shares are issuable to the CMG Sellers and IMC Parent, respectively, and (ii) if within the two years after the Closing (the “Second Earnout Period”), the volume weighted average trading price of Class A Common Stock equals or exceeds $15.00 per share on any 20 trading days in any 30-day trading period (the “Second Share Price Trigger” and together with the First Share Price Trigger, the “Share Price Triggers”), then 1.75 million and 1.45 million Earnout Shares will be issued and paid to the CMG Sellers and IMC Parent, respectively. If prior to (i) the satisfaction of the Share Price Triggers, and (ii) the end of the Second Earnout Period, the Company enters into a change in control transaction as described in the Business Combination Agreement, and the price per share of the Company’s Class A Common Stock payable to the stockholders of the Company in such change in control transaction is greater than the Share Price Triggers that have not been satisfied during the Earnout Period, then at the closing of such change in control transaction, the Share Price Triggers will be deemed to have been satisfied and the Company is required to issue, as of such closing, the applicable unissued Earnout Shares. In accordance with ASC 815-40, as the Earnout Shares were not indexed to the Company’s common stock, they were accounted for as a liability at the Closing Date and subsequently remeasured at the reporting date with the change in fair value recorded as a gain on remeasurement of contingent earnout liabilities in the condensed consolidated statement of operations as of June 30, 2021. Subsequent to June 30, 2021, the volume weighted average trading price of Class A Common Stock exceeded the First Share Price Trigger, resulting in the satisfaction of the contingent conditions. Accordingly, 1.75 million and 1.45 million Earnout Shares were issued and paid to the CMG Sellers and IMC Parent, respectively.

Unless the context otherwise requires, “the Company,” “we,” “us,” and “our” refer, for periods prior to the completion of the Business Combination, to CMG and its subsidiaries, and, for periods upon or after the completion of the Business Combination, to CareMax, Inc. and its subsidiaries.

Subsequent to consummation of the Business Combination, the Company acquired Senior Medical Associates, LLC ("SMA"), Stallion Medical Management, LLC ("SMM"), Unlimited Medical Services of Florida, LLC ("DNF"), Advantis Physician Alliance, LLC ("Advantis"), Business Intelligence & Analytics LLC ("BIX"), and 3 additional businesses (together with the acquisitions of SMA, SMM, DNF, Advantis and BIX, the "Acquisitions") which did not have a material impact on our condensed consolidated financial statements. NaN significant measurement period adjustments related to the Acquisitions were recognized during the three and six months ended June 30, 2022.

Pending Steward Transaction

In May 2022, the Company entered into an Agreement and Plan of Merger (the “Merger Agreement”), by and among (i) the Company, (ii) Sparta Merger Sub I Inc., a Delaware corporation and wholly-owned subsidiary of the Company, (iii) Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company, (iv) Sparta Merger Sub III Inc., a Delaware corporation and wholly-owned subsidiary of the Company, (v) Sparta Merger Sub I LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company, (vi) Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company, (vii) Sparta Merger Sub III LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company, (viii) Sparta Sub Inc., a Delaware corporation ("SACN Holdco"), (ix) SNCN Holdco Inc. a Delaware corporation ("SNCN Holdco"), (x) SICN Holdco Inc., a Delaware corporation ("SICN Holdco" and, collectively with SACN Holdco, SNCN Holdco, Steward National Care Network, Inc., Steward Integrated Care Network, Inc., and Steward Accountable Care Network, Inc., each a "target" and, collectively, the "Targets"), (xi) Sparta Holding Co. LLC, a Delaware limited liability company (the “Seller”), and (xii) Steward Health Care System LLC, a Delaware limited liability company (referred to collectively with the Seller, the “Seller Parties”), pursuant to which the Company will acquire the Medicare value-based care business of the Seller Parties (such transaction, the “Steward Transaction”).

The aggregate consideration to be paid to the Seller at closing includes cash payment of $25 million, subject to customary adjustments, and 23,500,000 shares, subject to adjustment, of the Company's Class A common stock, $0.0001 par value per

(6)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

share ("Class A Common Stock"). In addition, the Merger Agreement provides for earnout share consideration that will be due to the Seller upon achievement of certain milestones. At closing, the Company will also issue to certain equityholders of the Seller shares of a newly designated series of preferred stock of the Company, which will provide voting rights to such Seller equityholders, until the earlier of (i) the two year anniversary of the closing of the Steward Transaction and (ii) the issuance of earnout share consideration on certain discrete matters where such Seller equityholders are permitted to vote the Company's securities in their discretion under the investor rights agreement to be entered into between such equityholders of the Seller and the Company. Finally, at closing, the Company will also pay the Seller an amount equal to the value of the Target's accounts receivable attributable to Medicare value-based payments for the period between January 1, 2021 and the closing, minus the amount of such payments payable to the affiliate physicians of the Targets, and subject to an advance rate that the Company’s lenders may finance (the “Financed Net Pre-Closing Medicare AR”). In order to fund the Financed Net Pre-Closing Medicare AR payment, the Company may draw all or part of the delayed draw term loans under its existing Credit Agreement, dated May 10, 2022 (the “Credit Agreement”), or the Company may secure alternative financing as permitted under the Credit Agreement.

The Steward Transaction is subject to customary closing conditions, including approval by the Company's stockholders for purposes of compliance with the rules of the Nasdaq Stock Market LLC and receipt of regulatory approvals.

During the three and six months ended June 30, 2022, we have recognized $2.8 million of acquisition costs related to the pending Steward Transaction. We will continue to incur acquisition costs, including $8 million in fees to a financial advisor, payment of $3 million of which is contingent upon closing of the Steward Transaction, and payment of $5 million of which is contingent upon payment of the earnout share consideration to the Seller Parties. We will reflect this $8 million fee in our financial statements during the period in which the Steward Transaction closes.

Note 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

Basis of Presentation and Principles of Consolidation

The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and in accordance with the instructions to Form 10-Q and Article 8 of Regulation S-X of the Securities and Exchange Commission (the “SEC”).S-X. Certain information or footnote disclosures normally included in financial statements prepared in accordance with GAAP has been condensed or omitted, pursuant to the rules and regulations of the SECSecurities and Exchange Commission (the “SEC”) for interim financial reporting. Accordingly, they do not include all the information and footnotes necessary for a complete presentation of financial position, results of operations, or cash flows. The condensed consolidated balance sheet at December 31, 2021, was derived from audited annual financial statements but does not contain all of the footnote disclosures from the annual financial statements. Accordingly, the unaudited condensed consolidated financial statements should be read in connection with the Company’s audited financial statements and related notes as of and for the year ended December 31, 2020.2021 as filed with the SEC on March 16, 2022.

Certain amounts in prior period financial statements have been reclassified to conform to the current period presentation. Such reclassifications have not materially affected previously reported amounts. In the opinion of management, the accompanying unaudited and condensed consolidated financial statements include all adjustments of a normal recurring nature, which are necessary for a fair presentationstatement of financial position, operating results and cash flows for the periods presented. Operating results for the three and nine months ended September 30, 2021, including the impacts of COVID-19,any interim period are not necessarily indicative of the results that may be expected for the year ending December 31, 2021.full year.

Pursuant to the Business Combination, the acquisition of CMG by DFHT was accounted for as a reverse recapitalization in accordance with GAAP (the “Reverse Recapitalization”). Under this method of accounting, DFHT was treated as the “acquired” company for financial reporting purposes.company. Accordingly, for accounting purposes, the Reverse Recapitalization was treated as the equivalent of CMG issuing equity for the net assets of DFHT, accompanied by a recapitalization. The net assets of DFHT arewere stated at historical cost, with 0 goodwill or other intangible assets recorded. The condensed consolidated assets, liabilities and results of operations prior to the Reverse Recapitalization are those of CMG. Further, CMG was determined to be the accounting acquirer in the acquisition of IMC (the “IMC Acquisition”), as. As such, the acquisition iswas considered a business combination under Accounting StandardsStandard Codification ("ASC") Topic 805, "Business Combinations," and was accounted for using the acquisition method of accounting. CareMax recorded the fair value of assets acquired and liabilities assumed from IMC. The presented financial

Unless otherwise noted, information for periods prior to the three and nine months ended September 30, 2021 includesClosing Date reflects the financial information and activities for IMC for the period from June 8, 2021 to (and including) September 30, 2021 (92 and 115 days,of CMG only.

(7)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

respectively). The presented financial information for the three and nine months ended September 30, 2021 includes the financial information and activities for SMA (as defined in Note 3 - Acquisitions) for the period from June 18, 2021 to (and including) September 30, 2021 (92 days and 105 days, respectively). The presented financial information for the three and nine months ended September 30, 2021 includes the financial information and activities for DNF (as defined in Note 3 - Acquisitions) for the period from September 1, 2021 to (and including) September 30, 2021 (30 days and 30 days, respectively). Unless otherwise noted, information for periods prior to the Closing of Business Combination reflects the financial information of CMG only.

The unaudited condensed consolidated financial statements include the accounts and operations of the Company. All intercompany accounts and transactions have been eliminated.

Segment Financial Information

The Company’s chief operating decision maker regularly reviews financial operating results on a condensed consolidated basis for purposes of allocating resources and evaluating financial performance. The Company identifies operating segments based on this review by its chief operating decision makers and operates in and reports as a single operating segment, the objective of which is to care for its patients’ needs. For the periods presented, all of the Company’s long-lived assets were located in the United States, and all revenue was earned in the United States.

Variable Interest Entities

The Company evaluates its ownership, contractual and other interests in entities to determine if it has any variable interest in a variable interest entity ("VIE"). These evaluations are complex, involve judgment, and the use of estimates and assumptions based on available historical information, among other factors. The Company considers itself to control an entity if it is the majority owner of or has voting control over such entity. The Company also assesses control through means other than voting rights and determines which business entity is the primary beneficiary of the VIE. The Company consolidates VIEs when it is determined that the Company is the primary beneficiary of the VIE. Management performs ongoing reassessments of whether changes in the facts and circumstances regarding the Company’s involvement with a VIE will cause the consolidation conclusion to change. Changes in consolidation status are applied prospectively. Refer to Note 14 “Variable Interest Entities” for additional information.

Significant Accounting Policies

Other than addition of the Variable Interest Entity policy, there have been no changes to our critical accounting policies and estimates as described in our Annual Report on Form 10-K for the year ended December 31, 2021, which was filed with the SEC on March 16, 2022.

Use of Estimates

The preparation of condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported inand disclosed. The Company bases its estimates on the condensed consolidated financial statementsavailable information, its experiences and accompanying notes.various other assumptions believed to be reasonable under the circumstances including estimates of the impact of COVID-19. The areas where significant estimates are used in the accompanying financial statements include, but are not limited to, revenues and related receivables from risk adjustments, medical services expense and related payables, purchase price allocations, including fair value estimates of intangibles and contingent consideration; the valuation of and related impairment recognitionstesting of long-lived assets, including goodwill and intangible assets; the valuation of the derivative warrant liabilities; the estimated useful lives of fixed assets and intangible assets, including internally developed software; settlements related to revenue recognition and the revenue accrual and accrued expenses.liability for unpaid claims. Actual results could differ from those estimates.

Emerging Growth Company

(8)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Section 102(b)(1) of the JOBSJumpstart Our Business Startups Act (the "JOBS Act") exempts emerging growth companies from being required to comply with new or revised financial accounting standards until private companies (that is, those that have not had a Securities Act registration statement declared effective or do not have a class of securities registered under the Exchange Act) are required to comply with the new or revised financial accounting standards. The JOBS Act provides that a company can elect to opt out of the extended transition period and comply with the requirements that apply to nonemerging growth companies, but any such election to opt out is irrevocable. The Company has elected not to opt out of such extended transition period, which means that when a standard is issued or revised and it has different application dates for public or private companies, the Company, as an emerging growth company, can adopt the new or revised standard at the time private companies adopt the new or revised standard. This may make comparison of the Company’s unaudited condensed consolidated financial statements with another public company which is neither an emerging growth company nor an emerging growth company that has opted out of using the extended transition period difficult or impossible because of the potential differences in accounting standards used. Additionally, as an emerging growth company, the Company is exempt from the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act of 2002, as amended, and the Company’s independent registered public accounting firm is not required to evaluate and report on the effectiveness of internal control over financial reporting.

Acquisitions

The Company accounts for business combinations under the acquisition method of accounting, in accordance with ASC Topic 805, Business Combinations, which requires assets acquired and liabilities assumed to be recognized at their fair values on the acquisition date. Any excess of the fair value of purchase consideration over the fair value of the assets acquired less liabilities assumed is recorded as goodwill. The fair values of the assets acquired, and liabilities assumed are determined based upon the valuation of the acquired business and involves management making significant estimates and assumptions.

(8)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Revenue Recognition

Since capitated revenue is received regardless of whether services are performed, the performance obligation is the completion of enrollment of the patient and providing access to care. Fee-for-service revenue generally relates to contracts with patients in which our performance obligation is to provide healthcare services to the patients. Revenues are recorded during the period our obligations to provide healthcare services are satisfied.

Medicare Risk-based and Medicaid Risk-based revenue consists primarily of capitated fees for medical services provided by us under capitated arrangements directly made with various Medicare Advantage and Medicaid managed care payors. The Company receives a fixed fee per patient under what is typically known as a “risk contract.” Risk contracting, or full risk capitation, refers to a model in which the Company receives from the third-party payor a fixed payment of At-risk premium less an administrative charge for reporting on enrollees on a per patient per month basis (“PPPM” payment) for a defined patient population, and the Company is then responsible for providing healthcare services required by that patient population. Neither the Company nor any of its affiliates is a registered insurance company because state law in the states in which it operates does not require such registration for risk-bearing providers.

The Company’s payor contracts generally have a term of one year or longer, but the contracts between the enrolled members (our customers) and the payor are one calendar year or less. In general, the Company considers all contracts with customers (enrolled members) as a single performance obligation to stand ready to provide managed healthcare services. The Company identified that contracts with customers for capitation arrangements have similar performance obligations and therefore groups them into 1 portfolio. This performance obligation is satisfied as the Company stands ready to fulfill its obligation to enrolled members.

Settlements with third-party payors for retroactive adjustments due to capitation risk adjustment, or claim audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and the Company’s historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews, and investigations.

The Company has determined that the nature, amount, timing, and uncertainty of revenue and cash flows are affected by the following factors:

Geography of the service location
Demographics of members
Health needs of members
Method of reimbursement (capitation or fee for service)
Enrollment changes
Rate changes; and
For fee for service activities, the payors (for example, Medicare, Medicaid, commercial insurance, patient) which have different reimbursement/payment methodologies.

(9)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The Company has elected the practical expedient allowed under ASC 606-10-32-18, “Revenue from Contracts with Customers-The Existence of a Significant Financing Component in the Contract,” and does not adjust the promised amount of consideration from patients and third-party payors for the effects of a significant financing component due to the Company’s expectation that the period between the time the service is provided to a patient and the time that the patient or a third-party payor pays for that service will be one year or less.

The Company has applied the practical expedient provided by ASC 340-40-25-4, “Other Assets and Deferred Costs,” and all incremental customer contract acquisition costs are expensed as they are incurred as the amortization period of the asset that the Company otherwise would have recognized is one year or less in duration.

For the three and nine months ended September 30, 2021 and 2020, substantially all of the revenue recognized by the Company was from goods and services, namely, providing access to physicians and wellness centers.

Other Revenue

Other revenue includes professional capitation payments. These revenues are a fixed amount of money per patient per month paid in advance for the delivery of primary care services only, whereby the Company is not liable for medical costs in excess of the fixed payment. Capitated revenues are typically prepaid monthly to the Company based on the number of patients selecting us as their primary care provider. Our capitated rates are fixed, contractual rates. Incentive payments for Healthcare Effectiveness Data and Information Set (“HEDIS”) and any services paid on a fee for service basis by a health plan are also included in other revenue. Other revenue also includes ancillary fees earned under contracts with certain payors for the provision of certain care coordination and other care management services. These services are provided to patients covered by these payors regardless of whether those patients receive their care from our affiliated medical groups. Revenue for primary care service for patients in a partial risk or up-side only contracts are reported in other revenue

Concentration of Credit Risk and Significant Customers

Financial instruments that potentially subject the Company to concentration of credit risk consist of cash and accounts receivable. The Company’s cash balances with individual banking institutions are in excess of federally insured limits from time to time. The Company believes it is not exposed to any significant concentrations of credit risk from these financial instruments. The Company has not experienced any losses on its deposits of cash and cash equivalents.

Composition of the Company's revenues and accounts receivable balances for the payors comprising 10% or more of revenue was as follows:

Anthem, Inc. ("Anthem") represented approximately

 

Total Revenue

 

 

Three months ended June 30, 2022

 

 

Six months ended June 30, 2022

 

 

Three months ended June 30, 2021

 

 

Six months ended June 30, 2021

 

Payor A

 

27

%

 

 

30

%

 

 

59

%

 

 

69

%

Payor B

 

24

%

 

 

18

%

 

 

7

%

 

 

4

%

Payor C

 

17

%

 

 

17

%

 

 

7

%

 

 

8

%

Payor D

 

13

%

 

 

14

%

 

 

9

%

 

 

5

%

Payor E

 

10

%

 

 

12

%

 

 

12

%

 

 

8

%

Total

 

91

%

 

 

91

%

 

 

94

%

 

 

94

%

25% and 100% of the Company’s accounts receivable balance as of September 30, 2021 and December 31, 2020, respectively. Anthem represented 46% and 94% of the Company’s revenues for the three months ended September 30, 2021 and 2020 and 51% and 97% of the Company’s revenues for the nine months ended September 30, 2021 and 2020, respectively.

 

Accounts Receivable, net

 

 

As of June 30, 2022

 

 

As of December 31, 2021

 

Payor A

 

23

%

 

 

27

%

Payor B

 

8

%

 

 

7

%

Payor C

 

16

%

 

 

12

%

Payor D

 

25

%

 

 

23

%

Payor E

 

12

%

 

 

15

%

Total

 

84

%

 

 

84

%

Fair Value of Financial InstrumentsRecent Accounting Pronouncements

 

Fair value is definedThe Company has elected to defer compliance with ASC Topic 842, Leases ("ASC 842"), consistent with those requirements for a private company due to the Company’s status as the price that would be received for sale of an asset or paid for transfer of a liability, in an orderly transaction between market participants at the measurement date. GAAP establishes a three-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurements)emerging growth company and the lowest priorityprovisions of the JOBS Act. Accordingly, the Company adopted ASC 842 for the annual reporting period beginning January 1, 2022, and interim reporting periods within the annual reporting period beginning after December 15, 2022. As such, the Company has continued to unobservable inputs (Level 3 measurements). These tiers include:present accounting for leases in its condensed consolidated financial statements in accordance with ASC Topic 840, Leases, in this Quarterly Report on Form 10-Q. The effect of adoption to be presented in the Company’s 2022 Form 10-K is expected to be

material, adding approximately $0.1

Levelbillion right of use assets and corresponding lease liabilities to the Company’s balance sheet as of January 1, - defined as observable inputs such as quoted prices (unadjusted) for identical instruments in active markets.

Level 2 - defined as inputs other than quoted prices in active markets that are either directly or indirectly observable such as quoted prices for similar instruments in active markets or quoted prices for identical or similar instruments in markets that are not active.

Level 3 - defined as unobservable inputs in which little or no market data exists, therefore requiring an entity to develop its own assumptions, such as valuations derived from valuation techniques in which one or more significant inputs or significant value drivers are unobservable.2022.

 

In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, "Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments", which was subsequently amended by ASU 2020-03, "Codification Improvements to financial Instruments" (collectively referred to as "ASC 326"), which is intended to improve financial reporting by requiring earlier recognition of credit losses on certain financial assets. This standard replaces the previous incurred loss impairment model that recognizes losses when a probable threshold is met

(10)

(9)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

In some circumstances,with a requirement to recognize lifetime expected credit losses immediately when a financial asset is acquired or purchased. The standard has been further refined through subsequent releases by the inputs used to measure fair value might be categorized within different levels of the fair value hierarchy. In those instances, the fair value measurement is categorized in its entirety in the fair value hierarchy basedFASB. The Company adopted ASC 326 on the lowest level input that is significantJanuary 1, 2022 with no material impact to the fair value measurement.

Derivative Instruments

The Company does not use derivative instruments to hedge exposures to cash flow, market, or foreign currency risks. The Company evaluates all of itsconsolidated financial instruments, including issued stock purchase warrants, to determine if such instruments are derivatives or contain features that qualify as embedded derivatives, pursuant to ASC 480 statements.“Distinguishing Liabilities from Equity,” and ASC 815-15, “Derivatives and Hedging - Embedded Derivatives.” The classification of derivative instruments, including whether such instruments should be recorded as liabilities or as equity, is re-assessed at the end of each reporting period.

 

The Company issued 2,875,000 common stock warrants in connection with DFHT's initial public offering (the “IPO”) (the “Public Warrants”). Simultaneously with the closing of the IPO, DFHT consummated the private placement of 2,916,667 common stock warrants (the “Private Placement Warrants”). The Public Warrants and Private Placement Warrants are accounted for as derivative warrant liabilities in accordance with ASC 815-40 , “Derivatives and Hedging - Contracts in an Entities Own Equity.” Accordingly, the Company recognizes the warrant instruments as liabilities at fair value and adjusts the instruments to fair value at each reporting period. The liabilities are subject to re-measurement at each balance sheet date until exercised, and any change in fair value is recognized in the Company’s unaudited condensed consolidated statement of operations. The fair value of the Public Warrants and Private Placement Warrants was initially measured at fair value using a Monte Carlo simulation model and subsequently, the fair value of the Private Placement Warrants has been estimated using a Monte Carlo simulation model at each measurement date. The fair value of Public Warrants issued in connection with the IPO has subsequently been measured based on the listed market price of such warrants.

As further described in Note 8, in connection with the Business Combination, up to 6,400,000 Earnout Shares become issuable to IMC Parent and CMG Sellers as contingent consideration if certain Share Price Triggers are met or if a change in control occurs that equates to a share price equivalent to the Share Price Triggers (also referred to as “Earnout Shares”). On the Closing Date, the Earnout Shares were accounted for as derivative earnout liabilities in accordance with ASC 815-40, “Derivatives and Hedging - Contracts in an Entities Own Equity” and accordingly, the Company recognized the contingent consideration as a liability at fair value upon issuance. The liabilities were subject to remeasurement at each balance sheet date until the Earnout Shares were issued or conditions or events required the Company to reassess the classification, and the change in fair value was recognized in the Company’s consolidated statement of operations. On July 9, 2021, the First Share Price Trigger was achieved, resulting in the issuance of 1,750,000 and 1,450,000 Earnout Shares to the CMG Sellers and IMC Parent, respectively. The remaining unissued Earnout Shares were re-assessed and determined to be indexed to the Company's own equity, resulting in reclassification to equity under ASC 815-40 “Derivatives and Hedging - Contracts in an Entities Own Equity.” The remaining Earnout Shares were remeasured at fair value upon achievement of the First Share Price Trigger on July 9, 2021, which was the event that caused the reclassification, and the change in fair value was recorded in earnings in the three months ended September 30, 2021. Subsequent to the July 9, 2021 remeasurement and reclassification to equity, the Company determined the remaining 3,200,000 unissued Earnout Shares do not require fair value remeasurement.

Goodwill and intangible assets

Goodwill represents the excess of cost over the fair value of net assets acquired. Pursuant to ASC 350, “Intangibles – Goodwill and Other,” we review goodwill annually in the fourth quarter or whenever significant events or changes indicate the possibility of impairment. For purposes of the annual goodwill impairment assessment, the Company has identified a single reporting unit. The most recently completed impairment test of goodwill was performed in the fourth quarter of 2020, and it was determined that 0 impairment existed.

Intangible assets with a finite useful life are amortized over their useful lives.

We review the recoverability of any long-lived intangible assets whenever events or changes in circumstances indicate the carrying amount of such assets may not be recoverable.

Property and Equipment

(11)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Property and equipment is recorded at cost. Maintenance and repairs are charged to expense as incurred. Depreciation is provided over the estimated useful life of each class of depreciable asset and is computed on the straight-line method. Leasehold improvements are depreciated over the lesser of the length of the related lease plus any renewal options or the estimated life of the asset.

A summary of estimated useful lives is as follows:

Leasehold Improvements

15 to 39 Years

Furniture and Equipment

5 to 7 Years

Vehicles

5 Years

Software

3 Years

Income Taxes

The Company follows the asset and liability method of accounting for income taxes under ASC 740, “Income Taxes.” Deferred tax assets and liabilities are recognized for the estimated future tax consequences attributable to differences between the unaudited condensed consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax bases. 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 included the enactment date. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount expected to be realized.

ASC 740 prescribes a recognition threshold and a measurement attribute for the financial statement recognition and measurement of tax positions taken or expected to be taken in a tax return. For those benefits to be recognized, a tax position must be more likely than not to be sustained upon examination by taxing authorities. There were 0 unrecognized tax benefits as of September 30, 2021 and December 31, 2020. The Company recognizes accrued interest and penalties related to unrecognized tax benefits as income tax expense.

External Provider Costs

External Provider Costs include capitation payments and fee for service claims paid, claims in process and pending, and an estimate of unreported claims and charges by physicians, hospitals, and other health care providers for services rendered to enrollees during the period. Changes to prior-period estimates of medical expenses are reflected in the current period.

Net Income (Loss) Per Share

Net income (loss) per share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding during the period. The Company follows the provisions of ASC Topic 260, Earnings Per Share” for determining whether contingently issuable shares are included for purposes of calculating net income (loss) per share and determining whether instruments granted in equity-based compensation arrangements are participating securities for purposes of calculating net income (loss) per share. See Note 9, Net Income (Loss) Per Share.

Recent Accounting Pronouncements Not Yet Adopted

In February 2016, the Financial Accounting Standards Board (“FASB”) issued ASU 2016-02, "Leases" (“ASU 2016-02”), which amended the accounting for leases, requiring lessees to recognize most leases on their balance sheet with a right-of-use asset and a lease liability. Leases will be classified as either finance or operating leases, which will impact the expense recognition of such leases over the lease term. ASU 2016-02 also modifies the lease classification criteria for lessors and eliminates some of the real estate leasing guidance previously applied for certain leasing transactions. In June 2020, the FASB issued ASU 2020-05, “Revenue from Contracts with Customers and Leases,” that deferred the required effective date for non-issuers to fiscal years beginning after December 15, 2021 and to interim periods within fiscal years beginning after December 15, 2022. Because the Company is currently an emerging growth company, the Company plans to adopt ASU 2016-02 on January 1, 2022. Because of the number of leases the Company utilizes to support its operations, the adoption of ASU 2016-02 is expected to have a significant impact on the Company’s financial position and results of operations. The total future estimated gross annual lease payments are $67.6 million as of September 30, 2021. Management is currently evaluating the

(12)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

extent of this anticipated impact on the Company’s financial statements, including quantitative and qualitative factors, as well as any changes to its leasing strategy that may be needed.

In June 2016, the FASB issued ASU 2016-13, "Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments" (“ASU 2016-13”). ASU 2016-13 introduced a new model for recognizing credit losses on financial instruments based on an estimate of current expected credit losses. The guidance is effective for us beginning January 1, 2022. The new current expected credit losses (CECL) model generally calls for the immediate recognition of all expected credit losses and applies to loans, accounts and trade receivables as well as other financial assets measured at amortized cost, loan commitments and off-balance sheet credit exposures, debt securities and other financial assets measured at fair value through other comprehensive income, and beneficial interests in securitized financial assets. The new guidance replaces the current incurred loss model for measuring expected credit losses, requires expected losses on available for sale debt securities to be recognized through an allowance for credit losses rather than as reductions in the amortized cost of the securities, and provides for additional disclosure requirements. The Company plans to adopt this standard on January 1, 2022 and does not believe adoption will have a material effect on its condensed consolidated financial statements.

In January 2020, the FASB issued ASU 2020-01, "Investments—Equity Securities (Topic 321), Investments—Equity Method and Joint Ventures (Topic 323), and Derivatives and Hedging (Topic 815)—Clarifying the Interactions between Topic 321, Topic 323, and Topic 815" (“ASU 2020-01”). ASU 2020-01 clarifies the interaction of the accounting for equity securities under Topic 321 and investments accounted for under the equity method of accounting in Topic 323 and the accounting for certain forward contracts and purchased options accounted for under Topic 815. The guidance is effective for fiscal years and interim periods within those fiscal years beginning after December 15, 2021. The Company is currently evaluating the impact the adoption of ASU 2020-01 will have on its condensed consolidated financial statements.

In March 2020, the FASB issued temporary guidance to provide temporaryease the potential burden in accounting for reference rate reform primarily resulting from the discontinuation of LIBOR. In addition, in January 2021, the FASB issued guidance which refined the scope of ASC Topic 848, Reference Rate Reform, and clarified some of its guidance as part of FASB's ongoing monitoring of global reference rate reform activities. This guidance permitted entities to elect certain optional expedients and exceptions through December 31, 2022 towhen accounting for derivative contracts and certain hedging relationships affected by changes in the U.S. GAAP guidance on contract modificationsinterest rates used for discounting cash flows, computing variation margin settlements and hedge accounting to ease thecalculating price alignment interest in connection with reference rate reform activities under way in global financial reporting burdens of the expected market transition from the London Interbank Offered Rate (LIBOR) and other interbank offered rates to alternative reference rates, such as the Secured Overnight Financing Rate (SOFR). The amendments are effective for all entities from the beginning of an interim period that includes the issuance date of the ASU.markets. An entity may elect to apply thethese amendments prospectively through December 31, 2022. The Company is currently evaluating the effect the update will have on its unaudited condensed consolidated financial statements and related disclosures.

In October 2021, the FASB issued ASU 2021-08, "Business Combinations (Topic 805) - Accounting for Contract Assets and Contract Liabilities from Contracts with Customers." The ASU improves comparability after business combinations by providing consistent recognition and measurement guidance for revenue contracts with customers acquired in a business combination and revenue contracts with customers not acquired in a business combination. ASU 2021-08 is effective for the Company on January 1, 2023, with early adoption permitted. The Company is currently evaluating the effect this ASU will have on its condensed consolidated financial statements.

We do not expect that any other recently issued accounting guidance will have a significant effect on our condensed consolidated financial statements.

Restatement of Previously Reported Financial Statements

The restatement reflects the reclassification of the Earnout Shares related to the Business Combination from stockholders’ equity to a liability for the period from the closing of the Business Combination on June 8, 2021 to the achievement of the First Share Price Trigger on July 9, 2021.

In accordance with SEC Staff Accounting Bulletin No. 99, “Materiality,” and SEC Staff Accounting Bulletin No. 108, “Considering the Effects of Prior Year Misstatements when Quantifying Misstatements in Current Year Financial Statements,” the Company evaluated the corrections and determined that the related impact was material to the Company's previously filed unaudited condensed consolidated financial statements for the three and nine month periods ended and September 30, 2021. Therefore, on March 7, 2022, after discussion with WithumSmith+Brown, PC ("Withum"), the Company's current independent registered public accounting firm, the Audit Committee of the Company's Board of Directors and the Company's management concluded that the unaudited condensed financial statements for the three-month and nine-month periods ended September 30, 2021 should be restated to present the entire amount of the Earnout Shares as a liability as of the Closing Date of the Business Combination through July 9, 2021 and to record the change in fair value in profit (loss) in the three months ended September 30, 2021. As such, the Company is reporting the aforementioned restatements to the periods presented in this Form 10-Q/A.

Impact of the Restatement

The table below presents the effect of the financial statement adjustments related to the restatement of the Company's unaudited condensed consolidated balance sheet as of September 30, 2021 reported in the Original Filing:

(13)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

September 30, 2021

 

 

As Previously Reported

 

Adjustments

 

As Restated

 

ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT ASSETS

 

 

 

 

 

 

Cash

$

80,451

 

$

-

 

$

80,451

 

Accounts receivable, net

 

33,624

 

 

-

 

 

33,624

 

Inventory

 

398

 

 

-

 

 

398

 

Prepaid expenses

 

17,926

 

 

-

 

 

17,926

 

Risk settlements due from providers

 

464

 

 

-

 

 

464

 

Due from related parties

 

-

 

 

-

 

 

-

 

Total Current Assets

 

132,863

 

 

-

 

 

132,863

 

 

 

-

 

 

 

 

-

 

Property and equipment, net

 

16,163

 

 

-

 

 

16,163

 

Goodwill

 

449,470

 

 

2,438

 

 

451,908

 

Intangible assets, net

 

61,575

 

 

-

 

 

61,575

 

Deferred debt issuance costs

 

2,084

 

 

-

 

 

2,084

 

Other assets

 

1,109

 

 

-

 

 

1,109

 

Total Assets

$

663,264

 

$

2,438

 

$

665,701

 

 

 

 

 

 

 

 

LIABILITIES AND STOCKHOLDERS'/MEMBERS' EQUITY

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT LIABILITIES

 

 

 

 

 

 

Accounts payable

$

5,677

 

$

-

 

$

5,677

 

Accrued expenses

 

8,346

 

 

-

 

 

8,346

 

Risk settlements due to providers

 

171

 

 

-

 

 

171

 

Current portion of long-term debt

 

6,279

 

 

-

 

 

6,279

 

Due to related parties

 

-

 

 

-

 

 

-

 

Other current liabilities

 

2,831

 

 

-

 

 

2,831

 

Total Current Liabilities

 

23,304

 

 

-

 

 

23,304

 

 

 

 

 

 

 

 

Derivative warrant liabilities

 

17,110

 

 

 

 

17,110

 

Long-term debt, less current portion

 

112,890

 

 

-

 

 

112,890

 

Other liabilities

 

6,032

 

 

-

 

 

6,032

 

Total Liabilities

 

159,336

 

 

-

 

 

159,336

 

COMMITMENTS AND CONTINGENCIES

 

 

 

 

 

 

STOCKHOLDERS'/MEMBER'S EQUITY

 

 

 

 

 

 

Class A common stock ($0.0001 par value; 250,000,000 shares
 authorized;
87,073,985 shares issued and outstanding at September 30, 2021)

 

9

 

 

-

 

 

9

 

Additional paid-in-capital

 

506,108

 

 

(3,357

)

 

502,751

 

(Accumulated deficit)/Retained earnings

 

(2,189

)

 

5,794

 

 

3,605

 

Members' equity

 

-

 

 

-

 

 

-

 

Total Stockholders'/Members' Equity

 

503,928

 

 

2,438

 

 

506,366

 

 

 

 

 

 

 

 

Total Liabilities and Stockholders'/Members' Equity

$

663,264

 

$

2,438

 

$

665,701

 

The tables below represent the effect of the financial statement adjustments related to the restatement of the unaudited condensed consolidated statements of operations for the three and nine months ended September 30, 2021 reported in the Original Filing:

(14)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

Three Months Ended September 30, 2021

 

 

As Previously Reported

 

Adjustments

 

As Restated

 

Revenue

 

 

 

 

 

 

Medicare risk-based revenue

$

76,428

 

$

-

 

$

76,428

 

Medicaid risk-based revenue

 

20,884

 

 

-

 

 

20,884

 

Other revenue

 

7,308

 

 

-

 

 

7,308

 

Total revenue

 

104,620

 

 

-

 

 

104,620

 

 

 

 

 

 

 

-

 

Operating expenses

 

 

 

 

 

-

 

External provider costs

 

73,329

 

 

-

 

 

73,329

 

Cost of care

 

21,602

 

 

-

 

 

21,602

 

Sales and marketing

 

1,274

 

 

-

 

 

1,274

 

Corporate, general and administrative

 

13,589

 

 

-

 

 

13,589

 

Depreciation and amortization

 

5,176

 

 

-

 

 

5,176

 

Acquisition related costs

 

879

 

 

-

 

 

879

 

Total operating expenses

 

115,849

 

 

-

 

 

115,849

 

Operating income (loss)

 

(11,229

)

 

-

 

 

(11,229

)

Interest expense, net

 

(1,291

)

 

-

 

 

(1,291

)

Gain on remeasurement of warrant liabilities

 

10,227

 

 

-

 

 

10,227

 

Loss on remeasurement of earnout liabilities

 

-

 

 

(11,625

)

 

(11,625

)

Gain on extinguishment of debt, net

 

279

 

 

-

 

 

279

 

Other expense, net

 

(840

)

 

 

 

(840

)

Loss before income tax

 

(2,854

)

 

(11,625

)

 

(14,479

)

Income tax provision

 

-

 

 

-

 

 

-

 

Net loss

 

(2,854

)

 

(11,625

)

 

(14,479

)

 

 

 

 

 

 

 

Net (loss) attributable to non-controlling interest

 

 

 

 

 

-

 

Net (loss) attributable to controlling interest

 

(2,854

)

 

(11,625

)

 

(14,479

)

 

 

 

 

 

 

 

Net (loss) attributable to CareMax, Inc. Class A Common stockholders

$

(2,854

)

$

(11,625

)

$

(14,479

)

Weighted average basic shares outstanding

 

82,552,520

 

$

-

 

 

82,552,520

 

Weighted average diluted shares outstanding

 

82,552,520

 

 

-

 

 

82,552,520

 

Net (loss) per share

 

 

 

 

 

-

 

Basic

$

(0.03

)

$

(0.15

)

$

(0.18

)

Diluted

$

(0.03

)

$

(0.15

)

$

(0.18

)

(15)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

Nine Months Ended September 30, 2021

 

 

As Previously Reported

 

Adjustments

 

As Restated

 

Revenue

 

 

 

 

 

 

Medicare risk-based revenue

$

142,005

 

$

-

 

$

142,005

 

Medicaid risk-based revenue

 

26,333

 

 

-

 

 

26,333

 

Other revenue

 

9,118

 

 

-

 

 

9,118

 

Total revenue

 

177,456

 

 

-

 

 

177,456

 

 

 

-

 

 

 

 

-

 

Operating expenses

 

-

 

 

 

 

-

 

External provider costs

 

127,023

 

 

-

 

 

127,023

 

Cost of care

 

34,822

 

 

-

 

 

34,822

 

Sales and marketing

 

2,340

 

 

-

 

 

2,340

 

Corporate, general and administrative

 

24,264

 

 

-

 

 

24,264

 

Depreciation and amortization

 

7,127

 

 

-

 

 

7,127

 

Acquisition related costs

 

1,028

 

 

-

 

 

1,028

 

Total operating expenses

 

196,604

 

 

-

 

 

196,603

 

Operating income (loss)

 

(19,148

)

 

-

 

 

(19,147

)

Interest expense, net

 

(2,587

)

 

-

 

 

(2,587

)

Gain on remeasurement of warrant liabilities

 

12,022

 

 

-

 

 

12,022

 

Gain on remeasurement of earnout liabilities

 

-

 

 

5,794

 

 

5,794

 

Gain on extinguishment of debt, net

 

1,637

 

 

-

 

 

1,637

 

Other expense, net

 

(840

)

 

 

 

(840

)

Loss income before income tax

 

(8,916

)

 

5,794

 

 

(3,120

)

Income tax provision

 

-

 

 

-

 

 

-

 

Net loss

 

(8,916

)

 

5,794

 

 

(3,120

)

 

 

 

 

 

 

 

Net (loss) attributable to non-controlling interest

 

-

 

 

-

 

 

-

 

Net (loss) attributable to controlling interest

 

(8,916

)

 

5,794

 

 

(3,120

)

 

 

 

 

 

 

 

Net (loss) attributable to CareMax, Inc. Class A Common stockholders

$

(8,916

)

$

5,794

 

$

(3,120

)

Weighted average basic shares outstanding

 

40,847,294

 

 

-

 

 

40,847,294

 

Weighted average diluted shares outstanding

 

40,847,294

 

 

-

 

 

40,847,294

 

Net (loss) per share

 

 

 

 

 

-

 

Basic

$

(0.22

)

$

0.14

 

$

(0.08

)

Diluted

$

(0.22

)

$

0.14

 

$

(0.08

)

The table below represents the effect of the financial statement adjustments related to the restatement of the Company's previously reported earnings per share as of September 30, 2021 reported in the Original Filing:

 

Three Months Ended September 30, 2021

 

 

As Reported

 

Adjustments

 

As Restated

 

Net loss attributable to CareMax, Inc. Class A common stockholders

$

(2,854

)

$

(11,625

)

$

(14,479

)

 

 

 

 

 

 

 

Weighted average basic shares outstanding

 

82,552,520

 

 

-

 

 

82,552,520

 

Weighted average diluted shares outstanding

 

82,552,520

 

 

-

 

 

82,552,520

 

 

 

 

 

 

 

 

Net loss per share

 

 

 

 

 

 

Basic

$

(0.03

)

$

(0.15

)

$

(0.18

)

Diluted

$

(0.03

)

$

(0.15

)

$

(0.18

)

 

Nine Months Ended September 30, 2021

 

 

As Reported

 

Adjustments

 

As Restated

 

Net loss attributable to CareMax, Inc. Class A common stockholders

$

(8,916

)

$

5,794

 

$

(3,120

)

 

 

 

 

 

 

 

Weighted average basic shares outstanding

 

40,847,294

 

 

-

 

 

40,847,294

 

Weighted average diluted shares outstanding

 

40,847,294

 

 

-

 

 

40,847,294

 

 

 

 

 

 

 

 

Net loss per share

 

 

 

 

 

 

Basic

$

(0.22

)

$

0.14

 

$

(0.08

)

Diluted

$

(0.22

)

$

0.14

 

$

(0.08

)

The tables below present the effect of the financial statement adjustments related to the restatement of the condensed consolidated statements of changes in stockholders'/members' equity reported in the Original Filing:

As Reported

Class A Common Stock

Additional

Total

Retained

Noncontrolling

Total

(16)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

Shares

 

Amount

 

Paid-in-capital

 

Controlling Interest

 

Earnings

 

Interest

 

Equity

 

BALANCE - DECEMBER 31, 2020

 

-

 

 

-

 

 

-

 

 

6,727

 

 

-

 

 

-

 

 

6,727

 

Net income

 

-

 

 

-

 

 

-

 

 

1,302

 

 

-

 

 

-

 

 

1,302

 

Distributions

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

BALANCE- MARCH 31, 2021

 

-

 

 

-

 

 

-

 

 

8,029

 

 

-

 

 

-

 

 

8,029

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

Activity prior to the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

0

 

Net loss

 

-

 

 

-

 

 

-

 

 

(6,487

)

 

-

 

 

-

 

 

(6,487

)

Effects of the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

Reverse recapitalization

 

28,780,819

 

 

3

 

 

(137,426

)

 

(1,542

)

 

1,542

 

 

-

 

 

(137,423

)

Equity consideration issued to acquire IMC

 

10,412,023

 

 

1

 

 

155,346

 

 

-

 

 

-

 

 

-

 

 

155,347

 

Contingent consideration

 

-

 

 

-

 

 

38,348

 

 

-

 

 

-

 

 

-

 

 

38,348

 

Shares issued for holdback

 

55,000

 

 

-

 

 

821

 

 

-

 

 

-

 

 

-

 

 

821

 

Proceeds from the sale of Class A common stock, net of offering costs

 

41,000,000

 

 

4

 

 

397,525

 

 

-

 

 

-

 

 

-

 

 

397,529

 

Activity after the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

-

 

Net loss

 

-

 

 

-

 

 

-

 

 

-

 

 

(877

)

 

-

 

 

(877

)

Equity consideration issued to acquire SMA

 

384,615

 

 

-

 

 

5,027

 

 

-

 

 

-

 

 

-

 

 

5,027

 

BALANCE- JUNE 30, 2021

 

80,632,457

 

 

8

 

 

459,641

 

 

-

 

 

665

 

 

-

 

 

460,314

 

  Equity consideration issued to acquire DNF

 

2,741,528

 

 

-

 

 

26,072

 

 

-

 

 

-

 

 

-

 

 

26,072

 

  Reverse recapitalization

 

-

 

 

-

 

 

(104

)

 

-

 

 

-

 

 

-

 

 

(104

)

  Contingent consideration

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

  Contingently issuable stock to CMG Sellers and IMC Parent

 

3,200,000

 

 

1

 

 

-

 

 

-

 

 

-

 

 

-

 

 

1

 

  Proceeds from the sale of Class A common stock, net of offering costs

 

500,000

 

 

-

 

 

6,650

 

 

-

 

 

-

 

 

-

 

 

6,650

 

  Stock compensation expense

 

-

 

 

-

 

 

966

 

 

-

 

 

-

 

 

-

 

 

966

 

  Series A Warrants issued under the Advisory Agreement

 

-

 

 

-

 

 

12,883

 

 

-

 

 

-

 

 

-

 

 

12,883

 

  Net loss

 

-

 

 

-

 

 

-

 

 

-

 

 

(2,854

)

 

-

 

 

(2,854

)

BALANCE- SEPTEMBER 30, 2021

 

87,073,985

 

 

9

 

 

506,108

 

 

-

 

 

(2,189

)

 

-

 

 

503,928

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adjustments

 

 

Class A Common Stock

 

Additional

 

Total

 

Retained

 

Noncontrolling

 

Total

 

 

Shares

 

Amount

 

Paid-in-capital

 

Controlling Interest

 

Earnings

 

Interest

 

Equity

 

BALANCE - DECEMBER 31, 2020

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

Net income (loss)

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

Distributions

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

BALANCE- MARCH 31, 2021

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

Effects of the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reverse recapitalization

 

-

 

 

-

 

 

(40,785

)

 

-

 

 

-

 

 

-

 

 

(40,785

)

Contingent consideration

 

-

 

 

-

 

 

(38,348

)

 

-

 

 

-

 

 

-

 

 

(38,348

)

Activity after the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net income

 

-

 

 

-

 

 

-

 

 

-

 

 

17,420

 

 

-

 

 

17,420

 

BALANCE- JUNE 30, 2021

 

-

 

$

-

 

$

(87,553

)

$

-

 

$

17,420

 

$

-

 

$

(70,134

)

  Contingently issuable stock to CMG Sellers and IMC Parent - First Share Price Trigger on Earnout Shares

 

-

 

 

-

 

 

45,088

 

 

-

 

 

-

 

 

-

 

 

45,088

 

  Earnout Share Consideration

 

3,200,000

 

 

1

 

 

39,109

 

 

-

 

 

-

 

 

-

 

 

39,110

 

  Post-close contingent consideration adjustment

 

-

 

 

-

 

 

(2,438

)

 

-

 

 

-

 

 

-

 

 

(2,438

)

Net loss

 

-

 

 

-

 

 

-

 

 

-

 

 

(11,625

)

 

-

 

 

(11,625

)

BALANCE- SEPTEMBER 30, 2021

 

-

 

$

-

 

$

(3,357

)

$

-

 

$

5,794

 

$

-

 

$

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As Restated

 

 

Class A Common Stock

 

Additional

 

Total

 

Retained

 

Noncontrolling

 

Total

 

 

Shares

 

Amount

 

Paid-in-capital

 

Controlling Interest

 

Earnings

 

Interest

 

Equity

 

BALANCE - DECEMBER 31, 2020

 

-

 

 

-

 

 

-

 

 

6,727

 

 

-

 

 

-

 

 

6,727

 

Net income

 

-

 

 

-

 

 

-

 

 

1,302

 

 

-

 

 

-

 

 

1,302

 

Distributions

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

BALANCE- MARCH 31, 2021

 

-

 

 

-

 

 

-

 

 

8,029

 

 

-

 

 

-

 

 

8,029

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Activity prior to the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net loss

 

-

 

 

-

 

 

-

 

 

(6,487

)

 

-

 

 

-

 

 

(6,487

)

Effects of the business combination:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Reverse recapitalization

 

28,780,819

 

 

3

 

 

(186,632

)

 

(1,542

)

 

1,542

 

 

-

 

 

(186,629

)

(17)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Equity consideration issued to acquire IMC

 

10,412,023

 

 

1

 

 

155,346

 

 

-

 

 

-

 

 

-

 

 

155,347

 

Shares issued for holdback

 

55,000

 

 

-

 

 

821

 

 

-

 

 

-

 

 

-

 

 

821

 

Proceeds from the sale of Class A common stock, net of offering costs

 

41,000,000

 

 

4

 

 

397,525

 

 

-

 

 

-

 

 

-

 

 

397,529

 

Activity after the business combination:

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

Net income

 

-

 

 

-

 

 

-

 

 

-

 

 

16,543

 

 

-

 

 

16,543

 

Equity consideration issued to acquire SMA

 

384,615

 

 

-

 

 

5,027

 

 

-

 

 

-

 

 

-

 

 

5,027

 

BALANCE- JUNE 30, 2021

 

80,632,457

 

 

8

 

 

372,088

 

 

-

 

 

18,085

 

 

-

 

 

390,180

 

  Equity consideration issued to acquire DNF

 

2,741,528

 

 

-

 

 

26,072

 

 

-

 

 

-

 

 

-

 

 

26,072

 

  Reverse recapitalization

 

-

 

 

-

 

 

(104

)

 

-

 

 

-

 

 

-

 

 

(104

)

  Contingently issuable stock to CMG Sellers and IMC Parent - First Share Price Trigger on Earnout Shares

 

3,200,000

 

 

1

 

 

39,109

 

 

-

 

 

-

 

 

-

 

 

39,110

 

  Reclassification of contingent consideration previously liability classified

 

-

 

 

-

 

 

45,088

 

 

-

 

 

-

 

 

-

 

 

45,088

 

  Proceeds from the sale of Class A Common stock, net of offering costs

 

500,000

 

 

-

 

 

6,650

 

 

-

 

 

-

 

 

-

 

 

6,650

 

  Stock compensation expense

 

-

 

 

-

 

 

966

 

 

-

 

 

-

 

 

-

 

 

966

 

  Series A Warrants issued under the Advisory Agreement

 

-

 

 

-

 

 

12,883

 

 

-

 

 

-

 

 

-

 

 

12,883

 

  Net loss

 

-

 

 

-

 

 

-

 

 

-

 

 

(14,479

)

 

-

 

 

(14,479

)

BALANCE- SEPTEMBER 30, 2021

 

87,073,985

 

 

9

 

 

502,751

 

 

-

 

 

3,605

 

 

-

 

 

506,365

 

The table below presents the effect of the financial statement adjustments related to the restatement of the condensed consolidated statements of cash flows for the nine months ended September 30, 2021 reported in the Original Filing:

(18)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

Nine Months Ended September 30, 2021

 

 

As Previously Reported

 

Adjustments

 

As Restated

 

CASH FLOWS FROM OPERATING ACTIVITIES

 

 

 

 

 

 

Net (Loss)/Income

$

(8,916

)

$

5,794

 

$

(3,121

)

Adjustments to reconcile net (loss)/income to net cash

 

-

 

 

 

 

-

 

(Used in)/provided by operating activities:

 

-

 

 

 

 

-

 

Depreciation expense

 

1,657

 

 

 

 

1,657

 

Amortization expense

 

5,488

 

 

 

 

5,488

 

Amortization of debt issuance costs

 

522

 

 

 

 

522

 

Stock compensation expense

 

966

 

 

 

 

966

 

Change in fair value of warrant liabilities

 

(12,022

)

 

 

 

(12,022

)

Change in fair value of contingent earnout liabilities

 

-

 

 

(5,794

)

 

(5,794

)

Gain on extinguishment of debt

 

(1,637

)

 

 

 

(1,637

)

Changes in operating assets and liabilities:

 

-

 

 

 

 

-

 

Accounts receivable

 

4,296

 

 

 

 

4,296

 

Inventory

 

67

 

 

 

 

67

 

Prepaid expenses

 

(1,371

)

 

 

 

(1,371

)

Risk settlements due from/due to providers

 

(384

)

 

 

 

(384

)

Due to/from related parties

 

235

 

 

 

 

235

 

Other assets

 

(312

)

 

 

 

(312

)

Accounts payable

 

1,583

 

 

 

 

1,583

 

Accrued expenses

 

(3

)

 

 

 

(3

)

Other liabilities

 

1,178

 

 

 

 

1,178

 

Accrued interest

 

(149

)

 

 

 

(149

)

Net Cash (Used In)/Provided by Operating Activities

 

(8,802

)

 

-

 

 

(8,802

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES

 

(2,967

)

 

 

 

(2,967

)

Purchase of property and equipment

 

(298,344

)

 

 

 

(298,344

)

Net Cash Used in Investing Activities

 

(301,311

)

 

-

 

 

(301,311

)

 

 

 

 

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES

 

 

 

 

 

 

Recapitalization transaction

 

415,000

 

 

 

 

415,000

 

Proceeds from borrowings on long-term debt and credit facilities

 

(12,471

)

 

 

 

(12,471

)

Principal payments on long-term debt

 

(108,386

)

 

 

 

(108,386

)

Payment of deferred financing costs

 

125,000

 

 

 

 

125,000

 

Long-term debt extinguishment costs

 

(26,143

)

 

 

 

(26,143

)

Borrowing under paycheck protection program

 

(6,883

)

 

 

 

(6,883

)

Distributions to members

 

(487

)

 

 

 

(487

)

Net Cash Provided by Financing Activities

 

-

 

 

 

 

-

 

 

 

385,630

 

 

-

 

 

385,630

 

NET INCREASE IN CASH

 

-

 

 

 

 

-

 

Cash - Beginning of Period

 

75,517

 

 

-

 

 

75,517

 

CASH - END OF PERIOD

 

4,934

 

 

-

 

 

4,934

 

 

$

80,451

 

$

-

 

$

80,451

 

As a result of a revised fair value calculation, the total purchase consideration for IMC increased by $2.4 million. This amount was recorded as goodwill. The table below presents the effect of the financial statement adjustments in Note 3, Acquisitions to the condensed consolidated financial statements reported in the Original Filing:

 

As Reported

 

Adjustments

 

As Restated

 

Cash consideration (1)

$

172,302

 

$

-

 

$

172,302

 

Share consideration (2)

$

155,347

 

$

-

 

$

155,347

 

Contingent consideration (3)

$

38,348

 

$

2,438

 

$

40,785

 

Other consideration (4)

$

1,271

 

 

 

$

1,271

 

(19)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

NOTE 3. ACQUISITIONS

Acquisition of IMC

On June 8, 2021, the Company acquired 100% of the equity interests of IMC for total purchase consideration of $369.7 million, subject to final closing adjustments. The purchase consideration was comprised of the following (in thousands):

 

(As Restated, Note 2)

 

Cash consideration (1)

$

172,302

 

Share consideration (2)

$

155,347

 

Contingent consideration (3)

$

40,785

 

Other consideration (4)

$

1,271

 


(1) Represents cash consideration inclusive of the payment of $79.8 million of IMC debt simultaneous with the Closing and the reimbursement of IMC Parent's transaction costs of $7.3 million.

(2) Represent the issuance of 10,412,023 shares of Class A Common Stock, which shares were issued at a reference price of $10.00 per share, but the value of which was $14.92 per share, the closing price on the date of the IMC Acquisition.

(3) Represents the fair value of contingent consideration.

(4) Represents the fair value of cash and equity purchase consideration held in escrow pending the finalization of final closing adjustments.

The IMC Acquisition was recorded as a business combination under ASC 805 with identifiable assets acquired recorded at their estimated fair values as of the acquisition date.

As of September 30, 2021, we have not finalized the acquisition accounting related to the IMC Acquisition and these amounts represent preliminary values. The allocation of the purchase price may be modified up to one year from the acquisition date as more information is obtained about the fair value of assets acquired and liabilities assumed. The following table summarizes the purchase consideration and the preliminary fair value of the assets acquired and liabilities assumed (in thousands):

 

 

Purchase
price
allocation
(As Restated, Note 2)

 

 

 

 

 

Cash

 

$

14,842

 

Accounts receivable

 

 

21,298

 

Other current assets

 

 

1,446

 

Property, plant, & equipment

 

 

6,198

 

Intangible assets

 

 

34,121

 

Other assets

 

 

448

 

Accounts payable and accrued expenses

 

 

(8,793

)

Long term debt

 

 

(197

)

Other long term liabilities

 

 

(1,898

)

Net Assets Acquired

 

 

67,465

 

Excess of Consideration over Net Assets Acquired

 

 

302,241

 

Total Consideration

 

$

369,706

 

Goodwill represents the excess of the gross consideration transferred over the fair value of the underlying net assets acquired and liabilities assumed. The goodwill generated is attributable to the assembled workforce and the expected growth and cost synergies and the expected contribution to the Company’s overall strategy. The amount allocated to goodwill and intangible assets is subject to final adjustment to reflect the final valuations. The goodwill recognized that is expected to be deductible for income tax purposes is $80.4 million.

(20)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The fair value associated with definite-lived intangible assets was $34.1 million, comprised of $33.9 million in risk contracts and $263,000 in trademarks. The definite-lived intangible assets will be amortized ranging from one to six years.

The Company’s net revenue and loss before income taxes for the nine months ended September 30, 2021 includes revenues of $88.2 million and net income before taxes of $970,000 related to IMC.

Acquisition of SMA Entities

On June 18, 2021, IMC completed the acquisition of 100% of the issued and outstanding equity interests of Senior Medical Associates, LLC, a Florida limited liability company (“SMA”), and Stallion Medical Management, LLC, a Florida limited liability company (“SMM” and together with SMA, the “SMA Entities”) (“the SMA Acquisition”). The purchase consideration was comprised of the following (in thousands):

Cash consideration (1)

 

$

52,000

 

Share consideration (2)

 

$

5,027

 

(1) Represents cash consideration of $52.0 million, including a holdback of $2.5 million.

(2) Represents equity consideration of 384,615 shares of Class A Common Stock valued at $5.0 million based on the June 18, 2021 closing price of $13.07.

The SMA Acquisition was recorded as a business combination under ASC 805 with identifiable assets acquired and liabilities assumed liabilities recorded at their estimated fair values as of the acquisition date.

As of September 30, 2021, we have not finalized the acquisition accounting related to the SMA Acquisition and these amounts represent preliminary values. The allocation of the purchase price may be modified up to one year from the acquisition date as more information is obtained about the fair value of assets acquired and liabilities assumed. The following table summarizes the consideration paid and the preliminary fair value of the assets acquired and liabilities assumed (in thousands):

 

 

Purchase
price
allocation

 

Cash

 

$

73

 

Accounts receivable

 

 

1,830

 

Property, plant & equipment

 

 

178

 

Intangible Assets

 

 

8,824

 

Other assets

 

 

29

 

Accounts payable and accrued expenses

 

 

(178

)

Net Assets Acquired

 

 

10,756

 

Excess of Consideration over Net Assets Acquired

 

 

46,271

 

Total Consideration

 

$

57,027

 

(21)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Goodwill was recognized as the excess of the purchase price over the net identifiable assets recognized. The goodwill is primarily attributed to our assembled workforce, the expected growth and cost synergies and the expected contribution to the Company’s overall strategy. The goodwill recognized that is expected to be deductible for income tax purposes is $46.3 million.

The Company incurred and expensed acquisition-related transaction costs of $149,000 related to the SMA Acquisition that were paid by the Company.

The fair value associated with definite-lived intangible assets was $8.8 million, comprised of $8.7 million in risk contracts and $92,000 in tradenames. The definite-lived intangible assets will be amortized over periods ranging from one to six years.

The Company’s net revenue and loss before income taxes for the nine months ended September 30, 2021 includes revenues of $6.5 million and net income before taxes of $661,000 related to SMA.

Acquisition of DNF

On September 1, 2021, the Company acquired 100% of the assets of Unlimited Medical Services of Florida, LLC, ("DNF"), a Florida limited liability company, dba DNF Medical Centers, for total purchase consideration of $114.2 million, subject to final closing adjustments (the "DNF Acquisition"). The purchase consideration was comprised of the following (in thousands):

Cash consideration (1)

 

$

88,118

 

Share consideration (2)

 

$

26,072

 

(1)
Represents cash consideration inclusive of the payment of DNF seller transaction costs of $242,000.
(2)
Represents equity consideration of 2,741,528 shares of Class A Common Stock valued at $26.1 million based on the September 1, 2021 closing price of $9.51.

The DNF Acquisition was recorded as a business combination under ASC 805 with identifiable assets acquired recorded at their estimated fair values as of the acquisition date.

As of September 30, 2021, we have not finalized the acquisition accounting related to the DNF Acquisition and these amounts represent preliminary values. The allocation of the purchase price may be modified up to one year from the acquisition date as more information is obtained about the fair value of assets acquired and liabilities assumed. The following table summarizes the purchase consideration and the preliminary fair value of the assets acquired (in thousands):

 

 

Purchase
price
allocation

 

 

 

 

 

Cash

 

$

0

 

Accounts receivable

 

$

3,732

 

Property, plant & equipment

 

 

3,520

 

Intangible Assets

 

 

14,691

 

Other assets

 

 

65

 

Net Assets Acquired

 

 

22,008

 

Excess of Consideration over Net Assets Acquired

 

 

92,182

 

Total Consideration

 

$

114,190

 

Goodwill represents the excess of the gross consideration transferred over the fair value of the underlying net assets acquired and liabilities assumed. The goodwill generated is attributable to the assembled workforce and the expected growth and cost synergies and the expected contribution to the Company’s overall strategy. The amount allocated to goodwill and intangible assets is subject to final adjustment to reflect the final valuations. The goodwill recognized that is expected to be deductible for income tax purposes is $92.2 million.

The Company incurred and expensed acquisition-related transaction costs of $701,000 related to the DNF Acquisition that were paid by the Company.

(22)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The fair value associated with definite-lived intangible assets was $14.7 million, comprised of $14.0 million in risk contracts and $646,000 in trademarks. The definite-lived intangible assets will be amortized ranging from one to six years.

The Company’s net revenues and loss before income taxes for the nine months ended September 30, 2021 includes revenue of $4.9 million and net income before income taxes of $14,000 related to DNF.

Other Acquisitions

During the nine months ended September 30, 2021, we acquired 100% of 2 additional business. The acquisitions were accounted for as business combinations and the overall impact to our unaudited condensed consolidated financial statements was not considered to be material. The fair value associated with definite-lived intangible assets from the acquisitions was $852,000. The total fair value of consideration paid or payable on the acquisition was $2.2 million.

NOTE 4. REINSURANCE

The Company has acquired insurance on catastrophic costs to limit the exposure on patient losses. Premiums and policy recoveries are reported in external provider costs in the accompanyingour condensed consolidated statements of operations.

The nature of the Company’s stop loss coverage is to limit the benefits paid under one patient. The Company’s stop loss limits are defined within each health plan contract and stop loss purchased from a third party and can range from $30,000 to $200,000 per patient per year. Premium expense incurred was $3.34.3 million and $5.57.9 million for the three and ninesix months ended SeptemberJune 30, 2021,2022, respectively and approximately $254,0001.8 million and $747,0002.2 million for the three and ninesix months ended SeptemberJune 30, 2020,2021, respectively. Physicians under capitation arrangements typically have stop loss coverage so that a physician’s financial risk for any single member is limited to a maximum amount on an annual basis. The Company monitors the financial performance and solvency of its stop loss providers. However, the Company remains financially responsible for health care services to its members in the event the health plans are unable to fulfill their obligations under stop loss contractual terms.

Recoveries recognized were $5.27.7 million and $6.914.1 million for the three and ninesix months ended SeptemberJune 30, 2021,2022, respectively, and $93,0001.3 million and $301,0001.7 million for the three and ninesix months ended SeptemberJune 30, 2020,2021, respectively. Estimated recoveries under stop loss policies are reported within the capitationaccounts receivable or amounts due to health plans as the counterparty responsible for the payment of the claims and the stop loss is the respective health plan.

NOTE 5.4. GOODWILL AND INTANGIBLE ASSETS

Goodwill

The following table showssummarizes changes in the carrying amount of goodwill from December 31, 2020 to Septemberfor the six months ended June 30, 20212022 (in thousands):

 

 

Carrying Amount

 

Balance at December 31, 2021

 

$

464,566

 

Measurement period adjustments

 

 

280

 

Balance at June 30, 2022

 

$

464,846

 

(10)

 

Carrying Amount
(As Restated, Note 2)

 

Balance at December 31, 2020

$

10,068

 

Acquired goodwill during the period

 

441,840

 

Balance at September 30, 2021

$

451,908

 


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Intangible Assets

The following table summarizes thetables summarize gross carrying amounts and accumulated amortization of intangible assets by major class (in thousands):

Gross Carrying
Amount

 

 

Accumulated
Amortization

 

 

Net Book
Value

 

 

Weighted Average
Amortization Period (years)

 

 

Gross Carrying
Amount

 

 

Accumulated
Amortization

 

 

Net Book
Value

 

 

Weighted Average
Amortization Period (years)

 

September 30, 2021

 

 

 

 

 

 

 

 

June 30, 2022

 

 

 

 

 

 

 

 

 

 

 

 

Risk Contracts

$

64,967

 

$

(5,655

)

 

$

59,312

 

7

 

 

$

64,570

 

 

$

(16,642

)

 

$

47,928

 

 

 

7

 

Non-compete agreements

 

 

4,170

 

 

 

(1,101

)

 

 

3,069

 

 

 

5

 

Trademarks

 

1,696

 

(318

)

 

1,378

 

1

 

 

 

1,862

 

 

 

(1,193

)

 

 

669

 

 

 

2

 

Non-compete agreements

 

1,320

 

 

 

(435

)

 

 

885

 

 

5

 

Other

 

 

251

 

 

 

(32

)

 

 

220

 

 

 

5

 

Total

$

67,983

 

 

$

(6,408

)

 

$

61,575

 

 

 

 

 

$

70,852

 

 

$

(18,967

)

 

$

51,885

 

 

 

 

(23)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Gross Carrying
Amount

 

 

Accumulated
Amortization

 

 

Net Book
Value

 

 

Weighted Average
Amortization Period (years)

 

 

Gross Carrying
Amount

 

 

Accumulated
Amortization

 

 

Net Book
Value

 

 

Weighted Average
Amortization Period (years)

 

December 31, 2020

 

 

 

 

 

 

 

 

December 31, 2021

 

 

 

 

 

 

 

 

 

 

 

 

Risk Contracts

$

8,174

 

$

(682

)

 

$

7,492

 

11

 

 

$

64,822

 

 

$

(9,818

)

 

$

55,004

 

 

 

7

 

Non-compete agreements

 

1,320

 

 

 

(237

)

 

 

1,083

 

 

5

 

 

 

4,202

 

 

 

(686

)

 

 

3,516

 

 

 

5

 

Trademarks

 

 

1,867

 

 

 

(827

)

 

 

1,040

 

 

 

2

 

Other

 

 

251

 

 

 

 

 

 

251

 

 

 

5

 

Total

$

9,494

 

 

$

(919

)

 

$

8,575

 

 

 

 

 

$

71,141

 

 

$

(11,331

)

 

$

59,811

 

 

 

 

Amortization expense totaled $3.7 and $7.6 million for the three and six months ended June 30, 2022 and $1.1 million and $1.3 million for the three and ninesix months ended SeptemberJune 30, 2021, respectively, and $141,000 and $281,000 for the three and nine months ended September 30, 2020, respectively.

The estimated amortization expense related to the fair value of acquired intangible assets for the remainder of 2021, each of the succeeding five years, and thereafter is (in thousands):

Remainder of 2021

$

4,798

 

2022

 

14,346

 

2023

 

11,636

 

2024

 

9,598

 

2025

 

7,945

 

2026

 

7,197

 

2027 and thereafter

 

6,055

 

NOTE 6.5. PROPERTY AND EQUIPMENT

A summary of property and equipment at SeptemberJune 30, 20212022 and December 31, 20202021 is as follows (in thousands):

 

September 30, 2021

 

 

December 31, 2020

 

 

June 30, 2022

 

 

December 31, 2021

 

Leasehold improvements

 

$

6,905

 

 

$

2,726

 

 

$

7,658

 

 

$

7,516

 

Vehicles

 

 

3,693

 

 

 

2,823

 

 

 

3,686

 

 

 

3,711

 

Furniture and equipment

 

 

8,040

 

 

 

1,983

 

 

 

6,549

 

 

 

5,470

 

Software

 

 

3,539

 

 

 

2,950

 

Construction in progress

 

 

2,278

 

 

 

360

 

 

 

4,071

 

 

 

2,254

 

Total

 

 

20,916

 

 

 

7,892

 

 

 

25,502

 

 

 

21,902

 

Less: Accumulated depreciation

 

 

(4,753

)

 

 

(3,096

)

 

 

(8,171

)

 

 

(5,909

)

Total Property and equipment, net

 

$

16,163

 

 

$

4,796

 

 

$

17,332

 

 

$

15,993

 

Construction in progress at SeptemberJune 30, 2021 is made up2022 consisted of various leasehold improvements at the Company's medical centers. The Company has a contractual commitment to complete the construction of its Homestead medical center with remaining estimated capital expenditures of $700,000. Plans have been submitted for the Company's East Hialeah medical center, and the opening of the facility is projected in the fourth quarter of 2022. The projects are being funded internally.

Depreciation expense totaled $1.01.2 million and $1.72.3 million for the three and ninesix months ended SeptemberJune 30, 2021 and 2020,2022, respectively, and $193,0000.4 million and $626,0000.6 formillion during the three and ninesix months ended SeptemberJune 30, 2020,2021, respectively.

NOTE 7.6. LONG TERM DEBT

Long-term debt consistedIn May 2022, the Company entered into a credit agreement (the “Credit Agreement”) that provided for an aggregate of up to $300 million in term loans, comprised of (i) initial term loans in aggregate principal amount of $190 million (the “Initial Term Loans”) and (ii) a delayed term loan facility in the aggregate principal amount of $110 million (the “Delayed Draw Term Loans”). The Credit Agreement permits the Company to enter into certain incremental facilities subject to compliance with the terms, conditions and covenants set forth therein. In May 2022, the Company drew $190 million of the following at SeptemberInitial Term Loans and used approximately $121 million of the net proceeds from this borrowing to repay its outstanding obligations under the credit agreement dated June 8, 2021, as amended (the "Existing Credit Agreement”). During the three and six months ended June 30, 2021 and December 31, 2020 (2022, the Company recognized debt extinguishment losses of $in thousands6.2): million related to early repayment of the Existing Credit Agreement.

 

 

September 30,
2021

 

 

December 31, 2020

 

Secured term loans

 

$

123,438

 

 

$

24,184

 

Payroll protection plan

 

 

-

 

 

 

2,164

 

Other

 

 

72

 

 

 

1,358

 

Unamortized debt issuance costs

 

 

(4,341

)

 

 

(377

)

 

 

 

119,169

 

 

 

27,329

 

Current portion

 

 

(6,279

)

 

 

(1,004

)

Long-term portion

 

$

112,890

 

 

$

26,325

 

(24)(11)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

On the Closing Date, the Company entered into a Credit Agreement (the “Credit Agreement , by and among the Company, Royal Bank of Canada, as Administrative Agent (in such capacity, the “Agent”), Collateral Agent, Swing Line Lender and Issuing Bank, RBC Capital Markets, LLC and Truist Securities, Inc., as Syndication Agents, Joint Lead Arrangers and Joint Book Runners, and certain other banks and financial institutions serving as lenders (collectively with their successors and assigns, the “Lenders”). The Credit Agreement provides for (i) initial term loans in an aggregate principal amount of $125.0 million (the “Initial Term Loans”), which was fully drawn on the Closing Date to finance the Business Combination and related transaction costs, (ii) a revolving credit facility in an aggregate principal amount of $40.0 million for working capital and other general corporate purposes, of which $0 was drawn as of September 30, 2021 and (iii) a delayed draw term loan facility in an aggregate principal amount of $20.0 million, which will be available to be drawn from and after the Closing until the six month anniversary of the Closing Date to finance permitted acquisitions and similar permitted investments and of which $0 was drawn as of September 30, 2021 (collectively, the “Credit Facilities”).

 

Interest is payableBased on the elections made by the Company, as of June 30, 2022, the Initial Term Loan borrowings bear interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus a spread adjustment of 0.114%), plus an applicable margin rate of 9.00%. As permitted under the Credit Agreement, the Company elected to capitalize 4.00% of the interest as principal amount on the outstanding loansTerm Loans. As a result of this election, the cash interest component of the applicable margin increases by 0.50%. Amortization payments under the Credit Facilities based on, at the option of the Company, either: (i) Eurocurrency (with a floor of 0.75% per annum) plus variable spreads ranging from 2.75% to 3.50% per annum based on first lien net leverage ratio levels or (ii) the Alternate Base Rate (defined as the highest of (a) the Prime Rate (as defined in the Credit Agreement and established by the Agent), (b) the Federal Funds Rate (as defined in the Credit Agreement) plus 0.50% per annum, and (c) the LIBOR Quoted Rate (as defined in the Credit Agreement) plus 1.00% per annum, in each case, with a floor of 1.75% per annum), plus variable spreads ranging from 1.75% to 2.50% per annum based on first lien net leverage ratio levels. Accrued and unpaid interest is payable with respect to LIBOR loans, on the last day interest period as selected by the Company but no later than three months, and with respect to Alternate Base Rate Loans, quarterly on the last business day of each of March, June, September and December.An unused commitment fee is also payable with respect to the revolving credit facility and the delayed draw term loan facility ranging between 0.35% and 0.50% depending on the Company’s first lien net leverage ratio, and is payable quarterly in arrears with respect to the revolving credit facility and on the earliest of the termination of the delayed draw term loan facility, the six month anniversary of the Closing Date with respect to any delayed draw term loan commitments that have expired and otherwise after the end of the first full fiscal quarter after the Closing Date.

Amortization payments with respect to the Initial Term Loans are payable in quarterly installments, commencing with the last business day of the first full fiscal quarter ending after the Closing Date,on March 31, 2024, in aggregate principal amounts equal to (i) 1.250.25% of the aggregateoutstanding principal amountbalance. As of June 30, 2022, 0 amounts were borrowed under the InitialDelayed Draw Term Loans outstanding on the Closing Date from the Closing Date until June 7, 2024, (ii) 1.875% of the aggregate principal amount of the Initial Term Loans outstanding on the Closing Date from June 8, 2024 to June 7, 2025 and (iii) 2.50% of the aggregate principal amount of the Initial Term Loans outstanding on the Closing Date from June 8, 2025 to June 7, 2026.Loans. All amounts owed under the Credit FacilitiesAgreement are due and payable upon thein five-yearMay 2027 anniversary of the Closing Date, unless otherwise extended in accordance with the terms of the Credit Agreement..

 

The Credit Agreement contains certain covenants that limit, among other things, the ability of the Company and its subsidiaries to incur additional indebtedness, liens or liens,encumbrances, to make certain investments, to enter into sale-leaseback transactions or sell certain assets, to make certain restricted payments includingor pay dividends, to enter into consolidations, mergers or sales of material assets and other fundamental changes, or to transact with affiliates and to amend certain agreements, subject in each case to the exceptions materiality and other qualifications as provided in the Credit Agreement. The Credit Agreement also contains customary eventscovenants that require the Company to satisfy a minimum liquidity requirement of default$50.0 million, which may be decreased to $25.0 million if the Company achieves a certain adjusted EBITDA, and also includes an equity cure right.

All obligations undermaintain a maximum total leverage ratio based on the Company’s consolidated EBITDA, as defined in the Credit Agreement, are guaranteed bywith de novo losses excluded from the calculation of such ratio for up to 36 months after the opening of a de novo center, which maximum total leverage ratio will initially be 8.50 to 1.00, commencing with the fiscal quarter ended September 30, 2022 and is subject to a series of step-downs. For the fiscal quarters ending September 30, 2026 and thereafter the Company and substantially all of its subsidiaries, and all obligations under the Credit Agreement, including the guarantees of those obligations, are secured by substantially all of the assets of the Company and its subsidiaries. As of September 30, 2021, the Company was in compliance, in all material respects, with all covenants under the Credit Agreement.must maintain a maximum total leverage ratio no greater than 5.50 to 1.00.

CMG Loan Agreement

On the Closing Date, the Company repaid all outstanding term loan borrowings under CMG's previous loan agreement (the “Loan Agreement”) and the Loan Agreement was terminated. The Company repaid $24.5 million, inclusive of $487,000 in prepayment penalties, fees and interest. The Company recorded a loss on early of extinguishment of debt of $806,000, inclusive of the write-off of deferred debt issuance costs and prepayment penalties related to the Loan Agreement.

Other Debt

Other long-term debt repaid on the Closing Date totaled $229,000. In addition, $2.0 million was deposited into an escrow account as security for amounts borrowed under the Paycheck Protection Program ("PPP"). In the three months ended

(25)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

September 30, 2021, the Company paid $2.0 million to the CMG sellers for the amount owed related to a loan under the PPP. This amount was held in escrow asAs of June 30, 2022 and December 31, 2021, and was reported long term debt consisted of the following (in restricted cash in the June 30, 2021 condensed consolidated balance sheet. During the three and nine months ended September 30, 2021, borrowings under the PPP of $thousands279,000 and $2.5 million were forgiven and are included in the gain on extinguishment of debt.):

 

 

June 30, 2022

 

 

December 31, 2021

 

Secured term loans

 

$

191,078

 

 

$

121,875

 

Other

 

 

50

 

 

 

65

 

Unamortized discounts and debt issuance costs

 

 

(9,609

)

 

 

(4,704

)

 

 

 

181,520

 

 

 

117,236

 

Current portion

 

 

(18

)

 

 

(6,275

)

Long-term portion

 

$

181,501

 

 

$

110,960

 

Future maturities of debt outstanding at SeptemberJune 30, 2021 are2022 were as follows (in thousands):

 

Amount

 

 

Amount

 

Remainder of 2021

 

$

1,570

 

2022

 

 

6,275

 

Remainder of 2022

 

 

11

 

2023

 

 

6,265

 

 

 

15

 

2024

 

 

8,611

 

 

 

1,928

 

2025

 

 

11,726

 

 

 

1,918

 

2026

 

 

89,063

 

 

 

1,911

 

Thereafter

 

 

185,346

 

Total

 

$

123,510

 

 

$

191,129

 

NOTE 8. STOCKHOLDERS’7. STOCKHOLDERS' EQUITY

The unaudited condensed consolidated statement of changes in equity reflects the Reverse Recapitalization and the IMC Acquisition as discussed in Notes 2 and 3.Note 2. As CMG was deemed the accounting acquirer in the Reverse Recapitalization with DFHT, all periods prior to the consummation of the Business Combination reflect the balances and activity of CMG.

In connection with the Business Combination, the Company adopted the third amended and restated certificate of incorporation, dated June 8, 2021 (the “Amended and Restated Charter”) to, among other things, increased the total number of authorized shares of all classes of capital stock, par value of $0.0001 per share, to 261,000,000 shares, consisting of (i) 260,000,000 shares of common stock, including 250,000,000 shares of Class A Common Stock and 10,000,000 shares of Class B Common Stock, and (ii) 1,000,000 shares of preferred stock. In addition, 3,593,750 shares of Class B Common Stock were converted, on a 1-for-one basis, into shares of Class A Common Stock, and as of September 30, 2021, there were 0 shares of Class B Common Stock issued or outstanding.

Also in connection with the Business Combination, (i) Deerfield Partners and the Sponsor purchased an aggregate of 10,000,000 shares of Class A Common Stock (the “Deerfield PIPE Investments”), consisting of 9,600,000 shares of Class A Common Stock purchased by Deerfield Partners and 400,000 shares of Class A Common Stock purchased by the Sponsor, for a purchase price of $10.00 per share and an aggregate purchase price of $100.0 million and (ii) certain investors purchased an aggregate of 31,000,000 shares of Class A Common Stock (the “Third-Party PIPE Investments,” and together with the Deerfield PIPE Investments, the “PIPE Investments”), for a purchase price of $10.00 per share, for an aggregate purchase price of $310.0 million. The Company paid offering costs of $12.8 million.

In connection with the acquisition of SMA (see Note 3 - Acquisitions), the Company issued 384,615 shares of Class A Common Stock.

On July 13, 2021, the Company issued 500,000 shares of Class A Common Stock to the Related Group in connection with the execution of the Advisory Agreement (as defined below).

 

In connection with the DNF Acquisition (see Note 3 - Acquisitions), the Company issued 2,741,528 shares of Class A Common Stock to DNF. Also, during the three months ended September 30, 2021, the first tranche of contingently issuable shares totaling an aggregate of 3,200,000 shares of Class A Common Stock were issued to the CMG Sellers and IMC Parent (“Earnout Shares” described in Contingent Consideration Common Shares below). In total, this activity brought the total number of shares of Class A Common Stock outstanding at September 30, 2021 to 87,073,985.

Related Advisory Agreement

On July 13, 2021, the Company entered into an exclusive real estate advisory agreement (the "Advisory Agreement") with Related CM Advisor, LLC (the “Advisor”), a Delaware limited liability company and a subsidiary of The Related Companies, L.P. (“Related”) (the “Advisory Agreement”), pursuant to which the Advisor has agreed provide certain real estate advisory services to the Company on an exclusive basis. The services include identifying locations for new medical centers nationwide as part of the Company’s de novo growth strategy, including, but not limited to, locations within and proximate to affordable housing communities that may be owned by Related.

(26)

(12)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

In connection with the Advisory Agreement, the Company and the Advisor entered into a subscription agreement (the “Subscription Agreement”), whereby the Advisor purchased 500,000 shares (the “Initial Shares”) of the Company’s Class A Common Stock for an aggregate purchase price of $5.0 million and the Company issued to the Advisor (i) a warrant (the “Series A Warrant”) to purchase 2,000,000 shares of Class A Common Stock (the “Series A Warrant Shares”), which vested immediately upon issuance, is exercisable for a period of five years and is not redeemable by the Company and (ii) a warrant (the “Series B Warrant” and together with the Series A Warrant, the “Warrants”) to purchase up to 6,000,000 shares of Class A Common Stock (the “Series B Warrant Shares” and, together with the Series A Warrant Shares, the “Warrant Shares”), pursuant to which 500,000 Series B Warrant Shares will vest and become exercisable from time to time upon the opening of each medical center under the Advisory Agreement for which the Advisor provides services, other than two initial medical centers.

The Company assessed the substance of the Subscription Agreement and determined that all instruments referenced in the Subscription Agreement should be assessed under the guidance of ASC Topic 718, Compensation - Stock Compensation, as non-employee awards issued to Related in exchange for real estate advisory services to be rendered per the Advisory Agreement. As a result, the Company recorded the Series A Warrants as a component of additional paid-in-capital using the fair value as of July 13, 2021.

The Series B Warrant is exercisable, to the extent vested, until the later of five years from the date of issuance or one year from vesting of the applicable Series B Warrant Shares and is redeemable with respect to vested Warrant Shares at a price of $0.01 per Warrant Share if the price of the Class A Common Stock equals or exceeds $18.00 per share, or $0.10 per Warrant Share if the price of the Class A Common Stock equals or exceeds $10.00 per share, in each case when such price conditions are satisfied for any 20 trading days within a 30-trading day period and subject to certain adjustments and conditions as described in the Series B Warrant. In the event that the Series B Warrant is called for redemption by the Company, the Advisor may pay the exercise price for the Series B Warrant Shares six months following the notice of redemption by the Company.

The company assessed

Series B Warrants are recognized at their grant date fair value once vesting becomes probable. During the substance of the Subscription Agreement and determined that all instruments referenced in the Subscription Agreement should be assessed under the guidance of ASC 718 as non-employee awards issued to Related in exchange for real estate advisory services to be rendered per the Advisory Agreement. As a result,three months ended June 30, 2022, the Company recorded $2.5 million in prepaid expenses to reflect vesting of 500,000 Series B Warrant Shares. During the six months ended June 30, 2022, the Company recorded $5.0 million in prepaid expenses to reflect vesting of 1 million Series A Warrants as a component ofB Warrant Shares. Refer to Note 10, Related Party Transactions, for additional paid-in-capital using the fair value as of July 13, 2021.information.

Preferred Stock

The Company's Third Amended and Restated CharterCertificate of Incorporation, dated June 8, 2021, authorizes the Company to issue 1,000,000 shares of preferred stock, with such designations, voting and other rights and preferences as may be determined from time to time by the Company’s board of directors. As of SeptemberJune 30, 2021,2022, there were 0 shares of preferred stock issued or outstanding.

Redeemable Warrants - Public Warrants

On July 16, 2020, in connection with the IPO,Company's initial public offering (the "IPO"), DFHT sold 2,875,000 Public Warrants. Each whole Public Warrant entitles the registered holder to purchase 1 share of Class A Common Stock at a price of $11.50 per share, subject to adjustment, at any time commencing on the later of 12 months from the closing of the IPO and 30 days after the completion of the Business Combination, provided in each case that the Company has an effective registration statement under the Securities Act covering the shares of Class A Common Stock issuable upon exercise of the Public Warrants and a current prospectus relating to them is available (or the Company permits holders to exercise their Public Warrants on a cashless basis under the circumstances specified in the warrant agreement) and such shares are registered, qualified or exempt from registration under the securities, or blue sky, laws of the state of residence of the holder. Pursuant to the warrant agreements entered into at the time of the IPO, a warrant holder may exercise its Public Warrants only for a whole number of shares of Class A Common Stock. This means only a whole Public Warrant may be exercised at a given time by a warrant holder. No fractional warrants were issued upon separation of the units issued in connection with the IPO and only whole Public Warrants will trade. The Company may redeem the Public Warrants when the price per share of Class A Common Stock equals or exceeds certain threshold prices.

Redeemable Warrants - Private Placement Warrants

Also in connection with the IPO, DFHT issued the 2,916,667 Private Placement Warrants at a purchase price of $1.50 per warrant. The Private Placement Warrants (including the Class A Common Stock issuable upon exercise of the Private Placement Warrants) are not transferable, assignable or salable until 30 days after the completion of the Business Combination (except, among other limited exceptions to DFHT’s officers and directors and other persons or entities affiliated with the initial purchasers of the Private Placement Warrants) and they will not be redeemable by CareMax for cash so long as they are held by the initial

(13)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

stockholders or their permitted transferees. With some exceptions, the Private Placement Warrants have terms and provisions that are identical to those of the Public Warrants. If the Private Placement Warrants are held by holders other

(27)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

than the initial purchasers or their permitted transferees, the Private Placement Warrants will be redeemable by the Company and exercisable by the holders on the same basis as the Public Warrants.

Contingent Consideration Common Shares

Pursuant to the Business Combination Agreement, the CMG Sellers and IMC Parent, who received Class A Common Stock in connection with the Business Combination, are entitled to receive earn-out consideration to be paid out in the form of Class A Common Stock. The Business Combination Agreement provides that upup to an additional 3,500,000 and 2,900,000 Earnout Sharescontingently issuable shares of Class A Common Stock (the "Earnout Shares") are payable after the Closing to the CMG Sellers and IMC Parent:Parent: (i) if within the first year after the Closing, the volume weighted average trading price of Class A Common Stock equals or exceeds $12.50 on any 20 trading days in any 30-day trading period (the “First Share Price Trigger”), then 1,750,000 and 1,450,000 Earnout Shares are issuable to the CMG Sellers and IMC Parent, respectively, and (ii) if within the two years after the Closing (the “Second Earnout Period”), the volume weighted average trading price of Class A Common Stock equals or exceeds $15.00 on any 20 trading days in any 30-day trading period (the “Second Share Price Trigger” and together with the First Share Price Trigger, the “Share Price Triggers”), then 1,750,000 and 1,450,000 Earnout Shares will be issued and paid to the CMG Sellers and IMC Parent, respectively. If prior to (i) the satisfaction of the Share Price Triggers, and (ii) the end of the Second Earnout Period, the Company enters into a change in control transaction as described in the Business Combination Agreement, and the price per share of the Company’s Class A Common Stock payable to the stockholders of the Company in such change in control transaction is greater than the Share Price Triggers that have not been satisfied during the Earnout Period, then at the closing of such change in control transaction, the Share Price Triggers will be deemed to have been satisfied and the Company is required to issue, as of such closing, the applicable unissuedEarnout Shares. The estimated fair value of the Earnout Shares was initially accounted foras a liability-classified instrument with changes in its fair value recorded in theour condensed consolidated statements of operations until July 9, 2021. On July 9, 2021, the First Share Price Trigger was achieved, resulting in issuance of 1,750,000 and 1,450,000 Earnout Shares to the CMG Sellers and IMC Parent, respectively. Subsequent to the achievement of the First Share Price Trigger, the Company determined the Earnout Shares subject to the second Share Price Trigger should be equity classified.classified and were recorded as such on July 9, 2021, the date of the event that caused the reclassification. As of June 30, 2022, the Second Share Price Trigger has not been achieved.

Equity-basedStock-based Compensation

On June 4, 2021, the stockholders of the Company approved the CareMax Inc. 2021 Long-term Incentive Plan (the “2021 Plan”), effective on the Closing Date. The 2021 Plan permits the grant of equity-based awards to officers, directors, employees and other service providers. The 2021 Plan permits the grant of an initial share pool of 7,000,000 shares of Class A Common Stock and will:

-will be increased automatically, without further action of the Company’s board of directors, on January 1st of each calendar year commencing after the Closing Date and ending on (and including) January 1, 2031, by a number of shares of Class A Common Stock equal to the lesser of (i) 4 percent of the aggregate number of shares of Class A Common Stock outstanding on December 31stof31st of the immediately preceding calendar year, excluding for this purpose any such outstanding shares of Class A Common Stock that were granted under the 2021 Plan and remain unvested and subject to forfeiture as of the relevant December 31st, or (B)(ii) a lesser number of shares of Class A Common Stock as determined by the Company’s board of directors or the Compensation Committee of the board of directors prior to the relevant January 1st1;st.

As of September 30, 2021, 0 grants have been made and thereThe following awards were 0 shares of Class A Common Stock issued or outstandinggranted under the 2021 Plan.Plan during the three and the six months ended June 30, 2022:

 

Three Months Ended June 30, 2022

 

 

Number of units (in millions)

Weighted-average grant date fair value

 

Restricted stock units

3.2

$

8.24

 

Performance stock units

0.2

$

5.71

 

Options

0.4

$

5.88

 

 

 

 

 

 

Six Months Ended June 30, 2022

 

 

Number of units (in millions)

Weighted-average grant date fair value

 

Restricted stock units

3.2

$

8.19

 

Performance stock units

0.2

$

5.79

 

Options

0.4

$

5.87

 

Stock Based Compensation Expense

In July 2021, the Company’s board of directors authorized an award of 100,000 shares of Class A Common Stock to an executive. The award has not been granted as of September 30, 2021. There are 0 additional performance or market conditions that will be required to be satisfied before the award is granted. The historical close price of the Class A Common Stock was $9.66 on September 30, 2021. Based on this fact pattern, the Company has recorded Stock Based Compensation expense totaling $966,000 for the three months ended September 30, 2021.

NOTE 9. NET INCOME (LOSS) PER SHARE

 

(28)(14)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

During the three and six months ended June 30, 2022, the Company recorded stock-based compensation expense of $2.8 million and $3.9 million, respectively ($0 during the three and six months ended June 30, 2021). Stock-based compensation expense is included in the corporate, general and administrative expenses in our condensed consolidated statements of operations. As of June 30, 2022, the Company had $26.7 million of compensation expense related to non-vested awards that will vest over the weighted-average period of 2.6 years (there were 0 awards outstanding as of June 30, 2021).

NOTE 8. NET INCOME (LOSS) PER SHARE

The Business Combination was accounted for as a reverse recapitalization by which CMG issued equity for the net assets of the Company accompanied by a recapitalization. Earnings per share hashave been recast for all historical periods to reflect the Company’s capital structure for all comparative periods.

The Earnout Shares are excluded from the computation of basic net income (loss) per share until the conditions to trigger the issuance of the Earnout Shares have been satisfied. During the three months ended September 30, 2021, the first tranche of Earnout Shares totaling 3,200,000 shares of Class A Common Stock were issued to the CMG Sellers and IMC Parent and such shares are included in the computation of basic net income (loss) per share from the date of issuance for the three and nine months ended September 30, 2021. The remaining Earnout Shares totaling 3,200,000 shares were excluded from the computation of basic net income (loss) per share for the three and nine months ended September 30, 2021 as the Second Share Price Trigger had not been achieved as of September 30, 2021.

The Company excluded the effect of the Public Warrants and the Private Placement Warrants from the computation of diluted net income (loss) per share in the three and nine months ended September 30, 2021 as their inclusion would have been anti-dilutive because the Company was in a loss position for such periods.

 

The following table sets forth the calculation of basic and diluted earnings per share for the periods indicated based on the weighted averageweighted-average number of common shareshares outstanding for the period subsequent to the transactions that occurred in connection with the Business Combination (in thousands, except share and per share data):

 

 

Three Months Ended June 30,

 

 

Six Months Ended June 30,

 

 

 

2022

 

 

2021

 

 

2022

 

 

2021

 

Net (loss) income attributable to CareMax, Inc. class A common stockholders

 

$

(9,381

)

 

$

10,057

 

 

$

(26,178

)

 

$

11,359

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average basic shares outstanding

 

 

87,422,917

 

 

 

28,404,759

 

 

 

87,395,596

 

 

 

19,649,057

 

Weighted average diluted shares outstanding

 

 

87,422,917

 

 

 

30,906,859

 

 

 

87,395,596

 

 

 

20,907,019

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net (loss) income per share

 

 

 

 

 

 

 

 

 

 

 

 

Basic

 

$

(0.11

)

 

$

0.35

 

 

$

(0.30

)

 

$

0.58

 

Diluted

 

$

(0.11

)

 

$

0.33

 

 

$

(0.30

)

 

$

0.54

 

The following potentially dilutive outstanding securities were excluded from the computation of diluted net loss per share because their effect would have been anti-dilutive or because issuance of shares underlying such securities is contingent upon the satisfaction of certain conditions which were not satisfied by the end of the period (in thousands):

 

 

Three Months Ended September 30,

 

 

Nine Months Ended September 30,

 

 

 

2021
(As Restated, Note 2)

 

 

2020

 

 

2021
(As Restated, Note 2)

 

 

2020

 

Net (loss) income attributable to CareMax, Inc. class A common stockholders

 

$

(14,479

)

 

$

(315

)

 

$

(3,120

)

 

$

6,328

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Weighted average basic shares outstanding

 

 

82,552,520

 

 

 

10,796,069

 

 

 

40,847,294

 

 

 

10,796,069

 

Weighted average diluted shares outstanding

 

 

82,552,520

 

 

 

10,796,069

 

 

 

40,847,294

 

 

 

10,796,069

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Net (loss) income per share

 

 

 

 

 

 

 

 

 

 

 

 

Basic

 

$

(0.18

)

 

$

(0.03

)

 

$

(0.08

)

 

$

0.59

 

Diluted

 

$

(0.18

)

 

$

(0.03

)

 

$

(0.08

)

 

$

0.59

 

 

 

Three Months Ended June 30,

 

 

Six Months Ended June 30,

 

 

 

2022

 

 

2021

 

 

2022

 

 

 

2021

 

Series A Warrants and Series B Warrants

 

 

8,000

 

 

 

 

 

 

8,000

 

 

 

 

 

Public and Private Placement Warrants

 

 

5,792

 

 

 

 

 

 

5,792

 

 

 

 

 

Earnout Shares

 

 

3,200

 

 

 

 

 

 

3,200

 

 

 

 

 

Unvested restricted stock units

 

 

3,246

 

 

 

 

 

 

3,246

 

 

 

 

 

Unvested performance stock units (assuming 100% target payout)

 

 

209

 

 

 

 

 

 

209

 

 

 

 

 

Unvested options

 

 

418

 

 

 

 

 

 

418

 

 

 

 

 

Total

 

 

20,864

 

 

 

 

 

 

20,864

 

 

 

 

 

NOTE 10.9. FAIR VALUE MEASUREMENTS

The following table presents information about the Company’s assets and liabilities that are measured at fair value on a recurring basis and indicate the fair value hierarchy of the valuation techniques that the Company utilized to determine such fair value (in thousands).:

September 30, 2021

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

Description

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Derivative warrant liabilities

 

$

-

 

 

$

-

 

 

$

17,110

 

Liability-classified contingent consideration

 

 

-

 

 

 

-

 

 

 

1,400

 

June 30, 2022

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

Description

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Derivative warrant liabilities - Public Warrants

 

$

2,070

 

 

$

 

 

$

 

Derivative warrant liabilities - Private Placement Warrants

 

$

 

 

$

 

 

$

2,450

 

The fair value of the Public Warrants issued in connection with the IPO and the Private Placement Warrants were initially measured at fair value using a Monte Carlo simulation model and subsequently, the fair value of the Private Placement Warrants has been estimated using a Monte Carlo simulation model each measurement date. The fair value of Public Warrants issued in connection with the IPO has been measured based on the listed market price of such warrants since the IPO. For the three months ended September 30, 2021, the Company recognized a benefit resulting from a decrease in the fair value of the derivative warrant liabilities of $10.2 million.

Transfers to/from Levels 1, 2, and 3 are recognized at the end of the reporting period. There were 0 transfers between levels for the nine months ended September 30, 2021.

(29)(15)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The estimated fair

December 31, 2021

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

Description

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Derivative warrant liabilities - Public Warrants

 

$

 

 

$

 

 

$

4,375

 

Derivative warrant liabilities - Private Placement Warrants

 

$

 

 

$

 

 

$

4,000

 

Fair value of the Private Placement Warrants and the Public Warrants prior to being separately listed and traded, was determinedis measured using Level 3 inputs. Inherent in a Monte Carlo simulation are assumptions relatedmodel, which is considered to be a Level 3 fair value measurement. Key inputs into the Monte Carlo simulation include the expected stock-pricestock price volatility, expected life, risk-free interest rate and dividend yield. The Company estimates the volatility of its common stock based onafter considering the historical volatility of select peer companies that matches the expected remaining life of the warrants. The risk-free interest rate is based on the U.S. Treasury zero-coupon yield curve on the grant date for a maturity similar to the expected remaining life of the warrants. The expected life of the warrants is assumed to be equivalent to their remaining contractual term. The dividend rate is based on the historical rate, which the Company anticipates remaining at zero.

The fair value of Public Warrants is measured using the listed market price of such warrants, which is considered to be a Level 1 fair value measurement.

During the three and six months ended June 30, 2022, the Company recognized a gain resulting from a decrease in the fair value of the derivative warrant liabilities of $7.4 million and $3.9 million, respectively.

There were 0 transfers between levels during the three and six months ended June 30, 2022 or the three and six months ended June 30, 2021.

 

The following table provides quantitative information regarding Level 3 fair value measurements inputs asused in measurement of the Closing (June 8, 2021) and September 30, 2021:fair value of Private Placement Warrants:

 

September 30,
2021

 

 

June 8,
2021

 

 

June 30,
2022

 

 

December 31, 2021

 

Exercise price

 

$

11.50

 

$

11.50

 

 

$

11.50

 

 

$

11.50

 

Unit price

 

$

9.66

 

$

14.92

 

 

$

3.63

 

 

$

7.68

 

Volatility

 

43.4

%

 

29.8

%

 

 

65.1

%

 

 

37.6

%

Expected life of the options to convert

 

4.69

 

5

 

 

 

3.94

 

 

 

4.44

 

Risk-free rate

 

0.93

%

 

0.77

%

 

 

2.96

%

 

 

1.17

%

Dividend yield

 

0.0

%

 

0.0

%

 

 

0.0

%

 

 

0.0

%

The change in the fair value of the warrant liabilities for the ninesix months ended SeptemberJune 30, 20212022 is summarized as follows (in thousands):

Fair value of derivative warrant liabilities at Closing

 

$

29,132

 

Change in fair value of derivative warrant liabilities

 

 

(12,022

)

Derivative warrant liabilities at September 30, 2021

 

$

17,110

 

The following table provides quantitative information regarding Level 3 fair value measurements of the Related Warrants as of the date of issuance:

 

 

July 13,
2021

 

Exercise price

 

$

11.50

 

Unit price

 

$

13.30

 

Volatility

 

 

50.9

%

Expected life of the options to convert

 

 

5.00

 

Risk-free rate

 

 

0.85

%

Dividend yield

 

 

0.0

%

The following table provides quantitative information regarding Level 3 fair value measurements of the IMC Parent and CMG Sellers Contingent Earnout consideration as of July 9, 2021:

CMG Sellers - Second Share Price Trigger

 

July 9,
2021

 

Share Price Trigger

 

$

15.00

 

Potential Shares

 

 

1,750,000

 

Beginning Share Price

 

$

14.09

 

Volatility

 

 

60.7

%

Remaining Term

 

 

1.92

 

Risk-free rate

 

 

0.22

%

Dividend yield

 

 

0.0

%

IMC Parent - Second Share Price Trigger

 

July 9,
2021

 

Share Price Trigger

 

$

15.00

 

Potential Shares

 

 

1,450,000

 

Beginning Share Price

 

$

14.09

 

Volatility

 

 

60.7

%

Remaining Term

 

 

1.92

 

Risk-free rate

 

 

0.22

%

Dividend yield

 

 

0.0

%

Fair value of derivative warrant liabilities at December 31, 2021

 

$

8,375

 

Change in fair value of derivative warrant liabilities

 

 

(3,855

)

Fair value of derivative warrant liabilities at June 30, 2022

 

$

4,520

 

NOTE 11.10. RELATED PARTY TRANSACTIONS

(30)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The Company had a 49% ownership interest in Care Smile, LLC (“Care Smile”), a dental care organization with majority ownership by the dental provider, who is the spouse of a member of the Company's senior management. The Company pays for dental services provided to enrollees by Care Smile on a capitated basis. Total capitation payments for the three and nine months ended September 30, 2020 were $0 and $222,000, respectively. The net loss of Care Smile for the three and nine months ended September 30, 2020 was $52,000 and $97,000, respectively. Care Smile was voluntarily dissolved on November 24, 2020.

The Company leases certain facilities from related parties under operating leases expiring through 2026. Rent expenses totaled $0 and $21,000 for the three and nine months ended September 30, 2021.

On July 13, 2021, the Company entered into the Advisory Agreement with the Advisor, the substance of which is described in detail in Note 8 - 7, Stockholders Equity.Equity.


The relative fair value method was used to allocate the $5.0 million purchase price between the Class A Common Shares and the Series A Warrants under the Subscription Agreement. The Company recorded the excess of the grant date fair value difference between the fair value of the equity and Series A Warrants instruments at the grant date (July 13, 2021) as prepaid service contracts totaling $14.5 million, subject to amortization over the terms of the respective agreements. In the three months ended September 30, 2021, the Company recognized $142,000 of expense related to amortization of the prepaid service contracts.

The Series B Warrants were assigned a value of $0 as the vesting was not probable at issuance through the three months ended September 30, 2021. The grant date fair value of the Series B Warrants will be used to determine the cost of these awards upon the opening of the 12 future sites not yet identified.

On July 13, 2021, the Company's board of directors appointed Mr. Bryan Cho, an Executive Vice President of Related, to serve as a Class III director of the Company. The appointment of Mr. Cho was made in connection with the Advisory Agreement, which provides the Advisor with the right to designate a director to serve on the Company's board of directors, subject to the continuing satisfaction of certain conditions, including that the Advisor and its affiliates maintain ownership of at least 500,000 shares of Class A Common Stock.

 

The boardDuring the six months ended June 30, 2022, the Company recognized vesting of directors has determined that Mr. Cho is independent1 million Series B Warrant Shares related to the upcoming opening of two centers for which the Advisor provided services under the rules ofAdvisory Agreement. Refer to Note 7, Stockholders' Equity, for additional information. In addition, during the Nasdaq Global Select Market. Mr. Cho has been appointedsix months ended June 30, 2022, we have recorded $0.4 million in construction in progress representing construction advisory services provided to serve as a member on the Compensation Committee and Nominating and Governance Committee of the Board. As a director of the Company, Mr. Cho will receive compensation in the same manner as the Company’s other non-employee directors and will enter into the Company’s standard indemnification agreement for directors.us by Related.

(16)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

NOTE 12.11. OPERATING LEASES AND COMMITMENTS

The Company has entered into non-cancelable operating lease agreements for office space and clinical spacecenters expiring at various times through 20312033. The operating lease agreements have renewal options ranging from one to seven years. Future minimum rental payments under these lease agreements, including renewal options which are considered reasonably certain of exercise and inclusive of leases which have not yet commenced, consisted of the following at SeptemberJune 30, 2021:2022 (in thousands):

 

Amount

 

 

Amount

 

Remainder of 2021

 

$

2,082

 

2022

 

 

8,610

 

Remainder of 2022

 

$

6,366

 

2023

 

 

7,542

 

 

 

14,640

 

2024

 

 

7,067

 

 

 

14,854

 

2025

 

 

6,685

 

 

 

14,568

 

2026

 

 

13,814

 

Thereafter

 

 

35,640

 

 

 

152,394

 

Total

 

$

67,626

 

 

$

216,636

 

Rent expense, including other related expenses for property taxes, salesales taxes, and utilities, was approximately $2.83.8 million and $4.48.1 million forduring the three and ninesix months ended SeptemberJune 30, 2021,2022, respectively, and $575,0000.7 million and $1,501,0001.4 formillion during the three and ninesix months ended SeptemberJune 30, 2020,2021, respectively. Rent expense is included in Corporate Generalgeneral and Administrative Expenses on the unauditedadministrative expenses and in cost of care in our condensed consolidated statements of operations.

(31)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

NOTE 13.12. INCOME TAXES

Prior to the completion of the Business Combination, CMG was a limited liability company and treated as a partnership for federal and state income tax purposes. A partnership is not a tax-paying entity for federal and state income tax purposes, and as such, the results of operations were allocated to the members for inclusion in their income tax returns. Following the Business Combination, the income of CMG will flowflows through to the Company and will beis taxed at the federal and state levels accordingly.

 

Income tax expense forprovision was $0.2 million and $0.4 million during the three and ninesix months ended SeptemberJune 30, 2021 was2022, respectively, and $0. during the three and six months ended June 30, 2021. The effective tax rate forwas (1.9)% and (1.4)% during the three and ninesix months ended SeptemberJune 30, 2021 was2022, respectively, and 0.0% during the three and six months ended June 30, 2021, based on the determination thatassessment of a full valuation allowance, was recorded.excluding a portion attributable to a "naked credit" deferred tax liability.

NOTE 14.13. COMMITMENTS AND CONTINGENCIES

Compliance

The health care industry is subject to numerous laws and regulations of federal, state, and local governments. These laws and regulations include, but are not limited to, matters such as licensure, accreditation, government healthcare program participation requirements, reimbursement for patient services, and Medicare and Medicaid fraud and abuse. Recently, government activity has increased with respect to investigations and allegations concerning possible violations of fraud and abuse statuesstatutes and regulations by healthcare providers. Violations of these laws and regulations could result in expulsion from government healthcare programs together with imposition of significant fines and penalties, as well as significant repayments for patient services billed. Compliance with these laws and regulations, specifically those related to the Medicare and Medicaid programs, can be subject to government review and interpretation, as well as regulatory actions unknown and not yet asserted at this time. Management believes that the Company is in substantial compliance with current laws and regulations.

Litigation

The Company is involved in various legal actions arising in the normal course of business. In consultation withManagement has not identified any legal counsel, management estimatesactions during the three and six months ended June 30, 2022 that these matters willwere deemed to be resolved without material adverse effectmaterial.

NOTE 14. VARIABLE INTEREST ENTITIES

Medical Care of NY, P.C. and Medical Care of Tennessee, PLLC (together, the "PCs") were established in 2022 to employ healthcare providers to deliver healthcare services to patients in New York and Tennessee. The Company concluded that it has variable interest in the PCs on the Company’s financial position.basis of its Administrative Service Agreements (the "ASAs") which provide for a

NOTE 15. SUBSEQUENT EVENTS

(17)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

management fee payable to the Company from the PCs in exchange for providing management and administrative services which creates risk and a potential return to the Company. The PCs' equity at risk, as defined by GAAP, is insufficient to finance their activities without additional support, and therefore, the PCs are considered to be VIEs.

In order to determine whether the Company has a controlling financial interest in the PCs, and, thus, is the PCs' primary beneficiary, the Company considered whether it has (i) the power to direct the activities of PCs that most significantly impacts their economic performance and (ii) the obligation to absorb losses of the PCs or the right to receive benefits from the PCs that could potentially be significant to them. The Company has evaluated subsequent events throughconcluded that the dateshareholder and employees of the Original Filing,PCs have no individual power to direct activities of the PCs that most significantly impact their economic performance. Under the ASAs, the Company is responsible for providing services that impact the growth of the patient population of the PCs, the management of that population's healthcare needs, the provision of required healthcare services to those patients, and determined that there have been no events that have occurred that would require adjustmentsthe PCs' ability to our disclosuresreceive revenue from health plans. In addition, the Company's variable interest in the condensed consolidated financial statements.PCs provides the Company with the right to receive benefits that could potentially be significant to them. The single member of the PCs is an employee of the Company. Based on this analysis the Company concluded that it is the primary beneficiary of the PCs and therefore consolidates the balance sheet, results of operations and cash flow of the PCs.

(32)

The following tables summarize financial position and operations of the PCs (in thousands):

 

June 30, 2022

 

December 31, 2021

 

Total assets

$

1,357

 

$

-

 

Total liabilities

$

1,749

 

$

-

 

 

Three Months Ended June 30, 2022

 

Six months Ended June 30, 2022

 

Revenues

$

-

 

$

-

 

Operating expenses

$

392

 

$

392

 

Net loss

$

(392

)

$

(392

)

(18)


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

 

Unless the context otherwise requires, references in this section to CareMax,“CareMax,” “we,” “us,” “our,” and the “Company” refers to CareMax, Inc. together with its consolidated subsidiaries. The following discussion and analysis summarizes the significant factors affecting the consolidated operating results, financial condition, liquidity, capital resources and cash flows of our company as of and for the periods presented below. The following discussion and analysis should be read in conjunction with our unaudited condensed consolidated financial statements and the related notes thereto included elsewhere in this Quarterly Report on Form 10-Q/A10-Q (the “Report”).

 

Forward-Looking Statements

 

This Report contains forward-looking statements that are based on the beliefs of management, as well as assumptions made by, and information currently available to, our management. The words “anticipate,” “believe,” “plan,” “expect,” “may,” “could,” “should,” “project,” and similar expressions may identify forward-looking statements, but the absence of these words does not mean that a statement in not forward-looking. Actual results could differ materially from those discussed in these forward-looking statements.

Factors that could cause or contributestatements due to such differences include,a variety of risks and uncertainties and other factors, including, but are not limited to those identified below,contained in Item 2 of thisour Annual Report and those set forth in the Company's Registration Statement on Form S-1,10-K for the year ended December 31, 2021 (the “Annual Report”), which was filed with the SECSecurities and Exchange Commission (the “SEC”) on June 30, 2021 (the "Registration Statement")March 16, 2022, under the caption “Risk Factors.” Some ofFactors” and, the risks and uncertainties we face include:following:

the impact of the COVID-19 pandemic or any other pandemic, epidemic or outbreak of an infectious disease in the United States or worldwide on our business, financial condition and results of operation;
our ability to grow and manage growth profitably, maintain relationships with customers, compete within its industry and retain our key employees;
our ability to integrate the businesses of CareMax Medical Group, L.L.C., a Florida limited liability company (“CMG”),CMG, IMC, Medical Group Holdings, LLC, a Delaware limited liability company (“IMC”),SMA, DNF, Advantis and Senior Medical Associates, LLC, a Florida limited liability company, and Stallion Medical Management, LLC, a Florida limited liability company (collectively, “SMA”), and, the assets of Unlimited Medical Services of Florida, LLC, a Florida limited liability company, d/b/a DNF Medical Centers (“DNF”);other acquisitions;
our ability to complete acquisitions and to open new medical centers and the timing of such acquisitions and openings;
the viability of our growth strategy, including both organic and de novo growth and growth by acquisition, and our ability to realize expected results, as well as our ability to access the capital necessary for such growth;
our ability to attract new patients;
the dependence of our revenue and operations on a limited number of key payors;
the risk of termination, non-renewal or renegotiation of the Medicare Advantage (“MA”) contracts held by the health plans with which we contract, or the termination, non-renewal or renegotiation of our contracts with those plans;
the impact on our business from changes in the payor mix of our patients and potential decreases in our reimbursement rates;
our ability to manage our growth effectively, execute our business plan, maintain high levels of service and patient satisfaction and adequately address competitive challenges;
the impact of restrictions contained in certain of our agreements on our current and future operations;
competition from primary care facilities and other healthcare services providers;
competition for physicians and nurses, and shortages of qualified personnel;
the impact on our business of reductions in Medicare reimbursement rates or changes in the rules governing the Medicare program, including the MA program;program and other programs governing accountable care organizations;
the impact on our business of state and federal efforts to reduce Medicaid spending;

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a shift in payor mix to Medicare payors as well as an increase in the number of Medicaid patients may result in a reduction in the average rate of reimbursement;
our assumption under most of our agreements with health plans of some or all of the risk that the cost of providing services will exceed our compensation;

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risks associated with estimating the amount of revenues and refund liabilities that we recognize under our risk agreements with health plans;
the impact on our business of security breaches, loss of data, or other disruptions causing the compromise of sensitive information or preventing us from accessing critical information;
the impact of our existing or future indebtedness and any associated debt covenants on our business and growth prospects;
the impact on our business of disruptions in our disaster recovery systems or management continuity planning;
the potential adverse impact of legal proceedings and litigation;
the impact of reductions in the quality ratings of the health plans we serve;
our ability to maintain and enhance our reputation and brand recognition;
our ability to effectively invest in, implement improvements to and properly maintain the uninterrupted operation and data integrity of our information technology and other business systems;
our ability to obtain, maintain and enforce intellectual property protection for our technology;
the potential adverse impact of claims by third parties that we are infringing on or otherwise violating their intellectual property rights;
our ability to protect the confidentiality of our trade secrets, know-how and other internally developed information;
the impact of any restrictions on our use of or ability to license data or our failure to license data and integrate third-party technologies;
our ability to protect data, including personal health data, and maintain our information technology systems from cybersecurity breaches and data leakage;
our ability to adhere to all of the complex government laws and regulations that apply to our business;
our reliance on strategic relationships with third-parties to implement our growth strategy;
the impact on our business if we are unable to effectively adapt to changes in the healthcare industry, including changes to laws and regulations regarding or affecting U.S. healthcare reformreform;
that estimates of market opportunity and forecasts of market and revenue growth included in this Quarterly Report may prove to be inaccurate, if at all;
our operating results and stock price may be volatile;
risks associated with estimating the amount of revenues that we recognize under our risk agreements with health plans;
our ability to navigate rules and regulations that govern our licensing and certification, as well as credentialing processes with private payors, before we can receive reimbursement for their services.services;

our ability to develop and maintain proper and effective internal control over financial reportingreporting; and
the Steward Transaction may not occur, and if it does, it may not be accretive and may cause dilution to our earnings per share, which may negatively affect the market price of our common stock.

Due to the uncertain nature of these factors, management cannot assess the impact of each factor on the business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements.

 

Any forward-looking statement speaks only as of the date on which statement is made, and we undertake no obligation to update any of these statements or circumstances occurring after the date of this Report. New factors may emerge, and it is not possible to predict all factors that may affect our business and prospects.

 

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Our Business

 

As of June 30, 2022, CareMax is a technology-enabled care platform providing high-quality, value-based care and chronic disease management through physicians and health care professionals committed to the overall health and wellness continuum of care for its patients. The Company is an at-risk primary-care provider contracted by MA and Medicaid plans to provide care to patients in Florida, which is one of the largest and fastest growing Medicare and dual-eligible markets in the US. We have embarked on a plan to expand our business nationwide – see - Expand our Center Base within Existing and New Markets. CareMax operates a growing network of physicians and multi-specialty medical and wellness centers. The Company utilizes a high touch, comprehensive approach to primary care for patients that incorporates both high quality clinical service and the integration of technology and data analytics to manage patient’s healthcare. By proactively managing patient’s health and working to impact patient wellbeing prior to acute healthcare episodes, the Company is able to maintain high patient satisfaction while also helping to reduce unnecessary healthcare expenses. The Company is able to benefit from this dynamic through value-based payor contracts that provide the Company with the opportunity to participate in performance bonuses and surplus sharing agreements. The Company currently operates 40 medicaloperated 48 centers in Florida, Tennessee and plansNew York and planned to open at least fifteen medical15 de novo centers induring 2022, inclusive of the three opened during the first half of 2022. CareMax offers a comprehensive range of medical services, including primary and preventative care, specialist services, diagnostic testing, chronic disease management and dental and optometry services under global capitation contracts.

CareMax also has a Management Services Organization/Independent Physician Association (“MSO" or "IPA”), arm Managed Healthcare Partners (“MHP”), that provides managerial support to physicians, allowing them to devote more time to patient care and less time to back-office activities. Through such services, physicians can benefit from the economies of scale, efficient specialty network and negotiated utilization network, dental and optometry services, technology, coding, quality support and overall infrastructure that CareMax and MHP have tirelessly built to better serve its network of independent physicians. CareMax has also developed a proprietary platform called CareOptimize that assists the care team in aggregating and curating data from across the care continuum. The CareOptimize platform uses a rules engine, powered by machine learning and artificial intelligence, to manifest cost, quality, and clinical data points at point of care during visits and between visits.

 

CareMax takes a “whole person health”CareMax’s comprehensive, high touch approach to health care delivery is powered by its CareOptimize technology platform. CareOptimize is a proprietary end-to-end technology platform that aggregates data and analyzes that data using proprietary algorithms and machine learning to support more informed care delivery decisions and to focus care decisions on preventative chronic disease management and the social determinants of health. CareMax believes that CareOptimize is designed to drive better outcomes and lower costs. CareMax has shifted from selling the CareOptimize platform to new outside customers for a software subscription fee and is instead focused on providing the software to affiliated practices of its managed services organization ("MSO") to further improve financial, clinical and quality outcomes from the affiliated providers. As of June 30, 2022, this MSO serviced more than 100 independent physician associations ("IPAs").

CareMax’s centers offer 24/7 access to care through employed providers and provide a comprehensive suite of high-touch health care and social services to its patients, including primary care, that goes abovespecialty care, telemedicine, health & wellness, optometry, dental, pharmacy and beyond the standard levelstransportation. CareMax’s differentiated healthcare delivery model is focused on care coordination with vertically integrated ambulatory care and community-centric services. The goal of care. In additionCareMax is to traditional medical services, the Company’s medical centers helpintercede as early as possible to manage chronic conditions for its patient members achievein a proactive, holistic, and maintain healthier lives with wellness engagement initiatives focused on:tailored manner to provide a positive influence on patient outcomes and a reduction in overall healthcare costs. CareMax focuses on providing access to high quality care in underserved communities.

preventive medicine;
exercise programs;
nutritional best practices;
fall prevention for seniors;
diabetes education, prevention and control;
Medicaid eligibility assistance;
social service application and eligibility assistance; and
transportation to and from appointments.

 

While CareMax’s primary focus is providing care to Medicare eligible seniors who are mostly 65+ (80%(approximately 81% and 73% of revenue for the ninesix months ended SeptemberJune 30, 2022 and 2021, respectively, came from these patients), we also provide services to children and adults through Medicaid programs as well as through commercial insurance plans. Substantially all of CareMax’s Medicare patients are enrolled in MA plans which are run by private insurance companies and are approved by and under contract with Medicare. With MA, patients get all of the same coverage as original Medicare, including emergency care, and most plans also include prescription drug coverage. In many cases, MA plans offer more benefits than original Medicare, including dental, vision, hearing and wellness programs.

We believe we can translate the above premium services into economic benefits. By focusing on interventions that keep our patients healthy, we can capture the cost savings that our care model creates and reinvest them further in our care model. We believe these investments lead to better outcomes and improved patient experiences, which will drive further cost savings, power patient retention and enable us to attract new patients. We believe increasing cost savings over a growing patient population will deliver an even greater surplus to the organization, enabling us to reinvest to scale and fund new centers, progress our care model and enhance our technology.

(35)Pending Steward Transaction


 

ComparabilityIn May 2022, the Company entered into an Agreement and Plan of Financial Results

Restatement

Management’s Discussion and Analysis of Financial Condition and Results of Operations have been updated to reflect the effects of the restatement described in Note 2 to our Condensed Consolidated Financial Statements in Part I, Item 1 included in this Quarterly Report on Form 10-Q/A.

On June 8, 2021, we consummated the transactions contemplated by that certain Business Combination Agreement, dated December 18, 2020Merger (the “Business Combination“Merger Agreement”), by and among CMG,(i) the entities listed in AnnexCompany, (ii) Sparta Merger Sub I toInc., a Delaware corporation and wholly-owned subsidiary of the Business Combination Agreement (the “CMG Sellers”)Company, (iii) Sparta Merger Sub II Inc., IMC, IMC Holdings, LP,a Delaware corporation and wholly-owned subsidiary of the Company, (iv) Sparta Merger Sub III Inc., a Delaware corporation and wholly-owned subsidiary of the Company, (v) Sparta Merger Sub I LLC, a Delaware limited partnership (“IMC Parent”liability company and wholly-owned subsidiary of the Company, (vi) Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company, (vii) Sparta Merger Sub III LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company, (viii) Sparta Sub Inc., a Delaware corporation ("SACN Holdco"), (ix) SNCN Holdco Inc. a Delaware corporation ("SNCN Holdco"), (x) SICN Holdco Inc., a Delaware corporation ("SICN Holdco" and, collectively with SACN Holdco, SNCN Holdco, Steward National Care Network, Inc., Steward Integrated Care Network, Inc., and Steward Accountable Care Network, Inc., each a "target" and, collectively, the "Targets"), (xi) Sparta Holding Co. LLC, a Delaware limited liability company (the “Seller”), and Deerfield Partners, L.P. (“Deerfield Partners”(xii) Steward Health Care System LLC, a Delaware limited liability company (referred to collectively with the Seller, the “Seller Parties”), pursuant to which on June 8, 2021 (the “Closing Date”), DFHT acquired 100%the Company will acquire the Medicare value-based care business of the equity interests of CMG and 100% ofSeller Parties (such transaction, the equity interests in IMC, with CMG and IMC becoming wholly owned subsidiaries of DFHT. Immediately upon completion (the “Closing”“Steward Transaction”) of the transactions contemplated by the Business Combination Agreement and the related financing transactions (the “Business Combination”), the name of the combined company was changed to CareMax, Inc. CMG was determined to be the accounting acquirer in the Business Combination. Accordingly, the acquisition of CMG by the Company was accounted for as a reverse recapitalization. Under this method of accounting, the Company was treated as the acquiree for financial reporting purposes. The net assets of the Company were stated at their historical cost, with no goodwill or other separately identifiable intangible assets recorded. The balance sheet, results of operations and cash flows prior to the Business Combination are those of CMG. Further, CMG was determined to the accounting acquirer of IMC and the acquisition of IMC (the “IMC Acquisition”) was accounted for in accordance with FASB ASC Topic 805, .Business Combinations (“ASC 805”) as a business combination. Accordingly, the IMC assets acquired, including separately identifiable intangible assets, and liabilities assumed were recorded at their fair value as of the Closing Date. The IMC Acquisition drove, among other things, increases of $5.8 million in Property and Equipment, $30.8 million in amortizable intangible assets and $302.2 million in goodwill as of September 30, 2021, compared to our balance sheet as of December 31, 2020. The amortization of the acquired intangibles is expected to materially increase our noncash amortization expense for the foreseeable future.

 

In connection withThe aggregate consideration to be paid to the Business Combination, we (i) issuedSeller at closing includes cash payment of $25 million, subject to customary adjustments, and sold in a private placement an aggregate23,500,000 shares, subject to adjustment, of 41,000,000 shares ofthe Company's Class A Common Stock, (ii) issued 10,796,069 shares of Class A Common Stock to the CMG Sellers, and 10,412,023 shares of Class A Common Stock to IMC Parent (See Note 1 to the Condensed Consolidated Financial Statements) and entered into the Credit Agreement. The Credit Agreement provides for credit facilities (collectively, the "Credit Facilities"), including (i) initial term loans in the aggregate principal amount of $125.0 million, which was fully drawn on the closing date to finance the Business Combination, (ii) a revolving credit facility in an aggregate principal amount of $40.0 million (the “Revolving Credit Facility”) and (iii) a delayed term loan facility in an aggregate principal amount of $20.0 million (the “Delayed Draw Term Loan”) (See Note 7 to the Condensed Consolidated Financial Statements - Credit Agreement). Interest and other costs associated with the Credit Facilities is expected to materially increase our interest expense for the foreseeable future.common stock, $0.0001 par value per

 

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share ("Class A Common Stock"). In connection withaddition, the Merger Agreement provides for earnout share consideration that will be due to the Seller upon achievement of certain milestones. At closing, the Company will also issue to certain equityholders of the Seller shares of a newly designated series of preferred stock of the Company, which will provide voting rights to such Seller equityholders, until the earlier of (i) the two year anniversary of the closing of the Business Combination,Steward Transaction and (ii) the issuance of earnout share consideration on certain discrete matters where such Seller equityholders are permitted to vote the Company's securities in their discretion under the investor rights agreement to be entered into between such equityholders of the Seller and the Company. Finally, at closing, the Company repaid all outstanding borrowings under CMG's Loan Agreement, which was terminated onwill also pay the Closing Date (See Note 7Seller an amount equal to the Condensed Consolidated Financial Statements - CMG Loan Agreement)value of the Target's accounts receivable attributable to Medicare value-based payments for the period between January 1, 2021 and the closing, minus the amount of such payments payable to the affiliate physicians of the Targets, and subject to an advance rate that the Company’s lenders may finance (the “Financed Net Pre-Closing Medicare AR”). In order to fund the Financed Net Pre-Closing Medicare AR payment, the Company may draw all or part of the delayed draw term loans under its existing Credit Agreement, dated May 10, 2022 (the “Credit Agreement”), or the Company may secure alternative financing as permitted under the Credit Agreement.

 

In addition, as a resultThe Steward Transaction is subject to customary closing conditions, including approval by the Company's stockholders for purposes of compliance with the rules of the Business Combination, we have had to hire personnelNasdaq Stock Market LLC and incur costs that are necessary and customary for our operations as a public company, which has contributed and is expected to continue contributing to higher corporate, general and administrative costs in the near term.receipt of regulatory approvals.

 

OnDuring the three and six months ended June 18, 2021,30, 2022, we completed thehave recognized $2.8 million of acquisition of SMA (the "SMA Acquisition") (See Note 3costs related to the Condensed Consolidated Financial Statements - Acquisition of SMA Entities). The SMA Acquisition was accounted for as a business combination. Accordingly, the SMA assets acquired,pending Steward Transaction. We will continue to incur acquisition costs, including separately identifiable intangible assets, and liabilities assumed were recorded at their fair value as of June 18, 2021. The SMA Acquisition drove, among other things, increases of $100,000 in Property and Equipment, $7.8$8 million in amortizable intangible assets and $45.8fees to a financial advisor, payment of $3 million in goodwill as of September 30, 2021, compared to our balance sheet as of December 31, 2020. The amortizationwhich is contingent upon closing of the acquired intangiblesSteward Transaction, and payment of $5 million of which is expected to materially increase our noncash amortization expense forcontingent upon payment of the foreseeable future.

On September 1, 2021, we completed the acquisition of DNF (the “DNF Acquisition”) (See Note 3earnout share consideration to the Condensed Consolidated Financial Statements - Acquisition of DNF). The DNF Acquisition was accounted for as a business combination.Seller Parties. We will reflect this $8 million fee in our financial statements during the period in which the Steward Transaction closes.

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Accordingly, the DNF assets acquired, including separately identifiable intangible assets, and liabilities assumed were recorded at their fair value as of September 1, 2021. The DNF Acquisition drove, among other things, increases of $3.4 million in Property and Equipment, $14.7 million in amortizable intangible assets and $92.2 million in goodwill as of September 30, 2021, compared to our balance sheet as of December 31, 2020. The amortization of the acquired intangibles is expected to materially increase our noncash amortization expense for the foreseeable future.

The following discussion includes our results of operations for the three months ended September 30, 2021 include the results of operations for the full quarter for CMG, IMC and SMA and the results of operations of DNF from September 1, 2021 through September 30, 2021. For the nine months ended September 30, 2021, our results of operations include the full period for CMG, results of operations of IMC from June 8, 2021 through September 30, 2021, results of operations from SMA from June 18, 2021 through September 30, 2021 and the results of operations of DNF from September 1, 2021 through September 30, 2021. Accordingly, our consolidated results of operations for prior periods are not comparable to our consolidated results of operations for prior periods and may not be comparable with our consolidated results of operations for future periods.

Key Factors Affecting Our Performance

Acquisitions

We account for our acquisitions in accordance with FASB ASC Topic 805, Business Combinations, and the operations of the acquired entities are included in the historical results of CareMax for the periods following the closing of the acquisition. The most significant of these acquisitions impacting the comparability of CareMax’s operating results in the three and nine months ended September 30, 2021, as compared to the three and nine months ended September 30, 2020 were IMC on June 8, 2021 in connection with the Business Combination with IMC. See to Note 3 to the Condensed Consolidated Financial Statements for additional information regarding CareMax’s acquisitions.

 

Our Patients

 

As discussed above, the CompanyCareMax partners with Medicare Advantage,MA, Medicaid, and commercial insurance plans. While CareMax currently services mostly MA patients, we also accept Medicare Fee-for-Service (FFS) patients. The chart below shows a breakdown of our current membership on a pro forma basis. This pro forma view assumes the Business Combination with IMC occurred on January 1, 2020 and areis based upon estimates which we believe are reasonable:

Patient Count as of*

March 31, 2020

 

June 30, 2020

 

September 30, 2020

 

December 31, 2020

 

March 31, 2021

 

June 30, 2021

 

September 30, 2021

 

Jun 30, 2020

 

Sep 30, 2020

 

Dec 31, 2020

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 30, 2022

 

Medicare

 

15,500

 

15,500

 

16,500

 

16,500

 

16,500

 

21,500

 

26,500

 

 

15,500

 

16,500

 

16,500

 

16,500

 

21,500

 

26,500

 

33,500

 

34,000

 

37,000

 

Medicaid

 

12,500

 

22,500

 

22,500

 

21,000

 

23,000

 

23,500

 

24,500

 

 

22,500

 

22,500

 

21,000

 

23,000

 

23,500

 

24,500

 

28,000

 

28,500

 

29,500

 

Commercial

 

15,500

 

13,500

 

15,000

 

14,500

 

15,000

 

17,500

 

17,500

 

 

13,500

 

 

15,000

 

 

14,500

 

 

15,000

 

 

17,500

 

 

17,500

 

 

21,500

 

 

21,500

 

 

21,500

 

Total Count

 

43,000

 

51,500

 

54,000

 

52,000

 

54,500

 

62,500

 

68,500

 

 

51,500

 

 

54,000

 

 

52,000

 

 

54,500

 

 

62,500

 

 

68,500

 

 

83,500

 

 

84,000

 

 

88,000

 

*Figures may not sum due to rounding

Because CareMax accepts multiple insurance types, it uses a Medicare-Equivalent Member (“MCREM”) value in reviewing key factors of its performance. To determine the Medicare-Equivalent, CareMax calculates the amount of support typically received by one Medicare patient as equivalent to the level of support received by three Medicaid or Commercial patients. This is due to Medicare patients on average having significantly higher levels of chronic and acute conditions that need higher levels of care. Due to this dynamic, a 3:1 ratio is applied when normalizing membership statistics year over year. The breakdown of membership on a pro forma basis using MCREM is below:

MCREM Count as of*

March 31, 2020

 

June 30, 2020

 

September 30, 2020

 

December 31, 2020

 

March 31, 2021

 

June 30, 2021

 

September 30, 2021

 

Jun 30, 2020

 

Sep 30, 2020

 

Dec 31, 2020

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 20, 2022

 

Medicare

 

15,500

 

15,500

 

16,500

 

16,500

 

16,500

 

21,500

 

26,500

 

 

15,500

 

16,500

 

16,500

 

16,500

 

21,500

 

26,500

 

33,500

 

34,000

 

37,000

 

Medicaid

 

4,200

 

7,400

 

7,500

 

7,000

 

7,600

 

7,900

 

8,100

 

 

7,400

 

7,500

 

7,000

 

7,600

 

7,900

 

8,100

 

9,400

 

9,400

 

9,900

 

Commercial

 

5,100

 

4,600

 

5,000

 

4,900

 

5,100

 

5,900

 

5,800

 

 

4,600

 

 

5,000

 

 

4,900

 

 

5,100

 

 

5,900

 

 

5,800

 

 

7,200

 

 

7,200

 

 

7,100

 

Total MCREM

 

24,800

 

27,500

 

29,000

 

28,400

 

29,200

 

35,300

 

40,400

 

 

27,500

 

 

29,000

 

 

28,400

 

 

29,200

 

 

35,300

 

 

40,400

 

 

50,100

 

 

50,600

 

 

54,000

 

*Figures may not sum due to rounding

Medicare Advantage Patients

 

As of SeptemberJune 30, 2021,2022, CareMax had approximately 26,500 Medicare Advantage37,000 MA patients of which 95%88% were in value-based, or risk-based, agreements.contracts. This means CareMax has been selected as the patient’s primary care provider and is financially responsible for all of

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the patient’s medical costs, including but not limited to emergency room and hospital visits,

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post-acute care admissions, prescription drugs, specialist physician spend (e.g., orthopedics) and primary care spend.costs. For these patients CareMax is attributed an agreed percentage of the premium the MA plan receives from the Centers for Medicare and Medicaid Services (“CMS”) (typically a substantial majority of such premium given the risk assumed by the Company)CareMax). CareMax’s value proposition to these patients and their MA plan is to improve these patients’ health and reduce these patients’ healthcare costs by providing a more comprehensive patient experience via the CareMax system, whereby CareMax has invested more heavily in primary care to avoid more expensive downstream costs, such as hospital admissions. Because CareMax is at-risk for the entirety of a patient’s medical expense, investing more heavily in preventative primary care makes economic sense given the relative costs to acute, episodic hospital-based care. CareMax is not delegated for claims payments and therefore does not receive the agreed percentage of premiums from the MA plan nor does it pay claims. A reconciliation is performed periodically and if premiums exceed medical costs paid by the MA plan, CareMax receives payment from the MA plan. If medical costs paid by the MA plan exceed premiums, CareMax is responsible to reimburse the MA plan.

 

Because plan premiums are enhanced when a contracted plan achieves high quality scores (STARS program), it is important for CareMax to deliver high quality of care to its members. Through its data analytics and outreach programs, IMC has achieved the highest quality rating possible, 5 STARS, for each of the last two years.

Medicare provides an annual enrollment period during the fall of each year to allow patients to select an MA program or traditional Medicare, with only limited ability for patients to make that selection during other periods of the year. Once patients have selected MA, they can change the selection of their primary care provider at any time. Accordingly, while the annual enrollment period is important to us, CareMax is able to attract new patients at any time during the year from the existing pool of MA patients and we must work to retain our patients throughout the year.

Medicaid Patients

 

As of SeptemberJune 30, 2021,2022, CareMax had approximately 24,50029,500 Medicaid patients of which approximately 96%93% were in value-based contracts. Using the MCREM metric, the level of support required to manage these Medicaid patients equates to that of approximately 8,1009,900 Medicare patients. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts of which CareMax accepts one: Managed Medical Assistance (“MMA”). This program provides covered medical services like doctors visits, hospital care, prescription drugs, mental health care, and transportation to these recipients. Most recipients on Medicaid will receive their care from a plan that covers MMA services. CareMax contracts with a majority of the plans that cover MMA patients in our service area.

 

Similar to the risk it takes with Medicare, CareMax is attributed an agreed percentage of the premium the Medicaid plan receives from Florida’s Agency for Health Care Administration (“AHCA”) (typically a substantial majority of such premium given the risk assumed by the Company)CareMax). Its value proposition to these patients and their Medicaid plan is to improve these patients’ health and reduce these patients’ healthcare costs by providing a more comprehensive patient experience via the CareMax system, whereby we invest more heavily in primary care to avoid more expensive downstream costs, such as hospital admissions. Because CareMax is at-risk for the entirety of a patient’s medical expense, investing more heavily in preventative primary care makes economic sense given the relative costs to acute, episodic hospital-based care. CareMax is not delegated for claims payments and therefore does not receive the agreed percentage of premiums from the Medicaid plan nor does it pay claims. A reconciliation is performed periodically and if premiums exceed medical costs paid by the Medicaid plan, CareMax receives payment from the Medicaid plan. If medical costs paid by the Medicaid plan exceed premiums, we are responsible to reimburse the Medicaid plan.

 

AHCA provides an annual enrollment period during the fall of each year to allow patients to select a Medicaid plan with only limited ability for patients to make that selection during other periods of the year. Although every enrolling Medicaid patient has the option to select a health plan, most patients do not and are auto assigned to the plans using AHCA’s methodology. Once patients are assigned to a Medicaid plan, they can change the selection of their primary care provider at any time. In the enrollment process, most Medicaid patients do not select a primary care provider and rely on the auto-assignment logic the plan has in place. CareMax leverages its ability to manage risk and provide the highest level of quality care to request their providers be in the top tier of the plan’s auto assignment logic. While the annual enrollment period is important, CareMax is able to attract new at-risk patients at any time during the year from the existing pool of Medicaid patients and we must work to retain our patients throughout the year.

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Commercial Patients

 

As of SeptemberJune 30, 2021,2022, CareMax managed approximately 17,50021,500 commercial patients of which 37%approximately 27% were under a value-based arrangementcontracts that provided upside onlyupside-only financial incentives for quality and utilization performance. Using the MCREM, the level of support required to manage these commercial patients equates to that of approximately 5,8007,100 Medicare patients. CareMax accepts the following insurance policies under commercial insurance: patients covered by the ACA, Florida Healthy Kids and other individual or group insurance coverage. The ACA represent 94% of the patients in this category.

 

For the patients that are under upside only arrangements, CareMax is initially compensated a contractually agreed upon flat capitation per patient per month (“PPPM”) rate for primary care services and care coordination. Like the risk it takes on Medicare, a reconciliation is performed periodically and if premiums exceed medical costs paid by the commercial plan, CareMax receives a percentage of the savings from the commercial plan. However, if medical costs paid by the commercial plan exceed premiums, CareMax is not responsible to reimburse the commercial plan. Because the risk is limited to savings generated by better utilization of medical services, CareMax does not recognize these premiums as “at-risk” premiums, nor does CareMax recognize the medical expenses. Instead, CareMax records the capitation amount and any upside as other revenue. CareMax also accrues any quality bonuses as other revenue as well.

CareMax counts fee-for-service patients as those that have been assigned by a Health Plan to one of its centers. A fee-for-service patient remains active until CareMax is informed by the Health Plan the patient is no longer active. CareMax cares for a number of commercial patients (approximately 23%15% of the Company’sCareMax's total patients) for whom it is reimbursed on a fee-for-service basis via their health plan in situations where it does not have a capitation relationship with that particular health plan.

 

CareMax fee for-service revenue, received directly from commercial plans, on a per patient basis is lower than its per patient revenue for at-risk patients basisbased in part because its fee-for-service revenue covers only the primary care services that it directly provides to the patient, while the risk revenue is intended to compensate it for the services directly performed by it as well as the financial risk that it assumes related to the third-party medical expenses of at-risk patients.

 

Our historical financial performance has been, and we expect our financial performance in the future to be, driven by our ability to:

Add New Patients in Existing Centers

We believe our ability to add new patients is a key indicator of the market’s recognition of the attractiveness of our care model, both to our patients and payor partners, and a key growth driver for the business. We have a largely embedded growth opportunity within our existing center base. With an average capacity of 1,750 patients, our 40 centers as of September 30, 2021 can support approximately 70,000 MCREM patients, and if we include the two centers scheduled to open in 2022, capacity increases to 73,000 MCREM patients. As we add patients to our existing centers, we expect these patients to contribute incremental economics to CareMax as we leverage our fixed cost base at each center. The additional de novo centers we expect to open in 2022 will also increase our capacity.

We utilize a proactive strategy to drive growth to our centers. We employ a grassroots approach to patient engagement led by our Outreach Team and supplemented by more traditional marketing, including digital and social media, print, mail and telemarketing. We leverage our Outreach Team to ensure we are connecting with Medicare-eligible patients across a number of channels to make them aware of their healthcare choices and the services we offer. These efforts have historically included hosting events within our centers and participating in community events. Each of our centers has a community room, a space designated and available for our patients’ use whenever the center is open. We also utilize this space to provide fitness and health education classes to our patients and often open up events to any older adults in the community regardless of their affiliation. During the global pandemic, we have leveraged our community centers as extra waiting room space as needed which allowed easier social distancing for patients or their companions. We are continuing to leverage our community-based marketing approach with less focus on in-person interactions and more focus on working with our community partners to identify older adults who need our services. It is our belief that the enhanced awareness of the importance of managing chronic illnesses as well as patient varied preferences on preferred method to interact with providers will continue to drive demand for CareMax’s services amongst older adults. We believe our marketing efforts lead to increased awareness of CareMax and to additional patients choosing us as their primary care provider, regardless of whether that patient is covered under MA or traditional Medicare. We believe that our outreach efforts also help to grow our payor partners’ membership base as we grow our own patient base and help educate patients about their choices on Medicare, further aligning our model with that of healthcare payors.

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Our payor partners will also direct patients to CareMax. They do this either by assigning patients who have not yet selected a primary care provider to CareMax, or by insurance agents informing their clients about CareMax, which we believe often results in the patient selecting us as their primary care provider when they select an MA plan. Payors dedicate a large share of their internal efforts to reducing medical costs, and they have a nearly unlimited desire to engage with solutions proven to achieve that goal. Due to our care delivery model’s patient-centric focus, we have been able to consistently help payors manage their costs while raising the quality of their plans, affording them quality bonuses that increase their revenue. We believe that we represent an attractive opportunity for payors to meaningfully improve their overall membership growth in a given market without assuming any financial downside.

Patient Satisfaction

Once we bring on new patients, we focus on engagement around a care plan and satisfaction. The result is high patient satisfaction. Our model provides visibility on our financial and growth trajectory given the recurring nature of the revenue we collect from our MA partners once their members begin utilizing CareMax programs.

CMS allows for MA enrollees to be risk-adjusted in order to compensate the MA plan for the greater medical costs associated with sicker patients, so long as the health plan appropriately and accurately documents the patients’ health conditions. Often, our patients have not previously engaged with the healthcare system, and therefore their health conditions are poorly documented. Through our care model, we organically determine and assess the health needs of our patients and create a care plan consistent with those needs. We capture and document health conditions as a part of this process. We believe our model aligns best with the risk adjustment framework as we scale the clinical intensity of our care model based upon the needs of the individual patient—we invest more dollars and resources towards our sicker patients.

Expand our Center Base within Existing and New Markets

We believe that we currently serve approximately 2% of the total patients in the markets where we currently have centers. As a result, there is significant opportunity to expand in our existing markets through the acquisition of new patients to existing centers and the addition of new centers. For the long term, these strategically developed new sites allow us to access additional neighborhoods while leveraging our established brand and infrastructure in a market. The table below reflects statistics of our current centers on a pro forma basis. This pro forma view assumes the Business Combination with IMC occurred on January 1, 2020 and are based upon estimates which we believe are reasonable.

 

March 31, 2020

 

June 30, 2020

 

September 30, 2020

 

December 31, 2020

 

March 31, 2021

 

June 30, 2021

 

September 30, 2021

 

Centers

 

21

 

 

21

 

 

22

 

 

24

 

 

24

 

 

34

 

 

40

 

Markets

 

1

 

 

1

 

 

1

 

 

1

 

 

1

 

 

1

 

 

1

 

Patients (MCREM)

 

24,800

 

 

27,500

 

 

29,000

 

 

28,400

 

 

29,200

 

 

35,300

 

 

40,400

 

At-risk

 

84.8

%

 

86.7

%

 

85.6

%

 

87.7

%

 

87.0

%

 

84.1

%

 

87.2

%

Fee for service

 

15.2

%

 

13.3

%

 

14.4

%

 

12.3

%

 

13.0

%

 

15.9

%

 

12.8

%

We estimate that the core addressable market for our services is approximately 1,279,000 Medicare eligible patients in our target demographic. We believe this market represents approximately $15.3 billion of annual healthcare expenditures based on multiplying an average annual revenue of $12,000 per member, which is derived from our experience and industry knowledge and which we believe represents a reasonable national assumption, by the number of Medicare eligible patients in our target markets. Our existing market today represent a small fraction of this massive market opportunity. Based upon our experience to date, we believe our innovative care model can scale nationally, and we therefore expect to selectively and strategically expand into new geographies. As we continue this expansion, our success will depend on the competitive dynamics in those markets, and our ability to attract patients and deploy our care model in those markets. Through CareOptimize’s clients, which are spread across more than 30 states, we already understand the healthcare dynamics in communities we are looking to expand to. This gives management a high degree of confidence that the CareMax care model can have similar clinical and financial outcomes as we have seen in South Florida in other locations.

Once we have identified a location for a new center, our typical center takes 6-12 months to open. Historically, our buildout costs have averaged approximately $90 per square foot, inclusive of licensing, center construction, center furnishing, and purchase of medical equipment and supplies, with roughly half covered by upfront capital expenditures and the balance covered by tenant improvement allowances, landlord or developer work and similar items. We typically enter into long-term triple-net leases with our landlords and do not own any real estate, enabling us to more quickly identify and build new centers with a capital efficient model.

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By adding new patients to our existing centers, retaining our existing patients, and strategically opening new centers in existing geographies, we have generated significant revenue growth over our competitors. We currently plan to continue pursuing further strategic acquisitions of medical centers in the future.

Contract with Payors

 

Our economic model relies on its capitated partnerships with payors which manage and market MA plans across the United States. CareMax has established strategic value-based relationships with eleven different payors for Medicare Advantage patients, four different payors for Medicaid patients and one payor for ACAAffordable Care Act ("ACA") patients. On a pro forma basis giving effect to the Business Combination with IMC as of January 1, 2020, ourOur three largest payor relationships were Anthem, Centene,Payor A, Payor B and United,Payor C, which generated 46%30%, 18% and 17%, 16% of our revenue, inrespectively, during the ninesix months ended SeptemberJune 30, 2022. During the six months ended June 30, 2021 respectively,our largest payor relationships were Payor A, Payor D, and 51%Payor E, which generated 47%, 16%18%, and 17% of our revenue inon a pro forma basis, assuming the nine months ended September 30, 2020, respectively.Business Combination with IMC occurred on January 1, 2021. These existing contracts and relationships with our partners’ understanding of the value of the CareMax model reduces the risk of entering into new markets as CareMax typically has payor contracts before entering a new market. Maintaining, supporting, and growing these relationships, particularly as CareMax enters new geographies,markets, is critical to our long-term success. We believe CareMax’s model is well-aligned with its payor partners - to drive better health outcomes for their patients, enhancing patient satisfaction, while driving incremental patient and revenue growth. This alignment of interests and its highly effective care model helps ensures our continued success with our payor partners.

 

Effectively Manage the Cost of Care for Our Patients

 

The capitated nature of our contracting with payors requires us to prudently manage the medical expense of our patients. Our external provider costs are our largest expense category, representing 65% of our total operating expenses for the ninesix months ended SeptemberJune 30, 2022 and 66% of our total operating expenses for the six months ended June 30, 2021. Our care model focuses on leveraging the primary care setting as a means of avoiding costly downstream healthcare costs, such as acute hospital admissions. Our patients retain the freedom to seek care at ERs or hospitals; we do not restrict their access to care. Therefore,

(23)


we could be liable for potentially large medical claims should we not effectively manage our patients’ health. We utilize stop-loss insurance for our patients, protecting us for medical claims per episode in excess of certain levels.

 

Center-Level Contribution Margin

 

We endeavor to expand our number of centers and number of patients at each center over time. Due to the significant fixed costs associated with operating and managing our centers, we generate significantly better center-level contribution margins as the patient base within our centers increases and our costs decrease as a percentage of revenue. As a result, the value of a center to our business increases over time.time when the number of patients at a center expands.

 

Seasonality to our Business

 

Due to the large number of dual-eligible patients (meaning eligible for both Medicare and Medicaid) we serve, the annual enrollment period does not materially affect our growth during the year. We typically see large increases in Affordable Care Act (“ACA”)ACA patients during the first quarter as a result of the ACA annual enrollment period (October to December). However, this is not a large portion of our business.

 

Our operational and financial results will experience some variability depending upon the time of year in which they are measured. This variability is most notable in the following areas:

 

Per-Patient Revenue

 

The revenue derived from our at-risk patients is a function of the percentage of premium we have negotiated with our payor partners, as well as our ability to accurately and appropriately document the acuity of a patient. We experience some seasonality with respect to our per-patient revenue, as it will generally decline over the course of the year. In January of each year, CMS revises the risk adjustment factor for each patient based upon health conditions documented in the prior year, leading to changes in per-patient revenue. As the year progresses, our per-patient revenue declines as new patients join us, typically with less complete or accurate documentation (and therefore lower risk-adjustment scores), and patient mortality disproportionately impacts our higher-risk (and therefore greater revenue) patients.

 

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External Provider Costs

 

External Provider Costsprovider costs will vary seasonally depending on a number of factors, but most significantly the weather. Certain illnesses, such as the influenza virus, are far more prevalent during colder months of the year, which can result in an increase in medical expenses during these time periods. We would therefore expect to see higher levels of per-patient medical costs in the first and fourth quarters. Medical costs also depend upon the number of business days in a period. Shorter periods will have lesser medical costs due to fewer business days. Business days can also create year-over-year comparability issues if one year has a different number of business days compared to another. We would also expect to experience an impact in the future should there be another pandemic such as COVID-19, which may result in increased or decreased total medical costs depending upon the severity of the infection, the duration of the infection and the impact to the supply and availability of healthcare services for our patients.

 

Investments in Growth

 

We expect to continue to focus on long-term growth through investments in our centers, care model and marketing. In addition, we expect our corporate, general and administrative expenses to increase in absolute dollars for the foreseeable future to support our growth and because of additional costs as a public company, including expenses related to compliance with the rules and regulations of the SEC, Sarbanes Oxley Act compliance, the stock exchange listing standards, additional corporate and director and officer insurance expenses, greater investor relations expenses and increased legal, audit and consulting fees. As we have communicated, we plan to invest in openings of new de novo centers both within and outside of Florida over the next several years. Historically, de novo centers require upfront capital and operating expenditures, which may not be fully offset by additional revenues in the near-term, and we similarly expect a period of unprofitability in our future de novo centers before they break even. While our net income may decrease in the future because of these activities, we plan to balance these investments in future growth with a continued focus on managing our results of operations and generating positive income from our core centers and scaled acquisitions. In the longer term we anticipate that these investments will positively impact our business and results of operations.

 

Key Business Metrics

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In addition to our financial information which conforms with generally accepted accounting principles in the United States of America (“GAAP”), management reviews a number of operating and financial metrics, including the following key metrics, to evaluate its business, measure its performance, identify trends affecting its business, formulate business plans, and make strategic decisions.

Use of Non-GAAP Financial Information

 

Certain financial information and data contained in this Report is unaudited and does not conform to Regulation S-X. Accordingly, such information and data may not be included in, may be adjusted in, or may be presented differently in, any periodic filing, information or proxy statement, or prospectus or registration statement to be filed by the Company with the SEC. Some of the financial information and data contained in this Report, such as Adjusted EBITDA and margin thereof, platform contribution and margin thereof and pro forma medical expense ratioPlatform Contribution have not been prepared in accordance with GAAP. These non-GAAP measures of financial results are not GAAP measures of our financial results or liquidity and should not be considered as an alternative to net income (loss) as a measure of financial results, cash flows from operating activities as a measure of liquidity, or any other performance measure derived in accordance with GAAP. The Company believes these non-GAAP measures of financial results provide useful information to management and investors regarding certain financial and business trends relating to the Company’s financial condition and results of operations. The Company’s managementManagement uses these non-GAAP measures for trend analyses and for budgeting and planning purposes.

 

The Company believes that the use of these non-GAAP financial measures provides an additional tool for investors to use in evaluating projected operating results and trends in and in comparing the Company’s financial measures with other similar companies, many of which present similar non-GAAP financial measures to investors. Management does not consider these non-GAAP measures in isolation or as an alternative to financial measures determined in accordance with GAAP. The principal limitation of these non-GAAP financial measures is that they exclude significant expenses and income that are required by GAAP to be recorded in the Company’s financial statements. In addition, they are subject to inherent limitations as they reflect the exercise of judgments by management about which expense and income are excluded or included in determining these non-GAAP financial measures. For this reason, these non-GAAP measures may not be comparable to other companies' similarly labeled non-GAAP financial measures. In order to compensate for these limitations, management presents non-GAAP financial measures

(42)


in connection with GAAP results. You should review the Company’s audited financial statements which have been filed bycontained in the Company with the SEC with the Registration Statement.Annual Report.

EBITDA and Adjusted EBITDA

 

Management defines “EBITDA” as net income or net loss before interest expense, income tax expense or benefit,provision, depreciation and amortization, change in fair value of warrant liabilities, and gain or loss on extinguishment of debt. “Adjusted EBITDA” is defined as EBITDA adjusted for special items such as duplicative costs, non-recurring legal, consulting, and professional fees, stock basedstock-based compensation, de novo costs for the first 1218 months after opening, discontinued operations, acquisition costs and other costs that are considered one-time in nature as determined by management. Additionally, Adjusted EBITDA presented on a pro forma basis gives effect to the acquisitions of IMC and Care Holdings Group, LLC ("Care Holdings"), which owned Care Optimize LLC, as if they had occurred in historical periods, which does not necessarily reflect what the Company’s Adjusted EBITDA would have been had the acquisitions occurred on the dates indicated. Adjusted EBITDA is intended to be used as a supplemental measure of our performance that is neither required by, nor presented in accordance with, GAAP. Management believes that the use of Adjusted EBITDA provides an additional tool for investors to use in evaluating ongoing operating results and trends and in comparing its financial measure with those of comparable companies, which may present similar non-GAAP financial measures to investors. However, we may incur future expenses similar to those excluded when calculating these measures. In addition, our presentations of these measures should not be construed as an inference that its future results will be unaffected by unusual or non-recurring items. Our computation of Adjusted EBITDA may not be comparable to other similarly titled measures computed by other companies, because all companies may not calculate Adjusted EBITDA in the same fashion.

 

Due to these limitations, Adjusted EBITDA should not be considered in isolation or as a substitute for performance measures calculated in accordance with GAAP. We compensate for these limitations by relying primarily on itsthe GAAP results and using

(25)


Adjusted EBITDA on a supplemental basis. Please review the reconciliation of net (loss) income (loss) to EBITDA and Adjusted EBITDA below and do not rely on any single financial measure to evaluate the Company’s business:

 

 

Three Months Ended

 

 

Nine Months Ended

 

 

Three Months Ended June 30,

 

 

Six Months Ended June 30,

 

($ in thousands)

 

September 30, 2021
(As Restated, Note 2)

 

 

September 30, 2020

 

 

Y/Y Change
(As Restated, Note 2)

 

 

September 30, 2021
(As Restated, Note 2)

 

 

September 30, 2020

 

 

Y/Y Change
(As Restated, Note 2)

 

 

2022

 

 

2021

 

 

Y/Y Change

 

 

2022

 

 

2021

 

 

Y/Y Change

 

Net (loss) income

 

$

(14,479

)

 

$

(281

)

 

$

(14,198

)

 

$

(3,120

)

 

$

6,354

 

$

(9,474

)

 

$

(9,381

)

 

$

10,057

 

 

$

(19,438

)

 

$

(26,178

)

 

$

11,359

 

 

$

(37,537

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GAAP Pro Forma adjustments(1)

 

 

-

 

 

 

(189

)

 

 

189

 

 

 

(8,917

)

 

 

(3,541

)

 

 

(5,376

)

 

 

-

 

 

 

(6,186

)

 

 

6,186

 

 

 

-

 

 

 

(8,917

)

 

 

8,917

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Pro Forma net (loss) income

 

 

(14,479

)

 

 

(470

)

 

 

(14,009

)

 

 

(12,037

)

 

 

2,813

 

 

 

(14,850

)

 

 

(9,381

)

 

 

3,871

 

 

 

(13,252

)

 

 

(26,178

)

 

 

2,442

 

 

 

(28,620

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interest expense

 

1,291

 

1,656

 

(364

)

 

4,358

 

5,002

 

(644

)

 

 

3,896

 

 

 

1,667

 

 

 

2,229

 

 

 

5,624

 

 

 

3,067

 

 

 

2,557

 

Depreciation and amortization

 

5,176

 

3,368

 

1,808

 

11,494

 

10,126

 

1,368

 

 

 

4,903

 

 

 

3,339

 

 

 

1,564

 

 

 

9,965

 

 

 

6,318

 

 

 

3,647

 

Gain on remeasurement of warrant liabilities

 

(10,227

)

 

-

 

(10,227

)

 

(12,022

)

 

-

 

(12,022

)

Loss (gain) on remeasurement of contingent earnout liability

 

11,625

 

-

 

11,625

 

(5,794

)

 

-

 

(5,794

)

Gain on extinguishment of debt

 

(279

)

 

-

 

(279

)

 

(1,637

)

 

-

 

(1,637

)

Change in warrant liabilities

 

 

(7,391

)

 

 

(1,795

)

 

 

(5,596

)

 

 

(3,855

)

 

 

(1,795

)

 

 

(2,060

)

Change in contingent earnout liabilities

 

 

-

 

 

 

(17,420

)

 

 

17,420

 

 

 

-

 

 

 

(17,420

)

 

 

17,420

 

Loss (gain) on extinguishment of debt

 

 

6,172

 

 

 

806

 

 

 

5,366

 

 

 

6,172

 

 

 

806

 

 

 

5,366

 

Income tax provision

 

 

171

 

 

 

-

 

 

 

171

 

 

 

351

 

 

 

-

 

 

 

351

 

Other expenses

 

 

840

 

 

 

100

 

 

 

740

 

 

 

849

 

 

 

86

 

 

 

763

 

 

 

45

 

 

 

(2,367

)

 

 

2,412

 

 

 

507

 

 

 

(2,155

)

 

 

2,662

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EBITDA

 

 

(6,053

)

 

 

4,653

 

 

 

(10,706

)

 

 

(14,791

)

 

 

18,027

 

 

 

(32,818

)

 

 

(1,585

)

 

 

(11,900

)

 

 

10,315

 

 

 

(7,414

)

 

 

(8,738

)

 

 

1,324

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Adjustments

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-recurring expenses

 

4,249

 

2,763

 

1,486

 

15,302

 

4,439

 

10,863

 

Acquisition costs

 

1,871

 

789

 

1,083

 

6,844

 

2,123

 

4,721

 

Stock based compensation

 

966

 

-

 

966

 

966

 

-

 

966

 

De novo losses

 

195

 

68

 

127

 

743

 

94

 

649

 

Other adjustments

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-recurring expenses (2)

 

 

3,104

 

 

 

8,257

 

 

 

(5,153

)

 

 

9,159

 

 

 

11,052

 

 

 

(1,893

)

Acquisition costs (3)

 

 

4,074

 

 

 

3,806

 

 

 

268

 

 

 

7,503

 

 

 

4,973

 

 

 

2,530

 

Stock-based compensation

 

 

2,788

 

 

 

-

 

 

 

2,788

 

 

 

3,875

 

 

 

-

 

 

 

3,875

 

De novo losses (4)

 

 

993

 

 

 

364

 

 

 

629

 

 

 

2,112

 

 

 

548

 

 

 

1,564

 

Discontinued operations

 

 

-

 

 

 

(35

)

 

 

35

 

 

 

(1

)

 

 

(35

)

 

 

34

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(1

)

 

 

1

 

Adjusted EBITDA

 

$

1,229

 

 

$

8,237

 

 

$

(7,009

)

 

$

9,064

 

 

$

24,648

 

 

$

(15,584

)

 

$

9,374

 

 

$

527

 

 

$

8,847

 

 

$

15,236

 

 

$

7,835

 

 

$

7,401

 

*Pro Forma figures give effect to the Business Combinations of IMC and Care Holdings as if they had occurred in historical periods. Figures may not sum due to rounding.

 

Figures may not sum due to rounding.

(1) Pro Forma figures give effect to the Business Combinations of IMC and Care Holdings as if they had occurred in historical periods.

(43)(2) Includes professional fees, salaries and wages, and other expenses deemed one-time in nature.


(3) Includes transaction costs, integration costs, and other costs to achieve synergies.

(4) Includes non-buildout related costs incurred prior to opening a de novo location and initial opening losses post-center opening up 18 months after center opening.

Platform Contribution

We define Platform Contribution as revenue less the sum of (i) external provider costs and (ii) cost of care. We believe this metric best reflects the economics of our care model as it includes all medical claims expense associated with our patients’ care. As a center matures, we expect the Platform Contribution from that center to increase both in terms of absolute dollars as well as a percentage of capitated revenue. This increase will be driven by improving patient contribution economics over time, as well as our ability to generate operating leverage on the costs of our centers. Our aggregate Platform Contribution may not increase despite improving economics at our existing centers should we open new centers at a pace that skews our mix of centers towards newer centers. We would expect to experience minimal seasonality in Platform Contribution due to minimal seasonality in our patient contribution.

In addition to our GAAP financial information, we review a number of operating and financial metrics, including the following key metrics, to evaluate our business, measure our performance, identify trends affecting our business, formulate business plans and make strategic decisions. The chart below is a pro forma view of our operations. This pro forma view assumes the Business Combination with IMC occurred on January 1, 2020, and areis based upon estimates which we believe are reasonable.

Non-GAAP Operating Metrics

 

Patient & Platform Contribution

March 31, 2020

 

June 30, 2020

 

September 30, 2020

 

December 31, 2020

 

March 31, 2021

 

June 30, 2021

 

September 30, 2021

 

Jun 30, 2020

 

Sep 30, 2020

 

Dec 31, 2020

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 30, 2022

 

Centers

 

21

 

21

 

22

 

24

 

24

 

34

 

40

 

 

21

 

22

 

24

 

24

 

34

 

40

 

45

 

48

 

48

 

Markets

 

1

 

1

 

1

 

1

 

1

 

1

 

1

 

 

1

 

1

 

1

 

1

 

2

 

3

 

4

 

6

 

6

 

Patients (MCREM)

 

24,800

 

27,500

 

29,000

 

28,400

 

29,200

 

35,300

 

40,400

 

 

27,500

 

29,000

 

28,400

 

29,200

 

35,300

 

40,400

 

50,100

 

50,600

 

54,000

 

At-risk

 

84.8

%

 

86.7

%

 

85.6

%

 

87.7

%

 

87.0

%

 

84.1

%

 

87.2

%

 

86.7

%

 

85.6

%

 

87.7

%

 

87.0

%

 

84.1

%

 

87.2

%

 

79.3

%

 

79.8

%

 

81.0

%

Platform Contribution ($, Millions)

$

14.1

 

$

18.1

 

$

15.5

 

$

17.9

 

$

14.7

 

$

8.2

 

$

11.0

 

$

18.1

 

$

15.5

 

$

17.9

 

$

14.7

 

$

8.2

 

$

11.0

 

$

16.0

 

$

17.3

 

$

21.7

 

(26)


Centers

 

We define our centers as those primary care centers open for business and capable of attending to patients at the end of a particular period.

 

Patients (MCREM)

MCREM Patientspatients includes both at-risk MA patients (those patients for whom we are financially responsible for their total healthcare costs) as well as risk and non-risk, non-MA patients. We define our total at-risk patients as at-risk patients who have selected us as their provider of primary care medical services as of the end of a particular period. We define our total fee-for-service patients as fee-for-service patients who come to one of our centers for medical care at least once per year. A fee-for-service and at-risk patient remains active in our system until we are informed by the health plan the patient is no longer active. As discussed above, CareMax calculates the amount of support typically received by one Medicare patient as equivalent to the level of support received by three Medicaid or Commercial patients.

Platform Contribution

We define platform contribution as revenue less the sum of (i) external provider costs and (ii) cost of care, excluding depreciation and amortization. We believe this metric best reflects the economics of our care model as it includes all medical claims expense associated with our patients’ care as well as the costs we incur to care for our patients via the CareMax System. As a center matures, we expect the platform contribution from that center to increase both in terms of absolute dollars as well as a percentage of capitated revenue. This increase will be driven by improving patient contribution economics over time, as well as our ability to generate operating leverage on the costs of our centers. Our aggregate platform contribution may not increase despite improving economics at our existing centers should we open new centers at a pace that skews our mix of centers towards newer centers. We would expect to experience minimal seasonality in platform contribution due to minimal seasonality in our patient contribution.

 

Impact of COVID-19

 

The rapid spread of COVID-19 around the world and throughout the United States altered the behavior of businesses and people, with significant negative effects on federal, state and local economies. The virus disproportionately impacts older adults, especially those with chronic illnesses, which describes many of our patients.

We estimate our performance for the ninesix months ended SeptemberJune 30, 20212022 has been negatively impacted by approximately $18.5$1.0 million of direct non-recurring COVID-19 costs. costs, with negligible impact noted during the three months ended June 30, 2022.

Management cannot accurately predict the future impacts of COVID-19 due to the impact foruncertainty surrounding future spikes in COVID-19 cases or new variants that may emerge in the foreseeable future especially given the geographical concentration of patients in South Florida.future.

Components of Results of Operations

 

Revenue

 

Medicare risk-based revenue and Medicaid risk-based revenue. Our capitated revenue consists primarily of fees for medical services provided by us or managed by our affiliated medical groupsMSO under a global capitation arrangement made directly with various MA payors. Capitation is a fixed amount of money per patient per month paid in advance for the delivery of health care services, whereby we are generally liable for medical costs in excess of the fixed payment and are able to retain any surplus created if medical costs are less than the fixed payment. A portion of our capitated revenues are typically prepaid monthly to us based on the number of MA patients selecting us as their primary care provider. Our capitated rates are determined as a

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percentage of the premium the MA plan receives from CMS for our at-risk members. Those premiums are determined via a competitive bidding process with CMS and are based upon the cost of care in a local market and the average utilization of services by the patients enrolled. Medicare pays capitation using a “risk adjustment model,” which compensates providers based on the health status (acuity) of each individual patient. Payors with higher acuity patients receive more in premium, and those with lower acuity patients receive less in premium. Under the risk adjustment model, capitation is paid on an interim basis based on enrollee data submitted for the preceding year and is adjusted in subsequent periods after the final data is compiled. As premiums are adjusted via this risk adjustment model, our capitation payments will change in unison with how our payor partners’ premiums change with CMS. Risk adjustment in future periods may be impacted by COVID-19 and our inability to accurately document the health needs of our patients in a compliant manner, which may have an adverse impact on our revenue.

 

For Medicaid in Florida, premiums are determined by Florida’s AHCA and basedAgency for Health Care Administration ("AHCA") base rates are adjusted annually using historical utilization data projected forward by a third-party actuarial firm. The rates are established based on specific cohorts by age and sex and geographical location. AHCA uses a “zero sum” risk adjustment model that establishes acuity for certain cohorts of patients quarterly, depending on the scoring of that acuity, and may periodically shift premiums from health plans with lower acuity members to health plans with higher acuity members.

(27)


 

Other revenue. Other revenue includes professional capitation payments. These revenues are a fixed amount of money per patient per month paid in advance for the delivery of primary care services only, whereby CareMax is not liable for medical costs in excess of the fixed payment. Capitated revenues are typically prepaid monthly to CareMax based on the number of patients selecting us as their primary care provider. Our capitated rates are fixed, contractual rates. Incentive payments for Healthcare Effectiveness Data and Information Set (“HEDIS”) and any services paid on a fee for service basis by a health plan are also included in other managed care revenue. Other revenue also includes ancillary fees earned under contracts with certain payors for the provision of certain care coordination and other care management services. These services are provided to patients covered by these payors regardless of whether those patients receive their care from our affiliated medical groups. Revenue for primary care service for patients in a partial risk or up-side only contracts,contract, pharmacy revenue and revenue generated from CareOptimize are reported in other revenue.

 

See “—Critical Accounting Policies—Revenue” for more information. We expect capitated revenue will increase as a percentage of total revenues over time because of the greater revenue economics associated with at-risk patients compared to fee-for-service patients.

 

Operating Expenses

 

Medicare and Medicaid external provider costs. External provider costs include all services at-risk patients utilize. These include claims paid by the health plan and estimates for unpaid claims. The estimated reserve for incurred but not paid claims is included in accounts receivable as we do not pay medical claims. Actual claims expense will differ from the estimated liability due to factors in estimated and actual patient utilization of health care services, the amount of charges, and other factors. We typically reconcile our medical claims expense with our payor partners on a monthly basis and adjust our estimate of incurred but not paid claims if necessary. To the extent we revise our estimates of incurred but not paid claims for prior periods up or down, there would be a correspondingly favorable or unfavorable effect on our current period results that may or may not reflect changes in long term trends in our performance. We expect our medical claims expenses to increase in both absolute dollar terms as well as on a PPPMper patient per month ("PPPM") basis given the healthcare spending trends within the Medicare population and the increasing disease burden of patients as they age.

 

Cost of care. Cost of care costs includes the costs of additional medical services we provide to patients that are not paid by the plan. These services include patient transportation, medical supplies, auto insurance and other specialty costs, like dental or vision. In some instances, we have negotiated better rates than the health plans for these health plan covered services. In addition, cost of care includes rent and facilities costs required to maintain and operate our centers.

 

Expenses from our physician groups that contract with our MSO are consolidated with other clinical and MSO expenses to determine profitability for our at-risk and fee-for-service arrangements. Physician group economics are not evaluated on a stand-alone basis, as certain non-clinical expenses need to be consolidated to consider profitability.

 

We measure the incremental cost of our capitation agreements by starting with our center-level expenses, which are calculated based upon actual expenses incurred at a specific center for a given period of time and expenses that are incurred centrally and allocated to centers on a ratable basis. These expenses are allocated to our at-risk patients based upon the number of visit slots

(45)


these patients utilized compared to the total slots utilized by all of our patients. All visits, however, are not identical and do not require the same level of effort and expense on our part. Certain types of visits are more time and resource intensive and therefore result in higher expenses for services provided internally. Generally, patients who are earlier in their tenure with CareMax utilize a higher percentage of these more intensive visits, as we get to know the patient and properly assess and document such patient’s health condition.

 

Selling and marketing expenses. Selling and marketing expenses include the cost of our sales and community relations team, including salaries and commissions, radio and television advertising, events and promotional items.

 

Corporate general and administrative expenses. Corporate general and administrative expenses include employee-related expenses, including salaries and related costs and stock-based compensation, for executive, technology infrastructure, operations, clinical and quality support, finance, legal, human resources, and business development departments. In addition, corporate general and administrative expenses include corporate technology, third party professional services and corporate occupancy costs. We expect these expenses to increase over time due to the additional legal, accounting, insurance, investor relations and other costs that we will incur as a public company, as well as other costs associated with continuing to grow itsour business. We also expect our corporate, general and administrative expenses to increase in absolute dollars in the foreseeable future. However, we anticipate corporate, general and administrative expenses to decrease as a percentage of revenue over the long term, although they may fluctuate as a percentage of revenue from period to period due to the timing and amount of these expenses.

 

(28)


Depreciation and amortization. Depreciation and amortization expenses are primarily attributable to our capital investments and consist of fixed asset depreciation, amortization of intangibles considered to have definite lives, and amortization of capitalized internal-use software costs.

 

OtherAcquisition related costs. Acquisition related costs consist of legal and other transaction-related expenses.

Nonoperating Income (Expense)(Expenses)

 

Interest expense. Interest expense consists primarily of interest payments on our outstanding borrowings (see “Note 7 - Condensed Consolidated Financial Statements - Long Term Debt”).borrowings.

 

Gain on remeasurement of warrant liabilities. Loss on remeasurement of warrant liabilities consists of changes in fair value of the Public Warrants and Private Placement Warrants.

(46)

Gain on remeasurement of contingent earnout liabilities. Gain on remeasurement of contingent earnout liabilities consists of changes in the fair value of contingent earnout liabilities.


Gain (loss) on extinguishment of debt. Gain (loss) on extinguishment of debt consists primarily of write-offs of unamortized debt issuance costs upon early repayments of debt.

Other income (expense), net. Other income (expense), net, includes research and development costs, franchise tax payments and other miscellaneous corporate expenses.

Results of Operations

 

Three Months Ended SeptemberJune 30, 20212022 compared to Three Months Ended SeptemberJune 30, 2020.2021

 

The following table sets forth our unaudited condensed consolidated statements of operations data for the periods indicated:

Three Months Ended September 30,

 

Three Months Ended June 30,

 

 

 

 

 

($ in thousands)

2021
(As Restated, Note 2)

 

2020

 

$ Change
(As Restated, Note 2)

 

% Change
(As Restated, Note 2)

 

2022

 

2021

 

$ Change

 

% Change

 

Revenue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medicare risk-based revenue

$

76,428

 

$

24,242

 

$

52,186

 

215.3

%

$

143,664

 

$

37,761

 

$

105,903

 

280.5

%

Medicaid risk-based revenue

 

20,884

 

 

20,884

 

 

 

 

19,896

 

5,449

 

14,447

 

265.1

%

Other revenue

 

7,308

 

 

64

 

 

7,244

 

 

11260.6

%

 

8,719

 

 

1,709

 

 

7,010

 

 

410.2

%

Total revenue

$

104,620

 

$

24,306

 

$

80,314

 

330.4

%

 

172,279

 

44,919

 

127,360

 

283.5

%

Operating expense

 

 

 

 

 

 

 

 

Operating expenses

 

 

 

 

 

 

 

 

External provider costs

 

73,329

 

17,304

 

56,025

 

323.8

%

 

120,348

 

35,535

 

84,813

 

238.7

%

Cost of care

 

21,602

 

4,341

 

17,261

 

397.7

%

 

30,364

 

7,867

 

22,497

 

286.0

%

Sales and marketing

 

1,274

 

311

 

963

 

309.5

%

 

2,299

 

775

 

1,524

 

196.7

%

Corporate, general and administrative

 

13,589

 

1,885

 

11,704

 

621.0

%

 

18,063

 

8,881

 

9,182

 

103.4

%

Depreciation and amortization

 

5,176

 

359

 

4,816

 

1340.7

%

 

4,903

 

1,437

 

3,466

 

241.2

%

Acquisition related costs

 

879

 

 

 

 

879

 

 

 

 

2,789

 

 

149

 

 

2,640

 

 

1,772.0

%

Total costs and expenses

$

115,848

 

$

24,200

 

$

91,648

 

 

378.7

%

 

178,767

 

 

54,643

 

 

124,124

 

 

227.2

%

Operating (loss) income

$

(11,228

)

$

106

 

$

(11,334

)

 

(10696.1

)%

$

(6,488

)

$

(9,724

)

$

3,236

 

 

(33.3

%)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Interest expense, net

 

1,291

 

387

 

904

 

233.6

%

Interest expense

 

(3,896

)

 

(792

)

 

(3,104

)

 

391.9

%

Gain on remeasurement of warrant liabilities

 

(10,227

)

 

 

(10,227

)

 

 

 

7,391

 

1,795

 

5,596

 

311.7

%

Loss on remeasurement of contingent earnout liabilities

 

11,625

 

 

11,625

 

 

 

Gain on extinguishment of debt, net

 

(279

)

 

 

(279

)

 

 

Other expenses

 

840

 

 

 

 

840

 

 

 

Loss before income taxes

$

(14,479

)

$

(281

)

$

(14,198

)

 

5050.1

%

Gain on remeasurement of contingent earnout liabilities

 

-

 

17,420

 

(17,420

)

 

(100.0

%)

Gain (loss) on extinguishment of debt

 

(6,172

)

 

1,358

 

(7,530

)

 

(554.5

%)

Other income (expense), net

 

(45

)

 

-

 

 

(45

)

 

(100.0

%)

Nonoperating (expenses) income

 

(2,722

)

 

19,781

 

(22,503

)

 

(113.8

%)

(Loss) income before income taxes

$

(9,210

)

$

10,057

 

$

(19,267

)

 

(191.6

%)

Income tax provision

 

 

 

 

 

 

 

 

 

(171

)

 

-

 

 

(171

)

 

(100.0

%)

Net loss

$

(14,479

)

$

(281

)

$

(14,198

)

 

5050.1

%

 

 

 

 

 

 

 

 

Net income attributable to non-controlling interest

$

 

$

34

 

$

(34

)

 

(100.0

)%

Net loss attributable to controlling interest

$

(14,479

)

$

(315

)

$

(14,164

)

 

4494.5

%

Net (loss) income

$

(9,381

)

$

10,057

 

$

(19,438

)

 

(193.3

%)

*Figures may not sum due to rounding

Medicare risk-based revenue. Medicare risk-based revenue was $76.4$143.7 million for the three months ended SeptemberJune 30, 2021,2022, an increase of $52.2$105.9 million or 215.3%, compared to $24.2$37.8 million for the three months ended SeptemberJune 30, 2020.2021. This increase was driven primarily by a 256%257% increase in the total number of at-risk patients primarily from the acquisitions of IMC, SMA, DNF and DNF,Advantis and due to conversion of partial risk patients to full risk, partially offset by a 11%7% reduction in rates, driven by member mix and COVID-19.mix.

(29)


 

Medicaid risk-based revenue. Medicaid risk-based revenue was $20.9$19.9 million for the three months ended SeptemberJune 30, 2022, an increase of $14.5 million compared to $5.4 million for the three months ended June 30, 2021. Medicaid risk-based revenue relates entirely to IMC.patients that were acquired from the Business Combination with IMC in June 2021.

 

Other revenue. Other revenue was $7.3$8.7 million for the three months ended SeptemberJune 30, 2021,2022, an increase of $7.2$7.0 million or 11,260.6%, compared to $64,000$1.7 million for the three months ended SeptemberJune 30, 2020.2021. The increase is almost entirely related to revenue from IMC.fee-for-service and pharmacy revenues acquired in various acquisitions and higher HEDIS and other partial risk surplus payments.

 

External provider costs. External provider costs were $73.3$120.4 million for the three months ended SeptemberJune 30, 2021,2022, an increase of $56.0$84.8 million or 323.8%, compared to $17.3$35.5 million for the three months ended SeptemberJune 30, 2020.2021. The increase was primarily due to a 370%261% increase in total at-risk MCREM patients, including Medicaid, from the acquisitions of IMC, SMA DNF and the additional costs attributable to claims withAdvantis, partially offset by a COVID-19 diagnosis.6% decrease in PPPM rates, driven by member mix.

 

Cost of care expenses. Cost of care expenses were $21.6$30.4 million for the three months ended SeptemberJune 30, 2021,2022, an increase of $17.3$22.5 million or 397.7%, compared to $4.3$7.9 million for the three months ended SeptemberJune 30, 2020.2021. The increase was due to additional membership growth from theacquisitions of IMC, SMA, DNF and DNF acquisitions and the reopening of the wellness centers.

Sales and marketing expenses. Sales and marketing expenses were $1.3 million for the three months ended September 30, 2021, an increase of $1.0 million or 309.5%, compared to $311,000 for the three months ended September 30, 2020. The increase was due to the acquisition of IMC and the recommencing of sales and community activities in 2021.

(47)


Corporate, general & administrative. Corporate, general & administrative expense was $13.6 million for the three months ended September 30, 2021, an increase of $11.7 million or 621.0% compared to $1.9 million for the three months ended September 30, 2020. The increase was primarily from the acquired overhead related to IMC, SMA, and DNF.

Depreciation and amortization. Depreciation and amortization expense was $5.2 million for the three months ended September 30, 2021, an increase of $4.8 million, or 1,340.7% compared to $359,000 for the three months ended September 30, 2020. This was due to amortization of intangible assets purchased in the IMC, SMA, and DNF acquisitions.

Interest expense. Interest expense was $1.3 million for the three months ended September 30, 2021, an increase of $904,000, or 233.6% compared to $387,000 for the three months ended September 30, 2020. This was due to the increased borrowings under the Credit Facilities.

Acquisition related costs. Acquisition related costs was $879,000 for the three months ended September 30, 2021. This cost was driven primarily by the acquisition of DNF.

Change in fair value of derivative warrant liabilities. We recorded a gain of $10.2 million during the three months ended September 30, 2021, as a result of a reduction in the fair value of derivative warrant liabilities.

Change in fair value of contingent earnout liabilities. We recorded a loss of $11.6 million during the three months ended September 30, 2021, as a result of an increase in the fair value of the contingent earnout liabilities.

Gain on extinguishment of debt. We recorded a gain of $279,000 related to the forgiveness of Paycheck Protection Program (“PPP”) loans.

Nine Months Ended September 30, 2021 compared to Nine Months Ended September 30, 2020.

The following table sets forth our unaudited condensed consolidated statements of operations data for the periods indicated:

 

Nine Months Ended September 30,

 

($ in thousands)

2021
(As Restated, Note 2)

 

2020

 

$ Change
(As Restated, Note 2)

 

% Change
(As Restated, Note 2)

 

Revenue

 

 

 

 

 

 

 

 

Medicare risk-based revenue

$

142,005

 

$

75,083

 

$

66,922

 

 

89.1

%

Medicaid risk-based revenue

 

26,333

 

 

 

 

26,333

 

 

 

Other revenue

 

9,118

 

 

251

 

 

8,868

 

 

3534.0

%

Total revenue

$

177,457

 

$

75,334

 

$

102,123

 

 

135.6

%

Operating expense

 

 

 

 

 

 

 

 

External provider costs

 

127,023

 

 

49,110

 

 

77,912

 

 

158.6

%

Cost of care

 

34,822

 

 

12,244

 

 

22,578

 

 

184.4

%

Sales and marketing

 

2,340

 

 

811

 

 

1,529

 

 

188.5

%

Corporate, general and administrative

 

24,265

 

 

4,625

 

 

19,639

 

 

424.6

%

Depreciation and amortization

 

7,127

 

 

1,072

 

 

6,055

 

 

565.0

%

Acquisition related costs

 

1,028

 

 

 

 

1,028

 

 

 

Total costs and expenses

$

196,604

 

$

67,863

 

$

128,741

 

 

189.7

%

Operating (loss) income

$

(19,147

)

$

7,471

 

$

(26,618

)

 

(356.3

)%

 

 

 

 

 

 

 

 

 

Interest expense, net

 

2,587

 

 

1,117

 

 

1,470

 

 

131.6

%

Gain on remeasurement of warrant liabilities

 

(12,022

)

 

 

 

(12,022

)

 

 

Gain on remeasurement of contingent earnout liabilities

 

(5,794

)

 

 

 

(5,794

)

 

 

Gain on extinguishment of debt, net

 

(1,637

)

 

 

 

(1,637

)

 

 

Other expenses

 

840

 

 

 

 

840

 

 

 

(Loss) income before income taxes

$

(3,120

)

$

6,354

 

$

(9,474

)

 

(149.1

)%

Income tax provision

 

 

 

 

 

 

 

 

Net (loss) income

$

(3,120

)

$

6,354

 

$

(9,474

)

 

(149.1

)%

 

 

 

 

 

 

 

 

 

Net income attributable to non-controlling interest

$

 

$

26

 

$

(26

)

 

 

Net (loss) income attributable to controlling interest

$

(3,120

)

$

6,328

 

$

(9,448

)

 

 

*Figures may not sum due to rounding

Medicare risk-based revenue. Medicare risk-based revenue was $142.0 million for the nine months ended September 30, 2021, an increase of $66.9 million, or 89.1%, compared to $75.1 million for the nine months ended September 30, 2020. This increase

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was driven primarily by a 114.1% increase in the total number of at-risk patients from IMC, SMA and DNF, partially offset by a 11.6% decrease in rate, driven by COVID-19 and patient mix.

Medicaid risk-based revenue. Medicaid risk-based revenue was $26.3 million for the nine months ended September 30, 2021. Medicaid risk-based revenue relates entirely to IMC.

Other revenue. Other revenue was $9.1 million for the nine months ended September 30, 2021, an increase of $8.9 million, or 3,534.0%, compared to $251,000 for three and nine months ended September 30, 2020. The increase is almost entirely related to revenue from IMC.

External provider costs. External provider costs were $127.0 million for the nine months ended September 30, 2021, an increase of $77.9 million, or 158.6%, compared to $49.1 million for the nine months ended September 30, 2020. The increase was primarily due to a 158.6% increase in total at-risk MCREM patients and the additional costs attributable to claims with a COVID-19 diagnosis.

Cost of care expenses. Cost of care expenses were $34.8 million for the nine months ended September 30, 2021, an increase of $22.6 million or 184.4%, compared to $12.2 million for the nine months ended September 30, 2020. The increase was due to additional membership growth from the IMC, SMA and DNF acquisitions and the reopening of the wellness centers.Advantis.

 

Sales and marketing expenses. Sales and marketing expenses were $2.3 million for the ninethree months ended SeptemberJune 30, 2021,2022, an increase of $1.5 million or 188.5%, compared to $811,000$0.8 million for the ninethree months ended SeptemberJune 30, 2020.2021. The increase was primarily due to the acquisition of IMCincrease in sales staff and resuming sales and community activities in 2021.marketing efforts resulting from acquisitions.

 

Corporate, general & administrative. Corporate, general & administrative expense was $24.3$18.1 million for the ninethree months ended SeptemberJune 30, 2021,2022, an increase of $19.6$9.2 million or 424.6% compared to $4.7$8.9 million for the ninethree months ended SeptemberJune 30, 2020.2021. The increase was primarily driven from the acquired overhead related to IMC, SMA, DNF, BIX and DNF.Advantis, as well as costs associated with becoming a publicly traded company.

 

Depreciation and amortization. Depreciation and amortization expense was $7.1$4.9 million for the ninethree months ended SeptemberJune 30, 2021,2022, an increase of $6.1$3.5 million or 565.0%, compared to $1.1$1.4 million for the ninethree months ended SeptemberJune 30, 2020.2021. This was due to amortization of intangible assets purchased in theacquired as part of acquisitions of IMC, SMA, DNF, BIX and DNF acquisitions.Advantis.

Acquisition related costs. Acquisition related costs were $2.8 million for the three months ended June 30, 2022, an increase of $2.6 million compared to $149,000 during the three months ended June 30, 2021. This cost relates primarily to the $2.8 million related to the pending Steward Transaction.

 

Interest expense. Interest expense was $2.6$3.9 million for the ninethree months ended SeptemberJune 30, 2021,2022, an increase of $1.5$3.1 million or 131.6% compared to $1.1$0.8 million for the ninethree months ended SeptemberJune 30, 2020.2021. This increase was due to the increased borrowings under the Credit Facilities.and higher weighted-average interest rate.

 

Change in fair value of derivative warrant liabilities. We have recorded a gain of $12.0$7.4 million during the ninethree months ended SeptemberJune 30, 2022, an increase of $5.6 million for the three months ended June 30, 2021. This increase in gain is driven primarily by the decrease in CareMax's stock price.

Gain (loss) on remeasurement of contingent earnout liabilities. We recorded a gain on remeasurement of contingent earnout liabilities of $17.4 million during the three months ended June 30, 2021. Contingent earnout liabilities are no longer remeasured to fair value following their reclassification to equity during the second quarter 2021, accordingly, no gain or loss on contingent earnout liabilities was recognized during the three months ended June 30, 2022.

Gain (loss) on extinguishment of debt. During the three months ended June 30, 2022, in connection with the early extinguishment and termination of the Existing Credit Agreement, we have recognized a loss on extinguishment of debt of $6.2 million. During the three months ended June 30, 2021, we recorded a gain of $2.2 million related to the forgiveness of Paycheck Protection Program (“PPP”) loans partially offset by a loss of extinguishment of debt of $800,000.

Other expenses. Other expenses were $45,000 for the three months ended June 30, 2022 as compared to $0 for the three months ended June 30, 2021. The increase is driven by miscellaneous corporate expenses.

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Six Months Ended June 30, 2022 compared to Six Months Ended June 30, 2021

The following table sets forth our condensed consolidated statements of operations data for the periods indicated:

 

Six Months Ended June 30,

 

 

 

 

 

($ in thousands)

2022

 

2021

 

$ Change

 

% Change

 

Revenue

 

 

 

 

 

 

 

 

Medicare risk-based revenue

$

251,410

 

$

65,577

 

$

185,833

 

 

283.4

%

Medicaid risk-based revenue

 

40,062

 

 

5,449

 

 

34,613

 

 

635.2

%

Other revenue

 

17,727

 

 

1,811

 

 

15,916

 

 

878.9

%

Total revenue

 

309,199

 

 

72,837

 

 

236,362

 

 

324.5

%

Operating expenses

 

 

 

 

 

 

 

 

External provider costs

 

213,204

 

 

53,694

 

 

159,510

 

 

297.1

%

Cost of care

 

57,712

 

 

13,220

 

 

44,492

 

 

336.6

%

Sales and marketing

 

5,600

 

 

1,066

 

 

4,534

 

 

425.4

%

Corporate, general and administrative

 

37,041

 

 

10,676

 

 

26,365

 

 

247.0

%

Depreciation and amortization

 

9,965

 

 

1,951

 

 

8,014

 

 

410.7

%

Acquisition related costs

 

3,055

 

 

149

 

 

2,906

 

 

1,950.5

%

Total costs and expenses

 

326,577

 

 

80,756

 

 

245,821

 

 

304.4

%

Operating (loss) income

$

(17,378

)

$

(7,918

)

$

(9,460

)

 

119.5

%

 

 

 

 

 

 

 

 

 

Interest expense

 

(5,624

)

 

(1,296

)

 

(4,328

)

 

334.0

%

Gain on remeasurement of warrant liabilities

 

3,855

 

 

1,795

 

 

2,060

 

 

114.8

%

Gain on remeasurement of contingent earnout liabilities

 

-

 

 

17,420

 

 

(17,420

)

 

(100.0

%)

Gain (loss) on extinguishment of debt, net

 

(6,172

)

 

1,358

 

 

(7,530

)

 

(554.5

%)

Other income (expense), net

 

(507

)

 

-

 

 

(507

)

 

(100.0

%)

Nonoperating (expenses) income

 

(8,448

)

 

19,277

 

 

(27,725

)

 

(143.8

%)

(Loss) income before income taxes

$

(25,826

)

$

11,359

 

$

(37,185

)

 

(327.4

%)

Income tax provision

 

(351

)

 

-

 

 

(351

)

 

(100.0

%)

Net (loss) income

$

(26,178

)

$

11,359

 

$

(37,537

)

 

(330.5

%)

Medicare risk-based revenue. Medicare risk-based revenue was $251.4 million for the six months ended June 30, 2022, an increase of $185.8 million compared to $65.6 million for the six months ended June 30, 2021. This increase was driven primarily by a result322% increase in the total number of at-risk patients from the acquisitions of IMC, SMA, DNF and Advantis, partially offset by a 9% reduction in the fair value of derivative warrant liabilities.rates, driven by member mix.

d

Medicaid risk-based revenue. Medicaid risk-based revenue was $40.0 million for the six months ended June 30, 2022, an increase of $34.6 million compared to $5.4 million for the six months ended June 30, 2021. Medicaid risk-based revenue relates entirely to patients that were acquired from the Business Combination with IMC in June 2021.

Other revenue. Other revenue was $17.7 million for the six months ended June 30, 2022 an increase of $15.9 million compared to $1.8 million for the six months ended June 30, 2021. The increase is related to fee-for-service and pharmacy revenues acquired in various acquisitions and higher HEDIS and other surplus bonuses.

External provider costs. External provider costs were $213.2 million for the six months ended June 30, 2022, an increase of $159.5 million compared to $53.7 million for the six months ended June 30, 2021. The increase was primarily due to a 357% increase in at-risk patients, including Medicaid, from the acquisitions of IMC, SMA, DNF and Advantis, partially offset by a 13% decrease in PPPM rates, driven by member mix.

Cost of care expenses. Cost of care expenses were $57.7 million for the six months ended June 30, 2022, an increase of $44.5 million compared to $13.2 million for the six months ended June 30, 2021. The increase was due to membership growth from acquisitions of IMC, SMA, DNF and Advantis.

Sales and marketing expenses. Sales and marketing expenses were $5.6 million for the six months ended June 30, 2022, an increase of $4.5 million compared to $1.1 million for the six months ended June 30, 2021. The increase was primarily due to the increase in sales staff and marketing efforts resulting from acquisitions.

Corporate, general & administrative. Corporate, general & administrative expense was $37.0 million for the six months ended June 30, 2022, an increase of $26.4 million compared to $10.7 million for the six months ended June 30, 2021. The increase was primarily from the acquired overhead related to IMC, SMA, DNF, BIX and Advantis, as well as costs associated with becoming a publicly traded company.

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Depreciation and amortization. Depreciation and amortization expense was $10.0 million for the six months ended June 30, 2022, an increase of $8.0 million compared to $2.0 million for the six months ended June 30, 2021. This was due to amortization of intangible assets acquired as part of acquisitions of IMC, SMA, DNF, BIX and Advantis.

Acquisition related costs. Acquisition related costs were $3.1 million for the six months ended June 30, 2022, an increase of $2.9 million compared to $149,000 for the six months ended June 30, 2021. This increase is primarily driven by the $2.8 million related to the pending Steward Transaction.

Interest expense. Interest expense was $5.6 million for the six months ended June 30, 2022, an increase of $4.3 million compared to $1.3 million for the six months ended June 30, 2021. This increase was due to the increased borrowings and higher weighted-average interest rate.

Change in fair value of contingent earnout liabilities.derivative warrant liabilities. We have recorded a gain of $5.8$3.9 million during the ninesix months ended SeptemberJune 30, 2021, as a result2022, an increase of a reduction$2.1 million for the six months ended June 30, 2021. This increase in gain is driven primarily by the fair value of the contingent earnout liabilities.decrease in CareMax's stock price.

 

Gain (loss) on extinguishmentremeasurement of debtcontingent earnout liabilities. We recorded a gain of $2.5$17.4 million during the six months ended June 30, 2021. Contingent earnout liabilities are no longer remeasured to fair value following their reclassification to equity during the second quarter 2021, accordingly, no gain or loss on contingent earnout liabilities was recognized during the six months ended June 30, 2022.

Gain (loss) on extinguishment of debt. During the six months ended June 30, 2022, in connection with the early extinguishment and termination of the Existing Credit Agreement, we have recognized a loss on extinguishment of debt of $6.2 million. During the six months ended June 30, 2021 we recorded a gain of $2.2 million related to the forgiveness of PPP loans partially offset by a loss ofon extinguishment of debt of $806,000 in connection with the early extinguishment and termination of the Loan Agreement in June 2021.$800,000.

Other expenses. Other expenses were $0.5 million for the six months ended June 30, 2022 as compared to $0 for the six months ended June 30, 2021. The increase is driven by miscellaneous corporate expenses.

Liquidity and Capital Resources

Overview

As of SeptemberJune 30, 2021,2022, we had cash on hand of $80.5$68.1 million. In addition, our Credit Agreement provides the ability to draw term loans in an amount up to $110 million under certain circumstances to finance permitted acquisitions and similar permitted investments, de novo center growth and optimization of de novo centers and management services organization performance.

Our principal sources of liquidity have been cash generated by our operating cash flows,centers and MSO operations, borrowings under our Credit Facilitiescredit facilities and proceeds from equity issuances. We have used these funds to meet our capital requirements, which consist of salaries, labor, benefits and other employee-related costs, product and supply costs, third-party customer service, billing and collections and logistics costs, capital expenditures including patient equipment, medical center and office lease expenses, insurance premiums, acquisitions and debt service. Our future capital expenditure requirements will depend on many factors, including the pace and scale of our expansion in new and existing markets, any future acquisitions, patient volume, and revenue growth rates. Many of our capital expenditures are made in advance of patients beginning service. Certain operating costs are incurred at the beginning of the equipment service period and during initial patient set up. We also

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expect to incur costs related to acquisitions and de novo growth through the opening of new medical facilities,centers, which we expect to require significant capital expenditures.expenditures, including lease and construction expenses. We may be required to seek additional equity or debt financing, in addition to cash on hand and borrowings under our Credit Facilities in connection with our business growth, including debt financing that may be available to us from certain Health Planshealth plans for each new medical center that we open under the terms of our agreements with those Health Plans.health plans. In the event that additional financing is required from outside sources, we may not be able to raise it on acceptable terms or at all. If additional capital is unavailable when desired, our business, results of operations, and financial condition would be materially and adversely affected. We believe that our expected operating cash flows, together with our existing cash, cash equivalents, amounts available under our Credit Facilities as described below,Agreement, and amounts available to us under our agreementsagreement with Anthem, each as described below, will continue to be sufficient to fund our operations and growth strategies for at least the next 12 months and remain in compliance with the covenants under the Credit Facilities.months.

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The Impact of COVID-19

 

As further detailed above in “Impact of COVID-19”, we estimate our performance during the ninesix months ended SeptemberJune 30, 20212022 has been impacted by approximately $18.5$1.0 million of direct non-recurring COVID-19 costs.costs, with negligible impact noted during the three months ended June 30, 2022. While it is impossible to predict the scope or duration of COVID-19 or the future impact on our liquidity and capital resources, COVID-19 could materially affect our liquidity and operating cash flows in future periods.

 

Credit Facilities

 

OnIn May 2022, the Closing Date, we drewCompany entered into the fullCredit Agreement that provided for an aggregate of up to $300 million in term loans, comprised of (i) initial term loans in aggregate principal amount of $125.0$190 million (the “Initial Term Loans”) and (ii) a delayed term loan facility in the aggregate principal amount of $110 million (the “Delayed Draw Term Loans”). The Credit Agreement permits the Company to enter into certain incremental facilities subject to compliance with the terms, conditions and covenants set forth therein. In May 2022, the Company drew $190 million of the Initial Term Loans and used approximately $121 million of the net proceeds from this borrowing to financerepay its outstanding obligations under the Business Combinationcredit agreement dated June 8, 2021, as amended (the "Existing Credit Agreement”). During the three and six months ended June 30, 2022, the Company recognized debt extinguishment losses of $6.2 million related transaction costs.to early repayment of the Existing Credit Agreement.

Based on the elections made by the Company, as of June 30, 2022, the Initial Term Loan borrowings bear interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus a spread adjustment of 0.114%), plus an applicable margin rate of 9.00%. As of September 30, 2021, we had approximately $60.0 million availablepermitted under the Credit Facilities (including $20.0 millionAgreement, the Company elected to capitalize 4.00% of the interest as principal amount on the outstanding Term Loans. As a result of this election, the cash interest component of the applicable margin increases by 0.50%. Amortization payments under the Credit Agreement are payable in quarterly installments, commencing on March 31, 2024, in aggregate principal amounts equal to 0.25% of the outstanding principal balance. As of June 30, 2022, no amounts were borrowed under the Delayed Draw Term LoanLoans and $40.0$190 million was outstanding under the RevolvingInitial Term Loans. All amounts owed under the Credit Facility, with no stand-by letters of credit outstanding).Agreement are due in May 2027.

Interest is payable on the outstanding term loans under the Credit Facilities at a variable interest rate (See Note 7 to the Condensed Consolidated Financial Statements - Long Term Debt).

The Delayed Draw Loan allowsCredit Agreement contains certain covenants that limit, among other things, the ability of the Company and its subsidiaries to incur additional indebtedness, liens or encumbrances, to make certain investments, to enter into sale-leaseback transactions or sell certain assets, to make certain restricted payments or pay dividends, to enter into consolidations, to transact with affiliates and to amend certain agreements, subject in each case to the exceptions and other qualifications as provided in the Credit Agreement. The Credit Agreement also contains covenants that require the Company to satisfy a minimum liquidity requirement of $50.0 million, which may be decreased to $25.0 million if the Company achieves a certain adjusted EBITDA, and maintains a maximum total leverage ratio based on the Company’s consolidated EBITDA, as defined in the Credit Agreement, with de novo losses excluded from the calculation of such ratio for up to $20.0 million36 months after the opening of a de novo center, which maximum total leverage ratio will initially be 8.50 to be drawn1.00, commencing with the fiscal quarter ended September 30, 2022 and is subject to fund permitted acquisitionsa series of step-downs. For the fiscal quarters ending September 30, 2026 and thereafter the Company must maintain a maximum total leverage ratio no greater than 5.50 to 1.00.

Anthem Collaboration Agreement

In connection with our collaboration agreement with Anthem, which was announced in August of 2021, we plan to open centers across eight priority states as part of our de novo strategy to open new centers in additional markets. Anthem has availabilityagreed to be drawn until the six month anniversaryprovide debt financing of the Closing Date. The Delayed Draw Loan may consist of Base Rate Loans or LIBOR Rate Loans. The Revolving Credit Facility allows up to $40.0$1 million for each new center opened in partnership with Anthem. We intend to be drawnuse such funds to partially offset the costs of opening new centers in order to finance working capital, make capital expenditures, finance permitted acquisitions and fund general corporate purposes.connection with our de novo growth strategy.

 

Cash Flows

 

The following table summarizes our cash flows for the periods presented:

 

(in thousands)

Nine Months Ended September 30,

 

Six Months Ended June 30,

 

2021

 

 

2020

 

2022

 

2021

 

Net cash (used in)/provided by operating activities

$

(8,801

)

 

$

5,998

 

Net cash used in operating activities

$

(27,398

)

$

(2,983

)

Net cash used in investing activities

 

(301,311

)

 

(5,094

)

$

(2,893

)

$

(211,779

)

Net cash provided by financing activities

 

385,630

 

4,236

 

$

50,505

 

$

381,864

 

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Operating Activities. Net cash used in operating activities for the ninesix months ended SeptemberJune 30, 20212022 was $8.8$27.4 million, an increase of $24.4 million as compared to $6.0$3.0 million providedused by operating activities forduring the ninesix months ended SeptemberJune 30, 2020,2021. This increase is partially due to a decreasenet increase of $14.8 million. The primary driver of the change is$0.7 million to net loss and non-cash charges, primarily due to the net loss from operations of $8.9$26.2 million reported for the ninesix months ended SeptemberJune 30, 20212022 compared to the net income from operations of $6.3$11.3 million reported for the ninesix months ended SeptemberJune 30, 2020. The primary driver2021, offset by increases to depreciation and amortization, loss on extinguishment of thisdebt, loss realized on remeasurement of warrant liabilities, and change is relatedin fair value of contingent earnout liabilities reported during the six months ended June 30, 2021. In addition, there was a net change of $23.8 million to the performanceCompany's operating assets and liabilities, mostly driven by the timing of collections and payments and the growth in our value-based contracts due to the impactsnumber of COVID-19 as described above.patients.

 

Investing Activities. Net cash used in investing activities for the ninesix months ended SeptemberJune 30, 20212022 was $301.3$2.9 million consisting primarily of leasehold improvements and medical equipment for our centers, as compared to $5.1$211.8 million for the ninesix months ended September 30, 2020. The use of funds in the nine months ended SeptemberJune 30, 2021, consisted of $298.3 million used in acquisitions, includingprimarily driven by the IMC Acquisition, SMA Acquisition in the second quarter of 2021, the DNF Acquisition in the third quarter of 2021 and $3.0 million for equipment and other fixed asset purchases. The use of funds in the nine months ended September 30, 2020 consisted primarily of $2.7 million for acquisitions of businessesIMC and $1.8 million for equipment and other fixed asset purchases.SMA.

 

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Financing Activities:Activities. Net cash provided by financing activities for the ninesix months ended SeptemberJune 30, 20212022 was $385.6$50.5 million compared to $4.2and was driven by the proceeds of $184 million duringfrom borrowings issued under the nine months ended September 30, 2020.Credit Agreement, offset by payment of related debt issuance costs of $6.0 million and the early repayment of our Existing Credit Agreement of $121.9 million. Net cash provided by financing activities forof $381.9 million during the ninesix months ended SeptemberJune 30, 2021 was primarily related to the Business Combination, and consisted of $125.0 million of borrowings from the borrowings under the Existing Credit Facilities,Agreement, $410.0 million for thefrom issuance and sale of Class A Common Stock, partially offset by cash used in the consummation of the reverse recapitalization of $108.8 million, repayment of borrowings including all outstanding borrowings under the Loan Agreement, of $24.5 million, equity issuance costs of $12.5 million, payment of deferred financing costs of $6.9 million and payment of debt prepayment penalties of $500,000 related to the early repayment of borrowings under the Loan Agreement.$500,000.

 

Net cash provided by financing activities for the nine months ended September 30, 2020 consisted of $2.5 million of borrowings under the Loan Agreement and $2.2 million of proceeds under the Paycheck Protection Program, partially offset by member distributions and repayments of debt under the Loan Agreement.

Contractual Obligations and Commitments

 

Our principal commitments consist of obligations under ourthe Credit Facilities and other long-term debtAgreement and operating leases for our centers. We also have a contractual commitment to complete the construction of a Homestead, FL medical center with remaining estimated capital expenditures of approximately $700,000 as of September 30, 2021. Plans have been submitted for a new medical center in East Hialeah, FL and opening is projected in the first or second quarter of 2022.

 

Off-Balance Sheet Arrangements

 

We did not have any off-balance sheet arrangements as of SeptemberJune 30, 20212022 or December 31, 20202021 other than operating leases.

 

JOBS Act

 

Section 102(b)(1) of the JOBS Act exempts emerging growth companies from being required to comply with new or revised financial accounting standards until private companies (that is, those that have not had a Securities Act registration statement declared effective or do not have a class of securities registered under the Exchange Act) are required to comply with the new or revised financial accounting standards. The JOBS Act provides that a company can elect to opt out of the extended transition period and comply with the requirements that apply to non-emerging growth companies, but any such election to opt out is irrevocable. We have elected not to opt out of such extended transition period, which means that when a standard is issued or revised and it has different application dates for public or private companies, as an emerging growth company, we can adopt the new or revised standard at the time private companies adopt the new or revised standard. This may make comparison of our consolidated financial statements with a public company which is neither an emerging growth company, nor an emerging growth company that has opted out of using the extended transition period, difficult or impossible because of the potential differences in accounting standards used.

 

Critical Accounting Policies and Estimates

 

The discussion and analysisOther than addition of our financial condition and results of operations are based upon our unaudited condensed consolidated financial statements, whicha policy related to accounting for VIEs, there have been preparedno changes to our critical accounting policies and estimates as described in accordanceour Annual Report on Form 10-K for the year ended December 31, 2021, which was filed with GAAP. The preparation of these financial statements requires management to make estimates and judgments that affect the reported amounts of assets and liabilities, revenue and expenses and related disclosures of contingent assets and liabilities at the date of our financial statements. Actual results may differ from these estimates under different assumptions or conditions, impacting our reported results of operations and financial condition.SEC on March 16, 2022.

 

Certain accounting policies involve significant judgments and assumptions by management, which have a material impact on the carrying value of assets and liabilities and the recognition of income and expenses. Management considers these accounting policies to be critical accounting policies. The estimates and assumptions used by management are based on historical experience and other factors, which are believed to be reasonable under the circumstances. The significant accounting policies which we believe are the most critical to aid in fully understanding and evaluating our reported financial results are described below. Refer to Note 2 “Summary of Significant Accounting Policies” to our unaudited condensed consolidated financial statements included elsewhere in this Report for more detailed information regarding our critical accounting policies.

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RevenueVariable Interest Entities

 

The transaction price for our capitated payor contracts isCompany evaluates its ownership, contractual and other interests in entities to determine if it has any variable as it primarily includes PPPM fees associated with unspecified membership. PPPM fees can fluctuate throughout the contract based on the health status (acuity) of each individual enrollee. In certain contracts, PPPM fees also include “risk adjustments” for items such as performance incentives, performance guarantees and risk shares. The capitated revenuesinterest in a variable interest entity ("VIE"). These evaluations are recognized based on the estimated PPPM fees earned net of projected performance incentives, performance guarantees, risk shares and rebates because we are able to reasonably estimate the ultimate PPPM payment of these contracts. We recognize revenue in the month in which eligible members are entitled to receive healthcare benefits. Subsequent changes in PPPM feescomplex, involve judgment, and the amountuse of revenue to be recognized are reflected through subsequent period adjustments to properly recognize the ultimate capitation amount.

External Provider Costs

External Provider Costs includes all costs of caring for our at-risk patients and for third-party healthcare service providers that provide medical care to our patients for which we are contractually obligated to pay (through our full-risk capitation arrangements). The estimated reserve for a liability for unpaid claims is included in "Accounts receivable, net" in the consolidated balance sheets. Actual claims expense will differ from the estimated liability due to factors in estimated and actual member utilization of health care services, the amount of charges and other factors. From time to time, but at least annually, we assess our estimates with an independent actuarial expert to ensure our estimates represent the best, most reasonable estimate given the data available to us at the time the estimates are made. Certain third-party payor contracts include a Medicare Part D payment related to pharmacy claims, which is subject to risk sharing through accepted risk corridor provisions. Under certain agreements the fund risk allocation is established whereby we, as the contracted provider, receive only a portion of the risk and the associated surplus or deficit. We estimate and recognize an adjustment to medical expenses for Part D claims related to these risk corridor provisions based upon pharmacy claims experience to date, as if the annual risk contract were to terminate at the end of the reporting period.

We assess the profitability of our capitation arrangements to identify contracts where current operating results or forecasts indicate probable future losses. If anticipated future variable costs exceed anticipated future revenues, a premium deficiency reserve is recognized. No premium deficiency reserves were recorded as of September 30, 2021 or December 31, 2020.

Business Combinations

We account for business acquisitions in accordance with ASC Topic 805, Business Combinations. We measure the cost of an acquisition as the aggregate of the acquisition date fair values of the assets transferred and liabilities assumed and equity instruments issued. Transaction costs directly attributable to the acquisition are expensed as incurred. We record goodwill for the excess of (i) the total costs of acquisition in the acquired business over (ii) the fair value of the identifiable net assets of the acquired business.

The acquisition method of accounting requires us to exercise judgment and make estimates and assumptions based on available historical information, regardingamong other factors. The Company considers itself to control an entity if it is the fair valuesmajority owner of the elements of a business combination as of the date of acquisition, including the fair values of identifiable intangible assets, deferred tax asset valuation allowances, liabilities related to uncertain tax positions, contingent consideration and contingencies. We may refine these estimatesor has voting control over a one-year measurement period, to reflect any new information obtained about facts and circumstances that existed as of the acquisition date that, if known, would have affected the measurement of the amounts recognized as of that date. If we are required to retroactively adjust provisional amounts that we have recorded for the fair value of assets and liabilities in connection with an acquisition, these adjustments could materially impact our results of operations and financial position. Estimates and assumptions that we must make in estimating the fair value of risk contracts andsuch entity. The Company also assesses control through means other identifiable intangible assets include future cash flows that we expect to generate from the acquired assets. If the subsequent actual results and updated projections of the underlying business activity change compared with the assumptions and projections used to develop these values, we could record impairment charges. In addition, we have estimated the economic lives of certain acquired assets and these lives are used to calculate depreciation and amortization expenses. If our estimates of the economic lives change, depreciation or amortization expenses could be accelerated or slowed, which could materially impact our results of operations.than voting

 

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The Business Combination acquisitions of IMC and the acquisitions of SMA and DNF were accounted for under ASC 805. Pursuant to ASC 805, CMG was determined to be the accounting acquirer. Refer to Note 3 “Acquisitions” of our unaudited condensed consolidated financial statements included elsewhere in this Report for more information. In accordance with the acquisition method, we recorded the fair value of assets acquired and liabilities assumed from IMC, SMA, and DNF. The allocation of the consideration to the assets acquired and liabilities assumed is based on various estimates. As of September 30, 2021, we performed our preliminary purchase price allocations. We continue to evaluate the fair value of the acquired assets, liabilities and goodwill. As such, these estimates are subject to change within the respective measurement period, which will not extend beyond one year from the acquisition date. Any adjustments will be recognized in the reporting period in which the adjustment amounts are determined.

 

Goodwillrights and Other Intangible Assets

Intangible assets consist primarilydetermines which business entity is the primary beneficiary of risk-based contracts acquired through business acquisitions. Goodwill represents the excessVIE. The Company consolidates VIEs when it is determined that the Company is the primary beneficiary of consideration paid over the fair valueVIE. Management performs ongoing reassessments of net assets acquired through business acquisitions. Goodwill is not amortized but is tested for impairment at least annually.

We test goodwill for impairment annually or more frequently if triggering events occur or other impairment indicators arise which might impair recoverability. These events or circumstances would include a significant changewhether changes in the business climate, legal factors, operating performance indicators, competition, sale, disposition of a significant portion of the business or other factors.

ASC 350, Intangibles—Goodwillfacts and Other (“ASC 350”) allows entities to first use a qualitative approach to test goodwill for impairment. ASC 350 permits an entity to first perform a qualitative assessment to determine whether it is more likely than not (a likelihood of greater than 50%) that the fair value of a reporting unit is less than its carrying value. We skip the qualitative assessment and proceed directly to the quantitative assessment. When the reporting units where we perform the quantitative goodwill impairment are tested, we compare the fair value of the reporting unit, which we primarily determine using an income approach based on the present value of discounted cash flows, to the respective carrying value, which includes goodwill. If the fair value of the reporting unit exceeds its carrying value, the goodwill is not considered impaired. If the carrying value is higher than the fair value, the difference would be recognized as an impairment loss. There were no goodwill impairments recorded during the nine months ended September 30, 2021.

Risk contracts represent the estimated values of customer relationships of acquired businesses and have definite lives. We amortize the risk contracts on an accelerated basis over their estimated useful lives ranging from eight to eleven years. We amortize non-compete agreement intangible assets over five yearson a straight-line basis.

The determination of fair values and useful lives require us to make significant estimates and assumptions. These estimates include, but are not limited to, future expected cash flows from acquired capitation arrangements from a market participant perspective, patient attrition rates, discount rates, industry data and management’s prior experience. Unanticipated events or circumstances may occur that could affect the accuracy or validity of such assumptions, estimates or actual results.

Derivative Warrant and Contingent Earnout Liabilities

We do not use derivative instruments to hedge exposures to cash flow, market, or foreign currency risks. We evaluate all of our financial instruments, including issued stock purchase warrants, to determine if such instruments are derivatives or contain features that qualify as embedded derivatives, pursuant to ASC 480 and ASC 815-15. The classification of derivative instruments, including whether such instruments should be recorded as liabilities or as equity, is re-assessed at the end of each reporting period.

We issued 5,791,667 common stock warrants in connection with our initial public offering (2,875,000) and private placement (2,916,667) which are recognized as derivative liabilities in accordance with ASC 815-40. Accordingly, we recognize the warrant instruments as liabilities at fair value and adjust the instruments to fair value at each reporting period. The liabilities are subject to re-measurement at each balance sheet date until exercised, and any change in fair value is recognized inregarding the Company’s statement of operations. The fair value of warrants issued has been estimated using Monte-Carlo simulations at each measurement date.

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In connectioninvolvement with a VIE will cause the Business Combination, upconsolidation conclusion to 6,400,000 Earnout Shares become issuable to the IMC Parent and the CMG sellers as contingent consideration if certain Share Price Triggerschange. Changes in consolidation status are met or if a change in control occurs that equates to a share price equivalent to the Share Price Triggers.

In this Form 10-Q/A, the Earnout Shares are accounted for as derivative earnout liabilities in accordance with ASC 815-40, “Derivatives and Hedging - Contracts in an Entities Own Equity,” and accordingly, the Company recognized the contingent consideration as a liability at fair value upon issuance. The liabilities were subject to re-measurement at each balance sheet date until the Earnout Shares were issued or conditions or events required the Company to reassess the classification, and any change in fair value was recognized in the Company’s consolidated statement of operations. On July 9, 2021, the First Share Price Trigger was achieved, resulting in the issuance of 1,750,000 and 1,450,000 Earnout Shares to the CMG Sellers and IMC Parent, respectively. The remaining unissued Earnout Shares were re-assessed and determined to be indexed to the Company's own equity, resulting in reclassification to equity under ASC 815-40 “Derivatives and Hedging - Contracts in an Entities Own Equity.” The remaining Earnout Shares were remeasured at fair value on July 9, 2021, the date of the event that caused the reclassification, and the change in fair value was recorded in earnings during the three months ended September 30, 2021. Subsequent to the July 9, 2021 remeasurement and reclassification to equity, the Company determined remaining 3,200,000 unissued Earnout Shares do not require fair value remeasurement.applied prospectively.

 

Recent Accounting Pronouncements

 

See Note 2 to our unaudited condensed consolidated financial statements “Summary of Significant Accounting Policies—Recent Accounting Pronouncements” included elsewhere in this Report for more information.

 

Item 3. Quantitative and Qualitative Disclosures About Market Risk

 

AsWe are a smaller reporting company weas defined by Rule 12b-2 of the Exchange Act and are not required to provide the information otherwise required under this information.item.

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Item 4. Controls and Procedures

Management’s Evaluation of Disclosure Controls and Procedures

Under supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, we evaluated the effectiveness of our disclosure controls and procedures (as that term is defined in Rules 13a-15(e) and 15d-15(e) under the Securities Exchange Act of 1934, as amended (the "Exchange Act")) as of SeptemberJune 30, 2021.2022. Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls were not effective as of SeptemberJune 30, 2021,2022, based on the material weaknesses identified below. In light of these material weaknesses, we performed additional analysis as deemed necessary to ensure that our financial statements were prepared in accordance with U.S. generally accepted accounting principles. Based on such analysis and notwithstanding the identified material weakness, management, including our Chief Executive Officer and Chief Financial Officer believe that the condensed consolidated financial statements included in this 10-Q/A fairly represent in all material respects our financial condition, results of operations and cash flows as at and for the periods presented in accordance with U.S. GAAP.

Material Weaknesses in Internal Control over Financial Reporting

As discussed in the Company's Amendment No. 1 to its Annual Report on Form 10-K for the year ended December 31, 2020 (the "2020 10-K"), a material weakness in the Company's internal control over financial reporting did not result in the proper classification of its previously issued warrants. A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting such that there is a reasonable possibility that a material misstatement of our annual or interim financial statements will not be prevented or detected on a timely basis. The warrants were previously classifiedmaterial weaknesses we identified include that we lack a sufficient complement of professionals with the appropriate level of knowledge, training and experience to appropriately analyze, record and disclose accounting matters commensurate with our accounting and reporting requirements as equity ina public company. This material weakness contributed to the Company's balance sheets; after discussionCompany not designing and evaluation, taking intomaintaining formal controls to analyze, account consideration statements byfor and disclose complex transactions, including the staffaccounting for financial instruments and contingent earnout liabilities. These material weaknesses resulted in:

the restatement of the SEC, including our independent registered public accounting firm, we concluded that the warrants should be presentedCompany’s previously filed consolidated financial statements as liabilities with subsequent fair value remeasurement, which required a restatement of our financial statementsand for the year ended December 31, 2020.2020, as well as the quarterly condensed consolidated financial information for the 2020 interim period ended September 30, 2020 related to derivative warrant liabilities, Class A ordinary shares subject to possible redemption, additional paid-in-capital, retained earnings/(deficit), fair value adjustment on derivative warrant liabilities, earnings per share and the related disclosures; and
the restatement of the Company’s previously filed quarterly condensed consolidated financial information for the 2021 interim periods ended June 30, 2021 and September 30, 2021 related to goodwill, contingent earnout liabilities, additional paid-in capital, retained earnings/(deficit), gain/(loss) on remeasurement of earnout liabilities, earnings per share and the related disclosures.

Remediation Plan for the Material Weaknesses

In additionresponse to the aforementioned material weakness identified above, we identifiedweaknesses, management has expended, and will continue to expend, a substantial amount of effort and resources for the remediation of material weaknessweaknesses in internal control over financial reporting. In 2021, management engaged an external advisor to assist in evaluating and documenting the design and operating effectiveness of our internal control over financial reporting, relatedand their work is ongoing. Additionally, management has developed and started to an improper classificationexecute a remediation plan, which included the hiring of the Earnout Shares which resulted in the restatementa Vice President of our unaudited condensed consolidatedFinancial Reporting and Technical Accounting with technical public company accounting and financial statements for the three-month and year-to-date periods ended September 30, 2021, as contained in this Form 10-Q/A. As further described in Note 2 the unaudited Condensed Consolidated Financial Statements, the Earnout Shares were originally classified as equity from and after the Closing Date, and the Company subsequently determined in connection with the preparation of 2021 Annual report Form 10-K that (i) the Earnout shares should have been liability classified and measured at fair value prior to the achievement of the First Share Price Trigger on July 9, 2021, with changes in fair value recorded in profit (loss) for the period reported and (ii) following the achievement of the First Share Price Trigger, the remaining Earnout Shares should have been remeasured at fair value on July 9, 2021 with the change in fair value recorded in profit (loss)reporting experience during the three months ended September 30, 2021. This control deficiency related to the interpretation and accountingfirst quarter of the obligation to issue the Earnout Shares resulted in us having to restate our unaudited condensed consolidated financial statements for the three-month and year-to-date periods ended September 30, 2021, and accordingly, management has determined that this control deficiency constitutes a material weakness.

We conclude to evaluate steps to remediate the material weakness. While we have processes to identify and appropriately apply applicable accounting requirements, we2022. Our plan to enhance our system of evaluating and implementing the complex accounting standards that apply to our financial statements. Our plans at this time includealso includes providing enhanced access to accounting training, literature, research materials and documents and increased communication among our personnelimplementation of controls to review and third-party professionals with whom we consultevaluate conclusions regarding accounting for complex transactions. The material weaknesses will not be considered remediated until management completes the applicationdesign and implementation of complex accounting applications. The elementsthe measures described above and the controls operate for a sufficient period of our remediation plan can only be accomplished over time and we can offer no assurancemanagement has concluded, through testing, that these initiatives will ultimately have the intended effects. For a discussion of management's consideration of the material weakness identified related to our accounting for a significant and unusual transaction related to the warrants we issued in connection with the July 2020 initial public offering, see Note 2, Restatement of Previously Issued Financial Statements to the financial statements in the 2020 10-K.controls are effective.

Changes in Internal Control over Financial Reporting

As discussed elsewhere Report on Form 10-Q, we completed the Business Combination on June 8, 2021. Prior to the Business Combination, DFHT was a special purpose acquisition company formed for the purpose of effecting a merger, capital stock exchange, asset acquisition, stock purchase, reorganization, or other similar business combination with one or more target

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businesses, and CMG was a privately held limited liability company. Additionally, the Business Combination included the acquisition of IMC, and subsequent to the Closing Date, the Company acquired the SMA and DNF entities.

The Company’s operations prior to the Business CombinationThere were materially different compared to the Company post-Business Combination. The design and implementation ofno changes in our internal control over financial reporting for the post-Business Combination Company has required and will continue to require significant time and resources from management and other personnel. Post consummation of the acquisitions, we began establishing standards and procedures at the acquired subsidiaries, controls over accounting systems and over the preparation of financial statements in accordance with generally accepted accounting principles to ensure that we have in place appropriate internal control over financial reporting at the acquired subsidiaries. We are continuing to integrate the acquired operations of each subsidiary into our overall internal control over financial reporting process.

We are in the process of implementing a new comprehensive enterprise resource planning (“ERP”) system on a company-wide basis, which is one of the systems used for financial reporting. The implementation of the ERP system involves changes to our financial systems and other systems and accordingly, necessitated changes to our internal controls over financial reporting. These changes to the Company’s internal control over financial reporting that occurred during the most recent quarterthree months ended SeptemberJune 30, 20212022 that have materially affected, or are reasonably likely to materially affect, the Company’sCompany's internal control over financial reporting.

Limitations on Effectiveness of Controls and Procedures

Disclosure controls and procedures are controls and other procedures that are designed to ensure that information required to be disclosed in our reports filed or submitted under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms. Disclosure controls and procedures include, without limitation, controls and procedures designed to ensure that information required to be disclosed in our reports filed or submitted under the Exchange Act is accumulated and communicated to our management, including our Chief Executive Officer and Chief Financial Officer, to allow timely decisions regarding required disclosure.

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PART II. – OTHER INFORMATION

From time to time, CareMax may be involved in various legal proceedings and subject to claims that arise in the ordinary course of business. Although the results of litigation and claims are inherently unpredictable and uncertain, CareMax is not currently a party to any legal proceedings the outcome of which, if determined adversely to CareMax, are believed to, either individually or taken together, have a material adverse effect on CareMax’s business, operating results, cash flows or financial condition. Regardless of the outcome, litigation has the potential to have an adverse impact on CareMax because of defense and settlement costs, diversion of management resources, and other factorsfactors.

Item1A. Risk Factors

Factors

Except as set forth below, there have been no material changes to the principal risks that could causewe believe to be material to our actualbusiness, results to differ materiallyof operations and financial condition, from thosethe risk factors previously disclosed in this Quarterlyour Annual Report on Form 10-Q are any10-K for the year ended December 31, 2021.

Risks Related to the Acquisition of the risks describedMedicare value-based care business of the Seller Parties

The Merger Agreement with the Seller Parties is subject to closing conditions, including our stockholders' approval of the issuance of the Share Consideration (as defined below), and there can be no guarantee that our stockholders will approve the issuance of the Share Consideration or that the Closing will occur.

On May 31, 2022, we entered into the Merger Agreement with the Seller Parties and the other parties thereto. Pursuant to the Merger Agreement, among other consideration, we will issue at the Steward Closing 23,500,000 shares of Class A Common Stock (the “Initial Share Consideration”), and immediately following the Steward Closing, the equityholders of Seller are expected to own, in our Registration Statement on Form S-1, filedthe aggregate, approximately 21% of the Company’s Class A Common Stock. Additionally, following the Steward Closing, upon the Company’s effective conversion of 100,000 Medicare patients from the Seller Parties’ Medicare network to risk-based, value-based care arrangements with a Medical Expense Ratio of less than 85% for two consecutive calendar quarters, we will issue the Seller, for immediate distribution to its equityholders, a number of shares of Class A Common Stock (the “Earnout Share Consideration” and together with the Initial Share Consideration, the “Share Consideration”) that, when added to the Initial Share Consideration, would have represented 41% of the issued and outstanding shares of Class A Common Stock as of the Steward Transaction Closing.

As a result of the potential issuance of the Share Consideration, we are required to receive stockholder approval of the issuance of the Share Consideration prior to the Steward Transaction Closing for purposes of compliance with Nasdaq rules. We plan to file a proxy statement with the SEC seeking approval by our stockholders of the issuance of the Share Consideration. Certain of our stockholders have agreed to vote in favor of the issuance of the Share Consideration, but there can be no guarantee that we will receive stockholder approval.

The Merger Agreement contains additional customary closing conditions set forth therein, including the receipt of regulatory approvals. Even if we receive stockholder approval for the issuance of the Share Consideration, there can be no guarantee that all other conditions to the Steward Transaction Closing will be satisfied on June 30, 2021. Anya timely basis or at all. In the event that the Steward Transaction Closing does not occur, the anticipated benefits of these factorsthe Steward Transactions will not be realized, which could result inhave a significant or material adverse effect on our results of operations orfuture growth, business, financial condition. Additional risk factors not presently known to us or that we currently deem immaterial may also impair our business orcondition and results of operations.

The issuance of the Share Consideration will result in dilution to our stockholders and may adversely affect us, including the market price of our securities.

The Initial Share Consideration to be issued under the Merger Agreement consists of 23,500,000 shares of Class A Common Stock, which is expected to be approximately 21% of the Company’s Class A Common Stock issued and outstanding, will result in a significant, immediate dilution to the Company’s stockholders and may cause the trading price of the Company’s securities to decline. Additionally, upon the issuance of the Earnout Share Consideration, there will be significant additional dilution to the Company’s stockholders, and even in the event that the Earnout Share Consideration is not issued, the potential for the issuance of the Earnout Share Consideration may negatively affect the trading price of the Company’s securities in anticipation of such dilution. Additionally, the dilution caused by the Share Consideration could, among other things, limit the ability of our current stockholders to influence management of the Company post-closing.

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Certain of the equityholders who will receive Share Consideration will be subject to lockup provisions that restrict the sale of the Class A Common Stock by such persons in excess of 4% of the total outstanding Class A Common Stock immediately following the Steward Transaction Closing for one year, subject to certain exceptions, but sales of a substantial number of the Equity Consideration Securities in the public market, or the perception that such sales may occur, could adversely affect the market price of our securities, notwithstanding such lockup provisions.

Failure to complete the Steward Transaction could negatively impact the Company.

If the Steward Transaction is not completed for any reason, there may be various adverse consequences and we may experience negative reactions from the financial markets and from our employees and patients. Additionally, if the Merger Agreement is terminated, the market price of our securities could decline to the extent that current market prices reflect a market assumption that the Steward Transaction will be beneficial and will be completed. We also could be subject to litigation related to any failure to complete the Steward Transaction or to perform our obligations under the Merger Agreement.

The Acquisition may be more difficult, costly, or time-consuming than expected, and we may not realize the anticipated benefits of the Steward Transaction.

To realize the anticipated benefits from the Steward Transaction, we must successfully integrate and combine our business with that of Steward Value-Based Care. If we are not able to successfully achieve these objectives, the anticipated benefits of the Steward Transaction may not be realized fully or at all or may take longer to realize than expected. In addition, the actual benefits of the Steward Transaction could be less than anticipated, and integration may result in additional unforeseen expenses. In addition, we and Steward Value-Based Care have operated and, until the completion of the Steward Transaction, must continue to operate, independently. It is possible that the integration process could result in the loss of one or more key employees, the disruption of each company’s ongoing businesses or inconsistencies in standards, controls, procedures, and policies that adversely affect each company’s ability to maintain relationships with doctors, patients, and employees or to achieve the anticipated benefits of the Steward Transaction. Integration efforts between the companies may also divert management attention and resources. These integration matters could have an adverse effect on CareMax during this transition period and for an undetermined period after completion of the Steward Transaction.

We are subject to business uncertainties and contractual restrictions while the Steward Transaction is pending.

Uncertainty about the effects of the Steward Transaction may have an adverse effect on us or Steward Value-Based Care. These uncertainties may impair Steward Value-Based Care’s and our ability to attract, retain and motivate key personnel until the Steward Transaction is completed, and could cause third parties that deal with Steward Value-Based Care or us to seek to change existing business relationships, any of which could materially adversely impact our operations.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

Information regarding all equity securities of the registrant sold by the Company during the period covered by this Report that were not registered under the Securities Act were included in a Current Report on Form 8-K filed by the Company, and therefore is not required to be furnished herein.None.

Item 3. Defaults Upon Senior Securities

None.

Item 4. Mine Safety Disclosures

None.

Item 5. Other Information

None.

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Item 6. Exhibits

The following exhibits are filed as part of, or incorporated by reference into, this Report.

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No.

Description of Exhibit

10.1†+10.1+

Asset Purchase Agreement and Plan of Merger, dated as of July 5, 2021,May 31, 2022, by and among, CareMax, Inc., CareMax Medical Centers of Central Florida,Sparta Merger Sub I Inc., Sparta Merger Sub II Inc., Sparta Merger Sub III Inc., Sparta Merger Sub I LLC, Unlimited Medical Services of Florida,Sparta Merger Sub II LLC, Sparta Merger Sub III LLC, Sparta Sub Inc., SNCN Holdco Inc., SICN Holdco Inc., Sparta Holding Co. LLC, and the other parties theretoSteward Health Care System LLC (Incorporated by reference to Exhibit 10.1 to the Company’s Current Report on Form 8-K (File No. 001-39391), filed with the SEC on July 7, 2021)June 1, 2022).

10.2†+10.2

Exclusive Real Estate AdvisorySupport Agreement, dated as of July 13, 2021,May 31, 2022, by and between CareMax, Inc., Related CM Advisor, LLC and with respect to certain sections thereof, The Related Companies,Deerfield Partners, L.P. (Incorporated by reference to Exhibit 10.110.2 to the Company’s Current Report on Form 8-K (File No. 001-39391), filed with the SEC on July 13, 2021)June 1, 2022).

10.3++

Credit Agreement, dated as of May 10, 2022, by and among the Company, certain of the Company’s subsidiaries as guarantors, Jefferies Finance LLC, as Administrative Agent, Collateral Agent, Sole Lead Arranger and Bookrunner, BlackRock Financial Management, as Lead Manager, Crestline Direct Finance, L.P., as Documentation Agent, and certain other banks and financial institutions serving as lenders (Incorporated by reference to Exhibit 10.24 to the Company’s Amendment No. 1 to the Registration Statement on Form S-1 (Reg. No. 333-264654), filed with the SEC on May 18, 2022).

31.1*

Certification of Principal Executive Officer Pursuant to Securities Exchange Act Rules 13a-14(a) and 15(d)-14(a), as adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

31.2*

Certification of Principal Financial Officer Pursuant to Securities Exchange Act Rules 13a-14(a) and 15(d)-14(a), as adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.

32.1**

Certification of Principal Executive Officer Pursuant to 18 U.S.C. Section 1350, as adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

32.2**

Certification of Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.

101.INS*

Inline XBRL Instance Document

101.CAL*

Inline XBRL Taxonomy Extension Calculation Linkbase Document

101.SCH*

Inline XBRL Taxonomy Extension Schema Document

101.DEF*

Inline XBRL Taxonomy Extension Definition Linkbase Document

101.LAB101.LAB*

Inline XBRL Taxonomy Extension Labels Linkbase Document

101.PRE101.PRE*

Inline XBRL Taxonomy Extension Presentation Linkbase Document

104104*

Cover Page Interactive Data File (embedded within the Inline XBRL document)

* Filed herewith.

** Furnished herewith.

+ Certain of the exhibits and schedules to this Exhibitexhibit have been omitted in accordance with Item 601(a)(5) of Regulation S-K. The RegistrantCompany agrees to furnish a copy of all omitted exhibits and schedules to the SEC upon its request.

++Certain portions of this exhibit have been omitted pursuant to Regulation S-K, Item (601)(b)(10) of Regulation S-K.

 

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SIGNATURES

 

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

 

CareMax Inc.

Date: March 16,August 9, 2022

/s/ Carlos A. de Solo

Name:

Carlos A. de Solo

Title:

President, Chief Executive Officer, and Director

(Principal Executive Officer)

 

Date: March 16,August 9, 2022

/s/ Kevin Wirges

Name:

Kevin Wirges

Title:

Executive Vice President, Chief Financial Officer and Treasurer

(Principal Financial and Principal Accounting Officer)

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