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 March 31, 20222023

OR

TRANSITION REPORT PURSUANT TO SECTION 13 OR

 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

 

Commission File Number: 001-39391

 

img230330315_0.jpgimg231253836_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 5757th 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

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 May 6, 2022,5, 2023, the registrant had 87,367,972111,374,586 shares of Class A common stock, $0.0001 par value per share, and no 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 March 31, 2022 (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 March 31, 2022, as filed with the Securities and Exchange Commission (“SEC”) on May 10, 2022 (the “Original Filing”). This Form 10-Q/A is being filed to restate the Company’s unaudited Condensed Consolidated Financial Statements for the three months ended March 31, 2022. The restatement reflects a correction of the classification of the equity consideration issued to the Company’s real estate advisor in July 2021 from prepaid expenses to other assets. 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 4: Controls and Procedures

Part II, Item 1A: Risk Factors

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 March 31, 20222023

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

1925

 

Item 3.

Quantitative and Qualitative DisclosureDisclosures About Market Risk

3241

 

Item 4.

Controls and Procedures

3342

PART II. OTHER INFORMATION

3444

 

Item 1.

Legal Proceedings

3444

 

Item 1A.

Risk Factors

3444

 

Item 2.

Unregistered Sales of Equity Securities and Use of Proceeds

3444

 

Item 3.

Defaults Upon Senior Securities

3444

 

Item 4.

Mine Safety Disclosures

3444

 

Item 5.

Other Information

3444

 

Item 6.

Exhibits

34Exhibits

44

 

 


 

PART I – FINANCIAL INFORMATION

 

ITEM 1. FINANCIAL STATEMENTS

 

CAREMAX, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(Unaudited)

(in thousands, except share and per share data)

 

 

March 31, 2022
(As Restated)

 

 

December 31, 2021

 

 

March 31,
2023

 

 

December 31,
2022

 

ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT ASSETS

 

 

 

 

 

 

Cash

 

$

32,740

 

 

$

47,917

 

Current Assets

 

 

 

 

 

 

Cash and cash equivalents

 

$

44,222

 

 

$

41,626

 

Accounts receivable, net

 

 

53,581

 

 

 

41,998

 

 

 

158,989

 

 

 

151,036

 

Inventory

 

 

702

 

 

 

550

 

Prepaid expenses

 

 

4,829

 

 

 

3,786

 

Risk settlements due from providers

 

 

655

 

 

 

539

 

Risk settlement assets

 

 

858

 

 

 

707

 

Other current assets

 

 

5,928

 

 

 

3,968

 

Total Current Assets

 

 

92,508

 

 

 

94,790

 

 

 

209,998

 

 

 

197,336

 

 

 

 

 

 

 

 

 

 

 

 

 

Property and equipment, net

 

 

16,895

 

 

 

15,993

 

 

 

22,726

 

 

 

21,006

 

Goodwill

 

 

464,264

 

 

 

464,566

 

Operating lease right-of-use assets

 

 

115,018

 

 

 

108,937

 

Goodwill, net

 

 

602,643

 

 

 

700,643

 

Intangible assets, net

 

 

55,604

 

 

 

59,811

 

 

 

118,189

 

 

 

123,585

 

Deferred debt issuance costs

 

 

1,860

 

 

 

1,972

 

 

 

1,842

 

 

 

1,685

 

Other assets

 

 

17,953

 

 

 

15,960

 

 

 

27,286

 

 

 

17,550

 

Total Assets

 

$

649,085

 

 

$

653,092

 

 

$

1,097,701

 

 

$

1,170,743

 

 

 

 

 

 

 

 

 

 

 

 

 

LIABILITIES AND STOCKHOLDERS' EQUITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CURRENT LIABILITIES

 

 

 

 

 

 

Current Liabilities

 

 

 

 

 

 

Accounts payable

 

$

5,165

 

 

$

3,110

 

 

$

8,134

 

 

$

7,687

 

Accrued expenses

 

 

12,365

 

 

 

8,690

 

 

 

18,602

 

 

 

18,631

 

Risk settlements due to providers

 

 

228

 

 

 

196

 

Current portion of long-term debt

 

 

6,272

 

 

 

6,275

 

Risk settlement liabilities

 

 

13,868

 

 

 

14,171

 

Related party debt, net

 

 

31,548

 

 

 

30,277

 

Current portion of third-party debt, net

 

 

274

 

 

 

253

 

Current portion of operating lease liabilities

 

 

3,898

 

 

 

5,512

 

Other current liabilities

 

 

4,107

 

 

 

3,687

 

 

 

4,103

 

 

 

790

 

Total Current Liabilities

 

 

28,137

 

 

 

21,959

 

 

 

80,428

 

 

 

77,322

 

 

 

 

 

 

 

Derivative warrant liabilities

 

 

11,911

 

 

 

8,375

 

 

 

2,868

 

 

 

3,974

 

Long-term debt, less current portion

 

 

109,660

 

 

 

110,960

 

Long-term debt, net

 

 

260,642

 

 

 

230,725

 

Long-term operating lease liabilities

 

 

106,291

 

 

 

96,539

 

Contingent earnout liability

 

 

98,425

 

 

 

134,561

 

Other liabilities

 

 

7,186

 

 

 

6,428

 

 

 

9,283

 

 

 

8,075

 

Total Liabilities

 

 

156,895

 

 

 

147,722

 

 

 

557,938

 

 

 

551,196

 

COMMITMENTS AND CONTINGENCIES (Note 13)

 

 

 

 

 

 

COMMITMENTS AND CONTINGENCIES (NOTE 15)

 

 

 

 

 

 

STOCKHOLDERS' EQUITY

 

 

 

 

 

 

 

 

 

 

 

 

Preferred stock (1,000,000 authorized and zero outstanding as of March 31, 2022 and December 31, 2021)

 

 

-

 

 

 

-

 

Class A common stock ($0.0001 par value; 250,000,000 shares authorized; 87,367,972 shares issued
and outstanding at March 31, 2022 and December 31, 2021)

 

 

9

 

 

 

9

 

Preferred stock (1,000,000 shares authorized; one share issued and outstanding as of March 31, 2023 and December 31, 2022)

 

 

-

 

 

 

-

 

Class A common stock ($0.0001 par value; 250,000,000 shares authorized; 111,360,802 and 111,332,584 shares issued and outstanding as of March 31, 2023 and December 31, 2022, respectively)

 

 

11

 

 

 

11

 

Additional paid-in-capital

 

 

508,945

 

 

 

505,327

 

 

 

659,424

 

 

 

657,126

 

Retained (deficit) earnings

 

 

(16,763

)

 

 

33

 

Accumulated deficit

 

 

(119,672

)

 

 

(37,590

)

Total Stockholders' Equity

 

 

492,190

 

 

 

505,370

 

 

 

539,763

 

 

 

619,547

 

 

 

 

 

 

 

 

 

 

 

 

 

Total Liabilities and Stockholders' Equity

 

$

649,085

 

 

$

653,092

 

 

$

1,097,701

 

 

$

1,170,743

 

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
March 31,

 

 

Three Months Ended
March 31,

 

 

Three Months Ended March 31,

 

 

2022

 

 

2021

 

 

2023

 

 

2022

 

Revenue

 

 

 

 

 

 

 

 

 

 

 

 

Medicare risk-based revenue

 

$

107,747

 

 

$

27,816

 

 

$

121,593

 

 

$

107,747

 

Medicaid risk-based revenue

 

 

20,165

 

 

 

-

 

 

 

25,626

 

 

 

20,165

 

Government value-based care revenue

 

 

10,010

 

 

 

-

 

Other revenue

 

 

9,008

 

 

 

102

 

 

 

15,754

 

 

 

9,008

 

Total revenue

 

 

136,920

 

 

 

27,918

 

 

 

172,983

 

 

 

136,920

 

 

 

 

 

 

 

 

 

 

 

 

 

Operating expenses

 

 

 

 

 

 

 

 

 

 

 

 

External provider costs

 

 

92,856

 

 

 

18,159

 

 

 

110,673

 

 

 

92,856

 

Cost of care

 

 

27,349

 

 

 

5,353

 

 

 

38,627

 

 

 

27,349

 

Sales and marketing

 

 

3,301

 

 

 

291

 

 

 

3,765

 

 

 

3,301

 

Corporate, general and administrative

 

 

18,978

 

 

 

1,795

 

 

 

23,945

 

 

 

18,978

 

Depreciation and amortization

 

 

5,062

 

 

 

514

 

 

 

6,576

 

 

 

5,062

 

Goodwill impairment

 

 

98,000

 

 

 

-

 

Acquisition related costs

 

 

266

 

 

 

-

 

 

 

20

 

 

 

266

 

Total operating expenses

 

 

147,811

 

 

 

26,112

 

 

 

281,606

 

 

 

147,811

 

Operating (loss) income

 

 

(10,890

)

 

 

1,806

 

Interest expense

 

 

(1,728

)

 

 

(504

)

Loss on remeasurement of warrant liabilities

 

 

(3,536

)

 

 

-

 

Operating loss

 

 

(108,623

)

 

 

(10,890

)

Nonoperating income (expense)

 

 

 

 

 

 

Interest expense, net

 

 

(10,458

)

 

 

(1,728

)

Change in fair value of derivative warrant liabilities

 

 

1,107

 

 

 

(3,536

)

Gain (loss) on remeasurement of contingent earnout liabilities

 

 

36,136

 

 

 

-

 

Other income (expense), net

 

 

(462

)

 

 

-

 

 

 

(66

)

 

 

(462

)

(Loss) income before income tax

 

 

(16,616

)

 

 

1,302

 

Income tax provision

 

 

(181

)

 

 

-

 

Net (loss) income

 

$

(16,797

)

 

$

1,302

 

 

 

 

 

 

 

 

 

26,718

 

 

 

(5,726

)

Weighted average basic shares outstanding

 

 

87,367,972

 

 

 

10,796,069

 

Weighted average diluted shares outstanding

 

 

87,367,972

 

 

 

10,796,069

 

Net (loss) income per share

 

 

 

 

 

 

Loss before income tax

 

 

(81,904

)

 

 

(16,616

)

Income tax expense

 

 

(177

)

 

 

(181

)

Net loss

 

$

(82,082

)

 

$

(16,797

)

 

 

 

 

 

 

Weighted-average basic shares outstanding

 

 

111,360,802

 

 

 

87,367,972

 

Weighted-average diluted shares outstanding

 

 

111,360,802

 

 

 

87,367,972

 

Net loss per share

 

 

 

 

 

 

Basic

 

$

(0.19

)

 

$

0.12

 

 

$

(0.74

)

 

$

(0.19

)

Diluted

 

$

(0.19

)

 

$

0.12

 

 

$

(0.74

)

 

$

(0.19

)

 

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

 

 

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

 

Net income

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

1,302

 

 

 

-

 

 

 

1,302

 

BALANCE- MARCH 31, 2021

 

 

-

 

 

$

-

 

 

$

-

 

 

$

-

 

 

$

223

 

 

$

7,805

 

 

$

-

 

 

$

8,028

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BALANCE - DECEMBER 31, 2021

 

 

87,367,972

 

 

$

9

 

 

$

-

 

 

$

505,327

 

 

$

-

 

 

$

-

 

 

$

33

 

 

$

505,370

 

Stock compensation expense

 

 

-

 

 

 

-

 

 

 

-

 

 

 

1,087

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

1,087

 

Vesting of Series B Warrants under Advisory Agreement

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,530

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,530

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(16,797

)

 

 

(16,797

)

BALANCE- MARCH 31, 2022

 

 

87,367,972

 

 

$

9

 

 

$

-

 

 

$

508,945

 

 

$

-

 

 

$

-

 

 

$

(16,763

)

 

$

492,190

 

 

Three Months Ended March 31, 2023 and 2022

 

 

 

Class A Common Stock

 

 

Preferred

 

 

Additional

 

 

Retained Earnings

 

 

Total

 

 

Shares

 

 

Amount

 

 

Stock

 

 

Paid-in-capital

 

 

(Deficit)

 

 

Equity

 

BALANCE - DECEMBER 31, 2022

 

 

111,332,584

 

 

$

11

 

 

$

-

 

 

$

657,126

 

 

$

(37,590

)

 

$

619,547

 

Stock-based compensation expense

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,298

 

 

 

-

 

 

 

2,298

 

Issuance of shares upon vesting of stock-based compensation awards

 

 

28,218

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(82,082

)

 

 

(82,082

)

BALANCE - MARCH 31, 2023

 

 

111,360,802

 

 

$

11

 

 

$

-

 

 

$

659,424

 

 

$

(119,672

)

 

$

539,763

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BALANCE - DECEMBER 31, 2021

 

 

87,367,972

 

 

$

9

 

 

$

-

 

 

$

505,327

 

 

$

33

 

 

 

505,369

 

Stock-based compensation expense

 

 

-

 

 

 

-

 

 

 

-

 

 

 

1,087

 

 

 

-

 

 

 

1,087

 

Vesting of Series B Warrants under Advisory Agreement

 

 

-

 

 

 

-

 

 

 

-

 

 

 

2,530

 

 

 

-

 

 

 

2,530

 

Net loss

 

 

-

 

 

 

-

 

 

 

-

 

 

 

-

 

 

 

(16,797

)

 

 

(16,797

)

BALANCE - MARCH 31, 2022

 

 

87,367,972

 

 

$

9

 

 

$

-

 

 

$

508,945

 

 

$

(16,763

)

 

$

492,190

 

 

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)

 

 

Three Months Ended
March 31,

 

 

Three Months Ended
March 31,

 

 

 

2022

 

 

2021

 

CASH FLOWS FROM OPERATING ACTIVITIES

 

 

 

 

 

 

Net (loss)/Income

 

$

(16,797

)

 

$

1,302

 

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

 

 

 

 

 

 

Depreciation and amortization expense

 

 

5,062

 

 

 

514

 

Amortization of debt issuance costs

 

 

378

 

 

 

35

 

Stock compensation expense

 

 

1,087

 

 

 

-

 

Loss on remeasurement of warrant liabilities

 

 

3,536

 

 

 

-

 

Other non-cash, net

 

 

202

 

 

 

-

 

Changes in operating assets and liabilities:

 

 

 

 

 

 

Accounts receivable

 

 

(10,992

)

 

 

639

 

Inventory

 

 

(152

)

 

 

(1

)

Prepaid expenses

 

 

(475

)

 

 

15

 

Risk settlements due from/due to providers

 

 

(84

)

 

 

(281

)

Due to/from related parties

 

 

-

 

 

 

(392

)

Other assets

 

 

(52

)

 

 

(205

)

Accounts payable

 

 

1,470

 

 

 

1,160

 

Accrued expenses

 

 

3,675

 

 

 

(134

)

Other liabilities

 

 

1,002

 

 

 

720

 

Net Cash (Used In)/Provided by Operating Activities

 

 

(12,139

)

 

 

3,372

 

 

 

 

 

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES

 

 

 

 

 

 

Purchase of property and equipment

 

 

(1,467

)

 

 

(1,690

)

Net Cash Used in Investing Activities

 

 

(1,467

)

 

 

(1,690

)

 

 

 

 

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES

 

 

 

 

 

 

Principal payments on long-term debt

 

 

(1,570

)

 

 

(181

)

Net Cash Used In Financing Activities

 

 

(1,570

)

 

 

(181

)

 

 

 

 

 

 

 

NET (DECREASE)/INCREASE IN CASH

 

 

(15,176

)

 

 

1,501

 

Cash - Beginning of Period

 

 

47,917

 

 

 

4,934

 

CASH - END OF PERIOD

 

$

32,740

 

 

$

6,435

 

 

Three Months Ended March 31,

 

 

2023

 

 

2022

 

CASH FLOWS FROM OPERATING ACTIVITIES

 

 

 

 

 

 

Net loss

 

$

(82,082

)

 

$

(16,797

)

Adjustments to reconcile net loss to net cash and cash equivalents

 

 

 

 

 

 

Depreciation and amortization expense

 

 

6,576

 

 

 

5,062

 

Amortization of debt issuance costs and discounts

 

 

1,839

 

 

 

378

 

Stock-based compensation expense

 

 

2,298

 

 

 

1,087

 

Income tax provision

 

 

177

 

 

 

181

 

Change in fair value of derivative warrant liabilities

 

 

(1,107

)

 

 

3,536

 

Loss (gain) on remeasurement of contingent earnout liabilities

 

 

(36,136

)

 

 

-

 

Payment-in-kind interest expense

 

 

2,453

 

 

 

-

 

Provision for credit losses

 

 

(104

)

 

 

-

 

Goodwill impairment

 

 

98,000

 

 

 

-

 

Other non-cash, net

 

 

1,080

 

 

 

21

 

Changes in operating assets and liabilities:

 

 

 

 

 

 

   Accounts receivable

 

 

(7,850

)

 

 

(10,992

)

   Other current assets

 

 

(1,961

)

 

 

(627

)

   Risk settlement assets and liabilities

 

 

(454

)

 

 

(84

)

   Other assets

 

 

(9,735

)

 

 

(52

)

   Operating lease assets and liabilities

 

 

1,445

 

 

 

-

 

   Accounts payable

 

 

(500

)

 

 

1,470

 

   Accrued expenses

 

 

(29

)

 

 

3,675

 

   Other liabilities

 

 

4,343

 

 

 

1,002

 

      Net cash used in operating activities

 

 

(21,746

)

 

 

(12,139

)

 

 

 

 

 

 

CASH FLOWS FROM INVESTING ACTIVITIES

 

 

 

 

 

 

Purchase of property and equipment

 

 

(2,286

)

 

 

(1,467

)

     Net cash used in investing activities

 

 

(2,286

)

 

 

(1,467

)

 

 

 

 

 

 

CASH FLOWS FROM FINANCING ACTIVITIES

 

 

 

 

 

 

Proceeds from borrowings on long-term debt, net

 

 

27,000

 

 

 

-

 

Principal payments of debt

 

 

(25

)

 

 

(1,570

)

Payments of debt issuance costs

 

 

(348

)

 

 

-

 

     Net cash provided by (used in) financing activities

 

 

26,627

 

 

 

(1,570

)

 

 

 

 

 

 

NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS

 

 

2,596

 

 

 

(15,176

)

Cash and cash equivalents - beginning of period

 

 

41,626

 

 

 

47,917

 

CASH AND CASH EQUIVALENTS - END OF PERIOD

 

$

44,222

 

 

$

32,740

 

 

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)

 

 

Three Months Ended
March 31,

 

 

Three Months Ended
March 31,

 

SUPPLEMENTAL SCHEDULE OF NON-CASH ACTIVITIES:

 

2022

 

 

2021

 

Vesting of Series B Warrants under Advisory Agreement

 

 

2,530

 

 

 

 

Additions to construction in progress funded through accounts payable

 

 

585

 

 

 

 

SUPPLEMENTAL CASH FLOW INFORMATION:

 

 

 

 

 

 

Cash paid for interest

 

 

1,353

 

 

 

504

 

 

 

Three Months Ended March 31,

 

 

 

2023

 

 

2022

 

SUPPLEMENTAL SCHEDULE OF NON-CASH ACTIVITIES:

 

 

 

 

 

 

Equity and warrant consideration issued to The Related Companies, L.P.

 

$

 

 

$

2,530

 

Additions to construction in progress funded through accounts payable

 

 

947

 

 

 

585

 

SUPPLEMENTAL CASH FLOW INFORMATION:

 

 

 

 

 

 

Cash paid for interest

 

 

6,375

 

 

 

1,353

 

 

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

 

(5)


 

CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(Unaudited)

 

Note 1. DESCRIPTION of business

CareMax, Inc. (“CareMax” or the “Company”), f/k/aformerly Deerfield Healthcare Technology Acquisitions Corp. (“DFHT”), is a Delaware corporation, was originally formedwhich announced its initial public offering in July 2020 (the "IPO") 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 March 31, 2023, the Company currently operatesoperated 4862 wholly owned, multi-specialty centers in Florida, Tennessee and New York,managed affiliated providers across 10 states 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”), theand 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 ofin 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.

Unless the context otherwise requires, “the Company,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, primarily during the second half of 2021, the Company acquired Senior Medical Associates, LLC ("SMA"), Stallion Medical Management, LLC ("SMM)SMM"), Unlimited Medical Services of Florida, LLC ("DNF"), Advantis Physician Alliance, LLC ("Advantis"), Business Intelligence & Analytics LLC ("BIX"), and three additional businesses (together with the acquisitions of SMA, SMM, DNF, Advantis and BIX, the "Acquisitions") which did not have a. Refer to Note 5, Goodwill and Other Intangible Assets, for information about measurement period adjustments.

On November 10, 2022, the Company acquired the Medicare value-based care business of Steward Health Care System ("Steward Value-Based Care"), further described in Note 3, Acquisitions. No material impact on our condensed consolidated financial statements. No significant measurement period adjustments related to the Acquisitions or the Steward Acquisition were recognized during the three months ended March 31, 2023 or 2022. As of March 31, 2022, due to the timing of these transactions, the initial accounting for acquisitions of Advantis and BIX and the three additional businesses is incomplete, pending determination of the final purchase price and any remaining working capital adjustments.

 

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. 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 Securities 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, 2021,2022, 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, 20212022 as filed with the SEC on March 16, 2022. 30, 2023.


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

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 statement

(6)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

of financial position, operating results and cash flows for the periods presented. Operating results for the three months ended March 31, 2022any interim period are not necessarily indicative of the results that may be expected for the year ending December 31, 2022.

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. 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 were stated at historical cost, with no goodwill or other intangible assets recorded. Further, CMG was determined to be the accounting acquirer in the acquisition of IMC (the “IMC Acquisition”), as such, the acquisition was considered a business combination under Accounting Standard 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.

Unless otherwise noted, information for periods prior to the Closing Date reflects the financial information of CMG only.full year.

 

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

Restatement of Previously Reported Financial Statements

In conjunction with the Company's close process for the year ended December 31, 2022, management identified an error related to classification of equity consideration issued to the Company's real estate advisor in July 2021 (the "Prepaid Asset"). The Prepaid Asset was previously presented as part of the Company's short-term assets, in Warrants and prepaid expenses. The Company determined that the Prepaid Asset relates to services that are performed by the real estate advisor over multiple years. Accordingly, the Prepaid Asset should be recorded in other assets, except for the portion that represents the Prepaid Asset amortization expense expected to be recognized during the next twelve months following a given period.

The following table reflects the impact of the restatement to the specified line items presented in the Company's previously reported unaudited condensed consolidated balance sheet as of March 31, 2022:

(in thousands)

As Originally Reported

 

Adjustment

 

As Restated

 

ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

Affected financial statement line items

 

 

 

 

 

 

Prepaid expenses

 

20,045

 

 

(15,215

)

 

4,829

 

Total Current Assets

$

107,723

 

$

(15,215

)

$

92,508

 

 

 

 

 

 

 

 

Other assets

 

2,738

 

 

15,215

 

 

17,953

 

 

There was no impact on the condensed consolidated statement of operations, statements of changes in stockholders'/members' equity or statement of cash flows.

The accompanying applicable Notes have been updated to reflect the restatement described above.

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 makersmaker and operates in and reports as a single operating segment, the objective of which is to care for its patients’ needs.segment. 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 EntitiesMedicare and Medicaid Risk-Based Revenue

Medicare and Medicaid Risk-Based Revenue consists primarily of fees for medical services provided under capitated arrangements directly 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 on a per patient per month basis (“PMPM”) for a defined patient population, and the Company is then responsible for providing healthcare services required by that patient population. PMPM fees can fluctuate throughout the contract based on the health status (acuity) of each individual enrollee. In certain contracts, PMPM fees also include “risk adjustments” for items such as performance incentives, performance guarantees and risk shares. The capitated revenues are recognized based on the estimated PMPM fees earned net of projected performance incentives, performance guarantees, risk shares and rebates because we are able to reasonably estimate the ultimate PMPM payment of these contracts. We recognize revenue in the month in which eligible members are entitled to receive healthcare benefits. Subsequent changes in PMPM fees and the amount of revenue to be recognized are reflected through subsequent period adjustments to properly recognize the ultimate capitation amount.

For enrolled members in which we control healthcare services, we act as the principal and the gross fees under these contracts are reported as revenue and the cost of third-party medical care is included in external provider costs.

The Company generates management services organization (“MSO”) revenue for services it renders to independent physician associations (the “IPAs”) under administrative service contracts. The MSO revenue is recognized in the month in which the eligible members are entitled to receive healthcare benefits during the contract term. For MSO contracts in which the Company acts as a principal in coordinating and controlling the range of services provided (other than clinical decisions) and, thus, accepts full financial risk for members attributed to the IPA and is therefore responsible for the cost of all healthcare services required by those members, the fees are recognized on a gross basis, consistent with ASC 606, Revenue From Contracts with Customers ("ASC 606"). The related revenue is recorded in Medicare risk-based and Medicaid risk-based revenue.

Government Value-Based Care Revenue

 

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"Government Value-Based Care Revenue consists primarily of revenue derived from the Medicare Shared Savings Program (“MSSP”). These evaluationsThe MSSP is sponsored by the Center for Medicare and Medicaid Services (“CMS”). The MSSP allows accountable care organizations (“ACOs”) to receive a share of cost savings they generate in connection with the managing of costs and quality of medical services rendered to Medicare beneficiaries. Payments to ACO participants, if any, are complex, involve judgment,calculated annually and paid once a year by CMS on cost savings generated by the useACO participant relative to the ACO participants’ CMS benchmark. Under the MSSP, an ACO must meet certain qualifications to receive the full amount of estimates and assumptions based on available historical information, among other factors.its allocable cost savings or they either receive nothing or are responsible for shared losses. The Company considers itselfMSSP rules require CMS to control an entitydevelop a benchmark for savings to be achieved by each ACO if itthe ACO is to receive shared savings. An ACO that meets 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 beneficiaryMSSP’s quality performance standards will be eligible to receive a share of the VIE. The Company consolidates VIEs when itsavings to the extent its assigned beneficiary medical expenditures are below the medical expenditure benchmark provided by CMS. A Minimum Savings Rate (“MSR”) must be achieved before the ACO can receive a share of the savings. Once the MSR is surpassed, all the savings below the benchmark

 

(7)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

provided by CMS will be shared at a certain percentage with the ACO. The MSR varies depending on the number of beneficiaries assigned to the ACO.

The promised services under the Company's MSSP arrangements are to provide the population health services to beneficiaries for a given performance period. As part of these arrangements, the Company stands ready to provide the population health services throughout the performance period.

The Company estimates the variable consideration that constitutes the transaction price of these arrangements by utilizing third-party data and historical experience. As the Company’s performance obligation is met, revenue is recorded over time using its estimation methods and consideration is made, to the extent possible, that it is probable that a significant reversal will not occur once any uncertainty associated with the variable consideration is subsequently resolved. Since the Company has determined thatit only has one performance obligation under each of these arrangements, it allocates the full transaction price towards each arrangement’s individual performance obligation.

Government Value-Based Care Revenue is recognized on a net basis, because the Company does not coordinate or control the range of services provided and, thus, accepts partial or no financial risk.

Other Revenue

Other revenue primarily represents partial and no risk capitation, MSO and pharmacy revenue. Capitation revenue represents a fixed amount of money per patient per month paid in advance for the delivery of primary care services only, whereby the Company is the primary beneficiarynot liable for medical costs in excess of the VIE. Management performs ongoing reassessmentsfixed 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 changesthose patients receive their care from our affiliated medical groups. Revenue for primary care services for patients in a partial risk or upside-only contracts is reported in other revenue.

For MSO contracts in which the Company does not coordinate or control the range of services provided and, thus, accepts partial or no financial risk for members attributed to the IPA, the revenue is recognized on a net basis, consistent with ASC 606, and is recorded in Other revenue.

Accounts Receivable

Accounts receivable are carried at the amounts the Company deems collectible. Accordingly, an allowance is provided based on credit losses expected over the contractual term. This allowance is netted against the receivable balance with the loss being recognized within general and administrative expenses in the factsconsolidated statements of operations. Accounts receivables are written off when they are deemed uncollectible. As of March 31, 2023 and circumstances regardingDecember 31, 2022, the Company’s involvement with a VIE will causeCompany's provision for credit losses was $1.1 million and $1.2 million, respectively.

Amounts due to the consolidation conclusionCompany within 12 months of the reporting period are recorded in Accounts receivable, net. Amounts which the Company excepts to change. Changesreceive following the 12-month period are recorded in consolidation status are applied prospectively. Refer to Note 14 “Other assets. Accordingly, as of March 31, 2023, $Variable Interest Entities9.6” for additional information. million of accounts receivable was included in Other Assets (none as of December 31, 2022).

 

Significant Accounting Policies

Other than addition of the Variable Interest Entity policy, thereThere have been no changes to our criticalsignificant accounting policies and estimates as described in our Annual Report on Form 10-K for the year ended December 31, 2021,2022, which was filed with the SEC on March 16, 2022.30, 2023.

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 in the consolidated financial statements and disclosed. The Company bases its estimates on the available information, its experiences and various other assumptions believed to be reasonable under the circumstances including estimates of the impact of COVID-19.accompanying notes. The areas where significant estimates are used in the accompanying financial statements include, but are not limited to, revenues

(8)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

and related receivables from risk adjustments, medical services expense and related payables, purchase price allocations, including fair value estimates of intangibles and contingent consideration;consideration, the valuation of and related impairment testing of long-lived assets, including goodwill and intangible assets;assets, the valuation of the derivative warrant liabilities;liabilities, and the estimated useful lives of fixed assets and intangible assets, including internally developed software; revenue recognition and liability for unpaid claims.software. Actual results could differ from those estimates.

The Company re-evaluated key assumptions and estimates related to risk contracts as of March 31, 2023. Based on this review, the Company identified changes in estimates to revenue, external provider costs and accounts receivable, net, driven by the new information from the Company's payors, as well as adverse claims development on prior period dates of service. Based on this updated information, the Company recognized a net decrease to revenue of $26.9 million, a net decrease to external provider costs of $12.4 million and a net decrease to accounts receivable, net, of $14.5 million during the three months ended March 31, 2023. Additionally, the Company recognized a net decrease to revenue of $0.7 million, a net increase to external provider costs of $6.3 million and a net decrease to accounts receivable, net, of $7.1 million during the three months ended March 31, 2022, driven by claims development from COVID related sicknesses.

 

Emerging Growth Company

 

Section 102(b)(1) of the ("JOBS ActAct") 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 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.

 

Concentration of Credit Risk and Significant Customers

 

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

 

Our three largest payor relationships were with Anthem, Humana and Centene, which as of March 31, 2022 represented 24%, 16%, and 26% of our accounts receivable balance, respectively. As of December 31, 2021, Anthem, Humana and Centene represented 27%, 12% and 23% of our accounts receivable balance, respectively. Anthem, Humana and Centene represented 35%, 17%, and 16%Composition of the Company's revenues duringand accounts receivable balances for the three months ended March 31, 2022 (payors comprising 10% or more of revenue was as follows:86

 

Total Revenue

 

Three Months Ended March 31,

 

 

2023

 

 

2022

 

Payor A

 

31

%

 

 

35

%

Payor B

n/a

 

 

n/a

 

Payor C

 

22

%

 

 

17

%

Payor D

 

12

%

 

 

16

%

Payor E

 

20

%

 

n/a

 

 

Accounts Receivable, net

 

As of March 31, 2023

 

 

As of December 31, 2022

 

Payor A

 

12

%

 

 

13

%

Payor B

 

7

%

 

 

11

%

Payor C

 

14

%

 

 

13

%

Payor D

 

14

%

 

 

13

%

Payor E

 

7

%

 

 

6

%

(9)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(u%, naudited11% and 0% during the three months ended March 31, 2021).)

 

RecentRecently Adopted Accounting Pronouncements

 

The Company has elected to defer compliance with ASC Topic 842, Leases("ASC 842"), consistent with thosethe requirements for a private company due to the Company’s status as an EGCemerging growth company and the provisions of the JOBS Act. Accordingly, the Company adoptedadoption of ASC 842 was applicable for the Company for the annual reporting period beginning January 1, 2022, and interim reporting periods within the annual reporting period beginning after December 15, 2022. The Company elected to adopt practical expedients which permits it to not reassess its prior conclusions about lease identification, lease classification and initial direct costs under the new standard. The Company elected to combine lease and non-lease components for all lease contracts and also elected not to recognize ROU assets and lease liabilities for leases with terms of 12 months or less. The Company did not elect the hindsight practical expedient, which would have allowed the Company to revisit key assumptions, such as lease term, that were made when the lease was originally entered.

We implemented ASC 842 effective January 1, 2022, using the modified retrospective approach, which allows entities to either apply the new lease standard to the beginning of the earliest period presented or only to the consolidated financial statements in the period of adoption without restating prior periods. We have elected to apply the new guidance at the date of the adoption, January 1, 2022, without restating prior periods. The financial effect of the adoption was an increase of approximately $73.7 million to the right-of-use asset and corresponding lease liabilities to the Company’s balance sheet as of January 1, 2022.

Accounting Pronouncements Not Yet Adopted

The Company has determined that there are no recently issued accounting pronouncements that will have a material impact on its consolidated financial position, results of operations, or cash flows.

NOTE 3. ACQUISITIONS

Steward Acquisition

On November 10, 2022, the Company completed its previously announced acquisition, pursuant to the 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 (“Merger Sub I”), (iii) Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company (“Merger Sub II”), (iv) Sparta Merger Sub III Inc., a Delaware corporation and wholly-owned subsidiary of the Company (“Merger Sub III” and, together with Merger Sub I and Merger Sub II, “Merger Subs” and each a “Merger Sub”), (v) Sparta Merger Sub I LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC I”), (vi) Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC II”), (vii) Sparta Merger Sub III LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC III” and, together with Merger LLC I and Merger LLC II, “Merger LLCs” and each a “Merger LLC”), (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. (n/k/a Steward National Care Network, LLC, “SNCN”), Steward Integrated Care Network, Inc., and Steward Accountable Care Network, Inc. (n/k/a as Steward Accountable Care Network, LLC, “SACN”), 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 acquired Steward Value-Based Care (such transaction, the “Steward Acquisition”).

The aggregate consideration paid to the Seller under the Merger Agreement on November 10, 2022, the date of the closing of the Steward Acquisition (the “Steward Closing”), consisted of (i) a cash payment of $25.0 million, subject to customary adjustments (ii) 23,500,000 shares (the “Initial Share Consideration”), subject to adjustments, of the Company’s Class A common stock, par value $0.0001 per share (the “Class A Common Stock”) and (iii) a cash payment of $35.5 million, an amount equal to the value of the Targets’ accounts receivable attributable to Medicare value-based payments for the period between January 1, 2022 and the Steward Closing, minus the amount of such payments payable to the affiliate physicians of the Targets (the “Financed Net Pre-Closing Medicare AR”).

In addition, the Merger Agreement provides that, following the Steward Closing, upon 100,000 Medicare lives from and/or attributable to the Seller Parties’ Medicare network participating in risk-based, value-based care arrangements contracted through the Company with a Medical Expense Ratio of less than 85% for two consecutive calendar quarters, the Company will

 

(8)(10)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

issue the annual reporting period beginningSeller, for immediate distribution to its equity holders, 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 the Company’s Class A Common Stock as of the Steward Closing, in each case after giving effect to issuances of Class A Common Stock between the Steward Closing and June 30, 2023 in connection with the exercise of warrants to purchase Class A Common Stock outstanding as of the Steward Closing, the potential earnout under the Company’s June 2021 Business Combination and any forfeitures, surrenders or other dispositions to the Company of Class A Common Stock outstanding as of the Steward Closing. If not previously issued, the Earnout Share Consideration will also be issuable upon a Change in Control (as defined in the Merger Agreement) of the Company.

The following summarizes the consideration transferred at the closing of the Steward Acquisition (in thousands):

Cash consideration

 

 

 

$

25,000

 

Initial Share Consideration (1)

 

 

 

 

134,420

 

Earnout Share Consideration (2)

 

 

 

 

212,355

 

Other consideration, net (3)

 

 

 

 

27,219

 

Total Steward Acquisition consideration

 

 

 

$

398,994

 

 

 

 

 

 

 

(1) Represents issuance of 23.5 million shares of Class A Common Stock of the Company using the closing price as of the date of the the Steward Closing of $5.72 per share.

 

(2) Calculated as the 37.5 million shares of Class A Common Stock the Company estimates that it will be obligated to issue to the Seller Parties upon achievement of certain milestones as Earnout Share Consideration, multiplied by CareMax's closing stock price as of the date of the Steward Closing of $5.72 per share and the estimated probability of payout of 99%.

 

(3) Represents funding of the Financed Net Pre-Closing Medicare AR of $35.5 million, offset by the Sellers' reimbursement to the Company of the interest and original issue discount of $6.8 million related to the Loan and Security Agreement (as defined in Note 7 of these consolidated financial statements) and by non-cash purchase price adjustment of $1.5 million.

 

The acquired assets and assumed liabilities of Steward Value-Based Care were recorded at their estimated fair values. The purchase price allocation for the Steward Acquisition has not been finalized as of March 31, 2023 and is based upon the best available information at the current time. January 1, 2022The following table summarizes the consideration paid and the preliminary fair value of the assets acquired and liabilities assumed as of closing (in thousands):

Accounts receivable

 

$

43,060

 

Other working capital adjustments

 

 

(21,584

)

Distribution liabilities

 

 

(7,032

)

Intangible asset - Risk contracts

 

 

37,500

 

Intangible asset - Provider network

 

 

42,900

 

Net Assets Acquired (a)

 

 

94,844

 

Purchase Consideration (b)

 

 

398,994

 

Goodwill (b) - (a)

 

$

304,150

 

 

The goodwill recorded as part of the acquisition included the expected synergies and interim reporting periods withinother expected contribution to the annual reporting period beginning after December 15, 2022. As such,Company's overall growth strategy. None of the Company has continuedgoodwill recognized as part of the Steward Acquisition is deductible for income tax purposes. Refer to present accounting for leases in its condensed consolidated financial statements in accordance with ASC 840 in this Quarterly Report on Form 10-Q/A. The effect of adoption to be presented in the Company’s 2022 Form 10-K is expected to beNote 5, materialGoodwill and Other Intangible Assets, adding approximately $0.1 billion right of use assets and corresponding lease liabilities to the Company’s balance sheet as of January 1, 2022.for additional information.

 

In June 2016, the FASB issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments - Credit Losses: MeasurementAs of Credit Losses on Financial Instruments, which was subsequently amended by ASU No. 2020-03, "Codification ImprovementsMarch 31, 2023 and December 31, 2022, Other liabilities included an accrual of $5.0 million for payment to financial Instruments" (collectively referred to as "ASC 326"),a Steward Acquisition advisor, payment of which is intended to improve financial reporting by requiring earlier recognitioncontingent upon the Company's issuance 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 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 Financial Accounting Standards Board ("FASB"). The Company adopted ASC 326 on January 1, 2022 with no material impactEarnout Share Consideration to the consolidated financial statements.Seller Parties.

Other Acquisitions

During the year ended December 31, 2022, we acquired a number of medical practices for total consideration of $3.3 million and recognized related goodwill in the amount of $2.9 million and intangible assets of $0.4 million.

 

InThere were no acquisitions during the three months ended March 2020, the FASB issued temporary guidance to ease 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 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 when accounting for derivative contracts and certain hedging relationships affected by changes in the interest rates used for discounting cash flows, computing variation margin settlements and calculating price alignment interest in connection with reference rate reform activities under way in global financial markets. An entity may apply these amendments prospectively through December 31, 2023 or 2022. The Company is currently evaluating the effect the update will have on its condensed consolidated financial statements and related disclosures.

NOTE 4. REINSURANCE

 

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 consolidated financial statements.

(11)


CAREMAX, inc.

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

(unaudited

NOTE 3. REINSURANCE)

 

The Company has acquiredpurchased stop loss insurance on catastrophic costs to limit the exposure on patient losses. Premiums and policy recoveries are reported in external provider costs in our condensedthe accompanying consolidated statements of operations.

 

The natureintent of the Company’s stop loss coverage is to limit the benefits paid under onefor any individual patient. The Company’s stop loss limits are defined within each respective health plan contract and stop loss purchased from aor other third party contract and can range typically from $30,000 to $200,000 per patient per year. Premium expense incurred was $3.76.8 million and $412,0003.7 million for the three months ended March 31, 20222023 and 2021,2022, 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 or other third parties are unable to fulfill their obligations under stop loss contractual terms.

 

Recoveries recognized were $6.44.6 million and $363,0006.4 million for the three months ended March 31, 20222023 and 2021,2022, respectively. Estimated recoveries under stop loss policies are reported within the capitation 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. GOODWILL AND OTHER INTANGIBLE ASSETS

 

(9)Goodwill

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

 

Carrying Amount

 

Balance at December 31, 2022

 

$

700,643

 

Impairment

 

 

(98,000

)

Balance at March 31, 2023

 

$

602,643

 

The Company's policy is to test goodwill for impairment annually on December 31 or on an interim basis if an event triggering impairment may have occurred. During the three months ended March 31, 2023, the economic uncertainty and market volatility resulting from the rising interest rate environment, the recent banking crisis and other industry developments resulted in a decrease in the Company's stock price and market capitalization. Management believes such decrease was a triggering event requiring an interim goodwill impairment quantitative analysis. The Company performed a market capitalization reconciliation to evaluate the Company’s estimated fair value balance and support the implied control premium. Based on the quantitative analysis performed, the Company's estimated fair value as of March 31, 2023 was less than its carrying value as of March 31, 2023 by 17.9% or $98.0 million. The $98.0 million goodwill impairment charge has been reflected in goodwill impairment in the accompanying statements of operations for the three months ended March 31, 2023.

If all other assumptions were held constant and the long-term projected growth rate was decreased by 50 basis points, the estimated fair value would decrease by approximately 1% or approximately $7.0 million. If all other assumptions were held constant and the share price decreased by 10%, the estimated fair value would decrease by approximately 5.8% or $31.4 million. If all other assumptions were held constant and the weighted average cost of capital increased by 100 basis points, the estimated fair value would decrease by approximately 2% or approximately $8.0 million. There is no assurance that actual results will not differ materially from the underlying assumptions used to prepare discounted cash flow analyses. Further adverse changes to macroeconomic conditions or our earnings forecasts could lead to additional goodwill or intangible asset impairment charges in future periods and such charges could be material to our results of operations.

The Company's cumulative goodwill impairment was $168.0 million and $70.0 million as of March 31, 2023 and December 31, 2022, respectively.

(12)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

NOTE 4. GOODWILL AND INTANGIBLE ASSETS

 

Goodwill

The following table summarizes changes in the carrying amount of goodwill for the three months ended March 31, 2022 (in thousands):

 

 

Carrying Amount

 

Balance at December 31, 2021

 

$

464,566

 

Measurement period adjustments

 

 

(302

)

Balance at March 31, 2022

 

$

464,264

 

Intangible Assets

 

The following tables summarizesummarizes the 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

 

March 31, 2022

 

 

 

 

 

 

 

 

 

 

 

 

Risk Contracts

 

$

64,570

 

 

$

(13,226

)

 

$

51,343

 

 

 

7

 

March 31, 2023

 

 

 

 

 

 

 

 

 

Risk contracts

 

$

102,070

 

 

$

(27,887

)

 

$

74,183

 

Provider network

 

 

42,900

 

 

 

(2,383

)

 

 

40,517

 

Non-compete agreements

 

$

4,170

 

 

$

(892

)

 

$

3,278

 

 

 

5

 

 

 

4,170

 

 

 

(1,725

)

 

 

2,445

 

Trademarks

 

 

1,862

 

 

 

(1,114

)

 

 

748

 

 

 

2

 

 

 

1,862

 

 

 

(1,387

)

 

 

475

 

Other

 

 

251

 

 

 

(16

)

 

 

235

 

 

 

5

 

 

 

693

 

 

 

(123

)

 

 

570

 

Total

 

$

70,852

 

 

$

(15,248

)

 

$

55,604

 

 

 

 

 

$

151,695

 

 

$

(33,506

)

 

$

118,189

 

 

 

Gross Carrying
Amount

 

 

Accumulated
Amortization

 

 

Net Book
Value

 

 

Weighted Average
Amortization Period (years)

 

 

Gross Carrying
Amount

 

 

Accumulated
Amortization

 

 

Net Book
Value

 

December 31, 2021

 

 

 

 

 

 

 

 

 

 

 

 

Risk Contracts

 

$

64,822

 

 

$

(9,818

)

 

$

55,004

 

 

 

7

 

December 31, 2022

 

 

 

 

 

 

 

 

 

Risk contracts

 

$

102,070

 

 

$

(24,217

)

 

$

77,853

 

Provider Network

 

 

42,900

 

 

 

(851

)

 

 

42,049

 

Non-compete agreements

 

$

4,202

 

 

$

(686

)

 

$

3,516

 

 

 

5

 

 

 

4,170

 

 

 

(1,518

)

 

 

2,652

 

Trademarks

 

$

1,867

 

 

$

(827

)

 

$

1,040

 

 

 

2

 

 

 

1,862

 

 

 

(1,352

)

 

 

510

 

Other

 

$

251

 

 

$

 

 

$

251

 

 

 

5

 

 

 

693

 

 

 

(171

)

 

 

522

 

Total

 

$

71,141

 

 

$

(11,331

)

 

$

59,811

 

 

 

 

 

$

151,695

 

 

$

(28,109

)

 

$

123,585

 

 

Amortization expense totaled $3.95.4 million and $252,0003.9 million for the three months ended March 31, 20222023 and 2021,2022, respectively.

NOTE 5.6. PROPERTY AND EQUIPMENT

A summary of property Property and equipment at March 31, 20222023 and December 31, 2021 is as follows2022 consisted of the following (in thousands):

 

 

March 31, 2022

 

 

December 31, 2021

 

 

March 31, 2023

 

 

December 31, 2022

 

Leasehold improvements

 

$

7,648

 

 

$

7,516

 

 

$

10,775

 

 

$

10,661

 

Vehicles

 

 

3,711

 

 

 

3,711

 

 

 

3,743

 

 

 

3,743

 

Furniture and equipment

 

 

5,509

 

 

 

5,470

 

 

 

9,455

 

 

 

8,871

 

Software

 

 

3,465

 

 

 

2,950

 

 

 

3,745

 

 

 

3,725

 

Construction in progress

 

 

3,523

 

 

 

2,254

 

 

 

6,786

 

 

 

4,621

 

Total

 

 

23,856

 

 

 

21,902

 

 

 

34,504

 

 

 

31,620

 

Less: Accumulated depreciation

 

 

(6,961

)

 

 

(5,909

)

 

 

(11,778

)

 

 

(10,614

)

Total Property and equipment, net

 

$

16,895

 

 

$

15,993

 

 

$

22,726

 

 

$

21,006

 

 

Construction in progress at March 31, 2022 consistedprimarily consists of various leasehold improvements at the Company's centers.centers, which have not opened as of March 31, 2023.

 

Depreciation expense totaled $1.11.2 million and $211,0001.1 million for the three months ended March 31, 20222023 and 2021,2022, respectively.

NOTE 7. DEBT AND RELATED PARTY DEBT

 

(10)Credit Agreement

In 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 the 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 Initial 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 and recognized related debt extinguishment losses of $6.2 million. In November 2022 and March 2023, the Company drew $45 million and $30 million of the Delayed Draw Term Loans, respectively.

(13)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

NOTE 6. LONG TERM DEBTBased on the elections made by the Company, as of March 31, 2023, borrowings under the Credit Agreement bore interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus the applicable credit spread adjustment, based on the elected interest period), 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. As a result of this election, the cash interest component of the applicable margin increased by 0.50%.

Amortization payments under the Credit Agreement are payable in quarterly installments, commencing at the end of the quarter of the second anniversary of the closing of the Credit Agreement, in amounts equal to 0.25% of the aggregate outstanding principal amount of Initial Term Loans and Delayed Draw Term Loans. All amounts owed under the Credit Agreement are due in May 2027.

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 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 maintain 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 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 must maintain a maximum total leverage ratio no greater than 5.50 to 1.00.

On March 8, 2023 (the “Amendment Closing Date”), the Company entered into a Second Amendment (the “Second Amendment”) to the Credit Agreement.

The Second Amendment amended the Credit Agreement to, among other things, (i) provide for a new incremental delayed draw term loan B facility in an aggregate principal amount of $60.0 million (the “Delayed Draw Term Loan B Facility”); (ii) revise the commitment expiration date for the Company’s existing $110.0 million Delayed Draw Term Loan to forty-five days following the Amendment Closing Date, (iii) extend the commencement of amortization payments on loans under the Credit Agreement from March 31, 2024 to May 31, 2025; (iv) reduce the amount of interest that the Company may elect to capitalize from 4.00% to 3.50% beginning on the second anniversary of the execution date of the Credit Agreement, 3.00% beginning on the third anniversary of the execution date of the Credit Agreement, and 1.50% beginning on December 10, 2025; (v) increase the amount of the super-priority revolving credit facility that is permitted to be added to the Credit Agreement to $45.0 million and provide that the entirety of such facility may be used for general corporate purposes; and (vi) amend the prepayment provisions of the Credit Agreement, including to have such provisions run as of the Amendment Closing Date.

Loan and Security Agreement - Related Party Debt

In November 2022, the Company entered into a Loan and Security Agreement (the “Loan and Security Agreement”), by and among Sparta Merger Sub I Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub I LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC I”), Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (together with Merger LLC I, the “Guarantors”), Steward Accountable Care Network, Inc. (n/k/a as Steward Accountable Care Network, LLC) and Steward National Care Network, Inc. (n/k/a Steward National Care Network, LLC), as borrowers (the “Borrowers”), , CAJ Lending LLC (“CAJ”) and Deerfield Partners L.P., as lenders (the “Lenders”), and CAJ, as administrative agent and collateral agent (in such capacity, the “Agent”). Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ.

Pursuant to the Loan and Security Agreement, the Lenders provided the Borrowers a term loan (the “Term Loan”) in the aggregate principal amount of approximately $35.5 million. The Company used the proceeds of the Term Loan to fund the Financed Net Pre-Closing Medicare AR acquired in connection with the Steward Acquisition.

(14)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The Term Loan bears fixed interest of 12.0% per annum. In addition, the Borrowers paid a facility fee equal to 3.0% of the aggregate principal amount of the Term Loan, which was accounted for as a debt discount. Any additional interest (if applicable) accrued and owing during the term of the Loan and Security Agreement will be paid in-kind and capitalized to principal monthly in arrears. From and after the occurrence and during the continuance of an event of default, the Term Loan will bear interest at a rate equal to 4.0% above the interest rate applicable immediately prior to the occurrence of the event of default. If Mr. Carlos de Solo is no longer serving as the Chief Executive Officer of the Company under certain circumstances and, following a request from CAJ, the Borrowers are unable to refinance the portion of the Term Loan advanced by CAJ, then the interest rate applicable to such portion may be increased by 5.0%. Pursuant to the Agreement and Plan of Merger relating to the Steward Acquisition (the “Merger Agreement”), Sparta Holding Co. LLC, a Delaware limited liability company (the “Seller”), agreed to pay the costs of financing the Financed Net Pre-Closing Medicare AR and, at the Steward Closing, paid to the Borrowers $6.8 million, representing all scheduled payments of interest and fees from the Steward Closing Date up to and including November 30, 2023, which amount was then paid in advance by the Borrowers to the Lenders.

The Loan and Security Agreement matures on the earlier of November 30, 2023, or three business days after the Borrowers receive payment for the Financed Net Pre-Closing Medicare AR from the federal government. The Term Loan may be prepaid, in whole or in part, without penalty or premium.

The Loan and Security Agreement contains customary representations, warranties, affirmative covenants, negative covenants and events of default. The Loan and Security Agreement is secured by the Borrowers’ rights in the Medicare Shared Savings Receivables (as defined in the Loan and Security Agreement) and any and all proceeds thereof. The Loan and Security Agreement is subordinated in right of payment to the Credit Agreement.

Elevance Health

In October 2022, in connection with the collaboration agreement with Elevance Health (formerly known as Anthem), which was announced in August 2021, the Company entered into a promissory note for an amount of $1.0 million due in October 2032. This borrowing bears fixed interest of 6.25% per annum.

 

As atof March 31, 20222023 and December 31, 2021, long term2022, debt consisted of the following ((in thousands):

 

 

 

March 31, 2022

 

 

December 31, 2021

 

Secured term loans

 

$

120,313

 

 

$

121,875

 

Other

 

 

58

 

 

 

65

 

Unamortized debt issuance costs

 

 

(4,438

)

 

 

(4,704

)

 

 

 

115,932

 

 

 

117,236

 

Current portion

 

 

(6,272

)

 

 

(6,275

)

Long-term portion

 

$

109,660

 

 

$

110,960

 

 

March 31, 2023

 

 

December 31, 2022

 

Indebtedness under the Credit Agreement

 

$

272,730

 

 

$

240,277

 

Indebtedness under the Loan and Security Agreement - Related party debt

 

 

35,510

 

 

 

35,510

 

Other

 

 

1,647

 

 

 

1,657

 

Less: Unamortized discounts and debt issuance costs

 

 

(17,422

)

 

 

(16,188

)

 

 

292,465

 

 

 

261,256

 

Less: Current portion

 

 

(31,822

)

 

 

(30,530

)

Long-term portion

 

$

260,642

 

 

$

230,725

 

 

Future maturities of debt outstanding at March 31, 20222023 were as follows (in thousands):

 

 

Amount

 

Remainder of 2022

 

 

4,706

 

2023

 

 

6,265

 

Year

 

Amount

 

Remainder of 2023

 

$

35,715

 

2024

 

 

8,611

 

 

 

275

 

2025

 

 

11,726

 

 

 

2,480

 

2026

 

 

89,063

 

 

 

2,923

 

2027

 

 

267,907

 

Thereafter

 

 

588

 

Total

 

$

120,370

 

 

$

309,887

 

As of March 31, 2023, we were in compliance, in all material respects, with all covenants under our credit facilities.

 

NOTE 7.8. STOCKHOLDERS' EQUITY

The condensed consolidated statement of changes in equity reflects the Reverse Recapitalization discussed in 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.

 

Related Advisory Agreement

 

On July 13, 2021, the Company entered into an exclusive real estate advisory agreement (the "Advisory Agreement"“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 to provide certain real estate advisory

(15)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

services to the Company on an exclusive basis. The services include identifying locations for new 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.

 

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, par value $0.0001 per share ("Class A Common Stock")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 center under the Advisory Agreement for which the Advisor provides services, other than two initial 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 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

(11)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

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.

 

Series B Warrants are recognized at their grant date fair value once vesting becomes probable.No warrants vested during the three months ended March 31, 2023. During the three months ended March 31, 2022, the Company recorded $2.5 million which represents the fair value of vested Series B Warrants, in other assets except for the portion that represents Series B Warrant amortization expected to be recognized during the next twelve months, which is recorded in prepaid expenses, to reflect vesting of 500,000 Series B Warrant Shares using their grant date fair value. Refer to Note 10, 12, Related Party Transactions,, for additional information.

 

Preferred Stock

The AmendedBalances associated with the Series A and Restated Charter authorizesSeries B warrants are recorded in the Company to issue 1,000,000 shares of preferred stock, with such designations, votingright-of-use assets and other rightsassets, except for the portion that represents amortization expected to be recognized over the next twelve months, which is recorded in other current assets. The portion of Series A and preferencesSeries B warrants recorded in other current assets as may be determined from time to time by the Company’s board of directors. As of March 31, 2023 and December 31, 2022 there were was $no0.6 shares of preferred stock issued or outstanding.million and $0.6 million, respectively.

 

Redeemable Warrants - Public Warrants

 

OnIn July, 16, 2020, in connection with the IPO, DFHT sold 2,875,000 Public Warrants. Each whole Public Warrant entitles the registered holder to purchase one 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

(16)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

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 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 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.

 

(12)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Contingent Consideration Common Shares- Business Combination

 

Pursuant to the Business Combination Agreement, the CMG Sellers and IMC Parent, who received Class A Common Stock in connection with the Business Combination, arebecame entitled to receive earn-out considerationContingent Consideration to be paid out in the form of Class A Common Stock. The Business Combination Agreement providesprovided that up to an additional 3,500,000 and 2,900,000 contingently issuable shares of Class A Common (the "Earnout Shares") areEarnout Shares would become payable after the Closing to the CMG Sellers 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 on any 20 trading days in any 3030-day-day trading period (the “First Share Price Trigger”), then 1,750,000 and 1,450,000 Earnout Shares arewould become 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 3030-day-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 bewould become issued and paid to the former owners of 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 willwould be deemed to have been satisfied and the Company is required toshall issue, as of such closing, all of the applicable unissuedEarnout Shares. The contingent consideration was classified as a liability for the period ended June 30, 2021. On July 9th, 2021, the volume weighted average trading price of Class A Common Stock exceeded the $12.50 on 20 or more days resulting in the satisfaction of the First Share Price Trigger. After the First Share Price Trigger was achieved on July 9, 2021, the estimated fair value of the Earnout Shares was initially accounted forrecorded as an equity-classified instrument as a liability-classified instrumentcomponent of stockholders' equity, with changesthe change in its fair value from the prior reporting period recorded in our condensed consolidated statements of operations until July 9, 2021. On July 9, 2021, the First Share Price Trigger was achieved, resulting in issuance ofearnings. Accordingly, 1,750,000 and 1,450,000 Earnout Shares were issued and paid 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 and were recorded as such on July 9, 2021, the date of the event that caused the reclassification.

 

Stock-based compensationContingent Consideration - Steward Acquisition

Pursuant to the Merger Agreement signed in connection with Steward Acquisition, upon 100,000 Medicare lives from and/or attributable to the seller parties' Medicare network participating in risk-based, value-based care arrangements contracted through the Company with a Medical Expense Ratio of less than 85% for two consecutive calendar quarters, the Company will issue the seller, for immediate distribution to its equity holders, 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 issued as part of the Steward Acquisition, would have represented 41% of the issued and outstanding shares of the Company’s Class A Common Stock as of the November 10, 2022 (the "Steward Closing"), in each case after giving effect to issuances of Class A Common Stock between the Steward Closing and June 30, 2023 in connection with the exercise of warrants to purchase Class A Common Stock outstanding as of the Steward Closing, the potential earnout under the Company’s Business Combination and any forfeitures, surrenders or other dispositions to the Company of Class A Common Stock outstanding as of the Steward Closing. If not previously issued, the Earnout Share Consideration will also be issuable upon a Change in Control (as defined in the Merger Agreement) of the Company. The Company accounts for the Earnout Share Consideration as a liability, because the number of shares issuable at the time the contingency is resolved is not fixed, based on the provisions summarized above.

Preferred Stock

The Company’s third amended and restated certificate of incorporation authorizes the Company to issue up to 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. During the year ended December 31, 2022, the Company issued one share of Series A Preferred Stock to the seller of Steward Value-Based Care. This share of Series A Preferred Stock has a stated par value of $0.0001 and has no economic rights. The holder of the outstanding share of Series A Preferred Stock is entitled to vote with

(17)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

holders of outstanding shares of Common Stock, voting together as a single class, with respect to the Special Matters (as defined in the Certificate of Designation of Series A Preferred Stock filed by the Company with the Secretary of State of the State of Delaware on November 10, 2022), and has no other voting rights. In any such vote, the share of Series A Preferred Stock will be entitled to 37,241,783 votes. The voting rights under the share of Series A Preferred Stock last until the earlier of (i) the two year anniversary of the Steward Closing and (ii) the issuance of the Earnout Share Consideration in connection with the Steward Acquisition.

NOTE 9. STOCK-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 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) four percent of the aggregate number of shares of Class A Common Stock outstanding on December 31st 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 1st.

 

During the three months ended March 31, 2023 and 2022, wethe Company grantedzero and 77,000 restricted stock units, respectively, under the 2021 Plan at a weighted-average grant date fair value of $7.41 per share (there were no grants duringPlan. During the three months ended March 31, 2021). In addition, during the three months ended March 31,2023 and 2022, and 2021 there was no vesting of previously grantedissued awards.

During the three months ended March 31, 2023 and 2022, the Company recorded stock-based compensation expense oftotaling $2.3 million and $1.1 million, ($0 during the three months ended March 31, 2021). Stock-based compensation expense is included in the corporate, general and administrative expenses in our condensed consolidated statements of operations.respectively. As of March 31, 2023 and 2022, the Company had $16.4 million and $7.9 million, respectively, of compensation expense related to all non-vestedunvested equity awards (RSU, PSU,(RSUs, PSUs, options) that will vest over the weighted-averageweighted average period of1.9 years and 2.5 years, (there were no awards outstanding as of March 31, 2021).respectively.

NOTE 8.10. NET INCOME (LOSS)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 have been recast for all historical periods to reflect the Company’s capital structure for all comparative periods.

(13)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

The following table sets forth the calculation of basic and diluted earningsnet loss per share for the periods indicated based on the weighted-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 March 31,

 

 

 

2022

 

 

2021

 

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

 

$

(16,797

)

 

$

1,302

 

 

 

 

 

 

 

 

Weighted average basic shares outstanding

 

 

87,367,972

 

 

 

10,796,069

 

Weighted average diluted shares outstanding

 

 

87,367,972

 

 

 

10,796,069

 

 

 

 

 

 

 

 

Net (loss) income per share

 

 

 

 

 

 

Basic

 

$

(0.19

)

 

$

0.12

 

Diluted

 

$

(0.19

)

 

$

0.12

 

 

 

Three Months Ended March 31,

 

 

 

2023

 

 

2022

 

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

 

 

$

(82,082

)

 

$

(16,797

)

 

 

 

 

 

 

 

Weighted-average basic shares outstanding

 

 

 

111,360,802

 

 

 

87,367,972

 

Weighted-average diluted shares outstanding

 

 

 

111,360,802

 

 

 

87,367,972

 

 

 

 

 

 

 

 

Net loss per share

 

 

 

 

 

 

 

Basic

 

 

$

(0.74

)

 

$

(0.19

)

Diluted

 

 

$

(0.74

)

 

$

(0.19

)

 

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:

 

 

Three Months Ended March 31,

 

 

Three Months Ended March 31,

 

 

2022

 

 

2021

 

 

2023

 

 

2022

 

Series A Warrants and Series B Warrants

 

 

8,000

 

 

 

 

Public and Private Warrants

 

 

5,792

 

 

 

 

Series A and Series B Warrants

 

 

 

8,000,000

 

 

 

8,000,000

 

Public and Private Placement Warrants

 

 

 

5,791,652

 

 

 

5,791,652

 

Earnout Shares

 

 

3,200

 

 

 

 

 

 

 

40,700,000

 

 

 

3,200,000

 

Unvested restricted stock units

 

 

1,162

 

 

 

 

 

 

 

2,547,830

 

 

 

1,162,000

 

Unvested performance stock units

 

 

66

 

 

 

 

Unvested performance stock units (assumes 100% target payout)

 

 

 

209,163

 

 

 

66,000

 

Unvested options

 

 

131

 

 

 

 

 

 

 

373,565

 

 

 

131,000

 

Total

 

 

18,351

 

 

 

 

 

 

 

57,622,210

 

 

 

18,350,652

 

(18)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

NOTE 9.11. FAIR VALUE MEASUREMENTS

Financial Instruments that are Measured at Fair Value on a Recurring Basis

 

The following table presentstables present 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):

 

March 31, 2022

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

Description

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Derivative warrant liabilities

 

$

 

 

$

 

 

$

11,911

 

 

 

 

 

 

Fair Value

 

March 31, 2023

 

 

 

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

Description

 

Carrying Value

 

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Derivative warrant liabilities - Public Warrants

 

$

1,380

 

 

$

1,380

 

 

$

 

 

$

 

Derivative warrant liabilities - Private Placement Warrants

 

 

1,488

 

 

 

 

 

 

 

 

 

1,488

 

Contingent earnout consideration

 

 

98,425

 

 

 

 

 

 

 

 

 

98,425

 

Total liabilities measured at fair value

 

$

101,293

 

 

$

1,380

 

 

$

 

 

$

99,913

 

 

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

 

$

 

 

$

 

 

$

8,375

 

 

 

 

 

 

Fair Value

 

December 31, 2022

 

 

 

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

Description

 

Carrying Value

 

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Derivative warrant liabilities - Public Warrants

 

$

1,495

 

 

$

1,495

 

 

$

 

 

$

 

Derivative warrant liabilities - Private Placement Warrants

 

 

2,479

 

 

 

 

 

 

 

 

 

2,479

 

Contingent earnout consideration

 

 

134,561

 

 

 

 

 

 

 

 

 

134,561

 

Total liabilities measured at fair value

 

$

138,535

 

 

$

1,495

 

 

$

 

 

$

137,040

 

Fair value of Public Warrants is measured using the listed market price of such warrants.

 

Fair value of the Public Warrants issued in connection with the IPO and the 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 beenis estimated using a Monte Carlo simulation model each measurement date. Inherent in a Monte Carlo simulation are assumptions related to expected stock-price volatility, expected life, risk-free interest rate and dividend yield. The fair valueCompany estimates the volatility of Public Warrants issued in connection withits common stock based on historical volatility of select peer companies that matches the IPO has been measuredexpected remaining life of the warrants. The risk-free interest rate is based on the listed market priceU.S. Treasury zero-coupon yield curve on the grant date for a maturity similar to the expected remaining life of suchthe warrants. The expected life of the warrants sinceis assumed to be equivalent to their remaining contractual term. The dividend rate is based on the IPO. historical rate, which the Company anticipates remaining at zero.

During the three months ended March 31, 2022,2023, the Company recognized a lossbenefit resulting from an increasea decrease in the fair value of the derivative warrant liabilities of $1.1 million (a loss of $3.5 million.million during the three months ended March 31, 2022).

 

Fair value of contingent earnout consideration is calculated using 37.5 million shares, which the Company estimates will be issuable to the seller of Steward Value-Based Care upon achievement of certain performance metrics, the closing price of the Company's Class A Common Stock at the end of the relevant reporting period ($2.67 and $3.65 as of March 31, 2023 and December 31, 2022, respectively), and a 99% probability of payout.

Transfers between level 1, 2 and 3 are recognized at the end of the reporting period. There were no transfers between levels duringfor the three months ended March 31, 2022.2023 or 2022.

 

 

(14)(19)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

Activity of the liabilities measured at fair value was as follows (in thousands):

Balance as of December 31, 2021

$

9,250

 

Change in fair value of derivative warrant liabilities

 

(4,401

)

Payment of contingent consideration

 

(875

)

Contingent consideration issued as part of the Steward Acquisition

 

210,856

 

Change in fair value of contingent consideration

 

(76,295

)

Balance as of December 31, 2022

 

138,535

 

Change in fair value of derivative warrant liabilities

 

(1,107

)

Change in fair value of contingent consideration

 

(36,136

)

Balance as of March 31, 2023

$

101,293

 

The following table provides quantitative information regarding Level 3 fair value measurementsmeasurement inputs used in measurement of fair value of Private Placement Warrants:

 

 

March 31,
2022

 

 

December 31, 2021

 

 

March 31, 2023

 

 

December 31, 2022

 

Exercise price

 

$

11.50

 

 

$

11.50

 

 

$

11.50

 

 

$

11.50

 

Unit price

 

$

7.47

 

 

$

7.68

 

Underlying stock price

 

$

2.67

 

 

$

3.65

 

Volatility

 

 

50.8

%

 

 

37.6

%

 

 

75.3

%

 

 

69.1

%

Expected life of the options to convert

 

 

4.19

 

 

 

4.44

 

Expected life of the options to convert (years)

 

 

3.19

 

 

 

3.44

 

Risk-free rate

 

 

2.40

%

 

 

1.17

%

 

 

3.72

%

 

 

4.08

%

Dividend yield

 

 

0.0

%

 

 

0.0

%

 

 

0.0

%

 

 

0.0

%

 

The change in the fair value of the warrant liabilities for the three months ended March 31, 2022 is summarized as follows (in thousands):Financial Instruments that are not Measured at Fair Value on a Recurring Basis

 

Fair value of derivative warrant liabilities at December 31, 2021

 

$

8,375

 

Change in fair value of derivative warrant liabilities

 

 

3,536

 

Fair value of derivative warrant liabilities at March 31, 2022

 

$

11,911

 

March 31, 2023

 

 

 

 

Fair Value

 

 

 

Carrying Value

 

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

(in thousands)

 

 

 

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Liabilities

 

 

 

 

 

 

 

 

 

 

 

 

   Fixed rate debt (a)

 

$

36,479

 

 

 

 

 

 

$

33,767

 

   Floating rate debt (a)

 

 

272,730

 

 

 

 

 

 

 

294,165

 

Total

 

$

309,209

 

 

$

 

 

$

 

 

$

327,932

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fair Value

 

December 31, 2022

 

Carrying Value

 

 

Quoted Prices
in Active
Markets

 

 

Significant other
Observable
Units

 

 

Significant other
Unobservable
Units

 

(in thousands)

 

 

 

 

(Level 1)

 

 

(Level 2)

 

 

(Level 3)

 

Liabilities

 

 

 

 

 

 

 

 

 

 

 

 

   Fixed rate debt (a)

 

$

36,498

 

 

 

 

 

 

$

32,820

 

   Floating rate debt (a)

 

 

240,277

 

 

 

 

 

 

 

240,280

 

Total

 

$

276,775

 

 

$

 

 

$

 

 

$

273,100

 

(a) The debt amounts above do not include the impact of debt issuance costs or discounts.‌

 

NOTE 10.12. RELATED PARTY TRANSACTIONS

The Related Companies

 

On July 13, 2021, the Company entered into the Advisory Agreement with the Advisor, the substance of which is described in Note 7,8, StockholdersStockholders' Equity. The relative fair value method was used to allocate the $5.0 million purchase price between the shares of Class A Common Stock 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 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. During the three months ended March 31, 2023, the Company recognized $0 of expense related to amortization of the Series A Warrants ($0.1 million during the three months ended March 31, 2022).‌

Series B Warrants are recognized at their grant date fair value once vesting becomes probable. No warrants vested during the three months ended March 31, 2023. During the three months ended March 31, 2022, the Company recorded $2.5 million in

(20)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

other assets to reflect vesting of 500,000 Series B Warrant Shares using their grant date fair value. Refer to Note 8, Stockholders' Equity, for additional information.

Balances associated with the Series A and Series B warrants are recorded in the right-of-use assets and other assets, except for the portion that represents amortization expected to be recognized over the next twelve months, which is recorded in other current assets. The portion of Series A and Series B warrants recorded in other current assets as of March 31, 2023 and December 31, 2022 was $0.6 million and $0.6 million, respectively.

In addition, during the three months ended March 31, 2022, we recorded $0.4 million in construction in progress representing construction advisory services provided to us by Related (none during the three months ended March 31, 2023).

 

On July 13, 2021, the Company's board of directors (the "Board") 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.

As a director of the Company, Mr. Cho will receive compensation in the same manner as the Company’s other non-employee directors.

Steward Health Care System LLC

In connection with closing of the Steward Acquisition, the Company issued 23,500,000 shares of the Company's Class A Common Stock, which at closing, resulted in the equity holders of the Seller owning approximately 21% of the Company’s Class A Common Stock.

On and effective as of November 17, 2022, the Board appointed Dr. Ralph de la Torre to serve as a Class II director of the Board. Dr. de la Torre will serve until the Company’s 2023 Annual Meeting of Stockholders and until his successor is duly elected or appointed or his earlier death, resignation or removal. The appointment of Dr. de la Torre was made in connection with that certain Investor Rights Agreement, dated November 10, 2022, by and among the Company, the Seller, Dr. de la Torre, Dr. Michael Callum, the Executive Vice President for Physician Services and an equity holder of the Seller, Medical Properties Trust, Inc., a Maryland corporation, and certain other equity holders of the Seller, which provides that Dr. de la Torre has the right to designate an individual to be nominated to serve on the Board, subject to the continuing satisfaction of certain conditions. Dr. de la Torre is the Chairman, Chief Executive Officer and principal equity holder of Steward Health Care System, LLC.

CAJ and Deerfield

In November 2022, the Company entered into Loan and Security Agreement, described in Note 7, Debt and Related Party Debt, whereby CAJ and Deerfield are the lenders.‌

Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ.

Mr. Kevin Berg, who is on the Company’s Board, is a Senior Advisor with Deerfield. As a director of the Company, Mr. Berg will receive compensation in the same manner as the Company’s other non-employee directors.‌

MSP Recovery, Inc.‌

Ms. Beatriz Assapimonwait serves on the Company's Board. Ms. Assapimonwait also joined the board of directors of MSP Recovery, Inc. ("MSP Recovery") in 2022. As of March 31, 2023 and December 31, 2022, the Company had accounts receivable from MSP Recovery of $1.1 million and $2.3 million, respectively. During the three months ended March 31, 2023 and 2022, the Company recognized vestinghad subrogation income from MSP Recovery of $500,0000 shares of Series B Warrants related to opening of one center for which the Advisor provides services under the Advisory Agreement. Refer to Note 7, and $Stockholder's Equity0.2, for additional information.

NOTE 11. OPERATING LEASES AND COMMITMENTS million, respectively.

 

The Company has entered into non-cancelable operating lease agreements for office space and centers expiring at various times through 2033. 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 March 31, 2022 (in thousands):

 

 

Amount

 

Remainder of 2022

 

$

8,381

 

2023

 

 

13,531

 

2024

 

 

13,440

 

2025

 

 

13,130

 

2026

 

 

12,556

 

Thereafter

 

 

139,501

 

Total

 

$

200,539

 

Rent expense, including related property taxes, sales taxes, and utilities, was approximately $4.3 million and $700,000 for the three months ended March 31, 2022 and 2021, respectively. Rent expense is included in general and administrative expenses in our condensed consolidated statements of operations.

NOTE 12. INCOME TAXESSecond Wave Delivery System, LLC

 

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

(15)(21)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

 

Business Combination,

Hon. Dr. David J. Shulkin, M.D. serves on the incomeCompany's Board. Dr. Shulkin also serves on the board of CMG flowsdirectors of Second Wave Delivery System, LLC ("Second Wave"). As of March 31, 2023 and December 31, 2022, the Company had prepaid expenses for services from Second Wave of $0.3 million and $0, respectively.

NOTE 13. LEASES

The Company has entered into operating lease agreements for centers and office space expiring at various times through 2043, inclusive of renewal options that the Company is reasonably certain to exercise. The exercise of such lease renewal options is at our sole discretion, and to the extent we are reasonably certain we will exercise a renewal option, the years related to that option are included in our determination of the lease term for purposes of classifying and measuring a given lease.‌

Operating lease expense primarily represents fixed lease payments for operating leases recognized on a straight-line basis over the applicable lease term. Variable lease expense represents the payment of real estate taxes, insurance, maintenance and, for certain locations, additional rentals based on a percentage of sales in excess of stipulated minimums (excess rent). The payment of variable real estate taxes, insurance and maintenance is generally based on the Company’s pro-rata share of the total building square footage. Lease expense is recorded in cost of care and corporate, general and administrative expenses in the condensed consolidated statements of operations.

ASC 842 Disclosures

Lease costs were as follows (in thousands):

 

Three Months Ended March 31, 2023

 

Operating lease cost

$

4,284

 

Variable lease cost

 

669

 

Short-term lease cost

 

281

 

Total lease cost

$

5,234

 

During the three months ended March 31, 2023, we obtained $5.7 million of right-of-use assets in exchange for new operating lease liabilities and paid $2.8 million for amounts included in the measurement of operating lease liabilities, included in the operating cash flows from operating lease assets and liabilities in our consolidated statements of cash flows.

Weighted-average of the remaining lease terms and weighted-average discount rate were as follows:

Three Months Ended March 31, 2023

Weighted average remaining lease term (years)

11.9

Weighted-average discount rate

7.18

%

As of March 31, 2023, maturities of operating lease liabilities were as follows (in thousands):

Year

 

Amount

 

Remainder of 2023

 

$

6,053

 

2024

 

 

15,883

 

2025

 

 

15,223

 

2026

 

 

14,361

 

2027

 

 

13,545

 

Thereafter

 

 

106,604

 

Total lease payments

 

 

171,668

 

Less: Present value discount

 

 

(61,478

)

Present value of lease liabilities

 

$

110,190

 

At March 31, 2023, the Company and is taxedentered into leases that have not yet commenced with aggregated estimated future lease payments of approximately $103.0 million, which are not included in the above table. These leases relate to properties that are being constructed by the future lessors. These leases are expected to commence throughout 2023 or 2024, with initial lease terms ranging from 10 to 20 years.

ASC 840 Disclosures

(22)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

Prior to adoption of ASC 842, the Company accounted for its lease arrangements under ASC 840, Leases, with no right-of-use assets or lease liabilities being reflected on the condensed consolidated balance sheets. The Company recognized $4.3 million of lease expense during the three months ended March 31, 2022.

Future minimum rental payments under these lease agreements, including renewal options which are considered reasonably certain of exercise, consisted of the following at the federal and state levels accordingly.March 31, 2022:

Year

 

Amount

 

2022

 

$

8,381

 

2023

 

 

13,531

 

2024

 

 

13,440

 

2025

 

 

13,130

 

2026

 

 

12,556

 

Thereafter

 

 

139,501

 

Total lease payments

 

$

200,539

 

NOTE 14. INCOME TAXES

 

Income tax provision forexpense was $0.2 million and $0.2 million during the three months ended March 31, 2023 and 2022, respectively. The effective tax rate was $(181,0000.2, compared to $)% and (01.1 for)% during the three months ended March 31, 2021. The effective tax rate for the three months ended March 31,2023 and 2022, was (1.1)%respectively, based on the assessment of a full valuation allowance, excluding a portion attributable to athe "naked credit" deferred tax liability.

NOTE 13.15. 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. Management has not identified any legal actions during the three months ended March 31, 2023 or 2022 that were deemed to be material.

 

NOTE 14.16. VARIABLE INTEREST ENTITIES

 

Medical Care of NY, P.C., Medical Care of Tennessee, PLLC and Medical Care of Tennessee,Texas, PLLC (together, the "PCs") were established in 2022 to employ healthcare providers to deliver healthcare services to patients in New York, Tennessee, and Tennessee.Texas. In addition, the Company has an Administrative Service Agreement (the "ASA") with Care Optical, LLC (the "Care Optical"), which provides optometry services in the state of Florida. The Company concluded that it has variable interest in the PCs and Care Optical on the basis of its Administrative Service Agreements (the "ASAs")ASAs which provide for a management fee payable to the Company from the PCs and Care Optical in exchange for providing management and administrative services which creates risk and a potential return to the Company. The PCs' and Care Optical's equity at risk, as defined by GAAP, is insufficient to finance their activities without additional support, and therefore, the PCs and Care Optical are considered to be VIEs.

In order to determine whether the Company has a controlling financial interest in the PCs and Care Optical, and, thus, is the PCs' primary beneficiary, the Company considered whether it has i)(i) the power to direct the activities of PCs and Care Optical that most significantly impacts their economic performance and ii)(ii) the obligation to absorb losses of the PCs and Care Optical or the right to receive benefits from the PCs and Care Optical that could potentially be significant to them. The Company

(23)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

concluded that the shareholdermember and employees of the PCs and Care Optical have no individual power to direct activities of the PCs and Care Optical 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 and Care Optical, the management of that population's healthcare needs, the provision of required healthcare services to those patients, and the PCs' and Care Optical's ability to receive revenue from health plans. In addition, the Company's variable interest in the PCs and Care Optical provides the Company with the right to receive benefits that could potentially be significant to them. The single membermembers of the PCs is an employeeand Care Optical are employees of the Company. Based on this analysis, the Company concluded that it is the primary beneficiary of the PCs and Care Optical and therefore consolidates the balance sheet, results of operations and cash flowflows of the PCs.PCs and Care Optical.

Assets and liabilitiesFurthermore, as a direct result of nominal initial equity contributions by the single members of the PCs were as followsand Care Optical, the financial support CareMax provides to the PCs and Care Optical (e.g. loans) and the provisions of the arrangements described above, the interest held by the single member lacks economic substance and does not provide the member with the ability to participate in the residual profits or losses generated by the PCs and Care Optical. Therefore, all income and expenses recognized by the PCs and Care Optical are allocated to CareMax.

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

 

March 31, 2022

 

December 31, 2021

 

March 31,
2023

 

December 31, 2022

 

Total assets

$

1,500

 

$

-

 

$

2,381

 

$

1,097

 

Total liabilities

$

1,500

 

$

-

 

$

5,725

 

$

2,961

 

 

Three Months Ended March 31, 2023

 

Three Months Ended March 31, 2022

 

Revenues

$

417

 

$

-

 

Operating expenses

$

1,714

 

$

-

 

 

No revenues or expenses have been generated or incurred by the PCs during the three months ended March 31, 2022.

(16)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

NOTE 15.17. SUBSEQUENT EVENTS

 

On May 10, 2022 (the “Credit Agreement Closing Date”),In April 2023, the Company entered into a Credit Agreement (the “Credit Agreement”), by and among the Company, certain of the Company’s subsidiaries as guarantors (the “Subsidiary Guarantors”), Jefferies Finance LLC, as Administrative Agent, Collateral Agent, Sole Lead Arranger and Bookrunner, BlackRock Financial Management (as defined in the Credit Agreement), as Lead Manager, Crestline Direct Finance, L.P., as Documentation Agent, and certain other banks and financial institutions serving as lenders (collectively with their successors and assigns, the “Lenders”). The Credit Agreement provides for an aggregate of up todrew $300.0 million in term loans, comprised of (i) initial term loans in an aggregate principal amount of $190.0 million (the “Initial Term Loans”), which will be fully drawn on the Credit Agreement Closing Date and (ii) a delayed draw term loan facility in an aggregate principal amount of $110.0 million (the “Delayed Draw Term Loans” and together with the Initial Term Loans, the “Term Loans”), which will be available to be drawn in up to five (5) borrowings from and after the Credit Agreement Closing Date until the eighteen (18) month anniversary of the Credit Agreement Closing Date 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, as set forth in the Credit Agreement. The Credit Agreement provides that it may be amended to provide for a $30.0 million revolving credit facility, of which up to $5.0 million may be used for revolving loans for general corporate purposes and up to $30.0 million may be used to issue letters of credit (the “Revolving Facility” and, together with the Term Loans, the “Credit Facilities”). The Credit Agreement also provides for certain uncommitted incremental facilities.

The Company is using approximately $120.335.0 million of the net proceeds of the Initial Term Loans to repay its outstanding obligations under that certain credit agreement, dated June 8, 2021, as amended (the “Existing Credit Agreement”). During the second quarter 2022, the Company expects to recognize estimated debt extinguishment loss of $6.3 million related to early repayment of the Existing Credit Agreement.

At the Company’s option, borrowings under the Credit Agreement bear interest at: (i) the Alternate Base Rate (defined as the highest of (a) the U.S. Prime Lending Rate as published in The Wall Street Journal, (b) the Federal Funds Rate plus 0.50% and (c) Term SOFR for an interest period of one month, subject to a floor of 1.00%, plus 1.00%), plus an applicable margin rate of 8.00%; or (ii) 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%, 0.262% or 0.428%, depending on if the Company selects a one-month, three-month or six-month interest period, respectively), plus an applicable margin rate of 9.00%. The Company may, at its option, elect to capitalize up to 4.00% of the interest as principal amount on the outstanding Term Loans, provided that in such case the applicable margin rate will be increased by 0.50%. Accrued and unpaid interest is payable (x) with respect to Alternate Base Rate loans, quarterly on the last business day of each of March, June, September and December (each, a “Quarterly Payment Date”), with any remaining accrued and unpaid interest paid upon the Maturity Date (as defined below), (y) with respect to Term SOFR loans, on the last day of interest period as selected by the Company and, in the case of any Term SOFR loan with an interest period greater than three months, each day that is the three-month anniversary of such Term SOFR loan, with any remaining accrued and unpaid interest paid upon the Maturity Date and (z) for loans under the Revolving Facility, upon the Maturity Date.

Amortization payments with respect to the Initial Term Loans will be payable in quarterly installments, commencing on March 31, 2024, in aggregate principal amounts equal to 0.25% of the original aggregate principal amount of the Initial Term Loans, and amortization with respect to any Delayed Draw Term Loans will be payable in quarterly installments, commencing on March 31, 2024, in aggregate principal amounts equal to 0.25% of the original aggregate principal amount of each funded Delayed Draw Term Loan. In addition, the Credit Agreement provides for certain mandatory prepayments based on the Company’s secured leverage ratio or upon any asset sale and provides for prepayment penalties of up to 3.00% in certain circumstances. All amounts owed under the Credit Facilities are due and payable on the five-year anniversary of the Credit Agreement Closing Date (the "Maturity Date"), or earlier following a change in control or an event of default, 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 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 maintain a maximum total leverage ratio based on the Company’s adjusted EBITDA, with de novo losses excluded from

(17)


CAREMAX, inc.

NOTES TO condensed consolidated FINANCIAL STATEMENTS

(unaudited)

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 8.5 to 1 and is subject to a 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.Loans.

 

All obligations under the Credit Agreement are guaranteed by the Company and the Subsidiary Guarantors, 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 the Subsidiary Guarantors subject to customary exceptions and qualifications. The Credit Agreement contains customary events of default, with default interest of 2% in excess of the non-default rate, and also includes cure rights for the Company upon certain events of default.

(18)(24)


 

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,” “we,” “us,” “our,” and the “Company” refersrefer 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 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 inis not forward-looking. Actual results could differ materially from those discussed in these forward-looking statements due to a variety of risks and uncertainties and other factors, including but not limited to those contained in our Annual Report on Form 10-K for the year ended December 31, 20212022 (the “Annual Report”"Annual Report"), which was filed with the Securities and Exchange Commission (the “SEC”"SEC") on March 16, 2022,30, 2023, under the caption “Risk Factors”"Risk Factors" and, the 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 Steward Value-Based Care, CMG, IMC, SMA, DNF, Advantis and other acquisitions;
our ability to complete acquisitions and to open new 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 on our current and future operations contained in certain of our agreements on our current and future operations;agreements;
competition from primary care facilities and other healthcare servicesservice providers;
competition for physicians and nurses, and shortages of qualified personnel;
the impact on our business offrom reductions in Medicare reimbursement rates or changes in the rules governing the Medicare program, including the MA program;
the impact on our business of state and federal efforts to reduce Medicaid spending;
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;

(25)


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;

(19)


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 reform;reform;
that estimates of market opportunity and forecasts of market and revenue growth included in this QuarterlyAnnual 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; and
our ability to develop and maintain proper and effective internal control over financial reporting.reporting; and
the impact of any prior period developments.

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.

 

(20)(26)


 

Our Business

As of March 31, 2023, CareMax currently operates 48operated 62 centers in Florida, Tennessee, and New York and plans to open 15 de novo centers during 2022, inclusive of the three opened in the first quarter of 2022.Texas. 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’s comprehensive, high touch approach to health care delivery is powered by its CareOptimize technology platform. CareOptimize is a proprietarypurpose built 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"(“MSO”) to further improve financial, clinical and quality outcomes from the affiliated providers. As of March 31, 2022, this MSO serviced more than 100 independent physician associations ("IPAs").

CarMax’sCareMax’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, specialty care, telemedicine, health & wellness, optometry, dental, pharmacy and transportation. CareMax’s differentiated healthcare delivery model is focused on care coordination with vertically integrated ambulatory care and community-centric services. The goal of CareMax is to intercede as early as possible to manage chronic conditions for its patient members in a proactive, holistic, and tailored manner to provide a positive influence on patient outcomes and a reduction in overall healthcare costs. CareMax specifically focuses on providing access to high quality care in underserved communities, with approximately 61% of its MA patients being dual-eligible (meaning eligible for both Medicare and Medicaid) and low-income subsidy eligible as of March 31, 2022 (60% as of December 31, 2021).communities.

While CareMax’s primary focus is providing care to Medicare eligible seniors who are mostly 65+ (approximately 79%76% and 100%79% of revenue for the three months ended March 31, 20222023 and 2021,2022, 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’sthe Medicare patients cared for in CareMax's centers 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 contract with nearly all national and most regional, local Medicare Advantage plans.

 

We believeIn addition to Medicare Advantage contracts, through our MSO we can translate the above premium services into economic benefits. By focusing on interventions that keep ourservice other Medicare patients healthy, we can capture the cost savings that our care model createsthrough a variety of value-based contracts, such as Medicare Shared Savings Program (“MSSP”) 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.ACO Reach.

 

Key Factors Affecting Our Performance

Our Patients

As discussed above, CareMaxthe Company partners with MA,Medicare, Medicaid, and commercial insurance plans. While CareMax currently services mostly MAMedicare patients, we also accept Medicare Fee-for-Servicefee-for-service 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, 20202021, and is based upon estimates which we believe are reasonable:reasonable. Given the close proximity of the closing of the acquisition of the Medicare value-based care business of Steward Health Care System (the "Steward Acquisition") on November 10, 2022 to our year-end December 31, 2022, we did not calculate pro forma adjustments related to this acquisition.

Pro forma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Patient Count as of*

Mar 31, 2020

 

Jun 30, 2020

 

Sep 30, 2020

 

Dec 31, 2020

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 30, 2022

 

Sep 30, 2022

 

Dec 31, 2022

 

Mar 31, 2023

 

Medicare

 

15,500

 

15,500

 

16,500

 

16,500

 

16,500

 

21,500

 

26,500

 

33,500

 

34,000

 

Medicare Advantage

 

16,500

 

21,500

 

26,500

 

33,500

 

34,000

 

37,000

 

39,500

 

93,500

 

95,500

 

Medicare Government VBC

 

 

 

 

 

 

 

 

109,500

 

107,000

 

Medicaid

 

12,500

 

22,500

 

22,500

 

21,000

 

23,000

 

23,500

 

24,500

 

28,000

 

28,500

 

 

23,000

 

23,500

 

24,500

 

28,000

 

28,500

 

29,500

 

31,500

 

33,500

 

33,500

 

Commercial

 

15,500

 

 

13,500

 

 

15,000

 

 

14,500

 

 

15,000

 

 

17,500

 

 

17,500

 

 

21,500

 

 

21,500

 

 

15,000

 

 

17,500

 

 

17,500

 

 

21,500

 

 

21,500

 

 

21,500

 

 

22,000

 

 

22,000

 

 

34,500

 

Total Count

 

43,000

 

 

51,500

 

 

54,000

 

 

52,000

 

 

54,500

 

 

62,500

 

 

68,500

 

 

83,500

 

 

84,000

 

 

54,500

 

 

62,500

 

 

68,500

 

 

83,500

 

 

84,000

 

 

88,000

 

 

93,000

 

 

258,500

 

 

271,000

 

*Figures may not sum due to rounding

(21)


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 calculatesestimates the amount of support typically

(27)


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 statisticsto make year over year.year comparisons of total membership more comparable. The breakdown of membership on a pro forma basis using MCREM is below:

Pro forma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MCREM Count as of*

Mar 31, 2020

 

Jun 30, 2020

 

Sep 30, 2020

 

Dec 31, 2020

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 20, 2022

 

Sep 30, 2022

 

Dec 31, 2022

 

Mar 31, 2023

 

Medicare

 

15,500

 

15,500

 

16,500

 

16,500

 

16,500

 

21,500

 

26,500

 

33,500

 

34,000

 

Medicare Advantage

 

16,500

 

21,500

 

26,500

 

33,500

 

34,000

 

37,000

 

39,500

 

93,500

 

 

95,500

 

Medicare Government VBC

 

 

 

 

 

 

 

 

109,500

 

107,000

 

Medicaid

 

4,200

 

7,400

 

7,500

 

7,000

 

7,600

 

7,900

 

8,100

 

9,400

 

9,400

 

 

7,600

 

7,900

 

8,100

 

9,400

 

9,400

 

9,900

 

10,600

 

11,100

 

 

11,200

 

Commercial

 

5,100

 

 

4,600

 

 

5,000

 

 

4,900

 

 

5,100

 

 

5,900

 

 

5,800

 

 

7,200

 

 

7,200

 

 

5,100

 

 

5,900

 

 

5,800

 

 

7,200

 

 

7,200

 

 

7,100

 

 

7,300

 

 

7,400

 

 

11,400

 

Total MCREM

 

24,800

 

 

27,500

 

 

29,000

 

 

28,400

 

 

29,200

 

 

35,300

 

 

40,400

 

 

50,100

 

 

50,600

 

Total Count

 

29,200

 

 

35,300

 

 

40,400

 

 

50,100

 

 

50,600

 

 

54,000

 

 

57,400

 

 

221,500

 

 

225,100

 

*Figures may not sum due to rounding

Medicare Advantage Patients

As of March 31, 2022,2023, CareMax had approximately 34,00095,500 MA patients of which 86%98% were in value-based or risk-based,agreements. Approximately 37% of patients in the Medicare Advantage value-based care agreements were in full-risk contracts. This means CareMax has been selected as the patient’s primary care provider and is financially responsible for some or all of the patient’s medical costs. For these patients CareMax is attributed an agreed percentage of the premium the MAMedicare plan receives from the Centers for Medicare and Medicaid Services (“CMS”) (typically a substantial majority of such premium given the risk assumed by CareMax)the Company). A reconciliation is performed periodically and if premiums exceed medical costs paid by the MA plan, CareMax receives payment from the MAMedicare plan. If medical costs paid by the MAMedicare plan exceed premiums, CareMax is responsible to reimburse the MAMedicare plan.

Medicare Government Value-Based Care ("VBC") Programs

As of March 31, 2023, CareMax had approximately 107,000 patients enrolled in Medicare Government VBC Programs, of which 92% were in the Medicare Shared Savings Program ("MSSP") and 8% were in the ACO REACH program. The MSSP is sponsored by the CMS. The MSSP allows participating Accountable Care Organizations ("ACOs") to receive a share of cost savings they generate in connection with the management of costs and quality of medical services rendered to Medicare beneficiaries. Payments to the ACO participants, if any, are calculated annually and paid once a year by CMS on cost savings generated by the ACO participant relative to the ACO participants’ CMS benchmark. Under the MSSP, the ACO must meet certain qualifications to receive the full amount of its allocable cost savings or they either receive nothing or are responsible for shared losses. The MSSP rules require CMS to develop a benchmark for savings to be achieved by each participant if the participant is to receive shared savings. An ACO that meets the MSSP’s quality performance standards will be eligible to receive a share of the savings to the extent its assigned beneficiary medical expenditures are below the medical expenditure benchmark provided by CMS. A Minimum Savings Rate (“MSR”), which varies depending on the number of beneficiaries assigned to the ACO, must be achieved before the ACO can receive up to 75% of share of the savings if quality performance standards are met; the ACO is also responsible for 40% of the deficit. Once the MSR is surpassed, all the savings below the benchmark provided by CMS will be shared with the ACO.

 

Medicaid Patients

As of March 31, 2022,2023, CareMax had approximately 28,50033,500 Medicaid patients of which approximately 92%100% were in value-based agreements. Approximately 91% of patients in the Medicaid value-based care agreements were in full-risk contracts. Using the MCREM metric, the level of support required to manage these Medicaid patients equates to that of approximately 9,40011,200 Medicare patients. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program.

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 CareMax)the Company). 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.

(28)


 

Commercial Patients

As of March 31, 2022,2023, CareMax managed approximately 21,50034,500 commercial patients of which approximately 30%97% were under a value-based contractsagreement that provided upside-only financial incentives for quality and utilization performance. Using the MCREM metric, the level of support required to manage these commercial patients equates to that of approximately 7,20011,400 Medicare patients.

CareMax cares for a number of commercial patients (approximately 15%(less than 1% of CareMax'sthe Company'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 typically 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 itCareMax as well as the financial risk that it assumes related to the third-party medical expenses of at-risk patients.

ContractContracts with Payors

Our economic model relies on its capitated partnerships with payors which manage and market MAMedicare plans across the United States. CareMax has established strategic value-based relationships with elevena number of different payors for Medicare Advantage patients, four different payors for Medicaid patients, and one payor for Affordable Care Act ("ACA")ACA patients. Our three largest

(22)


payor relationships were Anthem, HumanaPayor A, Payor C and Centene,Payor E, which generated 35%31%, 17%22% and 16%20% of our revenue, respectively, during the three months ended March 31, 2022, respectively, and 49%, 4%, and 18% of our revenue on a pro forma basis, assuming the Business Combination with IMC occurred on January 1, 2020, during2023. During the three months ended March 31, 2021, respectively.2022 our three largest payor relationships were Payor A, Payor C, and Payor D, which generated 35%, 17%, and 16% of our revenue. These existing contracts and relationships with our partners’national partners and their understanding of the value of the CareMax model reduces the risk of entering into new markets as CareMax typically hasseeks to have payor contracts in place before entering a new market. Maintaining, supporting, and growing these relationships, particularly as CareMax enters new markets, isare 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, enhancingenhance patient satisfaction, while drivingand drive incremental patient and revenue growth. This alignment of interests helps ensuresensure 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 39% of our total operating expenses for the three months ended March 31, 2023 and 63% of our total operating expenses for the three months ended March 31, 2022 and 70% of our total operating expenses for the three months ended March 31, 2021.2022. 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 ERsemergency rooms or hospitals; we do not restrict their access to care. Therefore, 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 forfrom 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 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 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

(29)


complete or accurate documentation (and therefore lower risk-adjustment scores), and patient mortality disproportionately impacts our higher-risk (and therefore greater revenue) patients.

External Provider Costs

External Provider 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

(23)


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.

 

Payor Settlements

As it relates to our MSSP contracts, settlements from the prior year from the CMS typically take place during the fourth quarter of each year, which results in variability of our accounts receivable, cash flow from operations, and cash balances throughout the year.

Investments in Growth

We expect to continue to focus on long-term growth through investments in our centers, MSO, platform, 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 to operate 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. company.

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, deDe novo centers require upfront capital and operating expenditures, which maytypically are not be fully offset by additional revenues in the near-term, andas a result of which we similarly expect a period of unprofitability in our future de novo centers before they break even. Costs we incur prior to opening of a de novo center include (1) incremental payroll costs from employees specifically associated with the operational, contractual, physical, or regulatory infrastructure for de novo centers, prior to their opening; (2) legal costs incurred directly associated with the de novo centers, prior to their opening, which includes services such as execution of leases, health plan contracts and other agreements; (3) other expenses related to diligence, design, permitting, and other “soft costs” at new sites; and (4) rent and facility expenses prior to center opening. Once a de novo center opens, we incur post-opening losses, which consist of center-level operating losses recognized at a de novo center until the center breaks even, up to 18 months after opening. The de novo post-opening losses consist of revenue, external provider costs and cost of care allocated to the de novo center. During the three months ended March 31, 2023 and 2022, we incurred de novo pre-opening costs and post-opening losses, on a combined basis, of $6.4 million and $2.1 million, respectively.

While our net income (loss) 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

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

(30)


SEC. Some of the financial information and data contained in this Report, such as Adjusted EBITDA and margin thereof, and Platform Contribution and margin thereof 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. Management 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 judgmentsjudgment 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 in connection with GAAP results. You should review the Company’s audited financial statements, containedwhich are included in the Annualthis Report.

EBITDA and Adjusted EBITDA

Management defines “EBITDA”Adjusted EBITDA is defined as net income or net loss before interest expense, depreciation and amortization, remeasurement of warrant and contingent earnout liabilities, goodwill impairment, stock-based compensation, acquisition and integration related costs, Business Combination integration costs, income tax 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 based compensation, de novo costs for the first 18 months after opening, discontinued operations, acquisition costsbenefit, and other costsincome or expenses 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

(24)


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

 

Three Months Ended March 31,

 

($ in thousands)

2022

 

2021

 

Y/Y Change

 

Net (loss) income

$

(16,797

)

$

1,302

 

$

(18,099

)

 

 

 

 

 

 

 

GAAP Pro Forma adjustments (1)

 

-

 

 

(2,730

)

 

2,730

 

 

 

 

 

 

 

 

Pro Forma net loss

 

(16,797

)

 

(1,429

)

 

(15,368

)

 

 

 

 

 

 

 

Interest expense

 

1,728

 

 

1,400

 

 

328

 

Depreciation and amortization

 

5,062

 

 

2,979

 

 

2,083

 

Loss on remeasurement of warrant
   liabilities

 

3,536

 

 

-

 

 

3,536

 

Income tax provision

 

181

 

 

-

 

 

181

 

Other expenses

 

462

 

 

212

 

 

250

 

 

 

 

 

 

 

 

EBITDA

 

(5,829

)

 

3,162

 

 

(8,991

)

 

 

 

 

 

 

 

Other adjustments

 

 

 

 

 

 

Non-recurring expenses (2)

 

6,055

 

 

2,795

 

 

3,260

 

Acquisition costs (3)

 

3,429

 

 

1,168

 

 

2,261

 

Stock based compensation

 

1,087

 

 

-

 

 

1,087

 

De novo losses (4)

 

1,119

 

 

184

 

 

935

 

Discontinued operations

 

-

 

 

(1

)

 

1

 

Adjusted EBITDA

$

5,862

 

$

7,308

 

$

(1,446

)

Figures may not sum due to rounding.

 

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

(2)

 

Three Months Ended March 31,

 

 

 

 

(in thousands)

 

2023

 

 

2022

 

 

Y/Y Change

 

Net loss

 

$

(82,082

)

 

$

(16,797

)

 

$

(65,285

)

Interest expense, net

 

 

10,458

 

 

 

1,728

 

 

 

8,730

 

Depreciation and amortization

 

 

6,576

 

 

 

5,062

 

 

 

1,514

 

Remeasurement of warrant and contingent earnout liabilities

 

 

(37,242

)

 

 

3,536

 

 

 

(40,778

)

Goodwill impairment

 

 

98,000

 

 

 

-

 

 

 

98,000

 

Stock-based compensation

 

 

2,298

 

 

 

1,087

 

 

 

1,211

 

Acquisition and integration related costs (1)

 

 

622

 

 

 

3,429

 

 

 

(2,807

)

Business Combination integration costs (2)

 

 

1,066

 

 

 

5,114

 

 

 

(4,048

)

Other (3)

 

 

66

 

 

 

430

 

 

 

(364

)

Income tax provision (benefit)

 

 

177

 

 

 

181

 

 

 

(4

)

Adjusted EBITDA

 

$

(61

)

 

$

3,769

 

 

$

(3,831

)

(1)
Includes professional fees, salariesall costs recognized in acquisition related costs in our consolidated statements of operations and wages, and other expenses deemed one-time in nature.

(3) Includes transaction costs, integration costs, and other costsincremental payroll compensation expense for employees directly associated with services to achieve synergies.

(4)Includes non-buildoutsynergies related to closed transactions. Significant components of acquisition and integration related costs incurred prior to opening a de novo location and initial opening losses post-center opening up to the point of breakeven.were as follows:

 

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 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.

(25)(31)


 

 

Three Months Ended March 31,

 

(in thousands)

2023

 

2022

 

Advisor and other professional fees (a)

$

42

 

$

1,622

 

Compensation costs (b)

 

580

 

 

1,808

 

 

$

622

 

$

3,429

 

(a) Includes payments to our third-party transaction advisory firm associated with transaction contracts, including the Steward transaction that was closed in November 2022. Also, costs include legal and accounting fees directly associated with contemplated or closed transactions.
(b) Includes incremental payroll compensation expense for employees directly associated with services to achieve synergies related to closed transactions.

(2)
Represents initial costs to set up public company processes, incremental compensation and vendor expenses identified as temporary or duplicative and expected to be rationalized in the short term, and legal and professional expenses outside of the ordinary course of business, which are being incurred as part of the Company’s efforts as it integrates the two privately held companies that were combined in the Business Combination. Significant components of Business Combination integration costs were as follows:

 

Three Months Ended March 31,

 

(in thousands)

2023

 

2022

 

Consulting and legal fees (a)

$

282

 

$

3,190

 

Other compensation costs (b)

 

351

 

 

760

 

Other (c)

 

433

 

 

1,164

 

 

$

1,066

 

$

5,114

 

(a) Represents consulting and legal costs directly associated with efforts related to integration of the two privately held companies that were combined in the Business Combination.

(b) Represents incremental compensation expense directly associated with efforts related to integration of the two privately held companies that were combined in the Business Combination.

(c) Represents primarily vendor expenses identified as temporary or duplicative and/or expenses outside the ordinary course of business and not necessary to run the Company's business.

(3)
Components of other were as follows:

 

 

Three Months Ended March 31,

 

(in thousands)

 

2023

 

2022

 

Tax-related costs

 

$

-

 

$

265

 

Other

 

 

66

 

 

165

 

 

 

$

66

 

$

430

 

 

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 was calculated in a manner consistent with the concepts of Article 8 of Regulation S-X, assumes the Business Combination occurred on January 1, 2020,2021, and areis based upon estimates which we believe are reasonable.

Non-GAAP Operating Metrics and Non-GAAP Platform Contribution and Pro Forma Platform Contribution

The following metrics are as of the end of the indicated period, except for Platform Contribution, which is for the indicated period ended:

 

Patient & Platform Contribution

Mar 31, 2020

 

Jun 30, 2020

 

Sep 30, 2020

 

Dec 31, 2020

 

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Centers

 

21

 

 

21

 

 

22

 

 

24

 

 

24

 

 

34

 

 

40

 

 

45

 

 

48

 

Markets

 

1

 

 

1

 

 

1

 

 

1

 

 

1

 

 

2

 

 

3

 

 

4

 

 

6

 

Patients (MCREM)

 

24,800

 

 

27,500

 

 

29,000

 

 

28,400

 

 

29,200

 

 

35,300

 

 

40,400

 

 

50,100

 

 

50,600

 

At-risk

 

84.8

%

 

86.7

%

 

85.6

%

 

87.7

%

 

87.0

%

 

84.1

%

 

87.2

%

 

79.3

%

 

79.8

%

Platform Contribution ($, Millions)

$

14.1

 

$

18.1

 

$

15.5

 

$

17.9

 

$

14.7

 

$

8.2

 

$

11.0

 

$

16.0

 

$

17.3

 

 

Pro Forma**

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Non-GAAP Operating Metrics

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 30, 2022

 

Sep 30, 2022

 

Dec 31, 2022

 

Mar 31, 2023

 

Centers

 

24

 

 

34

 

 

40

 

 

45

 

 

48

 

 

48

 

 

51

 

 

62

 

 

62

 

Markets

 

1

 

 

2

 

 

3

 

 

4

 

 

6

 

 

6

 

 

7

 

 

7

 

 

7

 

Patients (MCREM)*

 

29,200

 

 

35,300

 

 

40,400

 

 

50,100

 

 

50,600

 

 

54,000

 

 

57,400

 

 

221,500

 

 

225,100

 

Patients in value-based care arrangements (MCREM)

 

87.0

%

 

84.1

%

 

87.2

%

 

79.3

%

 

79.8

%

 

81.0

%

 

78.2

%

 

97.6

%

 

99.0

%

Platform Contribution ($, millions)**

$

14.7

 

$

8.2

 

$

11.0

 

$

16.0

 

$

17.2

 

$

21.6

 

$

20.7

 

$

25.6

 

$

24.7

 

* MCREM defined as Medicare Equivalent Members, which assumes the level of support received by a Medicare patient is equivalent to that received by three Medicaid or Commercial patients.

 

** For periods prior to and including June 30, 2021, the measure was calculated in a manner consistent with the concepts of Article 8 of Regulation S-X and represents Pro Forma Platform Contribution.

 

(32)


 

Centers

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

Patients (MCREM)

MCREM patients 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 centersperiod and for medical carewhom we take responsibility for at least once per year. A fee-for-service and at-risksome degree of downside risk in capitated contracts. 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.

Pro Forma Platform Contribution and Platform Contribution

We define Platform Contribution as gross profit plus depreciation and amortization, share-based compensation recognized within cost of care and other adjustments, as disclosed below. Gross profit is defined as revenue less the sum of (i) external provider costs; (ii) cost of care, including share-based compensation, and (iii) depreciation and amortization expense. 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 at our centers. 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 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.

The following table provides a reconciliation of gross profit, the most closely comparable GAAP financial measure, to Pro Forma Platform Contribution and Platform Contribution:

(in millions)

Mar 31, 2021

 

Jun 30, 2021

 

Sep 30, 2021

 

Dec 31, 2021

 

Mar 31, 2022

 

Jun 30, 2022

 

Sep 30, 2022

 

Dec 31, 2022

 

Mar 31, 2023

 

 Gross profit (a)

$

3.9

 

$

0.1

 

$

4.5

 

$

9.6

 

$

11.2

 

$

15.4

 

$

14.8

 

$

17.2

 

$

17.1

 

 Depreciation and amortization

 

0.6

 

 

1.4

 

 

5.2

 

 

6.1

 

 

5.1

 

 

4.9

 

 

4.6

 

 

7.2

 

 

6.6

 

 Share-based compensation

 

-

 

 

-

 

 

-

 

 

0.1

 

 

0.4

 

 

1.3

 

 

1.2

 

 

1.2

 

 

1.0

 

 Pro forma adjustments (b)

 

10.3

 

 

6.7

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 

-

 

 Other adjustments (c)

 

-

 

 

-

 

 

1.3

 

 

0.2

 

 

0.5

 

 

0.1

 

 

0.1

 

 

-

 

 

-

 

 Pro forma Platform Contribution

$

14.7

 

$

8.2

 

n/a

 

n/a

 

n/a

 

n/a

 

n/a

 

n/a

 

n/a

 

 Platform Contribution

n/a

 

n/a

 

$

11.0

 

$

16.0

 

 

17.2

 

$

21.7

 

$

20.7

 

$

25.6

 

$

24.7

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(a) Gross profit reflects the reclassification of stock compensation expense previously included in corporate, general and administrative expenses, which decreased gross profit by $0.1 million during the three months ended December 31, 2021, $0.4 million during the three months ended March 31, 2022, $1.3 million during the three months ended June 30, 2022, $1.2 million during the three months ended September 30, 2022, and $1.2 million during the three months ended December 31, 2022.

 

(b) Pro Forma adjustments are computed in a manner consistent with the concepts of Article 8 of Regulation S-X and give effect to the Business Combinations of IMC and Care Holdings as if they had occurred on January 1, 2021. Components of the pro forma adjustments were as follows:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Three Months Ended March 31, 2021

 

 

 

Three Months Ended June 30, 2021

 

 

 

 

 

(in thousands)

IMC

 

Care Holdings

 

Total

 

 

 

IMC

 

Care Holdings

 

Total

 

 

 

 

 

 Gross profit prior to Business Combination

$

8,326

 

$

913

 

$

9,239

 

 

 

$

4,682

 

$

932

 

$

5,614

 

 

 

 

 

 Depreciation and amortization prior to Business Combination

 

1,066

 

 

2

 

 

1,068

 

 

 

 

1,066

 

 

1

 

 

1,067

 

 

 

 

 

 Pro forma adjustment

$

9,392

 

$

915

 

$

10,307

 

 

 

$

5,748

 

$

933

 

$

6,681

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(c) Other adjustments include incremental costs primarily related to post-Business Combination integration initiatives. Other adjustments reflected during the three months ended September 30, 2021 include $0.6 million of incremental costs relating to one-time operational projects and $0.3 million of non-cash true-up of deferred rent expense. Other adjustments reflected during the three months ended March 31, 2022 include $0.3 million of costs for a pilot project regarding outsourcing of certain costs.

 

(33)


 

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 the impact of direct COVID-19 costs had a negligible negative impact on our performance for the three months ended March 31, 2022 has been negatively impacted by2023 and an approximately $1.0$1 million of direct COVID-19 costs.

negative impact on our performance for the three months ended March 31, 2022. Management cannot accurately predict the future impacts of COVID-19 due to the uncertainty surrounding future spikes in COVID-19 cases or new variants that may emerge in the future.

Components of Results of Operations

Revenue

Medicare risk-based revenueRisk-Based Revenue and Medicaid risk-based revenue.Risk-Based Revenue. Our capitatedMedicare and Medicaid risk-based revenue consists primarily of capitation fees for medical services provided by us or managed by our MSO 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 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

(26)


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 unisoncorrelate 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, premiums are determined by Florida’s AHCA and basedbase 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, and 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.

 

Government Value-Based Care Revenue. Government Value-Based Care Revenue consists primarily of revenue derived from the Medicare Shared Savings Program (“MSSP”). The MSSP is sponsored by the Center for Medicare and Medicaid Services (“CMS”). The MSSP allows accountable care organizations (“ACOs”) to receive a share in cost savings they generate in connection with the managing of costs and quality of medical services rendered to Medicare beneficiaries. Payments to ACO participants, if any, are calculated annually and paid once a year by CMS on cost savings generated by the ACO participant relative to the ACO participants’ CMS benchmark. Under the MSSP, an ACO must meet certain qualifications to receive the full amount of its allocable cost savings or they either receive nothing or are responsible for shared losses. The MSSP rules require CMS to develop a benchmark for savings to be achieved by each ACO if the ACO is to receive shared savings. An ACO that meets the MSSP’s quality performance standards will be eligible to receive a share of the savings to the extent its assigned beneficiary medical expenditures are below the medical expenditure benchmark provided by CMS. A Minimum Savings Rate (“MSR”) must be achieved before the ACO can receive a share of the savings. Once the MSR is surpassed, all the savings below the benchmark provided by CMS will be shared at a certain percentage with the ACO. The MSR varies depending on the number of beneficiaries assigned to the ACO.

Other revenue.Revenue. Other revenue includesconsists primarily of professional capitation payments.payments and pharmacy revenue. 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 prepaidpaid 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 servicefee-for-service basis by a health plan are also included in other revenue. Other revenue also includes ancillary fees earned under

(34)


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 onlyupside-only contracts, pharmacy revenue and revenue generated from CareOptimize are reported in other revenue.

 

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. External provider costs include all services at-risk patients utilize.utilize that are rendered by providers other than CareMax. These include claims paid by the health plan and estimates for unpaid claims. The estimated reserve for incurred but not paid claims is included inas a reduction to accounts receivable as we do not pay medical claims. Actual claims expense will differ from the estimated liability due to factorsdifferences 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 per patient per month ("PPPM")PMPM basis given the healthcare spending trends within the Medicare population and the increasing disease burden of patients as they age.

 

The Company re-evaluated key assumptions and estimates related to risk contracts as of March 31, 2023. Based on this review, the Company identified changes in estimates to revenue, external provider costs and accounts receivable, net, driven by the new information from the Company's payors, as well as adverse claims development on prior period dates of service. Based on this updated information, the Company recognized a net decrease to revenue of $26.9 million, a net decrease to external provider costs of $12.4 million and a net decrease to accounts receivable, net, of $14.5 million during the three months ended March 31, 2023. Additionally, the Company recognized a net decrease to revenue of $0.7 million, a net increase to external provider costs of $6.3 million and a net decrease to accounts receivable, net, of $7.1 million during the three months ended March 31, 2022, driven by claims development from COVID related sicknesses.

Cost of care.Care. Cost of care 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, utilities and facilities costs required to maintain and operate our centers.centers, and compensation of the clinic and support staff.

Cost of care also includes distributions to affiliate IPA physicians and physician groups. 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-alonean individual provider basis, as certain non-clinicalMSO related medical expenses need to beare consolidated to consider profitability.at the contract level.

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 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.

Sales and Marketing Expenses.

(27)


Selling and marketing expenses. SellingSales and marketing expenses represent employee-related expenses, such as salaries, commissions and related benefits, including stock-based compensation for sales and marketing departments. These expenses also include the cost of our salesmarketing and community relations team, including salaries and commissions,related costs, such as radio and television advertising, events and promotional items.

Corporate, generalGeneral and administrative expenses.Administrative Expenses. Corporate, general, and administrative expenses includerepresent employee-related expenses, includingsuch as salaries and related costs andbenefits, including stock-based compensation technology infrastructure, operations, clinical and qualityfor support functions like finance, legal, human resources, and business development departments.developments. In addition, corporate general and administrativethese 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 our 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.

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

 

Other Income (Expenses)(35)


 

Nonoperating Income (Expense)

Interest expense.expense, net. Interest expense, net, consists primarily of interest payments, paid-in-kind interest, amortization of debt issuance costs and debt discount on our outstanding borrowings.borrowings, offset by interest income on cash equivalents.

Change in fair value of derivative warrant liabilities. Change in fair value of derivative warrant liabilities consists of changes in fair value of the PublicWarrants and Private Placement Warrants.

Gain (loss) on remeasurement of contingent earnout liabilities. Gain (loss) on remeasurement of contingent earnout liabilities consists of changes in the fairvalue of contingent earnout liabilities.

Other income (expense), net. Other income (expense), net, includes researchconsists of miscellaneous non-operating corporate expenses and development costs, franchise tax payments and other miscellaneous corporate expenses.

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

 

Results of Operations

Three Months Ended March 31, 20222023 compared to Three Months Ended March 31, 20212022

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

 

Three Months Ended March 31,

 

 

 

Three Months Ended March 31,

 

 

 

 

 

($ in thousands)

2022

 

2021

 

$ Change

 

% Change

 

2023

 

2022

 

$ Change

 

% Change

 

Revenue

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Medicare risk-based revenue

$

107,747

 

$

27,816

 

$

79,931

 

287.4

%

$

121,593

 

$

107,747

 

$

13,847

 

12.9

%

Medicaid risk-based revenue

 

20,165

 

-

 

20,165

 

100.0

%

 

25,626

 

20,165

 

5,460

 

27.1

%

Government value-based care revenue

 

10,010

 

-

 

10,010

 

100.0

%

Other revenue

 

9,008

 

 

102

 

 

8,906

 

 

8,731.8

%

 

15,754

 

 

9,008

 

 

6,746

 

 

74.9

%

Total revenue

 

136,920

 

27,918

 

109,002

 

390.4

%

 

172,983

 

136,920

 

36,063

 

26.3

%

Operating expense

 

 

 

 

 

 

 

 

Operating expenses

 

 

 

 

 

 

 

 

External provider costs

 

92,856

 

18,159

 

74,697

 

411.3

%

 

110,673

 

92,856

 

17,818

 

19.2

%

Cost of care

 

27,349

 

5,353

 

21,996

 

410.9

%

 

38,627

 

27,349

 

11,278

 

41.2

%

Sales and marketing

 

3,301

 

291

 

3,010

 

1,034.4

%

 

3,765

 

3,301

 

464

 

14.1

%

Corporate, general and administrative

 

18,978

 

1,795

 

17,183

 

957.3

%

 

23,945

 

18,978

 

4,967

 

26.2

%

Depreciation and amortization

 

5,062

 

514

 

4,548

 

884.7

%

 

6,576

 

5,062

 

1,515

 

29.9

%

Goodwill impairment

 

98,000

 

-

 

98,000

 

100.0

%

Acquisition related costs

 

266

 

 

-

 

 

266

 

 

100.0

%

 

20

 

 

266

 

 

(246

)

 

(92.6

%)

Total costs and expenses

 

147,811

 

 

26,112

 

 

121,699

 

 

466.1

%

 

281,606

 

 

147,811

 

 

133,795

 

 

90.5

%

Operating (loss) income

$

(10,890

)

$

1,806

 

$

(12,696

)

 

(703.0

%)

Operating loss

 

(108,623

)

 

(10,890

)

 

(97,733

)

 

897.4

%

Nonoperating income (expense)

 

 

 

 

 

 

 

 

Interest expense, net

 

(10,458

)

 

(1,728

)

 

(8,730

)

 

505.3

%

Change in fair value of derivative warrant liabilities

 

1,107

 

(3,536

)

 

4,643

 

(131.3

%)

Gain (loss) on remeasurement of contingent earnout liabilities

 

36,136

 

-

 

36,136

 

100.0

%

Other income (expense), net

 

(66

)

 

(462

)

 

396

 

 

(85.6

%)

 

 

 

 

 

 

 

 

 

26,718

 

 

(5,726

)

 

32,444

 

 

(566.6

%)

Interest expense

 

(1,728

)

 

(504

)

 

(1,224

)

 

242.8

%

Loss on remeasurement of warrant liabilities

 

(3,536

)

 

-

 

(3,536

)

 

(100.0

%)

Other expenses

 

(462

)

 

-

 

 

(462

)

 

(100.0

%)

(Loss) income before income taxes

$

(16,616

)

$

1,302

 

$

(17,918

)

 

(1,376.2

%)

Income tax provision

 

(181

)

 

-

 

 

(181

)

 

(100.0

%)

Net (loss) income

$

(16,797

)

$

1,302

 

$

(18,099

)

 

(1,390.1

%)

Loss before income tax

 

(81,904

)

 

(16,616

)

 

(65,289

)

 

392.9

%

Income tax expense

 

(177

)

 

(181

)

 

4

 

 

(2.0

%)

Net loss

$

(82,082

)

$

(16,797

)

$

(65,285

)

 

388.7

%

*Figures may not sum due to rounding

 

Medicare risk-based revenue. Medicare risk-based revenue was $121.6 million for the three months ended March 31, 2023, an increase of $13.8 million, or 12.9%, compared to $107.7 million for the three months ended March 31, 2022, an increase of $79.9 million compared to $27.8 million for the three months ended March 31, 2021.2022. This increase was driven primarily by a 345%14% increase in the total number of at-risk patients, from the acquisitions of IMC, SMA, and DNF, partially offset by a 13% reduction1% net decrease in rates, driven by member mix.mix, and the impact of the net prior period development. Medicare-risk based revenue was negatively impacted by the prior period development in the amount of $25.0 million.

(28)


Medicaid risk-based revenue. Medicaid risk-based revenue was $25.6 million for the three months ended March 31, 2023, an increase of $5.5 million, or 27%, compared to $20.2 million for the three months ended March 31, 2022. Medicaid risk-basedThis increase was driven primarily by the 64% increase in patients, partially offset by a 22% decrease in rates, driven by member mix and the impact of the net prior period development. Medicaid-risk based revenue relates entirely to patients that were acquired fromwas negatively impacted by the Business Combination with IMC.prior period development in the amount of $1.9 million.

(36)


Government value-based care revenue. Government value-based care revenue was $10.0 million for the three months ended March 31, 2023. This increase is a result of the Steward Acquisition.

 

Other revenue. Other revenue was $15.8 million for the three months ended March 31, 2023, an increase of $6.7 million, or 74.9%, compared to $9.0 million for the three months ended March 31, 2022, an increase of $8.9 million compared to $102,000 for the three months ended March 31, 2021.2022. The increase is related to fee-for-service andthe growth in pharmacy revenues acquired in various acquisitions.due to enhanced service offerings, such as home delivery, and higher other partial risk surplus payments.

External provider costs. External provider costs were $110.7 million for the three months ended March 31, 2023, an increase of $17.8 million, or 19.2%, compared to $92.9 million for the three months ended March 31, 2022, an2022. The increase was mostly driven by incremental costs to support the 22% increase in full-risk revenue over the same period, and due to the impact of $74.7 million compared to $18.2the net prior period development. External provider costs were negatively impacted by the prior period development in the amount of $12.4 million.

Cost of care. Cost of care expenses were $38.6 million for the three months ended March 31, 2021. The2023, an increase was primarily dueof $11.3 million, or 41%, compared to a 452% increase in at-risk patients from the acquisitions of IMC, SMA and DNF, partially offset by a 7% decrease in PPPM rates, driven by member mix.

Cost of care expenses. Cost of care expenses were $27.3 million for the three months ended March 31, 2022, an increase of $22.0 million compared to $5.3 million for the three months ended March 31, 2021.2022. The increase was due to membership growth from acquisitionsincreases in headcount, medical supplies, and other related costs to support and operate the higher number of IMC, SMA,centers, including de novo centers, and DNF.members in the current period, as compared to the prior period.

 

Sales and marketing expenses. Sales and marketing expenses were $3.8 million for the three months ended March 31, 2023, an increase of $0.5 million, or 14.1%, compared to $3.3 million for the three months ended March 31, 2022, an2022. The increase was primarily due to expanding our sales staff and marketing efforts to increase membership levels in our centers, as we have grown the number of $3.0 millioncenters, including de novo centers, we operate in 2023 as compared to $291,0002022.

Corporate, general and administrative expenses. Corporate, general and administrative expenses were $23.9 million for the three months ended March 31, 2021. The2023, an increase was primarily dueof $5.0 million, or 26.2%, compared to the increase in sales staff and marketing efforts resulting from acquisitions.

Corporate, general & administrative. Corporate, general & administrative expense was $19.0 million for the three months ended March 31, 2022, an increase of $17.2 million compared to $1.8 million for the three months ended March 31, 2021.2022. The increase was primarily from the acquired overhead relatedhigher salaries, wages and professional fees as we grow our corporate infrastructure to IMC, SMA, DNF, BIX and Advantis, as well as costs associated with becoming a publicly traded company.support our operational growth.

Depreciation and amortization. Depreciation and amortization expense was $5.0$6.6 million for the three months ended March 31, 2022,2023, an increase of $4.5$1.5 million, or 29.9%, compared to $514,000$5.1 million for the three months ended March 31, 2021.2022. This was due toincrease is primarily driven by the amortization of intangible assets purchased inintangibles acquired as part of the IMC, SMA, and DNF acquisitions.Steward Acquisition.

Goodwill impairment. During the three months ended March 31, 2023, we recognized goodwill impairment of $98.0 million, mainly driven by the reduction of the market value of our quoted stock price. No goodwill impairment charges were recognized during the three months ended March 31, 2022.

 

Acquisition related costs. Acquisition related costs were $266,000less than $0.1 million for the three months ended March 31, 2023, a decrease of $0.2 million, or 92.6%, compared to $0.3 million during for the three months ended March 31, 2022.

Interest expense, net. Interest expense, net, was $10.5 million for the three months ended March 31, 2023, an increase of $8.7 million, or 505.3%, compared to $1.7 million for the three months ended March 31, 2022. This cost relates primarily to the acquisition of DNF and Advantis.

Interest expense. Interest expense was $1.7 million for the three months ended March 31, 2022, an increase of $1.2 million compared to $504,000 for the three months ended March 31, 2021. This was due to the increased borrowings underand higher weighted-average interest rate. Refer to Note 7, Debt, for further information on the Existing Credit Agreement.borrowings outstanding as of March 31, 2023.

Change in fair value of derivative warrant liabilities. We have recorded a lossgain of $3.5$1.1 million during the three months ended March 31, 2022, as a result of2023, an increase in the fair value of derivative warrant liabilities. There were no warrant liabilities as$4.6 million, or 131%, compared to a loss of March 31, 2021.

Other expenses. Other expenses were $456,000$3.5 million for the three months ended March 31, 20222022. This decrease is primarily driven by the decrease in CareMax's stock price during the three months ended March 31, 2023, as compared to $0the increase in CareMax's stock price during the three months ended March 31, 2022.

Gain (loss) on remeasurement of contingent earnout liabilities. We recorded a gain on remeasurement of contingent earnout liabilities related to the Steward Acquisition of $36.1 million during the three months ended March 31, 2023 driven by the decrease in the market value of the Company's Class A Common Stock since December 31, 2022.

Other income (expenses), net. Other expenses were $0.1 million for the three months ended March 31, 2021. The increase is driven by miscellaneous corporate expenses.2023, a decrease of $0.4 million, or 85.6%, as compared to other expenses of $0.5 million for the three months ended March 31, 2022.

(37)


 

Liquidity and Capital Resources

 

Overview

 

As of March 31, 2022,2023, we had cash and cash equivalents on hand of $32.7$44.2 million. In addition, as of March 31, 2023, we had $95.0 million in availability under our Credit Agreement (as defined below) to draw term loans 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. In April 2023, we drew $35 million of the Delayed Draw Term Loans (as defined below).

Our principal sources of liquidity have been cash generated by our operating cash flows,centers and MSO operations, borrowings under our Existing Credit Agreementcredit 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, center and office lease expenses, insurance premiums, acquisitions, and debt service.

Our future capital expenditure requirementsexpenditures 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. Certainoperating costs are incurred at the beginning of the equipment service period and during initial patient set up. We also expect to incur costs related to acquisitions and de novo growth through the opening of new centers, which we expect to require significant capital expenditures, including lease and construction expenses. We may be required to seek additional equity or

(29)


debt financing, in addition to cash on hand and borrowings under our Credit Facilitiescredit facilities in connection with our business growth, including debt financing that may be available to us from certain health plans for each new center that we open under the terms of our agreements with those 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,Agreement, and amounts available to us under our agreement with Anthem,Elevance Health, each as described below, will continue to be sufficient to fund our operations and growth strategies for at least the next 12 months.months from the issuance date of this report. As of March 31, 2023, we were in compliance, in all material respects, with all covenants under our credit facilities.

The Impact of COVID-19

As further detailed above in “Impact of COVID-19”, we estimate our performance during the three months ended March 31, 2022 has been impacted by approximately $1.0 million of direct COVID-19 costs. 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

OnCredit Agreement

In May 2022, the Credit Agreement Closing Date, weCompany entered into the Credit Agreement, which providesa credit agreement (the “Credit Agreement”) that provided for an aggregate of up to $300.0$300 million in term loans, comprised of (i) Initial Term Loansinitial term loans in an aggregate principal amount of $190.0$190 million which will be fully drawn on the Credit Agreement Closing Date(the “Initial Term Loans”) and (ii) Delayed Term Loansa delayed term loan facility in anthe aggregate principal amount of $110.0$110 million which will be available to be drawn in up to five (5) borrowings from and after the Credit Agreement Closing Date until the eighteen (18) month anniversary of the Credit Agreement Closing Date 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, as set forth in the Credit Agreement.(the “Delayed Draw Term Loans”). The Credit Agreement provides that it may be amendedpermits the Company to provide forenter into certain incremental facilities subject to compliance with the $30.0terms, conditions and covenants set forth therein. In May 2022, the Company drew $190 million Revolving Facility, of which up to $5.0 million may be used for revolving loans for general corporate purposes and up to $30.0 million may be used to issue letters of credit. The Credit Agreement also provides for certain uncommitted incremental facilities.

The Company is using approximately $120.3 million of the net proceeds of the Initial Term Loans to repay our outstanding obligations under the Existing Credit Agreement. We intend to use the remaining net proceeds of the Initial Term Loans and other funds availableused 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 to fund our de novo growth strategy, for working capitalAgreement”) and for other permitted corporate purposes.recognized related debt extinguishment losses of $6.2 million. In November 2022, March 2023 and April 2023, the Company drew $45 million, $30 million and $35 million of the Delayed Draw Term Loans, respectively.

At our option,Based on the elections made by the Company, as of December 31, 2022, borrowings under the Credit Agreement bearbore interest at: (i) the Alternate Base Rate (defined as the highest of (a) the U.S. Prime Lending Rate as published in The Wall Street Journal, (b) the Federal Funds Rate plus 0.50% and (c) Term SOFR for an interest period of one month, subject to a floor of 1.00%, plus 1.00%), plus an applicable margin rate of 8.00%; or (ii) Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus athe applicable credit spread adjustment of 0.114%, 0.262% or 0.428%, dependingbased on if we select a one-month, three-month or six-monththe elected interest period, respectively),period) plus an applicable margin rate of 9.00%. We may, at our option, electAs permitted under the Credit Agreement, the Company elected to capitalize up to 4.00% of the interest as principal amount onamount. As a result of this election, the outstanding Term Loans, provided that in such casecash interest component of the applicable margin rate will be increased by 0.50%. Accrued and unpaid interest is payable (x) with respect to Alternate Base Rate loans, quarterly on the last business day of each of March, June, September and December (each, a “Quarterly Payment Date”), with any remaining accrued and unpaid interest paid upon the Maturity Date, (y) with respect to Term SOFR loans, on the last day of interest period as selected by the Company and , in the case of any Term SOFR loan with an interest period greater than three months, each day that is the three-month anniversary of such Term SOFR loan, with any remaining accrued and unpaid interest paid upon the Maturity Date, and (z) for loansAmortization payments under the Revolving Facility, upon the Maturity Date.

Amortization payments with respect to the Initial Term Loans will beCredit Agreement are payable in quarterly installments, commencing on MarchMay 31, 2024,2025, in aggregate principal amounts equal to 0.25% of the original aggregate outstanding principal amount of the Initial Term Loans and amortization with respect to any Delayed Draw Term Loans will be payable in quarterly installments, commencing on March 31, 2024, in aggregate principal amounts equal to 0.25% of the original aggregate principal amount of each funded Delayed Term Loan. In addition, the Credit Agreement provides for certain mandatory prepayments based on our secured leverage ratio or upon any asset sale and provides for prepayment penalties of up to 3.00% in certain circumstances.Loans. All amounts owed under the Credit FacilitiesAgreement are due and payable onin May 2027.

On March 8, 2023 (the “Amendment Closing Date”), the Maturity Date, or earlier followingCompany entered into a change in control or an event of default, unless otherwise extended in accordance with the terms ofSecond Amendment (the “Second Amendment”) to the Credit Agreement. The Second Amendment amended the Credit Agreement to, among other things, (i) provide for a new incremental delayed draw term loan B facility in an aggregate principal amount of $60.0 million; (ii) revise

 

(30)(38)


 

the commitment expiration date for the Company’s existing $110.0 million Delayed Draw Term Loan to forty-five days following the Amendment Closing Date, (iii) extend the commencement of amortization payments on loans under the Credit Agreement from March 31, 2024 to May 31, 2025;(iv) reduce the amount of interest that the Company may elect to capitalize from 4.00% to 3.50% beginning on the second anniversary of the execution date of the Credit Agreement, 3.00% beginning on the third anniversary of the execution date of the Credit Agreement, and 1.50% beginning on December 10, 2025; (v) increase the amount of the super-priority revolving credit facility that is permitted to be added to the Credit Agreement to $45.0 million and provide that the entirety of such facility may be used for general corporate purposes; and (vi) amend the prepayment provisions of the Credit Agreement, including to have such provisions run as of the Amendment Closing Date.

The Credit Agreement contains certain covenants that limit, among other things, the ability of usthe Company and ourits 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 usthe Company to satisfy a minimum liquidity requirement of $50.0 million, which may be decreased to $25.0 million if we achievethe Company achieves a certain adjusted EBITDA, and maintain a maximum total net leverage ratio based on our adjustedthe Company’s consolidated EBITDA, as defined in the Credit Agreement, with 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 8.58.50 to 11.00, 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 must maintain a maximum total net leverage ratio no greater than 5.50 to 1.00.

All obligations underLoan and Security Agreement

In November 2022, the CreditCompany entered into a Loan and Security Agreement are guaranteed(the “Loan and Security Agreement”), by us and the Subsidiary Guarantors,among Sparta Merger Sub I Inc., a Delaware corporation and all obligations under the Credit Agreement, including the guarantees of those obligations, are secured by substantially allwholly-owned subsidiary of the assetsCompany, Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub I LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC I”), Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (together with Merger LLC I, the “Guarantors”), Steward Accountable Care Network, Inc. (n/k/a as Steward Accountable Care Network, LLC) and Steward National Care Network, Inc. (n/k/a Steward National Care Network, LLC), as borrowers (the “Borrowers”), CAJ Lending LLC (“CAJ”) and Deerfield Partners L.P., as lenders (the “Lenders”), and CAJ, as administrative agent and collateral agent (in such capacity, the “Agent”). Mr. Carlos A. de Solo, a director of the Company and the Subsidiary Guarantors subjectCompany’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ.

Pursuant to customary exceptionsthe Loan and qualifications.Security Agreement, the Lenders provided the Borrowers a term loan (the “Term Loan”) in the aggregate principal amount of approximately $35.5 million. The CreditCompany used the proceeds of the Term Loan to fund the Financed Net Pre-Closing Medicare AR acquired in connection with the Steward Acquisition.

The Term Loan bears interest at 12.0% per annum. In addition, the Borrowers paid a facility fee equal to 3.0% of the aggregate principal amount of the Term Loan. Any additional interest (if applicable) accrued and owing during the term of the Loan and Security Agreement will be paid in kind and capitalized to principal monthly in arrears. From and after the occurrence and during the continuance of an event of default, the Term Loan will bear interest at a rate equal to 4.0% above the interest rate applicable immediately prior to the occurrence of the event of default. If Mr. Carlos de Solo is no longer serving as the Chief Executive Officer of the Company under certain circumstances and, following a request from CAJ, the Borrowers are unable to refinance the portion of the Term Loan advanced by CAJ, then the interest rate applicable to such portion may be increased by 5.0%.

The Loan and Security Agreement matures on the earlier of November 30, 2023, or three business days after the Borrowers receive payment for the Financed Net Pre-Closing Medicare AR from the federal government. The Term Loan may be prepaid, in whole or in part, without penalty or premium.

The Loan and Security Agreement contains customary events of default, with default interest of 2% in excess of the non-default rate,representations, warranties, affirmative covenants, negative covenants and also includes cure rights for us upon certain events of default. The Loan and Security Agreement is secured by the Borrowers’ rights in the 2022 Medicare Shared Savings Receivables (as defined in the Loan and Security Agreement) and any and all proceeds thereof. The Loan and Security Agreement is subordinated in right of payment to the Credit Agreement.

 

Anthem(39)


Elevance Health Collaboration Agreement

In connection with our collaboration agreement with Anthem,Elevance Health, which was announced in August of 2021, we plan to open approximately 50 centers across eighta number of priority states as part of our de novo strategy to open new centers in additional markets. Anthemcenters. Elevance Health has agreed to provide debt financing of up to $1 million for each new center opened in partnership with Anthem.Elevance Health. We intend to use such funds to partially offset the costs of opening new centers in connection with our de novo growth strategy.

In October 2022, in connection with the Elevance Health Collaboration Agreement we entered into a promissory note for an amount of $1.0 million due in October 2032. Funds received from Elevance Health pursuant to the aforementioned promissory note will be used to finance costs of one new center that was opened in partnership with Elevance Health.

Cash Flows

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

 

(in thousands)

Three Months Ended March 31,

 

Three Months Ended March 31,

 

2022

 

2021

 

2023

 

2022

 

Net cash (used in)/provided by operating activities

$

(12,139

)

$

3,372

 

Net cash used in operating activities

$

(21,746

)

$

(12,139

)

Net cash used in investing activities

$

(1,467

)

$

(1,690

)

$

(2,286

)

$

(1,467

)

Net cash used in financing activities

$

(1,570

)

$

(181

)

Net cash provided by (used in) financing activities

$

26,627

 

$

(1,570

)

Operating Activities. Net cash used in operating activities for the three months ended March 31, 20222023 was $12.1$21.7 million, decreasean increase of $15.5$9.6 million, as compared to $3.4$12.1 million provided byused in operating activities forduring the three months ended March 31, 2021.2022. This decreaseincrease is partially due to net changeprimarily the result of $(8.3)an increase of $9.7 million in net loss and non-cash charges, primarily due to the net loss from operations of $16.8 million reported for the threeMSSP accounts receivable with expected collection cycle greater than 12 months ended March 31, 2022 compared to the net income from operations of $1.3 million reported for the three months ended March 31, 2021, offset by an increase to depreciation and amortization and loss realized on remeasurement of warrant liabilities. In addition, there was a net change of $(7.1) million to the Company's operating assets and liabilities, mostly driven by the timing of collections and payments and the growthincluded in the number of patients.Other assets.

Investing Activities. Net cash used in investing activities for the three months ended March 31, 2022 was $1.5$2.3 million compared to $1.7and $1.5 million for the three months ended March 31, 20212023 and during both periods consisted of2022, respectively, driven by purchases of property and equipment, primarily leasehold improvements at and medical equipment for our various centers.

Financing Activities:Activities. Net cash used inprovided by financing activities for the three months ended March 31, 2022 was $1.6 million compared to $0.2$26.6 million during the three months ended March 31, 20212023, driven by the $30.0 million drawn on our Delayed Draw Term Facility, partially offset by the related discounts and issuance costs. Net cash used in financing activities was $1.6 million during both periods consisted ofthe three months ended March 31, 2022 and represented scheduled principal payments of ouron debt.

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.

Off-Balance Sheet Arrangements

(31)


We did not have any off-balance sheet arrangements as of March 31, 20222023 or December 31, 20212022, other than operating leases.leases which have not yet commenced.

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

 

Other than addition of a policy related to accounting for VIEs, there(40)


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, 2021,2022, which was filed with the SEC on March 16, 2022.30, 2023.

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.

Recent Accounting Pronouncements

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

Item 3. Quantitative and Qualitative Disclosures About Market Risk

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

 

(32)

(41)


 

Item 4. Controls and Procedures

Disclosure Controls and Procedures

 

Under the 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 March 31, 2022.2023. Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that due to the material weaknesses described below, our disclosure controls wereinternal control over financial reporting was not effective as of March 31, 2022, based on the material weaknesses identified below.2023.

Material Weaknesses in Internal Control over Financial Reporting

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 material 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 a public company. This material weakness contributed to the Company not designing and maintaining formal controls to analyze, account for and disclose complex transactions, including the accounting for financial instruments and contingent earnout liabilities. These material weaknesses resulted in:

the restatement of the Company’s previously filed consolidated financial statements as of and for the year ended December 31, 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; and
the restatement of the Company's previously filed consolidated financial statements as of and for the year ended December 31, 2021, as well as the quarterly condensed consolidated financial information for the 2021 interim period ended September 30, 2021 and the 2022 interim periodperiods ended March 31, 2022, June 30, 2022, and September 30, 2022 related to prepaid expensesother current assets and other assets.

 

Additionally, these material weaknesses could result in misstatements of substantially all accounts or disclosures that would result in a material misstatement to the annual or interim consolidated financial statements that would not be prevented or detected.

Remediation Plan for the Material Weaknesses

In response to the aforementioned material weaknesses, management has expended, and will continue to expend, a substantial amount of effort and resources for the remediation of material weaknesses 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, and their work is ongoing. Additionally, management has developed and started to execute a remediation plan, which includedin 2022, the hiring ofCompany hired a Vice President of Financial Reporting and Technical Accounting and a Chief Accounting Officer, both with technical public company accounting and financial reporting experience during the first quarter of 2022.experience. Our plan also includes providing enhanced access to accounting training, literature, research materials and documents and implementation of controls to review and evaluate conclusions regarding accounting for complex transactions.transactions, including the accounting for financial instruments and contingent earnout liabilities, which management has begun to implement. The material weaknesses will not be considered remediated until management completes the design and implementation of the measures described above and the controls operate for a sufficient period of time and management has concluded, through testing, that these controls are effective. Management believes that the remediation measures described above will be implemented in a manner such that the controls can be tested and the identified material weaknesses can be determined to be remediated, however, no assurance can be made that such remediation will occur or that additional material weaknesses will not be identified.

(42)


 

Changes in Internal Control over Financial Reporting

As described above, thereThere were no changes in our internal control over financial reporting during the Company's first quarter of 2022three months ended March 31, 2023 that have materially affected, or are reasonably likely to materially affect, the Company's internal control over financial reporting.

 

(33)(43)


 

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 factors.

Item 1A.

Item1A. Risk Factors

There have been no material changes to the principal risks that we believe to be material to our business, results of operations and financial condition, from the Risk Factors except asrisk factors previously disclosed in Part 1, Item 1A, of Amendment No. 2 to our Annual Report on Form 10-K/A10-K for the fiscal year ended December 31, 2021, filed with the Securities and Exchange Commission on March 29, 2023.2022.

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

None.

Item 3. Defaults Upon Senior Securities

None.

Item 4. Mine Safety Disclosures

None.

Item 5. Other Information

None.

Item 6. Exhibits

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

 

No.

 

Description of Exhibit

10.1*+†

Second Amendment to Credit Agreement, dated as of March 8, 2023, 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.

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.LAB*

 

Inline XBRL Taxonomy Extension Labels Linkbase Document

101.PRE*

 

Inline XBRL Taxonomy Extension Presentation Linkbase Document

104*

 

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

* Filed herewith.

** Furnished herewith.

+ Certain portions of this exhibit have been omitted pursuant to Regulation S-K, Item (601)(b)(10).
† Certain of the exhibits and schedules to this exhibit have been omitted in accordance with Regulation S-K Item 601(a)(5). The Registrant agrees to furnish a copy of all omitted exhibits and schedules to the SEC upon its request.

 

(34)

(44)



(45)


 

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 29,May 10, 2023

 

/s/ Carlos A. de Solo

 

Name:

Carlos A. de Solo

 

Title:

President, Chief Executive Officer, and Director

(Principal Executive Officer)

 

 

Date: March 29,May 10, 2023

 

/s/ Kevin Wirges

 

Name:

Kevin Wirges

 

Title:

Executive Vice President, Chief Financial Officer and Treasurer

(Principal Financial and Principal Accounting Officer)

 

 

(35)(46)