Foundation Healthcare (FDNH) 10-Q 2 Sep 16 2016 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2016	Sep. 01, 2016
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Jun. 30, 2016
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q2
Trading Symbol	FDNH
Entity Registrant Name	FOUNDATION HEALTHCARE, INC.
Entity Central Index Key	1,272,597
Current Fiscal Year End Date	--12-31
Entity Filer Category	Smaller Reporting Company
Entity Common Stock, Shares Outstanding		18,078,337

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Unaudited) - USD ($)	Jun. 30, 2016	Dec. 31, 2015
ASSETS
Cash	$ 1,062,218	$ 5,062,492
Accounts receivable, net of allowance for doubtful accounts of $5,050,000 and $6,062,000, respectively	30,965,490	30,383,942
Receivables from affiliates	412,860	509,886
Supplies inventories	3,673,166	3,737,901
Prepaid and other current assets	12,166,019	3,325,330
Current assets from discontinued operations	408,303	416,390
Total current assets	48,688,056	43,435,941
Property and equipment, net	50,619,333	52,781,982
Equity method investments in affiliates	2,944,195	3,012,631
Deferred tax asset	836,290	836,290
Intangible assets, net	9,826,763	10,952,170
Goodwill	13,537,809	7,601,809
Other assets	836,835	1,016,093
Other assets from discontinued operations		8,713
Total assets	127,289,281	119,645,629
Liabilities:
Accounts payable	20,790,348	9,060,060
Accrued liabilities	14,305,754	13,252,521
Preferred noncontrolling interests dividends payable	156,171	157,888
Short-term debt	425,654	308,769
Current portion of long-term debt	9,028,572	4,601,320
Current portion of capital lease obligations	4,071,318	4,478,968
Other current liabilities	2,065,574	590,827
Current liabilities from discontinued operations	2,348,262	2,356,165
Total current liabilities	53,191,653	34,806,518
Long-term debt, net of current portion	40,153,072	41,529,277
Long-term capital lease obligations, net of current portion	28,373,441	29,130,693
Deferred lease incentive	7,289,403	7,672,745
Other liabilities	7,013,650	6,479,181
Total liabilities	136,021,219	119,618,414
Preferred noncontrolling interest	6,960,000	6,960,000
Commitments and contingencies (Note 11)
Foundation Healthcare shareholders’ deficit:
Preferred stock $0.0001 par value, 10,000,000 authorized; no shares issued and outstanding
Common stock $0.0001 par value, 500,000,000 shares authorized; 18,078,337 and 17,303,180 issued and outstanding, respectively	1,807	1,730
Paid-in capital	22,723,100	20,885,915
Accumulated deficit	(43,770,740)	(32,074,090)
Total Foundation Healthcare shareholders’ deficit	(21,045,833)	(11,186,445)
Noncontrolling interests	5,353,895	4,253,660
Total deficit	(15,691,938)	(6,932,785)
Total liabilities, preferred noncontrolling interest and shareholders’ deficit	$ 127,289,281	$ 119,645,629

Condensed Consolidated Balance3

Condensed Consolidated Balance Sheets (Unaudited) (Parenthetical) - USD ($)	Jun. 30, 2016	Dec. 31, 2015
Statement Of Financial Position [Abstract]
Accounts receivable, allowances for doubtful accounts	$ 5,050,000	$ 6,062,000
Preferred stock, par value	$ 0.0001	$ 0.0001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.0001	$ 0.0001
Common stock, shares authorized	500,000,000	500,000,000
Common stock, shares issued	18,078,337	17,303,180
Common stock, shares outstanding	18,078,337	17,303,180

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Net Revenues:
Patient services	$ 28,609,556	$ 30,152,597	$ 67,045,799	$ 58,090,495
Provision for doubtful accounts	(2,598,924)	(2,177,522)	(4,520,909)	(2,598,546)
Net patient services revenue	26,010,632	27,975,075	62,524,890	55,491,949
Management fees from affiliates	1,639,679	1,973,754	2,552,712	3,223,076
Other revenue, net	(307,828)	1,914,125	901,959	2,690,079
Revenues	27,342,483	31,862,954	65,979,561	61,405,104
Equity in earnings of affiliates	334,388	319,673	723,758	731,072
Operating Expenses:
Salaries and benefits	12,424,992	7,915,961	26,167,540	15,655,824
Supplies	9,500,381	7,390,390	17,123,144	13,460,051
Other operating expenses	13,334,836	13,398,977	30,127,633	27,482,454
Depreciation and amortization	2,660,038	1,345,948	5,408,900	2,727,455
Total operating expenses	37,920,247	30,051,276	78,827,217	59,325,784
Other Income (Expense):
Interest expense, net	(1,055,776)	(279,257)	(2,247,722)	(605,323)
Gain on sale of equity investment in affiliate	2,140,832		2,140,832
Other income (expense)	89,649	(32,231)	319,214	(14,882)
Net other income (expense)	1,174,705	(311,488)	212,324	(620,205)
Income (loss) from continuing operations, before taxes	(9,068,671)	1,819,863	(11,911,574)	2,190,187
Benefit (provision) for income taxes	(1,200,000)	114,038		114,038
Income (loss) from continuing operations, net of taxes	(10,268,671)	1,933,901	(11,911,574)	2,304,225
Income (loss) from discontinued operations, net of tax	(4,320)	3,857,135	(16,081)	3,771,057
Net income (loss)	(10,272,991)	5,791,036	(11,927,655)	6,075,282
Less: Net income (loss) attributable to noncontrolling interests	(1,271,443)	1,074,022	(543,348)	2,494,916
Net income (loss) attributable to Foundation Healthcare	(9,001,548)	4,717,014	(11,384,307)	3,580,366
Preferred noncontrolling interests dividends	(154,455)	(177,670)	(312,342)	(372,885)
Net income (loss) attributable to Foundation Healthcare common stock	$ (9,156,003)	$ 4,539,344	$ (11,696,649)	$ 3,207,481
Earnings per common share (basic and diluted):
Net income (loss) attributable to continuing operations attributable to Foundation Healthcare common stock	$ (0.52)	$ 0.04	$ (0.67)	$ (0.03)
Income (loss) from discontinued operations, net of tax	0	0.22	0	0.22
Net income (loss) per share, attributable to Foundation Healthcare common stock	$ (0.52)	$ 0.26	$ (0.67)	$ 0.19
Weighted average number of common and diluted shares outstanding	17,769,424	17,248,154	17,540,685	17,252,228

Condensed Consolidated Stateme5

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($)	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Operating activities:
Net income (loss)	$ (11,927,655)	$ 6,075,282
Less: Income (loss) from discontinued operations, net of tax	(16,081)	3,771,057
Income (loss) from continuing operations, net of tax	(11,911,574)	2,304,225
Adjustments to reconcile income (loss) from continuing operations, net of tax, to net cash provided by (used in) operating activities:
Depreciation and amortization	5,408,900	2,727,455
Stock-based compensation, net of cashless vesting	(87,738)	293,255
Provision for doubtful accounts	4,520,909	2,598,546
Equity in earnings of affiliates	(723,758)	(731,072)
Gain on sale of equity investment in affiliate	(2,140,832)
Changes in assets and liabilities, net of acquisition:
Accounts receivable, net of provision for doubtful accounts	(4,489,457)	(4,400,806)
Receivables from affiliates	97,026	243,924
Supplies inventories	64,735	(7,693)
Prepaid and other current assets	(8,840,689)	721,773
Other assets	136,089	(105,221)
Accounts payable	10,727,527	(1,694,267)
Accrued liabilities	1,428,043	1,483,207
Other current liabilities	374,747	227,516
Other liabilities	151,127	197,975
Net cash provided by (used in) operating activities from continuing operations	(5,284,945)	3,858,817
Net cash used in operating activities from discontinued operations	(7,184)	(602,074)
Net cash provided by (used in) operating activities	(5,292,129)	3,256,743
Investing activities:
Acquisition of business, net of cash received	(158,000)
Proceeds from sale of equity investment in affiliate	2,200,000
Purchase of property and equipment	(2,009,454)	(720,760)
Disposal of property and equipment		99,267
Distributions from affiliates	792,194	1,245,998
Net cash provided by investing activities from continuing operations	824,740	624,505
Net cash provided by investing activities from discontinued operations		8,388,233
Net cash provided by investing activities	824,740	9,012,738
Financing activities:
Debt proceeds	5,915,642	1,920,112
Debt payments	(3,977,052)	(9,881,531)
Preferred noncontrolling interest dividends	(314,059)	(390,405)
Preferred noncontrolling interest redemptions		(870,000)
Distributions to noncontrolling interests	(1,157,416)	(1,771,064)
Net cash provided by (used in) financing activities from continuing operations	467,115	(10,992,888)
Net cash provided by (used in) financing activities	467,115	(10,992,888)
Net change in cash	(4,000,274)	1,276,593
Cash at beginning of period	5,062,492	2,860,025
Cash at end of period	$ 1,062,218	$ 4,136,618

Nature of Business

Nature of Business	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Nature of Business	Note 1 – Nature of Business Foundation Healthcare, Inc. (the “Company”) is organized under the laws of the state of Oklahoma and owns controlling interests in surgical hospitals located in Texas. The Company also owns noncontrolling interests in ambulatory surgery centers (“ASCs”) located in Texas, Pennsylvania, New Jersey, Ohio, and Maryland. The Company provides management services to a majority of the facilities that it has noncontrolling interests (referred to as “Affiliates”) under the terms of various management agreements.

Basis of Presentation

Basis of Presentation	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Basis of Presentation	Note 2 – Basis of Presentation Going Concern and Management’s Plan – As of June 30, 2016, the Company had an accumulated deficit of $43.8 million and a working capital deficit of $5.4 million (adjusted for redemption payments of $0.9 million payable to preferred noncontrolling interest holders in October 2016). During the six months ended June 30, 2016, the Company generated a net loss attributable to Foundation Healthcare common stock of $11.7 million and used $5.3 million in cash flow from operating activities from continuing operations. As of June 30, 2016, the Company had cash and cash equivalents of $1.1 million and has no availability under a $15.5 million line of credit from its senior lender. Given the due dates of certain liability and debt payments and preferred noncontrolling interests redemption requirements, management projects that the Company may not be able to meet, at the current revenue levels, all of the Company’s obligations as they become due over the next twelve months. Management plans to meet the projected cash flow shortage from the sale of certain assets and from projected increase in revenues and decrease in expenses at the Company’s hospitals. If the Company is unable to sell assets, increase revenue or reduce expenses as described above, the Company may be forced to obtain extensions on existing debt and other obligations as they become due over the next twelve months. Although the Company has historically been successful in obtaining extensions, there is no assurance that the Company will be able to obtain them in the future. In addition, the Company may choose to raise additional funds through the sale of equity or assets, but there is no assurance that the Company will be successful in completing such actions. If the Company is not able to sell certain assets, generate additional revenue or reduce expenses at its hospitals, does not obtain extensions on some of its debt or other obligations during the next twelve months or if the Company is not able to raise additional funds through the sale of equity or assets, the Company may not have sufficient cash on hand or be able to generate sufficient cash flow from operations in order to meet the Company’s cash requirements over the next twelve months. These uncertainties raise substantial doubt about the Company’s ability to continue as a going concern. The Company’s consolidated financial statements do not include any adjustments that might be necessary if the Company is unable to continue as a going concern. Senior Credit Facility Modification and Waiver – The Company is required to maintain compliance with certain financial covenants imposed by its Senior Lenders. As of June 30, 2016, the Company was not in compliance with those covenants. On August 19, 2016, the Senior Lenders waived the financial covenant violations and modified the financial covenant requirements for the remainder of 2016 and first quarter of 2017. In addition, the Senior Lenders extended the due date of a required $3 million principal payment on the Revolving Loan to January 15, 2017. There is no assurance that the Senior Lenders will waive any future covenant violations. See Note 9 – Borrowings and Capital Lease Obligations for additional information.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Note 3 – Summary of Significant Accounting Policies For a complete list of the Company’s significant accounting policies, please see the Company’s Annual Report on Form 10-K for the year ended December 31, 2015. Interim Financial Information – The condensed consolidated financial statements included herein are unaudited and have been prepared in accordance with generally accepted accounting principles for interim financial statements and in accordance with Regulation S-X. Accordingly, they do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring adjustments) considered necessary for a fair presentation have been included. Operating results for the three months and six months ended June 30, 2016 are not necessarily indicative of results that may be expected for the year ended December 31, 2016. The consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Company’s Form 10-K for the year ended December 31, 2015. The December 31, 2015 consolidated balance sheet was derived from audited financial statements. Consolidation – The accompanying consolidated financial statements include the accounts of the Company and its wholly owned, majority owned and controlled subsidiaries. All significant inter-company accounts and transactions have been eliminated in consolidation. The Company accounts for its investments in Affiliates in which the Company exhibits significant influence, but does not control, in accordance with the equity method of accounting. The Company does not consolidate its equity method investments, but rather measures them at their initial costs and then subsequently adjusts their carrying values through income for their respective shares of the earnings or losses during the period. The Company monitors its investments for other-than-temporary impairment by considering factors such as current economic and market conditions and the operating performance of the companies and records reductions in carrying values when necessary. Use of estimates – The preparation of financial statements in conformity with generally accepted accounting principles requires management of the Company to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates. Reclassifications – Certain amounts presented in prior years have been reclassified to conform to the current year’s presentation. Such reclassifications had no effect on net income. Revenue recognition and accounts receivable – The Company recognizes revenues in the period in which services are performed and billed. Accounts receivable primarily consist of amounts due from third-party payors and patients. The Company’s ability to collect outstanding receivables is critical to its results of operations and cash flows. Amounts the Company receives for treatment of patients covered by governmental programs such as Medicare and Medicaid and other third-party payors such as health maintenance organizations, preferred provider organizations and other private insurers are generally less than the Company’s established billing rates. Additionally, to provide for accounts receivable that could become uncollectible in the future, the Company establishes an allowance for doubtful accounts to reduce the carrying value of such receivables to their estimated net realizable value. Accordingly, the revenues and accounts receivable reported in the Company’s consolidated financial statements are recorded at the net amount expected to be received. Contractual Discounts and Cost Report Settlements – The Company derives a significant portion of its revenues from Medicare, Medicaid and other payors that receive discounts from its established billing rates. The Company must estimate the total amount of these discounts to prepare its consolidated financial statements. The Medicare and Medicaid regulations and various managed care contracts under which these discounts must be calculated are complex and are subject to interpretation and adjustment. The Company estimates the allowance for contractual discounts on a payor-specific basis given its interpretation of the applicable regulations or contract terms. These interpretations sometimes result in payments that differ from the Company’s estimates. Additionally, updated regulations and contract renegotiations occur frequently, necessitating regular review and assessment of the estimation process by management. Changes in estimates related to the allowance for contractual discounts affect revenues reported in the Company’s accompanying consolidated statements of operations. Cost report settlements under reimbursement agreements with Medicare, Medicaid and Tricare are estimated and recorded in the period the related services are rendered and are adjusted in future periods as final settlements are determined. There is a reasonable possibility that recorded estimates will change by a material amount in the near term. The estimated net cost report settlements due to the Company were $2.8 million and $0.5 million as of June 30, 2016 and December 31, 2015 respectively, and are included in prepaid and other current assets in the accompanying consolidated balance sheets. We increased our cost report estimate by $2.3 million during the six months ended June 30, 2016 based on settlements from our final filed cost report for 2013 and 2014 and an estimate of the 2015 cost report and estimated recoveries from filing amended cost reports for 2012, 2013 and 2014 for the Houston hospital acquired in December 2015 (see Note 4 – Acquisitions). The Company’s management believes that adequate provisions have been made for adjustments that may result from final determination of amounts earned under these programs. Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on the Company’s financial statements. Compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties and exclusion from the Medicare and Medicaid programs. Provision and Allowance for Doubtful Accounts – To provide for accounts receivable that could become uncollectible in the future, the Company establishes an allowance for doubtful accounts to reduce the carrying value of such receivables to their estimated net realizable value. The primary uncertainty lies with uninsured patient receivables and deductibles, co-payments or other amounts due from individual patients. The Company has an established process to determine the adequacy of the allowance for doubtful accounts that relies on a number of analytical tools and benchmarks to arrive at a reasonable allowance. No single statistic or measurement determines the adequacy of the allowance for doubtful accounts. Some of the analytical tools that the Company utilizes include, but are not limited to, the aging of accounts receivable, historical cash collection experience, revenue trends by payor classification, revenue days in accounts receivable, the status of claims submitted to third party payors, reason codes for declined claims and an assessment of the Company’s ability to address the issue and resubmit the claim and whether a patient is on a payment plan and making payments consistent with that plan. Accounts receivable are written off after collection efforts have been followed in accordance with the Company’s policies. Due to the nature of the healthcare industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenues and accounts receivable at their net realizable values at the time products or services are provided. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes available, which could have a material impact on the Company’s operating results and cash flows in subsequent periods. Specifically, the complexity of many third-party billing arrangements and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. The patient and their third party insurance provider typically share in the payment for the Company’s products and services. The amount patients are responsible for includes co-payments, deductibles, and amounts not covered due to the provider being out-of-network. Due to uncertainties surrounding deductible levels and the number of out-of-network patients, the Company is not certain of the full amount of patient responsibility at the time of service. The Company estimates amounts due from patients prior to service and generally collects those amounts prior to service. Remaining amounts due from patients are then billed following completion of service. The activity in the allowance for doubtful accounts for the six months ending June 30, 2016 follows: 2016 Balance at beginning of period $ 6,062,000 Provisions recognized as reduction in revenues 4,520,909 Write-offs, net of recoveries (5,532,909 ) Balance at end of period $ 5,050,000 Cash and cash equivalents – The Company considers all highly liquid temporary cash investments with an original maturity of three months or less to be cash equivalents. Certificates of deposit with original maturities of more than three months are also considered cash equivalents if there are no restrictions on withdrawing funds from the account. Restricted Cash – As of June 30, 2016 and December 31, 2015, the Company had restricted cash of approximately $0.1 million and $0.2 million respectively, included in cash in the accompanying consolidated balance sheets. The restricted cash is pledged as collateral against certain debt of the Company. Goodwill and Intangible Assets – The Company evaluates goodwill for impairment at least on an annual basis and more frequently if certain indicators are encountered. Goodwill is to be tested at the reporting unit level, defined as an ASC or hospital (referred to as a component), with the fair value of the reporting unit being compared to its carrying amount, including goodwill. If the fair value of a reporting unit exceeds its carrying amount, goodwill of the reporting unit is not considered to be impaired. The Company will complete its annual impairment test in December 2016. Intangible assets other than goodwill which include physician membership interests, service contracts and covenants not to compete are amortized over their estimated useful lives using the straight line method. The remaining lives range from two to twenty years. The Company evaluates the recoverability of identifiable intangible asset whenever events or changes in circumstances indicate that an intangible asset’s carrying amount may not be recoverable. Net income (loss) per share – Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding for the period. Diluted income (loss) per share reflects the potential dilution that could occur if securities or other contracts to issue common stock were exercised or converted during the period. Dilutive securities having an anti-dilutive effect on diluted loss per share are excluded from the calculation. Supplemental Cash Flow Information – the following details the supplemental cash flow information for the six months ended June 30, 2016 and 2015: 2016 2015 Cash paid for interest and income taxes: Interest expense $ 1,778,000 $ 929,000 Income taxes $ — $ — Noncash investing activities: Common stock issued in business acquisition $ 1,925,000 $ — Recently Adopted and Recently Issued Accounting Guidance Adopted Guidance In January 2015, the FASB issued changes to the presentation of extraordinary items. Such items are defined as transactions or events that are both unusual in nature and infrequent in occurrence, and, currently, are required to be presented separately in an entity’s income statement, net of income tax, after income from continuing operations. The changes eliminate the concept of an extraordinary item and, therefore, the presentation of such items will no longer be required. Notwithstanding this change, an entity will still be required to present and disclose a transaction or event that is both unusual in nature and infrequent in occurrence in the notes to the financial statements. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. In February 2015, the FASB issued changes to the analysis that an entity must perform to determine whether it should consolidate certain types of legal entities. These changes (i) modify the evaluation of whether limited partnerships and similar legal entities are variable interest entities or voting interest entities, (ii) eliminate the presumption that a general partner should consolidate a limited partnership, (iii) affect the consolidation analysis of reporting entities that are involved with variable interest entities, particularly those that have fee arrangements and related party relationships, and (iv) provide a scope exception from consolidation guidance for reporting entities with interests in legal entities that are required to comply with or operate in accordance with requirements that are similar to those in Rule 2a-7 of the Investment Company Act of 1940 for registered money market funds. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. In April 2015, the FASB issued changes to the presentation of debt issuance costs. Currently, such costs are required to be presented as a noncurrent asset in an entity’s balance sheet and amortized into interest expense over the term of the related debt instrument. The changes require that debt issuance costs be presented in an entity’s balance sheet as a direct deduction from the carrying value of the related debt liability. The amortization of debt issuance costs remains unchanged. The Company adopted these changes on January 1, 2016. The adoption of these changes resulted in a decrease of approximately $580,000, to other assets and long-term debt, net of current portion, respectively, included in the accompanying consolidated balance sheet as of June 30, 2016. In August 2014, the FASB issued changes to the disclosure of uncertainties about an entity’s ability to continue as a going concern. Under GAAP, continuation of a reporting entity as a going concern is presumed as the basis for preparing financial statements unless and until the entity’s liquidation becomes imminent. Even if an entity’s liquidation is not imminent, there may be conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern. Because there is no guidance in GAAP about management’s responsibility to evaluate whether there is substantial doubt about an entity’s ability to continue as a going concern or to provide related note disclosures, there is diversity in practice with respect to whether, when, and how an entity discloses the relevant conditions and events in its financial statements. As a result, these changes require an entity’s management to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the date that financial statements are issued. Substantial doubt is defined as an indication that it is probable that an entity will be unable to meet its obligations as they become due within one year after the date that financial statements are issued. If management has concluded that substantial doubt exists, then the following disclosures should be made in the financial statements: (i) principal conditions or events that raised the substantial doubt, (ii) management’s evaluation of the significance of those conditions or events in relation to the entity’s ability to meet its obligations, (iii) management’s plans that alleviated the initial substantial doubt or, if substantial doubt was not alleviated, management’s plans that are intended to at least mitigate the conditions or events that raise substantial doubt, and (iv) if the latter in (iii) is disclosed, an explicit statement that there is substantial doubt about the entity’s ability to continue as a going concern. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. In September 2015, the FASB issued changes to the accounting for business combinations simplifying the accounting for measurement period Adjustments. The update eliminates the requirement for an acquirer to retrospectively adjust its financial statements for changes to provisional amounts that are identified during the measurement-period following the consummation of a business combination. Instead, the update requires these types of adjustments to be made during the reporting period in which they are identified and would require additional disclosure or separate presentation of the portion of the adjustment that would have been recorded in the previously reported periods as if the adjustment to the provisional amounts had been recognized as of the acquisition date. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. Issued Guidance In July 2015, the FASB issued changes to the subsequent measurement of inventory. Currently, an entity is required to measure its inventory at the lower of cost or market, whereby market can be replacement cost, net realizable value, or net realizable value less an approximately normal profit margin. The changes require that inventory be measured at the lower of cost and net realizable value, thereby eliminating the use of the other two market methodologies. Net realizable value is defined as the estimated selling prices in the ordinary course of business less reasonably predictable costs of completion, disposal, and transportation. These changes do not apply to inventories measured using LIFO (last-in, first-out) or the retail inventory method. Currently, the Company applies the net realizable value market option to measure its inventories at the lower of cost or market. These changes become effective for the Company on January 1, 2017. Management has determined that the adoption of these changes will not have an impact on the Company’s consolidated financial statements. In May 2014, the FASB issued changes to the recognition of revenue from contracts with customers. These changes created a comprehensive framework for all entities in all industries to apply in the determination of when to recognize revenue, and, therefore, supersede virtually all existing revenue recognition requirements and guidance. This framework is expected to result in less complex guidance in application while providing a consistent and comparable methodology for revenue recognition. The core principle of the guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. To achieve this principle, an entity should apply the following steps: (i) identify the contract(s) with a customer, (ii) identify the performance obligations in the contract(s), (iii) determine the transaction price, (iv) allocate the transaction price to the performance obligations in the contract(s), and (v) recognize revenue when, or as, the entity satisfies a performance obligation. These changes become effective for the Company on January 1, 2018. Management is currently evaluating the potential impact of these changes on the Company’s consolidated financial statements. In February 2016, the FASB issued changes to the accounting for leases, which requires an entity that leases assets to recognize on the balance sheet the assets and liabilities for the rights and obligations created by those leases. The update is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2018 and must be adopted using a modified retrospective approach. Management is currently evaluating the impact of this update on the consolidated financial statements. In March 2016, the FASB issued changes to employee share-based payment accounting, which simplifies several aspects of the accounting for employee share-based payment transactions, including the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification on the statement of cash flows. For public companies, the new guidance is effective for annual reporting periods (including interim periods within those periods) beginning after December 15, 2016, with early adoption permitted. The Company is in the process of evaluating the impact of adoption of this guidance on its financial statements. In June 2016, the FASB issued changes to the impairment model for most financial instruments, including trade receivables from an incurred loss method to a new forward-looking approach, based on expected losses. The estimate of expected credit losses will require entities to incorporate considerations of historical information, current information and reasonable and supportable forecasts. These changes are effective for the Company in the first quarter of 2020 and must be adopted using a modified retrospective transition approach. The Company is currently assessing the impact of the adoption of these changes on the Company’s results of operations, financial position and cash flows.

Acquisition

Acquisition	6 Months Ended
	Jun. 30, 2016
Business Combinations [Abstract]
Acquisition	Note 4 – Acquisitions On December 31, 2015, the Company closed the acquisition comprising substantially all of the hospital assets and hospital operating entity of University General Health Systems, Inc. (“UGHS”), consisting primarily of a sixty-nine bed acute care hospital located in the Medical City area of Houston, Texas (referred to as University General Hospital, LP or “UGH”). Subsequent to the acquisition, UGH is being operated as Foundation Surgical Hospital of Houston. The acquisition of UGH was based on management’s belief that UGH fits into the Company’s acquisition and development strategy and operating model that enables the Company to grow by taking advantage of highly-fragmented markets, an increasing demand for short stay surgery and a need by physicians to forge strategic alliances to meet the needs of the evolving healthcare landscape while also shaping the clinical environments in which they practice. The Company expects the acquisition of UGH will generate positive earnings and cash flow that will be accretive to the earnings and cash flow of the Company. The Company expects the goodwill attributable to UGH to be tax deductible. The Company paid $25.1 million in cash for the net assets acquired from UGHS. The fair value amounts have been initially recorded using preliminary estimates. The Company has engaged a third-party valuation company to complete a valuation of the fair value of the assets acquired and liabilities assumed in the acquisition. A portion of the valuation has been completed and management believes the valuation will be fully completed by September 30, 2016. The preliminary estimates will be revised in future periods and the revisions may materially affect the presentation of the Company’s consolidated financial results. Any changes to the initial estimates of the fair value of the assets and liabilities will be recorded as adjustments to those assets and liabilities and residual amounts will be allocated to goodwill. The preliminary purchase allocations for the acquisition of UGHS are as follows: Preliminary Adjustments Adjusted Accounts receivable $ 7,229,000 $ — $ 7,229,000 Supplies inventories 1,689,000 — 1,689,000 Other current assets 395,000 — 395,000 Total current assets 9,313,000 — 9,313,000 Property and equipment 40,363,000 (733,000 ) 39,630,000 Other assets 307,000 — 307,000 Intangible, net — 3,930,000 3,930,000 Goodwill 9,450,000 (2,822,000 ) 6,628,000 Total assets acquired 59,433,000 375,000 59,808,000 Liabilities assumed: Accounts payable and accrued liabilities 1,589,000 375,000 1,964,000 Current portion of long-term debt and capital lease obligations 4,740,000 — 4,740,000 Total current liabilities 6,329,000 375,000 6,704,000 Long-term debt and capital lease obligations, net of current portion 28,004,000 — 28,004,000 Total liabilities assumed 34,333,000 375,000 34,708,000 Net assets acquired $ 25,100,000 $ — $ 25,100,000 On May 11, 2016, the Company closed the acquisition of 51% of Ninety Nine Healthcare Management, LLC (“99 Mgmt”). 99 Mgmt has developed a clinically and financially integrated multi-specialty practice model which can increase participating physicians’ revenues. The acquisition of 99 Mgmt was based on management’s belief that 99 Mgmt will allow the Company to offer services to its physician partners that lead to higher revenues by aligning the goals and incentives for patients, physicians, hospitals, employers and payers. The Company expects the acquisition of 99 Mgmt to generate positive earnings and cash flow. The Company expects the goodwill attributable to 99 Mgmt will not be tax deductible. The Company paid $440,000 in cash and issued 700,000 shares of the Company’s common stock for purchase of 99 Mgmt. In addition, the Company has agreed to issue an additional 200,000 shares of the Company’s common stock upon 99 Mgmt’s completion of a signed network contract with BCBS of Texas that allows for one of the Company’s hospitals to participate as a contracted hospital provider. There is no time limit for completion of the contract. The fair value amounts have been initially recorded using preliminary estimates. The Company will complete a valuation of the fair value of the assets acquired and liabilities assumed in the acquisition. The preliminary estimates will be revised in future periods and the revisions may materially affect the presentation of the Company’s consolidated financial results. Any changes to the initial estimates of the fair value of the assets and liabilities will be recorded as adjustments to those assets and liabilities and residual amounts will be allocated to goodwill. The preliminary purchase allocations for the acquisition of 99 Mgmt are as follows: Preliminary Cash $ 282,000 Accounts receivable 613,000 Total current assets 895,000 Property and equipment 47,000 Goodwill 5,936,000 Other assets 16,000 Total assets acquired 6,894,000 Liabilities assumed: Accounts payable and accrued liabilities 628,000 Contingent consideration 550,000 Total liabilities assumed 1,178,000 Noncontrolling interests 2,801,000 Net assets acquired $ 2,915,000 During the three months and six months ended June 30, 2016, the Company incurred approximately $234,000 and $268,000, respectively, in expenses related to the acquisitions. The expenses incurred related primarily to legal fees related to the purchase agreement and structure of the transaction, professional fees related to the audits of the 2015 and 2014 financial statements of UGH and additional professional fees related to the valuation of the fair value of the acquisitions. Since the UGHS acquisition occurred on December 31, 2015, there are no acquisition revenues and earnings included in the Company’s consolidated statements of operations for the year ended December 31, 2015. The revenue and earnings of the combined entity had the acquisition dates of UGHS and 99 Mgmt been January 1, 2015 are as follows: Attributable to Foundation HealthCare common stock Revenue Loss From Continuing Operations Net Income (Loss) Net Loss Net Loss Per Share Actual: From 1/1/2016 to 6/30/2016 $ 21,511,000 $ (7,227,000 ) $ (7,227,000 ) $ (7,227,000 ) $ (0.41 ) Supplemental Pro Forma: From 1/1/2016 to 6/30/2016 $ 67,834,000 $ (12,048,000 ) $ (12,064,000 ) $ (11,833,000 ) $ (0.66 ) From 1/1/2015 to 12/31/2015 $ 184,169,000 $ (939,000 ) $ 5,792,000 $ (1,560,000 ) $ (0.09 ) The pro forma information is presented for informational purposes only and is not necessarily indicative of the results of operations that actually would have been achieved had the acquisition been consummated as of that time, nor is it intended to be a projection of future results.

Divestitures

Divestitures	6 Months Ended
	Jun. 30, 2016
Divestitures [Abstract]
Divestitures	Note 5 – Divestitures On June 30, 2016, the Company sold its 8% interest in Summit Hospital, an Equity Owned Hospital located in Edmond, Oklahoma. The Company received $2.2 million in proceeds from the sale of Summit resulting in a gain of $2.1 million. On July 15, 2015, the Company sold its 10% interest in the Kirby Glen Surgery, LLC, one of its Equity Owned ASCs located in Houston, Texas. The Company received $0.2 million in combined proceeds for the sale of the equity interest and termination of our management agreement. On June 12, 2015, the Company executed an agreement pursuant to which the Company sold a portion of its 20% equity investment in Grayson County Physician Property, LLC (“GCPP”) through a series of transactions. In conjunction with the sale, the management agreement under which the Company provided certain services including billing and collections, general management services, legal support, and accounting services was terminated. The Company’s decision to sell the assets of GCPP was part of the Company’s strategic plan to focus on the growth of its majority owned surgical hospital businesses. The Company received $7.8 million of proceeds as a result of the sale and $0.5 million for the termination of the management agreement. The Company used $7.0 million of these proceeds to reduce the Company’s principal balance of the note held by the Company’s senior lender. The remainder of the proceeds will be used for working capital needs and possible future acquisitions. See Note 6 – Discontinued Operations for additional information. On March 31, 2015, Houston Orthopedic Surgical Hospital, L.L.C. (“HOSH”), our Equity Owned hospital in Houston, Texas, sold substantially all of its assets under an asset purchase agreement. Given that the Company does not exhibit control with the 20% investment in HOSH, the Company accounts for the investment on a cost or cash basis. As a result of the HOSH sale, the Company received a distribution on May 12, 2015 $1.8 million, of which $0.6 million is being held in escrow until October 2016.

Discontinued Operations

Discontinued Operations	6 Months Ended
	Jun. 30, 2016
Discontinued Operations And Disposal Groups [Abstract]
Discontinued Operations	Note 6 – Discontinued Operations The partial sale of GCPP in June 2015 was part of the Company’s strategic plan to focus on majority owned hospital investments. As a result, the proceeds from the sale, the remaining equity ownership, and the results of operations and cash flows related to the equity investment in GCPP for all periods presented have been classified as discontinued operations. The operating results for the Company’s discontinued operations for the six months ended June 30, 2016 and 2015 are summarized below: 2016 2015 Revenues: Equity in earnings of GCCP $ — $ 24,784 Sleep operations — — Total revenues $ — $ 24,784 Net income (loss) before taxes: GCCP $ — $ 24,784 Sleep operations (16,081 ) (70,737 ) Gain on sale of equity investment in GCCP — 6,331,048 Gain on sale of building in GCCP — — Income tax (provision) benefit — (2,514,038 ) Net income (loss) from discontinued operations, net of tax $ (16,081 ) $ 3,771,057 The balance sheet items for the Company’s discontinued operations as of June 30, 2016 and December 31, 2015 are summarized below: June 30, 2016 December 31, 2015 Cash and cash equivalents $ — $ 5,219 Other current assets 408,303 411,171 Total current assets 408,303 416,390 Fixed assets, net — 8,713 Total assets $ 408,303 $ 425,103 Payables and accrued liabilities $ 766,928 $ 774,831 Income taxes payable 1,581,334 1,581,334 Total liabilities $ 2,348,262 $ 2,356,165

Equity Investments in Affiliate

Equity Investments in Affiliates	6 Months Ended
	Jun. 30, 2016
Investments In And Advances To Affiliates Schedule Of Investments [Abstract]
Equity Investments in Affiliates	Note 7 – Equity Investments in Affiliates The Company invests in non-majority interests in its Affiliates. The Company’s equity investments and respective ownership interest as of June 30, 2016 and December 31, 2015 are as follows: Ownership % June 30, December Affiliate Location 2016 2015 Surgical Hospitals: Summit Medical Center Edmond, OK 0% 8% ASCs: Foundation Surgery Affiliate of Nacogdoches, LLP Nacogdoches, TX 13% 13% Park Ten Surgery Center/Physicians West Houston Houston, TX 10% 10% Foundation Surgery Affiliate of Middleburg Heights, LLC Middleburg Heights, OH 10% 10% Foundation Surgery Affiliate of Huntingdon Valley, LP Huntingdon Valley, PA 20% 20% New Jersey Surgery Center, LLC Mercerville, NJ 10% 10% Foundation Surgery Affiliate of Northwest Oklahoma City, LLC Oklahoma City, OK 20% 20% Cumberland Valley Surgery Center, LLC Hagerstown, MD 34% 34% Frederick Surgical Center, LLC Frederick, MD 20% 20% The results of operations for the six months ended June 30, 2016 and 2015, of the Company’s equity investments in Affiliates are as follows: 2016 2015 Net operating revenues $ 23,035,340 $ 24,990,428 Net income $ 6,027,677 $ 6,159,449 The results of financial position as of June 30, 2016 and December 31, 2015, of the Company’s equity investments in Affiliates are as follows: June 30, December 2016 2015 Current assets $ 9,969,648 $ 12,371,752 Noncurrent assets 5,817,247 7,699,093 Total assets $ 15,786,895 $ 20,070,845 Current liabilities $ 3,833,829 $ 4,240,326 Noncurrent liabilities 1,540,610 2,266,793 Total liabilities $ 5,374,439 $ 6,507,119 Members' equity $ 10,412,456 $ 13,563,726

Goodwill and Other Intangibles

Goodwill and Other Intangibles	6 Months Ended
	Jun. 30, 2016
Goodwill And Intangible Assets Disclosure [Abstract]
Goodwill and Other Intangibles	Note 8 – Goodwill and Other Intangibles Changes in the carrying amount of goodwill as follows: Accumulated Net Gross Impairment Carrying Amount Loss Value December 31, 2015 $ 29,647,191 $ (22,045,382 ) $ 7,601,809 Acquisition - 99 Mgmt (Note 4) 5,936,000 — 5,936,000 June 30, 2016 $ 35,583,191 $ (22,045,382 ) $ 13,537,809 Goodwill and intangible assets with indefinite lives must be tested for impairment at least once a year. Carrying values are compared with fair values, and when the carrying value exceeds the fair value, the carrying value of the impaired asset is reduced to its fair value. The Company tests goodwill for impairment on an annual basis in the fourth quarter or more frequently if management believes indicators of impairment exist. The performance of the test involves a two-step process. The first step of the impairment test involves comparing the fair values of the applicable reporting units with their aggregate carrying values, including goodwill. The Company generally determines the fair value of its reporting units using the income approach methodology of valuation that includes the discounted cash flow method as well as other generally accepted valuation methodologies. If the carrying amount of a reporting unit exceeds the reporting unit’s fair value, the Company performs the second step of the goodwill impairment test to determine the amount of impairment loss. The second step of the goodwill impairment test involves comparing the implied fair value of the affected reporting unit’s goodwill with the carrying value of that goodwill. Changes in the carrying amount of intangible assets during the six months ended June 30, 2016 were as follows: Carrying Accumulated Amount Amortization Net December 31, 2015 $ 18,454,500 $ (7,502,330 ) $ 10,952,170 Amortization — (1,125,407 ) (1,125,407 ) June 30, 2016 $ 18,454,500 $ (8,627,737 ) $ 9,826,763 Intangible assets as of June 30, 2016 and December 31, 2015 include the following: June 30, 2016 December 31, Useful Carrying Accumulated 2015 Life (Years) Value Amortization Net Net Management fee contracts 6 - 8 $ 3,498,500 $ (2,822,807 ) $ 675,693 $ 893,723 Non-compete agreements 5 2,027,000 (1,458,925 ) 568,075 771,161 Physician memberships 7 6,468,000 (3,388,000 ) 3,080,000 3,542,000 Medicare provider agreements 20 3,930,000 (95,241 ) 3,834,759 3,930,000 Trade name 5 381,000 (227,447 ) 153,553 192,379 Service Contracts 10 2,150,000 (635,317 ) 1,514,683 1,622,907 $ 18,454,500 $ (8,627,737 ) $ 9,826,763 $ 10,952,170 Amortization expense for the three months ended June 30, 2016 and 2015 was $610,439 and $514,553, respectively. Amortization expense for the six months ended June 30, 2016 and 2015 was $1,125,407 and $1,029,113, respectively. Amortization expense for the next five years related to these intangible assets is expected to be as follows: Twelve months ending June 30, 2017 $ 2,248,629 2018 1,808,554 2019 1,329,931 2020 713,931 2021 405,931 Thereafter 3,319,786

Borrowings and Capital Lease Ob

Borrowings and Capital Lease Obligations	6 Months Ended
	Jun. 30, 2016
Debt Disclosure [Abstract]
Borrowings and Capital Lease Obligations	Note 9 – Borrowings and Capital Lease Obligations The Company’s short-term debt obligations are as of June 30, 2016 and December 31, 2015 are as follows: Rate (1) June 30, 2016 December 31, 2015 Insurance premium financings 4.8 - 5.0% $ 425,653 $ 308,769 (1) Effective rate as of June 30, 2016 The Company has various insurance premium financing notes payable that bear interest rates ranging from 4.8% to 5.0%. The insurance notes mature in October 2016 and the Company is required to make monthly principal and interest payments totaling $134,051. The Company’s long-term debt obligations at June 30, 2016 and December 31, 2015 are as follows: Rate (1) Maturity Date June 30, 2016 December 31, 2015 Senior Lender: Note payable 4.3% Dec. 2020 $ 27,361,606 $ 28,375,000 Line of credit 4.3% Dec. 2018 14,500,000 10,500,000 Unamortized loan origination costs (579,962 ) (644,403 ) Other Lenders: Note payable - subordinated note 3.0% Dec. 2019 7,900,000 7,900,000 Total 49,181,644 46,130,597 Less: Current portion of long-term debt (9,028,572 ) (4,601,320 ) Long-term debt $ 40,153,072 $ 41,529,277 (1) Effective rate as of June 30, 2016 Senior Credit Facility Effective December 31, 2015, the Company entered into a Credit Agreement (the “Senior Credit Facility”) with Texas Capital Bank, National Association, serving as the lead bank for two other banks (collectively “Senior Lenders”). The Senior Credit Facility replaced and consolidated all of the Company’s and the Company’s subsidiaries’ debt in the original principal amount of $28.4 million, which is referred to as the Term Loan, and provides for an additional revolving loan in the amount of $15.5 million, which is referred to as the Revolving Loan. The Company has also entered into a number of ancillary agreements in connection with the Senior Credit Facility, including deposit account control agreements, subsidiary guarantees, security agreements and promissory notes. Maturity Dates. The Term Loan matures on December 30, 2020 and the Revolving Loan matures on December 30, 2018. Interest Rates. Borrowings under the Senior Credit Facility are made, at the Company’s option, as either Base Rate loans or LIBOR loans. “Base Rate” for any day is the highest of (i) the Prime Rate, (ii) the Federal Funds Rate plus one half of one percent (0.5%), and (iii) Adjusted LIBOR plus one percent (1.00%). LIBOR loans are based on either the one month, two month or three month LIBOR rate at the Company’s option. From August 19, 2016 to June 30, 2017, all outstanding amounts under the Senior Credit Facility shall bear interest based on the Base Rate and the Base Rate shall not at be less than 3.5%. The interest rate is either a Base Rate or LIBOR plus the Applicable Margins based on our Senior Debt to EBITDA Ratio, as defined. The Applicable Margins are as follows: Pricing Level Senior Debt to EBITDA Ratio Base Rate Portion LIBOR Portion and Letter of Credit Fee Commitment Fee 1 < 2.0 : 1.0 2.75% 3.75% 0.375% 2 ≥ 2.0 : 1.0 but < 2.5 : 1.0 3.00% 4.00% 0.375% 3 ≤ 2.5 : 1.0 3.25% 4.25% 0.375% The Applicable Margin in effect will be adjusted within 45 days following the end of each quarter based on the Company’s Senior Debt to EBITDA ratio. The Senior Debt to EBITDA Ratio is calculated by dividing all of our senior indebtedness (excluding capital lease obligations for Foundation Surgical Hospital of Houston), that is by the Company’s EBITDA for the preceding four fiscal quarters. EBITDA is defined in the Senior Credit Facility as the Company’s net income plus the sum of minus the sum of Interest and Principal Payments. The Company is required to make quarterly payments of principal and interest on the Term Loan. The first four quarterly payments on the Term Loan will be $1,013,393, on the first day of each April, July, October, and January during the term hereof, commencing April 1, 2016. The Company is required to make quarterly payments on the Revolving Loan equal to the accrued and unpaid interest. All unpaid principal and interest on the Term Loan and Revolving Loan must be paid on the respective maturity dates of each Loan. Borrowing Base . The Company’s ability to borrow money under the Revolving Loan is limited to the Company’s Borrowing Base. The Company’s Borrowing Base is equal to the (i) 80% of the eligible account of Foundation Surgical Hospital of San Antonio, not to exceed the outstanding principal balance of the intercompany note payable by the San Antonio Hospital to the Company, (ii) 80% of the eligible account of Foundation Surgical Hospital of El Paso, not to exceed the outstanding principal balance of the intercompany note payable by the El Paso Hospital to the Company, and (iii) 80% of the eligible account of Foundation Surgical Hospital of Houston, not to exceed the outstanding principal balance of the intercompany note payable by the Houston Hospital to the Company. Mandatory Prepayments. The Company must make mandatory prepayments of the Term Loans in the following situations, among others: · The Company must apply 100% of the net proceeds from the sale of worn out and obsolete equipment not necessary or useful for the conduct of the Company’s business; · Commencing with the fiscal year ending December 31, 2016, the Company must apply 50% of our Excess Cash Flow for such fiscal year to the installment payments due on the Company’s Term Loan; · The Company must apply 50% of the net cash proceeds from the issuance of equity interests to the installment payments due on the Company’s Term Loan; provided that no prepayment need to be made for the year ended December 31, 2016 once the Company has made mandatory prepayments in excess of $10,000,000; · The Company must apply 100% of the net cash proceeds from the issuance of debt (other than certain permitted debt) to the prepayment of the Term Loan; · The Company must prepay 100% of the net cash proceeds paid to the Company other than in the ordinary course of business; and · The Company must prepay 100% of the net cash proceeds the Company receives from the prepayment of intercompany notes. Voluntary Prepayments. The Company may prepay amounts under the Term Loan or Revolving Loan at any time provided that the Company is required to pay a prepayment fee of 2% of the amount prepaid if payment is made prior to the first anniversary, 1.5% if the prepayment is made after the first anniversary but prior to the second anniversary and 1% if the prepayment is made after the second anniversary but prior to the third anniversary. Guaranties. Each of the Company’s direct or indirect wholly-owned subsidiaries jointly and severally and unconditionally guaranty payment of the Company’s obligations owed to Lenders. Financial Covenants: Debt to EBITDA Ratio. As of December 31, 2015, the Company must maintain a Debt to EBITDA Ratio, not in excess of 3.50 to 1.00. Thereafter, the Company must maintain a Debt to EBITDA Ratio as of the last day of any fiscal quarter, not in excess of (a) 3.25 to 1.00 for the fiscal quarters ending December 31, 2015, March 31, 2016 and June 30, 2016; (b) 2.75 to 1.00 for the fiscal quarters ending June 30, 2017 and September 30, 2017; (c) 2.50 to 1.00 for the fiscal quarters ending December 31, 2017, March 31, 2018, June 30, 2018 and September 30, 2018; and (d) 2.25 to 1.00 for the fiscal quarter ending December 31, 2018 and at the end of each fiscal quarter thereafter. As of June 30, 2016, the Company’s Debt to EBITDA Ratio was 7.21. Senior Debt to EBITDA Ratio . As of December 31, 2015, the Company must maintain a Senior Debt to EBITDA Ratio not in excess of 3.00 to 1.00. Thereafter, the Company must maintain a Senior Debt to EBITDA Ratio as of the last day of any fiscal quarter, not in excess of (a) 3.00 to 1.00 for the fiscal quarters ending December 31, 2015, March 31, 2016 and June 30, 2016; (b) 2.50 to 1.00 for the fiscal quarters ending June 30, 2017 and September 30, 2017; (c) 2.25 to 1.00 for the fiscal quarters ending December 31, 2017, March 31, 2018, June 30, 2018 and September 30, 2018; and (d) 2.00 to 1.00 for the fiscal quarter ending December 31, 2018 and at the end of each fiscal quarter thereafter. As of June 30, 2016, the Company’s Senior Debt to EBITDA Ratio was 6.23. Pre-Distribution Fixed Charge Coverage Ratio . The Company must maintain as of the last day of any fiscal quarter (excluding the fiscal quarters ending September 30, 2016, December 31, 2016 and March 31, 2017) a Pre-Distribution Fixed Charge Coverage Ratio in excess of 1.30 to 1.00. As of June 30, 2016, the Company’s Pre-Distribution Fixed Charge Coverage Ratio was 0.63. Post-Distribution Fixed Charge Coverage Ratio. The Company must maintain as of the last day of any fiscal quarter (excluding the fiscal quarters ending September 30, 2016, December 31, 2016 and March 31, 2017), a Post-Distribution Fixed Charge Coverage Ratio in excess of 1.05 to 1.00. As of June 30, 2016, the Company’s Post-Distribution Fixed Charge Coverage Ratio was 0.48. EBITDA. The Company must have EBITDA of at least $1,750,000 for the fiscal quarter ending September 30, 2016 and $4,250,000 for the fiscal quarter ending December 31, 2016 and each quarter thereafter. Capital Expenditures. The Company shall not make capital expenditures in excess of $5,000,000 during any fiscal year. As of June 30, 2016, the Company was not in compliance with the Senior Credit Facility financial covenants; however the Senior Lenders have waived the financial covenant violations. As described above, the Senior Lenders have modified the financial covenants for the remainder of 2016. Collateral. Payment and performance of the Company’s obligations under the Senior Credit Facility are secured in general by all of the Company and the Company’s guarantors’ assets. Negative Covenants . The Senior Credit Facility has restrictive covenants that, among other things, limits or restricts the Company’s ability to do the following without the consent of the Senior Lenders: · Incur additional indebtedness; · Create or incur additional liens on the Company’s assets; · Engage in mergers or acquisitions; · Pay dividends or make any other payment or distribution in respect of the Company’s equity interests; · Make loans and investments; · Issue equity, except for stock compensation awards to employees; · Engage in transaction with affiliates; · Dispose of the Company’s assets, except for certain approved assets; · Engage in any sale and leaseback arrangements; and · Prepay debt to debtors other than the Senior Lenders. Defaults and Remedies. In addition to the general defaults of failure to perform our obligations under the Loan Agreement, events of default also include the occurrence of a change in control, as defined, and the loss of our Medicare or Medicaid certification, collateral casualties, entry of a uninsured judgment of $500,000 or more, failure of first liens on collateral and the termination of any of the Company’s management agreements that represent more than 10% of the Company’s management fees for the preceding 18 month period. In the event of a monetary default, all of the Company’s obligations due under the Senior Credit Facility shall become immediately due and payable. In the event of a non-monetary default, the Company has 10 days or in some cases three days to cure before the Senior Lenders have the right to declare the Company’s obligations due under the Senior Credit Facility immediately due and payable. Modification and Waiver. On May 11, 2016, the Company entered into a Loan Modification Agreement and Waiver with its Senior Lenders (“Senior Credit Modification One”). Under the Senior Credit Modification One, the Company’s Revolving Loan was increased from $12.5 million to $15.5 million. The $3.0 million of borrowing represents a temporary advance that must be repaid by July 31, 2016 (the “Temporary Advance”). In addition, the Senior Lenders consented to the sale of certain of the Company’s assets and waived certain technical defaults in the Senior Credit Facility related to timing deadlines for certain financial information provided by the Company to the Senior Lenders for the UGH Acquisition. On August 19, 2016, the Company entered into a Loan Modification Agreement and Waiver with its Senior Lenders (“Senior Credit Modification Two”). Under the Senior Credit Modification Two, the Senior Lenders waived the financial covenant violations for the fiscal quarter ended June 30, 2016 and modified the financial covenants for the fiscal quarters ending September 30, 2016 and December 31, 2016 by replacing the Debt to EBITDA Ratio, Senior Debt to EBITDA Ratio, and Pre and Post Distribution Fixed Charge Coverage Ratios with the EBITDA covenant. In addition, the Senior Lenders extended the due date for the repayment of the Temporary Advance to January 15, 2017. During the period from August 19, 2016 to June 30, 2017, the Senior Credit Modification Two prohibits the Company from making any interest or redemption payments to its preferred noncontrolling interest holders (see Note 10 – Preferred Noncontrolling Interests) and prohibits the Company from making any payments on the $7.9 million subordinated note payable. Under the Senior Credit Modification Two, the Company must also maintain total cash balances in excess of $2 million (“Minimum Cash Balances”) and the Company’s total accounts payable past due by 91 days or more must be less than $6.3 million. At June 30, 2016, future maturities of long-term debt were as follows: Years ended June 30: 2017 $ 9,028,572 2018 5,883,582 2019 17,383,582 2020 4,073,786 2021 12,812,122 Thereafter — The Company’s capital lease obligations as of June 30, 2016 and December 31, 2015 are as follows: Rate (1) Maturity Date June 30, 2016 December 31, 2015 Building 7.5% Jul. 2036 $ 24,168,540 $ 24,424,341 Equipment 5.1 - 9.1% Mar. 2017 - Dec. 2020 8,276,219 9,185,320 Total 32,444,759 33,609,661 Less: Current portion of capital leases (4,071,318 ) (4,478,968 ) Capital leases obligations $ 28,373,441 $ 29,130,693 (1) Effective rate as of June 30, 2016 The Company has entered into a capital lease covering the FSH Houston hospital facility, see Note 4 - Acquisition. The capital lease bears an interest at fixed rate of 7.5%. The Company is required to make monthly principal and interest payments under the capital lease totaling $193,611. The Company is also required to maintain a $1.0 million letter of credit payable to the lessor in the event of a default on the lease. The Company has entered into various capital leases that are collateralized by certain computer and medical equipment used by the Company. The capital leases bear interest at fixed rates ranging from 5.1% to 9.1%. The Company is required to monthly principal and interest payments under the capital leases totaling $278,142. At June 30, 2016, future maturities of capital lease obligations were as follows: Years ended June 30: 2017 $ 4,071,318 2018 2,942,345 2019 1,560,415 2020 1,630,374 2021 1,227,285 Thereafter 21,013,022

Preferred Noncontrolling Intere

Preferred Noncontrolling Interests	6 Months Ended
	Jun. 30, 2016
Noncontrolling Interest [Abstract]
Preferred Noncontrolling Interests	Note 10 – Preferred Noncontrolling Interests During 2013, the Company’s wholly-owned subsidiary, Foundation Health Enterprises, LLC (“FHE”) completed a private placement offering of $9,135,000. The offering was comprised of 87 units (“FHE Unit” or “preferred noncontrolling interest”). Each FHE Unit was offered at $105,000 and entitled the purchaser to one (1) Class B membership interest in FHE, valued at $100,000, and 1,000 shares of the Company’s common stock, valued at $5,000. The total consideration of $9,135,000 was comprised of $8,700,000 attributable to the preferred noncontrolling interest and $435,000 attributable to the 87,000 shares of the Company’s common stock. The FHE Units provide for a cumulative preferred annual return of 9% on the amount allocated to the Class B membership interests. The FHE Units will be redeemed by FHE in five annual installments beginning in October 2014. The FHE Unit holders agreed to defer the first installment payment until March 2015. The first and second installments were paid in April 2015 and October 2015, respectively. The Senior Credit Modification Two also prohibits the Company from making any interest or redemption payments to its preferred noncontrolling interest holders (see Note 10 – Preferred Noncontrolling Interests) during the period from August 19, 2016 to June 30, 2017. The first four installments shall be in the amount of $10,000 per FHE Unit and the final installment will be in the amount of the unreturned capital contribution and any undistributed preferred distributions. The FHE Units are convertible at the election of the holder at any time prior to the complete redemption into restricted common shares of the Company at a conversion price of $20.00 per share. Since the FHE Units have a redemption feature and a conversion feature which the Company determined to be substantive, the preferred noncontrolling interests has been recorded at the mezzanine level in the accompanying consolidated balance sheets and the corresponding dividends are recorded as a reduction of accumulated deficit.

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2016
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	Note 11 – Commitments and Contingencies Legal claims – The Company is exposed to asserted and unasserted legal claims encountered in the normal course of business, including claims for damages for personal injuries, medical malpractice, breach of contracts, wrongful restriction of or interference with physicians’ staff privileges and employment related claims. In certain of these actions, plaintiffs request payment for damages, including punitive damages that may not be covered by insurance. Management believes that the ultimate resolution of these matters will not have a material adverse effect on the operating results or the financial position of the Company. There were no settlement expenses during the six months ended June 30, 2016 and 2015 related to the Company’s ongoing unasserted legal claims. Self-insurance – Effective January 1, 2014, the Company began using a combination of insurance and self-insurance for employee-related healthcare benefits. The self-insurance liability is determined actuarially, based on the actual claims filed and an estimate of incurred but not reported claims. Self-insurance reserves as of June 30, 2016 and December 31, 2015 were $629,909 and $424,593, respectively, and are included in accrued liabilities in the accompanying consolidated balance sheets.

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2016
Fair Value Disclosures [Abstract]
Fair Value Measurements	Note 12 – Fair Value Measurements Fair value is the price that would be received from the sale of an asset or paid to transfer a liability (i.e., an exit price) in the principal or most advantageous market in an orderly transaction between market participants. In determining fair value, the accounting standards established a three-level hierarchy that distinguishes between (i) market data obtained or developed from independent sources (i.e., observable data inputs) and (ii) a reporting entity’s own data and assumptions that market participants would use in pricing an asset or liability (i.e., unobservable data inputs). Financial assets and financial liabilities measured and reported at fair value are classified in one of the following categories, in order of priority of observability and objectivity of pricing inputs: · Level 1 – Fair value based on quoted prices in active markets for identical assets or liabilities. · Level 2 – Fair value based on significant directly observable data (other than Level 1 quoted prices) or significant indirectly observable data through corroboration with observable market data. Inputs would normally be (i) quoted prices in active markets for similar assets or liabilities, (ii) quoted prices in inactive markets for identical or similar assets or liabilities or (iii) information derived from or corroborated by observable market data. · Level 3 – Fair value based on prices or valuation techniques that require significant unobservable data inputs. Inputs would normally be a reporting entity’s own data and judgments about assumptions that market participants would use in pricing the asset or liability. The fair value measurement level for an asset or liability is based on the lowest level of any input that is significant to the fair value measurement. Valuation techniques should maximize the use of observable inputs and minimize the use of unobservable inputs. Recurring Fair Value Measurements: The carrying value of the Company’s financial assets and financial liabilities is their cost, which may differ from fair value. The carrying value of cash held as demand deposits, money market and certificates of deposit, accounts receivable, short-term borrowings, accounts payable and accrued liabilities approximated their fair value. At June 30, 2016, the fair value of the Company’s long-term debt, including the current portion was determined to be approximately equal to its carrying value. Nonrecurring Fair Value Measurements: In May 2016, the Company completed the acquisition of 99 Mgmt; see Note 3 – Acquisition for additional information. The assets acquired and liabilities assumed in the acquisition were recorded at their fair values on the date of the acquisition. For the acquisition, the nonrecurring fair value measurements were developed using significant unobservable inputs (Level 3) using discounted cash flow calculations based upon the Company’s weighted average cost of capital and third-party valuation services. Assumptions used were similar to those that would be used by market participants performing valuations of these business units and were based on analysis of current and expected future economic conditions and the updated strategic plan for each business unit. The assets acquired were valued at $6,894,000 and the liabilities assumed were $1,178,000.

Related Party Transactions

Related Party Transactions	6 Months Ended
	Jun. 30, 2016
Related Party Transactions [Abstract]
Related Party Transactions	Note 13 – Related Party Transactions Effective June 1, 2014, the Company’s hospital subsidiary located in El Paso, Texas entered into a sublease agreement with The New Sleep Lab International, Ltd., referred to as New Sleep. New Sleep is controlled by Dr. Robert Moreno, one of our Directors. The sublease with New Sleep calls for monthly rent payments of $8,767 and the sublease expires on November 30, 2018. The space subleased from New Sleep will be sublet to physician partners and casual uses of our hospital and is located in a building that also houses one of our imaging facilities. During the six months ended June 30, 2016, the Company incurred approximately $47,200 in lease expense under the terms of the lease. As of June 30, 2016, the Company had $0.1 million on deposit at Valliance Bank. Valliance Bank is controlled by Mr. Roy T. Oliver, one of our greater than 5% shareholders. A noncontrolling interest in Valliance Bank is held by Mr. Joseph Harroz, Jr., a director of the Company. Mr. Stanton Nelson, the Company’s Chief Executive Officer and Mr. Harroz also serve as directors of Valliance Bank. The Company has entered into agreements with certain of its Affiliate ASCs and hospitals to provide management services. As compensation for these services, the surgery centers and hospitals are charged management fees which are either fixed or are based on a percentage of the Affiliates cash collected or the Affiliates net revenue. The percentages range from 2.25% to 6.0%. As of June 30, 2016 and December 31, 2015, the Company has obligations of $1.4 million that are owed to Foundation Healthcare Affiliates (“FHA”), the Company’s majority shareholder, related to transactions that occurred prior to the Foundation acquisition in July 2013. The amounts owed to FHA are included in other liabilities in the accompanying consolidated balance sheets.

Subsequent Events

Subsequent Events	6 Months Ended
	Jun. 30, 2016
Subsequent Events [Abstract]
Subsequent Events	Note 14 – Subsequent Events Management evaluated all activity of the Company and concluded that no material subsequent events have occurred that would require recognition in the consolidated financial statements or disclosure in the notes to the consolidated financial statements, except for the following: On July 7, 2016, the Company sold certain raw land adjacent to its Consolidated Hospital located in El Paso, Texas to Chihuahua Development, LLC (“Chihuahua”) for $1.3 million. The sale resulted in a loss of $0.2 million. Chihuahua is controlled by Mr. Robert Byers who is a shareholder and director of FHA.

Summary of Significant Accoun20

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Interim Financial Information	Interim Financial Information – The condensed consolidated financial statements included herein are unaudited and have been prepared in accordance with generally accepted accounting principles for interim financial statements and in accordance with Regulation S-X. Accordingly, they do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring adjustments) considered necessary for a fair presentation have been included. Operating results for the three months and six months ended June 30, 2016 are not necessarily indicative of results that may be expected for the year ended December 31, 2016. The consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto included in the Company’s Form 10-K for the year ended December 31, 2015. The December 31, 2015 consolidated balance sheet was derived from audited financial statements.
Consolidation	Consolidation – The accompanying consolidated financial statements include the accounts of the Company and its wholly owned, majority owned and controlled subsidiaries. All significant inter-company accounts and transactions have been eliminated in consolidation. The Company accounts for its investments in Affiliates in which the Company exhibits significant influence, but does not control, in accordance with the equity method of accounting. The Company does not consolidate its equity method investments, but rather measures them at their initial costs and then subsequently adjusts their carrying values through income for their respective shares of the earnings or losses during the period. The Company monitors its investments for other-than-temporary impairment by considering factors such as current economic and market conditions and the operating performance of the companies and records reductions in carrying values when necessary.
Use of estimates	Use of estimates – The preparation of financial statements in conformity with generally accepted accounting principles requires management of the Company to make estimates and assumptions that affect the amounts reported in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.
Reclassifications	Reclassifications – Certain amounts presented in prior years have been reclassified to conform to the current year’s presentation. Such reclassifications had no effect on net income.
Revenue recognition and accounts receivable	Revenue recognition and accounts receivable – The Company recognizes revenues in the period in which services are performed and billed. Accounts receivable primarily consist of amounts due from third-party payors and patients. The Company’s ability to collect outstanding receivables is critical to its results of operations and cash flows. Amounts the Company receives for treatment of patients covered by governmental programs such as Medicare and Medicaid and other third-party payors such as health maintenance organizations, preferred provider organizations and other private insurers are generally less than the Company’s established billing rates. Additionally, to provide for accounts receivable that could become uncollectible in the future, the Company establishes an allowance for doubtful accounts to reduce the carrying value of such receivables to their estimated net realizable value. Accordingly, the revenues and accounts receivable reported in the Company’s consolidated financial statements are recorded at the net amount expected to be received.
Contractual Discounts and Cost Report Settlements	Contractual Discounts and Cost Report Settlements – The Company derives a significant portion of its revenues from Medicare, Medicaid and other payors that receive discounts from its established billing rates. The Company must estimate the total amount of these discounts to prepare its consolidated financial statements. The Medicare and Medicaid regulations and various managed care contracts under which these discounts must be calculated are complex and are subject to interpretation and adjustment. The Company estimates the allowance for contractual discounts on a payor-specific basis given its interpretation of the applicable regulations or contract terms. These interpretations sometimes result in payments that differ from the Company’s estimates. Additionally, updated regulations and contract renegotiations occur frequently, necessitating regular review and assessment of the estimation process by management. Changes in estimates related to the allowance for contractual discounts affect revenues reported in the Company’s accompanying consolidated statements of operations. Cost report settlements under reimbursement agreements with Medicare, Medicaid and Tricare are estimated and recorded in the period the related services are rendered and are adjusted in future periods as final settlements are determined. There is a reasonable possibility that recorded estimates will change by a material amount in the near term. The estimated net cost report settlements due to the Company were $2.8 million and $0.5 million as of June 30, 2016 and December 31, 2015 respectively, and are included in prepaid and other current assets in the accompanying consolidated balance sheets. We increased our cost report estimate by $2.3 million during the six months ended June 30, 2016 based on settlements from our final filed cost report for 2013 and 2014 and an estimate of the 2015 cost report and estimated recoveries from filing amended cost reports for 2012, 2013 and 2014 for the Houston hospital acquired in December 2015 (see Note 4 – Acquisitions). The Company’s management believes that adequate provisions have been made for adjustments that may result from final determination of amounts earned under these programs. Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. The Company believes that it is in compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on the Company’s financial statements. Compliance with such laws and regulations can be subject to future government review and interpretation as well as significant regulatory action including fines, penalties and exclusion from the Medicare and Medicaid programs.
Provision and Allowance for Doubtful Accounts	Provision and Allowance for Doubtful Accounts – To provide for accounts receivable that could become uncollectible in the future, the Company establishes an allowance for doubtful accounts to reduce the carrying value of such receivables to their estimated net realizable value. The primary uncertainty lies with uninsured patient receivables and deductibles, co-payments or other amounts due from individual patients. The Company has an established process to determine the adequacy of the allowance for doubtful accounts that relies on a number of analytical tools and benchmarks to arrive at a reasonable allowance. No single statistic or measurement determines the adequacy of the allowance for doubtful accounts. Some of the analytical tools that the Company utilizes include, but are not limited to, the aging of accounts receivable, historical cash collection experience, revenue trends by payor classification, revenue days in accounts receivable, the status of claims submitted to third party payors, reason codes for declined claims and an assessment of the Company’s ability to address the issue and resubmit the claim and whether a patient is on a payment plan and making payments consistent with that plan. Accounts receivable are written off after collection efforts have been followed in accordance with the Company’s policies. Due to the nature of the healthcare industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenues and accounts receivable at their net realizable values at the time products or services are provided. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes available, which could have a material impact on the Company’s operating results and cash flows in subsequent periods. Specifically, the complexity of many third-party billing arrangements and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. The patient and their third party insurance provider typically share in the payment for the Company’s products and services. The amount patients are responsible for includes co-payments, deductibles, and amounts not covered due to the provider being out-of-network. Due to uncertainties surrounding deductible levels and the number of out-of-network patients, the Company is not certain of the full amount of patient responsibility at the time of service. The Company estimates amounts due from patients prior to service and generally collects those amounts prior to service. Remaining amounts due from patients are then billed following completion of service. The activity in the allowance for doubtful accounts for the six months ending June 30, 2016 follows: 2016 Balance at beginning of period $ 6,062,000 Provisions recognized as reduction in revenues 4,520,909 Write-offs, net of recoveries (5,532,909 ) Balance at end of period $ 5,050,000
Cash and cash equivalents	Cash and cash equivalents – The Company considers all highly liquid temporary cash investments with an original maturity of three months or less to be cash equivalents. Certificates of deposit with original maturities of more than three months are also considered cash equivalents if there are no restrictions on withdrawing funds from the account.
Restricted Cash	Restricted Cash – As of June 30, 2016 and December 31, 2015, the Company had restricted cash of approximately $ 0.1 million and $0.2 million respectively, included in cash in the accompanying consolidated balance sheets. The restricted cash is pledged as collateral against certain debt of the Company.
Goodwill and Intangible Assets	Goodwill and Intangible Assets – The Company evaluates goodwill for impairment at least on an annual basis and more frequently if certain indicators are encountered. Goodwill is to be tested at the reporting unit level, defined as an ASC or hospital (referred to as a component), with the fair value of the reporting unit being compared to its carrying amount, including goodwill. If the fair value of a reporting unit exceeds its carrying amount, goodwill of the reporting unit is not considered to be impaired. The Company will complete its annual impairment test in December 2016. Intangible assets other than goodwill which include physician membership interests, service contracts and covenants not to compete are amortized over their estimated useful lives using the straight line method. The remaining lives range from two to twenty years. The Company evaluates the recoverability of identifiable intangible asset whenever events or changes in circumstances indicate that an intangible asset’s carrying amount may not be recoverable.
Net income (loss) per share	Net income (loss) per share – Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding for the period. Diluted income (loss) per share reflects the potential dilution that could occur if securities or other contracts to issue common stock were exercised or converted during the period. Dilutive securities having an anti-dilutive effect on diluted loss per share are excluded from the calculation.
Supplemental Cash Flow Information	Supplemental Cash Flow Information – the following details the supplemental cash flow information for the six months ended June 30, 2016 and 2015: 2016 2015 Cash paid for interest and income taxes: Interest expense $ 1,778,000 $ 929,000 Income taxes $ — $ — Noncash investing activities: Common stock issued in business acquisition $ 1,925,000 $ —
Recently Adopted and Recently Issued Accounting Guidance	Recently Adopted and Recently Issued Accounting Guidance Adopted Guidance In January 2015, the FASB issued changes to the presentation of extraordinary items. Such items are defined as transactions or events that are both unusual in nature and infrequent in occurrence, and, currently, are required to be presented separately in an entity’s income statement, net of income tax, after income from continuing operations. The changes eliminate the concept of an extraordinary item and, therefore, the presentation of such items will no longer be required. Notwithstanding this change, an entity will still be required to present and disclose a transaction or event that is both unusual in nature and infrequent in occurrence in the notes to the financial statements. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. In February 2015, the FASB issued changes to the analysis that an entity must perform to determine whether it should consolidate certain types of legal entities. These changes (i) modify the evaluation of whether limited partnerships and similar legal entities are variable interest entities or voting interest entities, (ii) eliminate the presumption that a general partner should consolidate a limited partnership, (iii) affect the consolidation analysis of reporting entities that are involved with variable interest entities, particularly those that have fee arrangements and related party relationships, and (iv) provide a scope exception from consolidation guidance for reporting entities with interests in legal entities that are required to comply with or operate in accordance with requirements that are similar to those in Rule 2a-7 of the Investment Company Act of 1940 for registered money market funds. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. In April 2015, the FASB issued changes to the presentation of debt issuance costs. Currently, such costs are required to be presented as a noncurrent asset in an entity’s balance sheet and amortized into interest expense over the term of the related debt instrument. The changes require that debt issuance costs be presented in an entity’s balance sheet as a direct deduction from the carrying value of the related debt liability. The amortization of debt issuance costs remains unchanged. The Company adopted these changes on January 1, 2016. The adoption of these changes resulted in a decrease of approximately $580,000, to other assets and long-term debt, net of current portion, respectively, included in the accompanying consolidated balance sheet as of June 30, 2016. In August 2014, the FASB issued changes to the disclosure of uncertainties about an entity’s ability to continue as a going concern. Under GAAP, continuation of a reporting entity as a going concern is presumed as the basis for preparing financial statements unless and until the entity’s liquidation becomes imminent. Even if an entity’s liquidation is not imminent, there may be conditions or events that raise substantial doubt about the entity’s ability to continue as a going concern. Because there is no guidance in GAAP about management’s responsibility to evaluate whether there is substantial doubt about an entity’s ability to continue as a going concern or to provide related note disclosures, there is diversity in practice with respect to whether, when, and how an entity discloses the relevant conditions and events in its financial statements. As a result, these changes require an entity’s management to evaluate whether there are conditions or events, considered in the aggregate, that raise substantial doubt about the entity’s ability to continue as a going concern within one year after the date that financial statements are issued. Substantial doubt is defined as an indication that it is probable that an entity will be unable to meet its obligations as they become due within one year after the date that financial statements are issued. If management has concluded that substantial doubt exists, then the following disclosures should be made in the financial statements: (i) principal conditions or events that raised the substantial doubt, (ii) management’s evaluation of the significance of those conditions or events in relation to the entity’s ability to meet its obligations, (iii) management’s plans that alleviated the initial substantial doubt or, if substantial doubt was not alleviated, management’s plans that are intended to at least mitigate the conditions or events that raise substantial doubt, and (iv) if the latter in (iii) is disclosed, an explicit statement that there is substantial doubt about the entity’s ability to continue as a going concern. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. In September 2015, the FASB issued changes to the accounting for business combinations simplifying the accounting for measurement period Adjustments. The update eliminates the requirement for an acquirer to retrospectively adjust its financial statements for changes to provisional amounts that are identified during the measurement-period following the consummation of a business combination. Instead, the update requires these types of adjustments to be made during the reporting period in which they are identified and would require additional disclosure or separate presentation of the portion of the adjustment that would have been recorded in the previously reported periods as if the adjustment to the provisional amounts had been recognized as of the acquisition date. The Company adopted these changes on January 1, 2016. The adoption of these changes had no impact on the Company’s consolidated financial statements. Issued Guidance In July 2015, the FASB issued changes to the subsequent measurement of inventory. Currently, an entity is required to measure its inventory at the lower of cost or market, whereby market can be replacement cost, net realizable value, or net realizable value less an approximately normal profit margin. The changes require that inventory be measured at the lower of cost and net realizable value, thereby eliminating the use of the other two market methodologies. Net realizable value is defined as the estimated selling prices in the ordinary course of business less reasonably predictable costs of completion, disposal, and transportation. These changes do not apply to inventories measured using LIFO (last-in, first-out) or the retail inventory method. Currently, the Company applies the net realizable value market option to measure its inventories at the lower of cost or market. These changes become effective for the Company on January 1, 2017. Management has determined that the adoption of these changes will not have an impact on the Company’s consolidated financial statements. In May 2014, the FASB issued changes to the recognition of revenue from contracts with customers. These changes created a comprehensive framework for all entities in all industries to apply in the determination of when to recognize revenue, and, therefore, supersede virtually all existing revenue recognition requirements and guidance. This framework is expected to result in less complex guidance in application while providing a consistent and comparable methodology for revenue recognition. The core principle of the guidance is that an entity should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. To achieve this principle, an entity should apply the following steps: (i) identify the contract(s) with a customer, (ii) identify the performance obligations in the contract(s), (iii) determine the transaction price, (iv) allocate the transaction price to the performance obligations in the contract(s), and (v) recognize revenue when, or as, the entity satisfies a performance obligation. These changes become effective for the Company on January 1, 2018. Management is currently evaluating the potential impact of these changes on the Company’s consolidated financial statements. In February 2016, the FASB issued changes to the accounting for leases, which requires an entity that leases assets to recognize on the balance sheet the assets and liabilities for the rights and obligations created by those leases. The update is effective for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2018 and must be adopted using a modified retrospective approach. Management is currently evaluating the impact of this update on the consolidated financial statements. In March 2016, the FASB issued changes to employee share-based payment accounting, which simplifies several aspects of the accounting for employee share-based payment transactions, including the accounting for income taxes, forfeitures, and statutory tax withholding requirements, as well as classification on the statement of cash flows. For public companies, the new guidance is effective for annual reporting periods (including interim periods within those periods) beginning after December 15, 2016, with early adoption permitted. The Company is in the process of evaluating the impact of adoption of this guidance on its financial statements. In June 2016, the FASB issued changes to the impairment model for most financial instruments, including trade receivables from an incurred loss method to a new forward-looking approach, based on expected losses. The estimate of expected credit losses will require entities to incorporate considerations of historical information, current information and reasonable and supportable forecasts. These changes are effective for the Company in the first quarter of 2020 and must be adopted using a modified retrospective transition approach. The Company is currently assessing the impact of the adoption of these changes on the Company’s results of operations, financial position and cash flows.

Summary of Significant Accoun21

Summary of Significant Accounting Policies (Tables)	6 Months Ended
	Jun. 30, 2016
Accounting Policies [Abstract]
Allowance for Doubtful Accounts	The activity in the allowance for doubtful accounts for the six months ending June 30, 2016 follows: 2016 Balance at beginning of period $ 6,062,000 Provisions recognized as reduction in revenues 4,520,909 Write-offs, net of recoveries (5,532,909 ) Balance at end of period $ 5,050,000
Supplemental Cash Flow Information	Supplemental Cash Flow Information – the following details the supplemental cash flow information for the six months ended June 30, 2016 and 2015: 2016 2015 Cash paid for interest and income taxes: Interest expense $ 1,778,000 $ 929,000 Income taxes $ — $ — Noncash investing activities: Common stock issued in business acquisition $ 1,925,000 $ —

Acquisition (Tables)

Acquisition (Tables)	6 Months Ended
	Jun. 30, 2016
Business Acquisition [Line Items]
Revenue and Earnings of Combined Entity Acquisition	The revenue and earnings of the combined entity had the acquisition dates of UGHS and 99 Mgmt been January 1, 2015 are as follows: Attributable to Foundation HealthCare common stock Revenue Loss From Continuing Operations Net Income (Loss) Net Loss Net Loss Per Share Actual: From 1/1/2016 to 6/30/2016 $ 21,511,000 $ (7,227,000 ) $ (7,227,000 ) $ (7,227,000 ) $ (0.41 ) Supplemental Pro Forma: From 1/1/2016 to 6/30/2016 $ 67,834,000 $ (12,048,000 ) $ (12,064,000 ) $ (11,833,000 ) $ (0.66 ) From 1/1/2015 to 12/31/2015 $ 184,169,000 $ (939,000 ) $ 5,792,000 $ (1,560,000 ) $ (0.09 )
UGHS
Business Acquisition [Line Items]
Preliminary Purchase Allocation to the fair value of the Assets Acquired and Liabilities Assumed	The preliminary purchase allocations for the acquisition of UGHS are as follows: Preliminary Adjustments Adjusted Accounts receivable $ 7,229,000 $ — $ 7,229,000 Supplies inventories 1,689,000 — 1,689,000 Other current assets 395,000 — 395,000 Total current assets 9,313,000 — 9,313,000 Property and equipment 40,363,000 (733,000 ) 39,630,000 Other assets 307,000 — 307,000 Intangible, net — 3,930,000 3,930,000 Goodwill 9,450,000 (2,822,000 ) 6,628,000 Total assets acquired 59,433,000 375,000 59,808,000 Liabilities assumed: Accounts payable and accrued liabilities 1,589,000 375,000 1,964,000 Current portion of long-term debt and capital lease obligations 4,740,000 — 4,740,000 Total current liabilities 6,329,000 375,000 6,704,000 Long-term debt and capital lease obligations, net of current portion 28,004,000 — 28,004,000 Total liabilities assumed 34,333,000 375,000 34,708,000 Net assets acquired $ 25,100,000 $ — $ 25,100,000
Ninety Nine Healthcare Management Limited Liability Company
Business Acquisition [Line Items]
Preliminary Purchase Allocation to the fair value of the Assets Acquired and Liabilities Assumed	The preliminary purchase allocations for the acquisition of 99 Mgmt are as follows: Preliminary Cash $ 282,000 Accounts receivable 613,000 Total current assets 895,000 Property and equipment 47,000 Goodwill 5,936,000 Other assets 16,000 Total assets acquired 6,894,000 Liabilities assumed: Accounts payable and accrued liabilities 628,000 Contingent consideration 550,000 Total liabilities assumed 1,178,000 Noncontrolling interests 2,801,000 Net assets acquired $ 2,915,000

Discontinued Operations (Tables

Discontinued Operations (Tables)	6 Months Ended
	Jun. 30, 2016
Discontinued Operations And Disposal Groups [Abstract]
Operating Results and Balance Sheet Items of Discontinued Operations	The operating results for the Company’s discontinued operations for the six months ended June 30, 2016 and 2015 are summarized below: 2016 2015 Revenues: Equity in earnings of GCCP $ — $ 24,784 Sleep operations — — Total revenues $ — $ 24,784 Net income (loss) before taxes: GCCP $ — $ 24,784 Sleep operations (16,081 ) (70,737 ) Gain on sale of equity investment in GCCP — 6,331,048 Gain on sale of building in GCCP — — Income tax (provision) benefit — (2,514,038 ) Net income (loss) from discontinued operations, net of tax $ (16,081 ) $ 3,771,057 The balance sheet items for the Company’s discontinued operations as of June 30, 2016 and December 31, 2015 are summarized below: June 30, 2016 December 31, 2015 Cash and cash equivalents $ — $ 5,219 Other current assets 408,303 411,171 Total current assets 408,303 416,390 Fixed assets, net — 8,713 Total assets $ 408,303 $ 425,103 Payables and accrued liabilities $ 766,928 $ 774,831 Income taxes payable 1,581,334 1,581,334 Total liabilities $ 2,348,262 $ 2,356,165

Equity Investments in Affilia24

Equity Investments in Affiliates (Tables)	6 Months Ended
	Jun. 30, 2016
Investments In And Advances To Affiliates Schedule Of Investments [Abstract]
Summary of Equity Investments and Ownership Interests	The Company invests in non-majority interests in its Affiliates. The Company’s equity investments and respective ownership interest as of June 30, 2016 and December 31, 2015 are as follows: Ownership % June 30, December Affiliate Location 2016 2015 Surgical Hospitals: Summit Medical Center Edmond, OK 0% 8% ASCs: Foundation Surgery Affiliate of Nacogdoches, LLP Nacogdoches, TX 13% 13% Park Ten Surgery Center/Physicians West Houston Houston, TX 10% 10% Foundation Surgery Affiliate of Middleburg Heights, LLC Middleburg Heights, OH 10% 10% Foundation Surgery Affiliate of Huntingdon Valley, LP Huntingdon Valley, PA 20% 20% New Jersey Surgery Center, LLC Mercerville, NJ 10% 10% Foundation Surgery Affiliate of Northwest Oklahoma City, LLC Oklahoma City, OK 20% 20% Cumberland Valley Surgery Center, LLC Hagerstown, MD 34% 34% Frederick Surgical Center, LLC Frederick, MD 20% 20%
Summary of Unaudited Results of Operations and Financial Position of Equity Investments in Affiliates	The results of operations for the six months ended June 30, 2016 and 2015, of the Company’s equity investments in Affiliates are as follows: 2016 2015 Net operating revenues $ 23,035,340 $ 24,990,428 Net income $ 6,027,677 $ 6,159,449 The results of financial position as of June 30, 2016 and December 31, 2015, of the Company’s equity investments in Affiliates are as follows: June 30, December 2016 2015 Current assets $ 9,969,648 $ 12,371,752 Noncurrent assets 5,817,247 7,699,093 Total assets $ 15,786,895 $ 20,070,845 Current liabilities $ 3,833,829 $ 4,240,326 Noncurrent liabilities 1,540,610 2,266,793 Total liabilities $ 5,374,439 $ 6,507,119 Members' equity $ 10,412,456 $ 13,563,726

Goodwill and Other Intangibles

Goodwill and Other Intangibles (Tables)	6 Months Ended
	Jun. 30, 2016
Goodwill And Intangible Assets Disclosure [Abstract]
Changes in Carrying Amount of Goodwill	Changes in the carrying amount of goodwill as follows: Accumulated Net Gross Impairment Carrying Amount Loss Value December 31, 2015 $ 29,647,191 $ (22,045,382 ) $ 7,601,809 Acquisition - 99 Mgmt (Note 4) 5,936,000 — 5,936,000 June 30, 2016 $ 35,583,191 $ (22,045,382 ) $ 13,537,809
Changes in Carrying Amount of Intangible Assets	Changes in the carrying amount of intangible assets during the six months ended June 30, 2016 were as follows: Carrying Accumulated Amount Amortization Net December 31, 2015 $ 18,454,500 $ (7,502,330 ) $ 10,952,170 Amortization — (1,125,407 ) (1,125,407 ) June 30, 2016 $ 18,454,500 $ (8,627,737 ) $ 9,826,763
Intangible Assets	Intangible assets as of June 30, 2016 and December 31, 2015 include the following: June 30, 2016 December 31, Useful Carrying Accumulated 2015 Life (Years) Value Amortization Net Net Management fee contracts 6 - 8 $ 3,498,500 $ (2,822,807 ) $ 675,693 $ 893,723 Non-compete agreements 5 2,027,000 (1,458,925 ) 568,075 771,161 Physician memberships 7 6,468,000 (3,388,000 ) 3,080,000 3,542,000 Medicare provider agreements 20 3,930,000 (95,241 ) 3,834,759 3,930,000 Trade name 5 381,000 (227,447 ) 153,553 192,379 Service Contracts 10 2,150,000 (635,317 ) 1,514,683 1,622,907 $ 18,454,500 $ (8,627,737 ) $ 9,826,763 $ 10,952,170
Amortization Expense for Next Five Years Related to Intangible Assets	Amortization expense for the next five years related to these intangible assets is expected to be as follows: Twelve months ending June 30, 2017 $ 2,248,629 2018 1,808,554 2019 1,329,931 2020 713,931 2021 405,931 Thereafter 3,319,786

Borrowings and Capital Lease 26

Borrowings and Capital Lease Obligations (Tables)	6 Months Ended
	Jun. 30, 2016
Debt Disclosure [Abstract]
Schedule of Short-Term Debt Obligations	The Company’s short-term debt obligations are as of June 30, 2016 and December 31, 2015 are as follows: Rate (1) June 30, 2016 December 31, 2015 Insurance premium financings 4.8 - 5.0% $ 425,653 $ 308,769 (1) Effective rate as of June 30, 2016
Schedule of Long-Term Debt Obligations	The Company’s long-term debt obligations at June 30, 2016 and December 31, 2015 are as follows: Rate (1) Maturity Date June 30, 2016 December 31, 2015 Senior Lender: Note payable 4.3% Dec. 2020 $ 27,361,606 $ 28,375,000 Line of credit 4.3% Dec. 2018 14,500,000 10,500,000 Unamortized loan origination costs (579,962 ) (644,403 ) Other Lenders: Note payable - subordinated note 3.0% Dec. 2019 7,900,000 7,900,000 Total 49,181,644 46,130,597 Less: Current portion of long-term debt (9,028,572 ) (4,601,320 ) Long-term debt $ 40,153,072 $ 41,529,277 (1) Effective rate as of June 30, 2016
Schedule of Applicable Margins Rate	The Applicable Margins are as follows: Pricing Level Senior Debt to EBITDA Ratio Base Rate Portion LIBOR Portion and Letter of Credit Fee Commitment Fee 1 < 2.0 : 1.0 2.75% 3.75% 0.375% 2 ≥ 2.0 : 1.0 but < 2.5 : 1.0 3.00% 4.00% 0.375% 3 ≤ 2.5 : 1.0 3.25% 4.25% 0.375%
Future Maturities of Long-Term Debt	At June 30, 2016, future maturities of long-term debt were as follows: Years ended June 30: 2017 $ 9,028,572 2018 5,883,582 2019 17,383,582 2020 4,073,786 2021 12,812,122 Thereafter —
Schedule of Capital Lease Obligations	The Company’s capital lease obligations as of June 30, 2016 and December 31, 2015 are as follows: Rate (1) Maturity Date June 30, 2016 December 31, 2015 Building 7.5% Jul. 2036 $ 24,168,540 $ 24,424,341 Equipment 5.1 - 9.1% Mar. 2017 - Dec. 2020 8,276,219 9,185,320 Total 32,444,759 33,609,661 Less: Current portion of capital leases (4,071,318 ) (4,478,968 ) Capital leases obligations $ 28,373,441 $ 29,130,693 (1) Effective rate as of June 30, 2016
Future Maturities of Capital Leases Obligations	At June 30, 2016, future maturities of capital lease obligations were as follows: Years ended June 30: 2017 $ 4,071,318 2018 2,942,345 2019 1,560,415 2020 1,630,374 2021 1,227,285 Thereafter 21,013,022

Basis of Presentation - Additio

Basis of Presentation - Additional Information (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015	May 11, 2016	Mar. 31, 2016	Dec. 31, 2015
Basis Of Presentation [Line Items]
Accumulated deficit	$ (43,770,740)		$ (43,770,740)				$ (32,074,090)
Working capital, net of redemption payments	5,400,000		5,400,000
Redemption payments, payable to preferred noncontrolling interest holders	900,000		900,000
Net loss attributable to Foundation Healthcare common stock	(9,156,003)	$ 4,539,344	(11,696,649)	$ 3,207,481
Cash flow from operating activities from continuing operations			(5,284,945)	$ 3,858,817
Cash and cash equivalents	1,100,000		1,100,000
Revolving Loan
Basis Of Presentation [Line Items]
Line of Credit	15,500,000		15,500,000		$ 15,500,000	$ 12,500,000
Default on principal payment	3,000,000		3,000,000
Senior Lender
Basis Of Presentation [Line Items]
Line of Credit, remaining borrowing capacity	0		0
Line of Credit	$ 15,500,000		$ 15,500,000

Summary of Significant Accoun28

Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($)	6 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
Summary Of Significant Accounting Policies [Line Items]
Adjustments for cost report settlements	$ 2,300,000
Minimum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives	2 years
Maximum
Summary Of Significant Accounting Policies [Line Items]
Estimated useful lives	20 years
Cash
Summary Of Significant Accounting Policies [Line Items]
Restricted cash	$ 100,000	$ 200,000
Prepaid and Other Current Assets
Summary Of Significant Accounting Policies [Line Items]
Cost settlements adjustment amount	2,800,000	$ 500,000
Net Income Loss
Summary Of Significant Accounting Policies [Line Items]
Prior period reclassification adjustment	0
New Accounting Pronouncement | Other Assets
Summary Of Significant Accounting Policies [Line Items]
Prior period reclassification adjustment	$ 580,000

Allowance for Doubtful Accounts

Allowance for Doubtful Accounts (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Allowance For Doubtful Accounts Receivable Rollforward
Balance at beginning of period			$ 6,062,000
Provisions recognized as reduction in revenues	$ 2,598,924	$ 2,177,522	4,520,909	$ 2,598,546
Write-offs, net of recoveries			(5,532,909)
Balance at end of period	$ 5,050,000		$ 5,050,000

Supplemental Cash Flow Informat

Supplemental Cash Flow Information (Detail) - USD ($)	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Cash paid for interest and income taxes:
Interest expense	$ 1,778,000	$ 929,000
Noncash investing activities:
Common stock issued in business acquisition	$ 1,925,000

Acquisition - Additional Inform

Acquisition - Additional Information (Detail)	May 11, 2016USD ($)shares	Jun. 30, 2016USD ($)	Jun. 30, 2016USD ($)	Dec. 31, 2015Bed
Business Acquisition [Line Items]
Incurred expenses		$ 234,000	$ 268,000
UGH
Business Acquisition [Line Items]
Number of acquired beds | Bed				69
Cash paid for net of asset acquired			$ 25,100,000
Ninety Nine Healthcare Management Limited Liability Company
Business Acquisition [Line Items]
Outstanding membership interests acquired	51.00%
Cash paid to acquire membership interests	$ 440,000
Common stock issued to purchase membership interest in entity | shares	700,000
Additional common stock issued upon execution | shares	200,000

Preliminary Purchase Allocation

Preliminary Purchase Allocation to the fair value of the Assets Acquired and Liabilities Assumed (Detail) - USD ($)	Jun. 30, 2016	Dec. 31, 2015
Business Acquisition [Line Items]
Goodwill	$ 13,537,809	$ 7,601,809
UGHS
Business Acquisition [Line Items]
Accounts receivable	7,229,000
Supplies inventories	1,689,000
Other current assets	395,000
Total current assets	9,313,000
Property and equipment	39,630,000
Other assets	307,000
Intangible, net	3,930,000
Goodwill	6,628,000
Total assets acquired	59,808,000
Accounts payable and accrued liabilities	1,964,000
Current portion of long-term debt and capital lease obligations	4,740,000
Total current liabilities	6,704,000
Long-term debt and capital lease obligations, net of current portion	28,004,000
Total liabilities assumed	34,708,000
Net assets acquired	25,100,000
UGHS | Preliminary
Business Acquisition [Line Items]
Accounts receivable	7,229,000
Supplies inventories	1,689,000
Other current assets	395,000
Total current assets	9,313,000
Property and equipment	40,363,000
Other assets	307,000
Goodwill	9,450,000
Total assets acquired	59,433,000
Accounts payable and accrued liabilities	1,589,000
Current portion of long-term debt and capital lease obligations	4,740,000
Total current liabilities	6,329,000
Long-term debt and capital lease obligations, net of current portion	28,004,000
Total liabilities assumed	34,333,000
Net assets acquired	25,100,000
UGHS | Adjustments
Business Acquisition [Line Items]
Property and equipment	(733,000)
Intangible, net	3,930,000
Goodwill	(2,822,000)
Total assets acquired	375,000
Accounts payable and accrued liabilities	375,000
Total current liabilities	375,000
Total liabilities assumed	375,000
Ninety Nine Healthcare Management Limited Liability Company | Preliminary
Business Acquisition [Line Items]
Cash	282,000
Accounts receivable	613,000
Total current assets	895,000
Property and equipment	47,000
Other assets	16,000
Goodwill	5,936,000
Total assets acquired	6,894,000
Accounts payable and accrued liabilities	628,000
Contingent consideration	550,000
Total liabilities assumed	1,178,000
Noncontrolling interests	2,801,000
Net assets acquired	$ 2,915,000

Revenue and Earnings of Combine

Revenue and Earnings of Combined Entity Acquisition (Detail) - USD ($)	3 Months Ended		6 Months Ended		12 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Business Acquisition [Line Items]
Revenues	$ 27,342,483	$ 31,862,954	$ 65,979,561	$ 61,405,104
Loss from Continuing Operations	(10,268,671)	1,933,901	(11,911,574)	2,304,225
Net income (loss)	(10,272,991)	5,791,036	(11,927,655)	6,075,282
Net Loss Attributable to Foundation HealthCare common stock	$ (9,001,548)	$ 4,717,014	(11,384,307)	$ 3,580,366
UGHS and 99 Mgmt
Business Acquisition [Line Items]
Revenues			21,511,000
Loss from Continuing Operations			(7,227,000)
Net income (loss)			(7,227,000)
Net Loss Attributable to Foundation HealthCare common stock			$ (7,227,000)
Net Loss Per Share Attributable to Foundation HealthCare common stock			$ (0.41)
Revenues, Proforma			$ 67,834,000		$ 184,169,000
Income Loss From Continuing Operations Before Income Taxes Extraordinary Items Noncontrolling Interest, Proforma			(12,048,000)		(939,000)
Net Income (Loss), Including Portion Attributable to Noncontrolling Interest, Proforma			(12,064,000)		5,792,000
Attributable to Foundation HealthCare common stock, Proforma			$ (11,833,000)		$ (1,560,000)
Attributable to Foundation HealthCare common stock, Proforma			$ (0.66)		$ (0.09)

Divestitures - Additional Infor

Divestitures - Additional Information (Detail) - USD ($)	Jun. 30, 2016	Jul. 15, 2015	Jun. 12, 2015	May 12, 2015	Jun. 30, 2016	Jun. 30, 2016
Divestitures [Line Items]
Proceeds from sale of equity investment			$ 7,800,000			$ 2,200,000
Gain on sale of equity investment in affiliate					$ 2,140,832	$ 2,140,832
Proceeds from termination of management agreement			500,000
Senior Lender
Divestitures [Line Items]
Repayment of principal balance of notes			$ 7,000,000
GCPP
Divestitures [Line Items]
Equity method investment percentage sold			20.00%
Edmond, Oklahoma | Summit Medical Center
Divestitures [Line Items]
Equity method investment percentage sold	8.00%
Proceeds from sale of equity investment	$ 2,200,000
Gain on sale of equity investment in affiliate	$ 2,100,000
Houston Texas | Kirby Glen Surgery, LLC
Divestitures [Line Items]
Equity method investment percentage sold		10.00%
Proceeds from sale of equity investment		$ 200,000
Houston Texas | Houston Orthopedic Surgical Hospital, L.L.C
Divestitures [Line Items]
Equity method investment percentage sold				20.00%
Proceeds from sale of equity investment				$ 1,800,000
Escrow related to sale of property of equity investee				$ 600,000

Operating Results and Balance S

Operating Results and Balance Sheet Items of Discontinued Operations (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Revenues				$ 24,784
Income tax (provision) benefit				(2,514,038)
Income (loss) from discontinued operations, net of tax	$ (4,320)	$ 3,857,135	$ (16,081)	3,771,057
Cash and cash equivalents					$ 5,219
Other current assets	408,303		408,303		411,171
Total current assets	408,303		408,303		416,390
Fixed assets, net					8,713
Total assets	408,303		408,303		425,103
Payables and accrued liabilities	766,928		766,928		774,831
Income taxes payable	1,581,334		1,581,334		1,581,334
Total liabilities	$ 2,348,262		2,348,262		$ 2,356,165
GCPP
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Revenues				24,784
Net income (loss) before taxes				24,784
Gain on sale of equity investment in GCCP				6,331,048
Sleep Operations
Income Statement Balance Sheet And Additional Disclosures By Disposal Groups Including Discontinued Operations [Line Items]
Net income (loss) before taxes			$ (16,081)	$ (70,737)

Summary of Equity Investments a

Summary of Equity Investments and Ownership Interests (Detail)	Jun. 30, 2016	Dec. 31, 2015
Summit Medical Center | Edmond OK
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	0.00%	8.00%
Foundation Surgery Affiliate of Nacogdoches LLP | Nacogdoches TX
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	13.00%	13.00%
Park Ten Surgery Center | Houston TX
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	10.00%	10.00%
Foundation Surgery Affiliate of Middleburg Heights LLC | Middleburg Heights OH
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	10.00%	10.00%
Foundation Surgery Affiliate of Huntingdon Valley LP | Huntingdon Valley PA
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	20.00%	20.00%
New Jersey Surgery Center LLC | Mercerville NJ
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	10.00%	10.00%
Foundation Surgery Affiliate of Northwest Oklahoma City LLC | Oklahoma City OK
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	20.00%	20.00%
Cumberland Valley Surgery Center LLC | Hagerstown MD
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	34.00%	34.00%
Frederick Surgical Center LLC | Frederick MD
Investments In And Advances To Affiliates [Line Items]
Equity investments, ownership interest	20.00%	20.00%

Summary of Unaudited Results of

Summary of Unaudited Results of Operations and Financial Position of Equity Investments in Affiliates (Detail) - USD ($)	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Investments In And Advances To Affiliates Schedule Of Investments [Abstract]
Net operating revenues	$ 23,035,340	$ 24,990,428
Net income	6,027,677	$ 6,159,449
Current assets	9,969,648		$ 12,371,752
Noncurrent assets	5,817,247		7,699,093
Total assets	15,786,895		20,070,845
Current liabilities	3,833,829		4,240,326
Noncurrent liabilities	1,540,610		2,266,793
Total liabilities	5,374,439		6,507,119
Members' equity	$ 10,412,456		$ 13,563,726

Changes in Carrying Amount of G

Changes in Carrying Amount of Goodwill (Detail)	6 Months Ended
	Jun. 30, 2016USD ($)
Goodwill [Line Items]
Goodwill Gross Amount, Beginning of period	$ 29,647,191
Goodwill Gross Amount, End of period	35,583,191
Goodwill Accumulated Impairment Loss, Beginning of period	(22,045,382)
Goodwill Accumulated Impairment Loss, End of period	(22,045,382)
Goodwill, Beginning of period	7,601,809
Goodwill, End of period	13,537,809
Ninety Nine Healthcare Management Limited Liability Company
Goodwill [Line Items]
Goodwill, Acquisition adjustment	$ 5,936,000

Changes in Carrying Amount of I

Changes in Carrying Amount of Intangible Assets (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Goodwill And Intangible Assets Disclosure [Abstract]
Intangible asset carrying amount, beginning balance			$ 18,454,500
Intangible asset carrying amount, ending balance	$ 18,454,500		18,454,500
Intangible asset accumulated amortization, beginning balance			(7,502,330)
Intangible asset, accumulated amortization			(1,125,407)
Intangible asset accumulated amortization, ending balance	(8,627,737)		(8,627,737)
Intangible asset beginning balance, net			10,952,170
Amortization expense	(610,439)	$ (514,553)	(1,125,407)	$ (1,029,113)
Intangible asset ending balance, net	$ 9,826,763		$ 9,826,763

Intangible Assets (Detail)

Intangible Assets (Detail) - USD ($)	6 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
Finite Lived Intangible Assets [Line Items]
Intangible asset carrying amount	$ 18,454,500	$ 18,454,500
Accumulated Amortization	(8,627,737)	(7,502,330)
Intangible assets, net	9,826,763	10,952,170
Management Fee Contracts
Finite Lived Intangible Assets [Line Items]
Intangible asset carrying amount	3,498,500
Accumulated Amortization	(2,822,807)
Intangible assets, net	$ 675,693	893,723
Non-compete agreements
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	5 years
Intangible asset carrying amount	$ 2,027,000
Accumulated Amortization	(1,458,925)
Intangible assets, net	$ 568,075	771,161
Physician memberships
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	7 years
Intangible asset carrying amount	$ 6,468,000
Accumulated Amortization	(3,388,000)
Intangible assets, net	$ 3,080,000	3,542,000
Medicare Provider Agreements
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	20 years
Intangible asset carrying amount	$ 3,930,000
Accumulated Amortization	(95,241)
Intangible assets, net	$ 3,834,759	3,930,000
Trade Name
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	5 years
Intangible asset carrying amount	$ 381,000
Accumulated Amortization	(227,447)
Intangible assets, net	$ 153,553	192,379
Service Contracts
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	10 years
Intangible asset carrying amount	$ 2,150,000
Accumulated Amortization	(635,317)
Intangible assets, net	$ 1,514,683	$ 1,622,907
Minimum
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	2 years
Minimum | Management Fee Contracts
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	6 years
Maximum
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	20 years
Maximum | Management Fee Contracts
Finite Lived Intangible Assets [Line Items]
Estimated useful lives	8 years

Goodwill and Other Intangible41

Goodwill and Other Intangibles - Additional Information (Detail) - USD ($)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Goodwill And Intangible Assets Disclosure [Abstract]
Amortization expense	$ 610,439	$ 514,553	$ 1,125,407	$ 1,029,113

Amortization Expense for Next F

Amortization Expense for Next Five Years Related to Intangible Assets (Detail)	Jun. 30, 2016USD ($)
Finite Lived Intangible Assets Future Amortization Expense [Abstract]
2,017	$ 2,248,629
2,018	1,808,554
2,019	1,329,931
2,020	713,931
2,021	405,931
Thereafter	$ 3,319,786

Schedule of Short-Term Debt Obl

Schedule of Short-Term Debt Obligations (Detail) - USD ($)		Jun. 30, 2016	Dec. 31, 2015
Short-term Debt [Line Items]
Short-term debt		$ 425,654	$ 308,769
Insurance premium financings
Short-term Debt [Line Items]
Short-term debt		$ 425,653	$ 308,769
Insurance premium financings | Minimum
Short-term Debt [Line Items]
Debt instrument, effective interest rate	[1]	4.80%
Insurance premium financings | Maximum
Short-term Debt [Line Items]
Debt instrument, effective interest rate	[1]	5.00%
[1]	Effective rate as of June 30, 2016

Borrowings and Capital Lease 44

Borrowings and Capital Lease Obligations - Additional Information (Detail) - USD ($)

Aug. 19, 2016

May 11, 2016

Dec. 31, 2018

Sep. 30, 2018

Jun. 30, 2018

Mar. 31, 2018

Dec. 31, 2017

Sep. 30, 2017

Jun. 30, 2017

Jun. 30, 2016

Mar. 31, 2016

Dec. 31, 2015

Jun. 30, 2016

Dec. 31, 2015

Dec. 31, 2016

Debt Instrument [Line Items]

Long term debt

$ 49,181,644

$ 46,130,597

$ 49,181,644

$ 46,130,597

Prepayment fee percentage on term loan or revolving loan prior to first anniversary

2.00%

Prepayment penalty percentage on term loan after first anniversary

1.50%

Prepayment penalty percentage on term loan after second anniversary but prior to third anniversary

1.00%

Debt to EBITDA ratio

721.00%

Pre-Distribution fixed charge coverage ratio

63.00%

Post-Distribution fixed charge coverage ratio

48.00%

Amount of uninsured judgment triggering default

$ 500,000

$ 500,000

Debt default, description

In addition to the general defaults of failure to perform our obligations under the Loan Agreement, events of default also include the occurrence of a change in control, as defined, and the loss of our Medicare or Medicaid certification, collateral casualties, entry of a uninsured judgment of $500,000 or more, failure of first liens on collateral and the termination of any of the Company’s management agreements that represent more than 10% of the Company’s management fees for the preceding 18 month period. In the event of a monetary default, all of the Company’s obligations due under the Senior Credit Facility shall become immediately due and payable. In the event of a non-monetary default, the Company has 10 days or in some cases three days to cure before the Senior Lenders have the right to declare the Company’s obligations due under the Senior Credit Facility immediately due and payable.

Senior Debt

Debt Instrument [Line Items]

Senior debt to EBITDA ratio

623.00%

Capital Lease Obligations

Debt Instrument [Line Items]

Monthly principal and interest payment

$ 278,142

Capital Lease Obligations | Foundation Surgical Hospital Of Houston

Debt Instrument [Line Items]

Debt instrument, effective interest rate

7.50%

7.50%

Monthly principal and interest payment

$ 193,611

Letter of credit minimum amount require to be maintain

$ 1,000,000

Senior Credit Facility

Debt Instrument [Line Items]

Debt instrument, interest rate description

“Base Rate” for any day is the highest of (i) the Prime Rate, (ii) the Federal Funds Rate plus one half of one percent (0.5%), and (iii) Adjusted LIBOR plus one percent (1.00%). LIBOR loans are based on either the one month, two month or three month LIBOR rate at the Company’s option.

Maximum allowable amount of capital expenditure

$ 5,000,000

Senior Credit Facility | Federal Funds Rate

Debt Instrument [Line Items]

Debt instrument basis spread on variable rate

0.50%

Senior Credit Facility | LIBOR Rate

Debt Instrument [Line Items]

Debt instrument basis spread on variable rate

1.00%

Term Loan

Debt Instrument [Line Items]

Debt instrument maturity date

Dec. 30, 2020

Long term debt

$ 28,400,000

$ 28,400,000

Percentage of prepayment on net proceeds from the sale of worn out and obsolete equipment

100.00%

100.00%

Percentage of prepayment on net cash proceeds from the issuance of equity interests

50.00%

50.00%

Mandatory prepayment for future payment condition description

provided that no prepayment need to be made for the year ended December 31, 2016 once the Company has made mandatory prepayments in excess of $10,000,000

Percentage of prepayment on net cash proceeds from issuance of debt

100.00%

100.00%

Percentage of prepayment on net cash proceeds paid to the Company other than ordinary course of business

100.00%

100.00%

Percentage of prepayment on net cash proceeds from the prepayment of intercompany notes

100.00%

100.00%

Term Loan | Scenario, Forecast

Debt Instrument [Line Items]

Percentage of installment payment on excess cash flow

50.00%

Term Loan | First Four Quarterly Payments

Debt Instrument [Line Items]

Quarterly principal payment

$ 1,013,393

Revolving Loan

Debt Instrument [Line Items]

Debt instrument maturity date

Dec. 30, 2018

Line of credit collateralized

$ 15,500,000

$ 15,500,000

$ 12,500,000

$ 15,500,000

Revolving Loan | Subsequent Event

Debt Instrument [Line Items]

Subordinated note payable with payment restriction

$ 7,900,000

Accounts payable past due over 91 days or more, maximum required amount

6,300,000

Revolving Loan | Subsequent Event | Cash

Debt Instrument [Line Items]

Minimum Cash Balances

$ 2,000,000

Revolving Loan | Senior Credit Facility | Foundation Surgical Hospital Of San Antonio

Debt Instrument [Line Items]

Percentage of eligible account not to exceed the outstanding principal balance of intercompany note payable

80.00%

Revolving Loan | Senior Credit Facility | Foundation Surgical Hospital Of El Paso

Debt Instrument [Line Items]

Percentage of eligible account not to exceed the outstanding principal balance of intercompany note payable

80.00%

Revolving Loan | Senior Credit Facility | Foundation Surgical Hospital Of Houston

Debt Instrument [Line Items]

Percentage of eligible account not to exceed the outstanding principal balance of intercompany note payable

80.00%

Temporary Advances

Debt Instrument [Line Items]

Debt instrument maturity date

Jul. 31, 2016

Borrowing as temporary advance

$ 3,000,000

Temporary Advances | Subsequent Event

Debt Instrument [Line Items]

Debt instrument maturity date

Jan. 15, 2017

Minimum | Capital Lease Obligations

Debt Instrument [Line Items]

Debt instrument, effective interest rate

5.10%

5.10%

Minimum | Senior Credit Facility | Base Rate

Debt Instrument [Line Items]

Debt instrument, effective interest rate

3.50%

3.50%

Maximum

Debt Instrument [Line Items]

Debt to EBITDA ratio

325.00%

325.00%

325.00%

350.00%

Pre-Distribution fixed charge coverage ratio

130.00%

Post-Distribution fixed charge coverage ratio

105.00%

Maximum | Scenario, Forecast

Debt Instrument [Line Items]

Debt to EBITDA ratio

225.00%

250.00%

250.00%

250.00%

250.00%

275.00%

275.00%

Maximum | Senior Debt

Debt Instrument [Line Items]

Senior debt to EBITDA ratio

300.00%

300.00%

300.00%

300.00%

Maximum | Senior Debt | Scenario, Forecast

Debt Instrument [Line Items]

Senior debt to EBITDA ratio

200.00%

225.00%

225.00%

225.00%

225.00%

250.00%

250.00%

Maximum | Capital Lease Obligations

Debt Instrument [Line Items]

Debt instrument, effective interest rate

9.10%

9.10%

Fiscal Quarter Ending September 30, 2016 | Senior Credit Facility

Debt Instrument [Line Items]

EBITDA, Minimum required amount

$ 1,750,000

Fiscal Quarter Ending December 31, 2016 | Senior Credit Facility

Debt Instrument [Line Items]

EBITDA, Minimum required amount

$ 4,250,000

Insurance premium financings

Debt Instrument [Line Items]

Debt instrument, maturity month and year

2016-10

Monthly principal and interest payment

$ 134,051

Insurance premium financings | Minimum

Debt Instrument [Line Items]

Debt instrument, effective interest rate

[1]

4.80%

4.80%

Insurance premium financings | Maximum

Debt Instrument [Line Items]

Debt instrument, effective interest rate

[1]

5.00%

5.00%

[1]

Effective rate as of June 30, 2016

Schedule of Long-Term Debt Obli

Schedule of Long-Term Debt Obligations (Detail) - USD ($)		6 Months Ended
		Jun. 30, 2016	Dec. 31, 2015
Debt Instrument [Line Items]
Long term debt		$ 49,181,644	$ 46,130,597
Less: Current portion of long-term debt		(9,028,572)	(4,601,320)
Long-term debt		40,153,072	41,529,277
Senior Lender
Debt Instrument [Line Items]
Note payable		27,361,606	28,375,000
Line of credit		14,500,000	10,500,000
Unamortized loan origination costs		$ (579,962)	(644,403)
Senior Lender | Note Payable
Debt Instrument [Line Items]
Debt instrument, effective interest rate	[1]	4.30%
Debt instrument maturity date		2020-12
Senior Lender | Line of credit
Debt Instrument [Line Items]
Debt instrument, effective interest rate	[1]	4.30%
Debt instrument maturity date		2018-12
Other Lenders | Note Payable Subordinated Note
Debt Instrument [Line Items]
Debt instrument, effective interest rate	[1]	3.00%
Debt instrument maturity date		2019-12
Note payable		$ 7,900,000	$ 7,900,000
[1]	Effective rate as of June 30, 2016

Schedule of Applicable Margins

Schedule of Applicable Margins Rate (Detail)	6 Months Ended
	Jun. 30, 2016
Senior Debt To EBITDA Ratio One
Debt Instrument [Line Items]
Commitment Fee	0.375%
Senior Debt To EBITDA Ratio One | Base Rate
Debt Instrument [Line Items]
Debt instrument basis spread on variable rate	2.75%
Senior Debt To EBITDA Ratio One | LIBOR Portion and Letter of Credit Fee
Debt Instrument [Line Items]
Debt instrument basis spread on variable rate	3.75%
Senior Debt To EBITDA Ratio One | Maximum
Debt Instrument [Line Items]
Senior Debt to EBITDA Ratio	200.00%
Senior Debt To EBITDA Ratio Two
Debt Instrument [Line Items]
Commitment Fee	0.375%
Senior Debt To EBITDA Ratio Two | Base Rate
Debt Instrument [Line Items]
Debt instrument basis spread on variable rate	3.00%
Senior Debt To EBITDA Ratio Two | LIBOR Portion and Letter of Credit Fee
Debt Instrument [Line Items]
Debt instrument basis spread on variable rate	4.00%
Senior Debt To EBITDA Ratio Two | Maximum
Debt Instrument [Line Items]
Senior Debt to EBITDA Ratio	250.00%
Senior Debt To EBITDA Ratio Two | Minimum
Debt Instrument [Line Items]
Senior Debt to EBITDA Ratio	200.00%
Senior Debt To EBITDA Ratio Three
Debt Instrument [Line Items]
Commitment Fee	0.375%
Senior Debt To EBITDA Ratio Three | Base Rate
Debt Instrument [Line Items]
Debt instrument basis spread on variable rate	3.25%
Senior Debt To EBITDA Ratio Three | LIBOR Portion and Letter of Credit Fee
Debt Instrument [Line Items]
Debt instrument basis spread on variable rate	4.25%
Senior Debt To EBITDA Ratio Three | Maximum
Debt Instrument [Line Items]
Senior Debt to EBITDA Ratio	250.00%

Future Maturities Long-Term Deb

Future Maturities Long-Term Debt (Detail)	Jun. 30, 2016USD ($)
Maturities Of Long Term Debt [Abstract]
2,017	$ 9,028,572
2,018	5,883,582
2,019	17,383,582
2,020	4,073,786
2,021	$ 12,812,122

Schedule of Capital Lease Oblig

Schedule of Capital Lease Obligations (Detail) - USD ($)		6 Months Ended
		Jun. 30, 2016	Dec. 31, 2015
Operating Leased Assets [Line Items]
Capital Leases Obligations:		$ 32,444,759	$ 33,609,661
Less: Current portion of capital leases		(4,071,318)	(4,478,968)
Capital leases obligations		28,373,441	29,130,693
Building
Operating Leased Assets [Line Items]
Capital Leases Obligations:		24,168,540	24,424,341
Equipment
Operating Leased Assets [Line Items]
Capital Leases Obligations:		$ 8,276,219	$ 9,185,320
Capital Lease Obligations | Building
Operating Leased Assets [Line Items]
Debt instrument, effective interest rate	[1]	7.50%
Debt instrument maturity date		2036-07
Capital Lease Obligations | Minimum
Operating Leased Assets [Line Items]
Debt instrument, effective interest rate		5.10%
Capital Lease Obligations | Minimum | Equipment
Operating Leased Assets [Line Items]
Debt instrument, effective interest rate	[1]	5.60%
Debt instrument maturity date		2017-03
Capital Lease Obligations | Maximum
Operating Leased Assets [Line Items]
Debt instrument, effective interest rate		9.10%
Capital Lease Obligations | Maximum | Equipment
Operating Leased Assets [Line Items]
Debt instrument, effective interest rate	[1]	9.00%
Debt instrument maturity date		2020-12
[1]	Effective rate as of June 30, 2016

Future Maturities of Capital Le

Future Maturities of Capital Leases (Detail)	Jun. 30, 2016USD ($)
Maturities Of Longterm Debt And Capital Lease Obligations [Abstract]
2,017	$ 4,071,318
2,018	2,942,345
2,019	1,560,415
2,020	1,630,374
2,021	1,227,285
Thereafter	$ 21,013,022

Preferred Noncontrolling Inte50

Preferred Noncontrolling Interests - Additional Information (Detail) - USD ($)	6 Months Ended	12 Months Ended
	Jun. 30, 2016	Dec. 31, 2013	Dec. 31, 2015
Schedule Of Equity Method Investments [Line Items]
Common stock, shares issued	18,078,337		17,303,180
Common stock value	$ 1,807		$ 1,730
Amount of unreturned capital contribution and undistributed preferred distributions	$ 10,000
Conversion price per share	$ 20
Common Stock
Schedule Of Equity Method Investments [Line Items]
Total consideration		$ 435,000
Number of shares sold		87,000
Foundation Health Enterprises LLC
Schedule Of Equity Method Investments [Line Items]
Offering cost		$ 100,000
Common stock, shares issued		1,000
Common stock value		$ 5,000
Total consideration		8,700,000
Cumulative preferred annual return	9.00%
Foundation Health Enterprises LLC | Class B member interests
Schedule Of Equity Method Investments [Line Items]
Offering cost		$ 105,000
Number offering units		87
Foundation Health Enterprises LLC | Private placement
Schedule Of Equity Method Investments [Line Items]
Offering cost		$ 9,135,000

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) - USD ($)	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2015
Commitments And Contingencies Disclosure [Abstract]
Legal claims settlement expenses	$ 0	$ 0
Self Insurance Reserves	$ 629,909		$ 424,593

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - Fair Value, Measurements, Nonrecurring - Significant Unobservable Inputs (Level 3) - Ninety Nine Healthcare Management Limited Liability Company	May 11, 2016USD ($)
Fair Value Assets And Liabilities Measured On Nonrecurring Basis [Line Items]
Assets acquired	$ 6,894,000
Liabilities assumed	$ 1,178,000

Related Party Transactions - Ad

Related Party Transactions - Additional Information (Detail) - USD ($)	Jun. 01, 2014	Jun. 30, 2016	Dec. 31, 2015
New Sleep Lab International, Ltd.
Related Party Transaction [Line Items]
Income on underlying sub-lease	$ 8,767
Sublease expiration date	Nov. 30, 2018
Lease expense		$ 47,200
Valliance Bank
Related Party Transaction [Line Items]
Related party deposit		$ 100,000
Roy T. Oliver
Related Party Transaction [Line Items]
Percentage of ownership in shareholders and affiliates		5.00%
Affiliate ASCs And Hospitals | Minimum
Related Party Transaction [Line Items]
Management fee Percentages range		2.25%
Affiliate ASCs And Hospitals | Maximum
Related Party Transaction [Line Items]
Management fee Percentages range		6.00%
FHA
Related Party Transaction [Line Items]
Obligations owed to FHA and other affiliates		$ 1,400,000	$ 1,400,000

Subsequent Events - Additional

Subsequent Events - Additional Information (Detail) - Subsequent Event - Chihuahua - El Paso, Texas $ in Millions	Jul. 07, 2016USD ($)
Subsequent Event [Line Items]
Proceeds from sale of raw land	$ 1.3
Loss on sale of raw land	$ (0.2)