Cover page
Cover page - USD ($) $ in Billions | 12 Months Ended | ||
Dec. 31, 2021 | Feb. 21, 2022 | Jun. 30, 2021 | |
Cover [Abstract] | |||
Document Type | 10-K | ||
Document Annual Report | true | ||
Document Period End Date | Dec. 31, 2021 | ||
Current Fiscal Year End Date | --12-31 | ||
Document Transition Report | false | ||
Entity File Number | 001-33989 | ||
Entity Registrant Name | LHC GROUP, INC. | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 71-0918189 | ||
Entity Address, Address Line One | 901 Hugh Wallis Road South | ||
Entity Address, City or Town | Lafayette | ||
Entity Address, State or Province | LA | ||
Entity Address, Postal Zip Code | 70508 | ||
City Area Code | 337 | ||
Local Phone Number | 233-1307 | ||
Title of 12(b) Security | Common Stock, par value $0.01 per share | ||
Trading Symbol | LHCG | ||
Security Exchange Name | NASDAQ | ||
Entity Well-known Seasoned Issuer | No | ||
Entity Voluntary Filers | No | ||
Entity Current Reporting Status | Yes | ||
Entity Interactive Data Current | Yes | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Small Business | false | ||
Entity Emerging Growth Company | false | ||
Entity Shell Company | false | ||
ICFR Auditor Attestation Flag | false | ||
Entity Public Float | $ 6.1 | ||
Entity Common Stock, Shares Outstanding | 31,682,604 | ||
Documents Incorporated by Reference | Portions of the Registrant’s Annual Report to Stockholders for the fiscal year ended December 31, 2021 are incorporated by reference in Part II of this Annual Report on Form 10-K. Portions of the Registrant’s Proxy Statement for its 2021 Annual Meeting of Stockholders are incorporated by reference in Part III of this Annual Report on Form 10-K. | ||
Amendment Flag | false | ||
Document Fiscal Year Focus | 2021 | ||
Document Fiscal Period Focus | FY | ||
Entity Central Index Key | 0001303313 |
Audit Information
Audit Information | 12 Months Ended |
Dec. 31, 2021 | |
Audit Information [Abstract] | |
Auditor Name | KPMG LLP |
Auditor Location | Baton Rouge, Louisiana |
Auditor Firm ID | 185 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Current assets: | ||
Cash | $ 9,809 | $ 286,569 |
Receivables: | ||
Patient accounts receivable | 348,820 | 301,209 |
Other receivables | 13,780 | 11,522 |
Total receivables | 362,600 | 312,731 |
Prepaid income taxes | 7,531 | |
Prepaid expenses | 28,401 | 22,058 |
Other current assets | 24,801 | 25,664 |
Total current assets | 433,142 | 647,022 |
Property, building and equipment, net of accumulated depreciation of $98,394 and $82,721, respectively | 153,959 | 138,366 |
Goodwill | 1,748,426 | 1,259,147 |
Intangible assets, net of accumulated amortization of $19,152 and $17,659, respectively | 400,002 | 315,355 |
Assets held for sale | 0 | 1,900 |
Operating lease right of use asset | 113,399 | 100,046 |
Other assets | 46,693 | 21,518 |
Total assets | 2,895,621 | 2,483,354 |
Current liabilities: | ||
Accounts payable and other accrued liabilities | 98,118 | 64,864 |
Salaries, wages and benefits payable | 100,532 | 88,666 |
Self insurance reserves | 33,784 | 35,103 |
Government stimulus advance | 0 | 93,257 |
Contract liabilities - deferred revenue | 106,489 | 317,962 |
Current operating lease payable | 37,630 | 32,676 |
Amounts due to governmental entities | 5,447 | 1,516 |
Income taxes payable | 0 | 21,464 |
Current liabilities - deferred employer payroll tax | 26,790 | 25,928 |
Total current liabilities | 408,790 | 681,436 |
Deferred income taxes | 70,026 | 47,237 |
Income taxes payable | 7,320 | 6,203 |
Revolving credit facility | 661,197 | |
Other long term liabilities | 0 | 25,928 |
Operating lease payable | 78,688 | 70,275 |
Total liabilities | 1,226,021 | 851,079 |
Noncontrolling interest-redeemable | 17,501 | 18,921 |
Commitments and contingencies | ||
LHC Group, Inc. stockholders’ equity: | ||
Preferred stock – $0.01 par value: 5,000,000 shares authorized; none issued or outstanding | 0 | 0 |
Common stock – $0.01 par value: 60,000,000 shares authorized; 36,549,524 and 36,355,497 shares issued, and 30,634,414 and 31,139,840 shares outstanding, respectively | 365 | 364 |
Treasury stock – 5,915,110 and 5,215,657 shares at cost, respectively | (164,790) | (69,011) |
Additional paid-in capital | 979,642 | 962,120 |
Retained earnings | 751,025 | 635,297 |
Total LHC Group, Inc. stockholders’ equity | 1,566,242 | 1,528,770 |
Noncontrolling interest – non-redeemable | 85,857 | 84,584 |
Total stockholders’ equity | 1,652,099 | 1,613,354 |
Total liabilities and stockholders’ equity | $ 2,895,621 | $ 2,483,354 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Statement of Financial Position [Abstract] | ||
Property, building and equipment, accumulated depreciation | $ 98,394 | $ 82,721 |
Intangible assets, accumulated amortization | $ 19,152 | $ 17,659 |
Preferred stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 60,000,000 | 60,000,000 |
Common stock, shares, issued (in shares) | 36,549,524 | 36,355,497 |
Common stock, shares outstanding (in shares) | 30,634,414 | 31,139,840 |
Treasury shares (in shares) | 5,915,110 | 5,215,657 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Statement [Abstract] | |||
Net service revenue | $ 2,219,622 | $ 2,063,204 | $ 2,080,241 |
Cost of service revenue (excluding depreciation and amortization) | 1,336,609 | 1,250,403 | 1,324,887 |
Gross margin | 883,013 | 812,801 | 755,354 |
General and administrative expenses | 696,435 | 632,847 | 596,006 |
Impairment of intangibles and other | 937 | 1,849 | 7,734 |
Operating income | 185,641 | 178,105 | 151,614 |
Interest expense | (4,338) | (4,129) | (11,155) |
Income before income taxes and noncontrolling interests | 181,303 | 173,976 | 140,459 |
Income tax expense | 37,687 | 36,043 | 26,607 |
Net income | 143,616 | 137,933 | 113,852 |
Less net income attributable to noncontrolling interests | 27,888 | 26,337 | 18,126 |
Net income attributable to LHC Group, Inc.’s common stockholders | $ 115,728 | $ 111,596 | $ 95,726 |
Earnings per share - basic: | |||
Net income attributable to LHC Group, Inc.’s common stockholders (in dollars per share) | $ 3.71 | $ 3.59 | $ 3.09 |
Earnings per share - diluted: | |||
Net income attributable to LHC Group, Inc.’s common stockholders (in dollars per share) | $ 3.69 | $ 3.56 | $ 3.07 |
Weighted average shares outstanding: | |||
Basic (in shares) | 31,195,305 | 31,092,417 | 30,932,607 |
Diluted (in shares) | 31,396,658 | 31,365,765 | 31,209,824 |
Revenue, product and service [Extensible Enumeration] | Service [Member] | ||
Cost, product and service [Extensible Enumeration] | Service [Member] |
CONSOLIDATED STATEMENTS OF STOC
CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands | Total | Common Stock | Treasury | Additional paid-in capital | Retained earnings | Noncontrolling interest non- redeemable | Non controlling interest redeemable |
Beginning balance at Dec. 31, 2018 | $ 1,424,474 | $ 358 | $ (49,373) | $ 937,965 | $ 427,975 | $ 107,549 | $ 14,596 |
Beginning balance (in shares) at Dec. 31, 2018 | 35,835,348 | 5,029,429 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income | 102,581 | 95,726 | 6,855 | 11,271 | |||
Net income | 113,852 | ||||||
Acquired noncontrolling interest | 10,478 | 10,478 | |||||
Purchase of additional controlling interest | (20,565) | (2,183) | (18,382) | ||||
Sale of noncontrolling interest | 1,613 | 819 | 794 | ||||
Noncontrolling interest distributions | (13,366) | (13,366) | (10,716) | ||||
Nonvested stock compensation | 9,646 | 9,646 | |||||
Issuance of vested stock | 2 | $ 2 | |||||
Issuance of vested stock (in shares) | 210,986 | ||||||
Treasury shares redeemed to pay income tax | $ (9,679) | $ (10,687) | 1,008 | ||||
Treasury shares redeemed to pay income tax (in shares) | 107,461 | 107,461 | |||||
Exercise of stock options | $ 1 | $ 1 | |||||
Exercise of stock options (in shares) | 63,051 | ||||||
Issuance of common stock under Employee Stock Purchase Plan | $ 2,066 | 2,066 | |||||
Issuance of common stock under Employee Stock Purchase Plan (in shares) | 19,895 | 19,895 | |||||
Ending balance at Dec. 31, 2019 | $ 1,507,251 | $ 361 | $ (60,060) | 949,321 | 523,701 | 93,928 | 15,151 |
Ending balance (in shares) at Dec. 31, 2019 | 36,129,280 | 5,136,890 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income | 123,746 | 111,596 | 12,150 | 14,187 | |||
Net income | 137,933 | ||||||
Acquired noncontrolling interest | 5,854 | 5,854 | 3,508 | ||||
Purchase of additional controlling interest | (23,913) | (1,709) | (22,204) | 382 | |||
Sale of noncontrolling interest | 5,290 | (860) | 6,150 | ||||
Noncontrolling interest distributions | (11,294) | (11,294) | (13,543) | ||||
Nonvested stock compensation | 14,347 | 14,347 | |||||
Issuance of vested stock | 3 | $ 3 | |||||
Issuance of vested stock (in shares) | 195,618 | ||||||
Treasury shares redeemed to pay income tax | $ (9,202) | $ (9,202) | 0 | ||||
Treasury shares redeemed to pay income tax (in shares) | 78,767 | 71,439 | |||||
Exercise of stock options | $ (905) | $ 251 | (1,156) | ||||
Exercise of stock options (in shares) | 16,286 | 7,328 | |||||
Issuance of common stock under Employee Stock Purchase Plan | $ 2,177 | 2,177 | |||||
Issuance of common stock under Employee Stock Purchase Plan (in shares) | 14,313 | 14,313 | |||||
Ending balance at Dec. 31, 2020 | $ 1,613,354 | $ 364 | $ (69,011) | 962,120 | 635,297 | 84,584 | 18,921 |
Ending balance (in shares) at Dec. 31, 2020 | 36,355,497 | 5,215,657 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net income | 131,673 | 115,728 | 15,945 | 11,943 | |||
Net income | 143,616 | ||||||
Acquired noncontrolling interest | 0 | 0 | 113 | ||||
Purchase of additional controlling interest | (1,740) | (951) | (789) | (373) | |||
Sale of noncontrolling interest | 1,788 | (83) | 1,871 | ||||
Noncontrolling interest distributions | (15,754) | (15,754) | (13,103) | ||||
Nonvested stock compensation | 15,868 | 15,868 | |||||
Issuance of vested stock | 1 | $ 1 | |||||
Issuance of vested stock (in shares) | 180,235 | ||||||
Treasury shares redeemed to pay income tax | $ (11,827) | $ (12,043) | 216 | ||||
Treasury shares redeemed to pay income tax (in shares) | 63,028 | 64,584 | |||||
Repurchase of common stock | $ (83,736) | $ (83,736) | |||||
Repurchase of common stock (in shares) | 634,869 | 634,869 | |||||
Issuance of common stock under Employee Stock Purchase Plan | $ 2,472 | 2,472 | |||||
Issuance of common stock under Employee Stock Purchase Plan (in shares) | 13,792 | 13,792 | |||||
Ending balance at Dec. 31, 2021 | $ 1,652,099 | $ 365 | $ (164,790) | $ 979,642 | $ 751,025 | $ 85,857 | $ 17,501 |
Ending balance (in shares) at Dec. 31, 2021 | 36,549,524 | 5,915,110 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Operating activities: | |||
Net income | $ 143,616 | $ 137,933 | $ 113,852 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Depreciation and amortization expense | 20,917 | 21,249 | 18,254 |
Amortization and impairment of operating lease right of use asset | 37,506 | 34,546 | 33,368 |
Stock-based compensation expense | 15,868 | 14,347 | 9,646 |
Deferred income taxes | 22,789 | (13,261) | 18,400 |
(Gain) loss on disposal of assets | (1,134) | 412 | 802 |
Impairment of intangibles and other | 937 | 1,849 | 7,734 |
Changes in operating assets and liabilities, net of acquisitions: | |||
Receivables | (35,361) | (16,561) | (38,907) |
Prepaid expenses | (5,902) | (754) | 3,530 |
Other assets | (11,015) | (3,169) | (2,923) |
Prepaid income taxes | (7,531) | 9,652 | (78) |
Accounts payable and accrued expenses | 12,345 | (22,506) | (457) |
Salaries, wages, and benefits payable and self-insurance reserves | 3,004 | 6,482 | (2,625) |
Other long term liabilities | (26,758) | 51,856 | 0 |
Contract liabilities - deferred revenue | (211,473) | 317,962 | 0 |
Operating lease payable | (37,360) | (34,226) | (28,062) |
Income tax payable | (20,347) | 23,800 | (431) |
Net amounts due to/from governmental entities | (433) | (364) | (1,641) |
Net cash (used in) provided by operating activities | (100,332) | 529,247 | 130,462 |
Investing activities: | |||
Cash paid for acquisitions, net of cash acquired | (569,583) | (24,545) | (74,293) |
Minority interest investments | (10,100) | 0 | 0 |
Proceeds from sale of assets | 3,350 | 7,920 | 0 |
Proceeds from sale of an entity | 1,531 | 0 | 0 |
Purchases of property, building and equipment | (32,976) | (65,875) | (33,609) |
Net cash used in investing activities | (607,778) | (82,500) | (107,902) |
Financing activities: | |||
Proceeds from line of credit | 1,025,559 | 296,229 | 267,000 |
Payments on line of credit | (384,362) | (529,229) | (249,000) |
Government stimulus advance | (93,257) | 93,257 | 0 |
Proceeds from employee stock purchase plan | 2,472 | 2,177 | 2,066 |
Payments on debt | 0 | 0 | (7,650) |
Payments on deferred financing fees | (3,556) | 0 | 0 |
Payments on repurchasing common stock | (74,643) | 0 | 0 |
Noncontrolling interest distributions | (28,857) | (24,837) | (24,082) |
Purchase of additional controlling interest | (2,113) | (24,295) | (19,663) |
Sale of noncontrolling interest | 1,934 | 4,856 | 756 |
Withholding taxes paid on stock-based compensation | (11,827) | (10,008) | (10,687) |
Exercise of options | 0 | 0 | 1,009 |
Net cash provided by (used in) financing activities | 431,350 | (191,850) | (40,251) |
Change in cash | (276,760) | 254,897 | (17,691) |
Cash at beginning of period | 286,569 | 31,672 | 49,363 |
Cash at end of period | 9,809 | 286,569 | 31,672 |
Supplemental disclosures of cash flow information | |||
Interest paid | 4,168 | 5,011 | 11,015 |
Income taxes paid | 43,728 | 16,830 | 10,109 |
Non-Cash Operating activity: | |||
Operating right of use assets in exchange for lease obligations | 41,364 | 43,047 | 129,290 |
Non-Cash Investing activity: | |||
Accrued capital expenditures | 417 | 2,922 | 2,729 |
Net working capital adjustment | 890 | 0 | 0 |
Non-Cash Financing activity: | |||
Contribution of noncontrolling interest | $ 0 | $ 230 | $ 0 |
Organization
Organization | 12 Months Ended |
Dec. 31, 2021 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Organization | Organization LHC Group, Inc. (the “Company”) is a health care provider specializing in the post-acute continuum of care. The Company provides services through five segments: home health, hospice, home and community-based services, facility-based services, the latter primarily through long-term acute care hospitals ("LTACHs"), and healthcare innovations ("HCI"). As of December 31, 2021, the Company, through its wholly and majority-owned subsidiaries, equity joint ventures, controlled affiliates, and management agreements, operated 970 service providers in 37 states within the continental United States and the District of Columbia. COVID-19 Update SARS-CoV-2 ("COVID-19") continues to spread and various responses related to stay-at-home restrictions, travel restrictions, and other public health and safety measures continue to evolve. We communicate with our clinicians and other employees all updated policies and procedures as we monitor changes related to the pandemic. Policies and procedures related to social distancing and cleaning procedures remain in place as the safety of our patients and employees are vital. The effects of COVID-19 continue to materially impact our business. As a result, operating results for the twelve months ended December 31, 2021 may not be directly comparable to operating results for the twelve months ended December 31, 2020. CARES Act In response to COVID-19, the U.S. Government enacted the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") on March 27, 2020. The CARES Act was passed to provide $100 billion of Provider Relief Funds for distribution to eligible providers who provided diagnoses, testing, or care for individuals with a possible or actual case of COVID-19, specifically to reimburse providers for health care related expenses related to the prevention of the spread of COVID-19, preparations for treating cases of COVID-19 positive patients, and for lost revenues attributable to COVID-19. The CARES Act also provided financial hardship relief to Medicare providers impacted by the COVID-19 pandemic in order to provide necessary funds when there is a disruption in Medicare claims submission and/or Medicare claims processing by distributing funds through the Accelerated and Advanced Payments Program ("CAAP"). In addition, the CARES Act suspended the 2% sequestration payment adjustments on Medicare patient claims with dates of service from May 1 through December 31, 2020, suspended the application of site-neutral payment for LTACH admissions that were admitted during the Public Health Emergency ("PHE"), and delayed payment of the employer portion of social security tax. On April 14, 2021, Congress passed legislation to continue the suspension of the 2% sequestration payment adjustments on Medicare patient claims with dates of service through December 31, 2021. On December 10, 2021, the Protecting Medicare and American Farmers from Sequester Cuts Act legislation passed, which will continue the suspension of the sequestration payment adjustments for Medicare patient claims with dates of service through March 31, 2022. Medicare patient claims with dates of service between April 1 through June 30, 2022 will have 1% sequestration adjustment and Medicare patient claims with dates of service beginning July 1, 2022 will have 2% sequestration adjustment. On January 14, 2022, the U.S. Department of Health and Human Services extended the PHE until April 15, 2022. Provider Relief Fund During the twelve months ended December 31, 2020, the Company received $93.3 million in payments from the Provider Relief Fund, which was recorded as a short-term liability in government stimulus advance in our consolidated balance sheets. The Company returned all Provider Relief Funds received of $93.3 million to the government during the twelve months ended December 31, 2021. CAAP During the twelve months ended December 31, 2020, the Company received $318.0 million of accelerated payments under the CAAP, which was recorded in contract liabilities - deferred revenue i n our consolidated balance sheets in accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers ("Topic 606") . On October 1, 2020, the repayment and recoupment terms for CAAP funds were amended by the Continuing Appropriations Act, 2021 and Other Extensions Act, which provides that recoupment will begin one year from the date the CAAP funds were received. The repayment terms begin one year starting from the date the CAAP funds were issued and continues 11 months, with CMS recouping the initial 25% of Medicare payments otherwise owed to the Company. If any amount of CAAP funds that we received from CMS remain unpaid after the initial 11 month period, CMS will recoup 50% of Medicare payments otherwise owed to the Company during the following six months. Interest will begin accruing on any amount of the CAAP funds that we received from CMS that remain unpaid following those recoupment periods. CMS will issue a repayment letter to the Company for any such outstanding amounts, which must be paid in full within 30 days from the date of the letter. The Company intends to repay the full amount before any interest accrues. During the twelve months ended December 31, 2021, $211.5 million was recouped by CMS and $106.5 million of contract liabilities - deferred revenue remains on our consolidated balance sheets as of December 31, 2021. Other During the twelve months ended December 31, 2021 and 2020, the Company recognized $26.8 million and $18.1 million of net service revenue, respectively, due to the suspension of the 2% sequestration payment adjustment. During the twelve months ended December 31, 2021 and 2020, the Company recognized $25.7 million and $19.2 million of net service revenue, respectively, due to the suspension of LTACH site-neutral payments. |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2021 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | Summary of Significant Accounting Policies Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles ("US GAAP") requires management to make estimates and assumptions that affect the reported amounts of the Company's accompanying consolidated financial statements and notes to the consolidated financial statements. Actual results could differ from those estimates. A description of the significant accounting policies and a discussion of the significant estimates and judgments associated with such policies are described below. Principles of Consolidation The consolidated financial statements include all subsidiaries and entities controlled by the Company through direct ownership of majority interest or controlling member ownership of such entities. Third party equity interests in the consolidated joint ventures are reflected as noncontrolling interests in the Company’s consolidated financial statements. All significant intercompany accounts and transactions have been eliminated in consolidation. All business combinations accounted for under the acquisition method have been included in the consolidated financial statements from the respective dates of acquisition. The Company consolidates equity joint venture entities as the Company has controlling interests, has voting control over these entities, or has ability to exercise significant influence in these entities. The members of the Company's equity joint ventures participate in profits and losses in proportion to their equity interests. The Company, through wholly owned subsidiaries, leases home health licenses necessary to operate certain of its home nursing and hospice agencies. As with wholly owned subsidiaries, the Company owns 100% of the equity of these entities and consolidates them based on such ownership. Revenue Recognition Basis of Presentation Net service revenue from contracts with customers is recognized in the period the performance obligations are satisfied under the Company's contracts by transferring the requested services to patients in amounts that reflect the consideration to which is expected to be received in exchange for providing patient care, which is the transaction price allocated to the services provided in accordance with Topic 606 and ASU 2015-14 , Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"). Net service revenue is recognized as performance obligations are satisfied, which can vary depending on the type of services provided. The performance obligation is the delivery of patient care in accordance with the requested services outlined in physicians' orders, which are based on specific goals for each patient. The performance obligations are associated with contracts in duration of less than one year; therefore, the optional exemption provided by ASC 606 was elected resulting in the Company not being required to disclose the aggregate amount of the transaction price allocated to the performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The Company's unsatisfied or partially unsatisfied performance obligations are primarily completed when the patients are discharged and typically occur within days or weeks of the end of the period. The Company determines the transaction price based on gross charges for services provided, reduced by explicit price concessions and estimates for implicit price concessions. Explicit price concessions include contractual adjustments provided to patients and third-party payors. Implicit price concessions include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from regulatory reviews, audits, billing reviews and other matters. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (i.e. change in credit risk) are recorded as a provision for doubtful accounts within general and administrative expenses. Explicit price concessions are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Implicit price concessions are recorded for self-pay, uninsured patients and other payors by major payor class based on historical collection experience, and current business and economic conditions, representing the difference between amounts billed and amounts expected to be collected. The Company assesses the ability to collect for the healthcare services provided at the time of patient admission based on the verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and reviews. The Company has determined estimates for price concessions related to regulatory reviews based on historical experience and success rates in the claim appeals and adjudication process. Revenue is recorded at amounts estimated to be realizable for services provided. The following table sets forth the percentage of net service revenue earned by category of payor for each segment for the years ending December 31: 2021 2020 2019 Home Health: Medicare 62.1 % 66.8 % 70.2 % Managed Care, Commercial, and Other 37.9 33.2 29.8 100.0 % 100.0 % 100.0 % Hospice: Medicare 94.2 % 93.1 % 92.0 % Managed Care, Commercial, and Other 5.8 6.9 8.0 100.0 % 100.0 % 100.0 % Home and Community-Based: Medicaid 31.5 % 21.4 % 23.2 % Managed Care, Commercial, and Other 68.5 78.6 76.8 100.0 % 100.0 % 100.0 % Facility-Based: Medicare 49.9 % 55.0 % 56.2 % Managed Care, Commercial, and Other 50.1 45.0 43.8 100.0 % 100.0 % 100.0 % Healthcare Innovations: Medicare 12.4 % 19.2 % 21.6 % Managed Care, Commercial, and Other 87.6 80.8 78.4 100.0 % 100.0 % 100.0 % Medicare The following describes the payment models in effect during the twelve months ended December 31, 2021. Such payment models have been subject to temporary adjustments made by CMS in response to COVID-19 pandemic as described elsewhere in this Annual Report on Form 10-K. The 2% sequestration reduction adjustment was suspended for patient claims with dates of service that began May 1, 2020 through December 31, 2021. Home Health Services The Company records revenue as services are provided under the Patient Driven Groupings Model ("PDGM"). For each 30-day period, the patient is classified into one of 432 home health resource groups prior to receiving services. Each 30-day period is placed into a subgroup falling under the following categories: (i) timing being early or late, (ii) admission source being community or institutional, (iii) one of 12 clinical groupings based on the patient's principal diagnosis, (iv) functional impairment level of low, medium, or high, and (v) a co-morbidity adjustment of none, low, or high based on the patient's secondary diagnoses. Each 30-day period payment from Medicare reflects base payment adjustments for case-mix and geographic wage differences. In addition, payments may reflect one of three retroactive adjustments to the total reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment whereby the number of visits is dependent on the clinical grouping; and/or (c) a partial payment if the patient transferred to another provider or from another provider before completing the episode. The retroactive adjustments outlined above are recognized in net service revenue when the event causing the adjustment occurs and during the period in which the services are provided to the patient. The Company reviews these adjustments to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustments is subsequently resolved. Net service revenue and related patient accounts receivable are recorded at amounts estimated to be realized from Medicare for services rendered. Hospice Services The Company records revenue based upon the date of service at amounts equal to the estimated payment rates. The Company receives one of four predetermined daily rates based upon the level of care provided by the Company, which can be routine care, general inpatient care, continuous home care, and respite care. There are two separate payment rates for routine care: payment for the first 60-days of care and care beyond 60-days. In addition to the two routine rates, the Company may also receive a service intensity add-on ("SIA"). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. Adjustments to Medicare revenue are made from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of these adjustments based on our historical experience. Hospice payments are subject to variable consideration through an inpatient cap and an overall Medicare payment cap. The inpatient cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from inpatient care services and the overall Medicare payment cap relates to individual programs receiving reimbursements in excess of a “cap amount,” determined by Medicare to be payment equal to 12 months of hospice care for the aggregate base of hospice patients, indexed for inflation. The determination for each cap is made annually based on the 12-month period ending on September 30 of each year. The Company monitors its limits on a provider-by-provider basis and records an estimate of its liability for reimbursements received in excess of the cap amount, if any, in the reporting period. Facility-Based Services Gross revenue is recorded as services are provided under the LTACH prospective payment system. Each patient is assigned a long-term care diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare LTACH patient classified in that particular long-term care diagnosis-related group. For selected LTACH patients, the amount may be further adjusted based on length-of-stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for LTACH claims paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Net service revenue adjustments resulting from reviews and audits of Medicare cost report settlements are considered implicit price concessions for LTACHs and are measured at expected value. Non-Medicare Revenue Other sources of net service revenue for all segments fall into Medicaid, managed care or other payors of the Company's services. Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized for Medicaid services as services are provided based on this fee schedule. The Company's managed care and other payors reimburse the Company based upon a predetermined fee schedule or an episodic basis, depending on the terms of the applicable contract. Accordingly, the Company recognizes revenue from managed care and other payors as services are provided, such costs are incurred, and estimates of expected payments are known for each different payer, thus the Company's revenue is recorded at the estimated transaction price. Contingent Service Revenues The HCI segment provides strategic health management services to Affordable Care Organizations ("ACOs") that have been approved to participate in the Medicare Shared Savings Program ("MSSP"). The HCI segment has service agreements with ACOs that provide for sharing of MSSP payments received by the ACO, if any. ACOs are legal entities that contract with CMS to provide services to the Medicare fee-for-service population for a specified annual period with the goal of providing better care for the individual, improving health for populations and lowering costs. ACOs share savings with CMS to the extent that the actual costs of serving assigned beneficiaries are below certain trended benchmarks of such beneficiaries and certain quality performance measures are achieved. The generation of shared savings is the performance obligation of each ACO, which only become certain upon the final issuance of unembargoed calculations by CMS, generally in the third quarter of each year. During the years ended December 31, 2021, 2020 and 2019, the HCI segment recorded net service revenue of $12.1 million, $9.6 million and $2.9 million, respectively, related to the 2020, 2019 and 2018 ACO respective service periods, as certain ACOs served by the HCI segment received a MSSP payment from CMS confirming the performance obligation has been met. Patient Accounts Receivable The Company reports patient accounts receivable from services rendered at their estimated transaction price, which includes price concessions based on the amounts expected to be due from payors. The Company's patient accounts receivable is uncollateralized and primarily consist of amounts due from Medicare, Medicaid, other third-party payors, and to a lesser degree patients. The credit risk from other payors is limited due to the significance of Medicare as the primary payor. The Company believes the credit risk associated with its Medicare accounts is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The Company does not believe that there are any other significant concentrations from any particular payor that would subject it to any significant credit risk in the collection of patient accounts receivable. The following table sets forth the percentage of patient accounts receivable by payor for the years ended December 31: 2021 2020 Medicare 60.3 % 55.3 % Medicaid 7.5 9.2 Managed Care, Commercial, and Other 32.2 35.5 Total patient accounts receivable 100.0 % 100.0 % Business Combinations The Company accounts for its acquisitions in accordance with ASC 805, "Business Combinations" ("ASC 805") using the acquisition method of accounting. Assets typically acquired consist primarily of Medicare licenses, trade names, certificates of need, and/or non-compete agreements. The assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is also measured and recorded at fair value as of the acquisition date. Goodwill represents the excess of the cost of an acquired entity over the net amounts assigned to assets acquired and liabilities assumed. The operations of the acquisitions are included in the consolidated financial statements from their respective dates of acquisition. Acquisition transactions that occurred in 2021 and 2020 are further described in Note 3 and Note 4 to the Consolidated Financial Statements included in this Annual Report on Form 10-K. Insurance Programs The Company bears significant risk under its large-deductible workers’ compensation insurance program and its self-insured employee health program. Under the workers’ compensation insurance program, the Company bears risk up to $1.0 million per incident, after which stop-loss coverage is maintained. The Company purchases stop-loss insurance for the employee health plan and bear risk up to $0.5 million per incident. Malpractice and general patient liability claims for incidents which may give rise to litigation have been asserted against the Company by various claimants. The claims are in various stages of processing and some may ultimately be brought to trial. The Company currently carries professional liability insurance coverage on a claims made basis and general liability insurance coverage on an occurrence basis for this exposure with a $0.3 million deductible. The Company also carries Directors and Officers coverage (also on a claims made basis) for potential claims against the Company’s directors and officers, including securities actions, with a deductible of $2.5 million. The Company records estimated liabilities for its insurance programs based on information provided by the third-party plan administrators, historical claims experience, the life cycle of claims, expected costs of claims incurred but not paid, and expected costs to settle unpaid claims. The Company monitors its estimated insurance-related liabilities and recoveries, if any, on a monthly basis and records amounts due under insurance policies in other current assets, while recording the estimated carrier liability in self-insurance reserves. As facts change, it may become necessary to make adjustments that could be material to the Company’s results of operations and financial condition. Goodwill and Intangible Assets Goodwill Goodwill represents the excess of amounts paid for acquisitions over the fair value of net identifiable assets acquired less liabilities assumed. The Company assigns assets acquired, including goodwill, and liabilities assumed to one or more reporting units as of the date of the acquisition. The Company's reporting units are home health, hospice, home and community-based, LTACHs, and HCI. The LTACHs are incorporated in the Company's facility-based operating segment. The other locations within the facility-based segment do not share in the economic benefits of the LTACH reporting unit, and as such, are excluded from the annual impairment testing. Goodwill and purchased intangible assets with indefinite useful live are not amortized. ASC 350, "Intangibles - Goodwill and Other" ("ASC 350") requires that all indefinite-lived intangible assets, such as goodwill, be tested for impairment at least annually or sooner whenever events or changes in circumstances indicate that the asset is impaired. An entity may perform a qualitative assessment to determine whether it is necessary to perform the quantitative impairment test. In assessing whether the asset is impaired, the Company assess all relevant events and circumstances for each of the Company's reporting units. The Company performs its annual impairment review of goodwill at November 30, and when a triggering event occurs between annual impairment tests. The Company assessed and reviewed factors such as: labor cost; financial performance, such as cash flows and planned revenue; regulatory factors; market considerations, such as market-dependent multiples; and access of capital. For 2021, the Company performed a qualitative assessment of goodwill for its reporting units of home health, hospice, home and community-based, and HCI. The Company performed a quantitative assessment of goodwill for its LTACH reporting unit based on current market considerations and market-dependent multiples. The Company determined that it is not more likely than not that the fair values of its reporting units are less than the carrying amounts. The Company has not recognized any goodwill impairment charges in 2021, 2020 or 2019 related to the annual impairment testing. Components of the Company's reporting units are collections of markets of similar service offerings that operate collaboratively under a house of brands, i.e. multiple brands are used across markets, states, and segments. The Company recognized an impairment of $0.02 million, $0.5 million and $0.6 million, respectively, for the twelve months ended December 31, 2021, 2020 and 2019 related to goodwill associated with the closure of underperforming locations. The impairments were determined using prices of comparable businesses in respective markets. Intangible assets: Indefinite-lived assets The Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need, and Medicare licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need, and licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the useful lives of these intangible assets and the Company intends to renew and operate the certificates of need and licenses and use the trade names indefinitely. In some cases, the value of licenses and certificates of need is increased by moratoriums in effect. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. The Company performed a qualitative assessment and determined that it is not more likely than not that the fair values of these assets are less than the carrying amounts. During the twelve months ended December 31, 2021, 2020, and 2019, the Company did not record an impairment charge related to indefinite-lived intangible assets in the annual impairment testing. During the twelve months ended December 31, 2021, 2020, and 2019, the Company closed underperforming locations and impaired certificates of need or Medicare licenses for these providers. The Company recognized an impairment of $0.9 million, $0.7 million, $7.1 million, respectively. During the year ended December 31, 2019, the impairment recognized of $7.1 million included $6.1 million related to impairment due to changes in moratorium regulations and $1.0 million related to the closure of underperforming locations. During 2019, CMS removed all federal moratoria with regard to Medicare provider enrollments in four states. The Medicare licenses were deemed impaired upon the notice of removal. The amounts of impairment of the Medicare licenses was its carrying value at the time of closure. Intangible assets: Definite-lived assets Included in intangible assets are definite-lived assets subject to amortization such as non-compete agreements, customer relationships, and defensive assets, which are defined as trade names that are not actively used. Amortization of definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets, ranging from four Due to/from Governmental Entities The Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. Additionally, reimbursements received in excess of hospice cap amounts are recorded in this account, if any. Property, Building and Equipment Property, building and equipment are recorded at cost. Property, building and equipment acquired in connection with business combinations are recorded at estimated fair value in accordance with the acquisition method of accounting in accordance with ASC 805. Expenditures that increase capacities or extend useful lives are capitalized to the appropriate property, building and equipment accounts. Costs and related accumulated depreciation associated with assets that are sold or retired are written off and any gain or losses are recorded in operating income. Routine repairs and maintenance costs are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the individual assets. The estimated useful life of buildings is 39 years, while the estimated useful lives of transportation equipment, fixed equipment, office furniture, and computer equipment range from three In accordance with ASC 360, "Property, Plant, and Equipment", the Company evaluates its long-lived assets for possible impairment whenever events or changes in circumstances occur that indicate that the carrying amount of the asset may not be recoverable. There we re no impairment charges reco gnized during the periods ended December 31, 2021, 2020, and 2019. The following table describes the Company’s components of property, building and equipment for the years ended December 31, 2021 and 2020 (amounts in thousands): 2021 2020 Land $ 7,339 $ 7,339 Building and leasehold improvements 105,431 40,766 Transportation equipment 19,898 19,821 Fixed equipment 365 365 Office furniture and medical equipment 116,732 104,557 Construction in progress 2,588 48,239 252,353 221,087 Less accumulated depreciation 98,394 82,721 Property, building and equipment, net $ 153,959 $ 138,366 Depreciation expense for the years ended December 31, 2021, 2020 and 2019 was $19.4 million, $20.0 million and $17.0 million, respectively, which was recorded in general and administrative expenses. In addition, during the years ended December 31, 2021 and 2020, the Company capitalized $1.0 million and $1.1 million, respectively, in interest costs related to the construction of its home office expansion project. Noncontrolling Interest The Company classifies noncontrolling interests of its joint ventures based upon a review of the legal provisions governing the redemption of such interests. In each of the Company’s joint ventures, those provisions are embodied within the joint venture’s operating agreement. For joint ventures with operating agreement provisions that establish an obligation for the Company to purchase the third party partners’ noncontrolling interests other than as a result of events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as redeemable noncontrolling interests in temporary equity. For joint ventures with operating agreement provisions that establish an obligation that the Company purchase the third party partners’ noncontrolling interests, but which obligation is triggered by events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. Additionally, for joint ventures with operating agreement provisions that do not establish an obligation for the Company to purchase the third party partners’ noncontrolling interests (e.g., where the Company has the option, but not the obligation, to purchase the third party partners’ noncontrolling interests), such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. The Company’s equity joint ventures that are classified as redeemable noncontrolling interests are subject to operating agreement provisions that require the Company to purchase the noncontrolling partner’s interest upon the occurrence of certain triggering events, which are defined as the bankruptcy of the partner or the partner’s exclusion from the Medicare or Medicaid programs. These triggering events and the related repurchase provisions are specific to each redeemable equity joint venture, since the triggering of a repurchase obligation for any one redeemable noncontrolling interest in an equity joint venture does not necessarily impact any of the other redeemable noncontrolling interests in other equity joint ventures. Upon the occurrence of a triggering event requiring the purchase of a redeemable noncontrolling interest, the Company would be required to purchase the noncontrolling partner’s interest based upon a valuation methodology set forth in the applicable joint venture agreement. Redeemable noncontrolling interests and nonredeemable noncontrolling interests are initially recorded at their fair value as of the closing date of the transaction establishing the joint venture. Such fair values are determined using various accepted valuation methods, including the income approach, the market approach, the cost approach, and a combination of one or more of these approaches. A number of facts and circumstances concerning the operation of the joint venture are evaluated for each transaction, including (but not limited to) the ability to choose management, control over acquiring or liquidating assets, and control over the joint venture’s strategy and direction, in order to determine the fair value of the noncontrolling interest. Subsequent to the closing date of the transaction establishing the joint venture, recorded values for both redeemable and nonredeemable noncontrolling interests are adjusted at the end of each reporting period for (a) comprehensive income (loss) that is attributed to the noncontrolling interest, which is calculated by multiplying the noncontrolling interest percentage by the comprehensive income (loss) of the joint venture’s operations during the reporting period, (b) dividends paid to the noncontrolling interest partner during the reporting period, and (c) any other transactions that increase or decrease the Company’s ownership interest in the joint venture, as a result of which the Company retains its controlling interest. If the Company determines based upon its analysis as of the end of each reporting period in accordance with authoritative accounting guidance, that it is not probable that an event would occur to otherwise require the redemption of a redeemable noncontrolling interest (i.e., the date for such event is not set or such event is not certain to occur), then the Company does not adjust the recorded amount of such redeemable noncontrolling interest. The carrying amount of each redeemable equity instrument presented in temporary equity as of December 31, 2021 is not less than the initial amount reported for each instrument. The activity of noncontrolling interest-redeemable for the twelve months ended December 31, 2021, 2020 and 2019 is summarized in the Company’s statements of stockholders' equity. Based upon the Company’s evaluation of the redemption provisions concerning redeemable noncontrolling interests as of December 31, 2021, the Company determined in accordance with authoritative accounting guidance that it was not probable that an event otherwise requiring redemption of any redeemable noncontrolling interest would occur (i.e., the date for such event was not set or such event is not certain to occur). Therefore, none of the redeemable noncontrolling interests were identified as mandatorily redeemable interests at such times, and the Company did not record any values in respect of any mandatorily redeemable interests. Stock-Based Compensation The Company accounts for its stock-based awards in accordance with provisions of ASC 718, "Compensation - Stock Compensation" ("ASC 718"). The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of compensation. In accordance with ASC 718, the expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis over the requisite service period. See Note 7 to the Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information. Earnings Per Share The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31, 2021, 2020 and 2019: 2021 2020 2019 Weighted average number of shares outstanding for basic per share calculation 31,195,305 31,092,417 30,932,607 Effect of dilutive potential shares: Nonvested restricted stock 201,353 273,348 277,217 Adjusted weighted average shares for diluted per share calculation 31,396,658 31,365,765 31,209,824 Antidilutive shares 117,238 1,155 157,608 Assets Held for Sale As of December 31, 2020, the Company's assets held for sale was $1.9 million, which consisted of one hospice facility in Knoxville, Tennessee. The Company sold the property during the twelve months ended December 31, 2021 for $3.2 million. The gain on the sale of the property of $1.2 million was recorded in general and administrative expenses on our consolidated statemen |
Acquisitions, Divestitures, and
Acquisitions, Divestitures, and Joint Venture Activities | 12 Months Ended |
Dec. 31, 2021 | |
Business Combinations [Abstract] | |
Acquisitions, Divestitures, and Joint Venture Activities | Acquisitions, Divestitures, and Joint Venture Activities 2021 Acquisitions On July 1, 2021, the Company purchased Heart n' Home Hospice for $50.1 million, which included seven wholly-owned hospice locations in Idaho and two wholly-owned hospice locations in Oregon. In addition, the Company purchased Casa de la Luz on July 1, 2021 for $48.0 million, which included two wholly-owned hospice and palliative care locations in Arizona. On September 1, 2021, the Company purchased Heart of Hospice for $278.0 million, which included 24 wholly-owned hospice locations in Arkansas, Louisiana, Mississippi, Oklahoma, and South Carolina. On November 1, 2021, the Company purchased Brookdale Health Care Services' agencies from the recently formed home health, hospice, and outpatient therapy venture between HCA Healthcare and Brookdale Senior Living, Inc. The wholly-owned purchased agencies included 23 home health locations, 11 hospice locations, and 13 main therapy agencies across 22 states. Total consideration for this acquisition was $197.0 million, of which $178.8 million was paid in cash, net of working capital adjustments. In separate acquisitions, the Company acquired the majority-ownership of four home health agencies, three hospice, and one home and community-based agencies during the twelve months ended December 31, 2021 for an aggregate purchase price $17.8 million. The purchase prices were determined based on the Company's analysis of comparable acquisitions and the target market's potential future cash flows. Goodwill generated from the acquisitions was recognized based on the expected contributions of each acquisition to the overall corporate strategy. The Company expects its portion of goodwill to be fully tax deductible. The acquisitions were accounted for under the acquisition method of accounting. Accordingly, the accompanying financial information includes the results of operations of the acquired entities from the date of acquisition. Transaction costs associated with acquisitions are expensed as incurred. During the twelve months ended December 31, 2021, the Company incurred $9.1 million in acquisition-related transaction costs, which was recorded in the consolidated statements of income as general and administrative expenses. The Company's net working capital adjustments for Heart of Hospice and Brookdale Health Care Services' agencies are being finalized and remain preliminary in accordance with the requirements of ASC Topic 805, Business Combinations. The final determination of the fair value of assets acquired and liabilities assumed will be completed in accordance with the applicable accounting guidance. The following table summarizes the amounts of the assets acquired and liabilities assumed at the acquisition dates, as well as their fair value at the acquisition dates and the noncontrolling interest acquired during the twelve months ended December 31, 2021 (amounts in thousands): Consideration Cash $ 570,935 Net working capital 890 Fair value of total consideration transferred Recognized amounts of identifiable assets acquired and liabilities assumed Cash $ 1,352 Patient accounts receivable 14,299 Other receivables 209 Prepaid expenses 441 Other current assets 155 Property and equipment 2,614 Trade names 39,942 Certificates of need/licenses 40,221 Non-compete agreements 7,257 Operating lease right of use asset 9,494 Other assets 168 Accounts payable and other accrued liabilities (10,378) Salaries, wages, and benefits payable (7,582) Current operating lease payable (3,600) Amounts due to governmental entities (4,364) Current liabilities - deferred employer payroll tax (1,692) Operating lease payable (5,897) Total identifiable assets and liabilities $ 82,639 Noncontrolling interest 113 Goodwill, including noncontrolling interest of $78 $ 489,299 Trade names, certificates of need and licenses are indefinite-lived assets and, therefore, not subject to amortization. Acquired trade names that are not being used actively are amortized over the estimated useful life on the straight line basis. Trade names are valued using the relief from royalty method, a form of the income approach. Certificates of need are valued using the replacement cost approach based on registration fees and opportunity costs. Licenses are valued based on the estimated direct costs associated with recreating the asset, including opportunity costs based on an income approach. In the case of states with a moratorium in place, the licenses are valued using the multi-period excess earnings method. Noncontrolling interest is recorded at fair value. 2021 Divestitures During the twelve months ended December 31, 2021, the Company sold its controlling membership interests in a home health agency previously operated as an equity joint venture and sold its pharmacy location which was wholly-owned. The total consideration for these controlling interest sales was $1.5 million and resulted in a loss of $0.1 million, which was accounted for as a loss on the sale of entities and recorded in general and administrative expenses. 2021 Joint Venture Activities During the twelve months ended December 31, 2021, the Company purchased additional controlling membership interests in four of our equity joint venture partnerships, whereby the agencies became wholly-owned subsidiaries of the Company. The total consideration for these additional controlling interest purchases was $2.1 million. The transactions were accounted for as equity transactions. During the twelve months ended December 31, 2021, the Company sold noncontrolling membership interests in two home health agencies. The total consideration of the sales of noncontrolling membership interest was $1.9 million. The transactions were accounted for as equity transactions. 2020 Acquisitions The Company acquired the majority-ownership of 13 home health agencies, six hospice agencies, four home and community-based agencies, and one physician practice during the twelve months ended December 31, 2020. The total aggregate purchase price for these transactions was $42.1 million. The Company funded three of these acquisitions in 2019 by paying cash consideration of $16.4 million. During the twelve months ended December 31, 2020, the Company received $3.1 million from an equity joint venture partnership for the partner's noncontrolling interest for one of the Company's acquired home health and hospice agencies. In separate transactions, the Company received $3.9 million for consideration of two equity joint venture partnerships, whereby the Company acquired home health, hospice, and home and community-based agencies for $6.6 million and sold membership interests in these agencies for $4.4 million. The transactions for the sale of the membership interests were accounted for as an equity transaction. The total cash consideration includes adjustments for assets acquired and liabilities assumed. The allocation of the purchase price of these acquisitions were allocated to goodwill of $40.1 million, indefinite lived intangibles trade names of $4.8 million, certificates of need/licenses of $6.0 million, and other assets and assumed liabilities of $0.5 million. Acquired noncontrolling interest was $9.4 million. 2020 Joint Venture Activities During the twelve months ended December 31, 2020, the Company purchased a portion of the noncontrolling membership interest in two of our equity joint venture partnerships, which prior to the purchase was classified as a nonredeemable noncontrolling interest in permanent equity. As a result of the purchases, the Company retained its controlling financial interests in the joint venture partnerships and the noncontrolling interest of our partner will continue to be classified as a nonredeemable noncontrolling interest in permanent equity. Total consideration for these noncontrolling interest purchases was $24.3 million. During the twelve months ended December 31, 2020, the Company sold minority ownership interests associated with seven home health agencies and one hospice agency. The total consideration for the sale of such ownership interests was $5.1 million, of which $4.9 million was paid in cash and $0.2 million was a contribution of a trade name. The transaction was accounted for as an equity transaction. |
Goodwill and Other Intangibles,
Goodwill and Other Intangibles, Net | 12 Months Ended |
Dec. 31, 2021 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill and Other Intangibles, Net | Goodwill and Other Intangibles, Net The following table summarizes changes in goodwill and other intangibles assets by segment during the twelve months ended December 31, 2021 and 2020 (amounts in thousands): Home Health Hospice Home and community- based Facility-based HCI Total Goodwill Balance as of December 31, 2019 $ 867,924 $ 128,875 $ 166,629 $ 15,682 $ 40,862 $ 1,219,972 Acquisitions 12,025 21,025 134 88 — 33,272 Noncontrolling interest 4,695 2,122 10 — — 6,827 Adjustments and disposals (644) (280) — — — (924) Balance as of December 31, 2020 $ 884,000 $ 151,742 $ 166,773 $ 15,770 $ 40,862 $ 1,259,147 Acquisitions 84,377 404,590 254 — — 489,221 Noncontrolling interest 78 — — — — 78 Adjustments and disposals (20) — — — — (20) Balance as of December 31, 2021 $ 968,435 $ 556,332 $ 167,027 $ 15,770 $ 40,862 $ 1,748,426 Intangibles Assets Balance as of December 31, 2019 $ 219,872 $ 40,590 $ 24,096 $ 5,317 $ 15,681 $ 305,556 Acquisitions 7,193 4,212 127 — — 11,532 Amortization (556) (70) (15) (6) (581) (1,228) Adjustments and disposals (505) — — — — (505) Balance as of December 31, 2020 $ 226,004 $ 44,732 $ 24,208 $ 5,311 $ 15,100 $ 315,355 Acquisitions 13,734 73,026 46 614 — 87,420 Amortization (480) (418) (9) (6) (581) (1,494) Adjustments and disposals (1,279) — — — — (1,279) Balance as of December 31, 2021 $ 237,979 $ 117,340 $ 24,245 $ 5,919 $ 14,519 $ 400,002 The Company determined that there was no impairment for the goodwill of any reporting units as of December 31, 2021, 2020, and 2019 based on the Company's annual impairment testing. During 2021, 2020, and 2019, the Company closed underperforming locations. Due to these closures, the Company recorded $0.02 million, $0.5 million, and $0.6 million of impairment of goodwill during the years ended December 31, 2021, 2020 and 2019. The amount of disposal of goodwill was determined using prices of comparable businesses in the market. This was recorded in impairment of intangibles and other on the Company's consolidated statements of income and disclosed in the changes in goodwill table in adjustments and disposals. The Company performed an impairment analysis on its indefinite-lived intangible assets related to the Company's trade names, certificates of needs, and licenses and determined that it is not more likely than not that the fair values of the indefinite-lived intangible assets are less than its carrying amount as of November 30, 2021; however, the Company did record $0.9 million, $0.7 million, and $7.1 million, during the years ended December 31, 2021, 2020, and 2019. During the years ended December 31, 2021 and 2020, the impairments related to closures of underperforming locations. During the year ended December 31, 2019, the impairments related to the lifting of a moratoria of $6.1 million and closure of underperforming locations of $1.0 million. The Medicare license impairment was a result of CMS action to remove all federal moratoria with regard to Medicare provider enrollment in four states. The amounts of disposal of the Medicare licenses was its carrying value at the time of closure. This was recorded in impairment of intangibles and other on the Company's consolidated statements of income and disclosed in the changes in intangible assets table in adjustments and disposals. During the twelve months ended December 31, 2021, the Company divested a certificate of need of $0.4 million, which was accounted for as a loss on the sale of an entity and recorded on the Company's consolidated statements of income in general and administrative expenses. The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2021 and 2020 (amounts in thousands): 2021 2020 Indefinite-lived intangible assets: Trade names $ 207,780 $ 168,700 Certificates of need/licenses 173,955 135,013 Net total $ 381,735 $ 303,713 Definite-lived intangible assets: Trade names Gross carrying amount $ 11,073 $ 10,212 Accumulated amortization (9,606) (9,480) Net total $ 1,467 $ 732 Non-compete agreements Gross carrying amount $ 14,524 $ 7,267 Accumulated amortization (7,172) (6,387) Net total $ 7,352 $ 880 Customer relationships Gross carrying amount $ 11,822 $ 11,822 Accumulated amortization (2,374) (1,792) Net total $ 9,448 $ 10,030 Total definite-lived intangible assets Gross carrying amount $ 37,419 $ 29,301 Accumulated amortization (19,152) (17,659) Net total $ 18,267 $ 11,642 Total intangible assets: Gross carrying amount $ 419,154 $ 333,014 Accumulated amortization (19,152) (17,659) Net total $ 400,002 $ 315,355 Remaining useful lives of trade names, customer relationships, and non-compete agreements were 7.8, 16.3 and 4.9 years, respectively at December 31, 2021. Similar amounts at December 31, 2020 were 8.8, 17.3 and 2.9 years, respectively. Amortization expense for the Company's intangible assets was $1.5 million, $1.2 million, and $1.3 million for the years ended December 31, 2021, 2020 and 2019, which was recorded on the Company's consolidated statements of income in general and administrative expenses. The estimated intangible asset amortization expense for each of the five years subsequent to December 31, 2021 is as follows (amounts in thousands): Year Amortization amount 2022 $ 3,696 2023 2,524 2024 2,098 2025 1,790 2026 1,578 Total $ 11,686 |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes The Company accounts for income taxes using the asset and liability method. Under the asset and liability method, deferred taxes are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax laws that will be in effect when the differences are expected to reverse. Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2021 and 2020 were as follows (amounts in thousands): 2021 2020 Deferred tax assets: Allowance for uncollectible accounts $ 8,394 $ 8,065 Accrued employee benefits 7,533 8,247 Stock compensation 2,735 2,373 Accrued self-insurance 6,626 6,596 Acquisition costs 2,631 1,635 Net operating loss carry forward 5,245 6,084 Intangible asset impairment 6 10 Lease payable 23,220 25,667 Government stimulus advance 21,591 19,114 Payroll tax 5,895 11,750 Other 312 285 Gross deferred tax assets 84,188 89,826 Less: valuation allowance (3,121) (3,876) Net deferred tax assets $ 81,067 $ 85,950 Deferred tax liabilities: Amortization of intangible assets (100,339) (85,826) Tax depreciation in excess of book depreciation (17,584) (14,065) Prepaid expenses (1,733) (1,538) Non-accrual experience accounting method (829) (743) Right of use asset (22,781) (25,202) Other (7,827) (5,813) Deferred tax liabilities (151,093) (133,187) Net deferred tax liability $ (70,026) $ (47,237) Based on the Company’s historical pattern of taxable income, the Company believes it will produce sufficient income in the future to realize its deferred income tax assets. Management provides a valuation allowance for any net deferred tax assets when it is more likely than not that a portion of such net deferred tax assets will not be recovered. The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, for the twelve months ended December 31, were as follows (amounts in thousands): 2021 2020 2019 Current: Federal $ 10,746 $ 37,253 $ 4,678 State 4,220 12,232 3,528 14,966 49,485 8,206 Deferred: Federal 17,699 (10,800) 14,549 State 5,022 (2,642) 3,852 22,721 (13,442) 18,401 Total income tax expense $ 37,687 $ 36,043 $ 26,607 A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each of the twelve months ended December 31, were as follows: 2021 2020 2019 Federal statutory tax rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal benefit 4.8 5.2 4.8 Nondeductible expenses 1.4 1.9 1.8 Uncertain tax position 0.1 1.5 (0.9) Cares Act Enactment — (2.9) — Excess tax benefit (1.5) (1.7) (2.5) Credits and other (1.2) (0.6) (2.5) % Effective tax rate 24.6 % 24.4 % 21.7 % The Company is subject to both federal tax and state income tax for jurisdictions within which it operates. Within these jurisdictions, the Company is open to examination for tax years ended after December 31, 2012. As of December 31, 2021, the Company has gross U.S. operating loss carry forwards of $5.5 million that are available to reduce future taxable income. If not used to offset taxable income, a portion of these losses will expire between 2032 and 2034. Losses generated in years ending after December 31, 2017 have an unlimited carryforward under the Tax Cut and Jobs Act ("2017 Tax Act"). Due to U.S. limitations on acquired operating losses, a valuation allowance has been established on $1.6 million of these losses. Gross state operating loss carryforwards totaling $82.3 million at December 31, 2021 are being carried forward in jurisdictions where the Company is permitted to use tax losses from prior periods to reduce future taxable income. If not used to offset future taxable income, these losses will expire between 2022 and 2041. Due to uncertainty regarding the Company's ability to use some of the carryforwards, a valuation allowance has been established on $49.1 million of state net operating loss carryforwards. Based on the Company's historical record of producing taxable income and expectations for the future, the Company has concluded that future operating income will be sufficient to give rise to taxable income sufficient to utilize the remaining state net operating loss carryforwards. The effective tax rate for the twelve months ended December 31, 2021 benefited from $2.4 million of excess tax benefits associated with stock-based compensation arrangements. For the twelve months ended December 31, 2020, the effective tax rate benefited from $2.4 million of excess tax benefits associated with stock-based compensation arrangements and $2.2 million ($4.3 million and $2.1 million, as further described below) associated with increased tax benefits associated with the CARES Act. In response to the COVID-19 pandemic, the CARES Act was signed into law in March 2020. The CARES Act lifts certain deduction limitations originally imposed by the 2017 Tax Act. Corporate taxpayers may carryback net operating losses ("NOLs") originating during 2018 through 2020 for up to five years, which was not previously allowed under the 2017 Tax Act. The CARES Act also eliminates the 80% of taxable income limitations by allowing corporate entities to fully utilize NOL carryforwards to offset taxable income in 2018, 2019, or 2020. Taxpayers may generally deduct interest up to the sum of 50% of adjusted taxable income plus business interest income (30% limit under the 2017 Tax Act) for tax years beginning January 1, 2019 and 2020. The CARES Act allows taxpayers with alternative minimum tax credits to claim a refund in 2020 for the entire amount of the credits instead of recovering the credits through refunds over a period of years, as originally enacted by the 2017 Tax Act. In addition, the CARES Act raises the corporate charitable deduction limit to 25% of taxable income and makes qualified improvement property generally eligible for 15-year cost-recovery and 100% bonus depreciation. The effective tax rate for the twelve months ended December 31, 2020 benefited from a $4.3 million impact from the enactment of the CARES Act. The benefit was primarily driven by NOL carryback provisions and rate differential between the affected years. There was no material impact to our net deferred tax assets as of December 31, 2020. US GAAP prescribes a recognition threshold and measurement attribute for the accounting and financial statement disclosure of tax positions taken or expected to be taken in a tax return. The evaluation of a tax position is a two-step process. The first step requires the Company to determine whether it is more likely than not that a tax position will be sustained upon examination based on the technical merits of the position. The second step requires the Company to recognize in the financial statements each tax position that meets the more likely than not criteria, measured at the amount of benefit that has a greater than 50% likelihood of being realized. The Company's unrecognized tax benefits would affect the tax rate, if recognized. The Company includes the full amount of unrecognized tax benefits in noncurrent income taxes payable in the consolidated balance sheets. The Company anticipates it is reasonably possible an increase or decrease in the amount of unrecognized tax benefits could be made in the next twelve months; however, the Company does not presently anticipate that any increase or decrease in unrecognized tax benefits will be material to the consolidated financial statements. The impact of the CARES Act increased unrecognized tax benefits by $2.1 million, which also had an impact on the Company's effective tax rate for the twelve months ended December 31, 2020. The impact was primarily driven by the NOL carryback mentioned above to previously closed years. As of December 31, 2021 and 2020, the Company recognized $7.3 million and $6.2 million, respectively, in unrecognized tax benefits. A reconciliation of the total amounts of unrecognized tax benefits follows: Unrecognized tax benefits As of January 1, 2020 $ 3,867 Acquired unrecognized tax position — Increased (decreased) in unrecognized tax benefits as a result of: Tax positions taken in the current year 2,391 Lapse of statute of limitations (55) As of December 31, 2020 $ 6,203 Increased (decreased) in unrecognized tax benefits as a result of: Tax positions taken in the current year 1,244 Lapse of statute of limitations (127) As of December 31, 2021 $ 7,320 |
Debt
Debt | 12 Months Ended |
Dec. 31, 2021 | |
Debt Disclosure [Abstract] | |
Debt | Debt Credit Facility On March 30, 2018, the Company entered into a Credit Agreement with JPMorgan Chase Bank, N.A., which was effective on April 2, 2018 (the "Credit Agreement"). The Credit Agreement provides a senior, secured revolving line of credit commitment with a maximum principal borrowing limit of $500.0 million, which includes an additional $200.0 million accordion expansion feature, and a letter of credit sub-limit equal to $50.0 million. The expiration date of the Credit Agreement was March 20, 2023. On August 3, 2021, the Company entered into an Amended and Restated Senior Credit Facility (the "2021 Amended Credit Agreement"), which amends and restates in its entirety the Credit Agreement. The 2021 Amended Credit Agreement provided a senior, secured revolving line of credit commitment with a maximum principal borrowing limit of $800.0 million, which included an additional $500.0 million accordion expansion, and a letter of credit sub-limit equal to $75.0 million. On December 31, 2021, the aggregate commitment was increased to a maximum borrowing limit of $1.0 billion, with an additional $300.0 million accordion expansion. The expiration date of the 2021 Amended Credit Agreement is August 3, 2026. The Company's obligations under the 2021 Amended Credit Agreement are secured by substantially all of the assets of the Company and its wholly-owned subsidiaries (subject to customary exclusions), which assets include the Company's equity ownership of its wholly-owned subsidiaries and its equity ownership in joint venture entities. The Company's wholly-owned subsidiaries also guarantee the obligations of the Company under the 2021 Amended Credit Agreement. Revolving loans under the 2021 Amended Credit Agreement bear interest at, as selected by the Company, either a (i) the prevailing London Interbank Offered Rate ("LIBOR") (with interest periods of one, three, or six months at the Company's option) plus a spread of 1.25% to 2.00% based on the Company's quarterly consolidated Leverage Ratio or (ii) the prevailing prime or base rate plus a spread of 0.25% to 1.00% based on the Company's quarterly consolidated Leverage Ratio. Swing line loans bear interest at the Base Rate. The Company is limited to 15 Eurodollar borrowings outstanding at any time. The Company is required to pay a commitment fee for the unused commitments at rates ranging from 0.15% to 0.30% per annum depending upon the Company's quarterly consolidated Leverage Ratio. The Base Rate at December 31, 2021 was 3.75% and the Eurodollar Rate was 1.63%. As of December 31, 2021, the effective interest rate on outstanding borrowings under the 2021 Amended Credit Agreement was 1.81%. On March 5, 2021, the ICE Benchmark Administration, the administrator of LIBOR, announced its intention to cease the publication of LIBOR settings for 1-month, 3-month, 6-month, and 12-month LIBOR borrowings immediately on June 30, 2023. JPMorgan Chase Bank, N.A will transition our 2021 Amended Credit Agreement to an alternate rate to CME Term SOFR Reference Rate ("SOFR"), which is administered by CME Group Benchmark Administration Ltd ("CME"). Due to the differences observed between LIBOR rates and SOFR published rates, JPMorgan Chase Bank, N.A. will use a credit spread adjustment ("CSA") in order to minimize value transfer and leave the existing margin applicable to our 2021 Amended Credit Agreement. The CSA used by JPMorgan Chase Bank, N.A. is based on the average of the differences between LIBOR and SOFR over a 12-month period and will be added to S OFR. As of December 31, 2021 the Company had $661.2 million drawn and letters of credit in the amount of $24.3 million outstanding under the credit facility. At December 31, 2020, the Company had $20.0 million drawn and letters of credit in the amount of $25.4 million outstanding under the credit facility. Under the terms of the 2021 Amended Credit Agreement, the Company is required to maintain certain financial ratios and comply with certain financial covenants. The 2021 Amended Credit Agreement permits the Company to make certain restricted payments, such as purchasing shares of its stock, within certain parameters, provided the Company maintains compliance with those financial ratios and covenants after giving effect to such restricted payments. The Company was in compliance with its debt covenants under the 2021 Amended Credit Agreement at December 31, 2021. The scheduled principal payments on long-term debt for each of the five years subsequent to December 31, 2021 is as follows (amounts in thousands): Year Principal payment amount 2022 $ — 2023 — 2024 — 2025 — 2026 661 Total $ 661 |
Stockholders' Equity
Stockholders' Equity | 12 Months Ended |
Dec. 31, 2021 | |
Equity [Abstract] | |
Stockholders' Equity | Stockholders’ Equity Equity Based Awards The 2018 Incentive Plan is administered by the Compensation Committee of the Company’s Board of Directors. The total number of shares of the Company's common stock originally reserved were 2,210,544 shares of our common stock and a total of 1,746,779 shares are currently available for issuance. A variety of discretionary awards for employees, officers, directors, and consultants are authorized under the 2018 Incentive Plan, including incentive or non-qualified stock options and restricted stock, restricted stock units and performance-based awards. All awards must be evidenced by a written award certificate which will include the provisions specified by the Compensation Committee of the Board of Directors. The Compensation Committee determines the exercise price for stock options, which cannot be less than the fair market value of the Company’s common stock as of the date of grant. Share Based Compensation Nonvested Stock The Company issues stock-based compensation to employees in the form of nonvested stock, which is an award of common stock subject to certain restrictions. The awards, which the Company calls nonvested shares, generally vest over five years, conditioned on continued employment for the full incentive period. Compensation expense for the nonvested stock is recognized for the awards that are expected to vest. The expense is based on the fair value of the awards on the grant date recognized on a straight-line basis over the requisite service period, which generally relates to the vesting period. The Company estimates forfeitures at the time of grant and revises the estimate in subsequent periods if actual forfeitures differ to ensure that total compensation expense recognized is at least equal to the value of vested awards. The Company applies the same guidance to nonemployee share-based awards. During 2021, employees and a consultant were granted 109,985 and 5,735, respectively, of nonvested shares of common stock. During 2020, employees and a consultant were granted 114,680 and 10,890, respectively. During 2019, 163,250 nonvested shares were granted to employees. All shares granted were granted pursuant to the 2018 Incentive Plan. The shares will vest over a period of five years, conditioned on continued employment and in accordance with the consulting agreement. During 2021, 2020 and 2019, respectively, the Company granted 7,200, 9,900 and 17,880 nonvested shares of stock to the independent directors. The shares vest 100% on the one year anniversary date. During 2021, the Company granted 3,500 nonvested shares of common stock to the Company's Lead Director, which shares vest one-third at the date of grant and one-third on each of the first two anniversaries of the grant date. During 2020, one retired director was granted 775 nonvested shares of common stock, which vest 100% at the grant date. Shares granted to directors were pursuant to the Second Amended and Restated 2005 Non-Employee Directors Compensation Plan. The fair value of nonvested shares is determined based on the closing trading price of the Company’s shares on the grant date. The weighted average grant date fair values of nonvested shares granted during the years ended December 31, 2021, 2020 and 2019 were $186.08, $123.89 and $110.56, respectively. The following table represents the share grants stock activity for the year ended December 31, 2021: Nonvested stock Options Number of Weighted average Number of Weighted average Share grants outstanding at December 31, 2020 469,631 $ 89.69 74,235 $ 42.07 Granted 126,420 186.08 — — Vested or exercised (180,235) 186.86 — — Share grants outstanding at December 31, 2021 415,816 $ 122.40 74,235 $ 42.07 As of December 31 2021, there was $37.3 million of total unrecognized compensation cost related to nonvested shares granted. That cost is expected to be recognized over the weighted average period of 2.90 years. The total fair value of shares vested in the year ended 2021, 2020 and 2019 were $14.1 million, $12.2 million, and $9.4 million, respectively. The Company recorded $15.9 million, $14.3 million and $9.6 million in compensation expense related to non-vested stock grants in the years ended December 31, 2021, 2020 and 2019, respectively. Aggregate intrinsic value for options represents the estimated value of the Company's common stock at the end of the period in excess of the weighted average exercise price multiplied by the number of options exercisable. The aggregate intrinsic value of options outstanding at December 31, 2021 was $7.4 million. The following table summarizes information about stock options outstanding and exercisable at December 31, 2021: Range of Exercise Price Shares Wtd. Avg. Remaining Contractual Life Wtd. Avg. Exercise Price $0.00 - $30.00 15,737 2.05 $ 26.11 $30.01 - $40.00 20,609 4.18 $ 39.38 Over $40.00 37,889 5.16 $ 47.74 74,235 4.00 $ 42.07 Employee Stock Purchase Plan In 2006, the Company adopted the Employee Stock Purchase Plan allowing eligible employees to purchase the Company’s common stock at 95% of the market price on the last day of each calendar quarter. There were 250,000 shares reserved for the plan. On June 20, 2013, the Amended and Restated Employee Stock Purchase Plan was approved by the Company’s stockholders. As a result of the amendment, the Employee Stock Purchase Plan was modified as follows: • An additional 250,000 shares of common stock were authorized for issuance over the term of the Employee Stock Purchase Plan. • The term of the Employee Stock Purchase Plan was extended from January 1, 2016 to January 1, 2023. The following table represents the shares issued during 2021, 2020, and 2019, under the Employee Stock Purchase Plan: Number of Weighted Average Shares available as of December 31, 2018 152,344 Shares issued in 2019 19,895 $ 103.84 Shares issued in 2020 14,313 $ 152.10 Shares issued in 2021 13,792 $ 186.20 Shares available as of December 31, 2021 104,344 Treasury Stock In conjunction with the vesting of the nonvested shares of stock or exercise of options, recipients incur personal income tax obligations. The Company allows the recipients to turn in shares of common stock to satisfy those personal tax obligations. The Company redeemed 63,028, 78,767 and 107,461 shares of common stock related to these tax obligations during the years ended December 31, 2021, 2020 and 2019, respectively. Additionally, 1,556 shares were forfeited for terminated employees. Such shares are held in treasury stock and are available for reissuance by the Company. Stock Repurchase |
Leases
Leases | 12 Months Ended |
Dec. 31, 2021 | |
Leases [Abstract] | |
Leases | Leases The Company determines if a contract contains a lease at inception date. The Company's leases are operating leases, primarily for office and office equipment, that expire at various dates over the next five years. The facility based leases have renewal options for periods ranging from one Payments due under operating leases include fixed and variable payments. These variable payments for the Company's office leases can include operating expenses, utilities, property taxes, insurance, common area maintenance, and other facility-related expense. Additionally, any leases with terms less than one year were not recognized as operating lease right of use assets or payables for short term leases in accordance with the election of ‘package of practical expedient’ under ASU 2016-02. The Company recognizes operating lease right of use assets and operating lease payable based on the present value of the future minimum lease payments at the lease commencement date. The Company's leases do not provide implicit rates. Therefore, the Company used an incremental borrowing rate based on the information available at the lease commencement date in determining the present value of future payments. As of December 31, 2021, the weighted-average remaining lease term was 3.85 years and weighted-average discount rate was 4.22%. As of December 31, 2020, the weighted-average remaining lease term was 4.15 years and weighted-average discount rate was 4.51%. The following table summarizes the operating lease right of use assets and related lease payables in the consolidated balance sheets at December 31, 2021 and 2020 (amounts in thousands): December 31, 2021 December 31, 2020 Operating lease right of use asset $ 113,399 $ 100,046 Current operating lease payable $ 37,630 $ 32,676 Long-term operating lease payable $ 78,688 $ 70,275 The components of lease costs for operating leases for the years ended December 31, 2021, 2020 and 2019 were as follows: (amounts in thousands): 2021 2020 2019 Operating lease cost $ 51,080 $ 47,288 $ 45,595 Short-term lease cost 3,480 4,273 3,243 Variable lease cost 4,013 4,187 3,879 Total lease costs $ 58,573 $ 55,748 $ 52,717 Maturities of operating lease payables as of December 31, 2021 were as follows (amounts in thousands): Year Total 2022 $ 41,605 2023 32,035 2024 22,660 2025 15,485 Thereafter 14,057 Total future minimum lease payments 125,842 Less: Imputed interest (9,524) Total $ 116,318 |
Employee Benefit Plan
Employee Benefit Plan | 12 Months Ended |
Dec. 31, 2021 | |
Share-based Payment Arrangement [Abstract] | |
Employee Benefit Plan | Employee Benefit Plan Defined Contribution Plan The Company sponsors a 401(k) plan for all eligible employees. The plan allows participants to contribute up to the IRS 402(g) limits each year, both on a pretax and after tax basis, which was $19,500 in 2021. The plan also allows discretionary Company contributions as determined by the Company’s Board of Directors. Effective January 1, 2006, the Company implemented a discretionary match of up to two percent of participating employee contributions. The employer contribution will vest 25% in an employee's account for each year of service with the Company and 25% each additional year until it is fully vested in year four |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2021 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Contingencies The Company provides services in a highly regulated industry and is a party to various proceedings and regulatory and other governmental and internal audits and investigations in the ordinary course of business (including audits by Zone Program Integrity Contractors ("ZPICs") and Recovery Audit Contractors ("RACs") and investigations resulting from the Company's obligation to self-report suspected violations of law). Management cannot predict the ultimate outcome of any regulatory, other governmental, and internal audits and investigations. While such audits and investigations are the subject of administrative appeals, the appeals process, even if successful, may take several years to resolve. The Department of Justice, CMS, or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company's businesses. These audits and investigations have caused and could potentially continue to cause delays in collections and, recoupments from governmental payors. Currently, the Company has recorded $16.9 million in other assets, which are from government payors related to the disputed finding of pending ZPIC audits. Additionally, these audits may subject the Company to sanctions, damages, extrapolation of damage findings, additional recoupments, fines, and other penalties (some of which may not be covered by insurance), which may, either individually or in the aggregate, have a material adverse effect on the Company's business and financial condition. We are involved in various legal proceedings arising in the ordinary course of business. Although the results of litigation cannot be predicted with certainty, we believe the outcome of pending litigation will not have a material adverse effect, after considering the effect of our insurance coverage, on our consolidated financial information. Legal fees related to all legal matters are expensed as incurred. Joint Venture Buy/Sell Provisions Most of the Company’s joint ventures include a buy/sell option that grants to the Company and its joint venture partners the right to require the other joint venture party to either purchase all of the exercising member’s membership interests or sell to the exercising member all of the non-exercising member’s membership interest, at the non-exercising member’s option, within 30 days of the receipt of notice of the exercise of the buy/sell option. In some instances, the purchase price is based on a multiple of the historical or future earnings before income taxes and depreciation and amortization of the equity joint venture at the time the buy/sell option is exercised. In other instances, the buy/sell purchase price will be negotiated by the partners and subject to a fair market valuation process. The Company has not received notice from any joint venture partners of their intent to exercise the terms of the buy/sell agreement nor has the Company notified any joint venture partners of its intent to exercise the terms of the buy/sell agreement. Compliance The laws and regulations governing the Company’s operations, along with the terms of participation in various government programs, regulate how the Company does business, the services offered and its interactions with patients and the public. These laws and regulations, and their interpretations, are subject to frequent change. Changes in existing laws or regulations, or their interpretations, or the enactment of new laws or regulations could materially and adversely affect the Company’s operations and financial condition. The Company is subject to various routine and non-routine governmental reviews, audits and investigations. In recent years, federal and state civil and criminal enforcement agencies have heightened and coordinated their oversight efforts related to the health care industry, including referral practices, cost reporting, billing practices, joint ventures and other financial relationships among health care providers. Violation of the laws governing the Company’s operations, or changes in the interpretation of those laws, could result in the imposition of fines, civil or criminal penalties, and/or termination of the Company’s rights to participate in federal and state-sponsored programs and suspension or revocation of the Company’s licenses. The Company believes that it is in material compliance with all applicable laws and regulations. |
Segment Information
Segment Information | 12 Months Ended |
Dec. 31, 2021 | |
Segment Reporting [Abstract] | |
Segment Information | Segment Information The Company's reporting segments include (1) home health services, (2) hospice services, (3) home and community-based services, (4) facility-based services and (5) healthcare innovations (“HCI”). The accounting policies of the segments are the same as those described in the summary of significant accounting policies, as described in Note 2 to the Consolidated Financial Statements included in this Annual Report on Form 10-K. Reportable segments have been identified based upon how management has organized the business by services provided to customers and how the chief operating decision maker manages the business and allocates resources, consistent with the criteria in ASC 280, Segment Reporting. The following tables summarize the Company’s segment information for the twelve months ended December 31, 2021, 2020 and 2019 (amounts in thousands): Year Ended December 31, 2021 Home Health Hospice Home and Community-Based Facility-Based HCI Total Net service revenue $ 1,551,542 $ 311,218 $ 189,561 $ 132,098 $ 35,203 $ 2,219,622 Cost of service revenue (excluding depreciation and amortization) 901,685 194,895 137,852 89,270 12,907 1,336,609 General and administrative expenses 501,132 89,693 46,724 45,304 13,582 696,435 Impairment of intangibles and other 937 — — — — 937 Operating income (loss) 147,788 26,630 4,985 (2,476) 8,714 185,641 Interest expense (3,103) (529) (413) (208) (85) (4,338) Income (loss) before income taxes and noncontrolling interests 144,685 26,101 4,572 (2,684) 8,629 181,303 Income tax expense (benefit) 30,089 5,344 1,069 (919) 2,104 37,687 Net income (loss) 114,596 20,757 3,503 (1,765) 6,525 143,616 Less net income (loss) attributable to noncontrolling interests 22,060 4,297 467 1,105 (41) 27,888 Net income (loss) attributable to LHC Group, Inc.’s common stockholders $ 92,536 $ 16,460 $ 3,036 $ (2,870) $ 6,566 $ 115,728 Total assets $ 1,719,403 $ 786,671 $ 239,314 $ 85,005 $ 65,228 $ 2,895,621 Year Ended December 31, 2020 Home Health Hospice Home and Community-Based Facility-Based HCI Total Net service revenue $ 1,463,779 $ 243,806 $ 194,584 $ 128,578 $ 32,457 $ 2,063,204 Cost of service revenue (excluding depreciation and amortization) 848,663 150,675 150,378 85,827 14,860 1,250,403 General and administrative expenses 464,568 66,454 45,443 43,435 12,947 632,847 Impairment of intangibles and other 1,249 600 — — — 1,849 Operating income (loss) 149,299 26,077 (1,237) (684) 4,650 178,105 Interest expense (2,856) (469) (390) (297) (117) (4,129) Income (loss) before income taxes and noncontrolling interests 146,443 25,608 (1,627) (981) 4,533 173,976 Income tax expense (benefit) 30,435 4,925 (357) (185) 1,225 36,043 Net income (loss) 116,008 20,683 (1,270) (796) 3,308 137,933 Less net income (loss) attributable to noncontrolling interests 20,525 4,822 (171) 1,193 (32) 26,337 Net income (loss) attributable to LHC Group, Inc.’s common stockholders $ 95,483 $ 15,861 $ (1,099) $ (1,989) $ 3,340 $ 111,596 Total assets $ 1,741,044 $ 301,475 $ 263,708 $ 103,401 $ 73,726 $ 2,483,354 Year Ended December 31, 2019 Home Health Hospice Home and Community-Based Facility-Based HCI Total Net service revenue $ 1,503,393 $ 226,922 $ 208,455 $ 111,809 $ 29,662 $ 2,080,241 Cost of service revenue (excluding depreciation and amortization) 939,035 140,177 157,817 73,274 14,584 1,324,887 General and administrative expenses 437,276 61,190 44,025 38,358 15,157 596,006 Impairment of intangibles and other 7,443 291 — — — 7,734 Operating income (loss) 119,639 25,264 6,613 177 (79) 151,614 Interest expense (7,762) (1,269) (1,112) (678) (334) (11,155) Income (loss) before income taxes and noncontrolling interests 111,877 23,995 5,501 (501) (413) 140,459 Income tax expense (benefit) 21,147 4,353 1,394 (204) (83) 26,607 Net income (loss) 90,730 19,642 4,107 (297) (330) 113,852 Less net income (loss) attributable to noncontrolling interests 14,651 3,979 (906) 435 (33) 18,126 Net income (loss) attributable to LHC Group, Inc.’s common stockholders $ 76,079 $ 15,663 $ 5,013 $ (732) $ (297) $ 95,726 Total assets $ 1,486,012 $ 244,105 $ 249,524 $ 91,337 $ 69,317 $ 2,140,295 |
Fair Value of Financial Instrum
Fair Value of Financial Instruments | 12 Months Ended |
Dec. 31, 2021 | |
Fair Value Disclosures [Abstract] | |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying amounts of the Company’s cash, receivables, accounts payable, accrued liabilities, and operating lease right of use assets and liabilities approximate their fair values because of their short maturity. The estimated fair value of intangible assets acquired was calculated using level 3 inputs based on the present value of anticipated future benefits. For the year ended December 31, 2021, the carrying value of the Company’s long-term debt approximates fair value as the interest rates approximates current rates. |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2021 | |
Accounting Policies [Abstract] | |
Use of Estimates | Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles ("US GAAP") requires management to make estimates and assumptions that affect the reported amounts of the Company's accompanying consolidated financial statements and notes to the consolidated financial statements. Actual results could differ from those estimates. |
Principles of Consolidation | Principles of Consolidation The consolidated financial statements include all subsidiaries and entities controlled by the Company through direct ownership of majority interest or controlling member ownership of such entities. Third party equity interests in the consolidated joint ventures are reflected as noncontrolling interests in the Company’s consolidated financial statements. All significant intercompany accounts and transactions have been eliminated in consolidation. All business combinations accounted for under the acquisition method have been included in the consolidated financial statements from the respective dates of acquisition. The Company consolidates equity joint venture entities as the Company has controlling interests, has voting control over these entities, or has ability to exercise significant influence in these entities. The members of the Company's equity joint ventures participate in profits and losses in proportion to their equity interests. The Company, through wholly owned subsidiaries, leases home health licenses necessary to operate certain of its home nursing and hospice agencies. As with wholly owned subsidiaries, the Company owns 100% of the equity of these entities and consolidates them based on such ownership. |
Revenue Recognition | Revenue Recognition Basis of Presentation Net service revenue from contracts with customers is recognized in the period the performance obligations are satisfied under the Company's contracts by transferring the requested services to patients in amounts that reflect the consideration to which is expected to be received in exchange for providing patient care, which is the transaction price allocated to the services provided in accordance with Topic 606 and ASU 2015-14 , Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"). Net service revenue is recognized as performance obligations are satisfied, which can vary depending on the type of services provided. The performance obligation is the delivery of patient care in accordance with the requested services outlined in physicians' orders, which are based on specific goals for each patient. The performance obligations are associated with contracts in duration of less than one year; therefore, the optional exemption provided by ASC 606 was elected resulting in the Company not being required to disclose the aggregate amount of the transaction price allocated to the performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The Company's unsatisfied or partially unsatisfied performance obligations are primarily completed when the patients are discharged and typically occur within days or weeks of the end of the period. The Company determines the transaction price based on gross charges for services provided, reduced by explicit price concessions and estimates for implicit price concessions. Explicit price concessions include contractual adjustments provided to patients and third-party payors. Implicit price concessions include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from regulatory reviews, audits, billing reviews and other matters. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (i.e. change in credit risk) are recorded as a provision for doubtful accounts within general and administrative expenses. Explicit price concessions are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Implicit price concessions are recorded for self-pay, uninsured patients and other payors by major payor class based on historical collection experience, and current business and economic conditions, representing the difference between amounts billed and amounts expected to be collected. The Company assesses the ability to collect for the healthcare services provided at the time of patient admission based on the verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and reviews. The Company has determined estimates for price concessions related to regulatory reviews based on historical experience and success rates in the claim appeals and adjudication process. Revenue is recorded at amounts estimated to be realizable for services provided. Medicare The following describes the payment models in effect during the twelve months ended December 31, 2021. Such payment models have been subject to temporary adjustments made by CMS in response to COVID-19 pandemic as described elsewhere in this Annual Report on Form 10-K. The 2% sequestration reduction adjustment was suspended for patient claims with dates of service that began May 1, 2020 through December 31, 2021. Home Health Services The Company records revenue as services are provided under the Patient Driven Groupings Model ("PDGM"). For each 30-day period, the patient is classified into one of 432 home health resource groups prior to receiving services. Each 30-day period is placed into a subgroup falling under the following categories: (i) timing being early or late, (ii) admission source being community or institutional, (iii) one of 12 clinical groupings based on the patient's principal diagnosis, (iv) functional impairment level of low, medium, or high, and (v) a co-morbidity adjustment of none, low, or high based on the patient's secondary diagnoses. Each 30-day period payment from Medicare reflects base payment adjustments for case-mix and geographic wage differences. In addition, payments may reflect one of three retroactive adjustments to the total reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment whereby the number of visits is dependent on the clinical grouping; and/or (c) a partial payment if the patient transferred to another provider or from another provider before completing the episode. The retroactive adjustments outlined above are recognized in net service revenue when the event causing the adjustment occurs and during the period in which the services are provided to the patient. The Company reviews these adjustments to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustments is subsequently resolved. Net service revenue and related patient accounts receivable are recorded at amounts estimated to be realized from Medicare for services rendered. Hospice Services The Company records revenue based upon the date of service at amounts equal to the estimated payment rates. The Company receives one of four predetermined daily rates based upon the level of care provided by the Company, which can be routine care, general inpatient care, continuous home care, and respite care. There are two separate payment rates for routine care: payment for the first 60-days of care and care beyond 60-days. In addition to the two routine rates, the Company may also receive a service intensity add-on ("SIA"). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. Adjustments to Medicare revenue are made from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of these adjustments based on our historical experience. Hospice payments are subject to variable consideration through an inpatient cap and an overall Medicare payment cap. The inpatient cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from inpatient care services and the overall Medicare payment cap relates to individual programs receiving reimbursements in excess of a “cap amount,” determined by Medicare to be payment equal to 12 months of hospice care for the aggregate base of hospice patients, indexed for inflation. The determination for each cap is made annually based on the 12-month period ending on September 30 of each year. The Company monitors its limits on a provider-by-provider basis and records an estimate of its liability for reimbursements received in excess of the cap amount, if any, in the reporting period. Facility-Based Services Gross revenue is recorded as services are provided under the LTACH prospective payment system. Each patient is assigned a long-term care diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare LTACH patient classified in that particular long-term care diagnosis-related group. For selected LTACH patients, the amount may be further adjusted based on length-of-stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for LTACH claims paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Net service revenue adjustments resulting from reviews and audits of Medicare cost report settlements are considered implicit price concessions for LTACHs and are measured at expected value. Non-Medicare Revenue Other sources of net service revenue for all segments fall into Medicaid, managed care or other payors of the Company's services. Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized for Medicaid services as services are provided based on this fee schedule. The Company's managed care and other payors reimburse the Company based upon a predetermined fee schedule or an episodic basis, depending on the terms of the applicable contract. Accordingly, the Company recognizes revenue from managed care and other payors as services are provided, such costs are incurred, and estimates of expected payments are known for each different payer, thus the Company's revenue is recorded at the estimated transaction price. |
Patient Accounts Receivable | Patient Accounts Receivable The Company reports patient accounts receivable from services rendered at their estimated transaction price, which includes price concessions based on the amounts expected to be due from payors. The Company's patient accounts receivable is uncollateralized and primarily consist of amounts due from Medicare, Medicaid, other third-party payors, and to a lesser degree patients. The credit risk from other payors is limited due to the significance of Medicare as the primary payor. The Company believes the credit risk associated with its Medicare accounts is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The Company does not believe that there are any other significant concentrations from any particular payor that would subject it to any significant credit risk in the collection of patient accounts receivable. |
Business Combinations | Business CombinationsThe Company accounts for its acquisitions in accordance with ASC 805, "Business Combinations" ("ASC 805") using the acquisition method of accounting. Assets typically acquired consist primarily of Medicare licenses, trade names, certificates of need, and/or non-compete agreements. The assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is also measured and recorded at fair value as of the acquisition date. Goodwill represents the excess of the cost of an acquired entity over the net amounts assigned to assets acquired and liabilities assumed. The operations of the acquisitions are included in the consolidated financial statements from their respective dates of acquisition. |
Insurance Programs | Insurance Programs The Company bears significant risk under its large-deductible workers’ compensation insurance program and its self-insured employee health program. Under the workers’ compensation insurance program, the Company bears risk up to $1.0 million per incident, after which stop-loss coverage is maintained. The Company purchases stop-loss insurance for the employee health plan and bear risk up to $0.5 million per incident. Malpractice and general patient liability claims for incidents which may give rise to litigation have been asserted against the Company by various claimants. The claims are in various stages of processing and some may ultimately be brought to trial. The Company currently carries professional liability insurance coverage on a claims made basis and general liability insurance coverage on an occurrence basis for this exposure with a $0.3 million deductible. The Company also carries Directors and Officers coverage (also on a claims made basis) for potential claims against the Company’s directors and officers, including securities actions, with a deductible of $2.5 million. |
Goodwill | Goodwill Goodwill represents the excess of amounts paid for acquisitions over the fair value of net identifiable assets acquired less liabilities assumed. The Company assigns assets acquired, including goodwill, and liabilities assumed to one or more reporting units as of the date of the acquisition. The Company's reporting units are home health, hospice, home and community-based, LTACHs, and HCI. The LTACHs are incorporated in the Company's facility-based operating segment. The other locations within the facility-based segment do not share in the economic benefits of the LTACH reporting unit, and as such, are excluded from the annual impairment testing. Goodwill and purchased intangible assets with indefinite useful live are not amortized. ASC 350, "Intangibles - Goodwill and Other" ("ASC 350") requires that all indefinite-lived intangible assets, such as goodwill, be tested for impairment at least annually or sooner whenever events or changes in circumstances indicate that the asset is impaired. An entity may perform a qualitative assessment to determine whether it is necessary to perform the quantitative impairment test. In assessing whether the asset is impaired, the Company assess all relevant events and circumstances for each of the Company's reporting units. |
Intangible assets: Indefinite-lived assets | Intangible assets: Indefinite-lived assetsThe Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need, and Medicare licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need, and licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the useful lives of these intangible assets and the Company intends to renew and operate the certificates of need and licenses and use the trade names indefinitely. In some cases, the value of licenses and certificates of need is increased by moratoriums in effect. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. The Company performed a qualitative assessment and determined that it is not more likely than not that the fair values of these assets are less than the carrying amounts. |
Intangible assets: Definite-lived assets | Intangible assets: Definite-lived assetsIncluded in intangible assets are definite-lived assets subject to amortization such as non-compete agreements, customer relationships, and defensive assets, which are defined as trade names that are not actively used. Amortization of definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets, ranging from four |
Due to/from Governmental Entities | Due to/from Governmental EntitiesThe Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. Additionally, reimbursements received in excess of hospice cap amounts are recorded in this account, if any. |
Property, Plant and Equipment | Property, Building and Equipment Property, building and equipment are recorded at cost. Property, building and equipment acquired in connection with business combinations are recorded at estimated fair value in accordance with the acquisition method of accounting in accordance with ASC 805. Expenditures that increase capacities or extend useful lives are capitalized to the appropriate property, building and equipment accounts. Costs and related accumulated depreciation associated with assets that are sold or retired are written off and any gain or losses are recorded in operating income. Routine repairs and maintenance costs are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the individual assets. The estimated useful life of buildings is 39 years, while the estimated useful lives of transportation equipment, fixed equipment, office furniture, and computer equipment range from three |
Noncontrolling Interest | Noncontrolling Interest The Company classifies noncontrolling interests of its joint ventures based upon a review of the legal provisions governing the redemption of such interests. In each of the Company’s joint ventures, those provisions are embodied within the joint venture’s operating agreement. For joint ventures with operating agreement provisions that establish an obligation for the Company to purchase the third party partners’ noncontrolling interests other than as a result of events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as redeemable noncontrolling interests in temporary equity. For joint ventures with operating agreement provisions that establish an obligation that the Company purchase the third party partners’ noncontrolling interests, but which obligation is triggered by events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. Additionally, for joint ventures with operating agreement provisions that do not establish an obligation for the Company to purchase the third party partners’ noncontrolling interests (e.g., where the Company has the option, but not the obligation, to purchase the third party partners’ noncontrolling interests), such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. The Company’s equity joint ventures that are classified as redeemable noncontrolling interests are subject to operating agreement provisions that require the Company to purchase the noncontrolling partner’s interest upon the occurrence of certain triggering events, which are defined as the bankruptcy of the partner or the partner’s exclusion from the Medicare or Medicaid programs. These triggering events and the related repurchase provisions are specific to each redeemable equity joint venture, since the triggering of a repurchase obligation for any one redeemable noncontrolling interest in an equity joint venture does not necessarily impact any of the other redeemable noncontrolling interests in other equity joint ventures. Upon the occurrence of a triggering event requiring the purchase of a redeemable noncontrolling interest, the Company would be required to purchase the noncontrolling partner’s interest based upon a valuation methodology set forth in the applicable joint venture agreement. Redeemable noncontrolling interests and nonredeemable noncontrolling interests are initially recorded at their fair value as of the closing date of the transaction establishing the joint venture. Such fair values are determined using various accepted valuation methods, including the income approach, the market approach, the cost approach, and a combination of one or more of these approaches. A number of facts and circumstances concerning the operation of the joint venture are evaluated for each transaction, including (but not limited to) the ability to choose management, control over acquiring or liquidating assets, and control over the joint venture’s strategy and direction, in order to determine the fair value of the noncontrolling interest. Subsequent to the closing date of the transaction establishing the joint venture, recorded values for both redeemable and nonredeemable noncontrolling interests are adjusted at the end of each reporting period for (a) comprehensive income (loss) that is attributed to the noncontrolling interest, which is calculated by multiplying the noncontrolling interest percentage by the comprehensive income (loss) of the joint venture’s operations during the reporting period, (b) dividends paid to the noncontrolling interest partner during the reporting period, and (c) any other transactions that increase or decrease the Company’s ownership interest in the joint venture, as a result of which the Company retains its controlling interest. If the Company determines based upon its analysis as of the end of each reporting period in accordance with authoritative accounting guidance, that it is not probable that an event would occur to otherwise require the redemption of a redeemable noncontrolling interest (i.e., the date for such event is not set or such event is not certain to occur), then the Company does not adjust the recorded amount of such redeemable noncontrolling interest. The carrying amount of each redeemable equity instrument presented in temporary equity as of December 31, 2021 is not less than the initial amount reported for each instrument. The activity of noncontrolling interest-redeemable for the twelve months ended December 31, 2021, 2020 and 2019 is summarized in the Company’s statements of stockholders' equity. Based upon the Company’s evaluation of the redemption provisions concerning redeemable noncontrolling interests as of December 31, 2021, the Company determined in accordance with authoritative accounting guidance that it was not probable that an event otherwise requiring redemption of any redeemable noncontrolling interest would occur (i.e., the date for such event was not set or such event is not certain to occur). Therefore, none of the redeemable noncontrolling interests were identified as mandatorily redeemable interests at such times, and the Company did not record any values in respect of any mandatorily redeemable interests. |
Share-Based Compensation | Stock-Based CompensationThe Company accounts for its stock-based awards in accordance with provisions of ASC 718, "Compensation - Stock Compensation" ("ASC 718"). The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of compensation. In accordance with ASC 718, the expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis over the requisite service period. |
Recently Adopted and Issued Accounting Pronouncements | Recently Adopted Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Simplifications to accounting for income taxes, which removes certain exceptions to the general principles of Topic 740 and adds guidance to reduce complexity in accounting for income taxes. The Company adopted the new guidance effective January 1, 2021. The adoption of the new guidance did not have a material impact to the Company. In March 2020, the FASB issued ASU 2020-04, Facilitation of the Effects of Reference Rate Reform on Financial Reporting, which provides optional expedients and exceptions for applying U.S. GAAP to contracts, hedging relationships and other transactions affected by the transition away from reference rates expected to be discontinued to alternative reference rates. The pronouncement is effective immediately and may be applied prospectively to contract modifications made and hedging relationships entered into on or before December 31, 2022. The adoption of the new guidance did not have an effect on the Company's condensed consolidation financial statements. |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Accounting Policies [Abstract] | |
Schedule of Percentage of Net Service Revenue Earned by Category of Payor | The following table sets forth the percentage of net service revenue earned by category of payor for each segment for the years ending December 31: 2021 2020 2019 Home Health: Medicare 62.1 % 66.8 % 70.2 % Managed Care, Commercial, and Other 37.9 33.2 29.8 100.0 % 100.0 % 100.0 % Hospice: Medicare 94.2 % 93.1 % 92.0 % Managed Care, Commercial, and Other 5.8 6.9 8.0 100.0 % 100.0 % 100.0 % Home and Community-Based: Medicaid 31.5 % 21.4 % 23.2 % Managed Care, Commercial, and Other 68.5 78.6 76.8 100.0 % 100.0 % 100.0 % Facility-Based: Medicare 49.9 % 55.0 % 56.2 % Managed Care, Commercial, and Other 50.1 45.0 43.8 100.0 % 100.0 % 100.0 % Healthcare Innovations: Medicare 12.4 % 19.2 % 21.6 % Managed Care, Commercial, and Other 87.6 80.8 78.4 100.0 % 100.0 % 100.0 % |
Schedules of Percentage of Patient Accounts Receivable by Payor | The following table sets forth the percentage of patient accounts receivable by payor for the years ended December 31: 2021 2020 Medicare 60.3 % 55.3 % Medicaid 7.5 9.2 Managed Care, Commercial, and Other 32.2 35.5 Total patient accounts receivable 100.0 % 100.0 % |
Schedule of Property, Plant and Equipment | The following table describes the Company’s components of property, building and equipment for the years ended December 31, 2021 and 2020 (amounts in thousands): 2021 2020 Land $ 7,339 $ 7,339 Building and leasehold improvements 105,431 40,766 Transportation equipment 19,898 19,821 Fixed equipment 365 365 Office furniture and medical equipment 116,732 104,557 Construction in progress 2,588 48,239 252,353 221,087 Less accumulated depreciation 98,394 82,721 Property, building and equipment, net $ 153,959 $ 138,366 |
Schedule of Shares Used in Computation of Basic and Diluted Per Share Information | The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31, 2021, 2020 and 2019: 2021 2020 2019 Weighted average number of shares outstanding for basic per share calculation 31,195,305 31,092,417 30,932,607 Effect of dilutive potential shares: Nonvested restricted stock 201,353 273,348 277,217 Adjusted weighted average shares for diluted per share calculation 31,396,658 31,365,765 31,209,824 Antidilutive shares 117,238 1,155 157,608 |
Acquisitions, Divestitures, a_2
Acquisitions, Divestitures, and Joint Venture Activities (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Business Combinations [Abstract] | |
Schedule of recognized identified assets acquired and liabilities assumed | The following table summarizes the amounts of the assets acquired and liabilities assumed at the acquisition dates, as well as their fair value at the acquisition dates and the noncontrolling interest acquired during the twelve months ended December 31, 2021 (amounts in thousands): Consideration Cash $ 570,935 Net working capital 890 Fair value of total consideration transferred Recognized amounts of identifiable assets acquired and liabilities assumed Cash $ 1,352 Patient accounts receivable 14,299 Other receivables 209 Prepaid expenses 441 Other current assets 155 Property and equipment 2,614 Trade names 39,942 Certificates of need/licenses 40,221 Non-compete agreements 7,257 Operating lease right of use asset 9,494 Other assets 168 Accounts payable and other accrued liabilities (10,378) Salaries, wages, and benefits payable (7,582) Current operating lease payable (3,600) Amounts due to governmental entities (4,364) Current liabilities - deferred employer payroll tax (1,692) Operating lease payable (5,897) Total identifiable assets and liabilities $ 82,639 Noncontrolling interest 113 Goodwill, including noncontrolling interest of $78 $ 489,299 |
Goodwill and Other Intangible_2
Goodwill and Other Intangibles, Net (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Changes in Goodwill by Segment | The following table summarizes changes in goodwill and other intangibles assets by segment during the twelve months ended December 31, 2021 and 2020 (amounts in thousands): Home Health Hospice Home and community- based Facility-based HCI Total Goodwill Balance as of December 31, 2019 $ 867,924 $ 128,875 $ 166,629 $ 15,682 $ 40,862 $ 1,219,972 Acquisitions 12,025 21,025 134 88 — 33,272 Noncontrolling interest 4,695 2,122 10 — — 6,827 Adjustments and disposals (644) (280) — — — (924) Balance as of December 31, 2020 $ 884,000 $ 151,742 $ 166,773 $ 15,770 $ 40,862 $ 1,259,147 Acquisitions 84,377 404,590 254 — — 489,221 Noncontrolling interest 78 — — — — 78 Adjustments and disposals (20) — — — — (20) Balance as of December 31, 2021 $ 968,435 $ 556,332 $ 167,027 $ 15,770 $ 40,862 $ 1,748,426 Intangibles Assets Balance as of December 31, 2019 $ 219,872 $ 40,590 $ 24,096 $ 5,317 $ 15,681 $ 305,556 Acquisitions 7,193 4,212 127 — — 11,532 Amortization (556) (70) (15) (6) (581) (1,228) Adjustments and disposals (505) — — — — (505) Balance as of December 31, 2020 $ 226,004 $ 44,732 $ 24,208 $ 5,311 $ 15,100 $ 315,355 Acquisitions 13,734 73,026 46 614 — 87,420 Amortization (480) (418) (9) (6) (581) (1,494) Adjustments and disposals (1,279) — — — — (1,279) Balance as of December 31, 2021 $ 237,979 $ 117,340 $ 24,245 $ 5,919 $ 14,519 $ 400,002 |
Schedule of Changes in Intangible Assets, Indefinite | The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2021 and 2020 (amounts in thousands): 2021 2020 Indefinite-lived intangible assets: Trade names $ 207,780 $ 168,700 Certificates of need/licenses 173,955 135,013 Net total $ 381,735 $ 303,713 Definite-lived intangible assets: Trade names Gross carrying amount $ 11,073 $ 10,212 Accumulated amortization (9,606) (9,480) Net total $ 1,467 $ 732 Non-compete agreements Gross carrying amount $ 14,524 $ 7,267 Accumulated amortization (7,172) (6,387) Net total $ 7,352 $ 880 Customer relationships Gross carrying amount $ 11,822 $ 11,822 Accumulated amortization (2,374) (1,792) Net total $ 9,448 $ 10,030 Total definite-lived intangible assets Gross carrying amount $ 37,419 $ 29,301 Accumulated amortization (19,152) (17,659) Net total $ 18,267 $ 11,642 Total intangible assets: Gross carrying amount $ 419,154 $ 333,014 Accumulated amortization (19,152) (17,659) Net total $ 400,002 $ 315,355 |
Schedule of Changes in Intangible Assets, Finite | The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2021 and 2020 (amounts in thousands): 2021 2020 Indefinite-lived intangible assets: Trade names $ 207,780 $ 168,700 Certificates of need/licenses 173,955 135,013 Net total $ 381,735 $ 303,713 Definite-lived intangible assets: Trade names Gross carrying amount $ 11,073 $ 10,212 Accumulated amortization (9,606) (9,480) Net total $ 1,467 $ 732 Non-compete agreements Gross carrying amount $ 14,524 $ 7,267 Accumulated amortization (7,172) (6,387) Net total $ 7,352 $ 880 Customer relationships Gross carrying amount $ 11,822 $ 11,822 Accumulated amortization (2,374) (1,792) Net total $ 9,448 $ 10,030 Total definite-lived intangible assets Gross carrying amount $ 37,419 $ 29,301 Accumulated amortization (19,152) (17,659) Net total $ 18,267 $ 11,642 Total intangible assets: Gross carrying amount $ 419,154 $ 333,014 Accumulated amortization (19,152) (17,659) Net total $ 400,002 $ 315,355 |
Schedule of Estimated Intangible Asset Amortization Expense | The estimated intangible asset amortization expense for each of the five years subsequent to December 31, 2021 is as follows (amounts in thousands): Year Amortization amount 2022 $ 3,696 2023 2,524 2024 2,098 2025 1,790 2026 1,578 Total $ 11,686 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |
Significant Components of Deferred Tax Assets and Liabilities | Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2021 and 2020 were as follows (amounts in thousands): 2021 2020 Deferred tax assets: Allowance for uncollectible accounts $ 8,394 $ 8,065 Accrued employee benefits 7,533 8,247 Stock compensation 2,735 2,373 Accrued self-insurance 6,626 6,596 Acquisition costs 2,631 1,635 Net operating loss carry forward 5,245 6,084 Intangible asset impairment 6 10 Lease payable 23,220 25,667 Government stimulus advance 21,591 19,114 Payroll tax 5,895 11,750 Other 312 285 Gross deferred tax assets 84,188 89,826 Less: valuation allowance (3,121) (3,876) Net deferred tax assets $ 81,067 $ 85,950 Deferred tax liabilities: Amortization of intangible assets (100,339) (85,826) Tax depreciation in excess of book depreciation (17,584) (14,065) Prepaid expenses (1,733) (1,538) Non-accrual experience accounting method (829) (743) Right of use asset (22,781) (25,202) Other (7,827) (5,813) Deferred tax liabilities (151,093) (133,187) Net deferred tax liability $ (70,026) $ (47,237) |
Components of the Company’s Income Tax Expense | The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, for the twelve months ended December 31, were as follows (amounts in thousands): 2021 2020 2019 Current: Federal $ 10,746 $ 37,253 $ 4,678 State 4,220 12,232 3,528 14,966 49,485 8,206 Deferred: Federal 17,699 (10,800) 14,549 State 5,022 (2,642) 3,852 22,721 (13,442) 18,401 Total income tax expense $ 37,687 $ 36,043 $ 26,607 |
Statutory Rate and Provisions for Income Taxes | A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each of the twelve months ended December 31, were as follows: 2021 2020 2019 Federal statutory tax rate 21.0 % 21.0 % 21.0 % State income taxes, net of federal benefit 4.8 5.2 4.8 Nondeductible expenses 1.4 1.9 1.8 Uncertain tax position 0.1 1.5 (0.9) Cares Act Enactment — (2.9) — Excess tax benefit (1.5) (1.7) (2.5) Credits and other (1.2) (0.6) (2.5) % Effective tax rate 24.6 % 24.4 % 21.7 % |
Schedule of Unrecognized Tax Benefits | A reconciliation of the total amounts of unrecognized tax benefits follows: Unrecognized tax benefits As of January 1, 2020 $ 3,867 Acquired unrecognized tax position — Increased (decreased) in unrecognized tax benefits as a result of: Tax positions taken in the current year 2,391 Lapse of statute of limitations (55) As of December 31, 2020 $ 6,203 Increased (decreased) in unrecognized tax benefits as a result of: Tax positions taken in the current year 1,244 Lapse of statute of limitations (127) As of December 31, 2021 $ 7,320 |
Debt (Tables)
Debt (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Debt Disclosure [Abstract] | |
Schedule of Principal Payments on Long-Term Debt | The scheduled principal payments on long-term debt for each of the five years subsequent to December 31, 2021 is as follows (amounts in thousands): Year Principal payment amount 2022 $ — 2023 — 2024 — 2025 — 2026 661 Total $ 661 |
Stockholders' Equity (Tables)
Stockholders' Equity (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Equity [Abstract] | |
Schedule of Share Grants Activity | The following table represents the share grants stock activity for the year ended December 31, 2021: Nonvested stock Options Number of Weighted average Number of Weighted average Share grants outstanding at December 31, 2020 469,631 $ 89.69 74,235 $ 42.07 Granted 126,420 186.08 — — Vested or exercised (180,235) 186.86 — — Share grants outstanding at December 31, 2021 415,816 $ 122.40 74,235 $ 42.07 |
Schedule of Stock Options | The following table represents the share grants stock activity for the year ended December 31, 2021: Nonvested stock Options Number of Weighted average Number of Weighted average Share grants outstanding at December 31, 2020 469,631 $ 89.69 74,235 $ 42.07 Granted 126,420 186.08 — — Vested or exercised (180,235) 186.86 — — Share grants outstanding at December 31, 2021 415,816 $ 122.40 74,235 $ 42.07 |
Schedule of Stock Option Outstanding, by Exercise Price Range | The following table summarizes information about stock options outstanding and exercisable at December 31, 2021: Range of Exercise Price Shares Wtd. Avg. Remaining Contractual Life Wtd. Avg. Exercise Price $0.00 - $30.00 15,737 2.05 $ 26.11 $30.01 - $40.00 20,609 4.18 $ 39.38 Over $40.00 37,889 5.16 $ 47.74 74,235 4.00 $ 42.07 |
Summary of Shares Issued Under Employee Stock Purchase Plan | The following table represents the shares issued during 2021, 2020, and 2019, under the Employee Stock Purchase Plan: Number of Weighted Average Shares available as of December 31, 2018 152,344 Shares issued in 2019 19,895 $ 103.84 Shares issued in 2020 14,313 $ 152.10 Shares issued in 2021 13,792 $ 186.20 Shares available as of December 31, 2021 104,344 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Leases [Abstract] | |
Assets And Liabilities, Lessee | The following table summarizes the operating lease right of use assets and related lease payables in the consolidated balance sheets at December 31, 2021 and 2020 (amounts in thousands): December 31, 2021 December 31, 2020 Operating lease right of use asset $ 113,399 $ 100,046 Current operating lease payable $ 37,630 $ 32,676 Long-term operating lease payable $ 78,688 $ 70,275 |
Lease, Cost | The components of lease costs for operating leases for the years ended December 31, 2021, 2020 and 2019 were as follows: (amounts in thousands): 2021 2020 2019 Operating lease cost $ 51,080 $ 47,288 $ 45,595 Short-term lease cost 3,480 4,273 3,243 Variable lease cost 4,013 4,187 3,879 Total lease costs $ 58,573 $ 55,748 $ 52,717 |
Lessee, Operating Lease, Liability, Maturity | Maturities of operating lease payables as of December 31, 2021 were as follows (amounts in thousands): Year Total 2022 $ 41,605 2023 32,035 2024 22,660 2025 15,485 Thereafter 14,057 Total future minimum lease payments 125,842 Less: Imputed interest (9,524) Total $ 116,318 |
Segment Information (Tables)
Segment Information (Tables) | 12 Months Ended |
Dec. 31, 2021 | |
Segment Reporting [Abstract] | |
Schedule of Segment Information | The following tables summarize the Company’s segment information for the twelve months ended December 31, 2021, 2020 and 2019 (amounts in thousands): Year Ended December 31, 2021 Home Health Hospice Home and Community-Based Facility-Based HCI Total Net service revenue $ 1,551,542 $ 311,218 $ 189,561 $ 132,098 $ 35,203 $ 2,219,622 Cost of service revenue (excluding depreciation and amortization) 901,685 194,895 137,852 89,270 12,907 1,336,609 General and administrative expenses 501,132 89,693 46,724 45,304 13,582 696,435 Impairment of intangibles and other 937 — — — — 937 Operating income (loss) 147,788 26,630 4,985 (2,476) 8,714 185,641 Interest expense (3,103) (529) (413) (208) (85) (4,338) Income (loss) before income taxes and noncontrolling interests 144,685 26,101 4,572 (2,684) 8,629 181,303 Income tax expense (benefit) 30,089 5,344 1,069 (919) 2,104 37,687 Net income (loss) 114,596 20,757 3,503 (1,765) 6,525 143,616 Less net income (loss) attributable to noncontrolling interests 22,060 4,297 467 1,105 (41) 27,888 Net income (loss) attributable to LHC Group, Inc.’s common stockholders $ 92,536 $ 16,460 $ 3,036 $ (2,870) $ 6,566 $ 115,728 Total assets $ 1,719,403 $ 786,671 $ 239,314 $ 85,005 $ 65,228 $ 2,895,621 Year Ended December 31, 2020 Home Health Hospice Home and Community-Based Facility-Based HCI Total Net service revenue $ 1,463,779 $ 243,806 $ 194,584 $ 128,578 $ 32,457 $ 2,063,204 Cost of service revenue (excluding depreciation and amortization) 848,663 150,675 150,378 85,827 14,860 1,250,403 General and administrative expenses 464,568 66,454 45,443 43,435 12,947 632,847 Impairment of intangibles and other 1,249 600 — — — 1,849 Operating income (loss) 149,299 26,077 (1,237) (684) 4,650 178,105 Interest expense (2,856) (469) (390) (297) (117) (4,129) Income (loss) before income taxes and noncontrolling interests 146,443 25,608 (1,627) (981) 4,533 173,976 Income tax expense (benefit) 30,435 4,925 (357) (185) 1,225 36,043 Net income (loss) 116,008 20,683 (1,270) (796) 3,308 137,933 Less net income (loss) attributable to noncontrolling interests 20,525 4,822 (171) 1,193 (32) 26,337 Net income (loss) attributable to LHC Group, Inc.’s common stockholders $ 95,483 $ 15,861 $ (1,099) $ (1,989) $ 3,340 $ 111,596 Total assets $ 1,741,044 $ 301,475 $ 263,708 $ 103,401 $ 73,726 $ 2,483,354 Year Ended December 31, 2019 Home Health Hospice Home and Community-Based Facility-Based HCI Total Net service revenue $ 1,503,393 $ 226,922 $ 208,455 $ 111,809 $ 29,662 $ 2,080,241 Cost of service revenue (excluding depreciation and amortization) 939,035 140,177 157,817 73,274 14,584 1,324,887 General and administrative expenses 437,276 61,190 44,025 38,358 15,157 596,006 Impairment of intangibles and other 7,443 291 — — — 7,734 Operating income (loss) 119,639 25,264 6,613 177 (79) 151,614 Interest expense (7,762) (1,269) (1,112) (678) (334) (11,155) Income (loss) before income taxes and noncontrolling interests 111,877 23,995 5,501 (501) (413) 140,459 Income tax expense (benefit) 21,147 4,353 1,394 (204) (83) 26,607 Net income (loss) 90,730 19,642 4,107 (297) (330) 113,852 Less net income (loss) attributable to noncontrolling interests 14,651 3,979 (906) 435 (33) 18,126 Net income (loss) attributable to LHC Group, Inc.’s common stockholders $ 76,079 $ 15,663 $ 5,013 $ (732) $ (297) $ 95,726 Total assets $ 1,486,012 $ 244,105 $ 249,524 $ 91,337 $ 69,317 $ 2,140,295 |
Organization - Narrative (Detai
Organization - Narrative (Details) | 12 Months Ended |
Dec. 31, 2021statesegmentserviceProvider | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Number of segments | segment | 5 |
Number of service providers | serviceProvider | 970 |
Number of states in which entity operates | state | 37 |
Organization - COVID-19 (Detail
Organization - COVID-19 (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Adjustments Due to Legislation [Line Items] | |||
Proceeds from provider relief funds | $ 93,300 | ||
Provider relief funds returned | $ 93,300 | ||
Contract liabilities - deferred revenue | 106,489 | 317,962 | |
Recoupment of Fund | 211,500 | ||
Net service revenue | 2,219,622 | 2,063,204 | $ 2,080,241 |
Sequestration Payment Adjustment | |||
Adjustments Due to Legislation [Line Items] | |||
Net service revenue | 26,800 | 18,100 | |
Suspension of LTACH | |||
Adjustments Due to Legislation [Line Items] | |||
Net service revenue | 25,700 | 19,200 | |
Due From Legislation | |||
Adjustments Due to Legislation [Line Items] | |||
Employee-related liabilities | $ 51,900 | ||
Deferred taxes related to acquisition | 1,700 | ||
Other Current Liabilities | Due From Legislation | |||
Adjustments Due to Legislation [Line Items] | |||
Provider relief funds returned | 26,800 | ||
Employee-related liabilities | $ 26,800 |
Summary of Significant Accoun_4
Summary of Significant Accounting Policies - Percentage of Net Service Revenue Earned by Category of Payor (Detail) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Home health | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 100.00% | 100.00% | 100.00% |
Home health | Medicare | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 62.10% | 66.80% | 70.20% |
Home health | Managed Care, Commercial, and Other | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 37.90% | 33.20% | 29.80% |
Hospice | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 100.00% | 100.00% | 100.00% |
Hospice | Medicare | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 94.20% | 93.10% | 92.00% |
Hospice | Managed Care, Commercial, and Other | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 5.80% | 6.90% | 8.00% |
Home and Community-Based | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 100.00% | 100.00% | 100.00% |
Home and Community-Based | Medicaid | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 31.50% | 21.40% | 23.20% |
Home and Community-Based | Managed Care, Commercial, and Other | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 68.50% | 78.60% | 76.80% |
Facility-Based | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 100.00% | 100.00% | 100.00% |
Facility-Based | Medicare | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 49.90% | 55.00% | 56.20% |
Facility-Based | Managed Care, Commercial, and Other | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 50.10% | 45.00% | 43.80% |
Healthcare Innovations | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 100.00% | 100.00% | 100.00% |
Healthcare Innovations | Medicare | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 12.40% | 19.20% | 21.60% |
Healthcare Innovations | Managed Care, Commercial, and Other | |||
Significant Accounting Policies [Line Items] | |||
Percentage of net service revenue | 87.60% | 80.80% | 78.40% |
Summary of Significant Accoun_5
Summary of Significant Accounting Policies - Additional Information (Detail) | 4 Months Ended | 12 Months Ended | ||
Apr. 30, 2020 | Dec. 31, 2021USD ($)groupseparate_paymentstateadjustmentperiodicRate | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($)state | |
Summary Of Significant Accounting Policies [Line Items] | ||||
Medicare sequestration reduction adjustment | 2.00% | |||
Number of days from date RAP paid to submit final medicare bill | 30 days | |||
Number of medicare home health resource groups | group | 432 | |||
Number of medicare clinical groups | group | 12 | |||
Number of retroactive adjustments | adjustment | 3 | |||
Selected hospice, periodic rates used to calculate revenue | periodicRate | 1 | |||
Number of hospice, periodic rates used to calculate revenue | periodicRate | 4 | |||
Number of separate payment rates | separate_payment | 2 | |||
Percentage subject to inpatient cap | 20.00% | |||
Determination period for hospice Medicare inpatient reimbursement cap | 12 months | |||
Net service revenue | $ 2,219,622,000 | $ 2,063,204,000 | $ 2,080,241,000 | |
Workers' compensation, maximum coverage per incident | 1,000,000 | |||
Maximum coverage per incident | 500,000 | |||
Goodwill impairment loss | 0 | 0 | 0 | |
Disposal related to goodwill associated with closure of underperforming locations | 20,000 | 500,000 | 600,000 | |
Loss on impairment of intangible assets | 0 | 0 | 0 | |
Impairment of long-lived assets | 900,000 | 700,000 | 7,100,000 | |
Disposal related to intangible assets | $ 900,000 | 700,000 | $ 7,100,000 | |
Number of states with Medicare provider enrollments | state | 4 | 4 | ||
Amortization expense | $ 1,500,000 | 1,200,000 | $ 1,300,000 | |
Depreciation expense | 19,400,000 | 20,000,000 | 17,000,000 | |
Interest costs capitalized | $ 1,000,000 | 1,100,000 | ||
Redeemable noncontrolling interests were identified as mandatorily redeemable interests | 0 | |||
General liability | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Deductibles | $ 300,000 | |||
D&O coverage | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Deductibles | $ 2,500,000 | |||
Minimum | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Intangible asset estimated useful life | 4 years | |||
Maximum | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Intangible asset estimated useful life | 16 years | |||
Buildings | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Estimated useful lives | 39 years | |||
Transportation Equipment, Furniture and Other Equipment | Minimum | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Estimated useful lives | 3 years | |||
Transportation Equipment, Furniture and Other Equipment | Maximum | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Estimated useful lives | 15 years | |||
Acquired Assets | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Impairment of long-lived assets | $ 0 | 0 | 0 | |
HCI | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Net service revenue | 35,203,000 | 32,457,000 | 29,662,000 | |
Accountable Care Organizations | HCI | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Net service revenue | $ 12,100,000 | 9,600,000 | $ 2,900,000 | |
Changes in Moratorium Regulations | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Disposal related to intangible assets | 6,100,000 | |||
Underperforming Locations | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Disposal related to intangible assets | $ 1,000,000 |
Summary of Significant Accoun_6
Summary of Significant Accounting Policies - Percentage of Patient Accounts Receivable by Payor (Details) - Customer concentration risk - Accounts Receivable | 12 Months Ended | |
Dec. 31, 2021 | Dec. 31, 2020 | |
Concentration Risk [Line Items] | ||
Concentration risk percentage | 100.00% | 100.00% |
Medicare | ||
Concentration Risk [Line Items] | ||
Concentration risk percentage | 60.30% | 55.30% |
Medicaid | ||
Concentration Risk [Line Items] | ||
Concentration risk percentage | 7.50% | 9.20% |
Managed Care, Commercial, and Other | ||
Concentration Risk [Line Items] | ||
Concentration risk percentage | 32.20% | 35.50% |
Summary of Significant Accoun_7
Summary of Significant Accounting Policies - Components of Property, Building and Equipment (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | $ 252,353 | $ 221,087 |
Less accumulated depreciation | 98,394 | 82,721 |
Property, building and equipment, net | 153,959 | 138,366 |
Land | ||
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | 7,339 | 7,339 |
Building and leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | 105,431 | 40,766 |
Transportation equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | 19,898 | 19,821 |
Fixed equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | 365 | 365 |
Office furniture and medical equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | 116,732 | 104,557 |
Construction in progress | ||
Property, Plant and Equipment [Line Items] | ||
Property, building and equipment, gross | $ 2,588 | $ 48,239 |
Summary of Significant Accoun_8
Summary of Significant Accounting Policies - Shares Used in Computation of Basic and Diluted Per Share Information (Detail) - shares | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Accounting Policies [Abstract] | |||
Weighted average number of shares outstanding for basic per share calculation (in shares) | 31,195,305 | 31,092,417 | 30,932,607 |
Effect of dilutive potential shares: | |||
Nonvested restricted stock (in shares) | 201,353 | 273,348 | 277,217 |
Adjusted weighted average shares for diluted per share calculation (in shares) | 31,396,658 | 31,365,765 | 31,209,824 |
Antidilutive shares (in shares) | 117,238 | 1,155 | 157,608 |
Summary of Significant Accoun_9
Summary of Significant Accounting Policies - Assets Held for Sale (Details) $ in Thousands | 3 Months Ended | 12 Months Ended | ||
Sep. 30, 2021USD ($) | Dec. 31, 2021USD ($) | Dec. 31, 2020USD ($)facility | Dec. 31, 2019USD ($) | |
Summary Of Significant Accounting Policies [Line Items] | ||||
Assets held-for-sale, fair value | $ 1,900 | |||
Proceeds from sale of property held-for-sale | $ 3,200 | |||
Gain on sale of property | $ 1,200 | $ 1,134 | $ (412) | $ (802) |
Hospice Facility | ||||
Summary Of Significant Accounting Policies [Line Items] | ||||
Assets held for sale | facility | 1 |
Summary of Significant Accou_10
Summary of Significant Accounting Policies - Investments (Details) $ in Millions | 12 Months Ended |
Dec. 31, 2021USD ($) | |
Healthcare Analytics Company | |
Summary Of Significant Accounting Policies [Line Items] | |
Contribution for investments, cost | $ 10 |
Jumpstart Nova Fund, LP | |
Summary Of Significant Accounting Policies [Line Items] | |
Contribution for investments, cost | $ 0.1 |
Acquisitions, Divestitures, a_3
Acquisitions, Divestitures, and Joint Venture Activities - Additional Information (Detail) $ in Thousands | Nov. 01, 2021USD ($)locationagencystate | Sep. 01, 2021USD ($)location | Jul. 01, 2021USD ($)location | Dec. 31, 2021USD ($)subsidiaryagencylocation | Dec. 31, 2020USD ($)acquisitionagency | Dec. 31, 2019USD ($)acquisition |
Business Acquisition [Line Items] | ||||||
Acquisitions across number of states | state | 22 | |||||
Number of acquisitions funded | acquisition | 3 | |||||
Goodwill | $ 1,748,426 | $ 1,259,147 | $ 1,219,972 | |||
Partnership Interest | ||||||
Business Acquisition [Line Items] | ||||||
Proceeds from sale of interest | $ 5,100 | |||||
Number of noncontrolling membership interest | acquisition | 2 | |||||
Consideration for joint venture | $ 24,300 | |||||
Cash proceeds from joint venture | $ 4,900 | |||||
Partnership Interest | Home Health Agencies | ||||||
Business Acquisition [Line Items] | ||||||
Number of agencies sold | agency | 7 | |||||
Partnership Interest | Hospice Agencies | ||||||
Business Acquisition [Line Items] | ||||||
Number of agencies sold | agency | 1 | |||||
Partnership Interest | Trade name | ||||||
Business Acquisition [Line Items] | ||||||
Indefinite-lived intangible assets | $ 200 | |||||
Home Health Agency and Facility Based Agency | Discontinued Operations, Disposed of by Sale | ||||||
Business Acquisition [Line Items] | ||||||
Proceeds from sale of interest | 1,500 | |||||
Loss on sale of investments | $ 100 | |||||
Health Agencies, Second Transaction | ||||||
Business Acquisition [Line Items] | ||||||
Number of noncontrolling membership interest | subsidiary | 4 | |||||
Consideration for joint venture | $ 2,100 | |||||
Health Agencies, Second Transaction | Discontinued Operations, Disposed of by Sale | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 2 | |||||
Proceeds from sale of interest | $ 1,900 | |||||
General and Administrative Expense | ||||||
Business Acquisition [Line Items] | ||||||
Transaction costs | 9,100 | |||||
Heart n' Home Hospice | ||||||
Business Acquisition [Line Items] | ||||||
Consideration transferred | $ 50,100 | |||||
Heart n' Home Hospice | Hospice Locations | IDAHO | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 7 | |||||
Heart n' Home Hospice | Hospice Locations | OREGON | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 2 | |||||
Casa de la Luz | ||||||
Business Acquisition [Line Items] | ||||||
Consideration transferred | $ 48,000 | |||||
Casa de la Luz | Hospice Locations and Palliative Care | ARIZONA | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 2 | |||||
Heart of Hospice | ||||||
Business Acquisition [Line Items] | ||||||
Consideration transferred | $ 278,000 | |||||
Heart of Hospice | Hospice Locations | Arkansas, Louisiana, Mississippi, Oklahoma, and South Carolina | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 24 | |||||
Brookdale Health Care Services | ||||||
Business Acquisition [Line Items] | ||||||
Consideration transferred | $ 197,000 | |||||
Cash paid for acquisitions | $ 178,800 | |||||
Brookdale Health Care Services | Hospice Locations | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 11 | |||||
Brookdale Health Care Services | Main Therapy Agencies | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | agency | 13 | |||||
Brookdale Health Care Services | Home Health Locations | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | location | 23 | |||||
Home Health Agencies and Hospice Agency | ||||||
Business Acquisition [Line Items] | ||||||
Consideration transferred | $ 17,800 | |||||
Cash paid for acquisitions | 42,100 | $ 16,400 | ||||
Cash proceeds from joint venture | $ 3,100 | |||||
Home Health Agencies and Hospice Agency | Partnership Interest | ||||||
Business Acquisition [Line Items] | ||||||
Number of noncontrolling membership interest | acquisition | 2 | |||||
Cash proceeds from joint venture | $ 3,900 | |||||
Home Health Agencies and Hospice Agency | Home Health Agency | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | agency | 4 | 13 | ||||
Home Health Agencies and Hospice Agency | Hospice Agency | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | agency | 3 | 6 | ||||
Home Health Agencies and Hospice Agency | Home and Community Based | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | 1 | 4 | ||||
Home Health Agencies and Hospice Agency | Physician Practice | ||||||
Business Acquisition [Line Items] | ||||||
Number of business acquired | acquisition | 1 | |||||
Home Health Agency and Home Community Based Agency | Partnership Interest | ||||||
Business Acquisition [Line Items] | ||||||
Cash paid for acquisitions | $ 6,600 | |||||
Home Health Agencies | Partnership Interest | ||||||
Business Acquisition [Line Items] | ||||||
Proceeds from sale of interest in joint venture | 4,400 | |||||
2020 Acquisitions | ||||||
Business Acquisition [Line Items] | ||||||
Goodwill | 40,100 | |||||
Other assets and (liabilities), net | 500 | |||||
Noncontrolling interest | 9,400 | |||||
2020 Acquisitions | Trade name | ||||||
Business Acquisition [Line Items] | ||||||
Indefinite-lived intangible assets | 4,800 | |||||
2020 Acquisitions | Certificates of need/licenses | ||||||
Business Acquisition [Line Items] | ||||||
Indefinite-lived intangible assets | $ 6,000 |
Acquisitions, Divestitures, a_4
Acquisitions, Divestitures, and Joint Venture Activities - Price Allocation (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Fair value of total consideration transferred | |||
Goodwill | $ 1,748,426 | $ 1,259,147 | $ 1,219,972 |
2021 Acquisitions | |||
Consideration | |||
Cash | 570,935 | ||
Net working capital | 890 | ||
Fair value of total consideration transferred | |||
Cash | 1,352 | ||
Patient accounts receivable | 14,299 | ||
Other receivables | 209 | ||
Prepaid expenses | 441 | ||
Other current assets | 155 | ||
Property and equipment | 2,614 | ||
Operating lease right of use asset | 9,494 | ||
Other assets | 168 | ||
Accounts payable and other accrued liabilities | (10,378) | ||
Salaries, wages, and benefits payable | (7,582) | ||
Current operating lease payable | (3,600) | ||
Amounts due to governmental entities | (4,364) | ||
Current liabilities - deferred employer payroll tax | (1,692) | ||
Operating lease payable | (5,897) | ||
Total identifiable assets and liabilities | 82,639 | ||
Noncontrolling interest | 113 | ||
Goodwill | 489,299 | ||
Goodwill, noncontrolling interest portion | $ 78 | ||
2021 Acquisitions | Non-compete agreements | |||
Fair value of total consideration transferred | |||
Finite-lived intangibles | 7,257 | ||
Trade names | 2021 Acquisitions | |||
Fair value of total consideration transferred | |||
Indefinite-lived intangible assets | 39,942 | ||
Certificates of need/licenses | 2021 Acquisitions | |||
Fair value of total consideration transferred | |||
Indefinite-lived intangible assets | $ 40,221 |
Goodwill and Other Intangible_3
Goodwill and Other Intangibles, Net - Schedule of Changes in Goodwill by Segment (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2021 | Dec. 31, 2020 | |
Goodwill | ||
Balance at beginning of period | $ 1,259,147 | $ 1,219,972 |
Acquisitions | 489,221 | 33,272 |
Noncontrolling interest | 78 | 6,827 |
Adjustments and disposals | (20) | (924) |
Balance at end of period | 1,748,426 | 1,259,147 |
Intangibles Assets | ||
Balance at beginning of period | 315,355 | 305,556 |
Acquisitions | 87,420 | 11,532 |
Amortization | (1,494) | (1,228) |
Adjustments and disposals | (1,279) | (505) |
Balance at end of period | 400,002 | 315,355 |
Home Health | ||
Goodwill | ||
Balance at beginning of period | 884,000 | 867,924 |
Acquisitions | 84,377 | 12,025 |
Noncontrolling interest | 78 | 4,695 |
Adjustments and disposals | (20) | (644) |
Balance at end of period | 968,435 | 884,000 |
Intangibles Assets | ||
Balance at beginning of period | 226,004 | 219,872 |
Acquisitions | 13,734 | 7,193 |
Amortization | (480) | (556) |
Adjustments and disposals | (1,279) | (505) |
Balance at end of period | 237,979 | 226,004 |
Hospice | ||
Goodwill | ||
Balance at beginning of period | 151,742 | 128,875 |
Acquisitions | 404,590 | 21,025 |
Noncontrolling interest | 0 | 2,122 |
Adjustments and disposals | 0 | (280) |
Balance at end of period | 556,332 | 151,742 |
Intangibles Assets | ||
Balance at beginning of period | 44,732 | 40,590 |
Acquisitions | 73,026 | 4,212 |
Amortization | (418) | (70) |
Adjustments and disposals | 0 | 0 |
Balance at end of period | 117,340 | 44,732 |
Home and community- based | ||
Goodwill | ||
Balance at beginning of period | 166,773 | 166,629 |
Acquisitions | 254 | 134 |
Noncontrolling interest | 10 | |
Adjustments and disposals | 0 | 0 |
Balance at end of period | 167,027 | 166,773 |
Intangibles Assets | ||
Balance at beginning of period | 24,208 | 24,096 |
Acquisitions | 46 | 127 |
Amortization | (9) | (15) |
Adjustments and disposals | 0 | 0 |
Balance at end of period | 24,245 | 24,208 |
Facility-based | ||
Goodwill | ||
Balance at beginning of period | 15,770 | 15,682 |
Acquisitions | 0 | 88 |
Noncontrolling interest | 0 | |
Adjustments and disposals | 0 | 0 |
Balance at end of period | 15,770 | 15,770 |
Intangibles Assets | ||
Balance at beginning of period | 5,311 | 5,317 |
Acquisitions | 614 | 0 |
Amortization | (6) | (6) |
Adjustments and disposals | 0 | 0 |
Balance at end of period | 5,919 | 5,311 |
HCI | ||
Goodwill | ||
Balance at beginning of period | 40,862 | 40,862 |
Acquisitions | 0 | 0 |
Noncontrolling interest | 0 | 0 |
Adjustments and disposals | 0 | |
Balance at end of period | 40,862 | 40,862 |
Intangibles Assets | ||
Balance at beginning of period | 15,100 | 15,681 |
Acquisitions | 0 | 0 |
Amortization | (581) | (581) |
Adjustments and disposals | 0 | 0 |
Balance at end of period | $ 14,519 | $ 15,100 |
Goodwill and Other Intangible_4
Goodwill and Other Intangibles, Net - Additional Information (Detail) | 12 Months Ended | ||
Dec. 31, 2021USD ($)state | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($)state | |
Indefinite-lived Intangible Assets [Line Items] | |||
Goodwill impairment loss | $ 0 | $ 0 | $ 0 |
Disposal related to goodwill associated with closure of underperforming locations | 20,000 | 500,000 | 600,000 |
Disposal related to intangible assets | $ 900,000 | 700,000 | 7,100,000 |
Intangible asset impairment | $ 6,100,000 | ||
Number of states with Medicare provider enrollments | state | 4 | 4 | |
Amortization expense | $ 1,500,000 | $ 1,200,000 | $ 1,300,000 |
Closure of Underperforming Locations | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Disposal related to goodwill associated with closure of underperforming locations | $ 1,000,000 | ||
Certificate Of Need | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Disposal related to intangible assets | $ 400,000 | ||
Trade name | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Intangible asset estimated useful life | 7 years 9 months 18 days | 8 years 9 months 18 days | |
Customer relationships | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Intangible asset estimated useful life | 16 years 3 months 18 days | 17 years 3 months 18 days | |
Non-compete agreements | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Intangible asset estimated useful life | 4 years 10 months 24 days | 2 years 10 months 24 days |
Goodwill and Other Intangible_5
Goodwill and Other Intangibles, Net - Schedule of Changes in Intangible Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 |
Indefinite-lived intangible assets: | |||
Indefinite-lived intangible assets | $ 381,735 | $ 303,713 | |
Definite-lived intangible assets: | |||
Gross carrying amount | 37,419 | 29,301 | |
Accumulated amortization | (19,152) | (17,659) | |
Net total | 18,267 | 11,642 | |
Total intangible assets, Gross carrying amount | 419,154 | 333,014 | |
Net total | 400,002 | 315,355 | $ 305,556 |
Trade names | |||
Definite-lived intangible assets: | |||
Gross carrying amount | 11,073 | 10,212 | |
Accumulated amortization | (9,606) | (9,480) | |
Net total | 1,467 | 732 | |
Non-compete agreements | |||
Definite-lived intangible assets: | |||
Gross carrying amount | 14,524 | 7,267 | |
Accumulated amortization | (7,172) | (6,387) | |
Net total | 7,352 | 880 | |
Customer relationships | |||
Definite-lived intangible assets: | |||
Gross carrying amount | 11,822 | 11,822 | |
Accumulated amortization | (2,374) | (1,792) | |
Net total | 9,448 | 10,030 | |
Trade names | |||
Indefinite-lived intangible assets: | |||
Indefinite-lived intangible assets | 207,780 | 168,700 | |
Certificates of need/licenses | |||
Indefinite-lived intangible assets: | |||
Indefinite-lived intangible assets | $ 173,955 | $ 135,013 |
Goodwill and Other Intangible_6
Goodwill and Other Intangibles, Net - Schedule of Intangible Asset Future Amortization Expense (Detail) $ in Thousands | Dec. 31, 2021USD ($) |
Amortization amount | |
2022 | $ 3,696 |
2023 | 2,524 |
2024 | 2,098 |
2025 | 1,790 |
2026 | 1,578 |
Total | $ 11,686 |
Income Taxes - Deferred Tax Ass
Income Taxes - Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Deferred tax assets: | ||
Allowance for uncollectible accounts | $ 8,394 | $ 8,065 |
Accrued employee benefits | 7,533 | 8,247 |
Stock compensation | 2,735 | 2,373 |
Accrued self-insurance | 6,626 | 6,596 |
Acquisition costs | 2,631 | 1,635 |
Net operating loss carry forward | 5,245 | 6,084 |
Intangible asset impairment | 6 | 10 |
Lease payable | 23,220 | 25,667 |
Government stimulus advance | 21,591 | 19,114 |
Payroll tax | 5,895 | 11,750 |
Other | 312 | 285 |
Gross deferred tax assets | 84,188 | 89,826 |
Less: valuation allowance | (3,121) | (3,876) |
Net deferred tax assets | 81,067 | 85,950 |
Deferred tax liabilities: | ||
Amortization of intangible assets | (100,339) | (85,826) |
Tax depreciation in excess of book depreciation | (17,584) | (14,065) |
Prepaid expenses | (1,733) | (1,538) |
Non-accrual experience accounting method | (829) | (743) |
Right of use asset | (22,781) | (25,202) |
Other | (7,827) | (5,813) |
Deferred tax liabilities | (151,093) | (133,187) |
Net deferred tax liability | $ (70,026) | $ (47,237) |
Income Taxes - Components of th
Income Taxes - Components of the Company’s Income Tax Expense (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Current: | |||
Federal | $ 10,746 | $ 37,253 | $ 4,678 |
State | 4,220 | 12,232 | 3,528 |
Total Current | 14,966 | 49,485 | 8,206 |
Deferred: | |||
Federal | 17,699 | (10,800) | 14,549 |
State | 5,022 | (2,642) | 3,852 |
Total Deferred | 22,721 | (13,442) | 18,401 |
Total income tax expense | $ 37,687 | $ 36,043 | $ 26,607 |
Income Taxes - Statutory Rate a
Income Taxes - Statutory Rate and Provisions for Income Taxes Percent (Detail) | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | |||
Federal statutory tax rate | 21.00% | 21.00% | 21.00% |
State income taxes, net of federal benefit | 4.80% | 5.20% | 4.80% |
Nondeductible expenses | 1.40% | 1.90% | 1.80% |
Uncertain tax position | 0.10% | 1.50% | (0.90%) |
Cares Act Enactment | 0.00% | (2.90%) | 0.00% |
Excess tax benefit | (1.50%) | (1.70%) | (2.50%) |
Credits and other | (1.20%) | (0.60%) | (2.50%) |
Effective tax rate | 24.60% | 24.40% | 21.70% |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Operating Loss Carryforwards [Line Items] | |||
Excess tax benefits associated with stock-based compensation arrangements | $ 2,400 | $ 2,400 | |
Valuation allowance, deferred tax asset change | 2,200 | ||
CARES Act Impact, tax benefit | 4,300 | ||
Unrecognized tax benefits, period change | 2,100 | ||
Unrecognized tax benefits | 7,320 | $ 6,203 | $ 3,867 |
Domestic Tax Authority | |||
Operating Loss Carryforwards [Line Items] | |||
Operating loss carryforwards | 5,500 | ||
Valuation allowance | 1,600 | ||
State and Local Jurisdiction | |||
Operating Loss Carryforwards [Line Items] | |||
Operating loss carryforwards | 82,300 | ||
Valuation allowance | $ 49,100 |
Income Taxes - Total Amounts of
Income Taxes - Total Amounts of Unrecognized Tax (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2021 | Dec. 31, 2020 | |
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward] | ||
Beginning balance | $ 6,203 | $ 3,867 |
Acquired unrecognized tax position | 0 | |
Increased (decreased) in unrecognized tax benefits as a result of: | ||
Tax positions taken in the current year | 1,244 | 2,391 |
Lapse of statute of limitations | (127) | (55) |
Ending balance | $ 7,320 | $ 6,203 |
Debt - Additional Information (
Debt - Additional Information (Details) | Aug. 03, 2021USD ($) | Dec. 31, 2021USD ($)instrument | Dec. 31, 2021USD ($) | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($) | Apr. 02, 2018USD ($) |
Debt Instrument [Line Items] | ||||||
Line of credit facility drawn | $ 661,197,000 | $ 661,197,000 | ||||
Line of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Maximum borrowing capacity | $ 500,000,000 | |||||
Credit facility maximum borrowing capacity under accordion feature | 200,000,000 | |||||
Line of Credit | 2021 Amended Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Maximum borrowing capacity | $ 800,000,000 | 1,000,000,000 | 1,000,000,000 | |||
Credit facility maximum borrowing capacity under accordion feature | 500,000,000 | $ 300,000,000 | $ 300,000,000 | |||
Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Letter of credit, sub-limit amount | $ 50,000,000 | |||||
Interest rate percentage | 1.81% | 1.81% | ||||
Line of credit facility drawn | $ 661,200,000 | $ 661,200,000 | $ 20,000,000 | $ 20,000,000 | ||
Letter of credit outstanding | $ 24,300,000 | $ 24,300,000 | $ 25,400,000 | |||
Letter of Credit | 2021 Amended Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Letter of credit, sub-limit amount | $ 75,000,000 | |||||
Minimum | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Commitment fee rates for unused commitments | 0.15% | |||||
Maximum | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Commitment fee rates for unused commitments | 0.30% | |||||
London Interbank Offered Rate (LIBOR) | Minimum | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility interest rate | 1.25% | |||||
London Interbank Offered Rate (LIBOR) | Maximum | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility interest rate | 2.00% | |||||
Base rate | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility interest rate | 3.75% | |||||
Base rate | Minimum | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility interest rate | 0.25% | |||||
Base rate | Maximum | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility interest rate | 1.00% | |||||
Eurodollar | Letter of Credit | Credit Agreement | ||||||
Debt Instrument [Line Items] | ||||||
Line of credit facility interest rate | 1.63% | |||||
Line of credit facility, borrowing outstanding | instrument | 15 |
Debt - Schedule of Principal Pa
Debt - Schedule of Principal Payments on Long-Term Debt (Detail) $ in Thousands | Dec. 31, 2021USD ($) |
Principal payment amount | |
2022 | $ 0 |
2023 | 0 |
2024 | 0 |
2025 | 0 |
2026 | 661 |
Total | $ 661 |
Stockholders' Equity - Addition
Stockholders' Equity - Additional Information (Details) | Jun. 20, 2013shares | Dec. 31, 2021USD ($)$ / sharesshares | Dec. 31, 2020USD ($)director$ / sharesshares | Dec. 31, 2019USD ($)$ / sharesshares | Dec. 31, 2006shares | Dec. 06, 2021USD ($) | Dec. 31, 2018shares |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Percentage of directors' stock grant vested on one year anniversary date | 100.00% | 100.00% | |||||
Granted (in dollars per share) | $ / shares | $ 186.08 | $ 123.89 | $ 110.56 | ||||
Total unrecognized compensation cost related to nonvested shares of common stock granted | $ | $ 37,300,000 | ||||||
Weighted average period of cost recognized | 2 years 10 months 24 days | ||||||
Fair value of shares vested | $ | $ 14,100,000 | $ 12,200,000 | $ 9,400,000 | ||||
Compensation expense related to nonvested stock grants | $ | $ 15,900,000 | $ 14,300,000 | $ 9,600,000 | ||||
Price of shares issued under employee stock purchase plan as a percentage of FMV | 95.00% | ||||||
Number of shares reserved for the employee stock purchase plan (in shares) | 250,000 | ||||||
Additional shares authorized for issuance (in shares) | 250,000 | ||||||
Shares redeemed to satisfy personal tax obligations (in shares) | 63,028 | 78,767 | 107,461 | ||||
Treasury stock, shares, forfeited for terminated employees | 1,556 | ||||||
Stock repurchase program, authorized amount | $ | $ 250,000,000 | ||||||
Repurchase of common stock (in shares) | 634,869 | ||||||
Treasury stock, value, acquired, cost method | $ | $ 83,700,000 | ||||||
Stock repurchase program, remaining authorized repurchase amount | $ | $ 166,300,000 | ||||||
Employee | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Period of vested shares | 5 years | ||||||
Independent Directors | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Nonvested stock grants to Independent directors (in shares) | 7,200 | 9,900 | 17,880 | ||||
2018 Long-Term Incentive Plan | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Common stock reserved and available for issuance (in shares) | 2,210,544 | ||||||
Common stock available for issuance (in shares) | 1,746,779 | ||||||
Period of vested shares | 5 years | ||||||
2018 Long-Term Incentive Plan | Employee | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Nonvested stock grants to employees (in shares) | 109,985 | 114,680 | 163,250 | ||||
2018 Long-Term Incentive Plan | Consultant | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Nonvested stock grants to employees (in shares) | 5,735 | 10,890 | |||||
Second Amended and Restated 2005 Non-Employee Directors Compensation Plan | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Period of vested shares | 1 year | ||||||
Second Amended and Restated 2005 Non-Employee Directors Compensation Plan | Lead Director | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Nonvested stock grants to Independent directors (in shares) | 3,500 | ||||||
Percentage of directors' stock grant vested on one year anniversary date | 33.33% | ||||||
Percentage of directors stock grant vested on grant date | 33.33% | ||||||
Percentage of directors stock grant vested on two year anniversary date | 33.33% | ||||||
Nonvested stock | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Aggregate intrinsic value, outstanding | $ | $ 7,400,000 | ||||||
Nonvested stock | Independent Directors | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Nonvested stock grants to Independent directors (in shares) | 775 | ||||||
Number of retiring directors | director | 1 |
Stockholders' Equity - Share Gr
Stockholders' Equity - Share Grants Activity (Details) - $ / shares | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Number of Shares | |||
Share grants outstanding, beginning balance (in shares) | 469,631 | ||
Granted (in shares) | 126,420 | ||
Vested or exercised (in shares) | (180,235) | ||
Share grants outstanding, ending balance (in shares) | 415,816 | 469,631 | |
Weighted average grant date fair value | |||
Share grants outstanding, beginning balance (in dollars per share) | $ 89.69 | ||
Granted (in dollars per share) | 186.08 | $ 123.89 | $ 110.56 |
Vested or exercised (in dollars per share) | 186.86 | ||
Share grants outstanding, ending balance (in dollars per share) | $ 122.40 | $ 89.69 | |
Options | |||
Number of Shares | |||
Share grants outstanding, beginning balance (in shares) | 74,235 | ||
Granted (in shares) | 0 | ||
Vested or exercised (in shares) | 0 | ||
Share grants outstanding, ending balance (in shares) | 74,235 | 74,235 | |
Weighted average grant date fair value | |||
Share grants outstanding, beginning balance (in dollars per share) | $ 42.07 | ||
Granted (in dollars per share) | 0 | ||
Vested or exercised (in dollars per share) | 0 | ||
Share grants outstanding, ending balance (in dollars per share) | $ 42.07 | $ 42.07 |
Stockholders' Equity - Schedule
Stockholders' Equity - Schedule of Stock Options Outstanding, by Exercise Price Range (Details) | 12 Months Ended |
Dec. 31, 2021$ / sharesshares | |
$0.00 - $30.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Range of exercise price, lower limit (in dollars per share) | $ 0 |
Range of exercise price, upper limit (in dollars per share) | 30 |
$30.01 - $40.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Range of exercise price, lower limit (in dollars per share) | 30.01 |
Range of exercise price, upper limit (in dollars per share) | 40 |
Over $40.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Range of exercise price, upper limit (in dollars per share) | $ 40 |
Options | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Shares | shares | 74,235 |
Wtd. Avg. Remaining Contractual Life | 4 years |
Wtd. Avg. Exercise Price (in dollars per share) | $ 42.07 |
Options | $0.00 - $30.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Shares | shares | 15,737 |
Wtd. Avg. Remaining Contractual Life | 2 years 18 days |
Wtd. Avg. Exercise Price (in dollars per share) | $ 26.11 |
Options | $30.01 - $40.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Shares | shares | 20,609 |
Wtd. Avg. Remaining Contractual Life | 4 years 2 months 4 days |
Wtd. Avg. Exercise Price (in dollars per share) | $ 39.38 |
Options | Over $40.00 | |
Share-based Payment Arrangement, Option, Exercise Price Range [Line Items] | |
Shares | shares | 37,889 |
Wtd. Avg. Remaining Contractual Life | 5 years 1 month 28 days |
Wtd. Avg. Exercise Price (in dollars per share) | $ 47.74 |
Stockholders' Equity - Shares o
Stockholders' Equity - Shares of Common Stock Issued Under Employee Stock Purchase Plan (Details) - $ / shares | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||
Number of shares available, beginning balance (in shares) | 152,344 | ||
Shares issued during period (in shares) | 13,792 | 14,313 | 19,895 |
Number of shares available, ending balance (in shares) | 104,344 | ||
Weighted average per share price of shares issued (in dollars per share) | $ 186.20 | $ 152.10 | $ 103.84 |
Leases - Additional information
Leases - Additional information (Detail) | Dec. 31, 2021 | Dec. 31, 2019 |
Lessee, Lease, Description [Line Items] | ||
Operating lease term | 5 years | |
Long-term operating lease payable | 3 years 10 months 6 days | 4 years 1 month 24 days |
Weighted average discount rate | 4.22% | 4.51% |
Minimum | ||
Lessee, Lease, Description [Line Items] | ||
Renewal term | 1 year | |
Maximum | ||
Lessee, Lease, Description [Line Items] | ||
Renewal term | 9 years |
Leases - Information Related to
Leases - Information Related to Leases (Details) (Details) - USD ($) $ in Thousands | Dec. 31, 2021 | Dec. 31, 2020 |
Leases [Abstract] | ||
Operating lease right of use asset | $ 113,399 | $ 100,046 |
Current operating lease payable | 37,630 | 32,676 |
Long-term operating lease payable | $ 78,688 | $ 70,275 |
Leases - Lease Cost (Details)
Leases - Lease Cost (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Leases [Abstract] | |||
Operating lease cost | $ 51,080 | $ 47,288 | $ 45,595 |
Short-term lease cost | 3,480 | 4,273 | 3,243 |
Variable lease cost | 4,013 | 4,187 | 3,879 |
Total lease costs | $ 58,573 | $ 55,748 | $ 52,717 |
Leases - Future Minimum Rental
Leases - Future Minimum Rental Commitments Under Non-cancelable Operating Leases (Detail) $ in Thousands | Dec. 31, 2021USD ($) |
Leases [Abstract] | |
2022 | $ 41,605 |
2023 | 32,035 |
2024 | 22,660 |
2025 | 15,485 |
Thereafter | 14,057 |
Total future minimum lease payments | 125,842 |
Less: Imputed interest | (9,524) |
Total | $ 116,318 |
Employee Benefit Plan - Additio
Employee Benefit Plan - Additional Information (Detail) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Share-based Payment Arrangement [Abstract] | |||
Employer contribution as a percentage of employee contributions | 2.00% | ||
Employer contribution | 25.00% | ||
Full vesting period of employer contribution | 4 years | ||
Contribution expenses | $ 12.6 | $ 11.9 | $ 12.2 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Detail) $ in Millions | 12 Months Ended |
Dec. 31, 2021USD ($) | |
Commitments and Contingencies Disclosure [Abstract] | |
Other assets, amount from government payors | $ 16.9 |
Period of joint venture buy/sell option | 30 days |
Segment Information - Summary o
Segment Information - Summary of segment Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract] | |||
Net service revenue | $ 2,219,622 | $ 2,063,204 | $ 2,080,241 |
Cost of service revenue (excluding depreciation and amortization) | 1,336,609 | 1,250,403 | 1,324,887 |
General and administrative expenses | 696,435 | 632,847 | 596,006 |
Impairment of intangibles and other | 937 | 1,849 | 7,734 |
Operating income | 185,641 | 178,105 | 151,614 |
Interest expense | (4,338) | (4,129) | (11,155) |
Income (loss) before income taxes and noncontrolling interests | 181,303 | 173,976 | 140,459 |
Income tax expense (benefit) | 37,687 | 36,043 | 26,607 |
Net income | 143,616 | 137,933 | 113,852 |
Less net income (loss) attributable to noncontrolling interests | 27,888 | 26,337 | 18,126 |
Net income attributable to LHC Group, Inc.’s common stockholders | 115,728 | 111,596 | 95,726 |
Total assets | 2,895,621 | 2,483,354 | 2,140,295 |
Home Health | |||
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract] | |||
Net service revenue | 1,551,542 | 1,463,779 | 1,503,393 |
Cost of service revenue (excluding depreciation and amortization) | 901,685 | 848,663 | 939,035 |
General and administrative expenses | 501,132 | 464,568 | 437,276 |
Impairment of intangibles and other | 937 | 1,249 | 7,443 |
Operating income | 147,788 | 149,299 | 119,639 |
Interest expense | (3,103) | (2,856) | (7,762) |
Income (loss) before income taxes and noncontrolling interests | 144,685 | 146,443 | 111,877 |
Income tax expense (benefit) | 30,089 | 30,435 | 21,147 |
Net income | 114,596 | 116,008 | 90,730 |
Less net income (loss) attributable to noncontrolling interests | 22,060 | 20,525 | 14,651 |
Net income attributable to LHC Group, Inc.’s common stockholders | 92,536 | 95,483 | 76,079 |
Total assets | 1,719,403 | 1,741,044 | 1,486,012 |
Hospice | |||
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract] | |||
Net service revenue | 311,218 | 243,806 | 226,922 |
Cost of service revenue (excluding depreciation and amortization) | 194,895 | 150,675 | 140,177 |
General and administrative expenses | 89,693 | 66,454 | 61,190 |
Impairment of intangibles and other | 0 | 600 | 291 |
Operating income | 26,630 | 26,077 | 25,264 |
Interest expense | (529) | (469) | (1,269) |
Income (loss) before income taxes and noncontrolling interests | 26,101 | 25,608 | 23,995 |
Income tax expense (benefit) | 5,344 | 4,925 | 4,353 |
Net income | 20,757 | 20,683 | 19,642 |
Less net income (loss) attributable to noncontrolling interests | 4,297 | 4,822 | 3,979 |
Net income attributable to LHC Group, Inc.’s common stockholders | 16,460 | 15,861 | 15,663 |
Total assets | 786,671 | 301,475 | 244,105 |
Home and Community-Based | |||
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract] | |||
Net service revenue | 189,561 | 194,584 | 208,455 |
Cost of service revenue (excluding depreciation and amortization) | 137,852 | 150,378 | 157,817 |
General and administrative expenses | 46,724 | 45,443 | 44,025 |
Impairment of intangibles and other | 0 | 0 | 0 |
Operating income | 4,985 | (1,237) | 6,613 |
Interest expense | (413) | (390) | (1,112) |
Income (loss) before income taxes and noncontrolling interests | 4,572 | (1,627) | 5,501 |
Income tax expense (benefit) | 1,069 | (357) | 1,394 |
Net income | 3,503 | (1,270) | 4,107 |
Less net income (loss) attributable to noncontrolling interests | 467 | (171) | (906) |
Net income attributable to LHC Group, Inc.’s common stockholders | 3,036 | (1,099) | 5,013 |
Total assets | 239,314 | 263,708 | 249,524 |
Facility-Based | |||
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract] | |||
Net service revenue | 132,098 | 128,578 | 111,809 |
Cost of service revenue (excluding depreciation and amortization) | 89,270 | 85,827 | 73,274 |
General and administrative expenses | 45,304 | 43,435 | 38,358 |
Impairment of intangibles and other | 0 | 0 | 0 |
Operating income | (2,476) | (684) | 177 |
Interest expense | (208) | (297) | (678) |
Income (loss) before income taxes and noncontrolling interests | (2,684) | (981) | (501) |
Income tax expense (benefit) | (919) | (185) | (204) |
Net income | (1,765) | (796) | (297) |
Less net income (loss) attributable to noncontrolling interests | 1,105 | 1,193 | 435 |
Net income attributable to LHC Group, Inc.’s common stockholders | (2,870) | (1,989) | (732) |
Total assets | 85,005 | 103,401 | 91,337 |
HCI | |||
Segment Reporting, Disclosure of Entity's Reportable Segments [Abstract] | |||
Net service revenue | 35,203 | 32,457 | 29,662 |
Cost of service revenue (excluding depreciation and amortization) | 12,907 | 14,860 | 14,584 |
General and administrative expenses | 13,582 | 12,947 | 15,157 |
Impairment of intangibles and other | 0 | 0 | 0 |
Operating income | 8,714 | 4,650 | (79) |
Interest expense | (85) | (117) | (334) |
Income (loss) before income taxes and noncontrolling interests | 8,629 | 4,533 | (413) |
Income tax expense (benefit) | 2,104 | 1,225 | (83) |
Net income | 6,525 | 3,308 | (330) |
Less net income (loss) attributable to noncontrolling interests | (41) | (32) | (33) |
Net income attributable to LHC Group, Inc.’s common stockholders | 6,566 | 3,340 | (297) |
Total assets | $ 65,228 | $ 73,726 | $ 69,317 |