AAC (AACH) 10-Q 13 May 19 2019 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2019	May 03, 2019
Document And Entity Information [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2019
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q1
Trading Symbol	AAC
Entity Registrant Name	AAC Holdings, Inc.
Entity Central Index Key	0001606180
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Common Stock Shares Outstanding		25,301,901

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Revenues
Total revenues	$ 55,370	$ 81,187
Operating expenses
Salaries, wages and benefits	40,553	40,084
Client related services	6,041	7,747
Advertising and marketing	3,295	2,599
Professional fees	4,122	3,650
Other operating expenses	11,363	10,588
Rentals and leases	2,000	2,116
Litigation settlement	(1,238)	2,791
Depreciation and amortization	4,344	5,464
Gain on sale	(1,010)
Acquisition-related expenses		305
Total operating expenses	69,470	75,344
(Loss) income from operations	(14,100)	5,843
Interest expense, net	10,260	6,709
Other (income) expense, net	(211)	9
Loss before income tax benefit	(24,149)	(875)
Income tax benefit	(33)	(38)
Net loss	(24,116)	(837)
Less: net loss attributable to noncontrolling interest	2,097	1,893
Net (loss) income attributable to AAC Holdings, Inc. common stockholders	$ (22,019)	$ 1,056
Basic (loss) earnings per common share	$ (0.90)	$ 0.04
Diluted (loss) earnings per common share	$ (0.90)	$ 0.04
Weighted-average common shares outstanding:
Basic	24,495,613	23,744,208
Diluted	24,495,613	23,781,604
Client Related Revenue
Revenues
Total revenues	$ 53,489	$ 78,630
Non-Client Related Revenue
Revenues
Total revenues	$ 1,881	$ 2,557

CONDENSED CONSOLIDATED BALANCE

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Current assets
Cash and cash equivalents	$ 17,869	$ 5,409
Accounts receivable, net of allowances	45,684	47,860
Prepaid expenses and other current assets	2,518	10,695
Total current assets	66,071	63,964
Property and equipment, net	163,045	166,921
Right-of-use assets - operating, net	29,442
Goodwill	198,952	198,952
Intangible assets, net	10,834	12,063
Other assets	11,880	10,377
Total assets	480,224	452,277
Current liabilities
Accounts payable	17,167	13,507
Accrued and other current liabilities	29,101	30,544
Accrued litigation	4,827	8,000
Current portion of lease liability - operating	5,076
Current portion of long-term debt	332,925	309,394
Total current liabilities	389,096	361,445
Deferred tax liabilities	1,137	1,227
Long-term debt, net of current portion and deferred financing costs	9,039	9,764
Lease liability - operating, net of current portion	29,411
Financing lease obligation, net of current portion	24,384	24,421
Other long-term liabilities	8,499	13,147
Total liabilities	461,566	410,004
Stockholders’ equity
Common stock, $0.001 par value: 70,000,000 shares authorized, 24,665,545 and 24,573,679 shares issued and outstanding at March 31, 2019 and December 31, 2018, respectively	25	25
Additional paid-in capital	162,463	161,962
Retained deficit	(119,593)	(97,574)
Total stockholders’ equity	42,895	64,413
Noncontrolling interest	(24,237)	(22,140)
Total stockholders’ equity including noncontrolling interest	18,658	42,273
Total liabilities and stockholders’ equity	$ 480,224	$ 452,277

CONDENSED CONSOLIDATED BALANC_2

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Mar. 31, 2019	Dec. 31, 2018
Statement Of Financial Position [Abstract]
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	70,000,000	70,000,000
Common stock, shares issued	24,665,545	24,573,679
Common stock, shares outstanding	24,665,545	24,573,679

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENT OF STOCKHOLDERS' EQUITY - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Retained Deficit	Total Stockholders' Equity of AAC Holdings, Inc.	Non-Controlling Interest
Balance at Dec. 31, 2017	$ 99,458	$ 24	$ 152,430	$ (38,170)	$ 114,284	$ (14,826)
Balance, shares at Dec. 31, 2017		23,872,436
Common stock granted and issued under stock incentive plan, net of forfeitures, amount	798		798		798
Common stock granted and issued under stock incentive plan, net of forfeitures, share		(19,503)
Effect of employee stock purchase plan	221		221		221
Effect of employee stock purchase plan, shares		27,900
Net loss	(837)			1,056	1,056	(1,893)
Balance at Mar. 31, 2018	105,031	$ 24	158,840	(37,114)	121,750	(16,719)
Balance, shares at Mar. 31, 2018		24,438,739
Balance at Dec. 31, 2018	42,273	$ 25	161,962	(97,574)	64,413	(22,140)
Balance, shares at Dec. 31, 2018		24,573,679
Common stock granted and issued under stock incentive plan, net of forfeitures, amount	364		364		364
Common stock granted and issued under stock incentive plan, net of forfeitures, share		(24,666)
Effect of employee stock purchase plan	137		137		137
Effect of employee stock purchase plan, shares		116,532
Net loss	(24,116)			(22,019)	(22,019)	(2,097)
Balance at Mar. 31, 2019	$ 18,658	$ 25	$ 162,463	$ (119,593)	$ 42,895	$ (24,237)
Balance, shares at Mar. 31, 2019		24,665,545

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Cash flows used in operating activities:
Net loss	$ (24,116)	$ (837)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	4,344	5,464
Equity compensation	364	798
Loss on disposal of property and equipment	145	34
Amortization of deferred financing costs	1,243	637
Deferred income tax benefit	(90)	436
Changes in operating assets and liabilities:
Accounts receivable	2,176	(3,843)
Prepaid expenses and other assets	7,808	1,485
Accounts payable	3,660	(4,739)
Accrued and other current liabilities	4,819	4,141
Accrued litigation	(3,173)	(22,300)
Other liabilities	(6,763)	(275)
Net cash used in operating activities	(9,583)	(18,999)
Cash flows used in investing activities:
Purchase of property and equipment	(913)	(7,305)
Acquisition of subsidiaries		(65,185)
Sale of subsidiary	887
Net cash used in investing activities	(26)	(72,490)
Cash flows provided by financing activities:
Proceeds from 2019 Priming Facility, net of deferred financing costs	24,284
Payments on finance leases and other	(291)	(221)
Payment of employee taxes for net share settlement		(475)
Net cash provided by financing activities	22,069	92,012
Net change in cash and cash equivalents	12,460	523
Cash and cash equivalents, beginning of period	5,409	13,818
Cash and cash equivalents, end of period	17,869	14,341
Cash and cash equivalents paid for:
Interest, net of capitalized interest	9,705
Acquisition of equipment through leases	65	975
Accrued purchase of property and equipment		1,208
Accrued employee taxes for net share settlement		14
2017 Credit Facility
Cash flows provided by financing activities:
Payments on 2017 Credit Facility	(1,924)	(1,724)
Proceeds from 2017 Credit Facility, net of deferred financing costs	250	94,432
AdCare, Inc
Cash flows provided by financing activities:
Payments on AdCare Note	$ (250)
2018 Acquisition
Cash and cash equivalents paid for:
Purchase price, including contingent consideration		85,103
Buyer common stock issued		(5,439)
Contingent consideration		(501)
Promissory note issued		(9,636)
Cash acquired		(2,700)
Change in funds held on acquisition		(1,000)
Cash paid for acquisition		$ 65,827

Description of Business

Description of Business	3 Months Ended
	Mar. 31, 2019
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Description of Business	1. AAC Holdings, Inc. (collectively with its subsidiaries, the “Company” or “AAC Holdings”) was incorporated on February 12, 2014. The Company is headquartered in Brentwood, Tennessee, and provides inpatient and outpatient substance use treatment services for individuals with drug addiction, alcohol addiction and co-occurring mental/behavioral health issues. In connection with the Company’s substance use treatment services, the Company performs drug testing, diagnostic laboratory services and provides physician services to clients. T he Company operates numerous facilities located throughout the United States, including inpatient substance abuse treatment facilities, standalone outpatient centers and sober living facilities that focus on delivering effective clinical care and treatment solutions.

Basis of Presentation and Recen

Basis of Presentation and Recently Issued Accounting Pronouncements	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Basis of Presentation and Recently Issued Accounting Pronouncements	2. Principles of Consolidation The Company conducts its business through limited liability companies and C-corporations, each of which is a direct or indirect wholly owned subsidiary of the Company. The accompanying condensed consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries, and the accounts of variable interest entities (“VIEs”) in which the Company is the primary beneficiary. All intercompany transactions and balances have been eliminated in consolidation. The Company consolidated seven professional groups (“Professional Groups”) that constituted VIEs as of March 31, 2019 and 2018. The Professional Groups are responsible for the supervision and delivery of medical services to the Company’s clients, and the Company provides management services to the Professional Groups. Based on the Company’s ability to direct the activities that most significantly impact the economic performance of the Professional Groups, provide necessary funding and the obligation and likelihood of absorbing all expected gains and losses, the Company has determined that it is the primary beneficiary of these Professional Groups. The accompanying condensed consolidated balance sheets as of March 31, 2019 and December 31, 2018 include assets of $1.7 million and $1.5 million, respectively, and liabilities of $0.6 million and $0.6 million, respectively, related to the VIEs. The accompanying condensed consolidated statements of operations include net loss attributable to noncontrolling interest of $2.1 million and $1.9 million for the three months ended March 31, 2019 and 2018, respectively. The accompanying condensed consolidated financial statements are unaudited, with the exception of the December 31, 2018 balance sheet, which is derived from the audited financial statements at that date but does not include all of the information and footnotes required by U.S. generally accepted accounting principles (“GAAP”) for a complete set of financial statements. The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto for the fiscal year ended December 31, 2018 included in the Company’s Annual Report filed with the United States Securities and Exchange Commission (the “SEC” or the “Commission”) on April 15, 2019. Management believes that all adjustments of a normal, recurring nature considered necessary for a fair presentation have been included. In addition, the interim financial information does not necessarily represent or indicate what the operating results will be for the year ending December 31, 2019 for many reasons including, but not limited to, acquisitions, dispositions, capital financing transactions, changes in interest rates and the effects of other trends, risks and uncertainties. Going Concern The Company incurred a loss from operations and had negative cash flows from operations for the year ended December 31, 2018 and the first quarter of 2019, which has contributed to limited liquidity. This resulted primarily from declines in patient census during the second half of 2018 and into the first quarter of 2019. The Company’s revenue is directly impacted by its ability to maintain census, which is dependent on a variety of factors, many of which are outside of the Company’s control, including its referral relationships, average length of stay of its clients, the extent to which third-party payors require preadmission authorization or utilization review controls, competition in the industry, the effectiveness of the Company’s multi-faceted sales and marketing strategy and the individual decisions of the Company’s clients to seek and commit to treatment. On March 8, 2019 the Company entered into an incremental senior credit facility for a principal loan of $30 million which originally matured on March 31, 2020 and was subsequently amended to mature on April 15, 2020. The uncertainties associated with the factors described above raise substantial doubt about the Company's ability to continue as a going concern. In order for the Company to continue operations beyond the next twelve months and to be able to discharge its liabilities and commitments in the normal course of business, the Company must do some or all of the following: (i) improve operating results by increasing census while maintaining efficiency regarding operating expenses through the cost savings initiatives implemented in late 2018 and early 2019; (ii) execute strategic alternatives related to the Company’s real-estate portfolio which could include further sale leasebacks of individual facilities or larger portions of the company’s real estate portfolio (iii) sell additional non-core or non-essential assets; and/or (iv) obtain additional financing. There can be no assurance that the Company will be able to achieve any or all of the foregoing. The consolidated financial statements were prepared on a going concern basis in accordance with U.S. GAAP. The going concern basis of presentation assumes that the Company will continue in operation for the next twelve months and will be able to realize its assets and discharge its liabilities and commitments in the normal course of business. It does not include any adjustments to reflect the possible future effects on the recoverability and classification of assets or the amounts and classification of liabilities that may result from its inability to continue as a going concern.

Client Related Revenue and Non-

Client Related Revenue and Non-Client Related Revenue	3 Months Ended
	Mar. 31, 2019
Revenue From Contract With Customer [Abstract]
Client Related Revenue and Non-Client Related Revenue	3 . Client Related Revenue Client related revenue primarily consists of service charges related to providing addiction treatment and related services, including diagnostic laboratory services. As it relates to recognizing revenue, the Company’s contracts are with the individuals for whom the Company provides care. The majority of the Company’s contracts with clients have a single performance obligation because the promise to deliver services is not separately identifiable from other promises in the contracts. The Company’s performance obligations are satisfied over time as clients simultaneously receive and consume the benefits provided. Therefore, the Company recognizes revenue in the same period the services are performed, and there are no remaining performance obligations at period-end. Due to the nature of the industry, there are often more than two parties to the service transactions (including customers, providers and payors), and the estimation of revenue is complex and requires significant judgment. Management estimates variable consideration using the expected value method. The expected value method is used when an entity has a large number of contracts with similar characteristics, as is the case with the Company’s contracts. The transaction price is recorded based on the estimated ultimate value remaining after all uncertainty is resolved. The estimates of variable consideration are based largely on an assessment of the Company’s anticipated performance as well as historical, current, and forecasted information. The Company updates its estimate of the transaction price at the end of each reporting period, and any amounts allocated to a satisfied performance obligation are recognized as revenue or a reduction of revenue in the period in which the transaction price changes. The following tables summarize the composition of the Company’s client related revenue for inpatient treatment facility services, outpatient facility and sober living services, and client related diagnostic services. Inpatient treatment facility services include revenues from related professional services, and client related diagnostic services includes revenues from point of care services as well as laboratory services. For the three months ended March 31, 2019 and 2018 (in thousands): Three Months Ended March 31, 2019 Three Months Ended March 31, 2018 Amount % Amount % Inpatient treatment facility services $ 44,889 83.9 $ 66,874 85.0 Outpatient facility and sober living services 6,454 12.1 8,946 11.4 Client related diagnostic services 2,146 4.0 2,810 3.6 Total client related revenue $ 53,489 100.0 $ 78,630 100.0 Non-Client Related Revenue Non-client related revenue consists of diagnostic laboratory services provided to clients of third-party addiction treatment providers, addiction care treatment services for individuals in the criminal justice system and services provided to third-party behavioral health providers who use the Company’s digital outreach platforms. Revenue from diagnostic laboratory services provided to clients of third-party addiction treatment providers is recognized at the point in time when the order is completed. These contracts have a single performance obligation, and the transaction price is agreed upon between the Company and the third-party lab provider to services being rendered. Revenue for addiction care treatment services for individuals in the criminal justice system is recognized as services are provided in accordance with contracts with certain Massachusetts state agencies. Revenue from third-party behavioral health providers who use the Company’s digital outreach platforms is recognized over time as these customers simultaneously receive and consume the benefits of the services provided. The Company’s marketing contracts typically have one performance obligation. There are no significant judgments in determining the transaction price as the price is listed in the contract and not subject to change.

General and Administrative Cost

General and Administrative Costs	3 Months Ended
	Mar. 31, 2019
General And Administrative Costs [Abstract]
General and Administrative Costs	4. The majority of the Company’s expenses are cost of revenue items. Costs that could be classified as general and administrative expenses include the Company’s corporate overhead costs, which were $16.4 million and $22.0 million for the three months ended March 31, 2019 and 2018, respectively.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	5. Earnings (Loss) Per Share Basic earnings (loss) per share (“EPS”) is computed by dividing net income (loss) attributable to common stockholders by the weighted-average number of shares of common stock outstanding for the period. For the calculation of diluted EPS, net income (loss) attributable to common stockholders for basic EPS is adjusted by the effect of dilutive securities, including awards under stock-based payment arrangements, and outstanding convertible debt securities. Diluted EPS attributable to common stockholders is computed by dividing net income (loss) attributable to common stockholders by the weighted average number of diluted common shares outstanding during the period. The following table presents the components of the numerator and denominator used in the calculation of basic and diluted EPS for the three months ended March 31, 2019 and 2018 (in thousands, except share data): Three Months Ended March 31, 2019 2018 Numerator Net (loss) income attributable to AAC Holdings, Inc. common stockholders $ (22,019 ) $ 1,056 Denominator Weighted-average common shares outstanding – basic 24,495,613 23,744,208 Dilutive securities — 37,396 Weighted-average common shares outstanding – diluted 24,495,613 23,781,604 Basic (loss) earnings per common share $ (0.90 ) $ 0.04 Diluted (loss) earnings per common share $ (0.90 ) $ 0.04 For the three months ended March 31, 2019 and 2018, t he Company had 27,396 and 37,396 potentially dilutive shares, respectively These dilutive shares are not included in the diluted EPS calculation above for the three months ended March 31, 2019, because to do so would be anti-dilutive for the period presented.

Acquisitions

Acquisitions	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Acquisitions	6. Acquisition On March 1, 2018, the Company acquired all of the outstanding shares of AdCare, Inc., a Massachusetts corporation (“AdCare”), and wholly owned subsidiary of AdCare Holding Trust, a Massachusetts business trust (the “Seller”) (the “AdCare Acquisition”). AdCare and its subsidiaries offer treatment of drug and alcohol addiction and own, among other things, a 114-bed hospital, five outpatient centers in Massachusetts, a 59-bed residential inpatient treatment center and two outpatient centers in Rhode Island. AdCare was purchased for total consideration of $85.1 million, including adjustments as set forth in the Securities Purchase Agreement (the “Purchase Agreement”), by and among AAC Healthcare Network, Inc., AAC Holdings, AdCare, and the Seller. The consideration was comprised of (i) approximately $66.8 million in cash, excluding expenses and other adjustments, (ii) approximately $5.4 million in shares of AAC Holdings’ common stock (or 562,051 shares at $9.68 per share), (iii) a promissory note in the aggregate principal amount of approximately $9.6 million (the “AdCare Note”), and (iv) contingent consideration valued at $0.5 million recorded in accrued and other current liabilities. The allocation of assets acquired and liabilities assumed on the acquisition date, based on the fair value of AdCare, is as follows (in thousands): AdCare Acquisition Cash and cash equivalents $ 2,700 Accounts receivable 4,357 Prepaid expenses and other assets 996 Property and equipment 15,309 Goodwill 64,556 Intangible assets 5,120 Total assets acquired 93,038 Accrued and other current liabilities 5,931 Long-term liabilities 2,004 Net assets acquired $ 85,103 Acquisition-related costs for the transaction were recorded as acquisition-related expenses in the consolidated statements of operations.

Accounts Receivable

Accounts Receivable	3 Months Ended
	Mar. 31, 2019
Receivables [Abstract]
Accounts Receivable	7. Accounts Receivable For the three months ended March 31, 2019 and 2018, no payor accounted for more than 10% of revenue reimbursements. As of March 31, 2019, substantially all accounts receivable aged greater than 360 days were fully reserved in the Company’s condensed consolidated financial statements. Approximately $0.9 million and $2.2 million of accounts receivable, as of March 31, 2019 and December 31, 2018, respectively, includes accounts where the Company has received a partial payment from a commercial insurance company and the Company is continuing to pursue additional collections for the balance that the Company estimates remains outstanding. An account is written off only after the Company has pursued collection efforts or otherwise determines an account to be uncollectible.

Property and Equipment, Net

Property and Equipment, Net	3 Months Ended
	Mar. 31, 2019
Property Plant And Equipment [Abstract]
Property and Equipment, Net	8. Property and Equipment, Net Property and equipment consisted of the following (in thousands): March 31, December 31, 2019 2018 Land $ 19,364 $ 19,364 Buildings and improvements 162,184 161,723 Equipment and software 30,717 35,059 Construction in progress 16,236 16,413 Total property and equipment 228,501 232,559 Less accumulated depreciation (65,456 ) (65,638 ) Property and equipment, net $ 163,045 $ 166,921 For the three months ended March 31, 2019 and 2018, depreciation expense was $3.6 million and $5.1 million, respectively.

Leases

Leases	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Leases	9. Leases On January 1, 2019, the Company adopted the cumulative accounting standard updates issued by the FASB that amend the accounting for leases under ASC 842. These changes to the lease accounting model require operating leases be recorded on the balance sheet through recognition of a liability for the discounted present value of future fixed lease payments and a corresponding right-of-use (“ROU”) asset. The Company’s accounting for finance leases remained substantially unchanged from its prior accounting for capital leases. The ROU asset recorded for the lease represents the right to use the underlying asset over the lease term in exchange for the lease payments. When able, the Company uses the interest rate implicit in a lease to determine the present value of future lease payments. For leases where the implicit rate is not determinable, the Company uses its incremental borrowing rate. Our lease agreements do not contain any residual value guarantees or material restrictive covenants. A modified retrospective transition approach is required for lessees for capital and operating leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements, with certain practical expedients available. The Company elected the transition requirements in accordance with Accounting Standards Update (“ASU”) 2018-11, which provide a transition election to not restate comparative periods for the effects of applying the new standard. This transition guidance elected by the Company permits entities to change the date of initial application to the beginning of the year of adoption and to recognize the effects of applying the new standard as a cumulative-effect adjustment to the opening balance of retained earnings. The Company utilized available practical expedients, including the package of practical expedients not to reassess whether a contract is or contains a lease, the lease classification and initial direct costs, as well as the expedient forgoing the separation of lease and non-lease components. Total right-of-use assets and related operating lease obligations of $32.9 million and $38.0 million, respectively were recorded on the consolidated balance sheet on adoption, with no material impact to our Consolidated Statements of Operations. The Company makes use of operating leases for property and equipment, and finance leases for equipment and vehicles. The Company’s leases have a remaining life ranging from 0.5 years to 11 years, some of which contain an option to extend at the discretion of the Company. The Company elected the transition provision of Topic 842 allowing entities to not restate comparative periods for the effects of the application of the new standard. The Topic 842 disclosures below are for the three months ended March 31, 2019. Components of lease expense are as follows (in thousands): March 31, 2019 Operating lease cost $ 2,032 Finance lease cost Amortization of ROU assets 263 Interest on lease liabilities 33 Total finance lease cost $ 296 Total lease cost $ 2,328 Supplemental balance sheet information related to leases are as follows (in thousands): Component of Lease Balances Classification March 31, 2019 Assets: Operating lease assets Right-of-use asset - operating, net $ 29,442 Finance lease assets Other assets 1,064 Accumulated Amortization ROU asset Other assets (263 ) Total leased assets $ 30,243 Liabilities: Operating lease liabilities: current portion Current portion of lease liability - operating $ 5,076 long-term portion Lease liability - operating, net of current portion 29,411 Total Operating lease liabilities 34,487 Finance lease liabilities: current portion Accrued and other current liabilities $ 569 long-term portion Other long-term liabilities 270 Total Finance lease liabilities 839 Total lease liabilities $ 35,326 Weighted average remaining lease term Operating leases 8 years Finance leases 2 years Weighted average discount rate Operating leases 9.9 % Finance leases 20.9 % Supplemental cash flow information related to leases are as follows (in thousands): March 31, 2019 Cash used in operating activities Operating leases $ 1,992 Finance leases 33 Cash used in financing activities Finance leases $ 238 Right-of-use assets recognized in exchange for new lease obligations Operating leases $ — Finance leases 65 Maturities of lease liabilities are as follows (in thousands): March 31, 2019 December 31, 2018 Finance Operating Capital Operating 2019 478 3,949 601 5,144 2020 231 4,158 200 4,158 2021 80 3,617 60 3,617 2022 26 3,768 12 3,768 2023 23 3,692 8 3,692 Thereafter 1 15,303 — 15,302 Total $ 839 $ 34,487 $ 881 $ 35,681

Goodwill and Intangible Assets

Goodwill and Intangible Assets	3 Months Ended
	Mar. 31, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	10. Goodwill and Intangible Assets The Company has only one operating segment, substance use and behavioral healthcare treatment services, for segment reporting purposes. The substance abuse and behavioral healthcare treatment services operating segment represents one reporting unit for purposes of the Company’s goodwill impairment test. Goodwill represents the excess of the purchase price over the fair value of the identifiable net assets acquired. Goodwill and intangible assets with indefinite lives are not amortized, but instead are tested for impairment at least annually or whenever events or changes in circumstances indicate the carrying value may not be recoverable. If the carrying value of goodwill exceeds its implied fair value, an impairment loss is recorded. The Company has no intangible assets with indefinite useful lives other than goodwill. The Company performed its most recent goodwill impairment testing as of December 31, 2018 and did not incur an impairment charge. The Company’s goodwill balance as of March 31, 2019 and December 31, 2018 was $199.0 million. The increase in goodwill during the three months ended March 31, 2018 is due to the AdCare Acquisition as shown below and discussed in Note 6. Acquisition (in thousands): Balance at December 31, 2017 $ 134,396 AdCare Acquisition $ 64,556 Balance at December 31, 2018 $ 198,952 2019 Activity — Balance at March 31, 2019 $ 198,952 Other identifiable intangible assets and related accumulated amortization consisted of the following as of March 31, 2019 and December 31, 2018 (in thousands): Gross Carrying Value Accumulated Amortization March 31, December 31, March 31, December 31, 2019 2018 2019 2018 Trademarks and trade names $ 7,552 $ 8,422 $ 2,726 $ 2,777 Non-compete agreements 1,777 2,107 1,445 1,583 Marketing intangibles 5,651 5,651 2,191 2,050 Leasehold interests 1,498 1,498 625 587 Service contracts 950 950 103 79 Other 601 601 105 90 $ 18,029 $ 19,229 $ 7,195 $ 7,166 Amortization expense for the three months ended March 31, 2019 and 2018 was $0.5 million and $0.4 million, respectively. A ll intangible assets are amortized using the straight-line method. The following table presents amortization expense expected to be recognized subsequent to March 31, 2019 (in thousands): Fiscal Year Ended Expected Amortization Expense 2019 1,351 2020 1,798 2021 1,652 2022 1,532 2023 1,298 Thereafter 3,203 Total $ 10,834

Debt

Debt	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Debt	11. Debt In connection with the 2019 Senior Credit Facility further described below, on March 8, 2019, the Company entered into the Amendments to the 2017 Credit Facility together with the required lenders party thereto, Credit Suisse AG, as administrative agent and collateral agent, and the other loan parties party thereto, amending that certain Credit Agreement (the “2017 Credit Facility”), dated as of June 30, 2017, by and among the Company, Credit Suisse AG, as administrative agent and collateral agent, and the lenders party thereto. The 2017 Credit Facility requires the maintenance of a certain coverage ratio in order for the Company to be in compliance with the agreement. As of December 31, 2018, the Company would have been in violation of this covenant absent the amendment. For the aforementioned factors, and in accordance with ASC 470-10-55, due to the uncertainties noted under Going Concern in Note 2 – Basis of Presentation, the Company has classified its obligations related to the 2017 Credit Facility as current liabilities as of March 31, 2019. This reclassification has no impact on the scheduled maturities or the timing of payments related to the debt obligations. A summary of the Company’s debt obligations is as follows (in thousands): March 31, December 31, 2019 2018 Senior secured loans $ 346,159 $ 317,479 Subordinated debt 8,634 8,884 Unamortized deferred financing costs (12,829 ) (8,085 ) Capital lease obligations — 880 Total debt 341,964 319,158 Less current portion of long-term debt (332,925 ) (309,394 ) Long-term debt, net of current portion and deferred financing costs $ 9,039 $ 9,764 2019 Senior Credit Facility On March 8, 2019, the Company entered into that certain Credit Agreement (the “2019 Senior Credit Facility”) with Credit Suisse AG, as administrative agent and collateral agent, and the lenders party thereto. The 2019 Senior Credit Facility makes available to the Company a term loan in the principal amount of $30.0 million. The 2019 Senior Credit Facility will mature on April 15, 2020. Net proceeds from funding of the 2019 Senior Credit Facility were approximately $23 million after the payment of fees, costs and other expenses. The 2019 Senior Credit Facility is guaranteed by the Company’s wholly-owned subsidiary, American Addiction Centers, Inc., and certain of its other subsidiaries. The obligations are secured by a first priority lien (senior to liens granted in connection with the 2017 Credit Facility) on substantially all of the Company’s and each subsidiary guarantor’s assets. The 2019 Senior Credit Facility bears interest at a rate per annum equal to LIBOR (with a 1.0% floor) plus 11.00% per annum. In the event of any repayment or prepayment of the 2019 Senior Credit Facility or any acceleration of the 2019 Senior Credit Facility after an event of default, the Company must make a payment equal to 1.00% of the then outstanding principal amount of the 2019 Senior Credit Facility (the “Exit Payment”) if such event occurs on or prior to the date that is nine months after the closing date of the 2019 Senior Credit Facility (the “2019 Senior Credit Facility Closing Date”). The Exit Payment will be increased by an additional 1.0% at the end of each 30-day period after the nine-month anniversary of the 2019 Senior Credit Facility Closing Date until the 2019 Senior Credit Facility matures. The terms of the 2019 Senior Credit Facility contain certain financial covenants, including, a maximum Senior Secured Leverage Ratio of (i) 7.75:1.00 as of the last day of the fiscal quarter ending June 30, 2019, (ii) 6.50:1.00 as of the last day of the fiscal quarter ending September 30, 2019, (iii) 6.25:1.00 as of the last day of the fiscal quarter ending December 31, 2019, (iv) 5.75:1.00 as of the last day of the fiscal quarter ending March 31, 2020, (v) 5.50:1.00 as of the last day of the fiscal quarter ending June 30, 2020, (vi) 5.25:1.00 as of the last day of the fiscal quarters ending September 30, 2020 and December 31, 2020, (vii) 5.00:1.00 as of the last day of the fiscal quarters ending March 31 and June 30, 2021 and (viii) 4.75:1.00 as of the last day of each fiscal quarter ending on and after December 31, 2020. The 2019 Senior Credit Facility requires the Company to periodically report to lenders with respect to, and to comply with, the Company’s operating budget. The Company is also required to (i) maintain no less than $5.0 million at any time of cash, cash equivalents and undrawn revolving loans under the 2017 Credit Facility (“Available Liquidity”) and (ii) to maintain no less than $7.5 million of Available Liquidity for any calendar week. Amendments to the 2017 Credit Facility In connection with the 2019 Senior Credit Facility, on March 8, 2019, the Company entered into the Amendment to the 2017 Credit Facility together with the required lenders party thereto, Credit Suisse AG, as administrative agent and collateral agent, and the other loan parties party thereto, amending that certain Credit Agreement, dated as of June 30, 2017, by and among the Company, Credit Suisse AG, as administrative agent and collateral agent, and the lenders party thereto. The Amendment to the 2017 Credit Facility increased the interest rate on the term loans outstanding under the 2017 Credit Facility (the “2017 Term Loans”) by, at the Company’s option, either (i) 2.00% per annum (which shall be reduced to 1.00% per annum if the Senior Secured Leverage Ratio Condition, as defined in the Amendment to the 2017 Credit Facility is satisfied), payable in cash or (ii) 4.00% per annum, payable-in-kind. In addition, the Amendment to the 2017 Credit Facility increased the commitment fee for the undrawn portion of the revolving credit facility under the 2017 Credit Facility from 0.50% to 1.00% per annum. If the Company has repaid all indebtedness under the 2019 Senior Credit Facility, the Amendments to the 2017 Credit Facility requires the Company to use net cash proceeds of certain asset sales and other dispositions of property to prepay outstanding term and revolving credit loans. If the 2017 Term Loans are prepaid at any time, the Amendment to the 2017 Credit Facility requires the payment of (i) a 2.00% premium if paid on or prior to the first anniversary of the closing of the Amendment to the 2017 Credit Facility and (ii) a 1.00% premium if paid after the first anniversary but before the second anniversary of the closing of the Amendment to the 2017 Credit Facility. The Amendment to the 2017 Credit Facility amended financial covenants with respect to the Senior Secured Leverage Ratio (as defined therein) and budgeting and lender reporting covenants that mirror those contained in the 2019 Senior Credit Facility. It also restricts certain Company actions, including certain acquisitions and joint venture arrangements. On March 1, 2018, in conjunction with the AdCare Acquisition, we secured a $65.0 million incremental term loan commitment under the 2017 Credit Facility. In connection with the incremental term loan, we incurred $2.6 million in deferred financing costs related to underwriting and other professional fees. 2017 Credit Facility On June 30, 2017, the Company entered into a senior secured credit agreement with Credit Suisse AG, as administrative agent and collateral agent and the lenders party thereto (the “2017 Credit Facility”). The 2017 Credit Facility initially made available to the Company a $40.0 million revolving line of credit (the “2017 Revolver”) and a term loan in an aggregate original principal amount of $210.0 million (the “2017 Term Loan”). As discussed further below, on September 25, 2017 the 2017 Revolver was increased to $55.0 million. The 2017 Credit Facility also provides for standby letters of credit in an aggregate undrawn amount not to exceed $7.0 million. The 2017 Term Loan matures on June 30, 2023 and requires scheduled quarterly principal repayments in an amount equal to $ 1.7 The 2017 Revolver matures on June 30, 2022. As of December 31, 2018, $52.0 million was outstanding on the 2017 Revolver. The 2017 Credit Facility also includes an incremental facility providing for the Company to incur Additional Term Loans in an aggregate principal amount of up to $25.0 million (plus such additional amounts, so long as, after giving pro forma effect to the incurrence of such additional borrowings, the Company’s Senior Secured Leverage Ratio (as defined in the 2017 Credit Facility) would be less than 3.90:1.00) (each, an “Incremental Term Loan”) and/or Additional Revolving Commitments in an aggregate principal amount of up to million (the “Incremental Revolver”), each subject to the satisfaction of certain conditions contained in the 2017 Credit Facility, including obtaining additional commitments from existing or additional lenders. On September 25, 2017, the Company obtained its Incremental Revolver from certain incremental revolving credit lenders thereby increasing the 2017 pursuant to the 2017 Credit Facility from $40.0 million to $55.0 million. The lenders under the 2017 Credit Facility are not under any obligation to provide any Incremental Term Loans. Borrowings under the 2017 Credit Facility bore interest at a rate tied to the Alternative Base Rate or the Adjusted London Interbank Offered Rate (“LIBOR”) Borrowings under the 2017 Credit Facility are guaranteed by the Company’s wholly owned subsidiary, AAC and certain of its other subsidiaries pursuant to that certain Guarantee and Collateral Agreement, dated as of June 30, 2017, by and among the Company, each of the subsidiary guarantors party thereto and Credit Suisse AG, as collateral agent (the “Guarantee and Collateral Agreement”). The obligations under the 2017 Credit Facility and the Guarantee and Collateral Agreement are secured by a lien on substantially all of the Company’s and each subsidiary guarantor’s assets. The Company is permitted to voluntarily reduce the unutilized portion of the commitment amount and repay outstanding loans under the 2017 Credit Facility at any time without premium or penalty, other than (i) customary “breakage” costs with respect to Eurodollar Loans and, (ii) with respect to the 2017 Term Loan, if certain repricing transactions are consummated or certain mandatory repayments are made, (x) a yield maintenance premium within one year after the closing as set forth in the 2017 Credit Facility, (y) a 2.0% premium if paid after the first anniversary of the closing but before the second anniversary of the closing and (z) a 1.0% premium if paid after the second anniversary of the closing but before the third anniversary of the closing. In addition, the 2017 Credit Facility places certain restrictions on the ability of the Company and its subsidiaries to, among other things, incur debt and liens; merge, consolidate or liquidate; dispose of assets; enter into hedging arrangements; pay dividends and make other restricted payments; undertake transactions with affiliates; enter into restrictive agreements on dividends and other distributions; make negative pledges; enter into certain sale-leaseback transactions; make certain investments; prepay or modify the terms of certain indebtedness and modify the terms of certain organizational agreements. The 2017 Credit Facility contains customary events of default, including payment defaults, breaches of representations and warranties, covenant defaults, cross-defaults to other material indebtedness, certain events of bankruptcy and insolvency, material judgments, certain ERISA events, invalidity of loan documents and certain changes in control. During the quarter ended June 30, 2017, t he Company incurred approximately $12.9 million in debt issuance costs related to underwriting and other professional fees, of which $7.6 million related to the 2017 Term Loan and $5.3 million related to the 2017 Revolver. On October 6, 2017, in conjunction with the Company’s pending acquisition of AdCare, Inc., the Company secured a $65.0 million incremental term loan commitment in conjunction with the 2017 Credit Facility, subject to customary closing conditions and regulatory provisions. In connection with the financing, the Company committed to a ticking fee that commenced on October 17, 2017, at a rate of LIBOR plus 3.375%, which increased to LIBOR plus 6.75% from November 2017, until the closing date of the acquisition. As of March 31, 2019, the Company had fully drawn on the 2017 Revolver less $2.9 million of outstanding letters of credit. Subordinated Note On March 1, 2018, in conjunction with the AdCare Acquisition, in consideration for covenants and agreements set forth in the Purchase Agreement, the Company issued the AdCare Note to the Seller, in the original principal amount of $9.6 million, which matures on September 29, 2023 and accrues interest at a fixed rate per annum equal to 5.0%, compounded annually. Payments of principal and interest pursuant to the AdCare Note commenced on April 30, 2018 and will continue until the maturity date

Financing Lease Obligation

Financing Lease Obligation	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Financing Lease Obligation	12. Financing Lease Obligation On August 9, 2017, the Company closed on a sale-leaseback transaction for subsidiaries of the Company sold two drug and alcohol rehabilitation outpatient facilities and two sober living facilities: the Desert Hope Facility and Resolutions Las Vegas, each located in Las Vegas, Nevada, and the Greenhouse Facility and Resolutions Arlington, each located in Arlington, Texas (collectively, the “Sale-Leaseback Facilities”). Simultaneously with the sale of the Sale-Leaseback Facilities, the Company, through its subsidiaries, entered into an operating lease, dated August 9, 2017, in which the Company will continue to operate the Sale-Leaseback Facilities. The operating lease provides for a 15-year term for each facility with two separate renewal terms of five years each if the Company chooses to exercise its right to extend the lease term. The initial annual minimum rent payable from the Company is $2.2 million due in equal monthly installments of $0.2 million. On the first, second and third anniversary of the lease date, the annual rent will increase 1.5% from the annual rent in effect for the immediately preceding year. On the fourth anniversary of the lease date and thereafter during the lease term, the annual rent will increase to the amount equal to the CPI Factor (as defined in the Lease) multiplied by the annual rent in effect for the immediately preceding year; provided, however, that the adjusted annual rent increase will always be between 1.5% and 3.0%. Due to the nature of the agreement, the transaction did not qualify for sale-leaseback accounting under GAAP. Therefore, the Sale-Leaseback Facilities remain on the Company’s balance sheets and continue to be depreciated over their remaining useful lives. The Company accounted for the $25.0 million of proceeds, less $0.4 million of transaction costs, as a financing obligation, of which $0.1 million was classified as a short-term liability. On a monthly basis, a portion of the payment is allocated to principal, which reduces the obligation balance, and interest, computed based on the Company’s incremental borrowing rate at the time of the transaction. A summary of the Company’s financing lease obligation is as follows (in thousands): March 31, December 31, 2019 2018 Financing lease obligation: Sale-Leaseback facilities $ 24,516 $ 24,542 Less current portion (included in accrued and other current liabilities) (132 ) (121 ) Total Financing lease obligation, net of current portion $ 24,384 $ 24,421

Stockholders' Equity and Stock

Stockholders' Equity and Stock Based Compensation	3 Months Ended
	Mar. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Stockholders' Equity and Stock Based Compensation	13. Stockholders’ Equity and Stock Based Compensation The Company’s statement of stockholder’s equity for the three months ended March 31, 2018 and 2019. Common Stock – Total AAC Holdings, Inc. Additional Stockholders’ Non- Total Shares Paid-in Retained Equity of Controlling Stockholders’ Outstanding Amount Capital Deficit AAC Holdings, Inc. Interest Equity Balance at December 31, 2017 23,872,436 $ 24 $ 152,430 $ (38,170 ) $ 114,284 $ (14,826 ) $ 99,458 Common stock granted and issued under stock incentive plan, net of forfeitures (19,503 ) — 798 — 798 — 798 Common stock withheld for minimum statutory taxes (4,145 ) — (48 ) — (48 ) — (48 ) Effect of employee stock purchase plan 27,900 — 221 — 221 — 221 Common stock issued upon acquisition of AdCare, Inc. 562,051 — 5,439 — 5,439 — 5,439 Net income (loss) — — — 1,056 1,056 (1,893 ) (837 ) Balance at March 31, 2018 24,438,739 $ 24 $ 158,840 $ (37,114 ) $ 121,750 $ (16,719 ) $ 105,031 Common Stock – Total AAC Holdings, Inc. Additional Stockholders’ Non- Total Shares Paid-in Retained Equity of Controlling Stockholders’ Outstanding Amount Capital Deficit AAC Holdings, Inc. Interest Equity Balance at December 31, 2018 24,573,679 $ 25 $ 161,962 $ (97,574 ) $ 64,413 $ (22,140 ) $ 42,273 Common stock granted and issued under stock incentive plan, net of forfeitures (24,666 ) — 364 — 364 — 364 Common stock withheld for minimum statutory taxes — — — — — — — Effect of employee stock purchase plan 116,532 — 137 — 137 — 137 Net loss — — — (22,019 ) (22,019 ) (2,097 ) (24,116 ) Balance at March 31, 2019 24,665,545 $ 25 $ 162,463 $ (119,593 ) $ 42,895 $ (24,237 ) $ 18,658 Stock Based Compensation Plans The Company recognized $0.4 million and $0.8 million in equity-based compensation expense for the three months ended March 31, 2019 and 2018, respectively. As of March 31, 2019, there was $1.3 million of unrecognized compensation expense related to unvested restricted stock, which is expected to be recognized over the remaining weighted average vesting period of 1.3 years. A summary of share activity under the Plan is set forth below: Shares Weighted- Average Grant Date Fair Value Unvested at December 31, 2018 181,825 $ 10.20 Granted — — Vested — — Forfeitures (24,666 ) 10.26 Unvested at March 31, 2019 157,159 $ 10.19 Employee Stock Purchase Plan For the three months ended March 31, 2019 and 2018, the Company issued 116,532 and 27,900 shares, respectively, of the Company’s common stock under its Employee Stock Purchase Plan, as amended from time to time (“ESPP”). For both the three months ended March 31, 2019 and 2018, the Company recognized $0.1 million of compensation expense related to the ESPP.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Income Taxes	14. Income Taxes The provision for income taxes reflects an effective tax rate of 0.1% and 4.3% for the three months ended March 31, 2019 and 2018, respectively. The difference in the Company’s effective tax rate for the three months ended March 31, 2019, when compared to the prior year, was primarily due to the change in the valuation allowance the Company now maintains against certain state and federal deferred tax assets.

Fair Value of Financial Instrum

Fair Value of Financial Instruments	3 Months Ended
	Mar. 31, 2019
Fair Value Disclosures [Abstract]
Fair Value of Financial Instruments	15. Fair Value of Financial Instruments The carrying amounts reported at March 31, 2019 and December 31, 2018 for cash and cash equivalents, accounts receivable, prepaid expenses and other current assets, accounts payable and accrued liabilities approximate fair value because of the short-term maturity of these instruments. The Company has debt with variable interest rates. The fair value of this debt was measured using Level 2 inputs, including good faith estimates of the market value for the particular debt instrument, which represent the amount an independent market participant would provide based upon market observations and other factors relevant under the circumstances. The carrying value of such debt approximated its estimated fair value at March 31, 2019 and December 31, 2018.

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2019
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies	16. Commitments and Contingencies SEC Matter The Company provided general accounting, finance and governance documentation in response to a subpoena received from the SEC in March 2018. Following this initial document request, the Commission requested additional information pertaining to the Company’s accounting for partial payments from insurance companies, where the Company is continuing to pursue additional collections for the estimated balance. Beginning in the third quarter of 2018, the Company’s Audit Committee initiated a review of the Company’s accounting for these partial payments. The Audit Committee has completed this review. In connection with this review, the Audit Committee determined that the Company’s change in estimate of the collectability of accounts receivable relating to partial payments was appropriate. The Commission’s investigation is ongoing, and the Company is continuing to fully cooperate on this matter, including providing the Commission with information regarding the restatements of historical financial reports contained in the Company’s most recent Annual Report. The Commission’s investigation is neither an allegation of wrongdoing nor a finding that any violation of law has occurred. At this time, the Company is unable to predict the final outcome of this matter or what impact it might have on the Company’s consolidated financial position, results of operations or cash flows. Other Matters The Company is also aware of various other legal matters arising in the ordinary course of business. To cover these other types of claims as well as the legal matters referenced above, the Company maintains insurance it believes to be sufficient for its operations, although some claims may potentially exceed the scope of coverage in effect and the insurer may argue that some claims, including, without limitation, the claims described above, are excluded from coverage. Plaintiffs in these matters may also request punitive or other damages that may not be covered by insurance. Except as described above, after taking into consideration the evaluation of such matters by the Company’s legal counsel, the Company’s management believes at this time that the anticipated outcome of these matters will not have a material impact on the Company’s consolidated financial position, results of operations or cash flows.

Basis of Presentation and Rec_2

Basis of Presentation and Recently Issued Accounting Pronouncements (Policies)	3 Months Ended
	Mar. 31, 2019
Accounting Policies [Abstract]
Going Concern	Going Concern The Company incurred a loss from operations and had negative cash flows from operations for the year ended December 31, 2018 and the first quarter of 2019, which has contributed to limited liquidity. This resulted primarily from declines in patient census during the second half of 2018 and into the first quarter of 2019. The Company’s revenue is directly impacted by its ability to maintain census, which is dependent on a variety of factors, many of which are outside of the Company’s control, including its referral relationships, average length of stay of its clients, the extent to which third-party payors require preadmission authorization or utilization review controls, competition in the industry, the effectiveness of the Company’s multi-faceted sales and marketing strategy and the individual decisions of the Company’s clients to seek and commit to treatment. On March 8, 2019 the Company entered into an incremental senior credit facility for a principal loan of $30 million which originally matured on March 31, 2020 and was subsequently amended to mature on April 15, 2020. The uncertainties associated with the factors described above raise substantial doubt about the Company's ability to continue as a going concern. In order for the Company to continue operations beyond the next twelve months and to be able to discharge its liabilities and commitments in the normal course of business, the Company must do some or all of the following: (i) improve operating results by increasing census while maintaining efficiency regarding operating expenses through the cost savings initiatives implemented in late 2018 and early 2019; (ii) execute strategic alternatives related to the Company’s real-estate portfolio which could include further sale leasebacks of individual facilities or larger portions of the company’s real estate portfolio (iii) sell additional non-core or non-essential assets; and/or (iv) obtain additional financing. There can be no assurance that the Company will be able to achieve any or all of the foregoing. The consolidated financial statements were prepared on a going concern basis in accordance with U.S. GAAP. The going concern basis of presentation assumes that the Company will continue in operation for the next twelve months and will be able to realize its assets and discharge its liabilities and commitments in the normal course of business. It does not include any adjustments to reflect the possible future effects on the recoverability and classification of assets or the amounts and classification of liabilities that may result from its inability to continue as a going concern.
Client Related Revenue	Client Related Revenue Client related revenue primarily consists of service charges related to providing addiction treatment and related services, including diagnostic laboratory services. As it relates to recognizing revenue, the Company’s contracts are with the individuals for whom the Company provides care. The majority of the Company’s contracts with clients have a single performance obligation because the promise to deliver services is not separately identifiable from other promises in the contracts. The Company’s performance obligations are satisfied over time as clients simultaneously receive and consume the benefits provided. Therefore, the Company recognizes revenue in the same period the services are performed, and there are no remaining performance obligations at period-end. Due to the nature of the industry, there are often more than two parties to the service transactions (including customers, providers and payors), and the estimation of revenue is complex and requires significant judgment. Management estimates variable consideration using the expected value method. The expected value method is used when an entity has a large number of contracts with similar characteristics, as is the case with the Company’s contracts. The transaction price is recorded based on the estimated ultimate value remaining after all uncertainty is resolved. The estimates of variable consideration are based largely on an assessment of the Company’s anticipated performance as well as historical, current, and forecasted information. The Company updates its estimate of the transaction price at the end of each reporting period, and any amounts allocated to a satisfied performance obligation are recognized as revenue or a reduction of revenue in the period in which the transaction price changes. The following tables summarize the composition of the Company’s client related revenue for inpatient treatment facility services, outpatient facility and sober living services, and client related diagnostic services. Inpatient treatment facility services include revenues from related professional services, and client related diagnostic services includes revenues from point of care services as well as laboratory services. For the three months ended March 31, 2019 and 2018 (in thousands): Three Months Ended March 31, 2019 Three Months Ended March 31, 2018 Amount % Amount % Inpatient treatment facility services $ 44,889 83.9 $ 66,874 85.0 Outpatient facility and sober living services 6,454 12.1 8,946 11.4 Client related diagnostic services 2,146 4.0 2,810 3.6 Total client related revenue $ 53,489 100.0 $ 78,630 100.0
Non-Client Related Revenue	Non-Client Related Revenue Non-client related revenue consists of diagnostic laboratory services provided to clients of third-party addiction treatment providers, addiction care treatment services for individuals in the criminal justice system and services provided to third-party behavioral health providers who use the Company’s digital outreach platforms. Revenue from diagnostic laboratory services provided to clients of third-party addiction treatment providers is recognized at the point in time when the order is completed. These contracts have a single performance obligation, and the transaction price is agreed upon between the Company and the third-party lab provider to services being rendered. Revenue for addiction care treatment services for individuals in the criminal justice system is recognized as services are provided in accordance with contracts with certain Massachusetts state agencies. Revenue from third-party behavioral health providers who use the Company’s digital outreach platforms is recognized over time as these customers simultaneously receive and consume the benefits of the services provided. The Company’s marketing contracts typically have one performance obligation. There are no significant judgments in determining the transaction price as the price is listed in the contract and not subject to change.

Client Related Revenue and No_2

Client Related Revenue and Non-Client Related Revenue (Tables)	3 Months Ended
	Mar. 31, 2019
Accounting Standards Update 2014-09
Summary of Composition of Client Related Revenue	The following tables summarize the composition of the Company’s client related revenue for inpatient treatment facility services, outpatient facility and sober living services, and client related diagnostic services. Inpatient treatment facility services include revenues from related professional services, and client related diagnostic services includes revenues from point of care services as well as laboratory services. For the three months ended March 31, 2019 and 2018 (in thousands): Three Months Ended March 31, 2019 Three Months Ended March 31, 2018 Amount % Amount % Inpatient treatment facility services $ 44,889 83.9 $ 66,874 85.0 Outpatient facility and sober living services 6,454 12.1 8,946 11.4 Client related diagnostic services 2,146 4.0 2,810 3.6 Total client related revenue $ 53,489 100.0 $ 78,630 100.0

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	3 Months Ended
	Mar. 31, 2019
Earnings Per Share [Abstract]
Schedule of Components of Numerator and Denominator Used in Calculation of Basic and Diluted Earnings Per Share	The following table presents the components of the numerator and denominator used in the calculation of basic and diluted EPS for the three months ended March 31, 2019 and 2018 (in thousands, except share data): Three Months Ended March 31, 2019 2018 Numerator Net (loss) income attributable to AAC Holdings, Inc. common stockholders $ (22,019 ) $ 1,056 Denominator Weighted-average common shares outstanding – basic 24,495,613 23,744,208 Dilutive securities — 37,396 Weighted-average common shares outstanding – diluted 24,495,613 23,781,604 Basic (loss) earnings per common share $ (0.90 ) $ 0.04 Diluted (loss) earnings per common share $ (0.90 ) $ 0.04

Acquisitions (Tables)

Acquisitions (Tables)	3 Months Ended
	Mar. 31, 2019
Business Combinations [Abstract]
Schedule of Unaudited Proforma Results	Error extracting Word content
Schedule of Allocation of Assets Acquired and Liabilities Assumed	The allocation of assets acquired and liabilities assumed on the acquisition date, based on the fair value of AdCare, is as follows (in thousands): AdCare Acquisition Cash and cash equivalents $ 2,700 Accounts receivable 4,357 Prepaid expenses and other assets 996 Property and equipment 15,309 Goodwill 64,556 Intangible assets 5,120 Total assets acquired 93,038 Accrued and other current liabilities 5,931 Long-term liabilities 2,004 Net assets acquired $ 85,103

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	3 Months Ended
	Mar. 31, 2019
Property Plant And Equipment [Abstract]
Components of Property and Equipment	Property and equipment consisted of the following (in thousands): March 31, December 31, 2019 2018 Land $ 19,364 $ 19,364 Buildings and improvements 162,184 161,723 Equipment and software 30,717 35,059 Construction in progress 16,236 16,413 Total property and equipment 228,501 232,559 Less accumulated depreciation (65,456 ) (65,638 ) Property and equipment, net $ 163,045 $ 166,921

Leases (Tables)

Leases (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Components of Lease Expense	Components of lease expense are as follows (in thousands): March 31, 2019 Operating lease cost $ 2,032 Finance lease cost Amortization of ROU assets 263 Interest on lease liabilities 33 Total finance lease cost $ 296 Total lease cost $ 2,328
Supplemental Balance Sheet Information Related to Leases	Supplemental balance sheet information related to leases are as follows (in thousands): Component of Lease Balances Classification March 31, 2019 Assets: Operating lease assets Right-of-use asset - operating, net $ 29,442 Finance lease assets Other assets 1,064 Accumulated Amortization ROU asset Other assets (263 ) Total leased assets $ 30,243 Liabilities: Operating lease liabilities: current portion Current portion of lease liability - operating $ 5,076 long-term portion Lease liability - operating, net of current portion 29,411 Total Operating lease liabilities 34,487 Finance lease liabilities: current portion Accrued and other current liabilities $ 569 long-term portion Other long-term liabilities 270 Total Finance lease liabilities 839 Total lease liabilities $ 35,326 Weighted average remaining lease term Operating leases 8 years Finance leases 2 years Weighted average discount rate Operating leases 9.9 % Finance leases 20.9 %
Supplemental Cash Flow Information Related to Leases	Supplemental cash flow information related to leases are as follows (in thousands): March 31, 2019 Cash used in operating activities Operating leases $ 1,992 Finance leases 33 Cash used in financing activities Finance leases $ 238 Right-of-use assets recognized in exchange for new lease obligations Operating leases $ — Finance leases 65
Schedule of Maturities of Lease Liabilities	Maturities of lease liabilities are as follows (in thousands): March 31, 2019 December 31, 2018 Finance Operating Capital Operating 2019 478 3,949 601 5,144 2020 231 4,158 200 4,158 2021 80 3,617 60 3,617 2022 26 3,768 12 3,768 2023 23 3,692 8 3,692 Thereafter 1 15,303 — 15,302 Total $ 839 $ 34,487 $ 881 $ 35,681

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2019
Goodwill And Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The increase in goodwill during the three months ended March 31, 2018 is due to the AdCare Acquisition as shown below and discussed in Note 6. Acquisition (in thousands): Balance at December 31, 2017 $ 134,396 AdCare Acquisition $ 64,556 Balance at December 31, 2018 $ 198,952 2019 Activity — Balance at March 31, 2019 $ 198,952
Components of Other Identifiable Intangible Assets	Other identifiable intangible assets and related accumulated amortization consisted of the following as of March 31, 2019 and December 31, 2018 (in thousands): Gross Carrying Value Accumulated Amortization March 31, December 31, March 31, December 31, 2019 2018 2019 2018 Trademarks and trade names $ 7,552 $ 8,422 $ 2,726 $ 2,777 Non-compete agreements 1,777 2,107 1,445 1,583 Marketing intangibles 5,651 5,651 2,191 2,050 Leasehold interests 1,498 1,498 625 587 Service contracts 950 950 103 79 Other 601 601 105 90 $ 18,029 $ 19,229 $ 7,195 $ 7,166
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	The following table presents amortization expense expected to be recognized subsequent to March 31, 2019 (in thousands): Fiscal Year Ended Expected Amortization Expense 2019 1,351 2020 1,798 2021 1,652 2022 1,532 2023 1,298 Thereafter 3,203 Total $ 10,834

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2019
Debt Disclosure [Abstract]
Summary of Debt Obligations	A summary of the Company’s debt obligations is as follows (in thousands): March 31, December 31, 2019 2018 Senior secured loans $ 346,159 $ 317,479 Subordinated debt 8,634 8,884 Unamortized deferred financing costs (12,829 ) (8,085 ) Capital lease obligations — 880 Total debt 341,964 319,158 Less current portion of long-term debt (332,925 ) (309,394 ) Long-term debt, net of current portion and deferred financing costs $ 9,039 $ 9,764

Financing Lease Obligation (Tab

Financing Lease Obligation (Tables)	3 Months Ended
	Mar. 31, 2019
Leases [Abstract]
Summary of Financing Lease Obligation	A summary of the Company’s financing lease obligation is as follows (in thousands): March 31, December 31, 2019 2018 Financing lease obligation: Sale-Leaseback facilities $ 24,516 $ 24,542 Less current portion (included in accrued and other current liabilities) (132 ) (121 ) Total Financing lease obligation, net of current portion $ 24,384 $ 24,421

Stockholders' Equity and Stoc_2

Stockholders' Equity and Stock Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2019
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract]
Statement of Stockholder's Equity	The Company’s statement of stockholder’s equity for the three months ended March 31, 2018 and 2019. Common Stock – Total AAC Holdings, Inc. Additional Stockholders’ Non- Total Shares Paid-in Retained Equity of Controlling Stockholders’ Outstanding Amount Capital Deficit AAC Holdings, Inc. Interest Equity Balance at December 31, 2017 23,872,436 $ 24 $ 152,430 $ (38,170 ) $ 114,284 $ (14,826 ) $ 99,458 Common stock granted and issued under stock incentive plan, net of forfeitures (19,503 ) — 798 — 798 — 798 Common stock withheld for minimum statutory taxes (4,145 ) — (48 ) — (48 ) — (48 ) Effect of employee stock purchase plan 27,900 — 221 — 221 — 221 Common stock issued upon acquisition of AdCare, Inc. 562,051 — 5,439 — 5,439 — 5,439 Net income (loss) — — — 1,056 1,056 (1,893 ) (837 ) Balance at March 31, 2018 24,438,739 $ 24 $ 158,840 $ (37,114 ) $ 121,750 $ (16,719 ) $ 105,031 Common Stock – Total AAC Holdings, Inc. Additional Stockholders’ Non- Total Shares Paid-in Retained Equity of Controlling Stockholders’ Outstanding Amount Capital Deficit AAC Holdings, Inc. Interest Equity Balance at December 31, 2018 24,573,679 $ 25 $ 161,962 $ (97,574 ) $ 64,413 $ (22,140 ) $ 42,273 Common stock granted and issued under stock incentive plan, net of forfeitures (24,666 ) — 364 — 364 — 364 Common stock withheld for minimum statutory taxes — — — — — — — Effect of employee stock purchase plan 116,532 — 137 — 137 — 137 Net loss — — — (22,019 ) (22,019 ) (2,097 ) (24,116 ) Balance at March 31, 2019 24,665,545 $ 25 $ 162,463 $ (119,593 ) $ 42,895 $ (24,237 ) $ 18,658
Summary of Share Activity Under 2014 Equity Incentive Plan	A summary of share activity under the Plan is set forth below: Shares Weighted- Average Grant Date Fair Value Unvested at December 31, 2018 181,825 $ 10.20 Granted — — Vested — — Forfeitures (24,666 ) 10.26 Unvested at March 31, 2019 157,159 $ 10.19

Basis of Presentation and Rec_3

Basis of Presentation and Recently Issued Accounting Pronouncements - Additional Information (Details)	Mar. 08, 2019USD ($)	Mar. 31, 2019USD ($)ProfessionalGroup	Mar. 31, 2018USD ($)ProfessionalGroup	Dec. 31, 2018USD ($)
Business And Basis Of Presentation [Line Items]
Assets		$ 480,224,000		$ 452,277,000
Liabilities		461,566,000		410,004,000
Net loss attributable to noncontrolling interest		$ 2,097,000	$ 1,893,000
2019 Senior Credit Facility
Business And Basis Of Presentation [Line Items]
Credit facility borrowing capacity	$ 30,000,000
Senior credit facility maturity date	Apr. 15, 2020	Mar. 31, 2020
VIEs
Business And Basis Of Presentation [Line Items]
Number of professional groups | ProfessionalGroup		7	7
Assets		$ 1,700,000		1,500,000
Liabilities		600,000		$ 600,000
Net loss attributable to noncontrolling interest		$ 2,100,000	$ 1,900,000

Client Related Revenue and No_3

Client Related Revenue and Non-Client Related Revenue - Summary of Composition of Client Related Revenue (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Health Care Organization Receivable And Revenue Disclosures [Line Items]
Client Related Revenue, Amount	$ 55,370	$ 81,187
Client Related Revenue
Health Care Organization Receivable And Revenue Disclosures [Line Items]
Client Related Revenue, Amount	$ 53,489	$ 78,630
Client Related Revenue, Percentage	100.00%	100.00%
Client Related Revenue | Inpatient Treatment Facility Services
Health Care Organization Receivable And Revenue Disclosures [Line Items]
Client Related Revenue, Amount	$ 44,889	$ 66,874
Client Related Revenue, Percentage	83.90%	85.00%
Client Related Revenue | Outpatient Facility and Sober Living Services
Health Care Organization Receivable And Revenue Disclosures [Line Items]
Client Related Revenue, Amount	$ 6,454	$ 8,946
Client Related Revenue, Percentage	12.10%	11.40%
Client Related Revenue | Client Related Diagnostic Services
Health Care Organization Receivable And Revenue Disclosures [Line Items]
Client Related Revenue, Amount	$ 2,146	$ 2,810
Client Related Revenue, Percentage	4.00%	3.60%

General and Administrative Co_2

General and Administrative Costs - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
General And Administrative Costs [Abstract]
General and administrative expense	$ 16.4	$ 22

Earnings (Loss) Per Share - Sch

Earnings (Loss) Per Share - Schedule of Components of Numerator and Denominator Used in Calculation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Numerator
Net (loss) income attributable to AAC Holdings, Inc. common stockholders	$ (22,019)	$ 1,056
Denominator
Weighted-average common shares outstanding – basic	24,495,613	23,744,208
Dilutive securities		37,396
Weighted-average common shares outstanding – diluted	24,495,613	23,781,604
Basic (loss) earnings per common share	$ (0.90)	$ 0.04
Diluted (loss) earnings per common share	$ (0.90)	$ 0.04

Earnings (Loss) Per Share - Add

Earnings (Loss) Per Share - Additional Information (Details) - shares	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Earnings Per Share [Abstract]
Potentially anti-dilutive shares excluded from calculation of earnings per share	27,396	37,396

Acquisitions - Additional Infor

Acquisitions - Additional Information (Details) $ / shares in Units, $ in Thousands	Mar. 01, 2018USD ($)BedCenter$ / sharesshares	Mar. 31, 2018USD ($)
Business Acquisition [Line Items]
Consideration paid in cash, excluding expenses and other adjustments		$ 65,185
AdCare, Inc. and AdCare Holding Trust
Business Acquisition [Line Items]
Consideration paid	$ 85,100
Consideration paid in cash, excluding expenses and other adjustments	66,800
AdCare, Inc. and AdCare Holding Trust | Accrued and Other Current Liabilities
Business Acquisition [Line Items]
Contingent consideration	500
AdCare, Inc. and AdCare Holding Trust | AdCare Note
Business Acquisition [Line Items]
Aggregate principal amount of promissory note	9,600
AdCare, Inc. and AdCare Holding Trust | Common Stock
Business Acquisition [Line Items]
Consideration paid in shares, amount	$ 5,400
Consideration paid in shares | shares	562,051
Average closing stock price | $ / shares	$ 9.68
AdCare, Inc. and AdCare Holding Trust | Massachusetts
Business Acquisition [Line Items]
Date of acquisition	Mar. 1, 2018
Number of bed capacity in acquired hospital | Bed	114
Number of outpatient centers acquired | Center	5
AdCare, Inc. and AdCare Holding Trust | Rhode Island
Business Acquisition [Line Items]
Number of outpatient centers acquired | Center	2
Number of bed capacity in acquired residential inpatient treatment center | Bed	59

Acquisitions - Schedule of Allo

Acquisitions - Schedule of Allocation of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018	Mar. 01, 2018	Dec. 31, 2017
Business Acquisition [Line Items]
Goodwill	$ 198,952	$ 198,952		$ 134,396
AdCare, Inc. and AdCare Holding Trust
Business Acquisition [Line Items]
Cash and cash equivalents			$ 2,700
Accounts receivable			4,357
Prepaid expenses and other assets			996
Property and equipment			15,309
Goodwill			64,556
Intangible assets			5,120
Total assets acquired			93,038
Accrued and other current liabilities			5,931
Long-term liabilities			2,004
Net assets acquired			$ 85,103

Accounts Receivable - Additiona

Accounts Receivable - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018	Dec. 31, 2018
Commercial Insurance Company
Accounts Notes And Loans Receivable [Line Items]
Accounts receivable, net of allowance for doubtful accounts	$ 0.9		$ 2.2
Revenues
Accounts Notes And Loans Receivable [Line Items]
Percentage of revenues reimbursed	10.00%	10.00%

Property and Equipment, Net - C

Property and Equipment, Net - Components of Property and Equipment (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Property Plant And Equipment [Line Items]
Total property and equipment	$ 228,501	$ 232,559
Less accumulated depreciation	(65,456)	(65,638)
Property and equipment, net	163,045	166,921
Land
Property Plant And Equipment [Line Items]
Total property and equipment	19,364	19,364
Buildings and Improvements
Property Plant And Equipment [Line Items]
Total property and equipment	162,184	161,723
Equipment and Software
Property Plant And Equipment [Line Items]
Total property and equipment	30,717	35,059
Construction in progress
Property Plant And Equipment [Line Items]
Total property and equipment	$ 16,236	$ 16,413

Property and Equipment, Net - A

Property and Equipment, Net - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Property Plant And Equipment [Abstract]
Depreciation expense	$ 3.6	$ 5.1

Leases - Additional Information

Leases - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Jan. 01, 2019
Lessee Lease Description [Line Items]
Right-of-use assets - operating, net	$ 29,442	$ 32,900
Operating lease liabilities	$ 34,487	$ 38,000
Operating lease existence of option to extend lease term	true
Finance lease existence of option to extend lease term	true
Minimum | Property And Equipment
Lessee Lease Description [Line Items]
Operating lease remaining life	6 months
Minimum | Equipment And Vehicles
Lessee Lease Description [Line Items]
Finance lease remaining life	6 months
Maximum | Property And Equipment
Lessee Lease Description [Line Items]
Operating lease remaining life	11 years
Maximum | Equipment And Vehicles
Lessee Lease Description [Line Items]
Finance lease remaining life	11 years

Leases - Components of Lease Ex

Leases - Components of Lease Expense (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Leases [Abstract]
Operating lease cost	$ 2,032
Finance lease cost
Amortization of ROU assets	263
Interest on lease liabilities	33
Total finance lease cost	296
Total lease cost	$ 2,328

Leases - Supplemental Balance S

Leases - Supplemental Balance Sheet Information Related to Leases (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Jan. 01, 2019
Assets:
Operating lease assets	$ 29,442	$ 32,900
Finance lease assets	$ 1,064
Finance lease, right-of-use asset, statement of financial position [Extensible List]	us-gaap:OtherAssetsNoncurrent
Accumulated Amortization ROU asset	$ (263)
Total leased assets	30,243
Operating lease liabilities:
Current portion of lease liability - operating	5,076
Lease liability - operating, net of current portion	29,411
Total Operating lease liabilities	34,487	$ 38,000
Finance lease liabilities:
current portion	$ 569
Finance lease, liability, current, statement of financial position [Extensible List]	aac:AccruedLiabilitiesAndOtherCurrentLiabilities
long-term portion	$ 270
Finance lease, liability, noncurrent, statement of financial position [Extensible List]	us-gaap:OtherLiabilitiesNoncurrent
Total Finance lease liabilities	$ 839
Total lease liabilities	$ 35,326
Weighted average remaining lease term
Operating leases	8 years
Finance leases	2 years
Weighted average discount rate
Operating leases	9.90%
Finance leases	20.90%

Leases - Supplemental Cash Flow

Leases - Supplemental Cash Flow Information Related to Leases (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2019USD ($)
Cash used in operating activities
Operating leases	$ 1,992
Finance leases	33
Cash used in financing activities
Finance leases	238
Right-of-use assets recognized in exchange for new lease obligations
Finance leases	$ 65

Leases - Schedule of Maturities

Leases - Schedule of Maturities of Lease Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Finance Lease Liabilities, Payments, Due [Abstract]
2019	$ 478
2020	231
2021	80
2022	26
2023	23
Thereafter	1
Total	839
Operating Lease Liabilities, Payments Due [Abstract]
2019	3,949
2020	4,158
2021	3,617
2022	3,768
2023	3,692
Thereafter	15,303
Total	$ 34,487
Capital Leases, Future Minimum Payments Due, Fiscal Year Maturity [Abstract]
2019		$ 601
2020		200
2021		60
2022		12
2023		8
Total		881
Operating Leases, Future Minimum Payments Due, Fiscal Year Maturity [Abstract]
2019		5,144
2020		4,158
2021		3,617
2022		3,768
2023		3,692
Thereafter		15,302
Total		$ 35,681

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Additional Information (Details)	3 Months Ended		12 Months Ended
	Mar. 31, 2019USD ($)Segment	Mar. 31, 2018USD ($)	Dec. 31, 2018USD ($)	Dec. 31, 2017USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
Intangible assets	$ 0
Impairment charge	$ 0		$ 0
Number of operating segments | Segment	1
Number of reportable segments | Segment	1
Goodwill	$ 198,952,000		$ 198,952,000	$ 134,396,000
Amortization expense	$ 500,000	$ 400,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Schedule of Goodwill (Details) $ in Thousands	12 Months Ended
	Dec. 31, 2018USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
Beginning balance	$ 134,396
AdCare Acquisition	64,556
Ending balance	$ 198,952

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets - Components of Other Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	$ 18,029	$ 19,229
Accumulated Amortization	7,195	7,166
Trademarks and trade names
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	7,552	8,422
Accumulated Amortization	2,726	2,777
Non-compete agreements
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	1,777	2,107
Accumulated Amortization	1,445	1,583
Marketing Intangibles
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	5,651	5,651
Accumulated Amortization	2,191	2,050
Leasehold interests
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	1,498	1,498
Accumulated Amortization	625	587
Service contracts
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	950	950
Accumulated Amortization	103	79
Other
Finite Lived Intangible Assets [Line Items]
Gross Carrying Value	601	601
Accumulated Amortization	$ 105	$ 90

Goodwill and Intangible Asset_5

Goodwill and Intangible Assets - Schedule of Finite Lived Intangible Assets Future Amortization Expense (Details) $ in Thousands	Mar. 31, 2019USD ($)
Goodwill And Intangible Assets Disclosure [Abstract]
2019	$ 1,351
2020	1,798
2021	1,652
2022	1,532
2023	1,298
Thereafter	3,203
Total	$ 10,834

Debt - Summary of Debt Obligati

Debt - Summary of Debt Obligations (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Line Of Credit Facility [Line Items]
Unamortized deferred financing costs	$ (12,829)	$ (8,085)
Capital lease obligations		880
Total debt	341,964	319,158
Less current portion of long-term debt	(332,925)	(309,394)
Long-term debt, net of current portion and deferred financing costs	9,039	9,764
Senior Secured Term Loan
Line Of Credit Facility [Line Items]
Long term debt	346,159	317,479
Subordinated Debt
Line Of Credit Facility [Line Items]
Subordinated debt	$ 8,634	$ 8,884

Debt - Senior Credit Facility -

Debt - Senior Credit Facility - Additional Information (Details) - USD ($)	Mar. 08, 2019	Mar. 31, 2019
Line Of Credit Facility [Line Items]
Proceeds from senior credit facility		$ 24,284,000
2019 Senior Credit Facility
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity	$ 30,000,000
Senior credit facility maturity date	Apr. 15, 2020	Mar. 31, 2020
Proceeds from senior credit facility	$ 23,000,000
Interest rate	1.00%
Percentage of exit payment for outstanding principal amount	1.00%
Percentage of additional exit payment for end of each 30-day period after the nine-month anniversary	1.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarter Ending June 30, 2019
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	775.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarter Ending September 30, 2019
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	650.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarter Ending December 31, 2019
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	625.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarter Ending March 31, 2020
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	575.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarter Ending June 30, 2020
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	550.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarters Ending September 30, 2020 and December 31, 2020
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	525.00%
2019 Senior Credit Facility | Maximum | Last Day of Fiscal Quarters Ending March 31 and June 30, 2021
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	500.00%
2019 Senior Credit Facility | Maximum | Last Day of each Fiscal Quarter Ending on and After December 31, 2020
Line Of Credit Facility [Line Items]
Senior Secured Leverage Ratio	475.00%
2019 Senior Credit Facility | Minimum | Revolving Loans under 2017 Credit Facility
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity	$ 5,000
2019 Senior Credit Facility | Minimum | Available Liquidity
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity	$ 7,500
2019 Senior Credit Facility | London Interbank Offered Rate (LIBOR)
Line Of Credit Facility [Line Items]
Interest rate	11.00%

Debt - Amendments to the 2017 C

Debt - Amendments to the 2017 Credit Facility - Additional Information (Details) - Amendments to the 2017 Credit Facility - USD ($) $ in Millions	Mar. 08, 2019	Mar. 31, 2019	Mar. 01, 2018
Line Of Credit Facility [Line Items]
Payable in cash	2.00%
Senior secured leverage ratio condition is satisfied	1.00%
Payable-in-kind	4.00%
Incremental Term Loan | AdCare, Inc
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity			$ 65
Deferred financing costs			$ 2.6
Paid on or Prior to First Anniversary of Closing of Amendment
Line Of Credit Facility [Line Items]
Premium percentage for repayment of outstanding loan	2.00%
Paid After First Anniversary but Before Second Anniversary of Closing of Amendment
Line Of Credit Facility [Line Items]
Premium percentage for repayment of outstanding loan	1.00%
2017 Revolver
Line Of Credit Facility [Line Items]
Quarterly commitment fee on undrawn amounts, percentage	1.00%	0.50%

Debt - Credit Facility - Additi

Debt - Credit Facility - Additional Information (Details) - USD ($) $ in Millions	Oct. 17, 2017	Jun. 30, 2017	Nov. 30, 2017	Jun. 30, 2017	Jun. 30, 2017	Mar. 31, 2019	Oct. 06, 2017	Sep. 25, 2017
2017 Revolver
Line Of Credit Facility [Line Items]
Interest rate	3.375%		6.75%
2017 Revolver | AdCare, Inc
Line Of Credit Facility [Line Items]
Business acquisition secured financing commitment subject to customary closing costs and regulatory provisions							$ 65
2017 Credit Facility
Line Of Credit Facility [Line Items]
Yield maintenance premium period		1 year
Debt issuance costs					$ 12.9
2017 Credit Facility | First Anniversary of Closing But Before Second Anniversary of Closing
Line Of Credit Facility [Line Items]
Premium percentage for repayment of outstanding loan		2.00%
2017 Credit Facility | Second Anniversary of Closing But Before Third Anniversary of Closing
Line Of Credit Facility [Line Items]
Premium percentage for repayment of outstanding loan		1.00%
2017 Credit Facility | 2017 Term Loan
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity		$ 210		$ 210	$ 210
Revolving line of credit maturity date				Jun. 30, 2023
Interest rate		1.00%		1.00%	1.00%
Debt issuance costs					$ 7.6
2017 Credit Facility | 2017 Term Loan | Base Rate
Line Of Credit Facility [Line Items]
Interest rate				5.75%
2017 Credit Facility | 2017 Term Loan | London Interbank Offered Rate (LIBOR)
Line Of Credit Facility [Line Items]
Interest rate				6.75%
2017 Credit Facility | 2017 Term Loan | September 30, 2017 through June 30, 2019
Line Of Credit Facility [Line Items]
Monthly principal payments				$ 1.7
2017 Credit Facility | 2017 Term Loan | September 30, 2019 through March 31, 2023
Line Of Credit Facility [Line Items]
Monthly principal payments				3.4
2017 Credit Facility | Incremental Term Loan
Line Of Credit Facility [Line Items]
Additional maximum borrowing amount under satisfaction of certain conditions		$ 25		$ 25	25
2017 Credit Facility | Incremental Term Loan | Minimum
Line Of Credit Facility [Line Items]
Senior secured leverage ratio				390.00%
2017 Credit Facility | Standby Letters of Credit
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity								$ 7
2017 Credit Facility | 2017 Revolver
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity		40		$ 40	40
Credit facility borrowing capacity								55
Revolving line of credit maturity date				Jun. 30, 2022
Revolver outstanding loans						$ 52
Commitment fee on undrawn amounts, percentage				0.50%
Debt issuance costs					5.3
Letters of credit outstanding						$ 2.9
2017 Credit Facility | 2017 Revolver | Base Rate
Line Of Credit Facility [Line Items]
Interest rate				5.00%
2017 Credit Facility | 2017 Revolver | London Interbank Offered Rate (LIBOR)
Line Of Credit Facility [Line Items]
Interest rate				6.00%
2017 Credit Facility | 2017 Revolver | Incremental Revolver
Line Of Credit Facility [Line Items]
Credit facility borrowing capacity		40		$ 40	40
Credit facility borrowing capacity								$ 55
Additional maximum borrowing amount under satisfaction of certain conditions		$ 15		$ 15	$ 15

Debt - Subordinated Note - Addi

Debt - Subordinated Note - Additional Information (Details) - AdCare, Inc - AdCare Note $ in Millions	Mar. 01, 2018USD ($)
Line Of Credit Facility [Line Items]
Date of acquisition	Mar. 1, 2018
Debt instrument, face amount	$ 9.6
Maturity Date	Sep. 29, 2023
Interest rate	5.00%

Financing Lease Obligation - Ad

Financing Lease Obligation - Additional Information (Details) $ in Thousands	Aug. 09, 2017USD ($)FacilityRenewal	Mar. 31, 2019USD ($)	Dec. 31, 2018USD ($)
Sale Leaseback Transaction [Line Items]
Sale-leaseback transaction, date	August 9, 2017
Sale-leaseback transaction, value	$ 25,000
Sale-leaseback transaction, assets description		drug and alcohol rehabilitation outpatient facilities and two sober living facilities: the Desert Hope Facility and Resolutions Las Vegas, each located in Las Vegas, Nevada, and the Greenhouse Facility and Resolutions Arlington, each located in Arlington, Texas (collectively, the “Sale-Leaseback Facilities”).
Number of drug and alcohol rehabilitation outpatient facilities sold | Facility	2
Number of sober living facilities sold | Facility	2
Sale-leaseback transaction, operating lease term	15-year
Sale-leaseback transaction, number of separate renewals | Renewal	2
Sale-leaseback transaction, each renewal term	5 years
Sale-leaseback transaction, initial annual minimum rent payable		$ 2,200
Sale-leaseback transaction, equal monthly installments		$ 200
Sale-leaseback transaction, percentage of rent increase annually in years one to three		1.50%
Sale-leaseback financing obligation, proceeds		$ 25,000
Sale-leaseback financing obligation, transaction costs		400
Sale-leaseback financing obligation, short term liability		$ 132	$ 121
Minimum
Sale Leaseback Transaction [Line Items]
Sale-leaseback transaction, percentage of rent increase annually in years four and thereafter		1.50%
Maximum
Sale Leaseback Transaction [Line Items]
Sale-leaseback transaction, percentage of rent increase annually in years four and thereafter		3.00%

Financing Lease Obligation - Su

Financing Lease Obligation - Summary of Financing Lease Obligation (Details) - USD ($) $ in Thousands	Mar. 31, 2019	Dec. 31, 2018
Leases [Abstract]
Financing lease obligation: Sale-Leaseback facilities	$ 24,516	$ 24,542
Less current portion (included in accrued and other current liabilities)	(132)	(121)
Total Financing lease obligation, net of current portion	$ 24,384	$ 24,421

Stockholders' Equity and Stoc_3

Stockholders' Equity and Stock Based Compensation - Statement of Stockholder's Equity (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Balance	$ 42,273	$ 99,458
Common stock granted and issued under stock incentive plan, net of forfeitures, amount	364	798
Common stock withheld for minimum statutory taxes		(48)
Effect of employee stock purchase plan	137	221
Common stock issued upon acquisition of AdCare, Inc.		5,439
Net loss	(24,116)	(837)
Balance	18,658	105,031
Common Stock
Balance	$ 25	$ 24
Balance, shares	24,573,679	23,872,436
Common stock granted and issued under stock incentive plan, net of forfeitures, share	(24,666)	(19,503)
Common stock withheld for minimum statutory taxes, shares		(4,145)
Effect of employee stock purchase plan, shares	116,532	27,900
Common stock issued upon acquisition of AdCare, Inc. shares		562,051
Balance	$ 25	$ 24
Balance, shares	24,665,545	24,438,739
Additional Paid-in Capital
Balance	$ 161,962	$ 152,430
Common stock granted and issued under stock incentive plan, net of forfeitures, amount	364	798
Common stock withheld for minimum statutory taxes		(48)
Effect of employee stock purchase plan	137	221
Common stock issued upon acquisition of AdCare, Inc.		5,439
Balance	162,463	158,840
Retained Deficit
Balance	(97,574)	(38,170)
Net loss	(22,019)	1,056
Balance	(119,593)	(37,114)
Total Stockholders' Equity of AAC Holdings, Inc.
Balance	64,413	114,284
Common stock granted and issued under stock incentive plan, net of forfeitures, amount	364	798
Common stock withheld for minimum statutory taxes		(48)
Effect of employee stock purchase plan	137	221
Common stock issued upon acquisition of AdCare, Inc.		5,439
Net loss	(22,019)	1,056
Balance	42,895	121,750
Non-Controlling Interest
Balance	(22,140)	(14,826)
Net loss	(2,097)	(1,893)
Balance	$ (24,237)	$ (16,719)

Stockholders' Equity and Stoc_4

Stockholders' Equity and Stock Based Compensation - Additional Information (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Compensation expense	$ 0.4	$ 0.8
Employee Stock Purchase Plan
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Compensation expense	$ 0.1	$ 0.1
Employee stock purchase plan, shares issued	116,532	27,900
2014 Equity Incentive Plan | Restricted Common Stock
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Unrecognized compensation expenses	$ 1.3
Weighted average life of remaining vesting period	1 year 3 months 18 days

Stockholders' Equity and Stoc_5

Stockholders' Equity and Stock Based Compensation - Summary of Share Activity Under 2014 Equity Incentive Plan (Details)	3 Months Ended
	Mar. 31, 2019$ / sharesshares
Nonvested, Number of Shares [Roll Forward]
Beginning Balance, Shares | shares	181,825
Forfeitures, Shares | shares	(24,666)
Ending Balance, Shares | shares	157,159
Nonvested, Weighted Average Grant Date Fair Value [Abstract]
Beginning Balance, Weighted-Average Grant Date Fair Value | $ / shares	$ 10.20
Forfeitures, Weighted-Average Grant Date Fair Value | $ / shares	10.26
Ending Balance, Weighted-Average Grant Date Fair Value | $ / shares	$ 10.19

Income Taxes - Additional Infor

Income Taxes - Additional Information (Details)	3 Months Ended
	Mar. 31, 2019	Mar. 31, 2018
Income Tax Disclosure [Abstract]
Effective tax rates on provision for income taxes	0.10%	4.30%