Cover Page
Cover Page - shares | 3 Months Ended | |
Mar. 31, 2022 | May 10, 2022 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2022 | |
Document Fiscal Year Focus | 2022 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | AKU | |
Entity Registrant Name | AKUMIN INC. | |
Entity Central Index Key | 0001776197 | |
Entity File Number | 333-261815 | |
Current Fiscal Year End Date | --12-31 | |
Entity Current Reporting Status | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Emerging Growth Company | true | |
Entity Ex Transition Period | false | |
Entity Shell Company | false | |
Title of 12(b) Security | Common Shares | |
Security Exchange Name | NASDAQ | |
Document Transition Report | false | |
Document Quarterly Report | true | |
Entity Interactive Data Current | Yes | |
Entity Small Business | true | |
Entity Common Stock, Shares Outstanding | 89,516,513 | |
Entity Address, State or Province | FL | |
Entity Address, Address Line One | 8300 W. Sunrise Boulevard | |
Entity Address, City or Town | Plantation | |
Entity Address, Postal Zip Code | 33322 | |
Entity Incorporation, State or Country Code | A6 | |
City Area Code | 844 | |
Local Phone Number | 730-0050 | |
Entity Tax Identification Number | 00-0000000 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Current assets: | ||
Cash and cash equivalents | $ 40,242 | $ 48,419 |
Accounts receivable | 126,480 | 121,525 |
Prepaid expenses | 8,409 | 8,196 |
Other current assets | 5,012 | 7,025 |
Total current assets | 180,143 | 185,165 |
Property and equipment, net | 247,138 | 259,122 |
Operating lease right-of-use assets | 189,263 | 194,565 |
Goodwill | 840,874 | 840,353 |
Other intangible assets, net | 409,157 | 414,146 |
Other assets | 24,908 | 25,475 |
Total assets | 1,891,483 | 1,918,826 |
Current liabilities: | ||
Accounts payable | 34,118 | 34,326 |
Current portion of long-term debt | 15,667 | 14,789 |
Current portion of obligations under finance leases | 6,031 | 6,460 |
Current portion of obligations under operating leases | 20,764 | 20,794 |
Other accrued liabilities | 85,476 | 87,813 |
Total current liabilities | 162,056 | 164,182 |
Long-term debt, net of current portion | 1,209,700 | 1,197,596 |
Obligations under finance leases, net of current portion | 13,986 | 15,951 |
Obligations under operating leases, net of current portion | 179,654 | 184,375 |
Other liabilities | 36,829 | 35,574 |
Total liabilities | 1,602,225 | 1,597,678 |
Redeemable noncontrolling interests | 37,049 | 37,469 |
Shareholders' equity: | ||
Common stock, no par value; unlimited number of shares authorized; 89,516,513 and 89,026,997 shares issued and outstanding as of March 31, 2022 and December 31, 2021, respectively | 229,656 | 228,595 |
Accumulated other comprehensive income | 64 | 18 |
Accumulated deficit | (154,235) | (123,424) |
Total shareholders' equity | 75,485 | 105,189 |
Noncontrolling interest | 176,724 | 178,490 |
Total equity | 252,209 | 283,679 |
Total liabilities, redeemable noncontrolling interests and equity | $ 1,891,483 | $ 1,918,826 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares | 3 Months Ended | 12 Months Ended |
Mar. 31, 2022 | Dec. 31, 2021 | |
Statement of Financial Position [Abstract] | ||
Common Stock, No Par Value | $ 0 | $ 0 |
Common Stock, Shares Authorized, Unlimited | Unlimited | Unlimited |
Common Stock, Shares, Issued | 89,516,513 | 89,026,997 |
Common Stock, Shares, Outstanding | 89,516,513 | 89,026,997 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Income Statement [Abstract] | ||
Revenues | $ 186,263 | $ 63,963 |
Operating expenses: | ||
Cost of operations, excluding depreciation and amortization | 157,479 | 55,142 |
Depreciation and amortization | 24,731 | 4,490 |
Stock-based compensation | 1,061 | 427 |
Other operating losses (gains), net | (54) | 90 |
Total operating expenses | 183,217 | 60,149 |
Income from operations | 3,046 | 3,814 |
Other expense (income): | ||
Interest expense | 28,681 | 8,368 |
Acquisition related costs | 382 | 1,279 |
Settlement and related recoveries | (137) | (24) |
Other non-operating gains, net | (11) | (3,366) |
Total other expense, net | 28,915 | 6,257 |
Loss before income taxes | (25,869) | (2,443) |
Income tax expense | 563 | 65 |
Net loss | (26,432) | (2,508) |
Less: Net income attributable to noncontrolling interest | 4,379 | 369 |
Net loss attributable to common shareholders | (30,811) | (2,877) |
Comprehensive loss, net of taxes: | ||
Net income (loss) | (26,432) | (2,508) |
Unrealized gain on hedging transactions, net of taxes | 29 | 0 |
Reclassification adjustment for losses included in net loss, net of taxes | 17 | 0 |
Other comprehensive income | 46 | 0 |
Comprehensive loss, net of taxes | (26,386) | (2,508) |
Less: Comprehensive income attributable to noncontrolling interest | 4,379 | 369 |
Comprehensive loss attributable to common shareholders | $ (30,765) | $ (2,877) |
Net loss per share attributable to common shareholders: | ||
Basic and diluted | $ (0.35) | $ (0.04) |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Equity - USD ($) $ in Thousands | Total | Common Stock [Member] | Accumulated Other Comprehensive Loss | Accumulated Deficit [Member] | Parent [Member] | Noncontrolling Interest [Member] |
Beginning Balance at Dec. 31, 2020 | $ 85,170 | $ 160,965 | $ (80,133) | $ 80,832 | $ 4,338 | |
Beginning balance, Shares at Dec. 31, 2020 | 70,178,428 | |||||
Net income (loss) | (2,508) | (2,877) | (2,877) | 369 | ||
Stock-based compensation | 427 | $ 427 | 427 | |||
Other comprehensive income | 0 | |||||
Distributions paid to noncontrolling interests | (449) | (449) | ||||
Ending Balance at Mar. 31, 2021 | 82,640 | $ 161,392 | (83,010) | 78,382 | 4,258 | |
Ending balance, Shares at Mar. 31, 2021 | 70,178,428 | |||||
Beginning Balance at Dec. 31, 2021 | 283,679 | $ 228,595 | $ 18 | (123,424) | 105,189 | 178,490 |
Beginning balance, Shares at Dec. 31, 2021 | 89,026,997 | |||||
Net income (loss) | (26,432) | |||||
Net income (loss), net of the net income attributable to redeemable noncontrolling interests | (27,012) | (30,811) | (30,811) | 3,799 | ||
Issuance of common stock under stock-based awards, Shares | 489,516 | |||||
Stock-based compensation | 1,061 | $ 1,061 | 1,061 | |||
Other comprehensive income | 46 | 46 | 46 | |||
Distributions paid to noncontrolling interests | (5,726) | (5,726) | ||||
Other equity transactions | 161 | 161 | ||||
Ending Balance at Mar. 31, 2022 | $ 252,209 | $ 229,656 | $ 64 | $ (154,235) | $ 75,485 | $ 176,724 |
Ending balance, Shares at Mar. 31, 2022 | 89,516,513 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Operating activities: | ||
Net loss | $ (26,432) | $ (2,508) |
Adjustments to reconcile net loss to net cash provided by operating activities: | ||
Depreciation and amortization | 24,731 | 4,490 |
Stock-based compensation | 1,061 | 427 |
Non-cash interest expense | 12,105 | 0 |
Amortization of deferred financing costs and accretion of discount on long-term debt | 30 | 478 |
Deferred income taxes | 307 | 0 |
Other non-cash items | 607 | (3,276) |
Changes in operating assets and liabilities, net of acquisitions: | ||
Accounts receivable | (4,922) | (1,902) |
Prepaid expenses and other assets | 1,510 | 968 |
Accounts payable and accrued liabilities | (207) | 8,627 |
Operating lease liabilities and right-of-use assets | 528 | 445 |
Net cash provided by operating activities | 9,318 | 7,749 |
Investing activities: | ||
Purchases of property and equipment | (9,878) | (1,173) |
Other investing activities | 3 | (4,588) |
Net cash used in investing activities | (9,875) | (5,761) |
Financing activities: | ||
Proceeds from revolving loan | 10,000 | 0 |
Principal payments on revolving loan | (10,000) | 0 |
Proceeds from long-term debt | 5,539 | 78,750 |
Principal payments on long-term debt | (4,039) | (99) |
Principal payments on finance leases | (2,394) | (699) |
Payment of debt issuance costs | 0 | (1,162) |
Distributions paid to noncontrolling interests | (6,726) | (449) |
Net cash provided by (used in) financing activities | (7,620) | 76,341 |
Net increase (decrease) in cash and cash equivalents | (8,177) | 78,329 |
Cash and cash equivalents, beginning of period | 48,419 | 44,396 |
Cash and cash equivalents, end of period | 40,242 | 122,725 |
Supplemental disclosure of cash flow information: | ||
Interest paid | 14,606 | 195 |
Income taxes paid, net | (10) | (39) |
Supplemental disclosure of non-cash investing and financing activities: | ||
Interest payable-in-kind on long-term debt | 12,105 | 0 |
Property and equipment purchases in accounts payable and other accrued liabilities | $ 6,118 | $ 306 |
Basis of Presentation
Basis of Presentation | 3 Months Ended |
Mar. 31, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | 1. Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared by Akumin Inc. (the “Company” or “Akumin”) and do not include all of the information and disclosures required by accounting principles generally accepted in the U.S. (“GAAP”). In the opinion of management, all normal recurring accruals and adjustments considered necessary for a fair presentation have been included. The results for the three months ended March 31, 2022 are not necessarily indicative of the results that may be expected for the year ending December 31, 2022. The accompanying condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes to the consolidated financial statements for the year ended December 31, 2021. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates. |
New Accounting Standards
New Accounting Standards | 3 Months Ended |
Mar. 31, 2022 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
New Accounting Standards | 2. New Accounting Standards Recently Adopted Accounting Standards ASU 2021-04, 470-50), 815-40) In April 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-04, 470-50), 815-40). ASU 2021-10 , Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance In November 2021, the FASB issued ASU 2021-10, Government Assistance (Topic 832): Disclosures by Business Entities about Government Assistance 2021-10 Government Assistance 2021-10 Recently Issued Accounting Standards Not Yet Effective ASU 2016-13, In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments ASU 2020-04, In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting ASU 2021-01, In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848): Scope ASU 2021-08, In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers Business Combinations Revenue from Contracts with Customers 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets off-market |
Alliance Acquisition
Alliance Acquisition | 3 Months Ended |
Mar. 31, 2022 | |
Business Combinations [Abstract] | |
Alliance Acquisition | 3. Alliance Acquisition On September 1, 2021, the Company acquired all of the issued and outstanding common stock of Thaihot Investment Company US Limited, which owns 100% of the common stock of Alliance, from Thaihot Investment Co., Ltd. for a total purchase price of $785.6 million (the “Alliance Acquisition”). The acquisition included Alliance’s ownership interests in its joint ventures which had a fair value of $212.0 million on the acquisition date. As of the acquisition date, the Company had preliminarily estimated the fair value of the assets acquired and liabilities assumed and allocated a portion of the total purchase price to tangible and identifiable intangible assets acquired and liabilities assumed based on their estimated fair values as of the date of the acquisition. Noncontrolling interests have also been recorded at fair value as of the acquisition date. The fair value of the total enterprise applicable to joint ventures has been allocated to the individual joint ventures. During the three months ended March 31, 2022, the Company updated the preliminary assessment of the fair value of the tangible and identifiable intangible assets acquired and liabilities assumed, resulting in certain changes to the preliminary amounts previously recorded. These changes were composed primarily of (i) a decrease in property and equipment acquired of $0.5 million due to a refinement in the valuation analysis, (ii) a decrease in other liabilities of $0.2 million due to an adjustment in an estimated accrued liability and (iii) an increase in noncontrolling interest of $0.2 million due to a refinement in the valuation analysis. The net effect of the changes to preliminary fair value of the assets acquired and liabilities assumed resulted in an increase in goodwill of $0.5 million. The final determination of the fair value of certain assets acquired and liabilities assumed, including deferred tax liabilities and the assignment of goodwill to reporting units, was not complete as of March 31, 2022, but will be finalized within the allowable one-year measurement period. The following table summarizes the revised preliminary assessment of fair value of the assets acquired and liabilities assumed as of the date of the acquisition: (in thousands) Assets acquired: Cash and cash equivalents $ 26,125 Net working capital 14,221 Property and equipment 205,940 Operating lease right-of-use 69,919 Goodwill 456,281 Intangibles – Customer contracts 266,224 Intangibles – Trade names 69,108 Intangibles – Third party management agreements 10,200 Intangibles – Certificates of need 69,558 Other assets 8,170 1,195,746 Liabilities assumed: Equipment debt 54,673 Obligations under finance leases 9,041 Obligations under operating leases 74,290 Deferred tax liabilities 52,760 Other liabilities 7,189 197,953 Net assets acquired 997,793 Less redeemable noncontrolling interests 37,040 Less noncontrolling interests 175,137 Purchase price $ 785,616 |
Variable Interest Entities
Variable Interest Entities | 3 Months Ended |
Mar. 31, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | 4. Variable Interest Entities In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, |
Property and Equipment
Property and Equipment | 3 Months Ended |
Mar. 31, 2022 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | 5. Property and Equipment Property and equipment consist of the following: (in thousands) March 31, December 31, Medical equipment $ 233,510 $ 227,796 Leasehold improvements 40,764 39,763 Equipment under finance leases 33,196 34,597 Office and computer equipment 17,794 16,701 Transportation and service equipment 8,980 8,996 Furniture and fixtures 3,336 3,130 Construction in progress 7,257 6,423 344,837 337,406 Less accumulated depreciation 97,699 78,284 $ 247,138 $ 259,122 Depreciation expense for the three months ended March 31, 2022 and 2021 was $19.7 million and $3.8 million, respectively. As of March 31, 2022 and December 31, 2021, the equipment under finance leases had a net book value of $19.6 million and $22.2 million, respectively. |
Goodwill
Goodwill | 3 Months Ended |
Mar. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | 6. Goodwill Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2021 $ 681,993 $ 158,360 $ 840,353 Adjustments 360 161 521 Balance, March 31, 2022 $ 682,353 $ 158,521 $ 840,874 The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. As of March 31, 2022, there were no indications of impairment of the Company’s goodwill balances. |
Other Intangible Assets
Other Intangible Assets | 3 Months Ended |
Mar. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Other Intangible Assets | 7. Other Intangible Assets Other intangible assets consist of the following: Weighted Life (in years) March 31, 2022 December 31, 2021 (dollars in thousands) Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 266,224 $ (7,764 ) $ 258,460 $ 266,224 $ (4,437 ) $ 261,787 Trade names 18 77,466 (7,337 ) 70,129 77,466 (6,054 ) 71,412 Management agreements 17 10,200 (350 ) 9,850 10,200 (200 ) 10,000 Other 4 4,814 (3,654 ) 1,160 4,814 (3,425 ) 1,389 Total $ 358,704 $ (19,105 ) 339,599 $ 358,704 $ (14,116 ) 344,588 Certificates of Need 69,558 69,558 Total other intangible assets $ 409,157 $ 414,146 The Company performs an impairment test when indicators of impairment are present. As of March 31, 2022, there were no indications of impairment of the Company’s other intangible assets balances. The aggregate amortization expense for the Company’s finite-lived intangible assets was $5.0 million and $0.7 million for the three months ended March 31, 2022 and 2021, respectively. Estimated annual amortization expense related to finite-lived intangible assets is presented below: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 14,825 2023 18,837 2024 18,132 2025 17,475 2026 17,421 Thereafter 252,909 $ 339,599 |
Long-Term Debt
Long-Term Debt | 3 Months Ended |
Mar. 31, 2022 | |
Disclosure Text Block [Abstract] | |
Long term debt | 8. Long-Term Debt Long-term debt consists of the following: March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 384,575 372,470 Equipment Debt 60,327 58,827 1,294,902 1,281,297 Debt discount and deferred issuance costs (69,535 ) (68,912 ) 1,225,367 1,212,385 Less current portion 15,667 14,789 Long-term debt, net of current portion $ 1,209,700 $ 1,197,596 During the three months ended March 31, 2022, the Company elected to pay interest in-kind The minimum annual principal payments with respect to long-term debt as of March 31, 2022 are as follows: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 11,485 2023 16,900 2024 14,140 2025 485,404 2026 3,732 Thereafter 763,241 $ 1,294,902 Certain of the debt obligations are subject to covenants with which the Company must comply on a quarterly or annual basis. The Company was in compliance with all such covenants as of March 31, 2022. |
Finance Leases
Finance Leases | 3 Months Ended |
Mar. 31, 2022 | |
Leases [Abstract] | |
Finance Leases | 9. Finance Leases The information pertaining to obligations under finance leases is as follows: (in thousands) March 31, December 31, Obligations under finance leases $ 20,017 $ 22,411 Less current portion 6,031 6,460 Non-current $ 13,986 $ 15,951 The components of finance lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Amortization expense for equipment under finance leases $ 1,271 $ 916 Interest expense on finance lease liabilities 298 181 Finance lease cost $ 1,569 $ 1,097 Undiscounted cash flows for finance leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 5,213 2023 5,666 2024 5,236 2025 3,411 2026 1,760 Thereafter 665 Total minimum lease payments 21,951 Less amount of lease payments representing interest 1,934 Present value of future minimum lease payments 20,017 Less current portion 6,031 Non-current $ 13,986 The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – finance leases (years) 3.7 4.8 Weighted average discount rate – finance leases 5.0 % 4.6 % Supplemental cash flow information related to finance leases is as follows: Three Months Ended March 31, (in thousands) 2022 2021 Operating cash flows from finance leases $ 298 $ 181 Equipment acquired in exchange for finance lease obligations — 617 |
Operating Leases
Operating Leases | 3 Months Ended |
Mar. 31, 2022 | |
Leases [Abstract] | |
Operating Leases | 10. Operating Leases The information pertaining to obligations under operating leases is as follows: March 31, December 31, (in thousands) 2022 2021 Obligations under operating leases $ 200,418 $ 205,169 Less current portion 20,764 20,794 Non-current $ 179,654 $ 184,375 The components of operating lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Operating lease cost $ 9,666 $ 5,094 Variable lease cost 1,936 959 Short-term lease cost 475 43 Total operating lease cost $ 12,077 $ 6,096 Undiscounted cash flows for operating leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 20,485 2023 34,247 2024 30,930 2025 27,895 2026 23,377 Thereafter 178,953 Total minimum lease payments 315,887 Less amount of lease payments representing interest 115,469 Present value of future minimum lease payments 200,418 Less current portion 20,764 Non-current $ 179,654 The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – operating leases (years) 11.4 12.5 Weighted average discount rate – operating leases 7.7 % 7.4 % Supplemental cash flow information related to operating leases is as follows: Three Months (in thousands) 2022 2021 Operating cash flows from operating leases $ 9,130 $ 4,649 Right-of-use 801 656 |
Other Accrued Liabilities
Other Accrued Liabilities | 3 Months Ended |
Mar. 31, 2022 | |
Payables and Accruals [Abstract] | |
Other Accrued Liabilities | 11. Other Accrued Liabilities Other accrued liabilities consist of the following: March 31, December 31, (in thousands) 2022 2021 Accrued compensation and related expenses $ 34,283 $ 26,486 Accrued interest expense 18,821 16,840 MAAPP funds (Note 23) 1,093 2,398 Other 31,279 42,089 Total $ 85,476 $ 87,813 |
Redeemable Noncontrolling Inter
Redeemable Noncontrolling Interests | 3 Months Ended |
Mar. 31, 2022 | |
Noncontrolling Interest [Abstract] | |
Redeemable Noncontrolling Interests | 12. Redeemable Noncontrolling Interests The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt As of March 31, 2022, the Company holds redeemable noncontrolling interests of $37.0 million which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s condensed consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interest securities will be triggered as the triggering events are generally not probable until they occur. As such, these noncontrolling interests have not been remeasured to redemption value. The following is a rollforward of the activity in the redeemable noncontrolling interests for the three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 37,469 Net income attributable to redeemable noncontrolling interests 580 Distribution paid to redeemable noncontrolling interests (1,000 ) Balance, March 31, 2022 $ 37,049 |
Financial Instruments
Financial Instruments | 3 Months Ended |
Mar. 31, 2022 | |
Financial Instruments [Abstract] | |
Financial Instruments | 13. Financial Instruments Assets and Liabilities that are Measured at Fair Value on a Recurring Basis The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis: Fair Value as of March 31, 2022 Fair Value as of December 31, 2021 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate contracts $ — $ 25 $ — $ 25 $ — $ 3 $ — $ 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 7,692 $ 7,692 $ — $ — $ 7,522 $ 7,522 Interest rate contracts $ — $ 14 $ — $ 14 $ — $ 53 $ — $ 53 The derivative in subordinated notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 8). The estimated fair values of the Change of Control Redemption Election as of March 31, 2022 and December 31, 2021 use unobservable inputs for probability weighted time until an exit event of 4.1 years and 4.2 years, respectively, and an exit event probability weighting of 24.3% and 24.5%, respectively. The following is a reconciliation of the opening and closing balances for the liability related to the embedded derivative included in the Subordinated Notes measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 7,522 Change in fair value 170 Balance, March 31, 2022 $ 7,692 The Company’s interest rate contracts are primarily pay-fixed, Assets and Liabilities for which Fair Value is only Disclosed The estimated fair values of other current and non-current March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 292,500 $ 345,938 2025 Senior Notes 389,500 446,500 Subordinated Notes 310,376 323,620 Equipment Debt 59,118 56,879 Total $ 1,051,494 $ 1,172,937 As of March 31, 2022 and December 31, 2021, the estimated fair values of the 2028 Senior Notes and 2025 Senior Notes were determined using Level 2 inputs and the estimated fair values of the Subordinated Notes and Equipment Debt were determined using Level 3 inputs. The carrying value of cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities, and the current portion of lease liabilities approximates their fair value given their short-term nature. The carrying value of the non-current Financial instruments are classified into one of the following categories: amortized cost, fair value through earnings and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments: March 31, December 31, (in thousands) 2022 2021 Financial assets measured at amortized cost: Cash and cash equivalents $ 40,242 $ 48,419 Accounts receivable 126,480 121,525 $ 166,722 $ 169,944 Financial liabilities measured at amortized cost: Accounts payable $ 34,118 $ 34,326 Current portion of long-term debt 15,667 14,789 Current portion of leases 26,795 27,254 Non-current 1,209,700 1,197,596 Non-current 193,640 200,326 Other accrued liabilities 85,476 87,813 $ 1,565,396 $ 1,562,104 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 7,692 $ 7,522 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 25 $ 3 Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ 14 $ 53 Assets and Liabilities that are Measured at Fair Value on a Nonrecurring Basis The Company measures certain non-financial Interest Rate Risk Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. Certain of the Company’s equipment debt arrangements have interest rate swap agreements to hedge the future variable cash interest payments in order to avoid volatility in operating results due to fluctuations in interest rates. As of March 31, 2022 and December 31, 2021, the Company had $1.2 million and $1.8 million, respectively, of variable interest rate equipment debt that is not hedged. In addition, the Company is exposed to variable interest rates related to the 2020 Revolving Facility, which had no outstanding balance as of March 31, 2022 or December 31, 2021. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates is not material. |
Stock-Based Awards
Stock-Based Awards | 3 Months Ended |
Mar. 31, 2022 | |
Share-based Payment Arrangement [Abstract] | |
Stock-Based Awards | 14. Stock-Based Awards The Company may grant stock-based awards to employees, directors and consultants under the Amended and Restated Restricted Share Unit Plan, adopted as of November 14, 2017 (the “RSU Plan”) and the Amended and Restated Stock Option Plan, adopted as of November 14, 2017 (the “Stock Option Plan” and together with the RSU Plan, the “2017 Stock Plans”). Under the 2017 Stock Plans, the collective maximum number of shares reserved for issuance is equal to 10% of the number of capital shares of the Company that are outstanding from time to time. As of March 31, 2022 and December 31, 2021, common shares reserved for issuance under the 2017 Stock Plans were 8,951,651 and 8,902,699, respectively. The 2017 Stock Plans are administered by the Board of Directors, which has authority to select eligible persons to receive awards and to determine the terms and conditions of the awards. Restricted Share Units Restricted stock units (“RSUs”) represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted generally vest over two years from the date of grant. A summary of RSU activity is as follows: Number of RSUs Weighted- Average Grant Date Fair Value Aggregate Fair Value (in thousands) Outstanding and unvested at December 31, 2021 2,029,032 $ 2.41 Granted 799,085 1.10 $ 875 Vested (489,516 ) 3.19 $ 1,561 Outstanding and unvested at March 31, 2022 2,338,601 $ 1.80 $ 4,210 Stock Options Stock options are awarded as consideration in exchange for services rendered to the Company. Stock options granted generally have terms of 7 to 10 years and vest over 3 years. A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate (in thousands) Outstanding at December 31, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Outstanding at March 31, 2022 5,680,120 $ 2.54 4.1 $ 1,144 Exercisable at March 31, 2022 5,084,519 $ 2.45 4.0 $ 1,144 Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on March 31, 2022 and the exercise price multiplied by the number of in-the-money No stock options were granted during the three months ended March 31, 2022. Stock-Based Compensation Expense During the three months ended March 31, 2022 and 2021, the Company recorded total stock-based compensation expense related to all stock-based awards of $1.1 million and $0.4 million, respectively. As of March 31, 2022, there was $3.1 million of total unrecognized compensation costs related to outstanding stock-based awards. These costs are expected to be recognized over a weighted-average period of 1.9 years. |
Commitments and Contingencies
Commitments and Contingencies | 3 Months Ended |
Mar. 31, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and contingencies | 15. Commitments and Contingencies Purchase Commitments The Company has certain binding purchase commitments primarily for the purchase of equipment from various suppliers. As of March 31, 2022, the obligations for these future purchase commitments totaled $35.7 million, of which $24.7 million is expected to be paid during the remaining nine months of 2022 and $11.0 million is expected to be paid thereafter. Guarantees and Indemnities In the normal course of business, the Company has made certain guarantees and indemnities, under which it may be required to make payments to a guaranteed or indemnified party, in relation to certain transactions. The Company indemnifies other parties, including customers, lessors, and parties to other transactions with the Company, with respect to certain matters. The Company has agreed to hold the other party harmless against losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims arising from a breach of representations or covenants. In addition, the Company has entered into indemnification agreements with its executive officers and directors and the Company’s bylaws contain similar indemnification obligations. Under these arrangements, the Company is obligated to indemnify, to the fullest extent permitted under applicable law, its current or former officers and directors for various amounts incurred with respect to actions, suits or proceedings in which they were made, or threatened to be made, a party as a result of acting as an officer or director. It is not possible to determine the maximum potential amount under these indemnification agreements due to the limited history of prior indemnification claims and the unique facts and circumstances involved in each particular agreement. Historically, payments made related to these indemnifications have been immaterial. As of March 31, 2022, the Company has determined that no liability is necessary related to these guarantees and indemnities. Legal Matters On November 22, 2021, an alleged shareholder of the Company filed a putative class action claim with the Ontario Superior Court of Justice against the Company and certain of its directors and officers alleging violations of Securities Act (Ontario), negligent misrepresentation and other related claims. The claims generally allege that certain of the Company’s prior public financial statements misrepresented the Company’s revenue, accounts receivable and the value of its assets based upon the Company’s August 12, 2021, October 12, 2021 and November 8, 2021 disclosures relating to a review of certain procedures related to its financial statements and to the restatement of financial statements affecting accounts receivable and net book value of property and equipment. The claim does not quantify a damage request. Defendants have not yet responded to the claim. On December 20, 2021, a second statement of claim was filed by a new plaintiff making similar allegations. Because the two statements of claim involve similar subject matter and some of the same class members, the second Ontario plaintiff firm requested a motion for carriage under the Class Proceedings Act, 1992 (Ontario) so the court could determine which plaintiff firm will have carriage of the class action proceedings. That carriage motion was heard by the court on March 31, 2022 and, on April 27, 2022, the court rendered a decision in favor of the second plaintiff. As such, the second plaintiff has been awarded carriage of the class action claim and the action by the first plaintiff is stayed. Other Matters The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, management evaluates the developments on a regular basis and accrues a liability when it believes a loss is probable and the amount can be reasonably estimated. Management believes that the amount or any estimable range of reasonably possible or probable loss will not, either individually or in the aggregate, have a material adverse effect on the Company’s business and condensed consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management’s expectations, the Company’s results of operations and financial condition could be materially and adversely affected. |
Supplemental Revenue Informatio
Supplemental Revenue Information | 3 Months Ended |
Mar. 31, 2022 | |
Revenue from Contract with Customer [Abstract] | |
Supplemental Revenue Information | 16. Supplemental Revenue Information Revenues consist primarily of net patient fees received from various payors and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties. The following table summarizes the components of the Company’s revenues by payor category: Three Months Ended March 31, (in thousands) 2022 2021 Patient fee payors: Commercial $ 69,101 $ 50,799 Medicare 21,172 8,184 Medicaid 3,102 1,831 Other patient revenue 3,274 2,652 96,649 63,466 Hospitals and healthcare providers 87,459 — Other revenue 2,155 497 $ 186,263 $ 63,963 |
Cost of Operations, excluding D
Cost of Operations, excluding Depreciation and Amortization | 3 Months Ended |
Mar. 31, 2022 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization | 17. Cost of Operations, excluding Depreciation and Amortization The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization: Three Months Ended March 31, (in thousands) 2022 2021 Employee compensation $ 77,365 $ 23,118 Third-party services and professional fees 29,177 6,859 Rent and utilities 12,477 7,684 Reading fees 11,498 9,984 Administrative 11,624 4,356 Medical supplies and other 15,338 3,141 $ 157,479 $ 55,142 |
Other Operating and Non-Operati
Other Operating and Non-Operating Losses (Gains) | 3 Months Ended |
Mar. 31, 2022 | |
Other Income and Expenses [Abstract] | |
Other Operating and Non-Operating Losses (Gains) | 18. Other Operating and Non-Operating Other operating losses (gains) consist of the following: Three Months Ended March 31, (in thousands) 2022 2021 Loss on disposal of property and equipment, net $ 202 $ 90 Other, net (256 ) — $ (54 ) $ 90 Other non-operating Three Months Ended March 31, (in thousands) 2022 2021 Earnings from equity method investments $ (240 ) $ — Fair value adjustment on derivative 170 — Gain on conversion of debt to equity investment (Note 19) — (3,360 ) Other, net 59 (6 ) $ (11 ) $ (3,366 ) |
Investment in Unconsolidated In
Investment in Unconsolidated Investees | 3 Months Ended |
Mar. 31, 2022 | |
Other Investments [Abstract] | |
Investment in Unconsolidated Investees | 19. Investments in Unconsolidated Investees Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business (“AI business”) as part of a private placement offering for $4.6 million. The AI business develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the AI business to the Company in May 2020 converted to common equity. The Company’s total common equity investment is estimated to be valued at $7.9 million and represents a 34.5% interest in the AI business on a non-diluted non-operating The Company has a 15% direct ownership in an unconsolidated investee and provides management services under a management agreement with the investee. The Company provides services as part of its ongoing operations for and on behalf of the unconsolidated investee, which reimburses the Company for the actual amount of the expenses incurred. The Company records the expenses in cost of operations and the reimbursement as revenue in the condensed consolidated statement of operations and comprehensive loss. The financial position and results of operations these |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2022 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 20. Income Taxes The effective tax rate for the three months ended March 31, 2022 and 2021 differs from the Canadian statutory rate of 26.5% primarily due to earnings in foreign jurisdictions that are subject to tax rates which differ from the Canadian statutory tax rate, as well as the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit or expense is recognized. |
Basic and Diluted Loss per Shar
Basic and Diluted Loss per Share | 3 Months Ended |
Mar. 31, 2022 | |
Earnings Per Share [Abstract] | |
Basic and Diluted Loss per Share | 21. Basic and Diluted Loss per Share The loss per share is calculated by dividing the net loss attributable to common shareholders by the weighted average common shares outstanding during the period. Three Months Ended March 31, (in thousands, except share and per share amounts) 2022 2021 Net loss attributable to common shareholders $ 30,811 $ (2,877 ) Weighted average common shares outstanding: Basic and diluted 89,074,282 70,178,428 Net loss per share attributable to common shareholders: Basic and diluted $ (0.35 ) $ (0.04 ) Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,844,044 1,811,298 |
Segment Information
Segment Information | 3 Months Ended |
Mar. 31, 2022 | |
Segment Reporting [Abstract] | |
Segment Information | 22. Segment Information Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. Prior to the Alliance Acquisition, the Company had one reportable segment, which was outpatient diagnostic imaging services. As a result of the acquisition, the Company operates in two reportable segments: Radiology and Oncology. All intercompany revenues, expenses, payables and receivables are eliminated in consolidation and are not reviewed when evaluating segment performance. Each segment’s performance is evaluated based on revenue and earnings before interest, income taxes, depreciation and amortization (“EBITDA”) and Adjusted EBITDA. The following table summarizes the Company’s revenues by segment: Three Months Ended March 31, (in thousands) 2022 2021 Radiology $ 155,340 $ 63,963 Oncology 30,923 — $ 186,263 $ 63,963 Adjusted EBITDA is defined as net income before interest expense, income tax expense (benefit), depreciation and amortization, stock-based compensation, acquisition-related costs, losses (gains) on disposal of property and equipment, settlement and related costs (recoveries), financial instruments revaluation and related losses (gains), loss on extinguishment of debt, severance and related costs, restructuring charges, asset impairments, other losses (gains), deferred rent expense and one-time The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended March 31, (in thousands) 2022 2021 Adjusted EBITDA: Radiology $ 28,589 $ 10,843 Oncology 10,033 — Corporate (6,604 ) (1,640 ) $ 32,018 $ 9,203 A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended March 31, (in thousands) 2022 2021 Net loss $ (26,432 ) $ (2,508 ) Interest expense 28,681 8,368 Income tax expense 563 65 Depreciation and amortization 24,731 4,490 EBITDA 27,543 10,415 Adjustments: Stock-based compensation 1,061 427 Acquisition-related costs 382 1,279 Loss on disposal of property and equipment, net 202 90 Settlement and related recoveries (137 ) (24 ) Gain on conversion of debt to equity investment — (3,360 ) Severance, restructuring and other charges 2,453 — Other losses (gains), net 182 (69 ) Deferred rent expense 332 445 Adjusted EBITDA $ 32,018 $ 9,203 The following table summarizes the Company’s total assets by segment: March 31, December 31, (in thousands) 2022 2021 Identifiable assets: Radiology $ 1,434,449 $ 1,451,905 Oncology 432,931 440,416 Corporate 24,103 26,505 Total $ 1,891,483 $ 1,918,826 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended March 31, (in thousands) 2022 2021 Capital expenditures: Radiology $ 8,812 $ 1,173 Oncology 976 — Corporate 90 — Total $ 9,878 $ 1,173 |
CARES Act
CARES Act | 3 Months Ended |
Mar. 31, 2022 | |
Coronavirus Aid Relief And Economic Security Act [Abstract] | |
CARES Act | 23. CARES Act The CARES Act provided for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP”) during the COVID-19 The CARES Act also provided for the deferred payment of the employer portion of Social Security taxes between March 27, 2020 and December 31, 2020, with 50% of the deferred amount due December 31, 2021 and the remaining 50% due December 31, 2022. As of March 31, 2022 and December 31, 2021, $4.3 million related to these deferred payments are included in other accrued liabilities in the condensed consolidated balance sheets. |
Alliance Acquisition (Tables)
Alliance Acquisition (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | The following table summarizes the revised preliminary assessment of fair value of the assets acquired and liabilities assumed as of the date of the acquisition: (in thousands) Assets acquired: Cash and cash equivalents $ 26,125 Net working capital 14,221 Property and equipment 205,940 Operating lease right-of-use 69,919 Goodwill 456,281 Intangibles – Customer contracts 266,224 Intangibles – Trade names 69,108 Intangibles – Third party management agreements 10,200 Intangibles – Certificates of need 69,558 Other assets 8,170 1,195,746 Liabilities assumed: Equipment debt 54,673 Obligations under finance leases 9,041 Obligations under operating leases 74,290 Deferred tax liabilities 52,760 Other liabilities 7,189 197,953 Net assets acquired 997,793 Less redeemable noncontrolling interests 37,040 Less noncontrolling interests 175,137 Purchase price $ 785,616 |
Property and Equipment (Tables
Property and Equipment (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Property, Plant and Equipment [Abstract] | |
Summary of Detailed Information of Property and Equipment | Property and equipment consist of the following: (in thousands) March 31, December 31, Medical equipment $ 233,510 $ 227,796 Leasehold improvements 40,764 39,763 Equipment under finance leases 33,196 34,597 Office and computer equipment 17,794 16,701 Transportation and service equipment 8,980 8,996 Furniture and fixtures 3,336 3,130 Construction in progress 7,257 6,423 344,837 337,406 Less accumulated depreciation 97,699 78,284 $ 247,138 $ 259,122 |
Goodwill (Tables)
Goodwill (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Goodwill | Changes in the carrying amount of goodwill are as follows: (in thousands) Radiology Oncology Total Balance, December 31, 2021 $ 681,993 $ 158,360 $ 840,353 Adjustments 360 161 521 Balance, March 31, 2022 $ 682,353 $ 158,521 $ 840,874 |
Other Intangible Assets - (Tabl
Other Intangible Assets - (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule Of Intangible Assets Excluding Goodwill | Other intangible assets consist of the following: Weighted Life (in years) March 31, 2022 December 31, 2021 (dollars in thousands) Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 266,224 $ (7,764 ) $ 258,460 $ 266,224 $ (4,437 ) $ 261,787 Trade names 18 77,466 (7,337 ) 70,129 77,466 (6,054 ) 71,412 Management agreements 17 10,200 (350 ) 9,850 10,200 (200 ) 10,000 Other 4 4,814 (3,654 ) 1,160 4,814 (3,425 ) 1,389 Total $ 358,704 $ (19,105 ) 339,599 $ 358,704 $ (14,116 ) 344,588 Certificates of Need 69,558 69,558 Total other intangible assets $ 409,157 $ 414,146 |
Summary of Finite-Lived Intangible Assets Net Amortization Expense | Estimated annual amortization expense related to finite-lived intangible assets is presented below: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 14,825 2023 18,837 2024 18,132 2025 17,475 2026 17,421 Thereafter 252,909 $ 339,599 |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Disclosure Text Block [Abstract] | |
Schedule of Long-term Debt Instruments | Long-term debt consists of the following: March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 384,575 372,470 Equipment Debt 60,327 58,827 1,294,902 1,281,297 Debt discount and deferred issuance costs (69,535 ) (68,912 ) 1,225,367 1,212,385 Less current portion 15,667 14,789 Long-term debt, net of current portion $ 1,209,700 $ 1,197,596 |
Summary of Maturities of Long-term Debt | The minimum annual principal payments with respect to long-term debt as of March 31, 2022 are as follows: (in thousands) Year ending December 31: 2022 (remaining nine months) $ 11,485 2023 16,900 2024 14,140 2025 485,404 2026 3,732 Thereafter 763,241 $ 1,294,902 |
Finance Leases (Tables)
Finance Leases (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Leases [Abstract] | |
Summary of Finance Lease Liabilities | The information pertaining to obligations under finance leases is as follows: (in thousands) March 31, December 31, Obligations under finance leases $ 20,017 $ 22,411 Less current portion 6,031 6,460 Non-current $ 13,986 $ 15,951 |
Summary of Finance Lease Cost | The components of finance lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Amortization expense for equipment under finance leases $ 1,271 $ 916 Interest expense on finance lease liabilities 298 181 Finance lease cost $ 1,569 $ 1,097 |
Summary of Undiscounted Cash Flows For Finance Leases | Undiscounted cash flows for finance leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 5,213 2023 5,666 2024 5,236 2025 3,411 2026 1,760 Thereafter 665 Total minimum lease payments 21,951 Less amount of lease payments representing interest 1,934 Present value of future minimum lease payments 20,017 Less current portion 6,031 Non-current $ 13,986 |
Summary of Finance Lease Term and Discount Rates | The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – finance leases (years) 3.7 4.8 Weighted average discount rate – finance leases 5.0 % 4.6 % |
Summary of Supplemental Cash Flow Information Related to Finance Leases | Supplemental cash flow information related to finance leases is as follows: Three Months Ended March 31, (in thousands) 2022 2021 Operating cash flows from finance leases $ 298 $ 181 Equipment acquired in exchange for finance lease obligations — 617 |
Operating Leases (Tables)
Operating Leases (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Leases [Abstract] | |
Summary of Operating Lease Liabilities | The information pertaining to obligations under operating leases is as follows: March 31, December 31, (in thousands) 2022 2021 Obligations under operating leases $ 200,418 $ 205,169 Less current portion 20,764 20,794 Non-current $ 179,654 $ 184,375 |
Summary of Operating Lease Cost | The components of operating lease cost recognized in the condensed consolidated statements of operations and comprehensive loss are as follows. Three Months Ended March 31, (in thousands) 2022 2021 Operating lease cost $ 9,666 $ 5,094 Variable lease cost 1,936 959 Short-term lease cost 475 43 Total operating lease cost $ 12,077 $ 6,096 |
Summary of Undiscounted Cash Flows For Operating Leases | Undiscounted cash flows for operating leases recorded in the condensed consolidated balance sheet as of March 31, 2022 are as follows. (in thousands) Year ending December 31: 2022 (remaining nine months) $ 20,485 2023 34,247 2024 30,930 2025 27,895 2026 23,377 Thereafter 178,953 Total minimum lease payments 315,887 Less amount of lease payments representing interest 115,469 Present value of future minimum lease payments 200,418 Less current portion 20,764 Non-current $ 179,654 |
Summary of Operating Lease Term and Discount Rates | The lease term and discount rates are as follows: Three Months Ended March 31, 2022 2021 Weighted average remaining lease term – operating leases (years) 11.4 12.5 Weighted average discount rate – operating leases 7.7 % 7.4 % |
Summary of Supplemental Cash Flow Information Related to Operating Leases | Supplemental cash flow information related to operating leases is as follows: Three Months (in thousands) 2022 2021 Operating cash flows from operating leases $ 9,130 $ 4,649 Right-of-use 801 656 |
Other Accrued Liabilities (Tabl
Other Accrued Liabilities (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Payables and Accruals [Abstract] | |
Summary of Other Accrued Liabilities | Other accrued liabilities consist of the following: March 31, December 31, (in thousands) 2022 2021 Accrued compensation and related expenses $ 34,283 $ 26,486 Accrued interest expense 18,821 16,840 MAAPP funds (Note 23) 1,093 2,398 Other 31,279 42,089 Total $ 85,476 $ 87,813 |
Redeemable Noncontrolling Int_2
Redeemable Noncontrolling Interests (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Noncontrolling Interest [Abstract] | |
Summary of Redeemable Noncontrolling Interests | The following is a rollforward of the activity in the redeemable noncontrolling interests for the three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 37,469 Net income attributable to redeemable noncontrolling interests 580 Distribution paid to redeemable noncontrolling interests (1,000 ) Balance, March 31, 2022 $ 37,049 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Financial Instruments [Abstract] | |
Schedule of Fair Value Measurements, Recurring and Nonrecurring | The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis: Fair Value as of March 31, 2022 Fair Value as of December 31, 2021 (in thousands) Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total Current and long-term assets: Interest rate contracts $ — $ 25 $ — $ 25 $ — $ 3 $ — $ 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 7,692 $ 7,692 $ — $ — $ 7,522 $ 7,522 Interest rate contracts $ — $ 14 $ — $ 14 $ — $ 53 $ — $ 53 |
Summary of Reconciliation of Liability Related to the Embedded Derivative | The following is a reconciliation of the opening and closing balances for the liability related to the embedded derivative included in the Subordinated Notes measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the three months ended March 31, 2022: (in thousands) Balance, December 31, 2021 $ 7,522 Change in fair value 170 Balance, March 31, 2022 $ 7,692 |
Schedule Of Fair Value Of Other Current And Non Current Liabilities | The estimated fair values of other current and non-current March 31, December 31, (in thousands) 2022 2021 2028 Senior Notes $ 292,500 $ 345,938 2025 Senior Notes 389,500 446,500 Subordinated Notes 310,376 323,620 Equipment Debt 59,118 56,879 Total $ 1,051,494 $ 1,172,937 |
Schedule of Information Regarding The Carrying Value Of Financial Instruments | The following table summarizes information regarding the carrying value of the Company’s financial instruments: March 31, December 31, (in thousands) 2022 2021 Financial assets measured at amortized cost: Cash and cash equivalents $ 40,242 $ 48,419 Accounts receivable 126,480 121,525 $ 166,722 $ 169,944 Financial liabilities measured at amortized cost: Accounts payable $ 34,118 $ 34,326 Current portion of long-term debt 15,667 14,789 Current portion of leases 26,795 27,254 Non-current 1,209,700 1,197,596 Non-current 193,640 200,326 Other accrued liabilities 85,476 87,813 $ 1,565,396 $ 1,562,104 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 7,692 $ 7,522 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 25 $ 3 Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ 14 $ 53 |
Stock-Based Awards (Tables)
Stock-Based Awards (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Share-based Payment Arrangement [Abstract] | |
Summary of RSU Activity | Restricted stock units (“RSUs”) represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted generally vest over two years from the date of grant. A summary of RSU activity is as follows: Number of RSUs Weighted- Average Grant Date Fair Value Aggregate Fair Value (in thousands) Outstanding and unvested at December 31, 2021 2,029,032 $ 2.41 Granted 799,085 1.10 $ 875 Vested (489,516 ) 3.19 $ 1,561 Outstanding and unvested at March 31, 2022 2,338,601 $ 1.80 $ 4,210 |
Summary of the Stock Option Activity | A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate (in thousands) Outstanding at December 31, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Outstanding at March 31, 2022 5,680,120 $ 2.54 4.1 $ 1,144 Exercisable at March 31, 2022 5,084,519 $ 2.45 4.0 $ 1,144 |
Supplemental Revenue Informat_2
Supplemental Revenue Information (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Revenue from Contract with Customer [Abstract] | |
Summary of Revenue Information | The following table summarizes the components of the Company’s revenues by payor category: Three Months Ended March 31, (in thousands) 2022 2021 Patient fee payors: Commercial $ 69,101 $ 50,799 Medicare 21,172 8,184 Medicaid 3,102 1,831 Other patient revenue 3,274 2,652 96,649 63,466 Hospitals and healthcare providers 87,459 — Other revenue 2,155 497 $ 186,263 $ 63,963 |
Cost of Operations, excluding_2
Cost of Operations, excluding Depreciation and Amortization (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization | The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization: Three Months Ended March 31, (in thousands) 2022 2021 Employee compensation $ 77,365 $ 23,118 Third-party services and professional fees 29,177 6,859 Rent and utilities 12,477 7,684 Reading fees 11,498 9,984 Administrative 11,624 4,356 Medical supplies and other 15,338 3,141 $ 157,479 $ 55,142 |
Other Operating and Non-Opera_2
Other Operating and Non-Operating Losses (Gains) (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Other Income and Expenses [Abstract] | |
Schedule of Other Operating Losses (gains) | Other operating losses (gains) consist of the following: Three Months Ended March 31, (in thousands) 2022 2021 Loss on disposal of property and equipment, net $ 202 $ 90 Other, net (256 ) — $ (54 ) $ 90 |
Schedule Of Other Non-operating Losses (gains) | Other non-operating Three Months Ended March 31, (in thousands) 2022 2021 Earnings from equity method investments $ (240 ) $ — Fair value adjustment on derivative 170 — Gain on conversion of debt to equity investment (Note 19) — (3,360 ) Other, net 59 (6 ) $ (11 ) $ (3,366 ) |
Basic and Diluted Loss per Sh_2
Basic and Diluted Loss per Share (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Earnings Per Share [Abstract] | |
Summary Of Earnings Per Share Basic And Diluted | Three Months Ended March 31, (in thousands, except share and per share amounts) 2022 2021 Net loss attributable to common shareholders $ 30,811 $ (2,877 ) Weighted average common shares outstanding: Basic and diluted 89,074,282 70,178,428 Net loss per share attributable to common shareholders: Basic and diluted $ (0.35 ) $ (0.04 ) Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,844,044 1,811,298 |
Segment Information (Tables)
Segment Information (Tables) | 3 Months Ended |
Mar. 31, 2022 | |
Segment Reporting [Abstract] | |
Summary Of Revenue By Segment | The following table summarizes the Company’s revenues by segment: Three Months Ended March 31, (in thousands) 2022 2021 Radiology $ 155,340 $ 63,963 Oncology 30,923 — $ 186,263 $ 63,963 |
Summary Of Company's Adjusted EBITDA | The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended March 31, (in thousands) 2022 2021 Adjusted EBITDA: Radiology $ 28,589 $ 10,843 Oncology 10,033 — Corporate (6,604 ) (1,640 ) $ 32,018 $ 9,203 |
Summary of Net Income (Loss) to Total Adjusted EBITDA | A reconciliation of the net loss to total Adjusted EBITDA is shown below: Three Months Ended March 31, (in thousands) 2022 2021 Net loss $ (26,432 ) $ (2,508 ) Interest expense 28,681 8,368 Income tax expense 563 65 Depreciation and amortization 24,731 4,490 EBITDA 27,543 10,415 Adjustments: Stock-based compensation 1,061 427 Acquisition-related costs 382 1,279 Loss on disposal of property and equipment, net 202 90 Settlement and related recoveries (137 ) (24 ) Gain on conversion of debt to equity investment — (3,360 ) Severance, restructuring and other charges 2,453 — Other losses (gains), net 182 (69 ) Deferred rent expense 332 445 Adjusted EBITDA $ 32,018 $ 9,203 |
Schedule Of Segment Reporting Information By Segment | The following table summarizes the Company’s total assets by segment: March 31, December 31, (in thousands) 2022 2021 Identifiable assets: Radiology $ 1,434,449 $ 1,451,905 Oncology 432,931 440,416 Corporate 24,103 26,505 Total $ 1,891,483 $ 1,918,826 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended March 31, (in thousands) 2022 2021 Capital expenditures: Radiology $ 8,812 $ 1,173 Oncology 976 — Corporate 90 — Total $ 9,878 $ 1,173 |
Alliance Acquisition - Addition
Alliance Acquisition - Additional information (Detail) - Alliance Acquisition [Member] - USD ($) $ in Thousands | Sep. 01, 2021 | Mar. 31, 2022 |
Alliance Acquisition | ||
Business combination, consideration transferred | $ 785,600 | |
Business acquisition, Percentage of voting interests acquired | 100.00% | |
Business combination, Acquisition of less than hundred percent, Noncontrolling interest, Fair value | $ 212,000 | $ 175,137 |
Goodwill purchase accounting adjustments | 500 | |
Business combination, provisional information, initial accounting incomplete, adjustment, property, plant, and equipment | 500 | |
Business combination, provisional information, initial accounting incomplete, adjustment, other liabilities | 200 | |
Business combination, provisional information, initial accounting incomplete, adjustment, non controlling interest | $ 200 |
Alliance Acquisition - Summary
Alliance Acquisition - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 | Sep. 01, 2021 |
Non-current assets | |||
Goodwill | $ 840,874 | $ 840,353 | |
Alliance Acquisition [Member] | |||
Current assets | |||
Cash and cash equivalents | 26,125 | ||
Net working capital | 14,221 | ||
Non-current assets | |||
Property and equipment | 205,940 | ||
Operating lease right-of-use assets | 69,919 | ||
Goodwill | 456,281 | ||
Other assets | 8,170 | ||
Assets | 1,195,746 | ||
Current liabilities | |||
Equipment debt | 54,673 | ||
Obligations under finance leases | 9,041 | ||
Non-current liabilities | |||
Obligations under operating leases | 74,290 | ||
Deferred tax liability | 52,760 | ||
Other liabilties | 7,189 | ||
Liabilities | 197,953 | ||
Net assets acquired | 997,793 | ||
Less redeemable noncontrolling interests | 37,040 | ||
Less noncontrolling interests | 175,137 | $ 212,000 | |
Purchase price | 785,616 | ||
Alliance Acquisition [Member] | Customer Contracts [Member] | |||
Non-current assets | |||
Intangible assets | 266,224 | ||
Alliance Acquisition [Member] | Trade Names [member] | |||
Non-current assets | |||
Intangible assets | 69,108 | ||
Alliance Acquisition [Member] | Certificates Of Need [Member] | |||
Non-current assets | |||
Intangible assets | 69,558 | ||
Alliance Acquisition [Member] | Third Party Management Agreements [Member] | |||
Non-current assets | |||
Intangible assets | $ 10,200 |
Variable Interest Entities - Ad
Variable Interest Entities - Additional information (Detail) - USD ($) $ in Thousands | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | |
Assets | $ 1,891,483 | $ 1,918,826 | |
Liabilities | 1,602,225 | 1,597,678 | |
Net cash provided by (used in) operating activities | 9,318 | $ 7,749 | |
Variable Interest Entity, Primary Beneficiary [member] | |||
Assets | 22,700 | 20,400 | |
Liabilities | 100 | $ 600 | |
Revenues | 46,000 | 39,000 | |
Net cash provided by (used in) operating activities | $ 46,300 | $ 51,200 |
Property and Equipment - Summar
Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | $ 344,837 | $ 337,406 |
Accumulated depreciation | 97,699 | 78,284 |
Total property and equipment – net | 247,138 | 259,122 |
Medical equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 233,510 | 227,796 |
Leasehold improvements [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 40,764 | 39,763 |
Equipment under finance leases [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 33,196 | 34,597 |
Total property and equipment – net | 19,600 | 22,200 |
Office and computer equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 17,794 | 16,701 |
Transportation and service equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 8,980 | 8,996 |
Furniture and fixtures [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 3,336 | 3,130 |
Construction in progress [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | $ 7,257 | $ 6,423 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | |
Property, Plant and Equipment [Line Items] | |||
Property and equipment - net | $ 247,138 | $ 259,122 | |
Depreciation | 19,700 | $ 3,800 | |
Equipment under finance leases [Member] | |||
Property, Plant and Equipment [Line Items] | |||
Property and equipment - net | $ 19,600 | $ 22,200 |
Goodwill - Schedule of Goodwill
Goodwill - Schedule of Goodwill (Detail) $ in Thousands | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Goodwill [Line Items] | |
Balance – Beginning of period | $ 840,353 |
Adjustments | 521 |
Balance – End of period | 840,874 |
Radiology [Member] | |
Goodwill [Line Items] | |
Balance – Beginning of period | 681,993 |
Adjustments | 360 |
Balance – End of period | 682,353 |
Oncology [Member] | |
Goodwill [Line Items] | |
Balance – Beginning of period | 158,360 |
Adjustments | 161 |
Balance – End of period | $ 158,521 |
Other Intangible Assets - Sched
Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Dec. 31, 2021 | |
Finite-Lived Intangible Assets [Line Items] | ||
Finite-Lived Intangible Assets, Gross Carrying Amount | $ 358,704 | $ 358,704 |
Finite-Lived Intangible Assets, Accumulated Amortization | (19,105) | (14,116) |
Finite-Lived Intangible Assets, Net | 339,599 | 344,588 |
Indefinite-lived Intangible Assets (Excluding Goodwill) | 69,558 | 69,558 |
Intangible Assets, Net (Including Goodwill) | $ 409,157 | 414,146 |
Customer Contracts [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 20 years | |
Finite-Lived Intangible Assets, Gross Carrying Amount | $ 266,224 | 266,224 |
Finite-Lived Intangible Assets, Accumulated Amortization | (7,764) | (4,437) |
Finite-Lived Intangible Assets, Net | $ 258,460 | 261,787 |
Trade Names [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 18 years | |
Finite-Lived Intangible Assets, Gross Carrying Amount | $ 77,466 | 77,466 |
Finite-Lived Intangible Assets, Accumulated Amortization | (7,337) | (6,054) |
Finite-Lived Intangible Assets, Net | $ 70,129 | 71,412 |
Management Agreements [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 17 years | |
Finite-Lived Intangible Assets, Gross Carrying Amount | $ 10,200 | 10,200 |
Finite-Lived Intangible Assets, Accumulated Amortization | (350) | (200) |
Finite-Lived Intangible Assets, Net | $ 9,850 | 10,000 |
Other Intangible Assets [Member] | ||
Finite-Lived Intangible Assets [Line Items] | ||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 4 years | |
Finite-Lived Intangible Assets, Gross Carrying Amount | $ 4,814 | 4,814 |
Finite-Lived Intangible Assets, Accumulated Amortization | (3,654) | (3,425) |
Finite-Lived Intangible Assets, Net | $ 1,160 | $ 1,389 |
Other Intangible Assets - Summa
Other Intangible Assets - Summary of Finite-Lived Intangible Assets Net Amortization Expense (Detail) $ in Thousands | Mar. 31, 2022USD ($) |
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract] | |
2022 (remaining nine months) | $ 14,825 |
2023 | 18,837 |
2024 | 18,132 |
2025 | 17,475 |
2026 | 17,421 |
Thereafter | 252,909 |
Total | $ 339,599 |
Other Intangible Assets - Addit
Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions | Mar. 31, 2022 | Mar. 31, 2021 |
Amortization expense of finite-lived intangible assets | $ 5 | $ 0.7 |
Long-Term Debt - Summary of Lon
Long-Term Debt - Summary of Long term debt consists (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term Debt, Gross | $ 1,294,902 | $ 1,281,297 |
Debt discount and deferred issuance costs | (69,535) | (68,912) |
Long-term Debt | 1,225,367 | 1,212,385 |
Less current portion | 15,667 | 14,789 |
Long-term debt, net of current portion | 1,209,700 | 1,197,596 |
2028 Senior Notes [Member] | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term Debt, Gross | 375,000 | 375,000 |
2025 Senior Notes [Member] | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term Debt, Gross | 475,000 | 475,000 |
Subordinated Debt [Member] | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term Debt, Gross | 384,575 | 372,470 |
Equipment Debt [Member] | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term Debt, Gross | $ 60,327 | $ 58,827 |
Long-Term Debt - Summary The mi
Long-Term Debt - Summary The minimum annual principal payments with respect to long-term debt (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
2022 (remaining nine months) | $ 11,485 | |
2023 | 16,900 | |
2024 | 14,140 | |
2025 | 485,404 | |
2026 | 3,732 | |
Thereafter | 763,241 | |
Long-term Debt, Gross | $ 1,294,902 | $ 1,281,297 |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Details) $ in Millions | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Subordinated Debt [Member] | |
Debt Instrument [Line Items] | |
Debt Instrument, Increase, Accrued Interest | $ 12.1 |
Finance Leases - Summary of Fin
Finance Leases - Summary of Finance Lease Liabilities (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Leases [Abstract] | ||
Obligations under finance leases | $ 20,017 | $ 22,411 |
Less current portion | 6,031 | 6,460 |
Non-current obligations under finance leases | $ 13,986 | $ 15,951 |
Finance Leases - Summary of F_2
Finance Leases - Summary of Finance Lease Cost (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Leases [Abstract] | ||
Amortization expense for equipment under finance leases | $ 1,271 | $ 916 |
Interest expense on finance lease liabilities | 298 | 181 |
Finance lease cost | $ 1,569 | $ 1,097 |
Finance Leases - Summary of Und
Finance Leases - Summary of Undiscounted Cash Flows For Finance Leases (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Finance Lease, Liability, Payment, Due [Abstract] | ||
2022 (remaining nine months) | $ 5,213 | |
2023 | 5,666 | |
2024 | 5,236 | |
2025 | 3,411 | |
2026 | 1,760 | |
Thereafter | 665 | |
Total minimum lease payments | 21,951 | |
Less amount of lease payments representing interest | 1,934 | |
Present value of future minimum lease payments | 20,017 | $ 22,411 |
Less current portion | 6,031 | 6,460 |
Non-current obligations under finance leases | $ 13,986 | $ 15,951 |
Finance Leases - Summary of F_3
Finance Leases - Summary of Finance Lease Term and Discount Rates (Detail) | Mar. 31, 2022 | Mar. 31, 2021 |
Leases [Abstract] | ||
Weighted average remaining lease term – finance leases (years) | 3 years 8 months 12 days | 4 years 9 months 18 days |
Weighted average discount rate – finance leases | 5.00% | 4.60% |
Finance Leases - Summary of Sup
Finance Leases - Summary of Supplemental Cash Flow Information Related to Finance Leases (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Leases [Abstract] | ||
Operating cash flows from finance leases | $ 298 | $ 181 |
Equipment acquired in exchange for finance lease obligations | $ 0 | $ 617 |
Operating Leases - Summary of O
Operating Leases - Summary of Operating Lease Liabilities (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Leases [Abstract] | ||
Obligations under operating leases | $ 200,418 | $ 205,169 |
Less current portion | 20,764 | 20,794 |
Non-current obligations under operating leases | $ 179,654 | $ 184,375 |
Operating Leases - Summary of_2
Operating Leases - Summary of Operating Lease Cost (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Leases [Abstract] | ||
Operating lease cost | $ 9,666 | $ 5,094 |
Variable lease cost | 1,936 | 959 |
Short-term lease cost | 475 | 43 |
Total operating lease cost | $ 12,077 | $ 6,096 |
Operating Leases - Summary of U
Operating Leases - Summary of Undiscounted Cash Flows For Operating Leases (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Lessee, Operating Lease, Liability, Payment, Due [Abstract] | ||
2022 (remaining nine months) | $ 20,485 | |
2023 | 34,247 | |
2024 | 30,930 | |
2025 | 27,895 | |
2026 | 23,377 | |
Thereafter | 178,953 | |
Total minimum lease payments | 315,887 | |
Less: Amount of lease payments representing interest | 115,469 | |
Present value of future minimum lease payments | 200,418 | $ 205,169 |
Less current portion | 20,764 | 20,794 |
Non-current obligations under operating leases | $ 179,654 | $ 184,375 |
Operating Leases - Summary of_3
Operating Leases - Summary of Operating Lease Term and Discount Rates (Detail) | Mar. 31, 2022 | Mar. 31, 2021 |
Leases [Abstract] | ||
Weighted average remaining lease term-operating leases (years) | 11 years 4 months 24 days | 12 years 6 months |
Weighted average discount rate-operating leases | 7.70% | 7.40% |
Operating Leases - Summary of S
Operating Leases - Summary of Supplemental Cash Flow Information Related To Operating Leases (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Leases [Abstract] | ||
Operating cash flows from operating leases | $ 9,130 | $ 4,649 |
Right-of-use assets obtained in exchange for operating lease obligations | $ 801 | $ 656 |
Other Accrued Liabilities - Sum
Other Accrued Liabilities - Summary of Other Accrued Liabilities (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Payables and Accruals [Abstract] | ||
Accrued compensation and related expenses | $ 34,283 | $ 26,486 |
Accrued interest expense | 18,821 | 16,840 |
MAAPP funds (Note 23) | 1,093 | 2,398 |
Other | 31,279 | 42,089 |
Total | $ 85,476 | $ 87,813 |
Redeemable Noncontrolling Int_3
Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Noncontrolling Interest [Abstract] | ||
Redeemable noncontrolling interests | $ 37,049 | $ 37,469 |
Redeemable Noncontrolling Int_4
Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Noncontrolling Interest [Abstract] | |
Balance, December 31, 2021 | $ 37,469 |
Net income attributable to redeemable noncontrolling interests | 580 |
Distributions paid to redeemable noncontrolling interests | (1,000) |
Balance, March 31, 2022 | $ 37,049 |
Financial Instruments - Schedul
Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring [Member] - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Derivative In Subordinated Notes [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Financial Liabilities Fair Value Disclosure | $ 7,692 | $ 7,522 |
Derivative In Subordinated Notes [Member] | Level 1 [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Financial Liabilities Fair Value Disclosure | 0 | 0 |
Derivative In Subordinated Notes [Member] | Level 2 [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Financial Liabilities Fair Value Disclosure | 0 | 0 |
Derivative In Subordinated Notes [Member] | Level 3 [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Financial Liabilities Fair Value Disclosure | 7,692 | 7,522 |
Interest Rate Contracts [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Receivables, Fair Value Disclosure | 25 | 3 |
Financial Liabilities Fair Value Disclosure | 14 | 53 |
Interest Rate Contracts [Member] | Level 1 [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Receivables, Fair Value Disclosure | 0 | 0 |
Financial Liabilities Fair Value Disclosure | 0 | 0 |
Interest Rate Contracts [Member] | Level 2 [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Receivables, Fair Value Disclosure | 25 | 3 |
Financial Liabilities Fair Value Disclosure | 14 | 53 |
Interest Rate Contracts [Member] | Level 3 [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Receivables, Fair Value Disclosure | 0 | 0 |
Financial Liabilities Fair Value Disclosure | $ 0 | $ 0 |
Financial Instruments - Summary
Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) $ in Thousands | 3 Months Ended |
Mar. 31, 2022USD ($) | |
Disclosure Of Movement In Embedded Derivative Liabilities [Line Items] | |
Change in fair value | $ (170) |
Subordinated Debt [Member] | Stone Peak Magnet | Level 3 [Member] | |
Disclosure Of Movement In Embedded Derivative Liabilities [Line Items] | |
Balance, December 31, 2021 | 7,522 |
Change in fair value | 170 |
Balance, March 31, 2022 | $ 7,692 |
Financial Instruments - Sched_2
Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | $ 1,051,494 | $ 1,172,937 |
2028 Senior Notes [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 292,500 | 345,938 |
2025 Senior Notes [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 389,500 | 446,500 |
Subordinated Notes [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 310,376 | 323,620 |
Equipment Debt [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | $ 59,118 | $ 56,879 |
Financial Instruments - Sched_3
Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands | Mar. 31, 2022 | Dec. 31, 2021 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Cash and cash equivalents | $ 40,242 | $ 48,419 |
Accounts receivable | 126,480 | 121,525 |
Accounts payable | 34,118 | 34,326 |
Current portion of long-term debt | 15,667 | 14,789 |
Non-current portion of long-term debt | 1,209,700 | 1,197,596 |
Reported Value Measurement [Member] | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Cash and cash equivalents | 40,242 | 48,419 |
Accounts receivable | 126,480 | 121,525 |
Financial assets measured at amortized cost | 166,722 | 169,944 |
Accounts payable | 34,118 | 34,326 |
Current portion of long-term debt | 15,667 | 14,789 |
Current portion of leases | 26,795 | 27,254 |
Non-current portion of long-term debt | 1,209,700 | 1,197,596 |
Non-current portion of leases | 193,640 | 200,326 |
Other accrued liabilities | 85,476 | 87,813 |
Financial liabilities measured at amortized cost | 1,565,396 | 1,562,104 |
Derivative in subordinated notes | 7,692 | 7,522 |
Financial assets measured at fair value through other comprehensive income: Interest rate contracts | 25 | 3 |
Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts | $ 14 | $ 53 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Millions | 3 Months Ended | 12 Months Ended |
Mar. 31, 2022USD ($)yr | Dec. 31, 2021USD ($)yr | |
Level 3 [Member] | Measurement Input Probability Weighted Time | ||
Embedded derivative liability measurment input | yr | 4.1 | 4.2 |
Level 3 [Member] | Measurement Input Probability Of Exit Event Percentage [Member] | ||
Embedded derivative liability measurment input | 24.3 | 24.5 |
Equipment Debt [Member] | ||
Long term debt unhedged | $ | $ 1.2 | $ 1.8 |
Revolving Credit Facility [Member] | Interest Rate Contract [Member] | ||
Increase decrease in the variable rate of interest | 1.00% | 1.00% |
Stock-Based Awards - Summary of
Stock-Based Awards - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands | 3 Months Ended |
Mar. 31, 2022USD ($)$ / sharesshares | |
Share-based Payment Arrangement [Abstract] | |
Number of RSUs, Outstanding and unvested | shares | 2,029,032 |
Number of RSUs, Granted | shares | 799,085 |
Number of RSUs, Vested | shares | (489,516) |
Number of RSUs, Outstanding and unvested | shares | 2,338,601 |
Weighted-Average Grant Date Fair Value, Outstanding and unvested | $ / shares | $ 2.41 |
Weighted-Average Grant Date Fair Value, Granted | $ / shares | 1.10 |
Weighted-Average Grant Date Fair Value, Vested | $ / shares | 3.19 |
Weighted-Average Grant Date Fair Value, Outstanding and unvested | $ / shares | $ 1.80 |
Aggregate Fair Value, Granted | $ | $ 875 |
Aggregate Fair Value, Vested | $ | 1,561 |
Aggregate Fair Value, Outstanding and unvested | $ | $ 4,210 |
Stock-Based Awards - Summary _2
Stock-Based Awards - Summary of the Stock Option Activity (Detail) - Stock Options [Member] - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 12 Months Ended |
Mar. 31, 2022 | Dec. 31, 2021 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Number of Options, Outstanding | 5,680,120 | |
Number of Options, Exercisable | 5,084,519 | |
Number of Options, Outstanding | 5,680,120 | 5,680,120 |
Weighted- Average Exercise price, Outstanding | $ 2.54 | |
Weighted-Average Exercise price, Exercisable | 2.45 | |
Weighted- Average Exercise price, Outstanding | $ 2.54 | $ 2.54 |
Weighted- Average Remaining Contractual Term, Outstanding | 4 years 1 month 6 days | 4 years 4 months 24 days |
Weighted-Average Remaining Contractual Term, Exercisable | 4 years | |
Aggregate Intrinsic Value, Outstanding | $ 1,144 | $ 2,344 |
Aggregate Intrinsic Value, Exercisable | $ 1,144 |
Stock-Based Awards - Additional
Stock-Based Awards - Additional Information (Detail) $ in Millions | Nov. 14, 2017 | Mar. 31, 2022USD ($)shares | Mar. 31, 2021USD ($) | Dec. 31, 2021shares |
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Share-based Payment Arrangement, Expense | $ 1.1 | $ 0.4 | ||
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Amount | $ 3.1 | |||
Share-based Payment Arrangement, Nonvested Award, Cost Not yet Recognized, Period for Recognition | 1 year 10 months 24 days | |||
Restricted Stock Units (RSUs) [Member] | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Share-based Compensation Arrangement by Share-based Payment Award, Terms of Award | two years | |||
Employee Stock Option | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Share-based Compensation Arrangement by Share-based Payment Award, Award Vesting Period | 3 years | |||
Employee Stock Option | Minimum [Member] | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Share-based Compensation Arrangement by Share-based Payment Award, Terms of Award | 7 | |||
Employee Stock Option | Maximum [Member] | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Share-based Compensation Arrangement by Share-based Payment Award, Terms of Award | 10 years | |||
2017 Stock Plans | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Percent Common stock options reserved for issuance | 10 | |||
Common stock options reserved for issuance | shares | 8,951,651 | 8,902,699 |
Commitments and Contingencies -
Commitments and Contingencies - Additional Information (Details) - Commitement For The Purchase Of Equipment [Member] $ in Millions | Mar. 31, 2022USD ($) |
Loss Contingencies [Line Items] | |
Purchase Obligation | $ 35.7 |
Within Next Twelve Months [Member] | |
Loss Contingencies [Line Items] | |
Purchase Obligation | 24.7 |
Greater Than Twelve Months [Member] | |
Loss Contingencies [Line Items] | |
Purchase Obligation | $ 11 |
Supplemental Revenue Informat_3
Supplemental Revenue Information - Summary of Revenue Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Disaggregation of Revenue [Line Items] | ||
Other revenue | $ 2,155 | $ 497 |
Total revenue | 186,263 | 63,963 |
Sales Channel, Directly to Consumer [Member] | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 96,649 | 63,466 |
Commercial | Sales Channel, Directly to Consumer [Member] | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 69,101 | 50,799 |
Medicare | Sales Channel, Directly to Consumer [Member] | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 21,172 | 8,184 |
Medicaid | Sales Channel, Directly to Consumer [Member] | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 3,102 | 1,831 |
Other patient revenue | Sales Channel, Directly to Consumer [Member] | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 3,274 | 2,652 |
Hospitals and healthcare providers | Sales Channel, Through Intermediary [Member] | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | $ 87,459 | $ 0 |
Cost of Operations, excluding_3
Cost of Operations, excluding Depreciation and Amortization - Summary of Cost of Goods and Services Excluding Depletion Depreciation And Amortization (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | $ 157,479 | $ 55,142 |
Employee compensation | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | 77,365 | 23,118 |
Third party services and professional fees | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | 29,177 | 6,859 |
Rent and utilities | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | 12,477 | 7,684 |
Reading fees | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | 11,498 | 9,984 |
Administrative | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | 11,624 | 4,356 |
Medical supplies and other | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization | $ 15,338 | $ 3,141 |
Other Operating and Non-Opera_3
Other Operating and Non-Operating Losses (Gains) - Schedule of Other Operating Losses (gains) (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Schedule Of Other Operating Cost And Expense By Component | ||
Loss on disposal of property and equipment, net | $ 202 | $ 90 |
Other, net | (256) | |
Other Operating Losses (gains) | $ (54) | $ 90 |
Other Operating and Non-Opera_4
Other Operating and Non-Operating Losses (Gains) - Schedule Of Other Non-operating Losses (gains) (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Schedule Of Other Non operating Income Expense [Line Items] | ||
Earnings from equity method investments | $ (240) | $ 0 |
Fair value adjustment on derivative | 170 | |
Gain on conversion of debt to equity investment (Note 19) | 0 | (3,360) |
Other, net | 59 | (6) |
Total other expense, net | $ (11) | $ (3,366) |
Investment in Unconsolidated _2
Investment in Unconsolidated Investees - Additional information (Detail) - USD ($) $ in Millions | Mar. 01, 2021 | Mar. 31, 2021 | Mar. 31, 2022 |
Other Investments [Line Items] | |||
Payments to acquire Investments | $ 4.6 | ||
Equity method investments | $ 7.9 | ||
Equity method investment, ownership percentage | 34.50% | 34.50% | |
Unconsolidated Investee [Member] | |||
Other Investments [Line Items] | |||
Equity method investment, ownership percentage | 15.00% | ||
Other Financial Instruments Revaluation and other (Gains) Losses Member [Member] | |||
Other Investments [Line Items] | |||
Gain (loss) on conversion of debt investments | $ 3.4 | ||
Common Equity Member [Member] | Share Purchase Warrants Member [Member] | |||
Other Investments [Line Items] | |||
Payments to acquire Investments | $ 0.4 | ||
Equity method investment, ownership percentage | 2.40% |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Operating Loss Carryforwards [Line Items] | ||
income tax rate, percent | 26.50% | 26.50% |
Basic and Diluted Loss per Sh_3
Basic and Diluted Loss per Share - Summary of Earnings Per Share Basic and Diluted (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Earnings Per Share [Abstract] | ||
Net loss attributable to common shareholders | $ (30,811) | $ (2,877) |
Weighted average common shares outstanding: | ||
Basic and diluted | 89,074,282 | 70,178,428 |
Net loss per share attributable to common shareholders: | ||
Basic and Diluted | $ (0.35) | $ (0.04) |
Employee stock options, warrants and restricted stock units excluded from the computation of diluted per share amounts as their effect would be antidilutive | 1,844,044 | 1,811,298 |
Segment Information - Summary o
Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Revenues | $ 186,263 | $ 63,963 |
Radiology [Member] | ||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Revenues | 155,340 | $ 63,963 |
Oncology [Member] | ||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Revenues | $ 30,923 |
Segment Information - Summary_2
Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Adjusted Earnings Before Interest Tax Depreciation And Amortization | $ 32,018 | $ 9,203 |
Radiology [Member] | ||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Adjusted Earnings Before Interest Tax Depreciation And Amortization | 28,589 | 10,843 |
Oncology [Member] | ||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Adjusted Earnings Before Interest Tax Depreciation And Amortization | 10,033 | 0 |
Corporate Segment [Member] | ||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||
Adjusted Earnings Before Interest Tax Depreciation And Amortization | $ (6,604) | $ (1,640) |
Segment Information - Summary_3
Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2022 | Mar. 31, 2021 | |
Segment Reporting [Abstract] | ||
Net loss | $ (26,432) | $ (2,508) |
Interest expense | 28,681 | 8,368 |
Income tax expense | 563 | 65 |
Depreciation and amortization | 24,731 | 4,490 |
EBITDA | 27,543 | 10,415 |
Adjustments: | ||
Stock-based compensation | 1,061 | 427 |
Acquisition-related costs | 382 | 1,279 |
Loss on disposal of property and equipment, net | 202 | 90 |
Settlement and related recoveries | (137) | (24) |
Gain on conversion of debt to equity investment | 0 | (3,360) |
Severance, restructuring and other charges | 2,453 | |
Other losses (gains), net | 182 | (69) |
Deferred rent expense | 332 | 445 |
Adjusted EBITDA | $ 32,018 | $ 9,203 |
Segment Information - Schedule
Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | ||
Mar. 31, 2022 | Mar. 31, 2021 | Dec. 31, 2021 | |
Segment Reporting Information [Line Items] | |||
Identifiable assets | $ 1,891,483 | $ 1,918,826 | |
Capital expenditures | 9,878 | $ 1,173 | |
Radiology [Member] | |||
Segment Reporting Information [Line Items] | |||
Identifiable assets | 1,434,449 | 1,451,905 | |
Capital expenditures | 8,812 | $ 1,173 | |
Oncology [Member] | |||
Segment Reporting Information [Line Items] | |||
Identifiable assets | 432,931 | 440,416 | |
Capital expenditures | 976 | ||
Corporate Segment [Member] | |||
Segment Reporting Information [Line Items] | |||
Identifiable assets | 24,103 | $ 26,505 | |
Capital expenditures | $ 90 |
CARES Act - Additional Informat
CARES Act - Additional Information (Detail) - Coronavirus Aid Relief And Economic Security Act [Member] - USD ($) $ in Millions | Sep. 01, 2021 | Dec. 31, 2020 | Mar. 31, 2022 | Dec. 31, 2021 |
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||||
Other accrued liabilities | $ 4.3 | $ 4.3 | ||
Social Security Tax [Member] | Due On December 31, 2021 [Member] | ||||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||||
Percentage of deferred payment of the employer portion | 50.00% | |||
Social Security Tax [Member] | Due On December 31, 2022 [Member] | ||||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||||
Percentage of deferred payment of the employer portion | 50.00% | |||
Medicare Accelerated and Advance Payments Program [Member] | ||||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||||
Amount received as accelerated medicare payments | $ 3.1 | |||
Medicare Accelerated and Advance Payments Program [Member] | Alliance [Member] | ||||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||||
Amount received as accelerated medicare payments | $ 3.3 | |||
Business combination identifiable advance medicare payments assumed | $ 1.1 | $ 2.4 |