Cover Page
Cover Page - shares | 9 Months Ended | |
Sep. 30, 2022 | Nov. 07, 2022 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Sep. 30, 2022 | |
Document Transition Report | false | |
Entity File Number | 333-261815 | |
Entity Registrant Name | AKUMIN INC. | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 88-4139425 | |
Entity Address, Address Line One | 8300 W. Sunrise Boulevard | |
Entity Address, City or Town | Plantation | |
Entity Address, State or Province | FL | |
Entity Address, Postal Zip Code | 33322 | |
City Area Code | 844 | |
Local Phone Number | 730-0050 | |
Title of 12(b) Security | Common Stock, $0.01 par value per share | |
Trading Symbol | AKU | |
Security Exchange Name | NASDAQ | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | true | |
Entity Common Stock, Shares Outstanding | 89,661,513 | |
Entity Ex Transition Period | false | |
Entity Shell Company | false | |
Entity Central Index Key | 0001776197 | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Year Focus | 2022 | |
Document Fiscal Period Focus | Q3 | |
Amendment Flag | false |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Current assets: | ||
Cash and cash equivalents | $ 59,356 | $ 48,419 |
Accounts receivable | 112,376 | 121,525 |
Prepaid expenses | 8,443 | 8,196 |
Other current assets | 9,151 | 7,025 |
Total current assets | 189,326 | 185,165 |
Property and equipment, net | 229,722 | 259,122 |
Operating lease right-of-use assets | 173,325 | 194,565 |
Goodwill | 795,610 | 840,353 |
Other intangible assets, net | 397,185 | 414,146 |
Other assets | 24,070 | 25,475 |
Total assets | 1,809,238 | 1,918,826 |
Current liabilities: | ||
Accounts payable | 27,696 | 34,326 |
Current portion of long-term debt | 18,714 | 14,789 |
Current portion of obligations under finance leases | 5,963 | 6,460 |
Current portion of obligations under operating leases | 17,864 | 20,794 |
Accrued liabilities | 97,062 | 87,813 |
Total current liabilities | 167,299 | 164,182 |
Long-term debt, net of current portion | 1,242,181 | 1,197,596 |
Obligations under finance leases, net of current portion | 15,037 | 15,951 |
Obligations under operating leases, net of current portion | 165,882 | 184,375 |
Other liabilities | 21,890 | 35,574 |
Total liabilities | 1,612,289 | 1,597,678 |
Redeemable noncontrolling interests | 34,200 | 37,469 |
Stockholders’ equity: | ||
Preferred stock, $0.01 par value; 50,000,000 shares authorized; no shares issued and outstanding at September 30, 2022 and December 31, 2021 | 0 | 0 |
Additional paid-in capital | 897 | 890 |
Additional paid-in capital | 230,073 | 227,705 |
Accumulated other comprehensive income | 87 | 18 |
Accumulated deficit | (238,575) | (123,424) |
Total stockholders’ equity | (7,518) | 105,189 |
Noncontrolling interests | 170,267 | 178,490 |
Total equity | 162,749 | 283,679 |
Total liabilities, redeemable noncontrolling interests and equity | $ 1,809,238 | $ 1,918,826 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares | Sep. 30, 2022 | Dec. 31, 2021 |
Statement of Financial Position [Abstract] | ||
Preferred stock, par or stated value per share (in USD per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 50,000,000 | 50,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Common stock, par or stated value per share (in USD per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 300,000,000 | 300,000,000 |
Common stock issued (in shares) | 89,661,513 | 89,026,997 |
Common stock outstanding (in shares) | 89,661,513 | 89,026,997 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Income Statement [Abstract] | ||||
Revenues | $ 186,605 | $ 108,177 | $ 564,996 | $ 241,636 |
Operating expenses: | ||||
Cost of operations, excluding depreciation and amortization | 150,674 | 90,964 | 460,409 | 203,874 |
Depreciation and amortization | 25,079 | 11,286 | 75,010 | 20,359 |
Impairment charges | 20,369 | 0 | 20,702 | 0 |
Restructuring charges | 4,042 | 479 | 11,366 | 479 |
Severance and related costs | 2,485 | 53 | 10,282 | 53 |
Settlements, recoveries and related costs | (576) | (52) | 101 | (394) |
Stock-based compensation | 556 | 785 | 2,375 | 1,997 |
Other operating expense (income), net | (7,574) | (68) | (7,328) | 278 |
Total operating expenses | 195,055 | 103,447 | 572,917 | 226,646 |
Income (loss) from operations | (8,450) | 4,730 | (7,921) | 14,990 |
Other expense (income): | ||||
Interest expense | 29,679 | 16,932 | 87,650 | 34,221 |
Acquisition-related costs | 99 | 8,784 | 567 | 14,412 |
Other non-operating income, net | (521) | (96) | (3,000) | (3,462) |
Total other expense, net | 29,257 | 25,620 | 85,217 | 45,171 |
Loss before income taxes | (37,707) | (20,890) | (93,138) | (30,181) |
Income tax expense (benefit) | 12,038 | (22,070) | 9,118 | (21,999) |
Net income (loss) | (49,745) | 1,180 | (102,256) | (8,182) |
Less: Net income attributable to noncontrolling interests | 4,126 | 2,517 | 12,895 | 3,388 |
Net loss attributable to common stockholders | (53,871) | (1,337) | (115,151) | (11,570) |
Comprehensive income (loss), net of taxes: | ||||
Net income (loss) | (49,745) | 1,180 | (102,256) | (8,182) |
Other comprehensive income (loss): | ||||
Unrealized gain (loss) on hedging transactions, net of taxes | 11 | (8) | 47 | (8) |
Reclassification adjustment for losses included in net loss, net of taxes | (4) | 7 | 22 | 7 |
Other comprehensive income | 7 | (1) | 69 | (1) |
Comprehensive income (loss), net of taxes | (49,738) | 1,179 | (102,187) | (8,183) |
Less: Comprehensive income attributable to noncontrolling interests | 4,126 | 2,517 | 12,895 | 3,388 |
Comprehensive loss attributable to common stockholders | $ (53,864) | $ (1,338) | $ (115,082) | $ (11,571) |
Earnings Per Share [Abstract] | ||||
Basic (in dollars per share) | $ (0.60) | $ (0.02) | $ (1.29) | $ (0.16) |
Diluted (in dollars per share) | $ (0.60) | $ (0.02) | $ (1.29) | $ (0.16) |
Condensed Consolidated Statem_2
Condensed Consolidated Statements of Equity - USD ($) $ in Thousands | Total | Cumulative Effect, Period of Adoption, Adjustment | Total Stockholders’ Equity | Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit | Noncontrolling Interests | Noncontrolling Interests Cumulative Effect, Period of Adoption, Adjustment |
Beginning balance (in shares) at Dec. 31, 2020 | 70,178,428 | ||||||||
Beginning balance at Dec. 31, 2020 | $ 85,170 | $ 80,832 | $ 702 | $ 160,263 | $ 0 | $ (80,133) | $ 4,338 | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||||
Net income (loss) | (8,182) | (11,570) | (11,570) | 3,388 | |||||
Issuance of common stock for acquisition consideration (in shares) | 15,198,569 | ||||||||
Issuance of common stock for acquisition consideration | 33,877 | 33,877 | $ 152 | 33,725 | |||||
Issuance of common stock - other (in shares) | 3,500,000 | ||||||||
Issuance of common stock - other | 10,416 | 10,416 | $ 35 | 10,381 | |||||
Warrants issued | 33,096 | 33,096 | 33,096 | ||||||
Stock options exercised (in shares) | 150,000 | ||||||||
Stock options exercised | 75 | 75 | $ 1 | 74 | |||||
Stock-based compensation | 1,997 | 1,997 | 1,997 | ||||||
Other comprehensive income (loss) | (1) | (1) | (1) | ||||||
Acquisition of noncontrolling interests | 212,210 | 212,210 | |||||||
Distributions paid to noncontrolling interests | (4,167) | (4,167) | |||||||
Ending balance (in shares) at Sep. 30, 2021 | 89,026,997 | ||||||||
Ending Balance at Sep. 30, 2021 | 364,491 | 148,722 | $ 890 | 239,536 | (1) | (91,703) | 215,769 | ||
Beginning balance (in shares) at Jun. 30, 2021 | 71,303,427 | ||||||||
Beginning balance at Jun. 30, 2021 | 79,100 | 74,898 | $ 713 | 164,551 | 0 | (90,366) | 4,202 | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||||
Net income (loss) | 1,180 | (1,337) | (1,337) | 2,517 | |||||
Issuance of common stock for acquisition consideration (in shares) | 14,223,570 | ||||||||
Issuance of common stock for acquisition consideration | 30,865 | 30,865 | $ 142 | 30,723 | |||||
Issuance of common stock - other (in shares) | 3,500,000 | ||||||||
Issuance of common stock - other | 10,416 | 10,416 | $ 35 | 10,381 | |||||
Warrants issued | 33,096 | 33,096 | 33,096 | ||||||
Stock-based compensation | 785 | 785 | 785 | ||||||
Other comprehensive income (loss) | (1) | (1) | (1) | ||||||
Acquisition of noncontrolling interests | 212,210 | 212,210 | |||||||
Distributions paid to noncontrolling interests | (3,160) | (3,160) | |||||||
Ending balance (in shares) at Sep. 30, 2021 | 89,026,997 | ||||||||
Ending Balance at Sep. 30, 2021 | 364,491 | 148,722 | $ 890 | 239,536 | (1) | (91,703) | 215,769 | ||
Beginning balance (in shares) at Dec. 31, 2021 | 89,026,997 | ||||||||
Beginning balance at Dec. 31, 2021 | 283,679 | 105,189 | $ 890 | 227,705 | 18 | (123,424) | 178,490 | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||||
Net income (loss) | (102,256) | ||||||||
Net income (loss), net of the net income attributable to redeemable noncontrolling interests | (103,738) | (115,151) | (115,151) | 11,413 | |||||
Settlement of restricted share units (in shares) | 634,516 | ||||||||
Settlement of restricted share units | 0 | $ 7 | (7) | ||||||
Stock-based compensation | 2,375 | 2,375 | 2,375 | ||||||
Other comprehensive income (loss) | 69 | 69 | 69 | ||||||
Distributions paid to noncontrolling interests | (17,343) | (17,343) | |||||||
Purchase accounting adjustments | $ (2,293) | $ (2,293) | |||||||
Ending balance (in shares) at Sep. 30, 2022 | 89,661,513 | ||||||||
Ending Balance at Sep. 30, 2022 | 162,749 | (7,518) | $ 897 | 230,073 | 87 | (238,575) | 170,267 | ||
Beginning balance (in shares) at Jun. 30, 2022 | 89,516,513 | ||||||||
Beginning balance at Jun. 30, 2022 | 220,492 | 45,790 | $ 895 | 229,519 | 80 | (184,704) | 174,702 | ||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||||
Net income (loss) | (49,745) | ||||||||
Net income (loss), net of the net income attributable to redeemable noncontrolling interests | (50,113) | (53,871) | (53,871) | 3,758 | |||||
Settlement of restricted share units (in shares) | 145,000 | ||||||||
Settlement of restricted share units | 0 | $ 2 | (2) | ||||||
Stock-based compensation | 556 | 556 | 556 | ||||||
Other comprehensive income (loss) | 7 | 7 | 7 | ||||||
Distributions paid to noncontrolling interests | (5,739) | (5,739) | |||||||
Purchase accounting adjustments | (2,454) | (2,454) | |||||||
Ending balance (in shares) at Sep. 30, 2022 | 89,661,513 | ||||||||
Ending Balance at Sep. 30, 2022 | $ 162,749 | $ (7,518) | $ 897 | $ 230,073 | $ 87 | $ (238,575) | $ 170,267 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2022 | Sep. 30, 2021 | |
Operating activities: | ||
Net income (loss) | $ (102,256) | $ (8,182) |
Adjustments to reconcile net loss to net cash provided by operating activities: | ||
Depreciation and amortization | 75,010 | 20,359 |
Impairment charges | 20,702 | 0 |
Stock-based compensation | 2,375 | 1,997 |
Non-cash interest expense | 37,509 | 0 |
Amortization of deferred financing costs and accretion of discount/premium on long-term debt | 71 | 1,959 |
Deferred income taxes | 9,012 | (22,731) |
Distributions from unconsolidated investees | 1,157 | 0 |
Earnings from unconsolidated investees | (738) | (46) |
Gain on sale of accounts receivable | (7,603) | 0 |
Other non-cash items, net | (247) | (3,032) |
Changes in operating assets and liabilities, net of acquisitions: | ||
Accounts receivable | 15,923 | 875 |
Prepaid expenses and other assets | (1,967) | 1,865 |
Accounts payable and other liabilities | 7,388 | 16,924 |
Operating lease liabilities and right-of-use assets | (400) | 2,761 |
Net cash provided by operating activities | 55,936 | 12,749 |
Investing activities: | ||
Purchases of property and equipment | (32,765) | (5,203) |
Business acquisitions, net of cash acquired | 0 | (758,114) |
Other investing activities | 1,139 | (4,563) |
Net cash used in investing activities | (31,626) | (767,880) |
Financing activities: | ||
Proceeds from revolving loan | 29,000 | 0 |
Principal payments on revolving loan | (29,000) | 0 |
Proceeds from long-term debt | 25,892 | 793,750 |
Principal payments on long-term debt | (12,829) | (2,697) |
Principal payments on finance leases | (5,568) | (2,720) |
Payment of debt issuance costs | 0 | (21,500) |
Payment of earn-out liability | 0 | (4,689) |
Proceeds from issuance of common stock | 0 | 10,505 |
Payment of issuance costs for common stock and warrants | 0 | (1,871) |
Distributions paid to noncontrolling interests | (20,868) | (4,167) |
Net cash provided by (used in) financing activities | (13,373) | 766,611 |
Net increase in cash and cash equivalents | 10,937 | 11,480 |
Cash and cash equivalents, beginning of period | 48,419 | 44,396 |
Cash and cash equivalents, end of period | 59,356 | 55,876 |
Supplemental disclosure of cash flow information: | ||
Interest paid | 47,774 | 17,372 |
Income taxes paid, net | 506 | 238 |
Supplemental disclosure of non-cash investing and financing activities: | ||
Property and equipment purchases in accounts payable and accrued liabilities | 4,414 | 300 |
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations | 6,561 | 1,058 |
Equipment acquired in exchange for finance lease obligations | 4,197 | 1,299 |
Operating lease right-of-use assets obtained in exchange for operating lease liabilities | $ 1,159 | $ 2,022 |
Basis of Presentation
Basis of Presentation | 9 Months Ended |
Sep. 30, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | 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 and nine months ended September 30, 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. On September 30, 2022, the Company changed its jurisdiction of incorporation from the province of Ontario, Canada, to the State of Delaware (the “Domestication”). The Company discontinued its existence as a corporation under Section 181 of the Ontario Business Corporations Act and, pursuant to Section 388 of the Delaware General Corporation Law (the “DGCL”), continued its existence under the DGCL as a corporation incorporated in the State of Delaware. In connection with the Domestication, the outstanding common shares of the Company were converted, on a one-for-one basis, into shares of common stock of the Company, respectively, as a corporation incorporated in the State of Delaware. Following the completion of the Domestication, the Company’s common stock will continue to be listed on the Nasdaq Stock Market and on the Toronto Stock Exchange under the symbol “AKU.” The business, assets and liabilities of the Company, as well as its principal place of business and fiscal year, were the same immediately after the Domestication as they were immediately prior to the Domestication. 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 | 9 Months Ended |
Sep. 30, 2022 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
New Accounting Standards | New Accounting Standards Recently Adopted Accounting Standards ASU 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40) In April 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40). This guidance clarifies and reduces diversity in an issuer’s accounting for modifications or exchanges of freestanding equity-classified written call options due to a lack of explicit guidance in the FASB Codification. This ASU is effective for all entities for fiscal years beginning after December 15, 2021. The Company adopted this standard as of January 1, 2022 and it did not have a material impact on the Company’s condensed consolidated financial statements. 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 , which aims to provide increased transparency by requiring business entities to disclose information about certain types of government assistance they receive in the notes to the financial statements. ASU 2021-10 also adds a new Topic, Accounting Standards Codification ("ASC") 832, Government Assistance, to the FASB’s Codification. The disclosure requirements only apply to transactions with a government that are accounted for by analogizing to either a grant model or a contribution model. The guidance in ASU 2021-10 is effective for financial statements of all entities, including private companies, for annual periods beginning after December 15, 2021, with early adoption permitted. The Company adopted this standard as of January 1, 2022 and it did not have a material impact on the Company’s condensed consolidated financial statements. Recently Issued Accounting Standards Not Yet Effective ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company is currently evaluating the impact of the standard on its consolidated financial statements. ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting 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 . This ASU provides optional expedients and exceptions for applying generally accepted accounting principles to certain contract modifications and hedging relationships that reference London Inter-bank Offered Rate (“LIBOR”) or another reference rate expected to be discontinued. For all entities, the guidance is effective upon issuance and generally can be applied through December 31, 2022. The Company is currently evaluating the impact of the standard on its consolidated financial statements. ASU 2021-01, Reference Rate Reform (Topic 848): Scope In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848): Scope . This ASU clarifies the scope of Topic 848 so that derivatives affected by the discounting transition are explicitly eligible for certain option expedients and exceptions in Topic 848. The guidance is effective upon issuance and generally can be applied through December 31, 2022. The Company is currently evaluating the impact of the standard on its consolidated financial statements. ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers , creating an exception to the recognition and measurement principles in ASC 805, Business Combinations . The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers , rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets , fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of |
Alliance Acquisition
Alliance Acquisition | 9 Months Ended |
Sep. 30, 2022 | |
Business Combination and Asset Acquisition [Abstract] | |
Alliance Acquisition | 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 Healthcare Services, Inc. ("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. 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 estimated 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 nine months ended September 30, 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 intangible assets of $1.2 million due to a refinement in the valuation analysis, partially offset by the valuation of a patent which had not previously been valued, (iii) a decrease in noncontrolling interests of $3.5 million due to a refinement in the valuation analysis, and (iv) a decrease in net deferred tax liabilities of $22.7 million due to further analysis of the difference between the book value and tax basis of the assets and liabilities reflected in the opening balance sheet of the acquired business, and the tax net operating loss carryforwards of both the acquired business and the acquiring business, as well as the valuation allowance required to reduce the carrying amount of deferred tax assets of the acquired business. The net effect of the changes to the preliminary fair value of the assets acquired and liabilities assumed resulted in a decrease in goodwill of $24.7 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 finalized as of August 31, 2022. The following table summarizes the final 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 assets 69,919 Goodwill 431,017 Intangibles – Customer contracts 264,401 Intangibles – Trade names 68,829 Intangibles – Third party management agreements 10,200 Intangibles – Patent 920 Intangibles – Certificates of need 69,558 Other assets 8,170 1,169,300 Liabilities assumed: Equipment debt 54,539 Obligations under finance leases 9,041 Obligations under operating leases 74,290 Deferred tax liabilities 30,082 Other liabilities 7,234 175,186 Net assets acquired 994,114 Less redeemable noncontrolling interests 35,813 Less noncontrolling interests 172,685 Purchase price $ 785,616 |
Variable Interest Entities
Variable Interest Entities | 9 Months Ended |
Sep. 30, 2022 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | 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, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in the condensed consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of September 30, 2022 and December 31, 2021, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were |
Sales of Accounts Receivable
Sales of Accounts Receivable | 9 Months Ended |
Sep. 30, 2022 | |
Receivables [Abstract] | |
Sales of Accounts Receivable | Sales of Accounts Receivable The Company uses accounts receivable sales facilities as part of managing its cash flows and improving liquidity. The Company accounts for transfers of financial assets under ASC 860, “Transfers and Servicing,” as either sales or financings. Transfers of financial assets that result in sales accounting are those in which (1) the transfer legally isolates the transferred assets from the transferor, (2) the transferee has the right to pledge or exchange the transferred assets and no condition both constrains the transferee’s right to pledge or exchange the assets and provides more than a trivial benefit to the transferor, and (3) the transferor does not maintain effective control over the transferred assets. If the transfer does not meet these criteria, the transfer is accounted for as a financing. Financial assets that are treated as sales are removed from the Company’s accounts with any realized gain or loss reflected in earnings during the period of sale. In August 2022, the Company entered into a One-Time Purchase Agreement (“OTPA”) with an independent third-party for the sale of certain existing accounts receivable that arose from healthcare services provided in the states of Georgia, Texas and Florida. Under the terms of the OTPA, the sale is on a non-recourse basis and the Company does not retain any interest in the receivables. In connection with the OTPA transaction, the Company sold accounts receivable with a carrying value of $20.3 million and received cash proceeds of $29.0 million. The transfer of accounts receivable under this agreement meets the criteria for a sale of financial assets. As a result, such receivables have been derecognized from the Company’s condensed consolidated balance sheet as of September 30, 2022 and the proceeds are included in cash flows from operating activities in the Company’s condensed consolidated statement of cash flows for the nine months ended September 30, 2022. In addition, the Company entered into a Master Purchase Agreement (“MPA”) with the same third-party to sell, on an ongoing basis and without recourse, future accounts receivable that arise from healthcare services provided in the states of Georgia, Texas and Florida. Under the MPA, the purchaser will buy from the Company accounts receivable that are acceptable to the purchaser and that the purchaser agrees to acquire. Either party may terminate the agreement at any time upon thirty days’ prior written notice to the other party. In connection with the OTPA and MPA, the Company entered into a servicing agreement to service the accounts receivable arising from the state of Florida. In accordance with ASC 860, the Company recognized a $1.1 million servicing liability related to the OTPA transaction for the cost of future servicing of the accounts receivable. This liability was initially measured at fair value and is being subsequently amortized on a straight-line basis over the estimated collection period of three years. The fair value of the servicing liability was determined using unobservable Level 3 inputs by obtaining an estimated rate that would be charged by an unrelated entity to service the accounts receivable and applying that rate to the estimated collections. The servicing liability is included in accrued liabilities (current portion) and other liabilities (non-current portion) in the Company's condensed consolidated balance sheet as of September 30, 2022. In connection with the OTPA transaction, the Company recorded a gain on sale of accounts receivable of $7.6 million, which is included in other operating expense, net in the condensed consolidated statements of operations and comprehensive loss for the three and nine months ended September 30, 2022. |
Property and Equipment
Property and Equipment | 9 Months Ended |
Sep. 30, 2022 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and Equipment Property and equipment consists of the following: (in thousands) September 30, December 31, Medical equipment $ 245,105 $ 227,796 Leasehold improvements 42,779 39,763 Equipment under finance leases 37,243 34,597 Office and computer equipment 20,484 16,701 Transportation and service equipment 11,672 8,996 Furniture and fixtures 3,372 3,130 Construction in progress 5,094 6,423 365,749 337,406 Less accumulated depreciation 136,027 78,284 $ 229,722 $ 259,122 Depreciation expense was $19.5 million and $9.4 million for the three months ended September 30, 2022 and 2021, respectively, and $59.4 million and $17.1 million for the nine months ended September 30, 2022 and 2021, respectively. |
Goodwill
Goodwill | 9 Months Ended |
Sep. 30, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | 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 Purchase accounting adjustments 732 (25,475) (24,743) Impairment — (20,000) (20,000) Balance, September 30, 2022 $ 682,725 $ 112,885 $ 795,610 The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. Such indicators include a significant decline in expected future cash flows due to changes in company-specific factors or the broader business climate. During the three months ended September 30, 2022, the Company determined that potential indicators of impairment existed and thus performed a quantitative test for impairment at the reporting unit level as of August 31, 2022. In estimating fair values, the Company gave equal weight to an income approach (the DCF method) and a market approach (the GPC method). Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis: Discount rate 10.0% to 11.0% Perpetual growth rate 2.5% Tax rate 26.0% Risk-free interest rate 3.5% Revenue multiple 1.9 to 2.3 EBITDA multiple 8.0 to 12.0 |
Other Intangible Assets
Other Intangible Assets | 9 Months Ended |
Sep. 30, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Other Intangible Assets | Other Intangible Assets Other intangible assets consist of the following: (dollars in thousands) Weighted September 30, 2022 December 31, 2021 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 264,236 $ (15,046) $ 249,190 $ 266,224 $ (4,437) $ 261,787 Trade names 18 77,189 (9,928) 67,261 77,466 (6,054) 71,412 Management agreements 17 10,200 (650) 9,550 10,200 (200) 10,000 Other 5 5,734 (4,108) 1,626 4,814 (3,425) 1,389 Total $ 357,359 $ (29,732) 327,627 $ 358,704 $ (14,116) 344,588 Certificates of Need 69,558 69,558 Total other intangible assets $ 397,185 $ 414,146 The Company performs an impairment test when indicators of impairment are present. During the three months ended September 30, 2022, the Company determined that potential indicators of impairment existed and thus performed a quantitative assessment for impairment by comparing the carrying amount of certain assets to the undiscounted future net cash flows expected to be generated by the assets. Based on the assessment performed, the Company concluded that there was no impairment associated with its other intangible assets. |
Long-Term Debt
Long-Term Debt | 9 Months Ended |
Sep. 30, 2022 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | Long-Term Debt Long-term debt consists of the following: (in thousands) September 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 409,979 372,470 Equipment Debt 71,715 58,827 1,331,694 1,281,297 Debt discount and deferred issuance costs (70,799) (68,912) 1,260,895 1,212,385 Less current portion 18,714 14,789 Long-term debt, net of current portion $ 1,242,181 $ 1,197,596 During the nine months ended September 30, 2022, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $37.5 million of accrued interest was added to the principal balance of the Subordinated Notes. 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, or had received waivers for, all such covenants as of September 30, 2022. |
Accrued Liabilities
Accrued Liabilities | 9 Months Ended |
Sep. 30, 2022 | |
Payables and Accruals [Abstract] | |
Accrued Liabilities | Accrued Liabilities Accrued liabilities consist of the following: (in thousands) September 30, December 31, Accrued compensation and related expenses $ 32,687 $ 26,486 Accrued interest expense 19,252 16,840 Other 45,123 44,487 $ 97,062 $ 87,813 |
Redeemable Noncontrolling Inter
Redeemable Noncontrolling Interests | 9 Months Ended |
Sep. 30, 2022 | |
Noncontrolling Interest [Abstract] | |
Redeemable Noncontrolling Interests | 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 status is jeopardized by the joint venture. As of September 30, 2022, the Company holds redeemable noncontrolling interests of $34.2 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 nine months ended September 30, 2022: (in thousands) Balance, December 31, 2021 $ 37,469 Net income attributable to redeemable noncontrolling interests 1,482 Distributions paid to redeemable noncontrolling interests (3,525) Purchase accounting adjustments (1,226) Balance, September 30, 2022 $ 34,200 |
Financial Instruments
Financial Instruments | 9 Months Ended |
Sep. 30, 2022 | |
Financial Instruments [Abstract] | |
Financial Instruments | 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 September 30, 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 $ — $ 58 $ — $ 58 $ — $ 3 $ — $ 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 6,412 $ 6,412 $ — $ — $ 7,522 $ 7,522 Interest rate contracts $ — $ — $ — $ — $ — $ 53 $ — $ 53 The derivative in subordinated notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 9). The fair value of the Change of Control Redemption Election liability was determined using a probability weighted scenario analysis regarding a potential change of control during the term. The estimated fair values of the Change of Control Redemption Election as of September 30, 2022 and December 31, 2021 use unobservable inputs for probability weighted time until an exit event of 3.7 years and 4.2 years, respectively, and an exit event probability weighting of 23.6% 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 nine months ended September 30, 2022: (in thousands) Balance, December 31, 2021 $ 7,522 Change in fair value (1,110) Balance, September 30, 2022 $ 6,412 The $1.1 million change in the fair value of the derivative in subordinated notes was recorded as a gain and included in other non-operating income, net in the Company's condensed consolidated statements of operations and comprehensive loss for the nine months ended September 30, 2022. The Company’s interest rate contracts are primarily pay-fixed, receive-variable interest rate swaps related to certain of the Company’s equipment debt. The amount that the Company expects to reclassify from accumulated other comprehensive income to interest expense over the next twelve months is immaterial. Assets and Liabilities for which Fair Value is only Disclosed The estimated fair values of other current and non-current liabilities are as follows: (in thousands) September 30, December 31, 2028 Senior Notes $ 294,583 $ 345,938 2025 Senior Notes 387,202 446,500 Subordinated Notes 241,622 323,620 Equipment Debt 63,944 56,879 $ 987,351 $ 1,172,937 As of September 30, 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, 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 portion of lease liabilities approximates their fair value given the difference between the discount rates used to recognize the liabilities in the condensed consolidated balance sheets and the normalized expected market rates of interest is insignificant. 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: (in thousands) September 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 59,356 $ 48,419 Accounts receivable 112,376 121,525 $ 171,732 $ 169,944 Financial liabilities measured at amortized cost: Accounts payable $ 27,696 $ 34,326 Current portion of long-term debt 18,714 14,789 Current portion of leases 23,827 27,254 Non-current portion of long-term debt 1,242,181 1,197,596 Non-current portion of leases 180,919 200,326 Accrued liabilities 97,062 87,813 $ 1,590,399 $ 1,562,104 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 6,412 $ 7,522 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 58 $ 3 Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ — $ 53 Assets and Liabilities that are Measured at Fair Value on a Nonrecurring Basis The Company measures certain non-financial assets at fair value on a nonrecurring basis, primarily intangible assets, goodwill and long-lived assets in connection with acquisitions and periodic evaluations for potential impairment. The Company estimates the fair value of these assets using primarily unobservable inputs; therefore, these are considered Level 3 fair value measurements. Interest Rate Risk |
Stockholders' Equity
Stockholders' Equity | 9 Months Ended |
Sep. 30, 2022 | |
Equity [Abstract] | |
Stockholders' Equity | Stockholders' Equity In connection with the Domestication (Note 1), the Company amended its Certificate of Incorporation to provide for the issuance of up to 300,000,000 shares of common stock, par value $0.01 per share, and 50,000,000 shares of undesignated preferred stock, par value $0.01 per share. The effect of the change in the common stock from no par value to $0.01 par value per share has been reflected in the condensed consolidated financial statements on a retroactive basis for all periods presented. 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 September 30, 2022 and December 31, 2021, common shares reserved for issuance under the 2017 Stock Plans were 8,966,151 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 share 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 2 years from the date of grant. A summary of RSU activity is as follows: Number of Weighted- Aggregate Outstanding and unvested at December 31, 2021 2,029,032 $ 2.41 Granted 799,085 1.10 $ 875 Vested (634,516) 2.98 $ 1,891 Cancelled (50,000) 1.69 $ (85) Outstanding and unvested at September 30, 2022 2,143,601 $ 1.77 $ 3,795 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 Outstanding at December 31, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Outstanding at September 30, 2022 5,498,120 $ 2.50 3.6 $ 2,269 Exercisable at September 30, 2022 4,925,619 $ 2.41 3.5 $ 2,269 Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on September 30, 2022 and the exercise price multiplied by the number of in-the-money options. No stock options were granted during the nine months ended September 30, 2022. |
Commitments and Contingencies
Commitments and Contingencies | 9 Months Ended |
Sep. 30, 2022 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Purchase Commitments The Company has certain binding purchase commitments primarily for the purchase of equipment from various suppliers. As of September 30, 2022, the obligations for these future purchase commitments totaled $50.7 million, of which $17.0 million is expected to be paid during the remaining three months of 2022 and $33.7 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 September 30, 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 |
Supplemental Revenue Informatio
Supplemental Revenue Information | 9 Months Ended |
Sep. 30, 2022 | |
Revenue from Contract with Customer [Abstract] | |
Supplemental Revenue Information | 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 September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Patient fee payors: Commercial $ 66,760 $ 60,010 $ 207,470 $ 165,612 Medicare 20,304 13,158 62,478 30,149 Medicaid 3,111 980 9,560 4,837 Other patient revenue 3,053 2,933 9,540 8,193 93,228 77,081 289,048 208,791 Hospitals and healthcare providers 91,092 30,081 269,202 30,081 Other revenue 2,285 1,015 6,746 2,764 $ 186,605 $ 108,177 $ 564,996 $ 241,636 |
Cost of Operations, excluding D
Cost of Operations, excluding Depreciation and Amortization | 9 Months Ended |
Sep. 30, 2022 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Cost of Operations, excluding Depreciation and Amortization | 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 September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Employee compensation $ 67,278 $ 41,247 $ 214,426 $ 88,156 Third-party services and professional fees 30,233 15,154 89,271 29,771 Rent and utilities 12,894 9,507 38,114 24,853 Reading fees 11,379 10,797 34,665 31,642 Administrative 12,473 7,156 35,621 16,341 Medical supplies and other 16,417 7,103 48,312 13,111 $ 150,674 $ 90,964 $ 460,409 $ 203,874 |
Supplemental Statement of Opera
Supplemental Statement of Operations Information | 9 Months Ended |
Sep. 30, 2022 | |
Other Income and Expenses [Abstract] | |
Supplemental Statement of Operations Information | Supplemental Statement of Operations Information Impairment Charges Impairment charges relate to the following assets: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Goodwill (Note 7) $ 20,000 $ — $ 20,000 $ — Property and equipment 369 — 702 — $ 20,369 $ — $ 20,702 $ — Restructuring Charges Restructuring charges consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Transformation costs $ 3,363 $ — $ 7,388 $ — Lease termination costs — — 1,840 — Domestication and related costs 350 — 1,413 — Other 329 479 725 479 $ 4,042 $ 479 $ 11,366 $ 479 Transformation costs consist of third-party consulting fees associated with a significant project to identify, plan, and implement various business improvement initiatives designed to enhance growth opportunities and improve operations. The project is expected to continue into 2024. The consulting agreement provides for fixed fees totaling $12.5 million, milestone fees totaling up to $7.0 million that are earned upon the achievement of certain milestones, and performance fees totaling up to $15.0 million that are earned based on the achievement of certain performance results during the period of the contract. The Company recognizes the fixed fees over the contract period as the services are rendered. Milestone and performance fees that are probable of ultimately being paid are recognized based on a percentage of achievement of the related milestone or performance result. As of September 30, 2022, the accrued liability for unpaid transformation consulting costs was $3.9 million. Lease termination costs relate to a $1.8 million payment made in May 2022 pursuant to an agreement to early terminate the lease for one of the Company’s office facilities. In addition, the Company derecognized $3.2 million for the related operating lease right-of-use asset and the associated lease liability during the three months ended June 30, 2022. Domestication and related costs consist of professional fees incurred related to the change in the Company’s jurisdiction of incorporation from the province of Ontario (Canada) to the State of Delaware (USA) (See Note 1). Severance and Related Costs Severance and related costs represent costs associated with employees whose employment with the Company has been terminated and are generally paid in the year recorded. During the nine months ended September 30, 2022, the Company implemented a small workforce reduction and recorded severance and related costs. In connection with certain terminated employees, severance benefits are being paid over periods of 12 to 18 months. As of September 30, 2022, the unpaid balance of severance and related costs totaled $6.3 million, of which $5.9 million will be paid during the next twelve months and the remaining $0.4 million will be paid thereafter. Other Operating and Non-Operating Expense (Income) Other operating expense (income), net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Gain on sale of accounts receivable (Note 5) $ (7,603) $ — $ (7,603) $ — Loss (gain) on disposal of property and equipment, net 26 (25) 398 321 Other, net 3 (43) (123) (43) $ (7,574) $ (68) $ (7,328) $ 278 Other non-operating income, net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Fair value adjustment on derivative in subordinated notes $ (271) $ (50) $ (1,110) $ (50) Earnings from unconsolidated investees (250) (46) (738) (46) Gain on conversion of debt to equity investment (Note 18) — — — (3,360) Other, net — — (1,152) (6) $ (521) $ (96) $ (3,000) $ (3,462) |
Investment in Unconsolidated In
Investment in Unconsolidated Investees | 9 Months Ended |
Sep. 30, 2022 | |
Other Investments [Abstract] | |
Investments in Unconsolidated Investees | 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. Upon conversion, the Company’s total common equity investment was estimated to be valued at $8.0 million and represented a 34.5% interest in the AI business on a non-diluted basis. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events and certain assumptions, and the payment of $0.4 million, would entitle the Company to acquire an additional 2.4% ownership interest in the AI business common equity. During the nine months ended September 30, 2021, the Company recognized a gain of $3.4 million on the conversion of the convertible note instrument to common equity and the share purchase warrants. This gain is included in other non-operating income, net in the condensed consolidated statements of operations and comprehensive loss. 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 statements of operations and comprehensive loss. |
Income Taxes
Income Taxes | 9 Months Ended |
Sep. 30, 2022 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes The effective tax rate for the three and nine months ended September 30, 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 | 9 Months Ended |
Sep. 30, 2022 | |
Earnings Per Share [Abstract] | |
Basic and Diluted Loss per Share | Basic and Diluted Loss per Share The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period. Three Months Ended September 30, Nine Months Ended September 30, (in thousands, except share and per share amounts) 2022 2021 2022 2021 Net loss attributable to common stockholders $ (53,871) $ (1,337) $ (115,151) $ (11,570) Weighted average common shares outstanding: Basic and diluted 89,540,046 77,082,852 89,378,653 72,727,721 Net loss per share attributable to common stockholders: Basic and diluted $ (0.60) $ (0.02) $ (1.29) $ (0.16) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 2,571,041 1,967,411 2,548,000 2,023,697 |
Segment Information
Segment Information | 9 Months Ended |
Sep. 30, 2022 | |
Segment Reporting [Abstract] | |
Segment Information | 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 adjusted earnings before interest, taxes, depreciation and amortization ("Adjusted EBITDA"). The following table summarizes the Company’s revenues by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Radiology $ 155,062 $ 95,021 $ 471,269 $ 228,480 Oncology 31,543 13,156 93,727 13,156 $ 186,605 $ 108,177 $ 564,996 $ 241,636 Adjusted EBITDA is defined as net income before interest expense, income tax expense (benefit), depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs (recoveries), stock-based compensation, gain on sale of accounts receivable, losses (gains) on disposal of property and equipment, acquisition-related costs, financial instrument revaluation adjustments, gain on conversion of debt to equity investment, deferred rent expense, other losses (gains), and one-time adjustments. Adjusted EBITDA should not be considered a measure of financial performance under GAAP, and the items excluded from Adjusted EBITDA should not be considered in isolation or as alternatives to net income, cash flows generated by operating, investing or financing activities, or other financial statement data presented in the condensed consolidated financial statements as an indicator of financial performance or liquidity. Adjusted EBITDA is not a measurement determined in accordance with GAAP and is therefore susceptible to varying methods of calculation and may not be comparable to other similarly titled measures of other companies. Adjusted EBITDA is the most frequently used measure of each segment’s performance and is commonly used in setting performance goals. The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Adjusted EBITDA: Radiology $ 31,218 $ 16,572 $ 95,832 $ 42,495 Oncology 11,048 4,899 31,383 4,899 Corporate (5,745) (3,503) (20,494) (8,013) $ 36,521 $ 17,968 $ 106,721 $ 39,381 A reconciliation of the net income (loss) to total Adjusted EBITDA is shown below: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Net income (loss) $ (49,745) $ 1,180 $ (102,256) $ (8,182) Interest expense 29,679 16,932 87,650 34,221 Income tax expense (benefit) 12,038 (22,070) 9,118 (21,999) Depreciation and amortization 25,079 11,286 75,010 20,359 Impairment charges 20,369 — 20,702 — Restructuring charges 4,042 479 11,366 479 Severance and related costs 2,485 53 10,282 53 Settlements, recoveries and related costs (576) (52) 101 (394) Stock-based compensation 556 785 2,375 1,997 Gain on sale of accounts receivable (7,603) — (7,603) — Loss (gain) on disposal of property and equipment, net 26 (25) 398 321 Acquisition-related costs 99 8,784 567 14,412 Fair value adjustment on derivative (271) (50) (1,110) (50) Gain on conversion of debt to equity investment — — — (3,360) Deferred rent expense 325 621 904 1,525 Other, net 18 45 (783) (1) Adjusted EBITDA $ 36,521 $ 17,968 $ 106,721 $ 39,381 The following table summarizes the Company’s total assets by segment: (in thousands) September 30, December 31, Identifiable assets: Radiology $ 1,411,032 $ 1,451,905 Oncology 375,937 440,416 Corporate 22,269 26,505 $ 1,809,238 $ 1,918,826 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Capital expenditures: Radiology $ 16,081 $ 2,619 $ 29,541 $ 5,203 Oncology 1,207 — 3,041 — Corporate 11 — 183 — $ 17,299 $ 2,619 $ 32,765 $ 5,203 |
New Accounting Standards (Polic
New Accounting Standards (Policies) | 9 Months Ended |
Sep. 30, 2022 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
Recently Adopted Standards and Standards Not Yet Effective | Recently Adopted Accounting Standards ASU 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40) In April 2021, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2021-04, Earnings Per Share (Topic 260), Debt—Modifications and Extinguishments (Subtopic 470-50), Compensation—Stock Compensation (Topic 718), and Derivatives and Hedging—Contracts in Entity’s Own Equity (Subtopic 815-40). This guidance clarifies and reduces diversity in an issuer’s accounting for modifications or exchanges of freestanding equity-classified written call options due to a lack of explicit guidance in the FASB Codification. This ASU is effective for all entities for fiscal years beginning after December 15, 2021. The Company adopted this standard as of January 1, 2022 and it did not have a material impact on the Company’s condensed consolidated financial statements. 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 , which aims to provide increased transparency by requiring business entities to disclose information about certain types of government assistance they receive in the notes to the financial statements. ASU 2021-10 also adds a new Topic, Accounting Standards Codification ("ASC") 832, Government Assistance, to the FASB’s Codification. The disclosure requirements only apply to transactions with a government that are accounted for by analogizing to either a grant model or a contribution model. The guidance in ASU 2021-10 is effective for financial statements of all entities, including private companies, for annual periods beginning after December 15, 2021, with early adoption permitted. The Company adopted this standard as of January 1, 2022 and it did not have a material impact on the Company’s condensed consolidated financial statements. Recently Issued Accounting Standards Not Yet Effective ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the Securities and Exchange Commission (“SEC”), which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company is currently evaluating the impact of the standard on its consolidated financial statements. ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting 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 . This ASU provides optional expedients and exceptions for applying generally accepted accounting principles to certain contract modifications and hedging relationships that reference London Inter-bank Offered Rate (“LIBOR”) or another reference rate expected to be discontinued. For all entities, the guidance is effective upon issuance and generally can be applied through December 31, 2022. The Company is currently evaluating the impact of the standard on its consolidated financial statements. ASU 2021-01, Reference Rate Reform (Topic 848): Scope In January 2021, the FASB issued ASU 2021-01, Reference Rate Reform (Topic 848): Scope . This ASU clarifies the scope of Topic 848 so that derivatives affected by the discounting transition are explicitly eligible for certain option expedients and exceptions in Topic 848. The guidance is effective upon issuance and generally can be applied through December 31, 2022. The Company is currently evaluating the impact of the standard on its consolidated financial statements. ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers , creating an exception to the recognition and measurement principles in ASC 805, Business Combinations . The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers , rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets , fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of |
Alliance Acquisition (Tables)
Alliance Acquisition (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Business Combination and Asset Acquisition [Abstract] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities | The following table summarizes the final 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 assets 69,919 Goodwill 431,017 Intangibles – Customer contracts 264,401 Intangibles – Trade names 68,829 Intangibles – Third party management agreements 10,200 Intangibles – Patent 920 Intangibles – Certificates of need 69,558 Other assets 8,170 1,169,300 Liabilities assumed: Equipment debt 54,539 Obligations under finance leases 9,041 Obligations under operating leases 74,290 Deferred tax liabilities 30,082 Other liabilities 7,234 175,186 Net assets acquired 994,114 Less redeemable noncontrolling interests 35,813 Less noncontrolling interests 172,685 Purchase price $ 785,616 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Property, Plant and Equipment [Abstract] | |
Summary of Detailed Information of Property and Equipment | Property and equipment consists of the following: (in thousands) September 30, December 31, Medical equipment $ 245,105 $ 227,796 Leasehold improvements 42,779 39,763 Equipment under finance leases 37,243 34,597 Office and computer equipment 20,484 16,701 Transportation and service equipment 11,672 8,996 Furniture and fixtures 3,372 3,130 Construction in progress 5,094 6,423 365,749 337,406 Less accumulated depreciation 136,027 78,284 $ 229,722 $ 259,122 |
Goodwill (Tables)
Goodwill (Tables) | 9 Months Ended |
Sep. 30, 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 Purchase accounting adjustments 732 (25,475) (24,743) Impairment — (20,000) (20,000) Balance, September 30, 2022 $ 682,725 $ 112,885 $ 795,610 |
Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill | Specifically, the Company utilized the following Level 3 estimates and assumptions in its analysis: Discount rate 10.0% to 11.0% Perpetual growth rate 2.5% Tax rate 26.0% Risk-free interest rate 3.5% Revenue multiple 1.9 to 2.3 EBITDA multiple 8.0 to 12.0 |
Other Intangible Assets - (Tabl
Other Intangible Assets - (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible Assets Excluding Goodwill | Other intangible assets consist of the following: (dollars in thousands) Weighted September 30, 2022 December 31, 2021 Gross Accumulated Other Gross Accumulated Other Finite-lived intangible assets: Customer contracts 20 $ 264,236 $ (15,046) $ 249,190 $ 266,224 $ (4,437) $ 261,787 Trade names 18 77,189 (9,928) 67,261 77,466 (6,054) 71,412 Management agreements 17 10,200 (650) 9,550 10,200 (200) 10,000 Other 5 5,734 (4,108) 1,626 4,814 (3,425) 1,389 Total $ 357,359 $ (29,732) 327,627 $ 358,704 $ (14,116) 344,588 Certificates of Need 69,558 69,558 Total other intangible assets $ 397,185 $ 414,146 |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Debt Disclosure [Abstract] | |
Schedule of Long-term Debt Instruments | Long-term debt consists of the following: (in thousands) September 30, December 31, 2028 Senior Notes $ 375,000 $ 375,000 2025 Senior Notes 475,000 475,000 Subordinated Notes 409,979 372,470 Equipment Debt 71,715 58,827 1,331,694 1,281,297 Debt discount and deferred issuance costs (70,799) (68,912) 1,260,895 1,212,385 Less current portion 18,714 14,789 Long-term debt, net of current portion $ 1,242,181 $ 1,197,596 |
Accrued Liabilities (Tables)
Accrued Liabilities (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Payables and Accruals [Abstract] | |
Summary of Other Accrued Liabilities | Accrued liabilities consist of the following: (in thousands) September 30, December 31, Accrued compensation and related expenses $ 32,687 $ 26,486 Accrued interest expense 19,252 16,840 Other 45,123 44,487 $ 97,062 $ 87,813 |
Redeemable Noncontrolling Int_2
Redeemable Noncontrolling Interests (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Noncontrolling Interest [Abstract] | |
Summary of Redeemable Noncontrolling Interests | The following is a rollforward of the activity in the redeemable noncontrolling interests for the nine months ended September 30, 2022: (in thousands) Balance, December 31, 2021 $ 37,469 Net income attributable to redeemable noncontrolling interests 1,482 Distributions paid to redeemable noncontrolling interests (3,525) Purchase accounting adjustments (1,226) Balance, September 30, 2022 $ 34,200 |
Financial Instruments (Tables)
Financial Instruments (Tables) | 9 Months Ended |
Sep. 30, 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 September 30, 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 $ — $ 58 $ — $ 58 $ — $ 3 $ — $ 3 Current and long-term liabilities: Derivative in subordinated notes $ — $ — $ 6,412 $ 6,412 $ — $ — $ 7,522 $ 7,522 Interest rate contracts $ — $ — $ — $ — $ — $ 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 nine months ended September 30, 2022: (in thousands) Balance, December 31, 2021 $ 7,522 Change in fair value (1,110) Balance, September 30, 2022 $ 6,412 |
Schedule of Fair Value Of Other Current And Non Current Liabilities | The estimated fair values of other current and non-current liabilities are as follows: (in thousands) September 30, December 31, 2028 Senior Notes $ 294,583 $ 345,938 2025 Senior Notes 387,202 446,500 Subordinated Notes 241,622 323,620 Equipment Debt 63,944 56,879 $ 987,351 $ 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: (in thousands) September 30, December 31, Financial assets measured at amortized cost: Cash and cash equivalents $ 59,356 $ 48,419 Accounts receivable 112,376 121,525 $ 171,732 $ 169,944 Financial liabilities measured at amortized cost: Accounts payable $ 27,696 $ 34,326 Current portion of long-term debt 18,714 14,789 Current portion of leases 23,827 27,254 Non-current portion of long-term debt 1,242,181 1,197,596 Non-current portion of leases 180,919 200,326 Accrued liabilities 97,062 87,813 $ 1,590,399 $ 1,562,104 Financial liabilities measured at fair value through earnings: Derivative in subordinated notes $ 6,412 $ 7,522 Financial assets measured at fair value through other comprehensive income: Interest rate contracts $ 58 $ 3 Financial liabilities measured at fair value through other comprehensive income: Interest rate contracts $ — $ 53 |
Stockholders' Equity (Tables)
Stockholders' Equity (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Equity [Abstract] | |
Summary of RSU Activity | Restricted share 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 2 years from the date of grant. A summary of RSU activity is as follows: Number of Weighted- Aggregate Outstanding and unvested at December 31, 2021 2,029,032 $ 2.41 Granted 799,085 1.10 $ 875 Vested (634,516) 2.98 $ 1,891 Cancelled (50,000) 1.69 $ (85) Outstanding and unvested at September 30, 2022 2,143,601 $ 1.77 $ 3,795 |
Summary of the Stock Option Activity | A summary of the stock option activity is as follows: Number of Weighted- Weighted- Aggregate Outstanding at December 31, 2021 5,680,120 $ 2.54 4.4 $ 2,344 Outstanding at September 30, 2022 5,498,120 $ 2.50 3.6 $ 2,269 Exercisable at September 30, 2022 4,925,619 $ 2.41 3.5 $ 2,269 |
Supplemental Revenue Informat_2
Supplemental Revenue Information (Tables) | 9 Months Ended |
Sep. 30, 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 September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Patient fee payors: Commercial $ 66,760 $ 60,010 $ 207,470 $ 165,612 Medicare 20,304 13,158 62,478 30,149 Medicaid 3,111 980 9,560 4,837 Other patient revenue 3,053 2,933 9,540 8,193 93,228 77,081 289,048 208,791 Hospitals and healthcare providers 91,092 30,081 269,202 30,081 Other revenue 2,285 1,015 6,746 2,764 $ 186,605 $ 108,177 $ 564,996 $ 241,636 |
Cost of Operations, excluding_2
Cost of Operations, excluding Depreciation and Amortization (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Summary of 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 September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Employee compensation $ 67,278 $ 41,247 $ 214,426 $ 88,156 Third-party services and professional fees 30,233 15,154 89,271 29,771 Rent and utilities 12,894 9,507 38,114 24,853 Reading fees 11,379 10,797 34,665 31,642 Administrative 12,473 7,156 35,621 16,341 Medical supplies and other 16,417 7,103 48,312 13,111 $ 150,674 $ 90,964 $ 460,409 $ 203,874 |
Supplemental Statement of Ope_2
Supplemental Statement of Operations Information (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Other Income and Expenses [Abstract] | |
Schedule of Impairment of Assets | Impairment charges relate to the following assets: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Goodwill (Note 7) $ 20,000 $ — $ 20,000 $ — Property and equipment 369 — 702 — $ 20,369 $ — $ 20,702 $ — |
Schedule of Restructuring Charges | Restructuring charges consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Transformation costs $ 3,363 $ — $ 7,388 $ — Lease termination costs — — 1,840 — Domestication and related costs 350 — 1,413 — Other 329 479 725 479 $ 4,042 $ 479 $ 11,366 $ 479 |
Schedule of Other Operating Losses (gains) | Other operating expense (income), net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Gain on sale of accounts receivable (Note 5) $ (7,603) $ — $ (7,603) $ — Loss (gain) on disposal of property and equipment, net 26 (25) 398 321 Other, net 3 (43) (123) (43) $ (7,574) $ (68) $ (7,328) $ 278 |
Schedule Of Other Non-operating Losses (gains) | Other non-operating income, net consists of the following: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Fair value adjustment on derivative in subordinated notes $ (271) $ (50) $ (1,110) $ (50) Earnings from unconsolidated investees (250) (46) (738) (46) Gain on conversion of debt to equity investment (Note 18) — — — (3,360) Other, net — — (1,152) (6) $ (521) $ (96) $ (3,000) $ (3,462) |
Basic and Diluted Loss per Sh_2
Basic and Diluted Loss per Share (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Earnings Per Share [Abstract] | |
Summary of Earnings Per Share Basic and Diluted | The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period. Three Months Ended September 30, Nine Months Ended September 30, (in thousands, except share and per share amounts) 2022 2021 2022 2021 Net loss attributable to common stockholders $ (53,871) $ (1,337) $ (115,151) $ (11,570) Weighted average common shares outstanding: Basic and diluted 89,540,046 77,082,852 89,378,653 72,727,721 Net loss per share attributable to common stockholders: Basic and diluted $ (0.60) $ (0.02) $ (1.29) $ (0.16) Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 2,571,041 1,967,411 2,548,000 2,023,697 |
Segment Information (Tables)
Segment Information (Tables) | 9 Months Ended |
Sep. 30, 2022 | |
Segment Reporting [Abstract] | |
Summary of Revenue By Segment | The following table summarizes the Company’s revenues by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Radiology $ 155,062 $ 95,021 $ 471,269 $ 228,480 Oncology 31,543 13,156 93,727 13,156 $ 186,605 $ 108,177 $ 564,996 $ 241,636 |
Summary of Company's Adjusted EBITDA | The following table summarizes the Company’s Adjusted EBITDA by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Adjusted EBITDA: Radiology $ 31,218 $ 16,572 $ 95,832 $ 42,495 Oncology 11,048 4,899 31,383 4,899 Corporate (5,745) (3,503) (20,494) (8,013) $ 36,521 $ 17,968 $ 106,721 $ 39,381 |
Summary of Net Income (Loss) to Total Adjusted EBITDA | A reconciliation of the net income (loss) to total Adjusted EBITDA is shown below: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Net income (loss) $ (49,745) $ 1,180 $ (102,256) $ (8,182) Interest expense 29,679 16,932 87,650 34,221 Income tax expense (benefit) 12,038 (22,070) 9,118 (21,999) Depreciation and amortization 25,079 11,286 75,010 20,359 Impairment charges 20,369 — 20,702 — Restructuring charges 4,042 479 11,366 479 Severance and related costs 2,485 53 10,282 53 Settlements, recoveries and related costs (576) (52) 101 (394) Stock-based compensation 556 785 2,375 1,997 Gain on sale of accounts receivable (7,603) — (7,603) — Loss (gain) on disposal of property and equipment, net 26 (25) 398 321 Acquisition-related costs 99 8,784 567 14,412 Fair value adjustment on derivative (271) (50) (1,110) (50) Gain on conversion of debt to equity investment — — — (3,360) Deferred rent expense 325 621 904 1,525 Other, net 18 45 (783) (1) Adjusted EBITDA $ 36,521 $ 17,968 $ 106,721 $ 39,381 |
Schedule of Segment Reporting Information By Segment | The following table summarizes the Company’s total assets by segment: (in thousands) September 30, December 31, Identifiable assets: Radiology $ 1,411,032 $ 1,451,905 Oncology 375,937 440,416 Corporate 22,269 26,505 $ 1,809,238 $ 1,918,826 The following table summarizes the Company’s capital expenditures by segment: Three Months Ended September 30, Nine Months Ended September 30, (in thousands) 2022 2021 2022 2021 Capital expenditures: Radiology $ 16,081 $ 2,619 $ 29,541 $ 5,203 Oncology 1,207 — 3,041 — Corporate 11 — 183 — $ 17,299 $ 2,619 $ 32,765 $ 5,203 |
Basis of Presentation (Details)
Basis of Presentation (Details) | Sep. 30, 2022 shares |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Conversion basis of stock | 1 |
Alliance Acquisition - Addition
Alliance Acquisition - Additional information (Detail) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 01, 2021 | Sep. 30, 2022 | |
Alliance Acquisition | ||
Decrease in goodwill | $ 24,743 | |
Alliance Acquisition | ||
Alliance Acquisition | ||
Business acquisition, percentage of voting interests acquired | 100% | |
Purchase price | $ 785,600 | |
Decrease in property and equipment acquired | 500 | |
Decrease in Intangibles | 1,200 | |
Decrease in noncontrolling interest acquired | 3,500 | |
Decrease in deferred tax liabilities | 22,700 | |
Decrease in goodwill | $ 24,700 |
Alliance Acquisition - Summary
Alliance Acquisition - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Detail) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 | Sep. 01, 2021 |
Assets acquired | |||
Goodwill | $ 795,610 | $ 840,353 | |
Alliance Acquisition | |||
Assets acquired | |||
Cash and cash equivalents | $ 26,125 | ||
Net working capital | 14,221 | ||
Property and equipment | 205,940 | ||
Operating lease right-of-use assets | 69,919 | ||
Goodwill | 431,017 | ||
Other assets | 8,170 | ||
Assets | 1,169,300 | ||
Current liabilities | |||
Equipment debt | 54,539 | ||
Obligations under finance leases | 9,041 | ||
Non-current liabilities | |||
Obligations under operating leases | 74,290 | ||
Deferred tax liabilities | 30,082 | ||
Other liabilities | 7,234 | ||
Liabilities | 175,186 | ||
Net assets acquired | 994,114 | ||
Less redeemable noncontrolling interests | 35,813 | ||
Less noncontrolling interests | 172,685 | ||
Purchase price | 785,616 | ||
Alliance Acquisition | Customer contracts | |||
Assets acquired | |||
Intangible assets | 264,401 | ||
Alliance Acquisition | Trade names | |||
Assets acquired | |||
Intangible assets | 68,829 | ||
Alliance Acquisition | Third party management agreements | |||
Assets acquired | |||
Intangible assets | 10,200 | ||
Alliance Acquisition | Patent | |||
Assets acquired | |||
Intangible assets | 920 | ||
Alliance Acquisition | Certificates of need | |||
Assets acquired | |||
Intangible assets | $ 69,558 |
Variable Interest Entities (Det
Variable Interest Entities (Details) - USD ($) $ in Thousands | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Dec. 31, 2021 | |
Variable Interest Entity [Line Items] | |||
Assets | $ 1,809,238 | $ 1,918,826 | |
Liabilities | 1,612,289 | 1,597,678 | |
Net cash provided by operating activities | 55,936 | $ 12,749 | |
Variable Interest Entity, Primary Beneficiary | |||
Variable Interest Entity [Line Items] | |||
Assets | 37,300 | 20,400 | |
Liabilities | 4,700 | $ 600 | |
Revenues | 137,200 | 128,600 | |
Net cash provided by operating activities | $ 161,000 | $ 135,100 |
Sales of Accounts Receivable (D
Sales of Accounts Receivable (Details) - USD ($) $ in Thousands | 1 Months Ended | 3 Months Ended | 9 Months Ended | ||
Aug. 31, 2022 | Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Accounts, Notes, Loans and Financing Receivable [Line Items] | |||||
Gain on sale of accounts receivable | $ 7,603 | $ 0 | $ 7,603 | $ 0 | |
One-Time Purchase Agreement | |||||
Accounts, Notes, Loans and Financing Receivable [Line Items] | |||||
Accounts receivable, sale | $ 20,300 | ||||
Proceeds from sale of accounts receivable | 29,000 | ||||
Servicing liability recognized | $ 1,100 | ||||
Estimated collection period | 3 years | ||||
Gain on sale of accounts receivable | $ 7,600 | $ 7,600 |
Property and Equipment - Summar
Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Property, Plant and Equipment [Line Items] | ||
Equipment under finance leases | $ 37,243 | $ 34,597 |
Total property and equipment, gross | 365,749 | 337,406 |
Less accumulated depreciation | 136,027 | 78,284 |
Property and equipment, net | 229,722 | 259,122 |
Medical equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 245,105 | 227,796 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 42,779 | 39,763 |
Office and computer equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 20,484 | 16,701 |
Transportation and service equipment | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 11,672 | 8,996 |
Furniture and fixtures | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 3,372 | 3,130 |
Construction in progress | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | $ 5,094 | $ 6,423 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | Dec. 31, 2021 | |
Property, Plant and Equipment [Abstract] | |||||
Depreciation expense | $ 19.5 | $ 9.4 | $ 59.4 | $ 17.1 | |
Net book value of equipment under finance leases | $ 21 | $ 21 | $ 22.2 |
Goodwill - Schedule of Goodwill
Goodwill - Schedule of Goodwill (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Goodwill [Roll Forward] | ||||
Balance, December 31, 2021 | $ 840,353 | |||
Purchase accounting adjustments | (24,743) | |||
Impairment | $ (20,000) | $ 0 | (20,000) | $ 0 |
Balance, September 30, 2022 | 795,610 | 795,610 | ||
Radiology | ||||
Goodwill [Roll Forward] | ||||
Balance, December 31, 2021 | 681,993 | |||
Purchase accounting adjustments | 732 | |||
Impairment | 0 | |||
Balance, September 30, 2022 | 682,725 | 682,725 | ||
Oncology | ||||
Goodwill [Roll Forward] | ||||
Balance, December 31, 2021 | 158,360 | |||
Purchase accounting adjustments | (25,475) | |||
Impairment | (20,000) | |||
Balance, September 30, 2022 | $ 112,885 | $ 112,885 |
Goodwill - Schedule Of Signific
Goodwill - Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill (Details) | Sep. 30, 2022 |
Discount rate | Minimum | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.100 |
Discount rate | Maximum | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.110 |
Perpetual growth rate | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.025 |
Tax rate | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.260 |
Risk-free interest rate | |
Goodwill [Line Items] | |
Goodwill measurement input | 0.035 |
Revenue multiple | Minimum | |
Goodwill [Line Items] | |
Goodwill measurement input | 1.9 |
Revenue multiple | Maximum | |
Goodwill [Line Items] | |
Goodwill measurement input | 2.3 |
EBITDA multiple | Minimum | |
Goodwill [Line Items] | |
Goodwill measurement input | 8 |
EBITDA multiple | Maximum | |
Goodwill [Line Items] | |
Goodwill measurement input | 12 |
Goodwill - Additional Informati
Goodwill - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Goodwill [Line Items] | ||||
Impairment | $ 20,000 | $ 0 | $ 20,000 | $ 0 |
Oncology | ||||
Goodwill [Line Items] | ||||
Impairment | $ 20,000 |
Other Intangible Assets - Sched
Other Intangible Assets - Schedule Of Intangible Assets Excluding Goodwill (Details) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2022 | Dec. 31, 2021 | |
Finite-Lived Intangible Assets [Line Items] | ||
Gross Carrying Amount | $ 357,359 | $ 358,704 |
Accumulated Amortization | (29,732) | (14,116) |
Other Intangible Assets, Net | 327,627 | 344,588 |
Certificates of Need | 69,558 | 69,558 |
Total other intangible assets | $ 397,185 | 414,146 |
Customer contracts | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 20 years | |
Gross Carrying Amount | $ 264,236 | 266,224 |
Accumulated Amortization | (15,046) | (4,437) |
Other Intangible Assets, Net | $ 249,190 | 261,787 |
Trade names | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 18 years | |
Gross Carrying Amount | $ 77,189 | 77,466 |
Accumulated Amortization | (9,928) | (6,054) |
Other Intangible Assets, Net | $ 67,261 | 71,412 |
Management agreements | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 17 years | |
Gross Carrying Amount | $ 10,200 | 10,200 |
Accumulated Amortization | (650) | (200) |
Other Intangible Assets, Net | $ 9,550 | 10,000 |
Other | ||
Finite-Lived Intangible Assets [Line Items] | ||
Weighted Average Useful Life (in years) | 5 years | |
Gross Carrying Amount | $ 5,734 | 4,814 |
Accumulated Amortization | (4,108) | (3,425) |
Other Intangible Assets, Net | $ 1,626 | $ 1,389 |
Other Intangible Assets - Addit
Other Intangible Assets - Additional Information (Detail) - USD ($) $ in Millions | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Goodwill and Intangible Assets Disclosure [Abstract] | ||||
Amortization expense of finite-lived intangible assets | $ 5.6 | $ 1.9 | $ 15.6 | $ 3.3 |
Long-Term Debt - Summary of Lon
Long-Term Debt - Summary of Long-term debt (Detail) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | $ 1,331,694 | $ 1,281,297 |
Debt discount and deferred issuance costs | (70,799) | (68,912) |
Total long-term debt | 1,260,895 | 1,212,385 |
Less current portion | 18,714 | 14,789 |
Long-term debt, net of current portion | 1,242,181 | 1,197,596 |
2028 Senior Notes | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | 375,000 | 375,000 |
2025 Senior Notes | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | 475,000 | 475,000 |
Subordinated Notes | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | 409,979 | 372,470 |
Equipment Debt | ||
Disclosure Details Of Allocation Of Gross Proceeds From Subordinated Debt Shares Warrants and Derivatives [Line Items] | ||
Long-term debt | $ 71,715 | $ 58,827 |
Long-Term Debt - Additional Inf
Long-Term Debt - Additional Information (Details) $ in Millions | 9 Months Ended |
Sep. 30, 2022 USD ($) | |
Subordinated Notes | |
Debt Instrument [Line Items] | |
Accrued interest added to the principal balance | $ 37.5 |
Accrued Liabilities - Summary o
Accrued Liabilities - Summary of Accrued Liabilities (Detail) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Payables and Accruals [Abstract] | ||
Accrued compensation and related expenses | $ 32,687 | $ 26,486 |
Accrued interest expense | 19,252 | 16,840 |
Other | 45,123 | 44,487 |
Total other accrued liabilities | $ 97,062 | $ 87,813 |
Redeemable Noncontrolling Int_3
Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Noncontrolling Interest [Abstract] | ||
Redeemable noncontrolling interests | $ 34,200 | $ 37,469 |
Redeemable Noncontrolling Int_4
Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands | 9 Months Ended |
Sep. 30, 2022 USD ($) | |
Stockholders' Equity Attributable to Noncontrolling Interest [Roll Forward] | |
Balance, December 31, 2021 | $ 37,469 |
Net income attributable to redeemable noncontrolling interests | 1,482 |
Distributions paid to redeemable noncontrolling interests | (3,525) |
Purchase accounting adjustments | (1,226) |
Balance, September 30, 2022 | $ 34,200 |
Financial Instruments - Schedul
Financial Instruments - Schedule of Fair Value Measurements, Recurring and Nonrecurring (Details) - Fair Value, Recurring - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Interest rate contracts | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets | $ 58 | $ 3 |
Current and long-term liabilities | 0 | 53 |
Interest rate contracts | Level 1 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets | 0 | 0 |
Current and long-term liabilities | 0 | 0 |
Interest rate contracts | Level 2 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets | 58 | 3 |
Current and long-term liabilities | 0 | 53 |
Interest rate contracts | Level 3 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term assets | 0 | 0 |
Current and long-term liabilities | 0 | 0 |
Derivative in subordinated notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term liabilities | 6,412 | 7,522 |
Derivative in subordinated notes | Level 1 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term liabilities | 0 | 0 |
Derivative in subordinated notes | Level 2 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term liabilities | 0 | 0 |
Derivative in subordinated notes | Level 3 | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Current and long-term liabilities | $ 6,412 | $ 7,522 |
Financial Instruments - Additio
Financial Instruments - Additional Information (Detail) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2022 USD ($) yr | Sep. 30, 2021 USD ($) | Sep. 30, 2022 USD ($) yr | Sep. 30, 2021 USD ($) | Dec. 31, 2021 USD ($) yr | |
Financial Instruments [Line Items] | |||||
Change in fair value | $ 271 | $ 50 | $ 1,110 | $ 50 | |
Level 3 | Stone Peak Magnet | Subordinated Notes | |||||
Financial Instruments [Line Items] | |||||
Change in fair value | $ (1,110) | ||||
Level 3 | Measurement Input Probability Weighted Time | |||||
Financial Instruments [Line Items] | |||||
Embedded derivative liability measurment input | yr | 3.7 | 3.7 | 4.2 | ||
Level 3 | Measurement Input Probability Of Exit Event Percentage | |||||
Financial Instruments [Line Items] | |||||
Embedded derivative liability measurment input | 0.236 | 0.236 | 0.245 | ||
Equipment Debt | |||||
Financial Instruments [Line Items] | |||||
Long term debt unhedged | $ 5,100 | $ 5,100 | $ 1,800 | ||
Revolving Credit Facility | Interest Rate Contract | |||||
Financial Instruments [Line Items] | |||||
Increase decrease in the variable rate of interest | 1% | 1% | 1% |
Financial Instruments - Summary
Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward] | ||||
Change in fair value | $ 271 | $ 50 | $ 1,110 | $ 50 |
Subordinated Notes | Stone Peak Magnet | Level 3 | ||||
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward] | ||||
Balance, December 31, 2021 | 7,522 | |||
Change in fair value | (1,110) | |||
Balance, September 30, 2022 | $ 6,412 | $ 6,412 |
Financial Instruments - Sched_2
Financial Instruments - Schedule Of Fair Value Of Other Current And Non Current Liabilities (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | $ 987,351 | $ 1,172,937 |
2028 Senior Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 294,583 | 345,938 |
2025 Senior Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 387,202 | 446,500 |
Subordinated Notes | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | 241,622 | 323,620 |
Equipment Debt | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Debt instrument fair value | $ 63,944 | $ 56,879 |
Financial Instruments - Sched_3
Financial Instruments - Schedule of Information Regarding The Carrying Value Of Financial Instruments (Details) - USD ($) $ in Thousands | Sep. 30, 2022 | Dec. 31, 2021 |
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Cash and cash equivalents | $ 59,356 | $ 48,419 |
Accounts receivable | 112,376 | 121,525 |
Current portion of long-term debt | 18,714 | 14,789 |
Long-term debt, net of current portion | 1,242,181 | 1,197,596 |
Accrued liabilities | 97,062 | 87,813 |
Reported Value Measurement | ||
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] | ||
Cash and cash equivalents | 59,356 | 48,419 |
Accounts receivable | 112,376 | 121,525 |
Financial assets measured at amortized cost | 171,732 | 169,944 |
Accounts payable | 27,696 | 34,326 |
Current portion of long-term debt | 18,714 | 14,789 |
Current portion of leases | 23,827 | 27,254 |
Long-term debt, net of current portion | 1,242,181 | 1,197,596 |
Non-current portion of leases | 180,919 | 200,326 |
Accrued liabilities | 97,062 | 87,813 |
Financial liabilities measured at amortized cost | 1,590,399 | 1,562,104 |
Financial liabilities measured at fair value through earnings: | ||
Derivative in subordinated notes | 6,412 | 7,522 |
Financial assets measured at fair value through other comprehensive income: | ||
Interest rate contracts | 58 | 3 |
Financial liabilities measured at fair value through other comprehensive income: | ||
Interest rate contracts | $ 0 | $ 53 |
Stockholders' Equity - Addition
Stockholders' Equity - Additional Information (Detail) | 9 Months Ended | |||
Nov. 14, 2017 | Sep. 30, 2022 $ / shares shares | Sep. 29, 2022 $ / shares | Dec. 31, 2021 $ / shares shares | |
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Common stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | $ 0.01 | ||
Preferred stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | $ 0.01 | ||
Common stock, shares authorized (in shares) | 300,000,000 | 300,000,000 | ||
Preferred stock, shares authorized (in shares) | 50,000,000 | 50,000,000 | ||
Restricted Stock Units (RSUs) | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Vesting period | 2 years | |||
Employee Stock Option | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Vesting period | 3 years | |||
Options granted (in shares) | 0 | |||
Employee Stock Option | Minimum | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Term of award | 7 years | |||
Employee Stock Option | Maximum | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Term of award | 10 years | |||
Domestication | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Common stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | $ 0 | ||
Preferred stock, par or stated value per share (in USD per share) | $ / shares | $ 0.01 | |||
Common stock, shares authorized (in shares) | 300,000,000 | |||
Preferred stock, shares authorized (in shares) | 50,000,000 | |||
2017 Stock Plans | ||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||
Common stock options reserved for issuance (as a percent) | 0.10 | |||
Common stock options reserved for issuance (in shares) | 8,966,151 | 8,902,699 |
Stockholders' Equity - Summary
Stockholders' Equity - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands | 9 Months Ended |
Sep. 30, 2022 USD ($) $ / shares shares | |
Number of RSUs | |
Beginning balance (in shares) | shares | 2,029,032 |
Granted (in shares) | shares | 799,085 |
Vested (in shares) | shares | (634,516) |
Cancelled (in shares) | shares | (50,000) |
Ending balance (in shares) | shares | 2,143,601 |
Weighted- Average Grant Date Fair Value | |
Beginning balance (in dollars per share) | $ / shares | $ 2.41 |
Granted (in dollars per share) | $ / shares | 1.10 |
Vested (in dollars per share) | $ / shares | 2.98 |
Cancelled (in dollars per share) | $ / shares | 1.69 |
Ending balance (in dollars per share) | $ / shares | $ 1.77 |
Aggregate Grant Date Fair Value, Granted | $ | $ 875 |
Aggregate Grant Date Fair Value, Vested | $ | 1,891 |
Aggregate Grant Date Fair Value, Cancelled | $ | (85) |
Aggregate Grant Date Fair Value, Outstanding and unvested | $ | $ 3,795 |
Stockholders' Equity - Summar_2
Stockholders' Equity - Summary of the Stock Option Activity (Detail) - Stock Options - USD ($) $ / shares in Units, $ in Thousands | 9 Months Ended | 12 Months Ended |
Sep. 30, 2022 | Dec. 31, 2021 | |
Number of Options | ||
Beginning balance (in shares) | 5,680,120 | |
Ending balance (in shares) | 5,498,120 | 5,680,120 |
Weighted- Average Exercise price | ||
Beginning balance (in dollars per share) | $ 2.54 | |
Ending balance (in dollars per share) | $ 2.50 | $ 2.54 |
Stock Options Additional Disclosures | ||
Number of Options, Exercisable (in shares) | 4,925,619 | |
Weighted-Average Exercise price, Exercisable (in dollars per share) | $ 2.41 | |
Weighted- Average Remaining Contractual Term (Years) | 3 years 7 months 6 days | 4 years 4 months 24 days |
Weighted-Average Remaining Contractual Term, Exercisable | 3 years 6 months | |
Aggregate Intrinsic Value (in thousands) | $ 2,269 | $ 2,344 |
Aggregate Intrinsic Value, Exercisable | $ 2,269 |
Commitments and Contingencies (
Commitments and Contingencies (Details) - Commitement For The Purchase Of Equipment $ in Millions | Sep. 30, 2022 USD ($) |
Loss Contingencies [Line Items] | |
Purchase commitments | $ 50.7 |
Within Next Twelve Months | |
Loss Contingencies [Line Items] | |
Purchase commitments | 17 |
Greater Than Twelve Months | |
Loss Contingencies [Line Items] | |
Purchase commitments | $ 33.7 |
Supplemental Revenue Informat_3
Supplemental Revenue Information - Summary of Revenue Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Disaggregation of Revenue [Line Items] | ||||
Other revenue | $ 2,285 | $ 1,015 | $ 6,746 | $ 2,764 |
Total revenue | 186,605 | 108,177 | 564,996 | 241,636 |
Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 93,228 | 77,081 | 289,048 | 208,791 |
Commercial | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 66,760 | 60,010 | 207,470 | 165,612 |
Medicare | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 20,304 | 13,158 | 62,478 | 30,149 |
Medicaid | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 3,111 | 980 | 9,560 | 4,837 |
Other patient revenue | Sales Channel, Directly to Consumer | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | 3,053 | 2,933 | 9,540 | 8,193 |
Hospitals and healthcare providers | Sales Channel, Through Intermediary | ||||
Disaggregation of Revenue [Line Items] | ||||
Service fees - net of allowances and discounts | $ 91,092 | $ 30,081 | $ 269,202 | $ 30,081 |
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 | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | $ 150,674 | $ 90,964 | $ 460,409 | $ 203,874 |
Employee compensation | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 67,278 | 41,247 | 214,426 | 88,156 |
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 | 30,233 | 15,154 | 89,271 | 29,771 |
Rent and utilities | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 12,894 | 9,507 | 38,114 | 24,853 |
Reading fees | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 11,379 | 10,797 | 34,665 | 31,642 |
Administrative | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | 12,473 | 7,156 | 35,621 | 16,341 |
Medical supplies and other | ||||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||||
Cost of operations, excluding depreciation and amortization | $ 16,417 | $ 7,103 | $ 48,312 | $ 13,111 |
Supplemental Statement of Ope_3
Supplemental Statement of Operations Information - Schedule of Impairment of Assets (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Other Income and Expenses [Abstract] | ||||
Goodwill (Note 7) | $ 20,000 | $ 0 | $ 20,000 | $ 0 |
Property and equipment | 369 | 0 | 702 | 0 |
Impairment charges | $ 20,369 | $ 0 | $ 20,702 | $ 0 |
Supplemental Statement of Ope_4
Supplemental Statement of Operations Information - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands | 1 Months Ended | 3 Months Ended | 9 Months Ended | ||
May 31, 2022 | Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Restructuring Cost and Reserve [Line Items] | |||||
Restructuring charges | $ 4,042 | $ 479 | $ 11,366 | $ 479 | |
Transformation costs | |||||
Restructuring Cost and Reserve [Line Items] | |||||
Restructuring charges | 3,363 | 0 | 7,388 | 0 | |
Lease termination costs | |||||
Restructuring Cost and Reserve [Line Items] | |||||
Restructuring charges | $ 1,800 | 0 | 0 | 1,840 | 0 |
Domestication and related costs | |||||
Restructuring Cost and Reserve [Line Items] | |||||
Restructuring charges | 350 | 0 | 1,413 | 0 | |
Other | |||||
Restructuring Cost and Reserve [Line Items] | |||||
Restructuring charges | $ 329 | $ 479 | $ 725 | $ 479 |
Supplemental Statement of Ope_5
Supplemental Statement of Operations Information - Additional Information (Details) - USD ($) $ in Thousands | 1 Months Ended | 3 Months Ended | 9 Months Ended | |||
May 31, 2022 | Sep. 30, 2022 | Jun. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Restructuring Cost and Reserve [Line Items] | ||||||
Restructuring charges | $ 4,042 | $ 479 | $ 11,366 | $ 479 | ||
Lease liability derecognized | $ 3,200 | |||||
Operating right-of-use asset derecognized | $ 3,200 | |||||
Minimum | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Severance benefits, payment period | 12 months | |||||
Maximum | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Severance benefits, payment period | 18 months | |||||
Transformation costs | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Accrued liability for unpaid transformation consulting costs | 3,900 | $ 3,900 | ||||
Restructuring charges | 3,363 | 0 | 7,388 | 0 | ||
Transformation Costs, Fixed Fees | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Remaining transformation costs | 12,500 | 12,500 | ||||
Transformation Costs, Milestone Fees | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Remaining transformation costs | 7,000 | 7,000 | ||||
Transformation Costs, Performance Fees | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Remaining transformation costs | 15,000 | 15,000 | ||||
Lease termination costs | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Restructuring charges | $ 1,800 | 0 | $ 0 | 1,840 | $ 0 | |
Employee Severance | ||||||
Restructuring Cost and Reserve [Line Items] | ||||||
Accrued liability for unpaid transformation consulting costs | 6,300 | 6,300 | ||||
Accrued liability for unpaid transformation consulting costs to be paid during the next twelve months | 5,900 | 5,900 | ||||
Accrued liability for unpaid transformation consulting costs to be paid thereafter | $ 400 | $ 400 |
Supplemental Statement of Ope_6
Supplemental Statement of Operations Information - Schedule of Other Operating Expense (Income) (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Other Income and Expenses [Abstract] | ||||
Gain on sale of accounts receivable (Note 5) | $ (7,603) | $ 0 | $ (7,603) | $ 0 |
Loss (gain) on disposal of property and equipment, net | 26 | (25) | 398 | 321 |
Other, net | 3 | (43) | (123) | (43) |
Total other operating expense, net | $ (7,574) | $ (68) | $ (7,328) | $ 278 |
Supplemental Statement of Ope_7
Supplemental Statement of Operations Information - Schedule of Other Non-operating Losses (gains) (Details) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Other Income and Expenses [Abstract] | ||||
Fair value adjustment on derivative in subordinated notes | $ (271) | $ (50) | $ (1,110) | $ (50) |
Earnings from unconsolidated investees | (250) | (46) | (738) | (46) |
Gain on conversion of debt to equity investment (Note 18) | 0 | 0 | 0 | (3,360) |
Other, net | 0 | 0 | (1,152) | (6) |
Total other expense, net | $ (521) | $ (96) | $ (3,000) | $ (3,462) |
Investment in Unconsolidated _2
Investment in Unconsolidated Investees (Detail) - USD ($) $ in Millions | 9 Months Ended | ||
Mar. 01, 2021 | Sep. 30, 2021 | Sep. 30, 2022 | |
Other Investments [Line Items] | |||
Payments to acquire Investments | $ 4.6 | ||
Equity method investments | $ 8 | ||
AI Business | |||
Other Investments [Line Items] | |||
Equity method investment, ownership percentage | 34.50% | 15% | |
Other Financial Instruments Revaluation and other (Gains) Losses | |||
Other Investments [Line Items] | |||
Gain (loss) on conversion of debt investments | $ 3.4 | ||
Common Equity | Share Purchase Warrants | |||
Other Investments [Line Items] | |||
Payments to acquire Investments | $ 0.4 | ||
Common Equity | Share Purchase Warrants | AI Business | |||
Other Investments [Line Items] | |||
Equity method investment, ownership percentage | 2.40% |
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 | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Earnings Per Share [Abstract] | ||||
Net loss attributable to common stockholders | $ (53,871) | $ (1,337) | $ (115,151) | $ (11,570) |
Weighted average common shares outstanding: | ||||
Basic (in shares) | 89,540,046 | 77,082,852 | 89,378,653 | 72,727,721 |
Diluted (in shares) | 89,540,046 | 77,082,852 | 89,378,653 | 72,727,721 |
Net loss per share attributable to common stockholders: | ||||
Basic (in dollars per share) | $ (0.60) | $ (0.02) | $ (1.29) | $ (0.16) |
Diluted (in dollars per share) | $ (0.60) | $ (0.02) | $ (1.29) | $ (0.16) |
Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive (in shares) | 2,571,041 | 1,967,411 | 2,548,000 | 2,023,697 |
Segment Information - Additiona
Segment Information - Additional Information (Details) - segment | 13 Months Ended | |
Aug. 31, 2021 | Sep. 30, 2022 | |
Segment Reporting [Abstract] | ||
Number of reportable segments | 1 | 2 |
Segment Information - Summary o
Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | $ 186,605 | $ 108,177 | $ 564,996 | $ 241,636 |
Radiology | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | 155,062 | 95,021 | 471,269 | 228,480 |
Oncology | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | $ 31,543 | $ 13,156 | $ 93,727 | $ 13,156 |
Segment Information - Summary_2
Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | $ 36,521 | $ 17,968 | $ 106,721 | $ 39,381 |
Corporate | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | (5,745) | (3,503) | (20,494) | (8,013) |
Radiology | Operating Segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | 31,218 | 16,572 | 95,832 | 42,495 |
Oncology | Operating Segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | $ 11,048 | $ 4,899 | $ 31,383 | $ 4,899 |
Segment Information - Summary_3
Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | |
Segment Reporting [Abstract] | ||||
Net income (loss) | $ (49,745) | $ 1,180 | $ (102,256) | $ (8,182) |
Interest expense | 29,679 | 16,932 | 87,650 | 34,221 |
Income tax expense (benefit) | 12,038 | (22,070) | 9,118 | (21,999) |
Depreciation and amortization | 25,079 | 11,286 | 75,010 | 20,359 |
Impairment charges | 20,369 | 0 | 20,702 | 0 |
Restructuring charges | 4,042 | 479 | 11,366 | 479 |
Severance and related costs | 2,485 | 53 | 10,282 | 53 |
Settlements, recoveries and related costs | (576) | (52) | 101 | (394) |
Stock-based compensation | 556 | 785 | 2,375 | 1,997 |
Gain on sale of accounts receivable | (7,603) | 0 | (7,603) | 0 |
Loss (gain) on disposal of property and equipment, net | 26 | (25) | 398 | 321 |
Acquisition-related costs | 99 | 8,784 | 567 | 14,412 |
Fair value adjustment on derivative in subordinated notes | (271) | (50) | (1,110) | (50) |
Gain on conversion of debt to equity investment | 0 | 0 | 0 | (3,360) |
Deferred rent expense | 325 | 621 | 904 | 1,525 |
Other, net | 18 | 45 | (783) | (1) |
Adjusted EBITDA | $ 36,521 | $ 17,968 | $ 106,721 | $ 39,381 |
Segment Information - Schedule
Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2022 | Sep. 30, 2021 | Sep. 30, 2022 | Sep. 30, 2021 | Dec. 31, 2021 | |
Segment Reporting Information [Line Items] | |||||
Identifiable assets | $ 1,809,238 | $ 1,809,238 | $ 1,918,826 | ||
Capital expenditures | 17,299 | $ 2,619 | 32,765 | $ 5,203 | |
Corporate | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 22,269 | 22,269 | 26,505 | ||
Capital expenditures | 11 | 0 | 183 | 0 | |
Radiology | Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 1,411,032 | 1,411,032 | 1,451,905 | ||
Capital expenditures | 16,081 | 2,619 | 29,541 | 5,203 | |
Oncology | Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 375,937 | 375,937 | $ 440,416 | ||
Capital expenditures | $ 1,207 | $ 0 | $ 3,041 | $ 0 |