Document and Entity Information
Document and Entity Information - shares | 6 Months Ended | |
Jun. 30, 2021 | Jul. 27, 2021 | |
Document and Entity Information | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Transition Report | false | |
Document Period End Date | Jun. 30, 2021 | |
Entity File Number | 1-10670 | |
Entity Registrant Name | HANGER, INC. | |
Entity Incorporation, State or Country Code | DE | |
Entity Tax Identification Number | 84-0904275 | |
Entity Address, Address Line One | 10910 Domain Drive, Suite 300 | |
Entity Address, City or Town | Austin | |
Entity Address, State or Province | TX | |
Entity Address, Postal Zip Code | 78758 | |
City Area Code | 512 | |
Local Phone Number | 777-3800 | |
Title of 12(b) Security | Common Stock, par value $0.01 per share | |
Trading Symbol | HNGR | |
Security Exchange Name | NYSE | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Small Business | false | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 38,690,454 | |
Entity Central Index Key | 0000722723 | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Year Focus | 2021 | |
Document Fiscal Period Focus | Q2 | |
Amendment Flag | false |
CONDENSED CONSOLIDATED BALANCE
CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Current assets: | ||
Cash and cash equivalents | $ 76,178 | $ 144,602 |
Accounts receivable, net | 124,956 | 128,596 |
Inventories | 83,959 | 76,429 |
Income taxes receivable | 12,831 | 12,888 |
Other current assets | 16,702 | 12,357 |
Total current assets | 314,626 | 374,872 |
Non-current assets: | ||
Property, plant, and equipment, net | 85,241 | 84,873 |
Goodwill | 318,383 | 277,223 |
Other intangible assets, net | 20,751 | 18,431 |
Deferred income taxes | 53,049 | 54,877 |
Operating lease right-of-use assets | 122,030 | 124,741 |
Other assets | 17,564 | 15,734 |
Total assets | 931,644 | 950,751 |
Current liabilities: | ||
Current portion of long-term debt | 12,257 | 10,085 |
Accounts payable | 58,400 | 65,091 |
Accrued expenses and other current liabilities | 63,333 | 62,861 |
Accrued compensation related costs | 51,256 | 72,541 |
Current portion of operating lease liabilities | 35,586 | 35,002 |
Total current liabilities | 220,832 | 245,580 |
Long-term liabilities: | ||
Long-term debt, less current portion | 495,245 | 493,012 |
Operating lease liabilities | 100,515 | 104,589 |
Other liabilities | 51,160 | 56,593 |
Total liabilities | 867,752 | 899,774 |
Commitments and contingencies (Note P) | ||
Shareholders' equity: | ||
Common stock, $0.01 par value; 60,000,000 shares authorized; 38,865,074 shares issued and 38,722,253 shares outstanding at 2021, and 38,321,796 shares issued and 38,178,975 shares outstanding at 2020, respectively | 389 | 383 |
Additional paid-in capital | 367,726 | 365,503 |
Accumulated other comprehensive loss | (16,358) | (20,215) |
Accumulated deficit | (287,169) | (293,998) |
Treasury stock, at cost; 142,821 shares at 2021 and 2020, respectively | (696) | (696) |
Total shareholders' equity | 63,892 | 50,977 |
Total liabilities and shareholders' equity | $ 931,644 | $ 950,751 |
CONDENSED CONSOLIDATED BALANC_2
CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares | Jun. 30, 2021 | Dec. 31, 2020 |
CONDENSED CONSOLIDATED BALANCE SHEETS | ||
Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized | 60,000,000 | 60,000,000 |
Common stock, shares issued | 38,865,074 | 38,321,796 |
Common stock, shares outstanding | 38,722,253 | 38,178,975 |
Treasury stock, shares | 142,821 | 142,821 |
CONDENSED CONSOLIDATED STATEMEN
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS | ||||
Net revenues | $ 280,819 | $ 233,434 | $ 518,289 | $ 467,173 |
Material costs | 89,271 | 69,972 | 164,441 | 147,213 |
Personnel costs | 97,549 | 73,822 | 187,429 | 163,007 |
Other operating costs | 32,721 | 8,277 | 64,181 | 44,163 |
General and administrative expenses | 33,177 | 33,623 | 64,118 | 65,392 |
Depreciation and amortization | 8,007 | 8,879 | 16,005 | 17,710 |
Income from operations | 20,094 | 38,861 | 22,115 | 29,688 |
Interest expense, net | 7,152 | 8,636 | 14,492 | 16,906 |
Non-service defined benefit plan expense | 167 | 158 | 334 | 316 |
Income before income taxes | 12,775 | 30,067 | 7,289 | 12,466 |
Provision (benefit) for income taxes | 2,616 | (987) | 460 | (2,840) |
Net income | $ 10,159 | $ 31,054 | $ 6,829 | $ 15,306 |
Basic and Diluted Per Common Share Data: | ||||
Basic income per share | $ 0.26 | $ 0.82 | $ 0.18 | $ 0.41 |
Weighted average shares used to compute basic earnings per common share | 38,647,042 | 37,958,408 | 38,458,733 | 37,749,930 |
Diluted income per share | $ 0.26 | $ 0.81 | $ 0.17 | $ 0.40 |
Weighted average shares used to compute diluted earnings per common share | 39,208,155 | 38,325,872 | 39,216,725 | 38,424,334 |
CONDENSED CONSOLIDATED STATEM_2
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS | ||||
Net income | $ 10,159 | $ 31,054 | $ 6,829 | $ 15,306 |
Other comprehensive income (loss): | ||||
Unrealized gain (loss) on cash flow hedges, net of tax provision (benefit) of $388, ($182), $1,184, and ($2,997), respectively | 1,225 | (573) | 3,737 | (9,475) |
Unrealized gain on defined benefit plan, net of tax provision of $19, $9, $38, and $18, respectively | 60 | 27 | 120 | 56 |
Total other comprehensive income (loss) | 1,285 | (546) | 3,857 | (9,419) |
Comprehensive income | $ 11,444 | $ 30,508 | $ 10,686 | $ 5,887 |
CONDENSED CONSOLIDATED STATEM_3
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (Parenthetical) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS | ||||
Unrealized gain (loss) on cash flow hedges tax | $ 388 | $ 182 | $ 1,184 | $ 2,997 |
Unrealized gain on defined benefit plan tax | $ 19 | $ 9 | $ 38 | $ 18 |
CONDENSED CONSOLIDATED STATEM_4
CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDERS' EQUITY - USD ($) $ in Thousands | Common StockAdjusted Balance | Common Stock | Additional Paid in CapitalAdjusted Balance | Additional Paid in Capital | Accumulated Other Comprehensive LossAdjusted Balance | Accumulated Other Comprehensive Loss | Accumulated DeficitCumulative effect of a change in accounting | Accumulated DeficitAdjusted Balance | Accumulated Deficit | Treasury StockAdjusted Balance | Treasury Stock | Cumulative effect of a change in accounting | Adjusted Balance | Total |
Balance (ASU 2016-13) at Dec. 31, 2019 | $ (238) | $ (238) | ||||||||||||
Balance at Dec. 31, 2019 | $ 376 | $ 376 | $ 354,326 | $ 354,326 | $ (12,551) | $ (12,551) | $ (332,189) | $ (331,951) | $ (696) | $ (696) | $ 9,266 | $ 9,504 | ||
Balance (in shares) at Dec. 31, 2019 | 37,460 | 37,460 | ||||||||||||
Increase (Decrease) in Stockholders' Equity | ||||||||||||||
Net income (loss) | (15,748) | (15,748) | ||||||||||||
Share-based compensation expense | 3,501 | 3,501 | ||||||||||||
Issuance of common stock upon vesting of restricted stock units | $ 4 | (4) | ||||||||||||
Issuance of common stock upon vesting of restricted stock units (in shares) | 354 | |||||||||||||
Effect of shares withheld to cover taxes | (4,146) | (4,146) | ||||||||||||
Total other comprehensive income (loss) | (8,873) | (8,873) | ||||||||||||
Balance at Mar. 31, 2020 | $ 380 | 353,677 | (21,424) | (347,937) | (696) | (16,000) | ||||||||
Balance (in shares) at Mar. 31, 2020 | 37,814 | |||||||||||||
Balance (ASU 2016-13) at Dec. 31, 2019 | $ (238) | $ (238) | ||||||||||||
Balance at Dec. 31, 2019 | $ 376 | $ 376 | $ 354,326 | 354,326 | $ (12,551) | (12,551) | $ (332,189) | (331,951) | $ (696) | (696) | $ 9,266 | 9,504 | ||
Balance (in shares) at Dec. 31, 2019 | 37,460 | 37,460 | ||||||||||||
Increase (Decrease) in Stockholders' Equity | ||||||||||||||
Net income (loss) | 15,306 | |||||||||||||
Total other comprehensive income (loss) | (9,419) | |||||||||||||
Balance at Jun. 30, 2020 | $ 383 | 360,014 | (21,970) | (316,883) | (696) | 20,848 | ||||||||
Balance (in shares) at Jun. 30, 2020 | 38,133 | |||||||||||||
Balance at Mar. 31, 2020 | $ 380 | 353,677 | (21,424) | (347,937) | (696) | (16,000) | ||||||||
Balance (in shares) at Mar. 31, 2020 | 37,814 | |||||||||||||
Increase (Decrease) in Stockholders' Equity | ||||||||||||||
Net income (loss) | 31,054 | 31,054 | ||||||||||||
Share-based compensation expense | 8,984 | 8,984 | ||||||||||||
Issuance in connection with the exercise of stock options | 38 | 38 | ||||||||||||
Issuance in connection with the exercise of stock options (in shares) | 3 | |||||||||||||
Issuance of common stock upon vesting of restricted stock units | $ 3 | (3) | ||||||||||||
Issuance of common stock upon vesting of restricted stock units (in shares) | 316 | |||||||||||||
Effect of shares withheld to cover taxes | (2,682) | (2,682) | ||||||||||||
Total other comprehensive income (loss) | (546) | (546) | ||||||||||||
Balance at Jun. 30, 2020 | $ 383 | 360,014 | (21,970) | (316,883) | (696) | 20,848 | ||||||||
Balance (in shares) at Jun. 30, 2020 | 38,133 | |||||||||||||
Balance at Dec. 31, 2020 | $ 383 | 365,503 | (20,215) | (293,998) | (696) | $ 50,977 | ||||||||
Balance (in shares) at Dec. 31, 2020 | 38,179 | 38,178,975 | ||||||||||||
Increase (Decrease) in Stockholders' Equity | ||||||||||||||
Net income (loss) | (3,330) | $ (3,330) | ||||||||||||
Share-based compensation expense | 3,179 | 3,179 | ||||||||||||
Issuance in connection with the exercise of stock options | 366 | 366 | ||||||||||||
Issuance in connection with the exercise of stock options (in shares) | 29 | |||||||||||||
Issuance of common stock upon vesting of restricted stock units | $ 4 | (4) | ||||||||||||
Issuance of common stock upon vesting of restricted stock units (in shares) | 365 | |||||||||||||
Effect of shares withheld to cover taxes | (4,520) | (4,520) | ||||||||||||
Total other comprehensive income (loss) | 2,572 | 2,572 | ||||||||||||
Balance at Mar. 31, 2021 | $ 387 | 364,524 | (17,643) | (297,328) | (696) | 49,244 | ||||||||
Balance (in shares) at Mar. 31, 2021 | 38,573 | |||||||||||||
Balance at Dec. 31, 2020 | $ 383 | 365,503 | (20,215) | (293,998) | (696) | $ 50,977 | ||||||||
Balance (in shares) at Dec. 31, 2020 | 38,179 | 38,178,975 | ||||||||||||
Increase (Decrease) in Stockholders' Equity | ||||||||||||||
Net income (loss) | $ 6,829 | |||||||||||||
Total other comprehensive income (loss) | 3,857 | |||||||||||||
Balance at Jun. 30, 2021 | $ 389 | 367,726 | (16,358) | (287,169) | (696) | $ 63,892 | ||||||||
Balance (in shares) at Jun. 30, 2021 | 38,722 | 38,722,253 | ||||||||||||
Balance at Mar. 31, 2021 | $ 387 | 364,524 | (17,643) | (297,328) | (696) | $ 49,244 | ||||||||
Balance (in shares) at Mar. 31, 2021 | 38,573 | |||||||||||||
Increase (Decrease) in Stockholders' Equity | ||||||||||||||
Net income (loss) | 10,159 | 10,159 | ||||||||||||
Share-based compensation expense | 3,239 | 3,239 | ||||||||||||
Issuance in connection with the exercise of stock options | $ 1 | 4 | 5 | |||||||||||
Issuance in connection with the exercise of stock options (in shares) | 80 | |||||||||||||
Issuance of common stock upon vesting of restricted stock units | $ 1 | (1) | ||||||||||||
Issuance of common stock upon vesting of restricted stock units (in shares) | 69 | |||||||||||||
Effect of shares withheld to cover taxes | (40) | (40) | ||||||||||||
Total other comprehensive income (loss) | 1,285 | 1,285 | ||||||||||||
Balance at Jun. 30, 2021 | $ 389 | $ 367,726 | $ (16,358) | $ (287,169) | $ (696) | $ 63,892 | ||||||||
Balance (in shares) at Jun. 30, 2021 | 38,722 | 38,722,253 |
CONDENSED CONSOLIDATED STATEM_5
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 9 Months Ended | ||||
Jun. 30, 2021 | Mar. 31, 2021 | Jun. 30, 2020 | Mar. 31, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | Sep. 30, 2020 | |
Cash flows (used in) provided by operating activities: | |||||||
Net income | $ 10,159 | $ (3,330) | $ 31,054 | $ (15,748) | $ 6,829 | $ 15,306 | |
Adjustments to reconcile net income to net cash (used in) provided by operating activities: | |||||||
Depreciation and amortization | 8,007 | 8,879 | 16,005 | 17,710 | |||
(Benefit) provision for doubtful accounts | (292) | 1,084 | |||||
Share-based compensation expense | 6,418 | 12,485 | |||||
Deferred income taxes | 232 | (9) | |||||
Amortization of debt discounts and issuance costs | 948 | 936 | |||||
Gain on sale and disposal of fixed assets | (718) | (531) | |||||
Changes in operating assets and liabilities, net of acquisitions: | |||||||
Accounts receivable, net | 5,363 | 44,917 | |||||
Inventories | (5,899) | 5,072 | |||||
Other current assets and other assets | (6,202) | (4,882) | |||||
Income taxes | 57 | (5,278) | |||||
Accounts payable | (6,577) | 305 | |||||
Accrued expenses and other current liabilities | (2,765) | 2,393 | |||||
Accrued compensation related costs | (21,412) | (15,536) | |||||
Other liabilities | (522) | 3,686 | |||||
Operating lease liabilities, net of amortization of right-of-use assets | (780) | 2,403 | |||||
Changes in operating assets and liabilities: | (38,737) | 33,080 | |||||
Net cash (used in) provided by operating activities | (9,315) | 80,061 | |||||
Cash flows used in investing activities | |||||||
Acquisitions, net of cash acquired | (35,349) | (16,788) | |||||
Purchase of property, plant, and equipment | (13,339) | (15,742) | |||||
Purchase of therapeutic program equipment leased to third parties under operating leases | (870) | (3,065) | |||||
Proceeds from sale of property, plant, and equipment | 1,332 | 1,134 | |||||
Purchase of company-owned life insurance investment | (250) | ||||||
Net cash used in investing activities | (48,226) | (34,711) | |||||
Cash flows (used in) provided by financing activities: | |||||||
Borrowings under revolving credit agreement | 79,000 | ||||||
Repayment of borrowings under revolving credit agreement | (57,000) | ||||||
Payment of employee taxes on share-based compensation | (4,560) | (6,828) | |||||
Repayment of term loan | (2,525) | (2,525) | |||||
Payment on Seller Notes | (2,265) | (1,799) | |||||
Payments under vendor financing arrangements | (1,375) | (275) | |||||
Payment of financing lease obligations | (529) | (314) | |||||
Payment of debt issuance costs | (214) | $ (200) | |||||
Proceeds from the exercise of options | 371 | 39 | |||||
Net cash (used in) provided by financing activities | (10,883) | 10,084 | |||||
(Decrease) increase in cash and cash equivalents | (68,424) | 55,434 | |||||
Cash and cash equivalents at beginning of period | $ 144,602 | $ 74,419 | 144,602 | 74,419 | $ 74,419 | ||
Cash and cash equivalents at end of period | $ 76,178 | $ 129,853 | 76,178 | 129,853 | |||
Non-cash financing and investing activities: | |||||||
Seller Notes and other non-cash consideration related to acquisitions | 10,057 | 29,393 | |||||
Purchase of property, plant, and equipment in accounts payable at period end | 3,349 | 4,659 | |||||
Right-of-use assets obtained in exchange for finance lease obligations | $ 95 | $ 1,335 |
Organization and Summary of Sig
Organization and Summary of Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2021 | |
Organization and Summary of Significant Accounting Policies | |
Organization and Summary of Significant Accounting Policies | Note A — Organization and Summary of Significant Accounting Policies Description of Business Hanger, Inc. (“we,” “our,” or “us”) is a leading national provider of products and services that assist in enhancing or restoring the physical capabilities of patients with disabilities or injuries. We provide orthotic and prosthetic (“O&P”) services, distribute O&P devices and components, manage O&P networks, and provide therapeutic solutions to patients and businesses in acute, post-acute, and clinic settings. We operate through two segments, Patient Care and Products & Services. Basis of Presentation The accompanying interim unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X, and, therefore, do not include all of the information and footnotes required by GAAP for complete financial statements. These financial statements should be read in conjunction with the audited consolidated financial statements in our Annual Report on Form 10-K for the year ended December 31, 2020 (the “2020 Form 10-K”), as previously filed with the Securities and Exchange Commission (the “SEC”). In our opinion, the information contained herein reflects all adjustments necessary for a fair statement of our results of operations, financial position, and cash flows. All such adjustments are of a normal, recurring nature. The results of operations for the interim periods are not necessarily indicative of those to be expected for the full year. A detailed description of our significant accounting policies and management judgments is contained in our 2020 Form 10-K. Reclassifications We have reclassified certain amounts in the prior year condensed consolidated financial statements to be consistent with the current year presentation. These relate to classifications within the condensed consolidated statements of operations. Recent Developments Regarding COVID-19 We are subject to risks and uncertainties as a result of the outbreak of the novel coronavirus (“COVID-19”) pandemic (“COVID-19 pandemic”). The extent and duration of the impact of the COVID-19 pandemic on our operations and financial condition remain uncertain and difficult to predict. As a result of the COVID-19 pandemic, we believe that our patients are deferring visits to our O&P clinics, as well as elective surgical procedures, both of which impact our business volumes through decreased patient encounters and physician referrals. It remains possible that further outbreaks of COVID-19, including the spread of variants,or reinstitution of restrictive measures by federal, state and local governments could cause a recessionary environment impacting the healthcare industry generally, including the O&P industry. The United States government has responded with fiscal policy measures intended to support the healthcare industry and economy as a whole, including the passage of the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) in March 2020. CARES Act The CARES Act established the Public Health and Social Services Emergency Fund, also referred to as the Cares Act Provider Relief Fund, which set aside $178.0 billion to be administered through grants and other mechanisms to hospitals, public entities, not-for-profit entities and Medicare- and Medicaid- enrolled suppliers and institutional providers. The purpose of these funds is to reimburse providers for lost revenue and health-care related expenses that are attributable to the COVID-19 pandemic. In April 2020, the U.S. Department of Health and Human Services (“HHS”) began making payments to healthcare providers from the $178.0 billion appropriation. These are grants, rather than loans, to healthcare providers, and will not need to be repaid. During 2020, we recognized a total benefit of $24.0 million in our consolidated statement of operations within Other operating costs for the grant proceeds we received under the CARES Act (“Grants”) from HHS. We recognize income related to grants on a systematic and rational basis when it becomes probable that we have complied with the terms and conditions of the grant and in the period in which the corresponding costs or income related to the grant are recognized. We recognized the benefit from the Grants within Other operating costs in our Patient Care segment. In April 2021, we recognized an additional $0.7 million in proceeds received from grants under the CARES Act. The CARES Act also provided for a deferral of the employer portion of payroll taxes incurred during the COVID-19 pandemic through December 2020. The provisions allowed us to defer half of such payroll taxes until December 2021 and the remaining half until December 2022. We deferred $11.8 million of payroll taxes within Accrued compensation related costs and Other liabilities in the condensed consolidated balance sheet as of June 30, 2021. Recent Accounting Pronouncements, Not Yet Adopted In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting |
Earnings Per Share
Earnings Per Share | 6 Months Ended |
Jun. 30, 2021 | |
Earnings Per Share | |
Earnings Per Share | Note B — Earnings Per Share Basic earnings per common share is computed using the weighted average number of common shares outstanding during the period. Diluted earnings per common share is computed using the weighted average number of common shares outstanding during the period plus any potentially dilutive common shares, such as stock options, restricted stock units, and performance-based units calculated using the treasury stock method. Total anti-dilutive shares excluded from the diluted earnings per share were 2,721 and 1,302 for the three and six months ended June 30, 2021, and 118,525 and 17,864 for the three and six months ended June 30, 2020. Our Credit Agreement (as defined below) restricts the payment of dividends or other distributions to our shareholders by us or any of our subsidiaries. See Note K - “Debt and Other Obligations” within these condensed consolidated financial statements. The reconciliation of the numerators and denominators used to calculate basic and diluted net income per share are as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands except share and per share amounts) 2021 2020 2021 2020 Net income $ 10,159 $ 31,054 $ 6,829 $ 15,306 Weighted average shares outstanding - basic 38,647,042 37,958,408 38,458,733 37,749,930 Effect of potentially dilutive restricted stock units and options 561,113 367,464 757,992 674,404 Weighted average shares outstanding - diluted 39,208,155 38,325,872 39,216,725 38,424,334 Basic income per share $ 0.26 $ 0.82 $ 0.18 $ 0.41 Diluted income per share $ 0.26 $ 0.81 $ 0.17 $ 0.40 |
Revenue Recognition
Revenue Recognition | 6 Months Ended |
Jun. 30, 2021 | |
Revenue Recognition | |
Revenue Recognition | Note C — Revenue Recognition Patient Care Segment Revenue in our Patient Care segment is primarily derived from contracts with third party payors for the provision of O&P devices and is recognized upon the transfer of control of promised products or services to the patient at the time the patient receives the device. At, or subsequent to delivery, we issue an invoice to the third party payor, which primarily consists of commercial insurance companies, Medicare, Medicaid, the U.S. Department of Veterans Affairs (the “VA”), or private or patient pay (“Private Pay”) individuals. We recognize revenue for the amounts we expect to receive from payors based on expected contractual reimbursement rates, which are net of estimated contractual discounts and implicit price concessions. These revenue amounts are further revised as claims are adjudicated, which may result in additional disallowances. The following table disaggregates revenue from contracts with customers in our Patient Care segment for the three and six months ended June 30, 2021 and 2020: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Patient Care Segment Medicare $ 74,248 $ 64,191 $ 131,583 $ 125,916 Medicaid 43,688 31,243 77,736 62,071 Commercial Insurance / Managed Care (excluding Medicare and Medicaid Managed Care) 79,769 70,828 149,432 137,268 Veterans Administration 21,633 16,826 41,397 34,718 Private Pay 17,449 12,771 32,321 26,069 Total $ 236,787 $ 195,859 $ 432,469 $ 386,042 The impact to revenue related to prior period performance obligations was not material for the three and six months ended June 30, 2021 and 2020. Products & Services Segment Revenue in our Products & Services segment is derived from the distribution of O&P components and from therapeutic solutions which includes the leasing and sale of rehabilitation equipment and ancillary consumable supplies combined with equipment maintenance, education, and training. The following table disaggregates revenue from contracts with customers in our Products & Services segment for the three and six months ended June 30, 2021 and 2020: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Products & Services Segment Distribution services, net of intersegment revenue eliminations $ 33,275 $ 26,527 $ 63,935 $ 58,217 Therapeutic solutions 10,757 11,048 21,885 22,914 Total $ 44,032 $ 37,575 $ 85,820 $ 81,131 |
Accounts Receivable, Net
Accounts Receivable, Net | 6 Months Ended |
Jun. 30, 2021 | |
Accounts Receivable, Net | |
Accounts Receivable, Net | Note D — Accounts Receivable, Net Accounts receivable, net represents outstanding amounts we expect to collect from the transfer of our products and services. Principally, these amounts are comprised of receivables from Medicare, Medicaid, and commercial insurance plans. Our accounts receivable represent amounts outstanding from our gross charges, net of contractual discounts, sales returns, and other implicit price concessions including estimates for payor disallowances and patient non-payments. We are exposed to credit losses primarily through our accounts receivable. These receivables are short in nature because their due date varies between due upon receipt of invoice and 90 days. We assess our receivables, divide them into similar risk pools, and monitor our ongoing credit exposure through active review of our aging buckets. Our activities include timely account reconciliations, dispute resolution, and payment confirmations. We also employ collection agencies and legal counsel to pursue recovery of defaulted receivables. Our expected loss methodology is developed using historical liquidation rates, current and future economic and market conditions, and a review of the current status of our patients and customers’ trade accounts receivable balances. We also grouped our receivables into similar risk pools to better measure the risks for each pool. After evaluating the risk for each pool, we determined that additional credit loss risk was immaterial for the Patient Care segment. For the Products & Services segment, an allowance for doubtful accounts is recorded, which is deducted from gross accounts receivable to arrive at “Accounts receivable, net.” As of June 30, 2021, we have considered the current and future economic and market conditions resulting in a decrease to the allowance for doubtful accounts by approximately $0.5 million since December 31, 2020. Accounts receivable, net as of June 30, 2021 and December 31, 2020 is comprised of the following: As of June 30, 2021 As of December 31, 2020 Products & Products & (in thousands) Patient Care Services Consolidated Patient Care Services Consolidated Gross charges before estimates for implicit price concessions $ 150,382 $ 20,933 $ 171,315 $ 156,504 $ 21,300 $ 177,804 Less estimates for implicit price concessions: Payor disallowances (37,080) — (37,080) (39,343) — (39,343) Patient non-payments (6,968) — (6,968) (7,042) — (7,042) Accounts receivable, gross 106,334 20,933 127,267 110,119 21,300 131,419 Allowance for doubtful accounts — (2,311) (2,311) — (2,823) (2,823) Accounts receivable, net $ 106,334 $ 18,622 $ 124,956 $ 110,119 $ 18,477 $ 128,596 |
Inventories
Inventories | 6 Months Ended |
Jun. 30, 2021 | |
Inventories | |
Inventories | Note E — Inventories Our inventories are comprised of the following: As of June 30, As of December 31, (in thousands) 2021 2020 Raw materials $ 20,502 $ 19,716 Work in process 17,905 12,040 Finished goods 45,552 44,673 Total inventories $ 83,959 $ 76,429 |
Acquisitions
Acquisitions | 6 Months Ended |
Jun. 30, 2021 | |
Acquisitions | |
Acquisitions | Note F — Acquisitions 2021 Acquisition Activity During 2021, we completed the following acquisitions of O&P clinics, none of which were individually material to our financial position, results of operations, or cash flows: ● In the first quarter of 2021, we completed the acquisitions of all the outstanding equity interests of three O&P businesses and the assets of one O&P business for total consideration of $24.2 million, of which $19.2 million was cash consideration, net of cash acquired, $4.0 million was issued in the form of notes to shareholders at fair value, and $1.0 million in additional consideration. We completed the acquisitions with the intention of expanding the geographic footprint of our patient care offerings through the acquisition of these high quality O&P providers. ● In the second quarter of 2021, we completed the acquisitions of all the outstanding equity interests of two O&P businesses for total consideration of $21.0 million, of which $16.0 million was cash consideration, net of cash acquired, $4.9 million was issued in the form of notes to shareholders at fair value, and $0.1 million in additional consideration. We accounted for these transactions under the acquisition method of accounting and have reported the results of operations of each acquisition as of the respective dates of the acquisitions. We based the estimated fair values of intangible assets on an income approach utilizing the excess earnings method for customer relationships. The income approach utilizes management’s estimates of future operating results and cash flows using a weighted average cost of capital that reflects market participant assumptions. Other significant judgments used in the valuation of tangible assets acquired in the acquisition include estimated selling price of inventory and estimated replacement cost for acquired property, plant, and equipment. For all other assets acquired and liabilities assumed, the fair value reflects the carrying value of the asset or liability due to their short maturity. We recorded the excess of the fair value of the consideration transferred in the acquisitions over the fair value of net assets acquired as goodwill. The goodwill reflects our expectations of favorable future growth opportunities, anticipated synergies through the scale of our O&P operations, and the assembled workforce. We expect that the majority of the goodwill acquired in the first quarter of 2021, which has been assigned to our Patient Care reporting unit, will not be deductible for federal income tax purposes. We expect that substantially all of the goodwill acquired in the second quarter of 2021, which has been assigned to our Patient Care reporting unit, will be deductible for federal income tax purposes. Acquisition-related costs are included in general and administrative expenses in our condensed consolidated statements of operations. Total acquisition-related costs incurred during the three and six months ended June 30, 2021 were $0.4 million and $0.8 million, respectively, which includes those costs for transactions that are in progress or were not completed during the respective period. Acquisition-related costs incurred for the acquisitions completed during the three and six months ended June 30, 2021 were $0.2 million and $0.4 million, respectively. We have not presented pro forma combined results for these acquisitions because the impact on previously reported statements of operations would not have been material individually or in the aggregate. Purchase Price Allocation We have performed a preliminary valuation analysis of the fair market value of the assets acquired and liabilities assumed in the acquisitions. The final purchase price allocations will be determined when we have completed and fully reviewed the detailed valuations and could differ materially from the preliminary allocations. The final allocations may include changes in allocations of acquired intangible assets as well as goodwill and other changes to assets and liabilities, including deferred taxes. The estimated useful lives of acquired intangible assets are also preliminary. The aggregate purchase price of these acquisitions were allocated on a preliminary basis as follows: (in thousands) Cash paid, net of cash acquired $ 35,199 Issuance of Seller Notes at fair value 8,893 Additional consideration, net 1,101 Aggregate purchase price 45,193 Accounts receivable 2,114 Inventories 1,631 Customer relationships (Weighted average useful life of 5.0 years) 4,495 Other assets and liabilities, net (3,720) Net assets acquired 4,520 Goodwill $ 40,673 Right 2020 Acquisition Activity During 2020, we completed the following acquisitions of O&P clinics, none of which were individually material to our financial position, results of operations, or cash flows: ● In the second quarter of 2020, we acquired all of the outstanding equity interests of an O&P business for total consideration of $46.2 million at fair value, of which $16.8 million was cash consideration, net of cash acquired, $21.9 million was issued in the form of notes to the former shareholders, $3.5 million in the form of a deferred payment obligation to the former shareholders, and $4.0 million in additional consideration. Of the $21.9 million in notes issued to the former shareholders, approximately $18.1 million of the notes were paid in October 2020 in a lump sum payment and the remaining $3.8 million of the notes are payable in annual installments over a period of three years on the anniversary date of the acquisition. Total payments of $4.0 million under the deferred payment obligation are due in annual installments beginning in the fourth year following the acquisition and for three years thereafter. Additional consideration includes approximately $3.6 million in liabilities incurred to the shareholders as part of the business combination payable in October 2020 and is included in Accrued expenses and other liabilities in the consolidated balance sheet. The remaining $0.4 million in additional consideration represents the effective settlement of amounts due to us from the acquired O&P business as of the acquisition date. We completed the acquisition with the intention of expanding the geographic footprint of our patient care offerings through the acquisition of this high quality O&P provider. ● In the fourth quarter of 2020, we completed the acquisitions of all the outstanding equity interests of four O&P businesses for total consideration of $7.1 million, of which $4.9 million was cash consideration, net of cash acquired, $1.9 million was issued in the form of notes to shareholders at fair value, and $0.3 million in additional consideration. The aggregate purchase price of these acquisitions were allocated on a preliminary basis as follows: (in thousands) Cash paid, net of cash acquired $ 21,709 Issuance of Seller Notes at fair value 23,766 Deferred payment obligation at fair value 3,468 Additional consideration, net 4,319 Aggregate purchase price 53,262 Accounts receivable 4,224 Inventories 2,276 Customer relationships (Weighted average useful life of 5.0 years) 6,358 Non-compete agreements (Weighted average useful life of 5.0 years) 200 Other assets and liabilities, net (4,561) Net assets acquired 8,497 Goodwill $ 44,765 Right |
Goodwill and Other Intangible A
Goodwill and Other Intangible Assets | 6 Months Ended |
Jun. 30, 2021 | |
Goodwill and Other Intangible Assets | |
Goodwill and Other Intangible Assets | Note G — Goodwill and Other Intangible Assets We assess goodwill and indefinite-lived intangible assets for impairment annually as of October 1st, and between annual tests if an event occurs, or circumstances change, that would more-likely-than-not reduce the fair value of a reporting unit below its carrying value. The following table summarizes the activity in goodwill of the Patient Care operating segment for the periods indicated: For the Six Months Ended June 30, 2021 Goodwill, Accumulated Goodwill, (in thousands) Gross Impairment Net As of December 31, 2020 $ 705,891 $ (428,668) $ 277,223 Additions from acquisitions 40,673 — 40,673 Measurement period adjustments (1) 487 — 487 As of June 30, 2021 $ 747,051 $ (428,668) $ 318,383 (1) Measurement period adjustments increasing goodwill relate to 2021 and 2020 acquisitions of approximately $0.1 million and $0.4 million, respectively, and are primarily attributable to adjustments to the preliminary allocations of customer relationship intangibles. For the Year Ended December 31, 2020 Goodwill, Accumulated Goodwill, (in thousands) Gross Impairment Net As of December 31, 2019 $ 660,912 $ (428,668) $ 232,244 Additions from acquisitions 45,144 — 45,144 Measurement period adjustments (1) (165) — (165) As of December 31, 2020 $ 705,891 $ (428,668) $ 277,223 (1) Measurement period adjustments reducing goodwill relate to acquisitions in the current and prior year of approximately $0.2 million and are primarily attributable to adjustments to the preliminary allocations of customer relationship intangibles. As of December 31, 2017, goodwill of approximately $139.3 million within the Products & Services operating segment was impaired in full. The balances related to intangible assets as of June 30, 2021 and December 31, 2020 are as follows: As of June 30, 2021 Gross Carrying Accumulated Accumulated Net Carrying (in thousands) Amount Amortization Impairment Amount Customer lists $ 21,374 $ (7,664) $ — $ 13,710 Trade name 255 (189) — 66 Patents and other intangibles 8,994 (6,136) — 2,858 Definite-lived intangible assets 30,623 (13,989) — 16,634 Indefinite-lived trade name 9,070 — (4,953) 4,117 Total other intangible assets $ 39,693 $ (13,989) $ (4,953) $ 20,751 As of December 31, 2020 Gross Carrying Accumulated Accumulated Net Carrying (in thousands) Amount Amortization Impairment Amount Customer lists $ 16,879 $ (5,845) $ — $ 11,034 Trade name 255 (176) — 79 Patents and other intangibles 9,011 (5,810) — 3,201 Definite-lived intangible assets 26,145 (11,831) — 14,314 Indefinite-lived trade name 9,070 — (4,953) 4,117 Total other intangible assets $ 35,215 $ (11,831) $ (4,953) $ 18,431 Amortization expense related to other intangible assets was approximately $1.2 million and $2.2 million for the three and six months ended June 30, 2021 and $1.6 million and $3.0 million for the three and six months ended June 30, 2020. Estimated aggregate amortization expense for definite-lived intangible assets for each of the next five years ended December 31, and thereafter is as follows: (in thousands) 2021 (remainder of the year) $ 2,397 2022 4,729 2023 4,483 2024 2,993 2025 1,804 Thereafter 228 Total $ 16,634 |
Other Current Assets and Other
Other Current Assets and Other Assets | 6 Months Ended |
Jun. 30, 2021 | |
Other Current Assets and Other Assets | |
Other Current Assets and Other Assets | Note H — Other Current Assets and Other Assets Other current assets consist of the following: As of June 30, As of December 31, (in thousands) 2021 2020 Non-trade receivables $ 6,116 $ 6,063 Prepaid maintenance 4,593 2,942 Prepaid insurance 1,738 266 Other prepaid assets 4,255 3,086 Total other current assets $ 16,702 $ 12,357 Other assets consist of the following: As of June 30, As of December 31, (in thousands) 2021 2020 Implementation costs for cloud computing arrangements $ 6,540 $ 4,811 Cash surrender value of company-owned life insurance 4,344 3,973 Finance lease right-of-use assets 2,729 3,016 Deposits 2,194 2,144 Non-trade receivables 1,339 1,274 Other 418 516 Total other assets $ 17,564 $ 15,734 |
Accrued Expenses and Other Curr
Accrued Expenses and Other Current Liabilities and Other Liabilities | 6 Months Ended |
Jun. 30, 2021 | |
Accrued Expenses and Other Current Liabilities and Other Liabilities | |
Accrued Expenses and Other Current Liabilities and Other Liabilities | Note I — Accrued Expenses and Other Current Liabilities and Other Liabilities Accrued expenses and other current liabilities consist of: As of June 30, As of December 31, (in thousands) 2021 2020 Patient prepayments, deposits, and refunds payable $ 25,738 $ 27,195 Accrued sales taxes and other taxes 9,661 9,863 Insurance and self-insurance accruals 8,213 7,651 Derivative liability 7,528 7,686 Accrued professional fees 1,486 1,016 Accrued interest payable 522 440 Other current liabilities 10,185 9,010 Total $ 63,333 $ 62,861 Other liabilities consist of: As of June 30, As of December 31, (in thousands) 2021 2020 Supplemental executive retirement plan obligations $ 20,668 $ 21,503 Derivative liability 9,626 14,388 Long-term insurance accruals 7,630 7,326 Deferred payroll taxes 5,918 5,918 Unrecognized tax benefits 5,142 5,465 Other 2,176 1,993 Total $ 51,160 $ 56,593 |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2021 | |
Income Taxes | |
Income Taxes | Note J — Income Taxes We recorded a provision for income taxes of $2.6 million and $0.5 million for the three and six months ended June 30, 2021. The effective tax rate was 20.5% and 6.3% for the three and six months ended June 30, 2021. We recorded a benefit for income taxes of $1.0 million and $2.8 million for the three and six months ended June 30, 2020. The effective tax rate was (3.3)% and (22.8)% for the three and six months ended June 30, 2020. The increase in the effective tax rate for the three and six months ended June 30, 2021 compared with the three and six months ended June 30, 2020 is primarily attributable to 2017 through 2019 research and development tax credits recognized in the three and six months ended June 30, 2020, partially offset by a windfall from share-based compensation for the three and six months ended June 30, 2021. Our effective tax rate for the three and six months ended June 30, 2021 differed from the federal statutory tax rate of 21% primarily due to research and development credits, non-deductible expenses, and a windfall from share-based compensation. Our effective tax rate for the three and six months ended June 30, 2020 differed from the federal statutory tax rate of 21% primarily due to research and development credits, non-deductible expenses, and a shortfall from share-based compensation. For the year ended December 31, 2020, we completed a formal study to identify qualifying research and development expenses resulting in the recognition of federal tax benefits of $2.2 million, net of tax reserves, related to 2020 and $6.1 million, net of tax reserves, related to prior years. We recorded the tax benefit, before tax reserves, as a deferred tax asset. For the year ended December 31, 2021, we estimate a federal tax benefit of $3.0 million, net of tax reserves. |
Debt and Other Obligations
Debt and Other Obligations | 6 Months Ended |
Jun. 30, 2021 | |
Debt and Other Obligations | |
Debt and Other Obligations | Note K — Debt and Other Obligations Debt consists of the following: As of June 30, As of December 31, (in thousands) 2021 2020 Debt: Term Loan B $ 488,588 $ 491,113 Seller Notes 18,105 11,510 Deferred payment obligation 4,000 4,000 Finance lease liabilities and other 3,437 3,869 Total debt before unamortized discount and debt issuance costs 514,130 510,492 Unamortized discount and debt issuance costs, net (6,628) (7,395) Total debt $ 507,502 $ 503,097 Current portion of long-term debt: Term Loan B $ 5,050 $ 5,050 Seller Notes 6,303 4,060 Finance lease liabilities and other 904 975 Total current portion of long-term debt 12,257 10,085 Long-term debt $ 495,245 $ 493,012 Refinancing of Credit Agreement and Term B Borrowings On March 6, 2018, we entered into a new $605.0 million Senior Credit Facility (the “Credit Agreement”). The Credit Agreement provides for (i) a revolving credit facility with an initial maximum aggregate amount of availability of $100.0 million that matures in March 2023 and (ii) a $505.0 million Term Loan B facility due in quarterly principal installments commencing June 29, 2018, with all remaining outstanding principal due at maturity in March 2025. Availability under the revolving credit facility is reduced by outstanding letters of credit, which were approximately $5.1 million as of June 30, 2021. We may (a) increase the aggregate principal amount of any outstanding tranche of term loans or add one or more additional tranches of term loans under the loan documents, and/or (b) increase the aggregate principal amount of revolving commitments or add one or more additional revolving loan facilities under the loan documents by an aggregate amount of up to the sum of (1) $125.0 million and (2) an amount such that, after giving effect to such incurrence of such amount (but excluding the cash proceeds of such incremental facilities and certain other indebtedness, and treating all commitments in respect of revolving indebtedness as fully drawn), the consolidated first lien net leverage ratio is equal to or less than 3.80 to 1.00, if certain conditions are satisfied, including the absence of a default or an event of default under the Credit Agreement at the time of the increase and that we obtain the consent of each lender providing any incremental facility. We had approximately $94.9 million in available borrowing capacity under our $100.0 million revolving credit facility as of June 30, 2021. Our obligations under the Credit Agreement are currently guaranteed by our material domestic subsidiaries and will from time to time be guaranteed by, subject in each case to certain exceptions, any domestic subsidiaries that may become material in the future. Subject to certain exceptions, the Credit Agreement is secured by first-priority perfected liens and security interests in substantially all of our personal property and each subsidiary guarantor. Borrowings under the Credit Agreement bear interest at a variable rate equal to (i) LIBOR plus a specified margin, or (ii) the base rate (which is the highest of (a) Bank of America, N.A.’s prime rate, (b) the federal funds rate plus 0.50% or (c) the sum of 1% plus one-month LIBOR) plus a specified margin. For the three months ended June 30, 2021, the weighted average interest rate on outstanding borrowings under our Term Loan B facility was approximately 3.6%. We have entered into interest rate swap agreements to hedge certain of our interest rate exposures, as more fully disclosed in Note M – “Derivative Financial Instruments.” We must also pay (i) an unused commitment fee ranging from 0.375% to 0.500% per annum of the average daily unused portion of the aggregate revolving credit commitments under the Credit Agreement, and (ii) a per annum fee equal to (a) for each performance standby letter of credit outstanding under the Credit Agreement with respect to nonfinancial contractual obligations, 50% of the applicable margin over LIBOR under the revolving credit facility in effect from time to time multiplied by the daily amount available to be drawn under such letter of credit, and (b) for each other letter of credit outstanding under the Credit Agreement, the applicable margin over LIBOR under the revolving credit facility in effect from time to time multiplied by the daily amount available to be drawn for such letter of credit. The Credit Agreement contains various restrictions and covenants, including: (i) requirements that we maintain certain financial ratios at prescribed levels, (ii) a prohibition on payment of dividends and other distributions and (iii) restrictions on our ability and certain of our subsidiaries to consolidate or merge, create liens, incur additional indebtedness, dispose of assets, or consummate acquisitions outside the healthcare industry. The Credit Agreement includes the following financial covenants applicable for so long as any revolving loans and/or revolving commitments remain outstanding under the Credit Agreement (some of which were amended in May 2020 by the Amendment (as defined and described below)): (i) a maximum consolidated first lien net leverage ratio (“Net Leverage Ratio”) (defined as, with certain adjustments and exclusions, the ratio of consolidated first-lien indebtedness to consolidated net income before interest, taxes, depreciation, amortization, non-cash charges and certain other items (“EBITDA”) for the most recently ended period of four fiscal quarters for which financial statements are available) of 4.25 to 1.00 for the fiscal quarters ended June 30, 2021 through March 31, 2022; and 3.75 to 1.00 for the fiscal quarter ended June 30, 2022 and the last day of each fiscal quarter thereafter; and (ii) a minimum interest coverage ratio (defined as, with certain adjustments, the ratio of our EBITDA to consolidated interest expense to the extent paid or payable in cash) of 2.75 to 1.00 as of the last day of any fiscal quarter. The Credit Agreement also contains customary events of default. If an event of default under the Credit Agreement occurs and is continuing, then the lenders may declare any outstanding obligations under the Credit Agreement to be immediately due and payable; provided, however, that the occurrence of an event of default as a result of a breach of a financial covenant under the Credit Agreement does not constitute a default or event of default with respect to any term facility under the Credit Agreement unless and until the required revolving lenders shall have terminated their revolving commitments and declared all amounts outstanding under the revolving credit facility to be due and payable. In addition, if we or any subsidiary guarantor becomes the subject of voluntary or involuntary proceedings under any bankruptcy, insolvency, or similar law, then any outstanding obligations under the Credit Agreement will automatically become immediately due and payable. Loans outstanding under the Credit Agreement will bear interest at a rate of 2.00% per annum in excess of the otherwise applicable rate (i) upon acceleration of such loans, (ii) while a payment event of default exists or (iii) upon the lenders’ request, during the continuance of any other event of default. In May 2020, we entered into an amendment to the Credit Agreement (the “Amendment”) that provided for, amongst other things, an increase in the maximum Net Leverage Ratio to 5.00 to 1.00 for the fiscal quarters ended June 30, 2021 through September 30, 2021; and 4.75 to 1.00 for the quarter ended December 31, 2021 and the last day of each fiscal quarter thereafter. In addition, the Amendment changed the definition of EBITDA used in the Net Leverage Ratio and minimum interest coverage ratio to adjust for declines in net revenue attributable to the COVID-19 pandemic. Borrowings under the revolving credit facility will bear interest at a variable rate equal to the greater of LIBOR or 1%, plus 3.75%. In addition, the Amendment contained certain restrictions and covenants that further limit our ability, and certain of our subsidiaries’ ability, to consolidate or merge, create liens, incur additional indebtedness, dispose of assets, or consummate acquisitions not financed with the proceeds of an equity offering, except that certain acquisitions are permitted after September 30, 2020, in the event we maintain certain leverage and liquidity thresholds. We capitalized debt issuance costs of $0.2 million in connection with the Amendment, which were recorded in Other assets. We were in compliance with all covenants at June 30, 2021. Seller Notes and the Deferred Payment Obligation We typically issue subordinated promissory notes (“Seller Notes”) as a part of the consideration transferred when making acquisitions. The Seller Notes are unsecured and are presented net of unamortized discount of $0.8 million and $0.9 million as of June 30, 2021 and December 31, 2020, respectively. We measure these instruments at their estimated fair values as of the respective acquisition dates. The stated interest rates on these instruments range from 2.50% to 3.00%. Principal and interest are payable in quarterly or annual installments and mature through February 2026. Amounts due under the deferred payment obligation to the former shareholders of an acquired O&P business are unsecured and presented net of unamortized discount of $0.5 million as of June 30, 2021 and December 31, 2020, respectively. The deferred payment obligation was measured at its estimated fair value as of the acquisition date and accrues interest at a rate of 3.0%. Principal and interest payments under the deferred payment obligation are due in annual installments beginning in 2024 and for three years thereafter. Scheduled Maturities of Total Debt Scheduled maturities of debt at June 30, 2021 were as follows: (in thousands) 2021 (remainder of year) $ 4,955 2022 11,661 2023 11,310 2024 10,697 2025 473,011 Thereafter 2,496 Total debt before unamortized discount and debt issuance costs, net 514,130 Unamortized discount and debt issuance costs, net (6,628) Total debt $ 507,502 |
Fair Value Measurements
Fair Value Measurements | 6 Months Ended |
Jun. 30, 2021 | |
Fair Value Measurements | |
Fair Value Measurements | Note L — Fair Value Measurements Financial Instruments The carrying value of our outstanding term loan as of June 30, 2021 (excluding unamortized discounts and debt issuance costs of $5.8 million) was $488.6 million compared to its fair value of $488.0 million. The carrying value of our outstanding term loan as of December 31, 2020 (excluding unamortized discounts and debt issuance costs of $6.5 million) was $491.1 million compared to its fair value of $489.9 million. Our estimates of fair value are based on a discounted cash flow model and an indicative quote using unobservable inputs, primarily, our risk-adjusted credit spread, which represents a Level 3 measurement. We have interest rate swap agreements designated as cash flow hedges and are measured at fair value based on inputs other than quoted market prices that are observable, which represents a Level 2 measurement. See Note K - “Debt and Other Obligations” and Note M - “Derivative Financial Instruments” for further information. We believe that the carrying value of the Seller Notes and the deferred payment obligation approximates their fair values based on a discounted cash flow model using unobservable inputs, primarily, our credit spread for subordinated debt, which represents a Level 3 measurement. The carrying value of our outstanding Seller Notes and the deferred payment obligation issued in connection with past acquisitions as of June 30, 2021 and December 31, 2020 was $21.3 million and $14.6 million, net of unamortized discounts of $0.8 million and $0.9 million, respectively. |
Derivative Financial Instrument
Derivative Financial Instruments | 6 Months Ended |
Jun. 30, 2021 | |
Derivative Financial Instruments | |
Derivative Financial Instruments | Note M — Derivative Financial Instruments Cash Flow Hedges of Interest Rate Risk In March 2018, we entered into interest rate swap agreements with notional values of $325.0 million at inception, which reduces $12.5 million annually until the swaps mature on March 6, 2024. As of June 30, 2021 and December 31, 2020, our swaps had a notional value outstanding of $287.5 million and $300.0 million, respectively. Change in Net Loss on Cash Flow Hedges Including Accumulated Other Comprehensive Income (Loss) The following table presents the activity of cash flow hedges included in accumulated other comprehensive loss for the three months ended June 30, 2021 and 2020, respectively: (in thousands) Cash Flow Hedges Balance as of March 31, 2021 $ (14,259) Unrealized loss recognized in other comprehensive loss, net of tax (712) Reclassification to interest expense, net 1,937 Balance as of June 30, 2021 $ (13,034) Balance as of March 31, 2020 $ (19,039) Unrealized loss recognized in other comprehensive loss, net of tax (2,290) Reclassification to interest expense, net 1,717 Balance as of June 30, 2020 $ (19,612) The following table presents the activity of cash flow hedges included in accumulated other comprehensive loss for the six months ended June 30, 2021 and 2020, respectively: (in thousands) Cash Flow Hedges Balance as of December 31, 2020 $ (16,771) Unrealized loss recognized in other comprehensive loss, net of tax (183) Reclassification to interest expense, net 3,920 Balance as of June 30, 2021 $ (13,034) Balance as of December 31, 2019 $ (10,137) Unrealized loss recognized in other comprehensive loss, net of tax (12,063) Reclassification to interest expense, net 2,588 Balance as of June 30, 2020 $ (19,612) The following table presents the fair value of derivative liabilities within the condensed consolidated balance sheets as of June 30, 2021 and December 31, 2020: As of June 30, 2021 As of December 31, 2020 (in thousands) Assets Liabilities Assets Liabilities Derivatives designated as cash flow hedging instruments: Accrued expenses and other current liabilities $ — $ 7,528 $ — $ 7,686 Other liabilities — 9,626 — 14,388 |
Share-Based Compensation
Share-Based Compensation | 6 Months Ended |
Jun. 30, 2021 | |
Share-Based Compensation | |
Share-Based Compensation | Note N — Share-Based Compensation On May 17, 2019, the shareholders approved the Hanger, Inc. 2019 Omnibus Incentive Plan (the “2019 Plan”). The 2019 Plan authorizes the issuance of (a) up to 2,025,000 shares of Common Stock, plus (b) 243,611 shares available for issuance under the Hanger, Inc. 2016 Omnibus Incentive Plan (the “2016 Plan”). Upon approval of the 2019 Plan, the 2016 Plan was no longer available for future awards. On May 19, 2017, the Board of Directors approved the Hanger, Inc. Special Equity Plan (the “Special Equity Plan”). The Special Equity Plan authorized up to 1.5 million shares of Common Stock and operates completely independent from our 2016 Omnibus Incentive Plan. All awards under the Special Equity Plan were made on May 19, 2017, which consisted of 0.8 million stock options and 0.3 million performance-based stock awards. No further grants of awards will be authorized or issued under the Special Equity Plan. As of June 30, 2021, there were 1,423,551 unvested restricted stock awards outstanding. This was comprised of 1,026,979 employee service-based awards with a weighted average grant date fair value of $21.30 per share, 342,017 employee performance-based awards with a weighted average grant date fair value of $21.61 per share, and 54,555 director service-based awards with a weighted average grant date value of $24.67 per share. As of June 30, 2021, there were 324,014 outstanding options exercisable with a weighted average exercise price of $12.77 and average remaining contractual term of 5.1 years. The 2017 Special Equity Plan was amended in May 2020 to modify the performance period ending date for purposes of the compounded annual growth rate calculation to February 20, 2020, shortening the performance period to approximately 33 months, representing a reduction of three months. This adjustment was considered a modification per ASC 718 Compensation - Stock Compensation We recognized a total of approximately $3.2 million and $6.4 million of share-based compensation expense for the three and six months ended June 30, 2021 and a total of approximately $9.0 million and $12.5 million for the three and six months ended June 30, 2020, respectively. Share-based compensation expense, net of forfeitures, relates to restricted stock units, performance-based restricted stock units, and stock options. |
Supplemental Executive Retireme
Supplemental Executive Retirement Plans | 6 Months Ended |
Jun. 30, 2021 | |
Supplemental Executive Retirement Plans | |
Supplemental Executive Retirement Plans | Note O — Supplemental Executive Retirement Plans Defined Benefit Supplemental Executive Retirement Plan Effective January 2004, we implemented an unfunded noncontributory defined benefit plan (“DB SERP”) for certain senior executives. The DB SERP, which we administer, calls for fifteen annual payments upon retirement with the payment amount based on years of service and final average salary. Benefit costs and liability balances are calculated based on certain assumptions including benefits earned, discount rates, interest costs, mortality rates, and other factors. Actual results that differ from the assumptions are accumulated and amortized over future periods, affecting the recorded obligation and expense in future periods. We believe the assumptions used are appropriate; however, changes in assumptions or differences in actual experience may affect our benefit obligation and future expenses. The change in net benefit cost and obligation during the three and six months ended June 30, 2021 and 2020 is as follows: Change in Benefit Obligation: (in thousands) 2021 2020 Benefit obligation as of March 31 $ 18,079 $ 17,556 Service cost 123 98 Interest cost 88 121 Payments (12) (12) Benefit obligation as of June 30 $ 18,278 $ 17,763 Benefit obligation as of December 31, 2020 and 2019, respectively $ 19,746 $ 19,214 Service cost 246 196 Interest cost 175 242 Payments (1,889) (1,889) Benefit obligation as of June 30 $ 18,278 $ 17,763 Amounts Recognized in the Condensed Consolidated Balance Sheets: As of June 30, As of December 31, (in thousands) 2021 2020 Current accrued expenses and other current liabilities $ 1,913 $ 1,913 Non-current other liabilities 16,365 17,833 Total accrued liabilities $ 18,278 $ 19,746 Defined Contribution Supplemental Executive Retirement Plan In 2013, we established a defined contribution plan (“DC SERP”) that covers certain of our senior executives. Each participant is given a notional account to manage his or her annual distributions and allocate the funds among various investment options (e.g. mutual funds). These accounts are tracking accounts only for the purpose of calculating the participant’s benefit. The participant does not have ownership of the underlying mutual funds. When a participant initiates or changes the allocation of his or her notional account, we will generally make an allocation of our investments to match those chosen by the participant. While the allocation of our sub accounts is generally intended to mirror the participant’s account records (i.e. the distributions and gains or losses on those funds), the employee does not have legal ownership of any funds until payout upon retirement. The underlying investments are owned by the insurance company with which we own an insurance policy. As of June 30, 2021 and December 31, 2020, the estimated accumulated obligation benefit is $4.3 million and $4.5 million, of which $4.0 million and $4.0 million is funded and $0.3 million and $0.5 million is unfunded at June 30, 2021 and December 31, 2020, respectively. In connection with the DC SERP benefit obligation, we maintain a company-owned life insurance policy (“COLI”). The carrying value of the COLI is measured at its cash surrender value and is presented within “Other assets” in our condensed consolidated balance sheets. See Note H - “Other Current Assets and Other Assets” for additional information. |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2021 | |
Commitments and Contingencies | |
Commitments and Contingencies | Note P — Commitments and Contingencies Guarantees and Indemnification In the ordinary course of our business, we may enter into service agreements with service providers in which we agree to indemnify or limit the service provider against certain losses and liabilities arising from the service provider’s performance of the agreement. We have reviewed our existing contracts containing indemnification or clauses of guarantees and do not believe that our liability under such agreements is material. Other Matters From time to time we are subject to legal proceedings and claims which arise in the ordinary course of our business, and are also subject to additional payments under business purchase agreements. In the opinion of management, the amount of ultimate liability, if any, with respect to these actions will not have a materially adverse effect on our consolidated financial position, liquidity or results of our operations. We operate in a highly regulated industry and receive regulatory agency inquiries from time to time in the ordinary course of our business, including inquiries relating to our billing activities. No assurance can be given that any discrepancies identified during a regulatory review will not have a material adverse effect on our consolidated financial statements. |
Segment and Related Information
Segment and Related Information | 6 Months Ended |
Jun. 30, 2021 | |
Segment and Related Information | |
Segment and Related Information | Note Q — Segment and Related Information We have identified two operating segments and both performance evaluation and resource allocation decisions are determined based on each segment’s income from operations. The operating segments are described further below. Patient Care — ● Commercial private payors and other, which consist of individuals, rehabilitation providers, commercial insurance companies, health management organizations (“HMOs”), preferred provider organizations (“PPOs”), hospitals, vocational rehabilitation, workers’ compensation programs, and similar sources; ● Medicare, a federally funded health insurance program providing health insurance coverage for persons aged 65 or older and certain persons with disabilities, which provides reimbursement for O&P products and services based on prices set forth in published fee schedules (generally with either 10 regional pricing areas or state level prices) for prosthetics and orthotics and by state for durable medical equipment (DMEPOS); ● Medicaid, a health insurance program jointly funded by federal and state governments providing health insurance coverage for certain persons requiring financial assistance, regardless of age, which may supplement Medicare benefits for persons aged 65 or older requiring financial assistance; and ● the VA. Our contract and network management business, known as Linkia, is the only network management company dedicated solely to serving the O&P market and is focused on managing the O&P services of national and regional insurance companies. We partner with healthcare insurance companies by securing a national or regional contract either as a preferred provider or to manage their O&P network of providers. Products & Services - Corporate & Other The accounting policies of the segments are the same as those described in Note A - “Organization and Summary of Significant Accounting Policies” in our 2020 Form 10-K. Intersegment revenue primarily relates to sales of O&P components from the Products & Services segment to the Patient Care segment. The sales are priced at the cost of the related materials plus overhead. Summarized financial information concerning our reporting segments is shown in the following tables. Total assets for each of the segments has not materially changed from December 31, 2020. Patient Care Products & Services For the Three Months Ended For the Three Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Net revenues Third party $ 236,787 $ 195,859 $ 44,032 $ 37,575 Intersegments — — 54,900 42,866 Total net revenues 236,787 195,859 98,932 80,441 Material costs Third party suppliers 62,631 50,489 26,640 19,483 Intersegments 9,086 4,747 45,814 38,119 Total material costs 71,717 55,236 72,454 57,602 Personnel expenses 83,198 63,576 14,351 10,246 Other expenses 37,445 13,601 6,763 4,337 Depreciation & amortization 4,787 4,827 1,963 2,498 Segment income from operations $ 39,640 $ 58,619 $ 3,401 $ 5,758 Patient Care Products & Services For the Six Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Net revenues Third party $ 432,469 $ 386,042 $ 85,820 $ 81,131 Intersegments — — 101,905 88,888 Total net revenues 432,469 386,042 187,725 170,019 Material costs Third party suppliers 114,290 103,613 50,151 43,600 Intersegments 17,349 11,300 84,556 77,588 Total material costs 131,639 114,913 134,707 121,188 Personnel expenses 158,952 139,921 28,477 23,086 Other expenses 73,586 51,749 12,566 12,657 Depreciation & amortization 9,602 9,303 3,898 5,250 Segment income from operations $ 58,690 $ 70,156 $ 8,077 $ 7,838 A reconciliation of the total of the reportable segments’ income from operations to consolidated net loss is as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Income from operations Patient Care $ 39,640 $ 58,619 $ 58,690 $ 70,156 Products & Services 3,401 5,758 8,077 7,838 Corporate & other (22,947) (25,516) (44,652) (48,306) Income from operations 20,094 38,861 22,115 29,688 Interest expense, net 7,152 8,636 14,492 16,906 Non-service defined benefit plan expense 167 158 334 316 Income before income taxes 12,775 30,067 7,289 12,466 Provision (benefit) for income taxes 2,616 (987) 460 (2,840) Net income $ 10,159 $ 31,054 $ 6,829 $ 15,306 A reconciliation of the reportable segments’ net revenues to consolidated net revenues is as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Net revenues Patient Care $ 236,787 $ 195,859 $ 432,469 $ 386,042 Products & Services 98,932 80,441 187,725 170,019 Corporate & other — — — — Consolidating adjustments (54,900) (42,866) (101,905) (88,888) Consolidated net revenues $ 280,819 $ 233,434 $ 518,289 $ 467,173 A reconciliation of the reportable segments’ material costs to consolidated material costs is as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Material costs Patient Care $ 71,717 $ 55,236 $ 131,639 $ 114,913 Products & Services 72,454 57,602 134,707 121,188 Corporate & other — — — — Consolidating adjustments (54,900) (42,866) (101,905) (88,888) Consolidated material costs $ 89,271 $ 69,972 $ 164,441 $ 147,213 |
Subsequent Events
Subsequent Events | 6 Months Ended |
Jun. 30, 2021 | |
Subsequent Events | |
Subsequent Events | Note R — Subsequent Events During the third quarter of 2021 to date, we completed the acquisitions of two O&P businesses for a total purchase price of $0.8 million. Total consideration transferred for these acquisitions is comprised of $0.6 million in cash consideration, and $0.2 million in the form of notes to the former shareholders. Due to the proximity of these transactions to the filing of this Form 10-Q, it is not practicable to provide a preliminary purchase price allocation of the fair value of the assets purchased and liabilities assumed in these acquisitions. Acquisition-related expenses related to these transactions were not material. In July 2021, we entered into definitive share purchase agreements in connection with the acquisitions of two O&P businesses for a total purchase price of $5.6 million. Due to the proximity of these transactions to the filing of this Form 10-Q, it is not practicable to provide a preliminary purchase price allocation of the fair value of the assets acquired and liabilities assumed in these acquisitions. |
Organization and Summary of S_2
Organization and Summary of Significant Accounting Policies (Policies) | 6 Months Ended |
Jun. 30, 2021 | |
Organization and Summary of Significant Accounting Policies | |
Basis of Presentation | Basis of Presentation The accompanying interim unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X, and, therefore, do not include all of the information and footnotes required by GAAP for complete financial statements. These financial statements should be read in conjunction with the audited consolidated financial statements in our Annual Report on Form 10-K for the year ended December 31, 2020 (the “2020 Form 10-K”), as previously filed with the Securities and Exchange Commission (the “SEC”). In our opinion, the information contained herein reflects all adjustments necessary for a fair statement of our results of operations, financial position, and cash flows. All such adjustments are of a normal, recurring nature. The results of operations for the interim periods are not necessarily indicative of those to be expected for the full year. A detailed description of our significant accounting policies and management judgments is contained in our 2020 Form 10-K. |
Reclassifications | Reclassifications We have reclassified certain amounts in the prior year condensed consolidated financial statements to be consistent with the current year presentation. These relate to classifications within the condensed consolidated statements of operations. |
Recent Developments Regarding COVID-19 | Recent Developments Regarding COVID-19 We are subject to risks and uncertainties as a result of the outbreak of the novel coronavirus (“COVID-19”) pandemic (“COVID-19 pandemic”). The extent and duration of the impact of the COVID-19 pandemic on our operations and financial condition remain uncertain and difficult to predict. As a result of the COVID-19 pandemic, we believe that our patients are deferring visits to our O&P clinics, as well as elective surgical procedures, both of which impact our business volumes through decreased patient encounters and physician referrals. It remains possible that further outbreaks of COVID-19, including the spread of variants,or reinstitution of restrictive measures by federal, state and local governments could cause a recessionary environment impacting the healthcare industry generally, including the O&P industry. The United States government has responded with fiscal policy measures intended to support the healthcare industry and economy as a whole, including the passage of the Coronavirus Aid, Relief and Economic Security Act (the “CARES Act”) in March 2020. CARES Act The CARES Act established the Public Health and Social Services Emergency Fund, also referred to as the Cares Act Provider Relief Fund, which set aside $178.0 billion to be administered through grants and other mechanisms to hospitals, public entities, not-for-profit entities and Medicare- and Medicaid- enrolled suppliers and institutional providers. The purpose of these funds is to reimburse providers for lost revenue and health-care related expenses that are attributable to the COVID-19 pandemic. In April 2020, the U.S. Department of Health and Human Services (“HHS”) began making payments to healthcare providers from the $178.0 billion appropriation. These are grants, rather than loans, to healthcare providers, and will not need to be repaid. During 2020, we recognized a total benefit of $24.0 million in our consolidated statement of operations within Other operating costs for the grant proceeds we received under the CARES Act (“Grants”) from HHS. We recognize income related to grants on a systematic and rational basis when it becomes probable that we have complied with the terms and conditions of the grant and in the period in which the corresponding costs or income related to the grant are recognized. We recognized the benefit from the Grants within Other operating costs in our Patient Care segment. In April 2021, we recognized an additional $0.7 million in proceeds received from grants under the CARES Act. The CARES Act also provided for a deferral of the employer portion of payroll taxes incurred during the COVID-19 pandemic through December 2020. The provisions allowed us to defer half of such payroll taxes until December 2021 and the remaining half until December 2022. We deferred $11.8 million of payroll taxes within Accrued compensation related costs and Other liabilities in the condensed consolidated balance sheet as of June 30, 2021. |
Recent Accounting Pronouncements, Not Yet Adopted | Recent Accounting Pronouncements, Not Yet Adopted In March 2020, the FASB issued ASU No. 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Earnings Per Share | |
Schedule of reconciliation of numerators and denominators used to calculate basic and diluted net income per share | For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands except share and per share amounts) 2021 2020 2021 2020 Net income $ 10,159 $ 31,054 $ 6,829 $ 15,306 Weighted average shares outstanding - basic 38,647,042 37,958,408 38,458,733 37,749,930 Effect of potentially dilutive restricted stock units and options 561,113 367,464 757,992 674,404 Weighted average shares outstanding - diluted 39,208,155 38,325,872 39,216,725 38,424,334 Basic income per share $ 0.26 $ 0.82 $ 0.18 $ 0.41 Diluted income per share $ 0.26 $ 0.81 $ 0.17 $ 0.40 |
Revenue Recognition (Tables)
Revenue Recognition (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Patient Care | |
Revenue Recognition | |
Schedule of disaggregates of revenue from contracts with customers | For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Patient Care Segment Medicare $ 74,248 $ 64,191 $ 131,583 $ 125,916 Medicaid 43,688 31,243 77,736 62,071 Commercial Insurance / Managed Care (excluding Medicare and Medicaid Managed Care) 79,769 70,828 149,432 137,268 Veterans Administration 21,633 16,826 41,397 34,718 Private Pay 17,449 12,771 32,321 26,069 Total $ 236,787 $ 195,859 $ 432,469 $ 386,042 |
Products and Services | |
Revenue Recognition | |
Schedule of disaggregates of revenue from contracts with customers | For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Products & Services Segment Distribution services, net of intersegment revenue eliminations $ 33,275 $ 26,527 $ 63,935 $ 58,217 Therapeutic solutions 10,757 11,048 21,885 22,914 Total $ 44,032 $ 37,575 $ 85,820 $ 81,131 |
Accounts Receivable, Net (Table
Accounts Receivable, Net (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Accounts Receivable, Net | |
Schedule of accounts receivable, net | As of June 30, 2021 As of December 31, 2020 Products & Products & (in thousands) Patient Care Services Consolidated Patient Care Services Consolidated Gross charges before estimates for implicit price concessions $ 150,382 $ 20,933 $ 171,315 $ 156,504 $ 21,300 $ 177,804 Less estimates for implicit price concessions: Payor disallowances (37,080) — (37,080) (39,343) — (39,343) Patient non-payments (6,968) — (6,968) (7,042) — (7,042) Accounts receivable, gross 106,334 20,933 127,267 110,119 21,300 131,419 Allowance for doubtful accounts — (2,311) (2,311) — (2,823) (2,823) Accounts receivable, net $ 106,334 $ 18,622 $ 124,956 $ 110,119 $ 18,477 $ 128,596 |
Inventories (Tables)
Inventories (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Inventories | |
Schedule of inventories | As of June 30, As of December 31, (in thousands) 2021 2020 Raw materials $ 20,502 $ 19,716 Work in process 17,905 12,040 Finished goods 45,552 44,673 Total inventories $ 83,959 $ 76,429 |
Acquisitions (Tables)
Acquisitions (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
2021 Acquisition activity, three O&P business | |
Schedule of aggregate purchase price of acquisitions allocated on a preliminary basis | (in thousands) Cash paid, net of cash acquired $ 35,199 Issuance of Seller Notes at fair value 8,893 Additional consideration, net 1,101 Aggregate purchase price 45,193 Accounts receivable 2,114 Inventories 1,631 Customer relationships (Weighted average useful life of 5.0 years) 4,495 Other assets and liabilities, net (3,720) Net assets acquired 4,520 Goodwill $ 40,673 |
2020 Acquisition activity, O&P business | |
Schedule of aggregate purchase price of acquisitions allocated on a preliminary basis | (in thousands) Cash paid, net of cash acquired $ 21,709 Issuance of Seller Notes at fair value 23,766 Deferred payment obligation at fair value 3,468 Additional consideration, net 4,319 Aggregate purchase price 53,262 Accounts receivable 4,224 Inventories 2,276 Customer relationships (Weighted average useful life of 5.0 years) 6,358 Non-compete agreements (Weighted average useful life of 5.0 years) 200 Other assets and liabilities, net (4,561) Net assets acquired 8,497 Goodwill $ 44,765 |
Goodwill and Other Intangible_2
Goodwill and Other Intangible Assets (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Goodwill and Other Intangible Assets | |
Schedule of goodwill allocated to the Company's reportable segments | The following table summarizes the activity in goodwill of the Patient Care operating segment for the periods indicated: For the Six Months Ended June 30, 2021 Goodwill, Accumulated Goodwill, (in thousands) Gross Impairment Net As of December 31, 2020 $ 705,891 $ (428,668) $ 277,223 Additions from acquisitions 40,673 — 40,673 Measurement period adjustments (1) 487 — 487 As of June 30, 2021 $ 747,051 $ (428,668) $ 318,383 (1) Measurement period adjustments increasing goodwill relate to 2021 and 2020 acquisitions of approximately $0.1 million and $0.4 million, respectively, and are primarily attributable to adjustments to the preliminary allocations of customer relationship intangibles. For the Year Ended December 31, 2020 Goodwill, Accumulated Goodwill, (in thousands) Gross Impairment Net As of December 31, 2019 $ 660,912 $ (428,668) $ 232,244 Additions from acquisitions 45,144 — 45,144 Measurement period adjustments (1) (165) — (165) As of December 31, 2020 $ 705,891 $ (428,668) $ 277,223 (1) Measurement period adjustments reducing goodwill relate to acquisitions in the current and prior year of approximately $0.2 million and are primarily attributable to adjustments to the preliminary allocations of customer relationship intangibles. |
Schedule of balances related to indefinite-lived intangible assets | As of June 30, 2021 Gross Carrying Accumulated Accumulated Net Carrying (in thousands) Amount Amortization Impairment Amount Customer lists $ 21,374 $ (7,664) $ — $ 13,710 Trade name 255 (189) — 66 Patents and other intangibles 8,994 (6,136) — 2,858 Definite-lived intangible assets 30,623 (13,989) — 16,634 Indefinite-lived trade name 9,070 — (4,953) 4,117 Total other intangible assets $ 39,693 $ (13,989) $ (4,953) $ 20,751 As of December 31, 2020 Gross Carrying Accumulated Accumulated Net Carrying (in thousands) Amount Amortization Impairment Amount Customer lists $ 16,879 $ (5,845) $ — $ 11,034 Trade name 255 (176) — 79 Patents and other intangibles 9,011 (5,810) — 3,201 Definite-lived intangible assets 26,145 (11,831) — 14,314 Indefinite-lived trade name 9,070 — (4,953) 4,117 Total other intangible assets $ 35,215 $ (11,831) $ (4,953) $ 18,431 |
Schedule of estimated aggregate amortization expense for definite-lived intangible assets | (in thousands) 2021 (remainder of the year) $ 2,397 2022 4,729 2023 4,483 2024 2,993 2025 1,804 Thereafter 228 Total $ 16,634 |
Other Current Assets and Othe_2
Other Current Assets and Other Assets (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Other Current Assets and Other Assets | |
Schedule of other current assets | As of June 30, As of December 31, (in thousands) 2021 2020 Non-trade receivables $ 6,116 $ 6,063 Prepaid maintenance 4,593 2,942 Prepaid insurance 1,738 266 Other prepaid assets 4,255 3,086 Total other current assets $ 16,702 $ 12,357 |
Schedule of other assets | As of June 30, As of December 31, (in thousands) 2021 2020 Implementation costs for cloud computing arrangements $ 6,540 $ 4,811 Cash surrender value of company-owned life insurance 4,344 3,973 Finance lease right-of-use assets 2,729 3,016 Deposits 2,194 2,144 Non-trade receivables 1,339 1,274 Other 418 516 Total other assets $ 17,564 $ 15,734 |
Accrued Expenses and Other Cu_2
Accrued Expenses and Other Current Liabilities and Other Liabilities (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Accrued Expenses and Other Current Liabilities and Other Liabilities | |
Schedule of accrued expenses and other current liabilities | As of June 30, As of December 31, (in thousands) 2021 2020 Patient prepayments, deposits, and refunds payable $ 25,738 $ 27,195 Accrued sales taxes and other taxes 9,661 9,863 Insurance and self-insurance accruals 8,213 7,651 Derivative liability 7,528 7,686 Accrued professional fees 1,486 1,016 Accrued interest payable 522 440 Other current liabilities 10,185 9,010 Total $ 63,333 $ 62,861 |
Schedule of other liabilities | As of June 30, As of December 31, (in thousands) 2021 2020 Supplemental executive retirement plan obligations $ 20,668 $ 21,503 Derivative liability 9,626 14,388 Long-term insurance accruals 7,630 7,326 Deferred payroll taxes 5,918 5,918 Unrecognized tax benefits 5,142 5,465 Other 2,176 1,993 Total $ 51,160 $ 56,593 |
Debt and Other Obligations (Tab
Debt and Other Obligations (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Debt and Other Obligations | |
Schedule of debt | As of June 30, As of December 31, (in thousands) 2021 2020 Debt: Term Loan B $ 488,588 $ 491,113 Seller Notes 18,105 11,510 Deferred payment obligation 4,000 4,000 Finance lease liabilities and other 3,437 3,869 Total debt before unamortized discount and debt issuance costs 514,130 510,492 Unamortized discount and debt issuance costs, net (6,628) (7,395) Total debt $ 507,502 $ 503,097 Current portion of long-term debt: Term Loan B $ 5,050 $ 5,050 Seller Notes 6,303 4,060 Finance lease liabilities and other 904 975 Total current portion of long-term debt 12,257 10,085 Long-term debt $ 495,245 $ 493,012 |
Schedule of maturities of debt | (in thousands) 2021 (remainder of year) $ 4,955 2022 11,661 2023 11,310 2024 10,697 2025 473,011 Thereafter 2,496 Total debt before unamortized discount and debt issuance costs, net 514,130 Unamortized discount and debt issuance costs, net (6,628) Total debt $ 507,502 |
Derivative Financial Instrume_2
Derivative Financial Instruments (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Derivative Financial Instruments | |
Schedule of activity of cash flow hedges included in accumulated other comprehensive income (loss) | (in thousands) Cash Flow Hedges Balance as of March 31, 2021 $ (14,259) Unrealized loss recognized in other comprehensive loss, net of tax (712) Reclassification to interest expense, net 1,937 Balance as of June 30, 2021 $ (13,034) Balance as of March 31, 2020 $ (19,039) Unrealized loss recognized in other comprehensive loss, net of tax (2,290) Reclassification to interest expense, net 1,717 Balance as of June 30, 2020 $ (19,612) (in thousands) Cash Flow Hedges Balance as of December 31, 2020 $ (16,771) Unrealized loss recognized in other comprehensive loss, net of tax (183) Reclassification to interest expense, net 3,920 Balance as of June 30, 2021 $ (13,034) Balance as of December 31, 2019 $ (10,137) Unrealized loss recognized in other comprehensive loss, net of tax (12,063) Reclassification to interest expense, net 2,588 Balance as of June 30, 2020 $ (19,612) |
Schedule of fair value of derivative liabilities within the consolidated balance sheets | As of June 30, 2021 As of December 31, 2020 (in thousands) Assets Liabilities Assets Liabilities Derivatives designated as cash flow hedging instruments: Accrued expenses and other current liabilities $ — $ 7,528 $ — $ 7,686 Other liabilities — 9,626 — 14,388 |
Supplemental Executive Retire_2
Supplemental Executive Retirement Plans (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Supplemental Executive Retirement Plans | |
Schedule of Change in Benefit Obligation | (in thousands) 2021 2020 Benefit obligation as of March 31 $ 18,079 $ 17,556 Service cost 123 98 Interest cost 88 121 Payments (12) (12) Benefit obligation as of June 30 $ 18,278 $ 17,763 Benefit obligation as of December 31, 2020 and 2019, respectively $ 19,746 $ 19,214 Service cost 246 196 Interest cost 175 242 Payments (1,889) (1,889) Benefit obligation as of June 30 $ 18,278 $ 17,763 |
Schedule of Amounts Recognized in the Consolidated Balance Sheets | As of June 30, As of December 31, (in thousands) 2021 2020 Current accrued expenses and other current liabilities $ 1,913 $ 1,913 Non-current other liabilities 16,365 17,833 Total accrued liabilities $ 18,278 $ 19,746 |
Segment and Related Informati_2
Segment and Related Information (Tables) | 6 Months Ended |
Jun. 30, 2021 | |
Segment and Related Information | |
Summary of financial information concerning the Company's reporting segments | Patient Care Products & Services For the Three Months Ended For the Three Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Net revenues Third party $ 236,787 $ 195,859 $ 44,032 $ 37,575 Intersegments — — 54,900 42,866 Total net revenues 236,787 195,859 98,932 80,441 Material costs Third party suppliers 62,631 50,489 26,640 19,483 Intersegments 9,086 4,747 45,814 38,119 Total material costs 71,717 55,236 72,454 57,602 Personnel expenses 83,198 63,576 14,351 10,246 Other expenses 37,445 13,601 6,763 4,337 Depreciation & amortization 4,787 4,827 1,963 2,498 Segment income from operations $ 39,640 $ 58,619 $ 3,401 $ 5,758 Patient Care Products & Services For the Six Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Net revenues Third party $ 432,469 $ 386,042 $ 85,820 $ 81,131 Intersegments — — 101,905 88,888 Total net revenues 432,469 386,042 187,725 170,019 Material costs Third party suppliers 114,290 103,613 50,151 43,600 Intersegments 17,349 11,300 84,556 77,588 Total material costs 131,639 114,913 134,707 121,188 Personnel expenses 158,952 139,921 28,477 23,086 Other expenses 73,586 51,749 12,566 12,657 Depreciation & amortization 9,602 9,303 3,898 5,250 Segment income from operations $ 58,690 $ 70,156 $ 8,077 $ 7,838 |
Schedule of reconciliation of reportable segments | A reconciliation of the total of the reportable segments’ income from operations to consolidated net loss is as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Income from operations Patient Care $ 39,640 $ 58,619 $ 58,690 $ 70,156 Products & Services 3,401 5,758 8,077 7,838 Corporate & other (22,947) (25,516) (44,652) (48,306) Income from operations 20,094 38,861 22,115 29,688 Interest expense, net 7,152 8,636 14,492 16,906 Non-service defined benefit plan expense 167 158 334 316 Income before income taxes 12,775 30,067 7,289 12,466 Provision (benefit) for income taxes 2,616 (987) 460 (2,840) Net income $ 10,159 $ 31,054 $ 6,829 $ 15,306 A reconciliation of the reportable segments’ net revenues to consolidated net revenues is as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Net revenues Patient Care $ 236,787 $ 195,859 $ 432,469 $ 386,042 Products & Services 98,932 80,441 187,725 170,019 Corporate & other — — — — Consolidating adjustments (54,900) (42,866) (101,905) (88,888) Consolidated net revenues $ 280,819 $ 233,434 $ 518,289 $ 467,173 A reconciliation of the reportable segments’ material costs to consolidated material costs is as follows: For the Three Months Ended For the Six Months Ended June 30, June 30, (in thousands) 2021 2020 2021 2020 Material costs Patient Care $ 71,717 $ 55,236 $ 131,639 $ 114,913 Products & Services 72,454 57,602 134,707 121,188 Corporate & other — — — — Consolidating adjustments (54,900) (42,866) (101,905) (88,888) Consolidated material costs $ 89,271 $ 69,972 $ 164,441 $ 147,213 |
Organization and Summary of S_3
Organization and Summary of Significant Accounting Policies (Details) $ in Millions | 1 Months Ended | 6 Months Ended | 12 Months Ended |
Apr. 30, 2021USD ($) | Jun. 30, 2021USD ($)segment | Dec. 31, 2020USD ($) | |
Organization and Summary of Significant Accounting Policies | |||
Number of operating segments | segment | 2 | ||
Proceeds received from grant | $ 0.7 | $ 24 | |
Deferred payroll taxes under CARES Act | $ 11.8 |
Earnings Per Share (Details)
Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 6 Months Ended | ||||
Jun. 30, 2021 | Mar. 31, 2021 | Jun. 30, 2020 | Mar. 31, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
Earnings Per Share | ||||||
Total anti-dilutive shares (in shares) | 2,721 | 118,525 | 1,302 | 17,864 | ||
Net income | $ 10,159 | $ (3,330) | $ 31,054 | $ (15,748) | $ 6,829 | $ 15,306 |
Weighted average shares outstanding - basic | 38,647,042 | 37,958,408 | 38,458,733 | 37,749,930 | ||
Effect of potentially dilutive restricted stock units and options | 561,113 | 367,464 | 757,992 | 674,404 | ||
Weighted average shares outstanding - diluted | 39,208,155 | 38,325,872 | 39,216,725 | 38,424,334 | ||
Basic and diluted: | ||||||
Basic income per share | $ 0.26 | $ 0.82 | $ 0.18 | $ 0.41 | ||
Diluted income per share | $ 0.26 | $ 0.81 | $ 0.17 | $ 0.40 |
Revenue Recognition (Details)
Revenue Recognition (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
Revenue Recognition | ||||
Net revenues | $ 280,819 | $ 233,434 | $ 518,289 | $ 467,173 |
Patient Care | ||||
Revenue Recognition | ||||
Net revenues | 236,787 | 195,859 | 432,469 | 386,042 |
Patient Care | Medicare | ||||
Revenue Recognition | ||||
Net revenues | 74,248 | 64,191 | 131,583 | 125,916 |
Patient Care | Medicaid | ||||
Revenue Recognition | ||||
Net revenues | 43,688 | 31,243 | 77,736 | 62,071 |
Patient Care | Commercial Insurance / Managed Care (excluding Medicare and Medicaid Managed Care) | ||||
Revenue Recognition | ||||
Net revenues | 79,769 | 70,828 | 149,432 | 137,268 |
Patient Care | VA | ||||
Revenue Recognition | ||||
Net revenues | 21,633 | 16,826 | 41,397 | 34,718 |
Patient Care | Private pay | ||||
Revenue Recognition | ||||
Net revenues | 17,449 | 12,771 | 32,321 | 26,069 |
Patient Care | Operating segments | ||||
Revenue Recognition | ||||
Net revenues | 236,787 | 195,859 | 432,469 | 386,042 |
Products and Services | ||||
Revenue Recognition | ||||
Net revenues | 98,932 | 80,441 | 187,725 | 170,019 |
Products and Services | Operating segments | ||||
Revenue Recognition | ||||
Net revenues | 44,032 | 37,575 | 85,820 | 81,131 |
Products and Services | Operating segments | Distribution services, net of intersegment revenue eliminations | ||||
Revenue Recognition | ||||
Net revenues | 33,275 | 26,527 | 63,935 | 58,217 |
Products and Services | Operating segments | Therapeutic solutions | ||||
Revenue Recognition | ||||
Net revenues | $ 10,757 | $ 11,048 | $ 21,885 | $ 22,914 |
Accounts Receivable, Net (Detai
Accounts Receivable, Net (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2021 | Dec. 31, 2020 | |
Accounts Receivable, net | ||
Gross charges before estimates for implicit price concessions | $ 171,315 | $ 177,804 |
Less estimates for implicit price concessions: | ||
Payor disallowances | (37,080) | (39,343) |
Patient non-payments | (6,968) | (7,042) |
Accounts receivable, gross | 127,267 | 131,419 |
Allowance for doubtful accounts | (2,311) | (2,823) |
Accounts receivable, net | 124,956 | 128,596 |
Decrease in allowance for doubtful accounts | 500 | |
Patient Care | ||
Accounts Receivable, net | ||
Gross charges before estimates for implicit price concessions | 150,382 | 156,504 |
Less estimates for implicit price concessions: | ||
Payor disallowances | (37,080) | (39,343) |
Patient non-payments | (6,968) | (7,042) |
Accounts receivable, gross | 106,334 | 110,119 |
Accounts receivable, net | 106,334 | 110,119 |
Products and Services | ||
Accounts Receivable, net | ||
Gross charges before estimates for implicit price concessions | 20,933 | 21,300 |
Less estimates for implicit price concessions: | ||
Accounts receivable, gross | 20,933 | 21,300 |
Allowance for doubtful accounts | (2,311) | (2,823) |
Accounts receivable, net | $ 18,622 | $ 18,477 |
Inventories (Details)
Inventories (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Inventories | ||
Raw materials | $ 20,502 | $ 19,716 |
Work in process | 17,905 | 12,040 |
Finished goods | 45,552 | 44,673 |
Total inventories | $ 83,959 | $ 76,429 |
Acquisitions (Detail)
Acquisitions (Detail) - USD ($) $ in Thousands | 1 Months Ended | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||||
Oct. 31, 2020 | Jun. 30, 2021 | Mar. 31, 2021 | Dec. 31, 2020 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | Dec. 31, 2020 | |
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Cash paid, net of cash acquired | $ 35,349 | $ 16,788 | ||||||
Additional consideration | $ 3,600 | |||||||
Acquisition-related costs | $ 200 | 400 | ||||||
General and Administrative Expense [Member] | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Acquisition-related costs | 400 | 800 | ||||||
2020 Acquisition activity, O&P business | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Cash paid, net of cash acquired | $ 4,900 | $ 16,800 | $ 21,709 | |||||
Issuance of Seller Notes at fair value | 1,900 | 21,900 | 23,766 | |||||
Deferred payment obligations at fair value | 3,500 | 3,468 | ||||||
Additional consideration | 300 | 4,000 | 4,319 | |||||
Aggregate purchase price | 7,100 | 46,200 | 53,262 | |||||
Accounts receivable | 4,224 | 4,224 | ||||||
Inventories | 2,276 | 2,276 | ||||||
Other assets and liabilities, net | (4,561) | (4,561) | ||||||
Net assets acquired | 8,497 | 8,497 | ||||||
Goodwill | 44,765 | |||||||
Operating right-of-use assets | 5,500 | 5,500 | ||||||
Operating lease liabilities | 5,500 | 5,500 | ||||||
Consideration through settlement of amounts due from acquiree | 400 | |||||||
2020 Acquisition activity, O&P business | Noncompete Agreements [Member] | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Other intangible assets, net | 200 | $ 200 | ||||||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 5 years | |||||||
2020 Acquisition activity, O&P business | Customer Relationships [Member] | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Other intangible assets, net | $ 6,358 | $ 6,358 | ||||||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 5 years | |||||||
2020 Acquisition activity, O&P business | Payable in lump sum payment due in October 2020 | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Issuance of Seller Notes at fair value | 18,100 | |||||||
2020 Acquisition activity, O&P business | Payable in annual installments over a period of 3 years | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Issuance of Seller Notes at fair value | $ 3,800 | |||||||
Beginning period for the deferred payment obligations payable | 4 years | |||||||
Thereafter period for payable deferred payment obligations | 3 years | |||||||
2021 Acquisition activity, two O&P business | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Cash paid, net of cash acquired | 16,000 | |||||||
Issuance of Seller Notes at fair value | 4,900 | |||||||
Additional consideration | 100 | |||||||
Aggregate purchase price | 21,000 | |||||||
2021 Acquisition activity, three O&P business | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Cash paid, net of cash acquired | $ 19,200 | 35,199 | ||||||
Issuance of Seller Notes at fair value | 4,000 | 8,893 | ||||||
Additional consideration | 1,000 | 1,101 | ||||||
Aggregate purchase price | $ 24,200 | 45,193 | ||||||
Accounts receivable | 2,114 | 2,114 | ||||||
Inventories | 1,631 | 1,631 | ||||||
Other assets and liabilities, net | (3,720) | (3,720) | ||||||
Net assets acquired | 4,520 | 4,520 | ||||||
Goodwill | 40,673 | |||||||
Operating right-of-use assets | 2,600 | 2,600 | ||||||
Operating lease liabilities | 2,600 | 2,600 | ||||||
2021 Acquisition activity, three O&P business | Customer Relationships [Member] | ||||||||
Aggregate purchase price of this acquisition was allocated on a preliminary basis | ||||||||
Other intangible assets, net | $ 4,495 | $ 4,495 | ||||||
Acquired Finite-lived Intangible Assets, Weighted Average Useful Life | 5 years |
Goodwill and Other Intangible_3
Goodwill and Other Intangible Assets - Goodwill (Details) - USD ($) $ in Thousands | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Dec. 31, 2020 | Dec. 31, 2019 | |
Goodwill | ||||
Measurement period adjustments related to acquisitions | $ 100 | $ 400 | $ 200 | |
Goodwill allocated | ||||
Goodwill, Net as of beginning of the year | 277,223 | |||
Goodwill, Net as of end of the year | 318,383 | 277,223 | ||
Patient Care | ||||
Goodwill allocated | ||||
Goodwill, Gross as of beginning of the year | 705,891 | 660,912 | 660,912 | |
Goodwill, Accumulated Impairment | (428,668) | (428,668) | $ (428,668) | |
Goodwill, Net as of beginning of the year | 277,223 | $ 232,244 | 232,244 | |
Additions from acquisitions | 40,673 | 45,144 | ||
Measurement period adjustments | 487 | (165) | ||
Goodwill, Gross as of end of the year | 747,051 | 705,891 | ||
Goodwill, Net as of end of the year | $ 318,383 | $ 277,223 |
Goodwill and Other Intangible_4
Goodwill and Other Intangible Assets - Intangible Assets (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | Dec. 31, 2020 | |
GOODWILL AND OTHER INTANGIBLE ASSETS | |||||
Definite-lived, Gross Carrying Amount | $ 30,623 | $ 30,623 | $ 26,145 | ||
Definite-lived, Accumulated Amortization | (13,989) | (13,989) | (11,831) | ||
Definite-lived, Net Carrying Amount | 16,634 | 16,634 | 14,314 | ||
Total other intangible assets, Gross Carrying Amount | 39,693 | 39,693 | 35,215 | ||
Total other intangible assets, Accumulated Amortization | (13,989) | (13,989) | (11,831) | ||
Accumulated Impairment | (4,953) | (4,953) | (4,953) | ||
Total other intangible assets, Net Carrying Amount | 20,751 | 20,751 | 18,431 | ||
Amortization expense | 1,200 | $ 1,600 | 2,200 | $ 3,000 | |
Trade Name | |||||
GOODWILL AND OTHER INTANGIBLE ASSETS | |||||
Indefinite lived, Gross Carrying Amount | 9,070 | 9,070 | 9,070 | ||
Indefinite lived, Accumulated Impairment | (4,953) | (4,953) | (4,953) | ||
Indefinite lived, Net Carrying Amount | 4,117 | 4,117 | 4,117 | ||
Customer Lists | |||||
GOODWILL AND OTHER INTANGIBLE ASSETS | |||||
Definite-lived, Gross Carrying Amount | 21,374 | 21,374 | 16,879 | ||
Definite-lived, Accumulated Amortization | (7,664) | (7,664) | (5,845) | ||
Definite-lived, Net Carrying Amount | 13,710 | 13,710 | 11,034 | ||
Trade Name | |||||
GOODWILL AND OTHER INTANGIBLE ASSETS | |||||
Definite-lived, Gross Carrying Amount | 255 | 255 | 255 | ||
Definite-lived, Accumulated Amortization | (189) | (189) | (176) | ||
Definite-lived, Net Carrying Amount | 66 | 66 | 79 | ||
Patents and Other Intangibles | |||||
GOODWILL AND OTHER INTANGIBLE ASSETS | |||||
Definite-lived, Gross Carrying Amount | 8,994 | 8,994 | 9,011 | ||
Definite-lived, Accumulated Amortization | (6,136) | (6,136) | (5,810) | ||
Definite-lived, Net Carrying Amount | $ 2,858 | $ 2,858 | $ 3,201 |
Goodwill and Other Intangible_5
Goodwill and Other Intangible Assets - Estimated Amortization (Details) $ in Thousands | Jun. 30, 2021USD ($) |
Estimated aggregate amortization expense for definite-lived intangible assets | |
2021 (remainder of the year) | $ 2,397 |
2022 | 4,729 |
2023 | 4,483 |
2024 | 2,993 |
2025 | 1,804 |
Thereafter | 228 |
Total | $ 16,634 |
Goodwill and Other Intangible_6
Goodwill and Other Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 | Dec. 31, 2017 |
Goodwill [Line Items] | |||
Goodwill | $ 318,383 | $ 277,223 | |
Products and Services | |||
Goodwill [Line Items] | |||
Goodwill | $ 139,300 |
Other Current Assets and Othe_3
Other Current Assets and Other Assets - Other Current Assets (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Other Current Assets and Other Assets | ||
Non-trade receivables | $ 6,116 | $ 6,063 |
Prepaid maintenance | 4,593 | 2,942 |
Prepaid insurance | 1,738 | 266 |
Other prepaid assets | 4,255 | 3,086 |
Total other current assets | $ 16,702 | $ 12,357 |
Other Current Assets and Othe_4
Other Current Assets and Other Assets - Other Assets (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Other Current Assets and Other Assets | ||
Implementation costs for cloud computing arrangements | $ 6,540 | $ 4,811 |
Cash surrender value of company-owned life insurance | 4,344 | 3,973 |
Finance lease right-of-use assets | 2,729 | 3,016 |
Deposits | 2,194 | 2,144 |
Non-trade receivables | 1,339 | 1,274 |
Other | 418 | 516 |
Total other assets | $ 17,564 | $ 15,734 |
Accrued Expenses and Other Cu_3
Accrued Expenses and Other Current Liabilities and Other Liabilities - Accrued expenses and other current liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Accrued Expenses and Other Current Liabilities and Other Liabilities | ||
Patient prepayments, deposits, and refunds payable | $ 25,738 | $ 27,195 |
Accrued sales taxes and other taxes | 9,661 | 9,863 |
Insurance and self-insurance accruals | 8,213 | 7,651 |
Derivative liability | 7,528 | 7,686 |
Accrued professional fees | 1,486 | 1,016 |
Accrued interest payable | 522 | 440 |
Other current liabilities | 10,185 | 9,010 |
Total | $ 63,333 | $ 62,861 |
Accrued Expenses and Other Cu_4
Accrued Expenses and Other Current Liabilities and Other Liabilities - Other liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Accrued Expenses and Other Current Liabilities and Other Liabilities | ||
Supplemental executive retirement plan obligations | $ 20,668 | $ 21,503 |
Derivative liability | 9,626 | 14,388 |
Long-term insurance accruals | 7,630 | 7,326 |
Deferred payroll taxes | 5,918 | 5,918 |
Unrecognized tax benefits | 5,142 | 5,465 |
Other | 2,176 | 1,993 |
Total | $ 51,160 | $ 56,593 |
Income Taxes - (Details)
Income Taxes - (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | Dec. 31, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | |
Income Taxes | |||||||
(Benefit) provision for income taxes | $ 2,616 | $ (987) | $ 460 | $ (2,840) | |||
Effective tax rate | 20.50% | (3.30%) | 6.30% | (22.80%) | |||
Federal statutory tax rate (as a percent) | 21.00% | 21.00% | 21.00% | 21.00% | |||
Recognition of tax benefits, Current year | $ 3,000 | $ 2,200 | |||||
Recognition of tax benefits, Prior years | $ 6,100 |
Debt and Other Obligations (Det
Debt and Other Obligations (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Debt and Other Obligations | ||
Total debt before unamortized discount and debt issuance costs | $ 514,130 | $ 510,492 |
Unamortized discount and debt issuance costs, net | (6,628) | (7,395) |
Total debt | 507,502 | 503,097 |
Total current portion of long-term debt | 12,257 | 10,085 |
Long-term debt | 495,245 | 493,012 |
Term Loan B | ||
Debt and Other Obligations | ||
Total debt before unamortized discount and debt issuance costs | 488,588 | 491,113 |
Total current portion of long-term debt | 5,050 | 5,050 |
Seller Notes | ||
Debt and Other Obligations | ||
Total debt before unamortized discount and debt issuance costs | 18,105 | 11,510 |
Total current portion of long-term debt | 6,303 | 4,060 |
Deferred payment obligation | ||
Debt and Other Obligations | ||
Total debt before unamortized discount and debt issuance costs | 4,000 | 4,000 |
Finance lease liabilities and other | ||
Debt and Other Obligations | ||
Total debt before unamortized discount and debt issuance costs | 3,437 | 3,869 |
Total current portion of long-term debt | $ 904 | $ 975 |
Debt and Other Obligations - Re
Debt and Other Obligations - Refinancing of Credit Agreement and Term B Borrowings (Details) $ in Thousands | Mar. 06, 2018USD ($) | May 31, 2020 | Jun. 30, 2020USD ($) | Sep. 30, 2020USD ($) | Jun. 30, 2021USD ($) | Dec. 31, 2020USD ($) |
Debt and Other Obligations | ||||||
Outstanding amount of debt | $ 514,130 | $ 510,492 | ||||
Letters of credit outstanding amount | $ 5,100 | |||||
Payment of debt issuance costs | $ 214 | $ 200 | ||||
LIBOR | Minimum | ||||||
Debt and Other Obligations | ||||||
Minimum interest base | 1.00% | |||||
LIBOR | Maximum | ||||||
Debt and Other Obligations | ||||||
Increase in margin(as a percent) | 3.75% | |||||
Fiscal quarters ended June 30, 2021 through September 30, 2021 | ||||||
Debt and Other Obligations | ||||||
Consolidated leverage ratio | 5.00% | |||||
December 31, 2021 and the last day of each fiscal quarter thereafter | ||||||
Debt and Other Obligations | ||||||
Consolidated leverage ratio | 4.75% | |||||
Credit Agreement, dated March 6, 2018, Term Loan B | ||||||
Debt and Other Obligations | ||||||
Outstanding amount of debt | $ 505,000 | |||||
Weighted average interest rate | 3.60% | |||||
Revolving Credit Facility | ||||||
Debt and Other Obligations | ||||||
Available borrowing capacity | $ 94,900 | |||||
Maximum borrowing capacity | 605,000 | |||||
Letters of credit outstanding amount | $ 100,000 | |||||
Increase in additional borrowing capacity | $ 125,000 | |||||
Leverage ratio to increase credit commitment | 3.80 | |||||
Increase in margin(as a percent) | 50.00% | |||||
Interest rate in excess of applicable rate upon acceleration and default ( as a percent) | 2.00% | |||||
Revolving Credit Facility | Minimum | ||||||
Debt and Other Obligations | ||||||
Unused commitment fee (as a percent) | 0.375% | |||||
Revolving Credit Facility | Maximum | ||||||
Debt and Other Obligations | ||||||
Unused commitment fee (as a percent) | 0.50% | |||||
Revolving Credit Facility | LIBOR | ||||||
Debt and Other Obligations | ||||||
Interest rate margin (as a percent) | 1.00% | |||||
Revolving Credit Facility | Federal funds rate | ||||||
Debt and Other Obligations | ||||||
Interest rate margin (as a percent) | 0.50% | |||||
Revolving Credit Facility | Fiscal quarters ended June 30, 2021 through March 31, 2022 | ||||||
Debt and Other Obligations | ||||||
Consolidated leverage ratio | 4.25% | |||||
Revolving Credit Facility | Fiscal quarters ended June 30, 2022 and the last day of each fiscal quarter thereafter | ||||||
Debt and Other Obligations | ||||||
Consolidated leverage ratio | 3.75% | |||||
Revolving Credit Facility | Last day of any fiscal quarter | ||||||
Debt and Other Obligations | ||||||
Consolidated leverage ratio | 2.75% | |||||
Revolving Credit Facility | Revolving Credit Facility | ||||||
Debt and Other Obligations | ||||||
Maximum borrowing capacity | $ 100,000 |
Debt and Other Obligations - Se
Debt and Other Obligations - Seller Notes (Details) - USD ($) $ in Millions | Jun. 30, 2021 | Dec. 31, 2020 |
Seller Notes | ||
Debt and Other Obligations | ||
Unamortized discount | $ 0.8 | $ 0.9 |
Seller Notes | Minimum | ||
Debt and Other Obligations | ||
Interest rate stated percentage | 2.50% | |
Seller Notes | Maximum | ||
Debt and Other Obligations | ||
Interest rate stated percentage | 3.00% | |
Deferred payment obligation | ||
Debt and Other Obligations | ||
Unamortized discount | $ 0.5 | $ 0.5 |
Interest rate stated percentage | 3.00% |
Debt and Other Obligations - Ma
Debt and Other Obligations - Maturities of Debt (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Maturities of debt | ||
2021 (remainder of year) | $ 4,955 | |
2022 | 11,661 | |
2023 | 11,310 | |
2024 | 10,697 | |
2025 | 473,011 | |
Thereafter | 2,496 | |
Total debt before unamortized discount and debt issuance costs, net | 514,130 | $ 510,492 |
Unamortized discount and debt issuance costs, net | (6,628) | (7,395) |
Total debt | $ 507,502 | $ 503,097 |
Fair Value Measurements - Finan
Fair Value Measurements - Financial Instruments (Details) - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
FAIR VALUE MEASUREMENTS | ||
Unamortized discount and debt issuance costs, net | $ 6,628 | $ 7,395 |
Credit Agreement, dated March 6, 2018, Term Loan B | ||
FAIR VALUE MEASUREMENTS | ||
Unamortized discount and debt issuance costs, net | 5,800 | 6,500 |
Credit Agreement, dated March 6, 2018, Term Loan B | Carrying Value | ||
FAIR VALUE MEASUREMENTS | ||
Debt | 488,600 | 491,100 |
Credit Agreement, dated March 6, 2018, Term Loan B | Fair Value | ||
FAIR VALUE MEASUREMENTS | ||
Debt | 488,000 | |
Credit Agreement, dated March 6, 2018, Term Loan B | Recurring basis | Level 3 | Fair Value | ||
FAIR VALUE MEASUREMENTS | ||
Debt | 488,000 | |
Credit Agreement, dated March 6, 2018, Term Loan B | Revolving Credit Facility | Recurring basis | Level 3 | Fair Value | ||
FAIR VALUE MEASUREMENTS | ||
Debt | 489,900 | |
Seller Notes | Level 3 | Carrying Value | ||
FAIR VALUE MEASUREMENTS | ||
Unamortized discount and debt issuance costs, net | 800 | 900 |
Outstanding amount | $ 21,300 | $ 14,600 |
Derivative Financial Instrume_3
Derivative Financial Instruments - Cash Flow Hedge (Details) - Interest rate swap agreements - Cash flow hedges - USD ($) $ in Millions | Jun. 30, 2021 | Dec. 31, 2020 | Mar. 31, 2018 |
DERIVATIVE FINANCIAL INSTRUMENTS | |||
Notional amount of derivative instrument | $ 287.5 | $ 300 | $ 325 |
Annual reduction in notional amount of derivative | $ 12.5 |
Derivative Financial Instrume_4
Derivative Financial Instruments - Changes in Net Loss on Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss) (Details) - Interest rate swap agreements - Cash flow hedges - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
Changes in Net Gain or Loss on Cash Flow Hedges Included in Accumulated Other Comprehensive Income (Loss) | ||||
Balance at the beginning of the period | $ (14,259) | $ (19,039) | $ (16,771) | $ (10,137) |
Unrealized loss recognized in other comprehensive loss, net of tax | (712) | (2,290) | (183) | (12,063) |
Reclassification to interest expense, net | 1,937 | 1,717 | 3,920 | 2,588 |
Balance at the end of the period | $ (13,034) | $ (19,612) | $ (13,034) | $ (19,612) |
Derivative Financial Instrume_5
Derivative Financial Instruments - Fair Value of Derivative Assets and Liabilities (Details) - Cash flow hedges - USD ($) $ in Thousands | Jun. 30, 2021 | Dec. 31, 2020 |
Accrued expenses and other current liabilities | ||
Derivatives designated as cash flow hedging instruments: | ||
Liabilities | $ 7,528 | $ 7,686 |
Other liabilities | ||
Derivatives designated as cash flow hedging instruments: | ||
Liabilities | $ 9,626 | $ 14,388 |
Share-Based Compensation (Detai
Share-Based Compensation (Details) - USD ($) $ / shares in Units, $ in Millions | May 19, 2017 | May 31, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | May 17, 2019 |
Share Based Compensation | |||||||
Options outstanding and exercisable (in share) | 324,014 | 324,014 | |||||
Weighted average exercise price of options exercisable (in dollars per share) | $ 12.77 | $ 12.77 | |||||
Average remaining contractual term of options exercisable | 5 years 1 month 6 days | ||||||
Stock-based compensation expense | $ 3.2 | $ 9 | $ 6.4 | $ 12.5 | |||
Special Equity Plan | |||||||
Share Based Compensation | |||||||
Shares of common stock authorized for issuance under the share-based compensation plan | 1,500,000 | ||||||
2019 Omnibus Incentive Plan | |||||||
Share Based Compensation | |||||||
Shares of common stock authorized for issuance under the share-based compensation plan | 2,025,000 | ||||||
2016 Omnibus Incentive Plan | |||||||
Share Based Compensation | |||||||
Available for issuance (in shares) | 243,611 | ||||||
Stock Options | Special Equity Plan | |||||||
Share Based Compensation | |||||||
Issued (in shares) | 800,000 | ||||||
Performance-based stock awards | |||||||
Share Based Compensation | |||||||
Shares outstanding | 342,017 | 342,017 | |||||
Weighted average grant date fair value | $ 21.61 | $ 21.61 | |||||
Performance-based stock awards | Special Equity Plan | |||||||
Share Based Compensation | |||||||
Issued (in shares) | 300,000 | ||||||
Performance period | 33 months | ||||||
Reduction in performance period | 3 months | ||||||
Incremental fair value | $ 5.9 | ||||||
Unvested restricted stock | |||||||
Share Based Compensation | |||||||
Shares outstanding | 1,423,551 | 1,423,551 | |||||
Employee Service Based Awards | |||||||
Share Based Compensation | |||||||
Shares outstanding | 1,026,979 | 1,026,979 | |||||
Weighted average grant date fair value | $ 21.30 | $ 21.30 | |||||
Director Service Based Awards | |||||||
Share Based Compensation | |||||||
Shares outstanding | 54,555 | 54,555 | |||||
Weighted average grant date fair value | $ 24.67 | $ 24.67 |
Supplemental Executive Retire_3
Supplemental Executive Retirement Plans - Plan Details and Change in Benefit Obligation (Details) $ in Thousands | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2021USD ($) | Jun. 30, 2020USD ($) | Jun. 30, 2021USD ($)payment | Jun. 30, 2020USD ($) | Dec. 31, 2020USD ($) | |
Supplemental Executive Retirement Plans | |||||
Number of annual payments | payment | 15 | ||||
Change in Benefit Obligation | |||||
Benefit obligation at the beginning of the period | $ 18,079 | $ 17,556 | $ 19,746 | $ 19,214 | |
Service cost | 123 | 98 | 246 | 196 | |
Interest cost | 88 | 121 | 175 | 242 | |
Payments | (12) | (12) | (1,889) | (1,889) | |
Benefit obligation at the end of the period | 18,278 | $ 17,763 | 18,278 | $ 17,763 | |
Amounts Recognized in the Condensed Consolidated Balance Sheets: | |||||
Current accrued expenses and other current liabilities | 1,913 | 1,913 | $ 1,913 | ||
Non-current other liabilities | 16,365 | 16,365 | 17,833 | ||
Total accrued liabilities | $ 18,278 | $ 18,278 | $ 19,746 |
Supplemental Executive Retire_4
Supplemental Executive Retirement Plans - DC SERP (Details) - USD ($) $ in Millions | Jun. 30, 2021 | Dec. 31, 2020 |
Supplemental Executive Retirement Plans | ||
Estimated accumulated benefit obligation | $ 4.3 | $ 4.5 |
Funded estimated accumulated benefit obligation | 4 | 4 |
Unfunded estimated accumulated benefit obligation | $ 0.3 | $ 0.5 |
Segment and Related Informati_3
Segment and Related Information - Paragraphs (Details) | 6 Months Ended |
Jun. 30, 2021segment | |
Segment and Related Information | |
Number of operating segments | 2 |
Segment and Related Informati_4
Segment and Related Information - Financial Information (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2021 | Jun. 30, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
Net revenue | ||||
Net revenues | $ 280,819 | $ 233,434 | $ 518,289 | $ 467,173 |
Material costs | 89,271 | 69,972 | 164,441 | 147,213 |
Personnel expenses | 97,549 | 73,822 | 187,429 | 163,007 |
Depreciation & amortization | 8,007 | 8,879 | 16,005 | 17,710 |
Segment income from operations | 20,094 | 38,861 | 22,115 | 29,688 |
Patient Care | ||||
Net revenue | ||||
Net revenues | 236,787 | 195,859 | 432,469 | 386,042 |
Material costs | 71,717 | 55,236 | 131,639 | 114,913 |
Personnel expenses | 83,198 | 63,576 | 158,952 | 139,921 |
Other expenses | 37,445 | 13,601 | 73,586 | 51,749 |
Depreciation & amortization | 4,787 | 4,827 | 9,602 | 9,303 |
Segment income from operations | 39,640 | 58,619 | 58,690 | 70,156 |
Patient Care | Operating segments | ||||
Net revenue | ||||
Net revenues | 236,787 | 195,859 | 432,469 | 386,042 |
Material costs | 62,631 | 50,489 | 114,290 | 103,613 |
Patient Care | Intersegments | ||||
Net revenue | ||||
Material costs | 9,086 | 4,747 | 17,349 | 11,300 |
Products and Services | ||||
Net revenue | ||||
Net revenues | 98,932 | 80,441 | 187,725 | 170,019 |
Material costs | 72,454 | 57,602 | 134,707 | 121,188 |
Personnel expenses | 14,351 | 10,246 | 28,477 | 23,086 |
Other expenses | 6,763 | 4,337 | 12,566 | 12,657 |
Depreciation & amortization | 1,963 | 2,498 | 3,898 | 5,250 |
Segment income from operations | 3,401 | 5,758 | 8,077 | 7,838 |
Products and Services | Operating segments | ||||
Net revenue | ||||
Net revenues | 44,032 | 37,575 | 85,820 | 81,131 |
Material costs | 26,640 | 19,483 | 50,151 | 43,600 |
Products and Services | Intersegments | ||||
Net revenue | ||||
Net revenues | 54,900 | 42,866 | 101,905 | 88,888 |
Material costs | $ 45,814 | $ 38,119 | $ 84,556 | $ 77,588 |
Segment and Related Informati_5
Segment and Related Information - Reconciliation of the Reportable Segments (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||||
Jun. 30, 2021 | Mar. 31, 2021 | Jun. 30, 2020 | Mar. 31, 2020 | Jun. 30, 2021 | Jun. 30, 2020 | |
Segment and Related Information | ||||||
Income (loss) from operations | $ 20,094 | $ 38,861 | $ 22,115 | $ 29,688 | ||
Interest expense, net | 7,152 | 8,636 | 14,492 | 16,906 | ||
Non-service defined benefit plan expense | 167 | 158 | 334 | 316 | ||
Income before income taxes | 12,775 | 30,067 | 7,289 | 12,466 | ||
Provision (benefit) for income taxes | 2,616 | (987) | 460 | (2,840) | ||
Net income | 10,159 | $ (3,330) | 31,054 | $ (15,748) | 6,829 | 15,306 |
Consolidated net revenues | 280,819 | 233,434 | 518,289 | 467,173 | ||
Consolidated material costs | 89,271 | 69,972 | 164,441 | 147,213 | ||
Corporate & other | ||||||
Segment and Related Information | ||||||
Income (loss) from operations | (22,947) | (25,516) | (44,652) | (48,306) | ||
Consolidating adjustments | ||||||
Segment and Related Information | ||||||
Consolidated net revenues | (54,900) | (42,866) | (101,905) | (88,888) | ||
Consolidated material costs | (54,900) | (42,866) | (101,905) | (88,888) | ||
Patient Care | ||||||
Segment and Related Information | ||||||
Income (loss) from operations | 39,640 | 58,619 | 58,690 | 70,156 | ||
Consolidated net revenues | 236,787 | 195,859 | 432,469 | 386,042 | ||
Consolidated material costs | 71,717 | 55,236 | 131,639 | 114,913 | ||
Patient Care | Operating segments | ||||||
Segment and Related Information | ||||||
Consolidated net revenues | 236,787 | 195,859 | 432,469 | 386,042 | ||
Consolidated material costs | 62,631 | 50,489 | 114,290 | 103,613 | ||
Products and Services | ||||||
Segment and Related Information | ||||||
Income (loss) from operations | 3,401 | 5,758 | 8,077 | 7,838 | ||
Consolidated net revenues | 98,932 | 80,441 | 187,725 | 170,019 | ||
Consolidated material costs | 72,454 | 57,602 | 134,707 | 121,188 | ||
Products and Services | Operating segments | ||||||
Segment and Related Information | ||||||
Consolidated net revenues | 44,032 | 37,575 | 85,820 | 81,131 | ||
Consolidated material costs | $ 26,640 | $ 19,483 | $ 50,151 | $ 43,600 |
Subsequent Events (Details)
Subsequent Events (Details) - 2021 Acquisition activity, two O&P business $ in Millions | 1 Months Ended | 3 Months Ended | |
Jul. 31, 2021USD ($)item | Sep. 30, 2021USD ($)item | Jun. 30, 2021USD ($) | |
Subsequent Events | |||
Total purchase price | $ 21 | ||
Consideration in the form of notes to the former shareholders | $ 4.9 | ||
Subsequent Events Member | |||
Subsequent Events | |||
Number of businesses acquired | item | 2 | ||
Total purchase price | $ 0.8 | ||
Consideration paid in cash | 0.6 | ||
Consideration in the form of notes to the former shareholders | $ 0.2 | ||
Subsequent Events Member | Definitive share purchase agreements | |||
Subsequent Events | |||
Number of businesses acquired | item | 2 | ||
Total purchase price | $ 5.6 |