Document and Entity Information
Document and Entity Information - shares | 6 Months Ended | |
Jun. 30, 2016 | Aug. 04, 2016 | |
Document And Entity Information [Abstract] | ||
Entity Registrant Name | U S PHYSICAL THERAPY INC /NV | |
Entity Central Index Key | 885,978 | |
Current Fiscal Year End Date | --12-31 | |
Entity Well-known Seasoned Issuer | No | |
Entity Voluntary Filers | No | |
Entity Current Reporting Status | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Common Stock, Shares Outstanding | 12,520,226 | |
Document Fiscal Year Focus | 2,016 | |
Document Fiscal Period Focus | Q2 | |
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Jun. 30, 2016 |
CONSOLIDATED BALANCE SHEETS (un
CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands | Jun. 30, 2016 | Dec. 31, 2015 |
Current assets: | ||
Cash and cash equivalents | $ 20,453 | $ 15,778 |
Patient accounts receivable, less allowance for doubtful accounts of $1,672 and $1,444, respectively | 39,356 | 36,231 |
Accounts receivable - other, less allowance for doubtful accounts of $-0- and $198, respectively | 2,335 | 2,388 |
Other current assets | 8,220 | 5,785 |
Total current assets | 70,364 | 60,182 |
Fixed assets: | ||
Furniture and equipment | 46,747 | 44,749 |
Leasehold improvements | 25,733 | 25,160 |
Fixed assets, gross | 72,480 | 69,909 |
Less accumulated depreciation and amortization | 55,642 | 53,255 |
Fixed assets, net | 16,838 | 16,654 |
Goodwill | 191,268 | 171,547 |
Other identifiable intangible assets, net | 33,909 | 30,296 |
Other assets | 1,219 | 1,234 |
Total assets | 313,598 | 279,913 |
Current liabilities: | ||
Accounts payable - trade | 1,668 | 1,636 |
Accrued expenses | 26,273 | 16,596 |
Current portion of notes payable | 1,044 | 775 |
Total current liabilities | 28,985 | 19,007 |
Notes payable | 4,547 | 4,335 |
Revolving line of credit | 42,500 | 44,000 |
Deferred rent | 1,285 | 1,395 |
Deferred taxes | 12,361 | 8,355 |
Other long-term liabilities | 869 | 868 |
Total liabilities | 90,547 | 77,960 |
Commitments and contingencies | ||
Redeemable non-controlling interests | 8,641 | 8,843 |
U. S. Physical Therapy, Inc. shareholders' equity: | ||
Preferred stock, $.01 par value, 500,000 shares authorized, no shares issued and outstanding | 0 | 0 |
Common stock, $.01 par value, 20,000,000 shares authorized, 14,734,963 and 14,635,874 shares issued, respectively | 147 | 146 |
Additional paid-in capital | 48,236 | 45,251 |
Retained earnings | 157,161 | 149,016 |
Treasury stock at cost, 2,214,737 shares | (31,628) | (31,628) |
Total U. S. Physical Therapy, Inc. shareholders' equity | 173,916 | 162,785 |
Non-controlling interests | 40,494 | 30,325 |
Total equity | 214,410 | 193,110 |
Total liabilities and equity | $ 313,598 | $ 279,913 |
CONSOLIDATED BALANCE SHEETS (u3
CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) $ in Thousands | Jun. 30, 2016 | Dec. 31, 2015 |
Current assets: | ||
Allowance for doubtful accounts, patient accounts receivable | $ 1,672 | $ 1,444 |
Allowance for doubtful accounts, accounts receivable - other | $ 0 | $ 198 |
U. S. Physical Therapy, Inc. shareholders' equity: | ||
Preferred stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 500,000 | 500,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 20,000,000 | 20,000,000 |
Common stock, shares issued (in shares) | 14,734,963 | 14,635,874 |
Treasury stock (in shares) | 2,214,737 | 2,214,737 |
CONSOLIDATED STATEMENTS OF NET
CONSOLIDATED STATEMENTS OF NET INCOME (unaudited) - USD ($) shares in Thousands, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2016 | Jun. 30, 2015 | Jun. 30, 2016 | Jun. 30, 2015 | |
CONSOLIDATED STATEMENTS OF NET INCOME (unaudited) [Abstract] | ||||
Net patient revenues | $ 88,433 | $ 81,451 | $ 173,482 | $ 157,258 |
Other revenues | 1,997 | 1,837 | 3,856 | 3,271 |
Net revenues | 90,430 | 83,288 | 177,338 | 160,529 |
Clinic operating costs: | ||||
Salaries and related costs | 48,837 | 44,398 | 96,641 | 87,450 |
Rent, clinic supplies, contract labor and other | 17,546 | 16,681 | 35,053 | 33,006 |
Provision for doubtful accounts | 956 | 1,062 | 2,045 | 2,052 |
Closure costs | 32 | 5 | 45 | 37 |
Total clinic operating costs | 67,371 | 62,146 | 133,784 | 122,545 |
Gross margin | 23,059 | 21,142 | 43,554 | 37,984 |
Corporate office costs | 8,026 | 7,593 | 17,030 | 15,250 |
Operating income | 15,033 | 13,549 | 26,524 | 22,734 |
Interest and other income, net | 21 | 16 | 41 | 24 |
Interest expense | (320) | (245) | (628) | (510) |
Income before taxes | 14,734 | 13,320 | 25,937 | 22,248 |
Provision for income taxes | 4,674 | 4,203 | 8,197 | 6,980 |
Net income including non-controlling interests | 10,060 | 9,117 | 17,740 | 15,268 |
Less: net income attributable to non-controlling interests | (2,989) | (2,813) | (5,341) | (4,798) |
Net income attributable to common shareholders | $ 7,071 | $ 6,304 | $ 12,399 | $ 10,470 |
Basic earnings per share attributable to common shareholders: | ||||
From operations prior to revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | $ 0.57 | $ 0.51 | $ 0.99 | $ 0.85 |
Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | 0 | (0.03) | 0 | (0.03) |
Basic (in dollars per share) | 0.57 | 0.48 | 0.99 | 0.82 |
Diluted earnings per share attributable to common shareholders: | ||||
From operations prior to revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | 0.57 | 0.51 | 0.99 | 0.85 |
Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | 0 | (0.03) | 0 | (0.03) |
Diluted (in dollars per share) | $ 0.57 | $ 0.48 | $ 0.99 | $ 0.82 |
Shares used in computation: | ||||
Basic and diluted (in shares) | 12,511 | 12,409 | 12,480 | 12,362 |
Dividends declared per common share (in dollars per share) | $ 0.17 | $ 0.15 | $ 0.34 | $ 0.30 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2016 | Jun. 30, 2015 | |
OPERATING ACTIVITIES | ||
Net income including non-controlling interests | $ 17,740 | $ 15,268 |
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities: | ||
Depreciation and amortization | 4,158 | 3,674 |
Provision for doubtful accounts | 2,045 | 2,052 |
Equity-based awards compensation expense | 2,484 | 2,206 |
Loss (gain) on sale of fixed assets | 0 | (13) |
Excess tax benefit from exercise of equity-based awards | 0 | (430) |
Deferred income tax | 4,170 | 2,130 |
Other | (556) | 111 |
Changes in operating assets and liabilities: | ||
Increase in patient accounts receivable | (2,449) | (2,880) |
Decrease in accounts receivable - other | 53 | 165 |
Increase in other assets | (2,443) | (13) |
Increase (decrease) in accounts payable and accrued expenses | 7,715 | (3,958) |
Increase in other liabilities | 447 | 927 |
Net cash provided by operating activities | 33,364 | 19,239 |
INVESTING ACTIVITIES | ||
Purchase of fixed assets | (3,453) | (2,873) |
Purchase of businesses, net of cash acquired | (12,958) | (14,467) |
Acquisitions of non-controlling interests (including redeemable non-controlling interests) | (1,386) | (968) |
Proceeds on sale of fixed assets, net | 42 | 72 |
Net cash used in investing activities | (17,755) | (18,236) |
FINANCING ACTIVITIES | ||
Distributions to non-controlling interests (including redeemable non-controlling interests) | (5,204) | (4,906) |
Cash dividends to shareholders - funded | (4,254) | (3,723) |
Proceeds from revolving line of credit | 93,000 | 51,000 |
Payments on revolving line of credit | (94,500) | (44,500) |
Principal payments on notes payable | (533) | (608) |
Tax benefit from equity-based awards | 556 | 430 |
Other | 1 | 5 |
Net cash used in financing activities | (10,934) | (2,302) |
Net increase in cash and cash equivalents | 4,675 | (1,299) |
Cash and cash equivalents - beginning of period | 15,778 | 14,271 |
Cash and cash equivalents - end of period | 20,453 | 12,972 |
Cash paid during the period for: | ||
Income taxes | 5,513 | 3,835 |
Interest | 512 | 460 |
Non-cash investing and financing transactions during the period: | ||
Purchase of business - seller financing portion | 500 | 1,350 |
Acquisition of noncontrolling interest - seller financing portion | 514 | 627 |
Sale of non-controlling interests | $ (148) | $ 0 |
CONSOLIDATED STATEMENT OF SHARE
CONSOLIDATED STATEMENT OF SHAREHOLDERS' EQUITY (unaudited) - 6 months ended Jun. 30, 2016 - USD ($) $ in Thousands | Common Stock [Member] | Additional Paid-In Capital [Member] | Retained Earnings [Member] | Treasury Stock [Member] | Total Shareholders' Equity [Member] | Non-controlling Interests [Member] | Total |
Beginning Balance at Dec. 31, 2015 | $ 146 | $ 45,251 | $ 149,016 | $ (31,628) | $ 162,785 | $ 30,325 | $ 193,110 |
Beginning Balance (in shares) at Dec. 31, 2015 | 14,636 | (2,215) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||
Net tax benefit from equity-based awards | $ 0 | 556 | 0 | $ 0 | 556 | 0 | 556 |
Issuance of restricted stock | $ 1 | 0 | 0 | 0 | 1 | 0 | 1 |
Issuance of restricted stock (in shares) | 99 | ||||||
Cancellation of restricted stock | $ 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Compensation expense - equity-based awards | 0 | 2,484 | 0 | 0 | 2,484 | 0 | 2,484 |
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans | 0 | 211 | 0 | 0 | 211 | 0 | 211 |
Purchase of business | 0 | 0 | 0 | 0 | 0 | 11,190 | 11,190 |
Acquisition of non-controlling interests, net | 0 | (266) | 0 | 0 | (266) | (98) | (364) |
Reclass to redeemable non-controlling interests | 0 | 0 | 0 | 0 | 0 | (976) | (976) |
Distributions to non-controlling interest partners | 0 | 0 | 0 | 0 | (4,776) | (4,776) | |
Cash dividends to shareholders | 0 | 0 | (4,254) | 0 | (4,254) | 0 | (4,254) |
Net income | 0 | 0 | 12,399 | 0 | 12,399 | 4,829 | 17,228 |
Ending Balance at Jun. 30, 2016 | $ 147 | $ 48,236 | $ 157,161 | $ (31,628) | $ 173,916 | $ 40,494 | $ 214,410 |
Ending Balance (in shares) at Jun. 30, 2016 | 14,735 | (2,215) |
BASIS OF PRESENTATION AND SIGNI
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES | 6 Months Ended |
Jun. 30, 2016 | |
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES [Abstract] | |
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES | 1. BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES The consolidated financial statements include the accounts of U.S. Physical Therapy, Inc. and its subsidiaries (the “Company”). All significant intercompany transactions and balances have been eliminated. The Company primarily operates through subsidiary clinic partnerships, in which the Company generally owns a 1% general partnership interest in all the Clinic Partnerships, The Company continues to seek to attract physical and occupational therapists who have established relationships with patients and physicians by offering therapists a competitive salary and a share of the profits of the clinic operated by that therapist. The Company has developed satellite clinic facilities of existing clinics, with the result that many Clinic Partnerships and Wholly-Owned Facilities operate more than one clinic location. In addition, the Company has acquired a controlling interest in a number of clinics through acquisitions. During the first six months of 2016 and the year ended 2015, the Company acquired the following clinic groups: Date % Interest Acquired Number of Clinics 2016 February 2016 Acquisition February 29 55% 8 2015 January 2015 Acquisition January 31 60% 9 April 2015 Acquisition April 30 70% 3 June 2015 Acquisition June 30 70% 4 December 2015 Acquisition December 31 59% 4 As of June 30, 2016, the Company operated 516 clinics in 42 states. The Company also manages physical therapy facilities for third parties, primarily physicians, with 22 third-party facilities under management as of June 30, 2016. The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition. The Company intends to continue to pursue additional acquisition opportunities, develop new clinics and open satellite clinics. The accompanying unaudited consolidated financial statements were prepared in accordance with accounting principles generally accepted in the United States of America for interim financial information and in accordance with the instructions for Form 10-Q. However, the statements do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America for complete financial statements. Management believes this report contains all necessary adjustments (consisting only of normal recurring adjustments) to present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented. For further information regarding the Company’s accounting policies, please read the audited financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2015. The Company believes, and the Chief Executive Officer, Chief Financial Officer and Corporate Controller have certified, that the financial statements included in this report present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented. Operating results for the six months ended June 30, 2016 are not necessarily indicative of the results the Company expects for the entire year. Please also review the Risk Factors section included in our Annual Report on Form 10-K for the year ended December 31, 2015. Clinic Partnerships For Clinic Partnerships, the earnings and liabilities attributable to the non-controlling interests, typically owned by the managing therapist, directly or indirectly, are recorded within the balance sheets and income statements as non-controlling interests. Wholly-Owned Facilities For Wholly-Owned Facilities with profit sharing arrangements, an appropriate accrual is recorded for the amount of profit sharing due to the profit sharing therapists. The amount is expensed as compensation and included in clinic operating costs – salaries and related costs. The respective liability is included in current liabilities – accrued expenses on the balance sheets. Significant Accounting Policies Cash Equivalents The Company maintains its cash and cash equivalents at financial institutions. The combined account balances at several institutions typically exceed Federal Deposit Insurance Corporation (“FDIC”) insurance coverage and, as a result, there is a concentration of credit risk related on deposits in excess of FDIC insurance coverage. Management believes that the risk is not significant. Long-Lived Assets Fixed assets are stated at cost. Depreciation is computed on the straight-line method over the estimated useful lives of the assets. Estimated useful lives for furniture and equipment range from three to eight years and for software purchased from three to seven years. Leasehold improvements are amortized over the shorter of the lease term or estimated useful lives of the assets, which is generally three to five years. Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of The Company reviews property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances which indicate that the amounts may be impaired. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell. Goodwill Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall, as applicable, is recognized as an adjustment to additional paid-in capital. The fair value of goodwill and other intangible assets with indefinite lives are tested for impairment annually and upon the occurrence of certain events, and are written down to fair value if considered impaired. The Company evaluates goodwill for impairment on at least an annual basis (in its third quarter) by comparing the fair value of its reporting units to the carrying value of each reporting unit including related goodwill. The Company operates a one segment business which is made up of various clinics within partnerships. The partnerships are components of regions and are aggregated to that operating segment level for the purpose of determining the Company’s reporting units when performing its annual goodwill impairment test. Currently, there are six regions. An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other intangible assets, exceeds the estimated fair value of the reporting unit. The estimated fair value of a reporting unit is determined using two factors: (i) earnings prior to taxes, depreciation and amortization for the reporting unit multiplied by a price/earnings ratio used in the industry and (ii) a discounted cash flow analysis. A weight is assigned to each factor and the sum of each weight times the factor is considered the estimated fair value. For 2015, the factors (i.e., price/earnings ratio, discount rate and residual capitalization rate) were updated to reflect current market conditions. The evaluations of goodwill in 2015 did not result in any goodwill amounts that were deemed impaired. During the six months ended June 30, 2016, the Company has not identified any triggering events occurring after the testing date that would impact the impairment testing results obtained. Non-controlling interests The Company recognizes non-controlling interests as equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the income statement. Changes in a parent entity’s ownership interest in a subsidiary that do not result in deconsolidation are treated as equity transactions if the parent entity retains its controlling financial interest. The Company recognizes a gain or loss in net income when a subsidiary is deconsolidated. Such gain or loss is measured using the fair value of the non-controlling interest on the deconsolidation date. When the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall, as applicable, is recognized as an adjustment to additional paid-in capital. Additionally, operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner. The non-controlling interests that are reflected as redeemable non-controlling interests in the consolidated financial statements consist of those outside owners that have certain redemption rights that are currently exercisable, and that, if exercised, require that the Company purchases the non-controlling interest of the particular limited partner. At June 30, 2016, the redeemable non-controlling interests reflect the book value of certain non-controlling interests for which is it not deemed probable that the limited partner will assert the redemption rights. The redeemable non-controlling interests will be adjusted to the fair value in the reporting period in which the Company deems it probable that the limited partner will assert the redemption rights and will be adjusted each reporting period thereafter. The adjustments are charged to additional paid-in capital and are not reflected in the statements of net income. Although the adjustments are not reflected in the statements of net income, current accounting rules require that the Company reflects the charge in the earnings per share calculation. Typically, for acquisitions, the Company agrees to purchase the individual’s non-controlling interest at a predetermined multiple of earnings before interest, taxes, depreciation and amortization. Revenue Recognition Revenues are recognized in the period in which services are rendered. Net patient revenues (patient revenues less estimated contractual adjustments) are reported at the estimated net realizable amounts from third-party payors, patients and others for services rendered. The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. The allowance for estimated contractual adjustments is based on terms of payor contracts and historical collection and write-off experience. The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in clinic operating costs in the statement of net income. Net accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible. Medicare Reimbursement The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (‘‘MPFS’’). The MPFS rates have historically been subject to an automatic annual update based on a formula, called the sustainable growth rate (‘‘SGR’’) formula. The use of the SGR formula would have resulted in calculated automatic reductions in rates in every year since 2002; however, for each year through September 30, 2015, Centers for Medicare & Medicaid Services (‘‘CMS’’) or Congress has taken action to prevent the implementation of SGR formula reductions. On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (‘‘MACRA’’) was signed into law, eliminating the SGR formula and the associated annual automatic rate reductions. For services provided between January 1, 2015 and June 30, 2015 a 0% payment update was applied to the Medicare physician fee schedule payment rates; for services provided between July 1, 2015 and December 31, 2015 a 0.5% increase was applied to the fee schedule payment rates; for services provided in 2016 a 0.3% decrease is being applied to the fee schedule payment rates, and for 2017 through 2019, a 0.5% increase will be applied each year to the fee schedule payment rates, unless further adjusted by CMS. In addition, the MACRA promotes the development of new payment models that focus on quality and outcomes. The Budget Control Act of 2011 increased the federal debt ceiling in connection with deficit reductions over the next ten years, and requires automatic reductions in federal spending by approximately $1.2 trillion. Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap. On April 1, 2013, a 2% reduction to Medicare payments was implemented. The Bipartisan Budget Act of 2015, enacted on November 2, 2015, extends the 2% reductions to Medicare payments through fiscal year 2025. As a result of the Balanced Budget Act of 1997, the formula for determining the total amount paid by Medicare in any one year for outpatient physical therapy, occupational therapy, and/or speech-language pathology services provided to any Medicare beneficiary (i.e., the ‘‘Therapy Cap’’ or ‘‘Limit’’) was established. Based on the statutory definitions which constrained how the Therapy Cap would be applied, there is one Limit for Physical Therapy and Speech Language Pathology Services combined, and one Limit for Occupational Therapy. For 2016, the annual Limit on outpatient therapy services is $1,960 for Physical and Speech Language Pathology Services combined and $1,960 for Occupational Therapy Services. Historically, these Therapy Caps applied to outpatient therapy services provided in all settings, except for services provided in departments of hospitals. However, the Protecting Access to Medicare Act of 2014, and prior legislation, extended the Therapy Caps to services furnished in hospital outpatient department settings. The application of these annual limits to hospital outpatient department settings will sunset on December 31, 2017 unless Congress extends it. In the Deficit Reduction Act of 2005, Congress implemented an exceptions process to the annual Limit for therapy expenses for therapy services above the annual Limit. Therapy services above the annual Limit that are medically necessary satisfy an exception to the annual Limit and such claims are payable by the Medicare program. The MACRA extended the exceptions process for outpatient therapy caps through December 31, 2017. Unless Congress extends the exceptions process further, the therapy caps will apply to all outpatient therapy services beginning January 1, 2018, except those services furnished and billed by outpatient hospital departments. For any claim above the annual Limit, the claim must contain a modifier indicating that the services are medically necessary and justified by appropriate documentation in the medical record. Furthermore, under the Middle Class Tax Relief and Job Creation Act of 2012 (‘‘MCTRA’’), since October 1, 2012, patients who met or exceeded $3,700 in therapy expenditures during a calendar year have been subject to a manual medical review to determine whether applicable payment criteria are satisfied. The $3,700 threshold is applied to Physical Therapy and Speech Language Pathology Services; a separate $3,700 threshold is applied to the Occupational Therapy. The MACRA directed CMS to modify the manual medical review process such that those reviews will no longer apply to all claims exceeding the $3,700 threshold and instead will be determined on a targeted basis based on a variety of factors that CMS considers appropriate. The new factors apply to exception requests for which CMS did not conduct a medical review by July 15, 2015. CMS adopted a multiple procedure payment reduction (‘‘MPPR’’) for therapy services in the final update to the MPFS for calendar year 2011. The MPPR applied to all outpatient therapy services paid under Medicare Part B — occupational therapy, physical therapy and speech-language pathology. Under the policy, the Medicare program pays 100% of the practice expense component of the Relative Value Unit (‘‘RVU’’) for the therapy procedure with the highest practice expense RVU, then reduces the payment for the practice expense component for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions. Since 2013, the practice expense component for the second and subsequent therapy service furnished during the same day for the same patient was reduced by 50%. In addition, the MCTRA directed CMS to implement a claims-based data collection program to gather additional data on patient function during the course of therapy in order to better understand patient conditions and outcomes. All practice settings that provide outpatient therapy services are required to include this data on the claim form. Since 2013, therapists have been required to report new codes and modifiers on the claim form that reflect a patient’s functional limitations and goals at initial evaluation, periodically throughout care, and at discharge, CMS has rejected claims if the required data is not included in the claim. The Physician Quality Reporting System, or ‘‘PQRS,’’ is a CMS reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by ‘‘eligible professionals.’’ Although physical therapists, occupational therapists and qualified speech-language therapists are generally able to participate in the PQRS program, therapy professionals for whose services we bill through our certified rehabilitation agencies cannot participate because the Medicare claims processing systems currently cannot accommodate institutional providers such as certified rehabilitation agencies. Eligible professionals, such as those of our therapy professionals for whose services we bill using their individual Medicare provider numbers, who do not satisfactorily report data on quality measures will be subject to a 2% reduction in their Medicare payment in 2016 and 2017. Statutes, regulations, and payment rules governing the delivery of therapy services to Medicare beneficiaries are complex and subject to interpretation. The Company believes that it is in compliance in all material respects with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on the Company’s financial statements as of June 30, 2016. Compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from the Medicare program. For the six months ended June 30, 2016, net revenue from Medicare accounts for approximately $41.1 million. Management Contract Revenues Management contract revenues are derived from contractual arrangements whereby the Company manages a clinic for third party owners. The Company does not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized when services are performed. Costs, typically salaries for the Company’s employees, are recorded when incurred. Management contract revenues are included in “other revenues” in the accompanying Consolidated Statements of Net Income. Contractual Allowances Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in Company clinics. The Company estimates contractual allowances based on its interpretation of the applicable regulations, payor contracts and historical calculations. Each month the Company estimates its contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on the Company’s historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow the Company to provide the necessary detail and accuracy with its collectability estimates. However, the services authorized and provided and related reimbursement are subject to interpretation that could result in payments that differ from the Company’s estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. The Company’s billing system does not capture the exact change in its contractual allowance reserve estimate from period to period in order to assess the accuracy of its revenues and hence its contractual allowance reserves. Management regularly compares its cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, the historical difference between net revenues and corresponding cash collections has generally reflected a difference within approximately 1% of net revenues. Additionally, analysis of subsequent period’s contractual write-offs on a payor basis reflects a difference within approximately 1% between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, the Company believes that a change in the contractual allowance reserve estimate would not likely be more than 1% at June 30, 2016. Income Taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. The Company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount to be recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority. The Company did not have any accrued interest or penalties associated with any unrecognized tax benefits nor was any interest expense recognized during the six months ended June 30, 2016 and 2015. The Company will book any interest or penalties, if required, in interest and/or other income/expense as appropriate. Fair Value of Financial Instruments The carrying amounts reported in the balance sheets for cash and cash equivalents, accounts receivable, accounts payable and notes payable approximate their fair values due to the short-term maturity of these financial instruments. The carrying amount under the Amended Credit Agreement (as defined in Note 9) approximates its fair value. The interest rate on the Amended Credit Agreement, which is tied to the Eurodollar Rate, is set at various short-term intervals, as detailed in the Amended Credit Agreement. Segment Reporting Operating segments are components of an enterprise for which separate financial information is available that is evaluated regularly by chief operating decision makers in deciding how to allocate resources and in assessing performance. The Company identifies operating segments based on management responsibility and believes it meets the criteria for aggregating its operating segments into a single reporting segment. Use of Estimates In preparing the Company’s consolidated financial statements, management makes certain estimates and assumptions, especially in relation to, but not limited to, purchase accounting, goodwill impairment, allowance for receivables, tax provision and contractual allowances, that affect the amounts reported in the consolidated financial statements and related disclosures. Actual results may differ from these estimates. Self-Insurance Program The Company utilizes a self-insurance plan for its employee group health insurance coverage administered by a third party. Predetermined loss limits have been arranged with the insurance company to minimize the Company’s maximum liability and cash outlay. Accrued expenses include the estimated incurred but unreported costs to settle unpaid claims and estimated future claims. Management believes that the current accrued amounts are sufficient to pay claims arising from self-insurance claims incurred through June 30, 2016. Restricted Stock Restricted stock issued to employees and directors is subject to continued employment or continued service on the board, respectively. Generally, restrictions on the stock granted to employees, other than executive officers, lapse in equal annual installments on the following four anniversaries of the date of grant. For those shares granted to directors, the restrictions will lapse in equal quarterly installments during the first year after the date of grant. For those granted to executive officers, the restriction will lapse in equal quarterly installments during the four years following the date of grant. Compensation expense for grants of restricted stock is recognized based on the fair value per share on the date of grant amortized over the vesting period. The restricted stock issued is included in basic and diluted shares for the earnings per share computation. Recently Adopted Accounting Guidance In September 2015, the FASB issued changes to the accounting for measurement-period adjustments related to business combinations. Currently, an acquiring entity is required to retrospectively adjust the balance sheet amounts of the acquiree recognized at the acquisition date with a corresponding adjustment to goodwill during the measurement period, as well as revise comparative information for prior periods presented within financial statements as needed, including revising income effects, such as depreciation and amortization, as a result of changes made to the balance sheet amounts of the acquiree. Such adjustments are required when new information is obtained about facts and circumstances that existed as of the acquisition date that if known, would have affected the measurement of the amounts initially recognized or would have resulted in the recognition of additional assets or liabilities. The measurement period is the period after the acquisition date during which the acquirer may adjust the balance sheet amounts recognized for a business combination (generally up to one year from the date of acquisition). The changes eliminate the requirement to make such retrospective adjustments, and, instead require the acquiring entity to record these adjustments in the reporting period they are determined. Additionally, the changes require the acquiring entity to present separately on the face of the income statement or disclose in the notes to the financial statements the portion of the amount recorded in current-period income by line item that would have been recorded in previous reporting periods if the adjustment to the balance sheet amounts had been recognized as of the acquisition date. These changes became effective for the Company on January 1, 2016. This change did not have a material impact on its consolidated financial statements. Recently Issued Accounting Guidance In February 2016, the FASB issued amended accounting guidance which replaced most existing lease accounting guidance under U. S. generally accepted accounting principles. Among other changes, the amended guidance requires that a right-to-use asset, which is an asset that represents the lessee’s right to use, and a lease liability, which is a lessee’s obligation to make lease payments arising for a lease measured on a discounted basis, be recognized on the balance sheet by lessees for those leases with a term of greater than 12 months. The amended guidance is effective for reporting periods beginning after December 15, 2018; however, early adoption is permitted. Entities are required to use a modified retrospective approach for leases that exist or are entered into after the beginning of the earliest comparative period in the financial statements. Since the Company leases all but one of its clinic facilities, it is currently evaluating various lease management systems to capture the necessary information and the impact that this amended accounting guidance will have on its consolidated financial statements. In March 2016, the FASB issued guidance to simplify some provisions in stock compensation accounting. The guidance amends how excess tax benefits, which are currently typically adjusted through additional paid-in capital but will become a component of the income tax provision/benefit in the interim period in which they occur, and a company’s payments to cover tax bills for shares’ recipients should be classified. This guidance allows companies to estimate the number of stock awards expected to vest and revises the withholding requirements for classifying stock awards as equity. For public business entities, this guidance is effective for fiscal years starting after December 15, 2016, including interim periods within those fiscal years. The Company is currently evaluating the impact that this guidance will have on its consolidated financial statements. Subsequent Event The Company has evaluated events occurring after the balance sheet date for possible disclosure as a subsequent event through the date that these consolidated financial statements were issued. |
EARNINGS PER SHARE
EARNINGS PER SHARE | 6 Months Ended |
Jun. 30, 2016 | |
EARNINGS PER SHARE [Abstract] | |
EARNINGS PER SHARE | 2. EARNINGS PER SHARE The computations of basic and diluted earnings per share for the Company are as follows (in thousands, except per share data): Three Months Ended Six Months Ended June 30, 2016 June 30, 2015 June 30, 2016 June 30, 2015 Earnings per share attributable to common shareholders: Prior to revaluation of redeemable non-controlling interests, net of tax $ 7,071 $ 6,304 $ 12,399 $ 10,470 Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax - (376 ) - (376 ) $ 7,071 $ 5,928 $ 12,399 $ 10,094 Basic earnings per share attributable to common shareholders: Prior to revaluation of redeemable non-controlling interests, net of tax $ 0.57 $ 0.51 $ 0.99 $ 0.85 Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax - (0.03 ) - (0.03 ) $ 0.57 $ 0.48 $ 0.99 $ 0.82 Diluted earnings per share attributable to common shareholders: Prior to revaluation of redeemable non-controlling interests, net of tax $ 0.57 $ 0.51 $ 0.99 $ 0.85 Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax - (0.03 ) - (0.03 ) $ 0.57 $ 0.48 $ 0.99 $ 0.82 Shares used in computation: Basic and diluted earnings per share - weighted-average shares 12,511 12,409 12,480 12,362 The Company’s restricted stock issued is included in basic and diluted shares for the earnings per share computation from the date of grant. There are no stock options or other dilutive securities outstanding. |
ACQUISITIONS OF BUSINESSES
ACQUISITIONS OF BUSINESSES | 6 Months Ended |
Jun. 30, 2016 | |
ACQUISITIONS OF BUSINESSES [Abstract] | |
ACQUISITIONS OF BUSINESSES | 3. ACQUISITIONS OF BUSINESSES On February 29, 2016, the Company acquired a 55% interest in an eight-clinic physical therapy practice. The purchase price for the 55% interest was $13.2 million in cash and $0.5 million in a seller note that is payable in two principal installments totaling $250,000 each, plus accrued interest, in February 2017 and 2018. On June 1, 2016, a subsidiary of the Company acquired a single clinic therapy practice for $50,000. The purchase price for the 2016 acquisitions has been preliminarily allocated as follows (in thousands): Cash paid, net of cash acquired $ 12,958 Seller notes 500 Total consideration $ 13,458 Estimated fair value of net tangible assets acquired: Total current assets $ 1,009 Total non-current assets 239 Total liabilities (417 ) Net tangible assets acquired $ 831 Referral relationships 1,915 Non-compete 525 Tradename 2,164 Goodwill 19,213 Fair value of non-controlling interest (11,190 ) $ 13,458 On December 31, 2015, the Company acquired a 59% interest in a four-clinic physical therapy practice. The purchase price was $4.6 million in cash and $400,000 in seller notes payable that are payable in two principal installments of an aggregate of $200,000 each, plus accrued interest, in December 2016 and 2017. On June 30, 2015, the Company acquired a 70% interest in a four-clinic physical therapy practice. The purchase price was $3.6 million in cash and $0.7 million in seller notes that are payable plus accrued interest, in June 2018. On April 30, 2015, the Company acquired a 70% interest in a three-clinic physical therapy practice. The purchase price was $4.7 million in cash and $150,000 in a seller note that is payable in two principal installments of $75,000 each, plus accrued interest, one of which was paid in April 2016 and the other is due in April 2017. On January 31, 2015, the Company acquired a 60% interest in a nine-clinic physical therapy practice. The purchase price for the 60% interest was $6.7 million in cash and $0.5 million in a seller note that is payable in two principal installments of $250,000 each, plus accrued interest, one of which was paid in January 2016 and the other is due in January 2017. In addition to the multi-clinic acquisitions, on August 31, 2015, the Company acquired a 60% interest in a single physical therapy clinic for $150,000 in cash and $50,000 in a seller note payable that is payable plus accrued interest in August 2016. The purchase prices for the 2015 acquisitions have been preliminarily allocated as follows (in thousands): Cash paid, net of cash acquired $ 18,965 Seller notes 1,800 Total consideration $ 20,765 Estimated fair value of net tangible assets acquired: Total current assets $ 1,969 Total non-current assets 1,070 Total liabilities (1,040 ) Net tangible assets acquired $ 1,999 Referral relationships 3,070 Non-compete 734 Tradename 3,317 Goodwill 23,937 Fair value of non-controlling interest (12,292 ) $ 20,765 For the 2016 and 2015 acquisitions that occurred after June 30, 2015, the purchase price plus the fair value of the non-controlling interests was allocated to the fair value of certain assets acquired (patient accounts receivable, equipment, prepaid expenses and deposits, tradename, non-compete agreements and referral relationships) and liabilities assumed (accounts payable and accrued employee salary and benefits) based on the preliminary estimates of the fair values at the acquisition date, with the amount exceeding the estimated fair values being recorded as goodwill. The Company is in the process of completing its formal valuation analysis. Thus, the final allocation of the purchase price will differ from the preliminary estimates used based on additional information obtained. Changes in the estimated valuation of the tangible and intangible assets acquired and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. For the above acquisitions, total current assets primarily represent patient accounts receivable. Total non-current assets are fixed assets, primarily equipment, used in the practices. The estimated values assigned to the referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives. For referral relationships, the range of the estimated lives was 12 to 13 years, and for non-compete agreements the estimated lives was six years. The values assigned to tradenames and goodwill is tested annually for impairment. The consideration for each transaction was agreed upon through arm’s length negotiations. Funding for the cash portion of the purchase price for the 2016 and 2015 acquisitions was derived from proceeds under the Amended Credit Agreement. The results of operations of these acquisitions have been included in the Company’s consolidated financial statements since acquired. Unaudited proforma consolidated financial information for acquisitions occurring in 2016 and 2015 have not been included as the results were not material to current operations. |
ACQUISITIONS OF NON-CONTROLLING
ACQUISITIONS OF NON-CONTROLLING INTERESTS | 6 Months Ended |
Jun. 30, 2016 | |
ACQUISITIONS OF NON-CONTROLLING INTERESTS [Abstract] | |
ACQUISITIONS OF NON-CONTROLLING INTERESTS | 4. ACQUISITIONS OF NON-CONTROLLING INTERESTS During the six months ended June 30, 2016, the Company acquired additional interests in two partnerships and sold interests in two partnerships. The interests in the partnerships purchased ranged from 23% to 35%. The aggregate purchase price paid was $388,000 in cash and $388,000 in a seller note, that is payable in two principal installments of $194,000 each in February 2017 and 2018. The purchase price included $59,000 of undistributed earnings. The remaining $716,000, less future tax benefits of $274,000, was recognized as an adjustment to additional paid-in capital. During the six months ended June 30, 2016, the Company sold a 4% interest in one partnership and 35% in another. The sales prices included aggregate cash of $138,000 plus notes receivable of $148,000 with payments due monthly based on percentages of distributions and bonuses earned by the purchasers. The total sales price of $286,000, less the tax effect of $110,000, was charged to additional paid-in capital. In 2015, the Company purchased additional interests in eight partnerships. The interests in the partnerships purchased ranged from 5% to 35%. The aggregate purchase price paid was $8.7 million of which $5.6 million was paid in cash and the Company entered into several notes payable of $3.1 million. The notes are payable in two installments plus accrued interest (interest accrues at 3.25%). The first principal installments in an aggregate of $1.2 million are due on December 31, 2018 and the second principal installments in an aggregate of $1.9 million are due on January 31, 2019. The purchase prices included an aggregate of $260,000 of undistributed earnings. The remaining $8.4 million, less future tax benefits of $3.3 million, was recognized as an adjustment to additional paid-in capital. |
REDEEMABLE NON-CONTROLLING INTE
REDEEMABLE NON-CONTROLLING INTERESTS | 6 Months Ended |
Jun. 30, 2016 | |
REDEEMABLE NON-CONTROLLING INTERESTS [Abstract] | |
REDEEMABLE NON-CONTROLLING INTERESTS | 5. REDEEMABLE NON-CONTROLLING INTERESTS In 2016, the Company purchased an additional interest in a partnership which was classified as redeemable non-controlling interest. The purchase price was $1.2 million in cash that is due and payable, with any accrued interest, in January 2018. The non-controlling interests that are reflected as redeemable non-controlling interests in the consolidated financial statements consist of those owners who have certain redemption rights that are currently exercisable, and that, if exercised, require that the Company purchase the non-controlling interests of those owners. The redeemable non-controlling interests are adjusted to the fair value in the reporting period in which the Company deems it probable that the limited partner will assert the redemption rights and it will be adjusted each reporting period thereafter. The adjustments are charged to additional paid-in capital and are not reflected in the statements of net income. For the six months ended June 30, 2016, the following table details the changes in the carrying amount of redeemable non-controlling interests: Six Months Ended June 30, 2016 Beginning balance $ 8,843 Operating results allocated to redeemable non-controlling interest partners 512 Distributions to redeemable non-controlling interest partners (428 ) Reclass of non-controlling interest 976 Payments for purchase of redeemable non-controlling interests (1,262 ) Ending balance $ 8,641 |
GOODWILL
GOODWILL | 6 Months Ended |
Jun. 30, 2016 | |
GOODWILL [Abstract] | |
GOODWILL | 6. GOODWILL The changes in the carrying amount of goodwill consisted of the following (in thousands): Six Months Ended June 30, 2016 Beginning balance $ 171,547 Goodwill acquired during the period 19,213 Goodwill adjustments for purchase price allocation of business acquired 508 Ending balance $ 191,268 |
INTANGIBLE ASSETS, NET
INTANGIBLE ASSETS, NET | 6 Months Ended |
Jun. 30, 2016 | |
INTANGIBLE ASSETS, NET [Abstract] | |
INTANGIBLE ASSETS, NET | 7. INTANGIBLE ASSETS, NET Intangible assets, net as of June 30, 2016 and December 31, 2015 consisted of the following (in thousands): June 30, 2016 December 31, 2015 Tradenames, net of accumulated amortization of $212 and $170, respectively $ 19,784 $ 17,660 Referral relationships, net of accumulated amortization of $4,438 and $3,763, respectively 12,108 10,866 Non-compete agreements, net of accumulated amortization of $3,136 and $2,855, respectively 2,017 1,770 $ 33,909 $ 30,296 Tradenames, referral relationships and non-compete agreements are related to the businesses acquired. Typically, the value assigned to tradenames has an indefinite life and is tested at least annually for impairment using the relief from royalty method in conjunction with the Company’s annual goodwill impairment test. However, for one acquisition, the value assigned to tradename which has a defined period of use is being amortized over the term of the six year agreement in which the Company has acquired the right to use the specific tradename. The value assigned to referral relationships is being amortized over their respective estimated useful lives which range from six to 16 years. Non-compete agreements are amortized over the respective term of the agreements which range from five to six years. The following table details the amount of amortization expense recorded for intangible assets for the three and six months ended June 30, 2016 and 2015 (in thousands): Three Months Ended Six Months Ended June 30, 2016 June 30, 2015 June 30, 2016 June 30, 2015 Tradenames $ 21 $ 21 $ 42 $ 42 Referral relationships 352 245 675 491 Non-compete agreements 147 104 281 208 $ 520 $ 370 $ 998 $ 741 Based on the balance of referral relationships and non-compete agreements as of June 30, 2016, the expected amount to be amortized in 2016 and thereafter by year is as follows (in thousands): Tradename Referral Relationships Non-Compete Agreements Years Annual Amount Years Annual Amount Years Annual Amount 2016 83 2016 1,379 2016 573 2017 84 2017 1,408 2017 546 2018 83 2018 1,362 2018 490 2019 80 2019 1,273 2019 418 2020 1,273 2020 203 2021 1,273 2021 65 2022 1,224 2023 1,117 2024 997 2025 891 2026 430 2027 135 2028 19 |
ACCRUED EXPENSES
ACCRUED EXPENSES | 6 Months Ended |
Jun. 30, 2016 | |
ACCRUED EXPENSES [Abstract] | |
ACCRUED EXPENSES | 8. ACCRUED EXPENSES Accrued expenses as of June 30, 2016 and December 31, 2015 consisted of the following (in thousands): June 30, 2016 December 31, 2015 Salaries and related costs $ 16,237 $ 9,414 Group health insurance claims 2,194 2,276 Credit balances due to patients and payors 3,549 1,472 Other 4,293 3,434 Total $ 26,273 $ 16,596 |
NOTES PAYABLE AND AMENDED CREDI
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT | 6 Months Ended |
Jun. 30, 2016 | |
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT [Abstract] | |
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT | 9. NOTES PAYABLE AND AMENDED CREDIT AGREEMENT Amounts outstanding under the Amended Credit Agreement and notes payable as of June 30, 2016 and December 31, 2015 consisted of the following (in thousands): June 30, 2016 December 31, 2015 Credit Agreement average effective interest rate of 2.3% inclusive of unused fee $ 42,500 $ 44,000 Various notes payable with $1,044 plus accrued interest due in the next year interest accrues in the range of 3.25% through 3.5% per annum 5,591 5,110 48,091 49,110 Less current portion (1,044 ) (775 ) Long term portion $ 47,047 $ 48,335 Effective December 5, 2013, we entered into an Amended and Restated Credit Agreement, as defined below, with a commitment for a $125.0 million revolving credit facility with a maturity date of November 30, 2018. This agreement was amended in August 2015 and January 2016 (hereafter referred to as “Amended Credit Agreement”). The Amended Credit Agreement is unsecured and has loan covenants, including requirements that the Company comply with a consolidated fixed charge coverage ratio and consolidated leverage ratio. Proceeds from the Amended Credit Agreement may be used for working capital, acquisitions, purchases of the Company’s common stock, dividend payments to the Company’s common shareholders, capital expenditures and other corporate purposes. The pricing grid is based on the Company’s consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.5% to 2.5% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Fees under the Amended Credit Agreement include an unused commitment fee ranging from 0.1% to 0.25% depending on the Company’s consolidated leverage ratio and the amount of funds outstanding under the Amended Credit Agreement. The January 2016 amendment to the Amended Credit Agreement increased the cash and noncash consideration that the Company could pay with respect to acquisitions permitted under the Amended Credit Agreement to $50,000,000 for any fiscal year, and increased the amount the Company may pay in cash dividends to its shareholders in an aggregate amount not to exceed $10,000,000 in any fiscal year. On June 30, 2016, $42.5 million was outstanding on the Amended Credit Agreement resulting in $82.5 million of availability. As of June 30, 2016, the Company was in compliance with all of the covenants thereunder. The Company generally enters into various notes payable as a means of financing a portion of its acquisitions and purchases of non-controlling interests. In conjunction with the acquisitions in 2016 and the purchases of a non-controlling interests, the Company entered into notes payable in the aggregate amount of $1.0 million of which an aggregate principal payment of $444,000 is due in 2017 and $570,000 in 2018. Interest accrues 3.5% per annum and is payable with each principal installment. In conjunction with the acquisitions in 2015 and the purchases of a non-controlling interest, the Company entered into notes payable in the aggregate amount of $4.9 million of which an aggregate principal payment of $575,000 was due in 2016 (of which $325,000 was paid prior to June 30, 2016), $525,000 in 2017, $1.9 million in 2018 and $1.9 million in 2019. Interest accrues in the range of 3.25% to 3.5% per annum and is payable with each principal installment. Aggregate annual payments of principal required pursuant to the Amended Credit Agreement and the above notes payable subsequent to June 30, 2016 are as follows (in thousands): During the twelve months ended June 30, 2017 $ 1,044 During the twelve months ended June 30, 2018 1,470 During the twelve months ended June 30, 2019 45,577 $ 48,091 |
COMMON STOCK
COMMON STOCK | 6 Months Ended |
Jun. 30, 2016 | |
COMMON STOCK [Abstract] | |
COMMON STOCK | 10. COMMON STOCK From September 2001 through December 31, 2008, the Board authorized the Company to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of the Company’s common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of its common stock (“March 2009 Authorization”). The Amended Credit Agreement permits share repurchases of up to $15,000,000, subject to compliance with convenants. The Company is required to retire shares purchased under the March 2009 Authorization. Under the March 2009 Authorization, the Company has purchased a total of 859,499 shares. There is no expiration date for the share repurchase program. There are currently an additional estimated 249,128 shares (based on the closing price of $60.21 on June 30, 2016) that may be purchased from time to time in the open market or private transactions depending on price, availability and the Company’s cash position. The Company did not purchase any shares of its common stock during the six months ended June 30, 2016. |
BASIS OF PRESENTATION AND SIG17
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Policies) | 6 Months Ended |
Jun. 30, 2016 | |
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES [Abstract] | |
Cash Equivalents | Cash Equivalents The Company maintains its cash and cash equivalents at financial institutions. The combined account balances at several institutions typically exceed Federal Deposit Insurance Corporation (“FDIC”) insurance coverage and, as a result, there is a concentration of credit risk related on deposits in excess of FDIC insurance coverage. Management believes that the risk is not significant. |
Long-Lived Assets | Long-Lived Assets Fixed assets are stated at cost. Depreciation is computed on the straight-line method over the estimated useful lives of the assets. Estimated useful lives for furniture and equipment range from three to eight years and for software purchased from three to seven years. Leasehold improvements are amortized over the shorter of the lease term or estimated useful lives of the assets, which is generally three to five years. |
Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of | Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of The Company reviews property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances which indicate that the amounts may be impaired. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell. |
Goodwill | Goodwill Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall, as applicable, is recognized as an adjustment to additional paid-in capital. The fair value of goodwill and other intangible assets with indefinite lives are tested for impairment annually and upon the occurrence of certain events, and are written down to fair value if considered impaired. The Company evaluates goodwill for impairment on at least an annual basis (in its third quarter) by comparing the fair value of its reporting units to the carrying value of each reporting unit including related goodwill. The Company operates a one segment business which is made up of various clinics within partnerships. The partnerships are components of regions and are aggregated to that operating segment level for the purpose of determining the Company’s reporting units when performing its annual goodwill impairment test. Currently, there are six regions. An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other intangible assets, exceeds the estimated fair value of the reporting unit. The estimated fair value of a reporting unit is determined using two factors: (i) earnings prior to taxes, depreciation and amortization for the reporting unit multiplied by a price/earnings ratio used in the industry and (ii) a discounted cash flow analysis. A weight is assigned to each factor and the sum of each weight times the factor is considered the estimated fair value. For 2015, the factors (i.e., price/earnings ratio, discount rate and residual capitalization rate) were updated to reflect current market conditions. The evaluations of goodwill in 2015 did not result in any goodwill amounts that were deemed impaired. During the six months ended June 30, 2016, the Company has not identified any triggering events occurring after the testing date that would impact the impairment testing results obtained. |
Non-controlling interests | Non-controlling interests The Company recognizes non-controlling interests as equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the income statement. Changes in a parent entity’s ownership interest in a subsidiary that do not result in deconsolidation are treated as equity transactions if the parent entity retains its controlling financial interest. The Company recognizes a gain or loss in net income when a subsidiary is deconsolidated. Such gain or loss is measured using the fair value of the non-controlling interest on the deconsolidation date. When the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall, as applicable, is recognized as an adjustment to additional paid-in capital. Additionally, operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner. The non-controlling interests that are reflected as redeemable non-controlling interests in the consolidated financial statements consist of those outside owners that have certain redemption rights that are currently exercisable, and that, if exercised, require that the Company purchases the non-controlling interest of the particular limited partner. At June 30, 2016, the redeemable non-controlling interests reflect the book value of certain non-controlling interests for which is it not deemed probable that the limited partner will assert the redemption rights. The redeemable non-controlling interests will be adjusted to the fair value in the reporting period in which the Company deems it probable that the limited partner will assert the redemption rights and will be adjusted each reporting period thereafter. The adjustments are charged to additional paid-in capital and are not reflected in the statements of net income. Although the adjustments are not reflected in the statements of net income, current accounting rules require that the Company reflects the charge in the earnings per share calculation. Typically, for acquisitions, the Company agrees to purchase the individual’s non-controlling interest at a predetermined multiple of earnings before interest, taxes, depreciation and amortization. |
Revenue Recognition | Revenue Recognition Revenues are recognized in the period in which services are rendered. Net patient revenues (patient revenues less estimated contractual adjustments) are reported at the estimated net realizable amounts from third-party payors, patients and others for services rendered. The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. The allowance for estimated contractual adjustments is based on terms of payor contracts and historical collection and write-off experience. The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in clinic operating costs in the statement of net income. Net accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible. Medicare Reimbursement The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (‘‘MPFS’’). The MPFS rates have historically been subject to an automatic annual update based on a formula, called the sustainable growth rate (‘‘SGR’’) formula. The use of the SGR formula would have resulted in calculated automatic reductions in rates in every year since 2002; however, for each year through September 30, 2015, Centers for Medicare & Medicaid Services (‘‘CMS’’) or Congress has taken action to prevent the implementation of SGR formula reductions. On April 16, 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (‘‘MACRA’’) was signed into law, eliminating the SGR formula and the associated annual automatic rate reductions. For services provided between January 1, 2015 and June 30, 2015 a 0% payment update was applied to the Medicare physician fee schedule payment rates; for services provided between July 1, 2015 and December 31, 2015 a 0.5% increase was applied to the fee schedule payment rates; for services provided in 2016 a 0.3% decrease is being applied to the fee schedule payment rates, and for 2017 through 2019, a 0.5% increase will be applied each year to the fee schedule payment rates, unless further adjusted by CMS. In addition, the MACRA promotes the development of new payment models that focus on quality and outcomes. The Budget Control Act of 2011 increased the federal debt ceiling in connection with deficit reductions over the next ten years, and requires automatic reductions in federal spending by approximately $1.2 trillion. Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap. On April 1, 2013, a 2% reduction to Medicare payments was implemented. The Bipartisan Budget Act of 2015, enacted on November 2, 2015, extends the 2% reductions to Medicare payments through fiscal year 2025. As a result of the Balanced Budget Act of 1997, the formula for determining the total amount paid by Medicare in any one year for outpatient physical therapy, occupational therapy, and/or speech-language pathology services provided to any Medicare beneficiary (i.e., the ‘‘Therapy Cap’’ or ‘‘Limit’’) was established. Based on the statutory definitions which constrained how the Therapy Cap would be applied, there is one Limit for Physical Therapy and Speech Language Pathology Services combined, and one Limit for Occupational Therapy. For 2016, the annual Limit on outpatient therapy services is $1,960 for Physical and Speech Language Pathology Services combined and $1,960 for Occupational Therapy Services. Historically, these Therapy Caps applied to outpatient therapy services provided in all settings, except for services provided in departments of hospitals. However, the Protecting Access to Medicare Act of 2014, and prior legislation, extended the Therapy Caps to services furnished in hospital outpatient department settings. The application of these annual limits to hospital outpatient department settings will sunset on December 31, 2017 unless Congress extends it. In the Deficit Reduction Act of 2005, Congress implemented an exceptions process to the annual Limit for therapy expenses for therapy services above the annual Limit. Therapy services above the annual Limit that are medically necessary satisfy an exception to the annual Limit and such claims are payable by the Medicare program. The MACRA extended the exceptions process for outpatient therapy caps through December 31, 2017. Unless Congress extends the exceptions process further, the therapy caps will apply to all outpatient therapy services beginning January 1, 2018, except those services furnished and billed by outpatient hospital departments. For any claim above the annual Limit, the claim must contain a modifier indicating that the services are medically necessary and justified by appropriate documentation in the medical record. Furthermore, under the Middle Class Tax Relief and Job Creation Act of 2012 (‘‘MCTRA’’), since October 1, 2012, patients who met or exceeded $3,700 in therapy expenditures during a calendar year have been subject to a manual medical review to determine whether applicable payment criteria are satisfied. The $3,700 threshold is applied to Physical Therapy and Speech Language Pathology Services; a separate $3,700 threshold is applied to the Occupational Therapy. The MACRA directed CMS to modify the manual medical review process such that those reviews will no longer apply to all claims exceeding the $3,700 threshold and instead will be determined on a targeted basis based on a variety of factors that CMS considers appropriate. The new factors apply to exception requests for which CMS did not conduct a medical review by July 15, 2015. CMS adopted a multiple procedure payment reduction (‘‘MPPR’’) for therapy services in the final update to the MPFS for calendar year 2011. The MPPR applied to all outpatient therapy services paid under Medicare Part B — occupational therapy, physical therapy and speech-language pathology. Under the policy, the Medicare program pays 100% of the practice expense component of the Relative Value Unit (‘‘RVU’’) for the therapy procedure with the highest practice expense RVU, then reduces the payment for the practice expense component for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions. Since 2013, the practice expense component for the second and subsequent therapy service furnished during the same day for the same patient was reduced by 50%. In addition, the MCTRA directed CMS to implement a claims-based data collection program to gather additional data on patient function during the course of therapy in order to better understand patient conditions and outcomes. All practice settings that provide outpatient therapy services are required to include this data on the claim form. Since 2013, therapists have been required to report new codes and modifiers on the claim form that reflect a patient’s functional limitations and goals at initial evaluation, periodically throughout care, and at discharge, CMS has rejected claims if the required data is not included in the claim. The Physician Quality Reporting System, or ‘‘PQRS,’’ is a CMS reporting program that uses a combination of incentive payments and payment reductions to promote reporting of quality information by ‘‘eligible professionals.’’ Although physical therapists, occupational therapists and qualified speech-language therapists are generally able to participate in the PQRS program, therapy professionals for whose services we bill through our certified rehabilitation agencies cannot participate because the Medicare claims processing systems currently cannot accommodate institutional providers such as certified rehabilitation agencies. Eligible professionals, such as those of our therapy professionals for whose services we bill using their individual Medicare provider numbers, who do not satisfactorily report data on quality measures will be subject to a 2% reduction in their Medicare payment in 2016 and 2017. Statutes, regulations, and payment rules governing the delivery of therapy services to Medicare beneficiaries are complex and subject to interpretation. The Company believes that it is in compliance in all material respects with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on the Company’s financial statements as of June 30, 2016. Compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from the Medicare program. For the six months ended June 30, 2016, net revenue from Medicare accounts for approximately $41.1 million. Management Contract Revenues Management contract revenues are derived from contractual arrangements whereby the Company manages a clinic for third party owners. The Company does not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized when services are performed. Costs, typically salaries for the Company’s employees, are recorded when incurred. Management contract revenues are included in “other revenues” in the accompanying Consolidated Statements of Net Income. |
Contractual Allowances | Contractual Allowances Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in Company clinics. The Company estimates contractual allowances based on its interpretation of the applicable regulations, payor contracts and historical calculations. Each month the Company estimates its contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on the Company’s historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow the Company to provide the necessary detail and accuracy with its collectability estimates. However, the services authorized and provided and related reimbursement are subject to interpretation that could result in payments that differ from the Company’s estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. The Company’s billing system does not capture the exact change in its contractual allowance reserve estimate from period to period in order to assess the accuracy of its revenues and hence its contractual allowance reserves. Management regularly compares its cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, the historical difference between net revenues and corresponding cash collections has generally reflected a difference within approximately 1% of net revenues. Additionally, analysis of subsequent period’s contractual write-offs on a payor basis reflects a difference within approximately 1% between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, the Company believes that a change in the contractual allowance reserve estimate would not likely be more than 1% at June 30, 2016. |
Income Taxes | Income Taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax basis and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. The Company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount to be recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority. The Company did not have any accrued interest or penalties associated with any unrecognized tax benefits nor was any interest expense recognized during the six months ended June 30, 2016 and 2015. The Company will book any interest or penalties, if required, in interest and/or other income/expense as appropriate. |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying amounts reported in the balance sheets for cash and cash equivalents, accounts receivable, accounts payable and notes payable approximate their fair values due to the short-term maturity of these financial instruments. The carrying amount under the Amended Credit Agreement (as defined in Note 9) approximates its fair value. The interest rate on the Amended Credit Agreement, which is tied to the Eurodollar Rate, is set at various short-term intervals, as detailed in the Amended Credit Agreement. |
Segment Reporting | Segment Reporting Operating segments are components of an enterprise for which separate financial information is available that is evaluated regularly by chief operating decision makers in deciding how to allocate resources and in assessing performance. The Company identifies operating segments based on management responsibility and believes it meets the criteria for aggregating its operating segments into a single reporting segment. |
Use of Estimates | Use of Estimates In preparing the Company’s consolidated financial statements, management makes certain estimates and assumptions, especially in relation to, but not limited to, purchase accounting, goodwill impairment, allowance for receivables, tax provision and contractual allowances, that affect the amounts reported in the consolidated financial statements and related disclosures. Actual results may differ from these estimates. |
Self-Insurance Program | Self-Insurance Program The Company utilizes a self-insurance plan for its employee group health insurance coverage administered by a third party. Predetermined loss limits have been arranged with the insurance company to minimize the Company’s maximum liability and cash outlay. Accrued expenses include the estimated incurred but unreported costs to settle unpaid claims and estimated future claims. Management believes that the current accrued amounts are sufficient to pay claims arising from self-insurance claims incurred through June 30, 2016. |
Restricted Stock | Restricted Stock Restricted stock issued to employees and directors is subject to continued employment or continued service on the board, respectively. Generally, restrictions on the stock granted to employees, other than executive officers, lapse in equal annual installments on the following four anniversaries of the date of grant. For those shares granted to directors, the restrictions will lapse in equal quarterly installments during the first year after the date of grant. For those granted to executive officers, the restriction will lapse in equal quarterly installments during the four years following the date of grant. Compensation expense for grants of restricted stock is recognized based on the fair value per share on the date of grant amortized over the vesting period. The restricted stock issued is included in basic and diluted shares for the earnings per share computation. |
Recently Adopted Accounting Guidance | Recently Adopted Accounting Guidance In September 2015, the FASB issued changes to the accounting for measurement-period adjustments related to business combinations. Currently, an acquiring entity is required to retrospectively adjust the balance sheet amounts of the acquiree recognized at the acquisition date with a corresponding adjustment to goodwill during the measurement period, as well as revise comparative information for prior periods presented within financial statements as needed, including revising income effects, such as depreciation and amortization, as a result of changes made to the balance sheet amounts of the acquiree. Such adjustments are required when new information is obtained about facts and circumstances that existed as of the acquisition date that if known, would have affected the measurement of the amounts initially recognized or would have resulted in the recognition of additional assets or liabilities. The measurement period is the period after the acquisition date during which the acquirer may adjust the balance sheet amounts recognized for a business combination (generally up to one year from the date of acquisition). The changes eliminate the requirement to make such retrospective adjustments, and, instead require the acquiring entity to record these adjustments in the reporting period they are determined. Additionally, the changes require the acquiring entity to present separately on the face of the income statement or disclose in the notes to the financial statements the portion of the amount recorded in current-period income by line item that would have been recorded in previous reporting periods if the adjustment to the balance sheet amounts had been recognized as of the acquisition date. These changes became effective for the Company on January 1, 2016. This change did not have a material impact on its consolidated financial statements. |
Recently Issued Accounting Guidance | Recently Issued Accounting Guidance In February 2016, the FASB issued amended accounting guidance which replaced most existing lease accounting guidance under U. S. generally accepted accounting principles. Among other changes, the amended guidance requires that a right-to-use asset, which is an asset that represents the lessee’s right to use, and a lease liability, which is a lessee’s obligation to make lease payments arising for a lease measured on a discounted basis, be recognized on the balance sheet by lessees for those leases with a term of greater than 12 months. The amended guidance is effective for reporting periods beginning after December 15, 2018; however, early adoption is permitted. Entities are required to use a modified retrospective approach for leases that exist or are entered into after the beginning of the earliest comparative period in the financial statements. Since the Company leases all but one of its clinic facilities, it is currently evaluating various lease management systems to capture the necessary information and the impact that this amended accounting guidance will have on its consolidated financial statements. In March 2016, the FASB issued guidance to simplify some provisions in stock compensation accounting. The guidance amends how excess tax benefits, which are currently typically adjusted through additional paid-in capital but will become a component of the income tax provision/benefit in the interim period in which they occur, and a company’s payments to cover tax bills for shares’ recipients should be classified. This guidance allows companies to estimate the number of stock awards expected to vest and revises the withholding requirements for classifying stock awards as equity. For public business entities, this guidance is effective for fiscal years starting after December 15, 2016, including interim periods within those fiscal years. The Company is currently evaluating the impact that this guidance will have on its consolidated financial statements. |
Subsequent Event | Subsequent Event The Company has evaluated events occurring after the balance sheet date for possible disclosure as a subsequent event through the date that these consolidated financial statements were issued. |
BASIS OF PRESENTATION AND SIG18
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES [Abstract] | |
Schedule of Clinic Acquisition | During the first six months of 2016 and the year ended 2015, the Company acquired the following clinic groups: Date % Interest Acquired Number of Clinics 2016 February 2016 Acquisition February 29 55% 8 2015 January 2015 Acquisition January 31 60% 9 April 2015 Acquisition April 30 70% 3 June 2015 Acquisition June 30 70% 4 December 2015 Acquisition December 31 59% 4 |
EARNINGS PER SHARE (Tables)
EARNINGS PER SHARE (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
EARNINGS PER SHARE [Abstract] | |
Computations of Basic and Diluted Earnings Per Share | The computations of basic and diluted earnings per share for the Company are as follows (in thousands, except per share data): Three Months Ended Six Months Ended June 30, 2016 June 30, 2015 June 30, 2016 June 30, 2015 Earnings per share attributable to common shareholders: Prior to revaluation of redeemable non-controlling interests, net of tax $ 7,071 $ 6,304 $ 12,399 $ 10,470 Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax - (376 ) - (376 ) $ 7,071 $ 5,928 $ 12,399 $ 10,094 Basic earnings per share attributable to common shareholders: Prior to revaluation of redeemable non-controlling interests, net of tax $ 0.57 $ 0.51 $ 0.99 $ 0.85 Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax - (0.03 ) - (0.03 ) $ 0.57 $ 0.48 $ 0.99 $ 0.82 Diluted earnings per share attributable to common shareholders: Prior to revaluation of redeemable non-controlling interests, net of tax $ 0.57 $ 0.51 $ 0.99 $ 0.85 Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax - (0.03 ) - (0.03 ) $ 0.57 $ 0.48 $ 0.99 $ 0.82 Shares used in computation: Basic and diluted earnings per share - weighted-average shares 12,511 12,409 12,480 12,362 |
ACQUISITIONS OF BUSINESSES (Tab
ACQUISITIONS OF BUSINESSES (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
ACQUISITIONS OF BUSINESSES [Abstract] | |
Schedule of Preliminary Purchase Prices Allocation | The purchase price for the 2016 acquisitions has been preliminarily allocated as follows (in thousands): Cash paid, net of cash acquired $ 12,958 Seller notes 500 Total consideration $ 13,458 Estimated fair value of net tangible assets acquired: Total current assets $ 1,009 Total non-current assets 239 Total liabilities (417 ) Net tangible assets acquired $ 831 Referral relationships 1,915 Non-compete 525 Tradename 2,164 Goodwill 19,213 Fair value of non-controlling interest (11,190 ) $ 13,458 The purchase prices for the 2015 acquisitions have been preliminarily allocated as follows (in thousands): Cash paid, net of cash acquired $ 18,965 Seller notes 1,800 Total consideration $ 20,765 Estimated fair value of net tangible assets acquired: Total current assets $ 1,969 Total non-current assets 1,070 Total liabilities (1,040 ) Net tangible assets acquired $ 1,999 Referral relationships 3,070 Non-compete 734 Tradename 3,317 Goodwill 23,937 Fair value of non-controlling interest (12,292 ) $ 20,765 |
REDEEMABLE NON-CONTROLLING IN21
REDEEMABLE NON-CONTROLLING INTERESTS (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
REDEEMABLE NON-CONTROLLING INTERESTS [Abstract] | |
Changes in Carrying Amount of Redeemable Non-Controlling Interest | For the six months ended June 30, 2016, the following table details the changes in the carrying amount of redeemable non-controlling interests: Six Months Ended June 30, 2016 Beginning balance $ 8,843 Operating results allocated to redeemable non-controlling interest partners 512 Distributions to redeemable non-controlling interest partners (428 ) Reclass of non-controlling interest 976 Payments for purchase of redeemable non-controlling interests (1,262 ) Ending balance $ 8,641 |
GOODWILL (Tables)
GOODWILL (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
GOODWILL [Abstract] | |
Summary of Changes in Carrying Amount of Goodwill | The changes in the carrying amount of goodwill consisted of the following (in thousands): Six Months Ended June 30, 2016 Beginning balance $ 171,547 Goodwill acquired during the period 19,213 Goodwill adjustments for purchase price allocation of business acquired 508 Ending balance $ 191,268 |
INTANGIBLE ASSETS, NET (Tables)
INTANGIBLE ASSETS, NET (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
INTANGIBLE ASSETS, NET [Abstract] | |
Intangible Assets, Net | Intangible assets, net as of June 30, 2016 and December 31, 2015 consisted of the following (in thousands): June 30, 2016 December 31, 2015 Tradenames, net of accumulated amortization of $212 and $170, respectively $ 19,784 $ 17,660 Referral relationships, net of accumulated amortization of $4,438 and $3,763, respectively 12,108 10,866 Non-compete agreements, net of accumulated amortization of $3,136 and $2,855, respectively 2,017 1,770 $ 33,909 $ 30,296 |
Amortization Expenses | The following table details the amount of amortization expense recorded for intangible assets for the three and six months ended June 30, 2016 and 2015 (in thousands): Three Months Ended Six Months Ended June 30, 2016 June 30, 2015 June 30, 2016 June 30, 2015 Tradenames $ 21 $ 21 $ 42 $ 42 Referral relationships 352 245 675 491 Non-compete agreements 147 104 281 208 $ 520 $ 370 $ 998 $ 741 |
Amortization of Tradename, Referral Relationships and Non-Competition Agreements | Based on the balance of referral relationships and non-compete agreements as of June 30, 2016, the expected amount to be amortized in 2016 and thereafter by year is as follows (in thousands): Tradename Referral Relationships Non-Compete Agreements Years Annual Amount Years Annual Amount Years Annual Amount 2016 83 2016 1,379 2016 573 2017 84 2017 1,408 2017 546 2018 83 2018 1,362 2018 490 2019 80 2019 1,273 2019 418 2020 1,273 2020 203 2021 1,273 2021 65 2022 1,224 2023 1,117 2024 997 2025 891 2026 430 2027 135 2028 19 |
ACCRUED EXPENSES (Tables)
ACCRUED EXPENSES (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
ACCRUED EXPENSES [Abstract] | |
Summary of Accrued Expenses | Accrued expenses as of June 30, 2016 and December 31, 2015 consisted of the following (in thousands): June 30, 2016 December 31, 2015 Salaries and related costs $ 16,237 $ 9,414 Group health insurance claims 2,194 2,276 Credit balances due to patients and payors 3,549 1,472 Other 4,293 3,434 Total $ 26,273 $ 16,596 |
NOTES PAYABLE AND AMENDED CRE25
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT (Tables) | 6 Months Ended |
Jun. 30, 2016 | |
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT [Abstract] | |
Summary of Credit Agreement and Notes Payable | Amounts outstanding under the Amended Credit Agreement and notes payable as of June 30, 2016 and December 31, 2015 consisted of the following (in thousands): June 30, 2016 December 31, 2015 Credit Agreement average effective interest rate of 2.3% inclusive of unused fee $ 42,500 $ 44,000 Various notes payable with $1,044 plus accrued interest due in the next year interest accrues in the range of 3.25% through 3.5% per annum 5,591 5,110 48,091 49,110 Less current portion (1,044 ) (775 ) Long term portion $ 47,047 $ 48,335 |
Summary of Aggregate Annual Payments of Principal Required to Revolving Credit Facility | Aggregate annual payments of principal required pursuant to the Amended Credit Agreement and the above notes payable subsequent to June 30, 2016 are as follows (in thousands): During the twelve months ended June 30, 2017 $ 1,044 During the twelve months ended June 30, 2018 1,470 During the twelve months ended June 30, 2019 45,577 $ 48,091 |
BASIS OF PRESENTATION AND SIG26
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Details) | 6 Months Ended | |
Jun. 30, 2016USD ($)ClinicStateFacilitySegmentRegion | Jun. 30, 2015USD ($) | |
Depreciation Amortization Impairment [Line Items] | ||
Percentage of general partnership interest owned | 1.00% | |
Percentage of limited partnership interest owned | 6.00% | |
Number of clinics operated | Clinic | 516 | |
Number of states where clinics are operated | State | 42 | |
Number of third party facilities | Facility | 22 | |
Number of business segments | Segment | 1 | |
Number of regions | Region | 6 | |
Federal debt ceiling in connection with deficit reductions | 10 years | |
Reductions in federal spending | $ 1,200,000,000,000 | |
Medicare spending cut percentage | 2.00% | |
Net revenue from Medicare accounts | $ 41,100,000 | |
Combined physical therapy/speech language pathology expenses | $ 3,700 | |
Percentage of practice expense component | 100.00% | |
Percentage reduction for service | 50.00% | |
Difference between net revenues and corresponding cash collections, approximately of net revenues | 1.00% | |
Difference between actual aggregate contractual reserve and estimated contractual allowance reserve percentage | 1.00% | |
Maximum contractual allowance reserve estimate | 1.00% | |
Unrecognized tax benefit | $ 0 | $ 0 |
Accrued interest and penalties associated with any unrecognized tax benefits | 0 | 0 |
Interest expense recognized | $ 0 | $ 0 |
Year 2016 [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Percentage increase (decrease) of medicare payment | (0.30%) | |
Expected reduction in Medicare spending percentage | 2.00% | |
Year 2017 [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Expected reduction in Medicare spending percentage | 2.00% | |
January 1, 2015 through June 30, 2015 [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Percentage increase (decrease) of medicare payment | 0.00% | |
July 1, 2015 through December 31, 2015 [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Percentage increase (decrease) of medicare payment | 0.50% | |
From 2017 through 2019 [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Percentage increase (decrease) of medicare payment | 0.50% | |
Minimum [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Percentage of limited partnership interest owned | 49.00% | |
Minimum [Member] | Furniture & Equipment [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Estimated useful lives | 3 years | |
Minimum [Member] | Software [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Estimated useful lives | 3 years | |
Minimum [Member] | Leasehold Improvements [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Estimated useful lives | 3 years | |
Maximum [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Percentage of limited partnership interest owned | 99.00% | |
Maximum [Member] | Year 2016 [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Annual limit on physical therapy and speech language pathology services | $ 1,960 | |
Annual limit occupational therapy services | $ 1,960 | |
Maximum [Member] | Furniture & Equipment [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Estimated useful lives | 8 years | |
Maximum [Member] | Software [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Estimated useful lives | 7 years | |
Maximum [Member] | Leasehold Improvements [Member] | ||
Depreciation Amortization Impairment [Line Items] | ||
Estimated useful lives | 5 years |
BASIS OF PRESENTATION AND SIG27
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES - Schedule of Clinic Acquisition (Details) - Clinic | 6 Months Ended | 12 Months Ended |
Jun. 30, 2016 | Dec. 31, 2015 | |
February 2016 Acquisition [Member] | ||
Business Acquisition [Line Items] | ||
Acquisition date | Feb. 29, 2016 | |
Percentage of interest acquired | 55.00% | |
Number of Clinics | 8 | |
January 2015 Acquisition [Member] | ||
Business Acquisition [Line Items] | ||
Acquisition date | Jan. 31, 2015 | |
Percentage of interest acquired | 60.00% | |
Number of Clinics | 9 | |
April 2015 Acquisition [Member] | ||
Business Acquisition [Line Items] | ||
Acquisition date | Apr. 30, 2015 | |
Percentage of interest acquired | 70.00% | |
Number of Clinics | 3 | |
June 2015 Acquisition [Member] | ||
Business Acquisition [Line Items] | ||
Acquisition date | Jun. 30, 2015 | |
Percentage of interest acquired | 70.00% | |
Number of Clinics | 4 | |
December 2015 Acquisition [Member] | ||
Business Acquisition [Line Items] | ||
Acquisition date | Dec. 31, 2015 | |
Percentage of interest acquired | 59.00% | |
Number of Clinics | 4 |
EARNINGS PER SHARE (Details)
EARNINGS PER SHARE (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2016 | Jun. 30, 2015 | Jun. 30, 2016 | Jun. 30, 2015 | |
Earnings per share attributable to common shareholders [Abstract] | ||||
Prior to revaluation of redeemable non-controlling interests, net of tax | $ 7,071 | $ 6,304 | $ 12,399 | $ 10,470 |
Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax | 0 | (376) | 0 | (376) |
Net income attributable to common shareholders | $ 7,071 | $ 5,928 | $ 12,399 | $ 10,094 |
Basic earnings per share attributable to common shareholders [Abstract] | ||||
Prior to revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | $ 0.57 | $ 0.51 | $ 0.99 | $ 0.85 |
Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | 0 | (0.03) | 0 | (0.03) |
Basic earnings per share attributable to common shareholders (in dollars per share) | 0.57 | 0.48 | 0.99 | 0.82 |
Diluted earnings per share attributable to common shareholders [Abstract] | ||||
Prior to revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | 0.57 | 0.51 | 0.99 | 0.85 |
Charges to additional paid-in-capital - revaluation of redeemable non-controlling interests, net of tax (in dollars per share) | 0 | (0.03) | 0 | (0.03) |
Diluted earnings per share attributable to common shareholders (in dollars per share) | $ 0.57 | $ 0.48 | $ 0.99 | $ 0.82 |
Shares used in computation [Abstract] | ||||
Basic and diluted earnings per share - weighted-average shares (in shares) | 12,511 | 12,409 | 12,480 | 12,362 |
ACQUISITIONS OF BUSINESSES (Det
ACQUISITIONS OF BUSINESSES (Details) | Jun. 01, 2016USD ($) | Feb. 29, 2016USD ($)ClinicInstallment | Aug. 31, 2015USD ($)Clinic | Jun. 30, 2015USD ($)Clinic | Apr. 30, 2015USD ($)ClinicInstallment | Jan. 31, 2015USD ($)ClinicInstallment | Jun. 30, 2016USD ($) | Jun. 30, 2015USD ($) | Dec. 31, 2015USD ($)ClinicInstallment |
Business Acquisition [Line Items] | |||||||||
Seller notes issued for acquisition of interest in clinic | $ 500,000 | $ 388,000 | $ 1,800,000 | ||||||
Cash paid, net of cash acquired | 12,958,000 | 12,958,000 | $ 14,467,000 | 18,965,000 | |||||
Seller notes | 500,000 | $ 388,000 | 1,800,000 | ||||||
Total consideration | 13,458,000 | 20,765,000 | |||||||
Estimated fair value of net tangible assets acquired [Abstract] | |||||||||
Total current assets | 1,009,000 | 1,969,000 | |||||||
Total non-current assets | 239,000 | 1,070,000 | |||||||
Total liabilities | (417,000) | (1,040,000) | |||||||
Net tangible assets acquired | 831,000 | 1,999,000 | |||||||
Referral relationships | 1,915,000 | 3,070,000 | |||||||
Non-compete | 525,000 | 734,000 | |||||||
Tradename | 2,164,000 | 3,317,000 | |||||||
Goodwill | 19,213,000 | 23,937,000 | |||||||
Fair value of non-controlling interest | (11,190,000) | (12,292,000) | |||||||
Total consideration | $ 13,458,000 | $ 20,765,000 | |||||||
Minimum [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Percentage of interest acquired | 23.00% | 5.00% | |||||||
Maximum [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Percentage of interest acquired | 35.00% | 35.00% | |||||||
February 2017 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 194,000 | ||||||||
February 2018 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 194,000 | ||||||||
Referral Relationships [Member] | Minimum [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Estimated useful lives of acquired intangibles | 12 years | ||||||||
Referral Relationships [Member] | Maximum [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Estimated useful lives of acquired intangibles | 13 years | ||||||||
Non-compete Agreements [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Estimated useful lives of acquired intangibles | 6 years | ||||||||
Acquisition Of Three Clinic Practices [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of clinic practices acquired | Clinic | 3 | ||||||||
Percentage of interest acquired | 70.00% | ||||||||
Cash paid for acquisition of interest in clinic | $ 4,700,000 | ||||||||
Seller notes issued for acquisition of interest in clinic | $ 150,000 | ||||||||
Business acquisition number of installments to payment of purchase consideration | Installment | 2 | ||||||||
Seller notes | $ 150,000 | ||||||||
Acquisition Of Three Clinic Practices [Member] | April 2016 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | 75,000 | ||||||||
Acquisition Of Three Clinic Practices [Member] | April 2017 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 75,000 | ||||||||
Acquisition Of Four Clinic Practices [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of clinic practices acquired | Clinic | 4 | 4 | |||||||
Percentage of interest acquired | 70.00% | 70.00% | 59.00% | ||||||
Cash paid for acquisition of interest in clinic | $ 3,600,000 | $ 4,600,000 | |||||||
Seller notes issued for acquisition of interest in clinic | 700,000 | $ 700,000 | $ 400,000 | ||||||
Business acquisition number of installments to payment of purchase consideration | Installment | 2 | ||||||||
Seller notes | 700,000 | $ 700,000 | $ 400,000 | ||||||
Acquisition Of Four Clinic Practices [Member] | December 2016 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | 200,000 | ||||||||
Acquisition Of Four Clinic Practices [Member] | December 2017 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 200,000 | ||||||||
Acquisition Of Four Clinic Practices [Member] | June 2018 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 700,000 | ||||||||
Acquisition Of Eight Clinic Practices [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of clinic practices acquired | Clinic | 8 | ||||||||
Percentage of interest acquired | 55.00% | ||||||||
Cash paid for acquisition of interest in clinic | $ 13,200,000 | ||||||||
Seller notes issued for acquisition of interest in clinic | $ 500,000 | ||||||||
Business acquisition number of installments to payment of purchase consideration | Installment | 2 | ||||||||
Seller notes | $ 500,000 | ||||||||
Acquisition Of Eight Clinic Practices [Member] | February 2017 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | 250,000 | ||||||||
Acquisition Of Eight Clinic Practices [Member] | February 2018 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 250,000 | ||||||||
Acquisition Of Nine Clinic Practices [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of clinic practices acquired | Clinic | 9 | ||||||||
Percentage of interest acquired | 60.00% | ||||||||
Cash paid for acquisition of interest in clinic | $ 6,700,000 | ||||||||
Seller notes issued for acquisition of interest in clinic | $ 500,000 | ||||||||
Business acquisition number of installments to payment of purchase consideration | Installment | 2 | ||||||||
Seller notes | $ 500,000 | ||||||||
Acquisition Of Nine Clinic Practices [Member] | January 2016 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | 250,000 | ||||||||
Acquisition Of Nine Clinic Practices [Member] | January 2017 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 250,000 | ||||||||
Acquisition Of Single Clinic Practices [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of clinic practices acquired | Clinic | 1 | ||||||||
Percentage of interest acquired | 60.00% | ||||||||
Cash paid for acquisition of interest in clinic | $ 150,000 | ||||||||
Seller notes issued for acquisition of interest in clinic | 50,000 | ||||||||
Seller notes | 50,000 | ||||||||
Acquisition Of Single Clinic Practices [Member] | August 2016 [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Acquisition cost payable in two principal installments including accrued interest | $ 50,000 | ||||||||
Acquisition of Single Clinic Therapy Practice [Member] | |||||||||
Business Acquisition [Line Items] | |||||||||
Cash paid for acquisition of interest in clinic | $ 50,000 |
ACQUISITIONS OF NON-CONTROLLI30
ACQUISITIONS OF NON-CONTROLLING INTERESTS (Details) | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2016USD ($)InstallmentPartnership | Jun. 30, 2015USD ($) | Dec. 31, 2015USD ($)InstallmentPartnership | Feb. 29, 2016USD ($) | |
Business Acquisition [Line Items] | ||||
Number of partnership in which interest acquired | Partnership | 2 | 8 | ||
Number of partnership in which interest sold | Partnership | 2 | |||
Sale of non-controlling interest percentage in partnership one | 4.00% | |||
Sale of non-controlling interest percentage in partnership two | 35.00% | |||
Cash proceeds from sale of non-controlling interest | $ 138,000 | |||
Amount of notes receivable from sale of non-controlling interest | 148,000 | |||
Total sale price | 286,000 | |||
Tax effect on sale price | 110,000 | |||
Purchase price for additional non controlling interest | 388,000 | $ 8,700,000 | ||
Acquisitions of noncontrolling interests | 1,386,000 | $ 968,000 | 5,600,000 | |
Seller notes | $ 388,000 | 1,800,000 | $ 500,000 | |
Notes payable | $ 3,100,000 | |||
Number of installments | Installment | 2 | 2 | ||
Accrued interest rate | 3.25% | |||
Book value of purchase price | $ 59,000 | $ 260,000 | ||
Remaining purchase price | 716,000 | 8,400,000 | ||
Future tax benefits | 274,000 | 3,300,000 | ||
February 2017 [Member] | ||||
Business Acquisition [Line Items] | ||||
Acquisition cost payable in two principal installments including accrued interest | 194,000 | |||
February 2018 [Member] | ||||
Business Acquisition [Line Items] | ||||
Acquisition cost payable in two principal installments including accrued interest | $ 194,000 | |||
December 31, 2018 [Member] | ||||
Business Acquisition [Line Items] | ||||
Acquisition cost payable in two principal installments including accrued interest | 1,200,000 | |||
January 31, 2019 [Member] | ||||
Business Acquisition [Line Items] | ||||
Acquisition cost payable in two principal installments including accrued interest | $ 1,900,000 | |||
Minimum [Member] | ||||
Business Acquisition [Line Items] | ||||
Percentage of interest acquired | 23.00% | 5.00% | ||
Maximum [Member] | ||||
Business Acquisition [Line Items] | ||||
Percentage of interest acquired | 35.00% | 35.00% |
REDEEMABLE NON-CONTROLLING IN31
REDEEMABLE NON-CONTROLLING INTERESTS (Details) - USD ($) | 6 Months Ended | 12 Months Ended |
Jun. 30, 2016 | Dec. 31, 2015 | |
Changes in Carrying Amount of Redeemable Non-Controlling Interest [Roll Forward] | ||
Beginning balance | $ 8,843,000 | |
Operating results allocated to redeemable non-controlling interest partners | 512,000 | |
Distributions to redeemable non-controlling interest partners | (428,000) | |
Reclass of non-controlling interest | 976,000 | |
Payments for purchase of redeemable non-controlling interests | (1,262,000) | |
Ending balance | 8,641,000 | $ 8,843,000 |
Redeemable Noncontrolling Interest [Line Items] | ||
Purchase price for additional non controlling interest | 388,000 | $ 8,700,000 |
January 2018 [Member] | ||
Redeemable Noncontrolling Interest [Line Items] | ||
Purchase price for additional non controlling interest in cash | 1,200,000 | |
Purchase price for additional non controlling interest | $ 100,000 |
GOODWILL (Details)
GOODWILL (Details) $ in Thousands | 6 Months Ended |
Jun. 30, 2016USD ($) | |
Goodwill [Roll Forward] | |
Beginning balance | $ 171,547 |
Goodwill acquired during the period | 19,213 |
Goodwill adjustments for purchase price allocation of business acquired | 508 |
Ending balance | $ 191,268 |
INTANGIBLE ASSETS, NET (Details
INTANGIBLE ASSETS, NET (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2016 | Dec. 31, 2015 | |
Finite Lived Intangible Assets [Line Items] | ||
Total | $ 33,909 | $ 30,296 |
Tradenames [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Total | 19,784 | 17,660 |
Accumulated amortization | $ 212 | 170 |
Estimated useful life | 6 years | |
Referral Relationships [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Total | $ 12,108 | 10,866 |
Accumulated amortization | $ 4,438 | 3,763 |
Referral Relationships [Member] | Minimum [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Estimated useful life | 6 years | |
Referral Relationships [Member] | Maximum [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Estimated useful life | 16 years | |
Non-compete Agreements [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Total | $ 2,017 | 1,770 |
Accumulated amortization | $ 3,136 | $ 2,855 |
Non-compete Agreements [Member] | Minimum [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Estimated useful life | 5 years | |
Non-compete Agreements [Member] | Maximum [Member] | ||
Finite Lived Intangible Assets [Line Items] | ||
Estimated useful life | 6 years |
INTANGIBLE ASSETS, NET - Amorti
INTANGIBLE ASSETS, NET - Amortization Expenses (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2016 | Jun. 30, 2015 | Jun. 30, 2016 | Jun. 30, 2015 | |
Finite Lived Intangible Assets [Line Items] | ||||
Total amortization expenses | $ 520 | $ 370 | $ 998 | $ 741 |
Tradenames [Member] | ||||
Finite Lived Intangible Assets [Line Items] | ||||
Total amortization expenses | 21 | 21 | 42 | 42 |
Referral Relationships [Member] | ||||
Finite Lived Intangible Assets [Line Items] | ||||
Total amortization expenses | 352 | 245 | 675 | 491 |
Non-compete Agreements [Member] | ||||
Finite Lived Intangible Assets [Line Items] | ||||
Total amortization expenses | $ 147 | $ 104 | $ 281 | $ 208 |
INTANGIBLE ASSETS, NET - Amor35
INTANGIBLE ASSETS, NET - Amortization of Referral Relationships and Non-Competition Agreements (Details) $ in Thousands | Jun. 30, 2016USD ($) |
Tradename [Member] | |
Finite Lived Intangible Assets [Line Items] | |
2,016 | $ 83 |
2,017 | 84 |
2,018 | 83 |
2,019 | 80 |
Referral Relationships [Member] | |
Finite Lived Intangible Assets [Line Items] | |
2,016 | 1,379 |
2,017 | 1,408 |
2,018 | 1,362 |
2,019 | 1,273 |
2,020 | 1,273 |
2,021 | 1,273 |
2,022 | 1,224 |
2,023 | 1,117 |
2,024 | 997 |
2,025 | 891 |
2,026 | 430 |
2,027 | 135 |
2,028 | 19 |
Non-compete Agreements [Member] | |
Finite Lived Intangible Assets [Line Items] | |
2,016 | 573 |
2,017 | 546 |
2,018 | 490 |
2,019 | 418 |
2,020 | 203 |
2,021 | $ 65 |
ACCRUED EXPENSES (Details)
ACCRUED EXPENSES (Details) - USD ($) $ in Thousands | Jun. 30, 2016 | Dec. 31, 2015 |
Payables and Accruals [Abstract] | ||
Salaries and related costs | $ 16,237 | $ 9,414 |
Group health insurance claims | 2,194 | 2,276 |
Credit balances due to patients and payors | 3,549 | 1,472 |
Other | 4,293 | 3,434 |
Total | $ 26,273 | $ 16,596 |
NOTES PAYABLE AND AMENDED CRE37
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT - Summary of Notes Payable and Credit Agreement (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2016 | Dec. 31, 2015 | |
Debt Instrument [Line Items] | ||
Payments/Long term debt, Total | $ 48,091 | $ 49,110 |
Less current portion | (1,044) | (775) |
Long term portion | 47,047 | $ 48,335 |
Percentage of interest accrued | 3.25% | |
Credit Facility [Member] | ||
Debt Instrument [Line Items] | ||
Payments/Long term debt, Total | $ 42,500 | $ 44,000 |
Average effective interest rate | 2.30% | |
3.25 % through 3.5 % notes payable due in next year [Member] | ||
Debt Instrument [Line Items] | ||
Payments/Long term debt, Total | $ 5,591 | $ 5,110 |
Annual installments | $ 1,044 | |
3.25 % through 3.5 % notes payable due in next year [Member] | Maximum [Member] | ||
Debt Instrument [Line Items] | ||
Percentage of interest accrued | 3.50% | |
3.25 % through 3.5 % notes payable due in next year [Member] | Minimum [Member] | ||
Debt Instrument [Line Items] | ||
Percentage of interest accrued | 3.25% |
NOTES PAYABLE AND AMENDED CRE38
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT (Details) - USD ($) | 1 Months Ended | 6 Months Ended | 12 Months Ended | |
Jan. 31, 2016 | Jun. 30, 2016 | Dec. 31, 2015 | Dec. 05, 2013 | |
Debt Instrument [Line Items] | ||||
Aggregate principal payment due in 2017 | $ 1,470,000 | |||
Aggregate principal payment due in 2018 | 45,577,000 | |||
Notes Payable, Other Payables [Member] | ||||
Debt Instrument [Line Items] | ||||
Aggregate amount of notes payable | $ 4,900,000 | |||
Aggregate principal payment due in 2016 | 575,000 | |||
Aggregate principal payment made prior to June 2016 | $ 325,000 | |||
Aggregate principal payment due in 2017 | 525,000 | |||
Aggregate principal payment due in 2018 | 1,900,000 | |||
Aggregate principal payment due in 2019 | $ 1,900,000 | |||
Notes Payable [Member] | ||||
Debt Instrument [Line Items] | ||||
Average effective interest rate | 3.50% | |||
Aggregate amount of notes payable | $ 1,000,000 | |||
Aggregate principal payment due in 2017 | 444,000 | |||
Aggregate principal payment due in 2018 | $ 570,000 | |||
Minimum [Member] | ||||
Debt Instrument [Line Items] | ||||
Percentage of unused commitment fee | 0.10% | |||
Minimum [Member] | Notes Payable, Other Payables [Member] | ||||
Debt Instrument [Line Items] | ||||
Average effective interest rate | 3.25% | |||
Minimum [Member] | LIBOR [Member] | ||||
Debt Instrument [Line Items] | ||||
Spread on variable rate | 1.50% | |||
Minimum [Member] | Base Rate [Member] | ||||
Debt Instrument [Line Items] | ||||
Spread on variable rate | 0.10% | |||
Maximum [Member] | ||||
Debt Instrument [Line Items] | ||||
Percentage of unused commitment fee | 0.25% | |||
Maximum [Member] | Notes Payable, Other Payables [Member] | ||||
Debt Instrument [Line Items] | ||||
Average effective interest rate | 3.50% | |||
Maximum [Member] | LIBOR [Member] | ||||
Debt Instrument [Line Items] | ||||
Spread on variable rate | 2.50% | |||
Maximum [Member] | Base Rate [Member] | ||||
Debt Instrument [Line Items] | ||||
Spread on variable rate | 1.00% | |||
Credit Facility [Member] | ||||
Debt Instrument [Line Items] | ||||
Average effective interest rate | 2.30% | |||
Revolving credit facility commitment | $ 125,000,000 | |||
Revolving credit facility maturity date | Nov. 30, 2018 | |||
Remaining revolving credit outstanding | $ 82,500,000 | |||
Credit Agreement [Member] | ||||
Debt Instrument [Line Items] | ||||
Cash and noncash consideration with respect to acquisition after amendment | $ 50,000,000 | |||
Credit Agreement [Member] | Maximum [Member] | ||||
Debt Instrument [Line Items] | ||||
Cash dividends after amendment | $ 10,000,000 |
NOTES PAYABLE AND AMENDED CRE39
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT- Summary of Aggregate Annual Payments of Principal Required to Revolving Credit Facility (Details) - USD ($) $ in Thousands | Jun. 30, 2016 | Dec. 31, 2015 |
Long Term Debt By Maturity [Abstract] | ||
During the twelve months ended June 30, 2017 | $ 1,044 | |
During the twelve months ended June 30, 2018 | 1,470 | |
During the twelve months ended June 30, 2019 | 45,577 | |
Payments/Long term debt, Total | $ 48,091 | $ 49,110 |
COMMON STOCK (Details)
COMMON STOCK (Details) - USD ($) | 1 Months Ended | 6 Months Ended | |
Mar. 31, 2009 | Jun. 30, 2016 | Dec. 31, 2008 | |
Equity, Class of Treasury Stock [Line Items] | |||
Common stock authorized by the Board of Directors (in shares) | 1,200,000 | 2,250,000 | |
Total purchased shares (in shares) | 859,499 | 0 | |
Additional estimated shares (in shares) | 249,128 | ||
Closing price (in dollars per share) | $ 60.21 | ||
Maximum [Member] | |||
Equity, Class of Treasury Stock [Line Items] | |||
Maximum percentage of repurchase of common stock | 10.00% | ||
Bank credit agreement to permit share repurchases of common stock | $ 15,000,000 |