ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
(State or other jurisdiction of incorporation or organization) | (I.R.S. Employer Identification No.) |
Title of each class | Trading Symbol(s) | Name of each exchange on which registered |
☒ | Accelerated filer | ☐ | Non-accelerated filer | ☐ | Smaller reporting company | |||||
Emerging growth company |
PART I. | |||
Cautionary Statement Regarding Forward-Looking Statements | |||
Item 1. | Business | ||
Item 1A. | Risk Factors | ||
Item 1B. | Unresolved Staff Comments | ||
Item 2. | Properties | ||
Item 3. | Legal Proceedings | ||
Item 4. | Mine Safety Disclosures | ||
PART II. | |||
Item 5. | Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities | ||
Item 6. | Selected Financial Data | ||
Item 7. | Management’s Discussion and Analysis of Financial Condition and Results of Operations | ||
Item 7A. | Quantitative and Qualitative Disclosures About Market Risk | ||
Item 8. | Financial Statements and Supplementary Data | ||
Item 9. | Changes In and Disagreements with Accountants on Accounting and Financial Disclosure | ||
Item 9A. | Controls and Procedures | ||
Item 9B. | Other Information | 59 | |
PART III. | |||
Item 10. | Directors, Executive Officers and Corporate Governance | ||
Item 11. | Executive Compensation | ||
Item 12. | Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters | ||
Item 13. | Certain Relationships and Related Transactions, and Director Independence | ||
Item 14. | Principal Accountant Fees and Services | ||
PART IV. | |||
Item 15. | Exhibits, and Financial Statement Schedules | ||
Signatures | |||
Exhibit Index |
PART I |
• | our expectations regarding financial condition or results of operations for periods after December 31, 2019; |
• | our critical accounting policies; |
• | our business strategies and our ability to grow our business; |
• | our participation in the Medicare and Medicaid programs; |
• | the reimbursement levels of Medicare and other third-party payors, including changes in reimbursement resulting from regulatory changes; |
• | the prompt receipt of payments from Medicare and other third-party payors; |
• | our future sources of and needs for liquidity and capital resources; |
• | the effect of any regulatory changes or anticipated regulatory changes; |
• | the effect of any changes in market rates on our operations and cash flows; |
• | our ability to obtain financing; |
• | our ability to make payments as they become due; |
• | the outcomes of various routine and non-routine governmental reviews, audits, and investigations; |
• | our expansion strategy, the successful integration of recent acquisitions and, if necessary, the ability to relocate or restructure our current facilities; |
• | the value of our proprietary technology; |
• | the impact of legal proceedings; |
• | our insurance coverage; |
• | our competitors and our competitive advantages; |
• | our ability to attract and retain valuable employees; |
• | the price of our stock; |
• | our compliance with environmental, health and safety laws and regulations; |
• | our compliance with health care laws and regulations; |
• | our compliance with Securities and Exchange Commission laws and regulations and Sarbanes-Oxley requirements; |
• | the impact of federal and state government regulation on our business; and |
• | the impact of changes in or future interpretations of fraud, anti-kickback or other laws. |
Item 1. | Business. |
Year Ended December 31, | ||||||||||||
2019 | 2018 | 2017 | ||||||||||
Home Health | $ | 1,503,393 | $ | 1,291,457 | $ | 777,583 | ||||||
Hospice | 226,922 | 199,118 | 157,287 | |||||||||
Home and Community-Based | 208,455 | 172,501 | 46,159 | |||||||||
Facility-Based | 111,809 | 113,784 | 81,573 | |||||||||
Healthcare Innovations | 29,662 | 33,103 | — | |||||||||
Consolidated Net Service Revenue | $ | 2,080,241 | $ | 1,809,963 | $ | 1,062,602 |
• | wound care and dressing changes, |
• | cardiac rehabilitation, |
• | infusion therapy, |
• | pain management, |
• | pharmaceutical administration, |
• | skilled observation and assessment, and |
• | patient education. |
• | performance improvement audits, |
• | Joint Commission accreditation, |
• | state and regulatory surveys, |
• | publicly reported quality data, and |
• | patient perception of care. |
• | ongoing education of staff and quarterly continuous quality improvement meetings at each of our agencies, facilities, and principal home offices, |
• | monthly comprehensive audits of patient charts performed at each of our agencies and facilities, |
• | at least annually, a comprehensive survey readiness assessment on each of our agencies and facilities, |
• | review of Home Health Compare scores, |
• | assessment of patients' and/or family members' perception of care using third party data, and |
• | assessment of infection control practices and risk events. |
• | our Chief Compliance Officer reports to and has direct oversight by the Audit Committee and Quality Committee of the Board of Directors, |
• | our compliance department has its own operating budget, and |
• | our compliance department has the authority to independently investigate any compliance or ethical concerns, including, when deemed necessary, the authority to interview any company personnel, access any company property, including electronic communications, and engage counsel to assist in any investigation. |
• | drafting and revising the Company’s policies and procedures related to compliance and ethics issues, |
• | reviewing, making recommended revisions, disseminating and tracking attestations to our Code of Conduct and Ethics, |
• | measuring compliance with our policies and procedures, Code of Conduct and Ethics and legal and regulatory requirements related to the Medicare and Medicaid programs and other government healthcare programs, laws and regulations, |
• | developing and providing compliance-related training and education to all of our employees and, as appropriate, directors, contractors and other representatives and agents, including new-hire compliance training for all new employees, annual compliance training for all employees, sales compliance training to all members of our sales team, billing compliance training to all members of our billing and revenue cycle team and other job-specific and role-based compliance training of certain employees, |
• | performing an annual company-wide risk assessment, |
• | implementing an annual compliance auditing and monitoring work plan and performing and following up on various risk-based auditing and monitoring activities, including both clinical and non-clinical auditing and monitoring activities at the corporate level and at the local agency/facility level, |
• | developing, implementing and overseeing our Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) privacy and security compliance program, |
• | monitoring, responding to and overseeing the resolution of issues and concerns raised through our anonymous compliance hotline, |
• | monitoring, responding to and resolving all compliance and ethics-related issues and concerns raised through any other form of communication, and |
• | ensuring that we take appropriate corrective and disciplinary action when noncompliant or improper conduct is identified. |
• | Restoration of the 3% rural add-on |
• | Restores the 3% home health rate add-on for home health patients who reside in rural geographies, effective January 1, 2018. The add-on rate will be phased downward over a five-year period following a formula specified in the legislation. |
• | Restores an important protection of access to Medicare home health care for rural America, and provides sufficient time for the industry to produce additional compelling evidence to demonstrate the positive impact of the rural add-on payment to rural Medicare beneficiaries. |
• | Since its inception, the rural rate has been repeatedly renewed by Congress in recognition of the continued need. |
• | A specific market basket update percentage of 1.5% for fiscal year 2020, leaving intact the full market basket update of 2.2% for fiscal year 2019. Suspends the productivity adjustment in 2020. |
• | Routine Care. Care that is not classified under any of the other levels of care, such as the work of nurses, social workers or home health aides. |
• | General Inpatient Care. Pain control or acute or chronic symptom management that cannot be managed in a setting other than an inpatient Medicare certified facility, such as a hospital, skilled nursing facility or hospice inpatient facility. |
• | Continuous Home Care. Care for patients experiencing a medical crisis that requires nursing services to achieve palliation and symptom control, if the agency provides a minimum of eight hours of care within a 24-hour period. |
• | Respite Care. Short-term, inpatient care to give temporary relief to the caregiver who regularly provides care to the patient. |
• | Short Stay Outlier Policy. CMS has established a modified payment methodology for Medicare patients with a length-of-stay less than or equal to five-sixths of the geometric average length-of-stay for that particular MS-LTC-DRG, referred to as a short stay outlier, or “SSO.” When LTACH-PPS was established, SSO cases were paid based on the lesser of (1) 120% of the average cost of the case; (2) 120% of the LTC-DRG specific per diem amount multiplied by the patient’s length-of-stay; or (3) the full LTC-DRG payment. CMS modified the payment methodology for discharges occurring on or after July 1, 2006, which changed the limitation in clause (1) above to reduce payment for SSO cases to 100% (rather than 120%) of the average cost of the case, and also added a fourth limitation, potentially further limiting payment for SSO cases at a per diem rate derived from blending 120% of the MS-LTC-DRG specific per diem amount with a per diem rate based on the general acute care hospital inpatient prospective payment system, or “IPPS”. Under this methodology, as a patient’s length-of-stay increases, the percentage of the per diem amount based upon the IPPS component will decrease and the percentage based on the MS-LTC-DRG component will increase. |
• | High Cost Outliers. Some cases are extraordinarily costly, producing losses that may be too large for healthcare providers to offset. Cases with unusually high costs, referred to as “high cost outliers,” receive a payment adjustment to reflect the additional resources utilized. CMS provides an additional payment if the estimated costs for the patient exceed the adjusted MS-LTC-DRG payment plus a fixed-loss amount that is established in the annual payment rate update. |
• | Interrupted Stays. An interrupted stay occurs when an LTACH patient is admitted upon discharge to a general acute care hospital, inpatient rehab facility, skilled nursing facility or a swing-bed hospital and returns to the same LTACH within a specified period of time. If the length-of-stay at the receiving provider is equal to or less than the applicable fixed period of time, it is considered to be an interrupted stay case and is treated as a single discharge for the purposes of payment to the LTACH. |
• | the federal Anti-Kickback Statute and similar state laws; |
• | the federal Stark Law and similar state laws; |
• | false claims laws and regulations; |
• | HIPAA; |
• | laws and regulations imposing civil monetary penalties; |
• | environmental health and safety laws; |
• | licensing laws and regulations; and |
• | laws and regulations governing certificates of need and permits of approval. |
• | for physician services that the person or entity knew or should have known were rendered by a person who was unlicensed, or by a person who misrepresented either their qualifications in obtaining their license or their certification in a medical specialty; |
• | for services furnished by a person who was, at the time the claim was made, excluded from the program to which the claim was made; or |
• | that show a pattern of medically unnecessary items or services. |
Item 1A. | Risk Factors. |
• | administrative or legislative changes to the base rates under the applicable prospective payment systems, |
• | the reduction or elimination of annual rate increases, |
• | the imposition or increase by Medicare of mechanisms shifting more responsibility for a portion of payment to beneficiaries, such as co-payments, |
• | adjustments to the relative components of the wage index used in determining reimbursement rates, |
• | changes to case mix or therapy thresholds, |
• | the reclassification of home health resource groups or long-term care diagnosis-related groups, or |
• | further limitations on referrals to long-term acute care hospitals from host hospitals. |
• | licensure and certification, |
• | adequacy and quality of health care services, |
• | qualifications of health care and support personnel, |
• | quality and safety of medical equipment, |
• | confidentiality, maintenance, and security issues associated with medical records and claims processing, |
• | relationships with physicians and other referral sources, |
• | operating policies and procedures, |
• | emergency preparedness risk assessments and policies and procedures, |
• | policies and procedures regarding employee relations, |
• | addition of facilities and services, |
• | coding and Billing for services, |
• | requirements for utilization of services, |
• | documentation required for billing and patient care, and |
• | reporting and maintaining records regarding adverse events. |
• | required refunding or retroactive adjustment of amounts we have been paid pursuant to the federal or state programs or from private payors, |
• | state or federal agencies imposing fines, penalties, and other sanctions on us, |
• | loss of our right to participate in the Medicare program, state programs, or one or more private payor networks, or |
• | damage to our business and reputation in various markets. |
• | The investment interest offered is not based upon actual or expected referrals by the hospital or physician. |
• | Our joint venture partners are not required to make or influence referrals to the joint venture. |
• | At the time the joint venture is formed, each hospital or physician joint venture partner is required to make an actual capital contribution to the joint venture equal to the fair market value of his or her investment interest and is at risk to lose his or her investment. |
• | Neither we nor the joint venture entity lends funds to or guarantees a loan to the hospital or physician to acquire interests in the joint venture. |
• | Distributions to our joint venture partners are based solely on their equity interests and are not affected by referrals from the hospital or physician. |
• | incur more debt, |
• | redeem or repurchase stock, pay dividends or make other distributions, |
• | make certain investments, |
• | create liens, |
• | enter into transactions with affiliates, |
• | make unapproved acquisitions, |
• | enter into joint ventures, |
• | merge or consolidate, |
• | transfer or sell assets, and/or |
• | make fundamental changes in our corporate existence and principal business. |
• | adverse changes in our estimates as a result of changes in payor mix and related collection rates, |
• | inability to collect funds due to missed filing deadlines or inability to prove that timely filings were made, |
• | adverse changes in the economy generally exceeding our expectations, or |
• | unanticipated changes in reimbursement from Medicare, Medicaid and private insurance companies. |
• | difficulties in achieving anticipated cost savings, synergies, business opportunities, and growth prospects from the combination, |
• | difficulties in the integration of operations and systems, including information technology systems, |
• | difficulties in establishing effective uniform controls, standards, systems, procedures, and accounting and other policies, business cultures and compensation structures between the two companies, |
• | difficulties in the acculturation of employees, |
• | difficulties managing the expanded operations of a larger and more complex company, |
• | challenges in keeping existing customers and obtaining new customers, |
• | challenges in attracting new joint venture partners and acquisition targets, |
• | challenges in attracting and retaining key personnel, including personnel that are considered key to the future success of the combined company, and |
• | challenges in keeping key business relationships in place. |
• | staggered terms for our Board of Directors, |
• | limitations on persons authorized to call a special meeting of stockholders, |
• | the authorization of undesignated preferred stock, the terms of which may be established and shares of which may be issued without stockholder approval, |
• | no cumulative voting for directors, |
• | director vacancies are filled by remaining directors (including vacancies resulting from removal), and |
• | advance notice procedures required for stockholders to nominate candidates for election as directors or to bring matters before an annual meeting of stockholders. |
Item 1B. | Unresolved Staff Comments. |
Item 2. | Properties. |
Item 3. | Legal Proceedings. |
Item 4. | Mine Safety Disclosures. |
PART II |
Item 5. | Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities |
High | Low | |||||||
2019 | ||||||||
Fourth Quarter | $ | 137.76 | $ | 107.94 | ||||
Third Quarter | 126.58 | 112.96 | ||||||
Second Quarter | 120.55 | 99.63 | ||||||
First Quarter | 113.79 | 88.98 | ||||||
High | Low | |||||||
2018 | ||||||||
Fourth Quarter | $ | 104.99 | $ | 85.06 | ||||
Third Quarter | 102.99 | 85.17 | ||||||
Second Quarter | 86.87 | 62.98 | ||||||
First Quarter | 66.13 | 60.09 |
Item 6. | Selected Financial Data. |
Year Ended December 31, | 2019 | 2018 | 2017 | 2016 | 2015 | |||||||||||||||
Consolidated Statements of Operations Data: | ||||||||||||||||||||
Net service revenue | $ | 2,080,241 | $ | 1,809,963 | $ | 1,062,602 | $ | 900,033 | $ | 797,123 | ||||||||||
Gross margin | 755,354 | 653,606 | 386,792 | 342,383 | 316,245 | |||||||||||||||
Operating income | 151,614 | 111,001 | 74,682 | 70,562 | 66,343 | |||||||||||||||
Net income | 113,852 | 78,923 | 60,386 | 45,942 | 41,650 | |||||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | 95,726 | 63,574 | 50,112 | 36,583 | 32,335 | |||||||||||||||
Net income attributable to LHC Group, Inc.'s common stockholders: | ||||||||||||||||||||
Basic | $ | 3.09 | $ | 2.31 | $ | 2.83 | $ | 2.08 | $ | 1.86 | ||||||||||
Diluted | $ | 3.07 | $ | 2.29 | $ | 2.79 | $ | 2.07 | $ | 1.84 | ||||||||||
Weighted average shares outstanding: | ||||||||||||||||||||
Basic | 30,932,607 | 27,498,351 | 17,715,992 | 17,559,477 | 17,405,379 | |||||||||||||||
Diluted | 31,209,824 | 27,773,396 | 17,961,018 | 17,682,820 | 17,547,531 | |||||||||||||||
As of December 31, | 2019 | 2018 | 2017 | 2016 | 2015 | |||||||||||||||
Consolidated Balance Sheet Data: | ||||||||||||||||||||
Cash | $ | 31,672 | $ | 49,363 | $ | 2,849 | $ | 3,264 | $ | 6,139 | ||||||||||
Total assets (1) | 2,140,295 | 1,928,715 | 793,702 | 614,071 | 566,054 | |||||||||||||||
Total debt | 253,000 | 243,703 | 144,286 | 87,796 | 98,784 | |||||||||||||||
Total LHC Group, Inc. stockholders’ equity | 1,413,323 | 1,316,925 | 448,868 | 395,126 | 354,582 |
Item 7. | Management’s Discussion and Analysis of Financial Condition and Results of Operations. |
Type of Segment | 2019 | 2018 | 2017 | ||||||
Home Health | 72.3 | % | 71.4 | % | 73.1 | % | |||
Hospice | 10.9 | 11.0 | 14.8 | ||||||
Home and Community-Based | 10.0 | 9.5 | 4.4 | ||||||
Facility-Based | 5.4 | 6.3 | 7.7 | ||||||
Healthcare Innovations | 1.4 | 1.8 | — | ||||||
100.0 | % | 100.0 | % | 100.0 | % |
Home Health Agencies | Hospice Agencies | Home and Community -Based Agencies | Long-Term Acute Care Hospitals | HCI | |||||||||||
Total at January 1, 2018 | 315 | 91 | 12 | 14 | — | ||||||||||
Developed | — | 1 | 4 | — | — | ||||||||||
Acquired (1) | 278 | 22 | 65 | — | 12 | ||||||||||
Divested/Merged | (38 | ) | (6 | ) | — | (2 | ) | — | |||||||
Total at December 31, 2018 | 555 | 108 | 81 | 12 | 12 | ||||||||||
Developed | 4 | — | 24 | — | |||||||||||
Acquired | 16 | 8 | 2 | 1 | — | ||||||||||
Divested/Merged | (22 | ) | (6 | ) | — | — | (2 | ) | |||||||
Total at December 31, 2019 | 553 | 110 | 107 | 13 | 10 |
Description | Rate per patient day | ||
Routine Home Care days 1-60 | $ | 196.25 | |
Routine Home Care days 61+ | $ | 154.21 | |
Continuous Home Care | $ | 997.38 | |
Full Rate = 24 hours of care | |||
$41.56 = hourly rate | |||
Inpatient Respite Care | $ | 176.01 | |
General Inpatient Care | $ | 758.07 |
Description | Rate per patient day | ||
Routine Home Care days 1-60 | $ | 194.50 | |
Routine Home Care days 61+ | $ | 153.72 | |
Continuous Home Care | $ | 1,395.63 | |
Full Rate = 24 hours of care | |||
$58.15 = hourly rate | |||
Inpatient Respite Care | $ | 450.10 | |
General Inpatient Care | $ | 1,021.25 |
• | Medicare discharges from LTACHs will continue to be paid at full LTACH PPS rates if: |
◦ | the patient spent at least three days in a STCH intensive care unit during a STCH stay that immediately preceded the LTACH stay, or |
◦ | the patient was on a ventilator for more than 96 hours in the LTACH (based on the MS-LTACH DRG assigned) and had a STCH stay immediately preceding the LTACH stay. |
◦ | Also, the LTACH discharge cannot have a principal diagnosis that is psychiatric or rehabilitation. |
• | All other Medicare discharges from LTACHs will be paid at a new “site neutral” rate, which is the lesser of the ("IPPS") comparable per diem amount determined using the formula in the short-stay outlier regulation at 42 C.F.R. § 412.529(d)(4) plus applicable outlier payments, or 100% of the estimated cost of the services involved. |
• | The above new payment policy will be effective for LTACH cost reporting periods beginning on or after October 1, 2015, and the site neutral payment rate will be phased-in over two years. |
• | For cost reporting periods beginning on or after October 1, 2015, discharges paid at the site neutral payment rate or by a Medicare Advantage plan (Part C) will be excluded from the LTACH average length-of-stay calculation. |
• | For cost reporting periods beginning in fiscal year 2016 and later, CMS will notify LTACHs of their “LTACH discharge payment percentage” (i.e., the number of discharges not paid at the site neutral payment rate divided by the total number of discharges). |
• | For cost reporting periods beginning in fiscal year 2020 and later, LTACHs with less than 50% of their discharges paid at the full LTACH PPS rates will be switched to payment under the IPPS for all discharges in subsequent cost reporting periods. However, CMS will set up a process for LTACHs to seek reinstatement of LTACH PPS rates for applicable discharges. |
• | MedPAC will study the impact of the above changes on quality of care, use of hospice and other post-acute care settings, different types of LTACHs and growth in Medicare spending on LTACHs. MedPAC is to submit a report to Congress with any recommendations by June 30, 2019. The report is to also include MedPAC’s assessment of whether the 25 Percent rule should continue to be applied. |
Three Months Ended March 31, 2019 | Three Months Ended June 30, 2019 | Three Months Ended September 30, 2019 | Three Months Ended December 31, 2019 | |||||||||
Home Health: | ||||||||||||
Average census | 75,675 | 77,138 | 76,905 | 78,380 | ||||||||
Average Medicare census | 49,411 | 49,827 | 49,016 | 49,108 | ||||||||
Admissions | 93,674 | 95,198 | 97,647 | 102,940 | ||||||||
Medicare admissions | 57,456 | 57,391 | 57,496 | 59,664 | ||||||||
Hospice: | ||||||||||||
Average census | 3,752 | 4,070 | 4,187 | 4,238 | ||||||||
Average Medicare census | 3,447 | 3,760 | 3,883 | 3,914 | ||||||||
Admissions | 4,587 | 4,637 | 4,522 | 4,768 | ||||||||
Medicare admissions | 4,089 | 4,131 | 3,987 | 4,213 | ||||||||
Patient days | 337,649 | 370,407 | 385,164 | 389,926 | ||||||||
Home and Community-Based: | ||||||||||||
Billable hours | 2,271,894 | 2,292,719 | 2,276,984 | 2,111,816 | ||||||||
LTACHs: | ||||||||||||
Patient days | 19,636 | 19,970 | 18,918 | 20,313 | ||||||||
Three Months Ended March 31, 2018 | Three Months Ended June 30, 2018 | Three Months Ended September 30, 2018 | Three Months Ended December 31, 2018 | |||||||||
Home Health: | ||||||||||||
Average census | 45,156 | 76,708 | 75,479 | 75,869 | ||||||||
Average Medicare census | 30,362 | 51,279 | 49,948 | 49,858 | ||||||||
Admissions | 53,123 | 93,905 | 92,643 | 92,168 | ||||||||
Medicare admissions | 33,028 | 59,012 | 57,118 | 56,919 | ||||||||
Hospice: | ||||||||||||
Average census | 3,136 | 3,659 | 3,804 | 3,823 | ||||||||
Average Medicare census | 2,910 | 3,372 | 3,491 | 3,502 | ||||||||
Admissions | 4,054 | 4,528 | 4,557 | 4,558 | ||||||||
Medicare admissions | 3,549 | 3,942 | 3,931 | 3,995 | ||||||||
Patient days | 282,220 | 332,978 | 346,153 | 322,197 | ||||||||
Home and Community-Based: | ||||||||||||
Billable hours | 478,952 | 2,227,831 | 2,284,980 | 2,257,127 | ||||||||
LTACHs: | ||||||||||||
Patient days | 22,560 | 19,983 | 21,617 | 18,409 |
Year Ended December 31, | ||||||||
2019 | 2018 | |||||||
Consolidated Services Data: | ||||||||
Net service revenue | $ | 2,080,241 | $ | 1,809,963 | ||||
Cost of service revenue | 1,324,887 | 1,156,357 | ||||||
Gross margin | 755,354 | 653,606 | ||||||
General and administrative expenses | 596,006 | 537,916 | ||||||
Impairment of intangibles and other | 7,734 | 4,689 | ||||||
Operating income | 151,614 | 111,001 | ||||||
Interest expense | (11,155 | ) | (9,679 | ) | ||||
Income tax expense | 26,607 | 22,399 | ||||||
Income attributable to noncontrolling interests | 18,126 | 15,349 | ||||||
Net income available to LHC Group, Inc.’s common stockholders | $ | 95,726 | $ | 63,574 |
Year Ended December 31, | ||||||
2019 | 2018 | |||||
Consolidated Services Data: | ||||||
Cost of service revenue | 63.7 | % | 63.9 | % | ||
Gross margin | 36.3 | 36.1 | ||||
General and administrative expenses | 28.7 | 29.7 | ||||
Impairment of intangibles and other | 0.4 | 0.3 | ||||
Operating income | 7.3 | 6.1 | ||||
Interest expense | (0.5 | ) | (0.5 | ) | ||
Income tax expense | 21.7 | 26.1 | ||||
Income attributable to noncontrolling interests | 0.9 | 0.8 | ||||
Net income attributable to LHC Group, Inc.’s common stockholders | 4.6 | 3.5 |
Segment | 2019 | 2018 | ||||
Home Health | 72.3 | % | 71.4 | % | ||
Hospice | 10.9 | 11.0 | ||||
Home and Community-Based | 10.0 | 9.5 | ||||
Facility-Based | 5.4 | 6.3 | ||||
Healthcare Innovations | 1.4 | 1.8 | ||||
100.0 | % | 100.0 | % |
Organic (1) | Organic Growth (Loss)% | Acquired (2) | Total | Total Growth (Loss) % | |||||||||
Home Health | |||||||||||||
Revenue | $ | 909,439 | 6.5 | % | $ | 607,226 | $ | 1,516,665 | 15.9 | % | |||
Revenue Medicare | $ | 605,974 | 3.4 | $ | 451,754 | $ | 1,057,728 | 13.9 | |||||
New admissions | 230,477 | 9.1 | 158,982 | $ | 389,459 | 17.4 | |||||||
New Medicare admissions | 132,727 | 2.9 | 99,280 | $ | 232,007 | 12.6 | |||||||
Average census | 47,116 | 5.1 | 29,909 | $ | 77,025 | 1.4 | |||||||
Average Medicare census | 29,576 | — | 19,764 | $ | 49,340 | (2.3 | ) | ||||||
Home health episodes | 219,970 | 1.3 | 152,846 | $ | 372,816 | 10.2 | |||||||
Hospice | |||||||||||||
Revenue | $ | 184,531 | 6.6 | $ | 42,164 | $ | 226,695 | 12.2 | |||||
Revenue Medicare | $ | 170,421 | 9.2 | $ | 37,610 | $ | 208,031 | 14.5 | |||||
New admissions | 15,007 | 5.6 | 3,508 | $ | 18,515 | 4.6 | |||||||
New Medicare admissions | 13,288 | 6.4 | 3,140 | $ | 16,428 | 6.6 | |||||||
Average census | 3,425 | 8.9 | 637 | $ | 4,062 | 12.8 | |||||||
Average Medicare census | 3,165 | 9.2 | 588 | $ | 3,753 | 13.2 | |||||||
Patient days | 1,254,443 | 9.3 | 228,522 | $ | 1,482,965 | 12.8 | |||||||
Home and Community-Based | |||||||||||||
Revenue | $ | 60,989 | 4.8 | $ | 153,304 | $ | 214,293 | 22.1 | |||||
Billable hours | 2,476,567 | 29.4 | 6,430,893 | $ | 8,907,460 | 22.7 | |||||||
Facility-Based | |||||||||||||
LTACHs | |||||||||||||
Revenue | $ | 101,194 | (1.9 | ) | $ | 1,641 | $ | 102,835 | (3.4 | ) | |||
Patient days | 77,572 | (5.1 | ) | 1,265 | $ | 78,837 | (6.0 | ) | |||||
Other facility-based | |||||||||||||
Revenue | $ | 11,501 | 17.1 | $ | — | $ | 11,501 | 17.1 | |||||
Healthcare Innovations | |||||||||||||
Revenue | $ | — | — | $ | 29,919 | $ | 29,919 | (10.3 | ) | ||||
Consolidated | |||||||||||||
Revenue | $ | 1,267,654 | 33.1 | % | $ | 834,254 | $ | 2,101,908 | 53.6 | % |
2019 | % of Net Service Revenue | 2018 | % of Net Service Revenue | |||||||||||
Revenue | $ | 2,101,908 | $ | 1,835,478 | ||||||||||
Less: Implicit price concessions | 21,667 | 1.0 | % | 25,515 | 1.4 | % | ||||||||
Net service revenue | $ | 2,080,241 | $ | 1,809,963 |
2019 | 2018 | ||||||||||
Home Health | |||||||||||
Salaries, wages, and benefits | $ | 860,184 | 57.2 | % | $ | 733,432 | 56.8 | % | |||
Transportation | 44,046 | 2.9 | 40,760 | 3.2 | |||||||
Supplies and services | 34,805 | 2.3 | 27,814 | 2.2 | |||||||
Total | $ | 939,035 | 62.4 | % | $ | 802,006 | 62.1 | % | |||
Hospice | |||||||||||
Salaries, wages, and benefits | $ | 101,927 | 44.9 | % | $ | 94,966 | 47.7 | % | |||
Transportation | 7,733 | 3.4 | 7,330 | 3.7 | |||||||
Supplies and services | 30,517 | 13.4 | 28,695 | 14.4 | |||||||
Total | $ | 140,177 | 61.7 | % | $ | 130,991 | 65.8 | % | |||
Home and Community-Based | |||||||||||
Salaries, wages, and benefits | $ | 154,665 | 74.2 | % | $ | 128,124 | 74.3 | % | |||
Transportation | 2,164 | 1.0 | 1,797 | 1.0 | |||||||
Supplies and services | 988 | 0.5 | 739 | 0.4 | |||||||
Total | $ | 157,817 | 75.7 | % | $ | 130,660 | 75.7 | % | |||
Facility-Based | |||||||||||
Salaries, wages, and benefits | $ | 51,941 | 46.5 | % | $ | 53,920 | 47.4 | % | |||
Transportation | 280 | 0.3 | 310 | 0.3 | |||||||
Supplies and services | 21,053 | 18.8 | 22,669 | 19.9 | |||||||
Total | $ | 73,274 | 65.4 | % | $ | 76,899 | 67.6 | % | |||
Healthcare Innovations | |||||||||||
Salaries, wages, and benefits | $ | 13,707 | 46.2 | % | $ | 15,101 | 45.6 | % | |||
Transportation | 444 | 1.5 | 551 | 1.7 | |||||||
Supplies and services | 433 | 1.5 | 149 | 0.5 | |||||||
Total | $ | 14,584 | 49.2 | % | $ | 15,801 | 47.8 | % | |||
Consolidated | |||||||||||
Total | $ | 1,324,887 | 63.7 | % | $ | 1,156,357 | 63.9 | % |
2019 | 2018 | ||||||||||
Home Health | |||||||||||
General and administrative | $ | 426,775 | 28.4 | % | $ | 368,761 | 28.6 | % | |||
Depreciation and amortization | 10,501 | 0.7 | 9,363 | 0.7 | |||||||
Total | $ | 437,276 | 29.1 | % | $ | 378,124 | 29.3 | % | |||
Hospice | |||||||||||
General and administrative | $ | 59,341 | 26.2 | % | $ | 58,655 | 29.5 | % | |||
Depreciation and amortization | 1,849 | 0.8 | 2,278 | 1.1 | |||||||
Total | $ | 61,190 | 27.0 | % | $ | 60,933 | 30.6 | % | |||
Home and Community-Based | |||||||||||
General and administrative | $ | 42,647 | 20.5 | % | $ | 39,847 | 23.1 | % | |||
Depreciation | 1,378 | 0.7 | 620 | 0.4 | |||||||
Total | $ | 44,025 | 21.2 | % | $ | 40,467 | 23.5 | % | |||
Facility-Based | |||||||||||
General and administrative | $ | 34,991 | 31.3 | % | $ | 36,732 | 32.3 | % | |||
Depreciation and amortization | 3,367 | 3.0 | 2,906 | 2.6 | |||||||
Total | $ | 38,358 | 34.3 | % | $ | 39,638 | 34.9 | % | |||
Healthcare Innovations | |||||||||||
General and administrative | $ | 13,998 | 47.2 | % | $ | 17,559 | 53.0 | % | |||
Depreciation | 1,159 | 3.9 | 1,195 | 3.6 | |||||||
Total | $ | 15,157 | 51.1 | % | $ | 18,754 | 56.6 | % | |||
Consolidated | |||||||||||
Total | $ | 596,006 | 28.7 | % | $ | 537,916 | 29.7 | % |
• | Operating Results – Our net income has a significant effect on our operating cash flows. Any significant increase or decrease in our net income could have a material effect on our operating cash flows. |
• | Timing of Acquisitions – We use a portion of our operating and/or financing cash flows for acquisitions. When the acquisitions occur at or near the end of a period, our cash outflows significantly increase. |
• | Timing of Payroll – Some of our employees are paid bi-weekly on Fridays, while others are paid weekly on Fridays. Operating cash outflows increase in reporting periods that end on a Friday. |
• | Self-Insurance Plan Funding – We are self-funded for health insurance and workers compensation insurance. Any significant changes in the amount of insurance claims submitted could have a direct effect on our operating cash flows. |
Year Ended December 31, | ||||||||
2019 | 2018 | |||||||
Net cash provided by (used in): | ||||||||
Operating activities | $ | 130,462 | $ | 108,585 | ||||
Investing activities | (107,902 | ) | (25,291 | ) | ||||
Financing activities | (40,251 | ) | (36,780 | ) | ||||
Change in cash | $ | (17,691 | ) | $ | 46,514 | |||
Cash at beginning of period | 49,363 | 2,849 | ||||||
Cash at end of period | $ | 31,672 | $ | 49,363 |
Leverage Ratio | Eurodollar Margin | Base Rate Margin | Commitment Fee Rate | ||||||
≤ 1.00:1.00 | 1.50 | % | 0.50 | % | 0.200 | % | |||
>1.00:1.00 ≤ 2.00:100 | 1.75 | % | 0.75 | % | 0.250 | % | |||
>2.00:1.00 ≤ 3.00:1.00 | 2.00 | % | 1.00 | % | 0.300 | % | |||
>3.00:1.00 | 2.25 | % | 1.25 | % | 0.350 | % |
Payment Due by Period | ||||||||||||||||||||
Recorded Liabilities: | Total | Less than 1 Year | 1-3 Years | 3-5 Years | More than 5 Years | |||||||||||||||
Long-term debt | $ | 253,000 | $ | — | $ | 253,000 | $ | — | $ | — | ||||||||||
Operating leases | 109,537 | 34,457 | 43,994 | 18,120 | 12,966 | |||||||||||||||
Uncertain tax position (1) | 3,867 | 3,867 | — | — | — | |||||||||||||||
Other: | ||||||||||||||||||||
Purchase obligations (2) | 43,664 | 43,664 | — | — | — | |||||||||||||||
Total contractual cash obligations | $ | 410,068 | $ | 81,988 | $ | 296,994 | $ | 18,120 | $ | 12,966 |
Payor | 2019 | 2018 | 2017 | ||||||
Medicare | 64.1 | % | 65.4 | % | 71.7 | % | |||
Medicaid | 2.9 | 3.2 | 1.7 | ||||||
Other | 33.0 | 31.4 | 26.6 | ||||||
100.0 | % | 100.0 | % | 100.0 | % |
Item 7A. | Quantitative and Qualitative Disclosures About Market Risk. |
Item 8. | Financial Statements and Supplementary Data. |
Item 9. | Changes In and Disagreements with Accountants on Accounting and Financial Disclosure. |
Item 9A. | Disclosure Controls and Procedures. |
Item 9B. | Other Information. |
PART III |
Item 10. | Directors, Executive Officers and Corporate Governance. |
Item 11. | Executive Compensation. |
Item 12. | Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters. |
(a) | (b) | (c) | ||||||||
Plan Category | Number of Shares to be Issued Upon Exercise of Outstanding Options, Warrants, and Rights | Weighted-Average Exercise Price of Outstanding Price of Outstanding Rights | Number of Shares Remaining Available for Future Issuance Under Equity Compensation Plans (Excluding Securities Reflected in Column a) (1) |
Equity compensation plans approved by Stockholders: | — | $ | — | 2,141,893 | ||||||
Equity compensation plans not approved by Stockholders: | — | — | — | |||||||
Total | — | $ | — | 2,141,893 |
Item 13. | Certain Relationships and Related Transactions, and Director Independence. |
Item 14. | Principal Accountant Fees and Services. |
PART IV |
Item 15. | Exhibits, Financial Statement Schedules. |
Report of Independent Registered Public Accounting Firm | F-1 |
Consolidated Balance Sheets as of December 31, 2019 and 2018 | F-3 |
For each of the years in the three-year period ended December 31, 2019 | |
Consolidated Statements of Income | |
Consolidated Statements of Changes in Equity | |
Consolidated Statements of Cash Flows | |
Notes to the Consolidated Financial Statements |
As of December 31, | ||||||||
2019 | 2018 | |||||||
ASSETS | ||||||||
Current assets: | ||||||||
Cash | $ | $ | ||||||
Receivables: | ||||||||
Patient accounts receivable | ||||||||
Other receivables | ||||||||
Amounts due from governmental entities | ||||||||
Total receivables, net | ||||||||
Prepaid income taxes | ||||||||
Prepaid expenses | ||||||||
Other current assets | ||||||||
Total current assets | ||||||||
Property, building and equipment, net of accumulated depreciation of $69,441 and $55,253, respectively | ||||||||
Goodwill | ||||||||
Intangible assets, net of accumulated amortization of $16,431 and $15,176, respectively | ||||||||
Assets held for sale | ||||||||
Operating lease right of use asset | ||||||||
Other assets | ||||||||
Total assets | $ | $ | ||||||
LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||
Current liabilities: | ||||||||
Accounts payable and other accrued liabilities | $ | $ | ||||||
Salaries, wages and benefits payable | ||||||||
Self insurance reserves | ||||||||
Current operating lease payable | ||||||||
Current portion of long-term notes payable | ||||||||
Amounts due to governmental entities | ||||||||
Total current liabilities | ||||||||
Deferred income taxes | ||||||||
Income taxes payable | ||||||||
Revolving credit facility | ||||||||
Long-term notes payable | ||||||||
Operating lease payable | ||||||||
Total liabilities | ||||||||
Noncontrolling interest-redeemable | ||||||||
Commitments and contingencies | ||||||||
Stockholders’ equity: | ||||||||
LHC Group, Inc. stockholders’ equity: | ||||||||
Preferred stock – $0.01 par value: 5,000,000 shares authorized; none issued or outstanding |
Common stock – $0.01 par value: 60,000,000 shares authorized; 36,129,280 and 35,835,348 shares issued, and 30,992,390 and 30,805,919 shares outstanding, respectively | ||||||||
Treasury stock – 5,136,890 and 5,029,429 shares at cost, respectively | ( | ) | ( | ) | ||||
Additional paid-in capital | ||||||||
Retained earnings | ||||||||
Total LHC Group, Inc. stockholders’ equity | ||||||||
Noncontrolling interest – non-redeemable | ||||||||
Total stockholders’ equity | ||||||||
Total liabilities and stockholders’ equity | $ | $ |
For the year ended December 31, | ||||||||||||
2019 | 2018 | 2017 | ||||||||||
Net service revenue | $ | $ | $ | |||||||||
Cost of service revenue (excluding depreciation and amortization) | ||||||||||||
Gross margin | ||||||||||||
General and administrative expenses | ||||||||||||
Impairment of intangibles and other | ||||||||||||
Operating income | ||||||||||||
Interest expense | ( | ) | ( | ) | ( | ) | ||||||
Income before income taxes and noncontrolling interests | ||||||||||||
Income tax expense | ||||||||||||
Net income | ||||||||||||
Less net income attributable to noncontrolling interests | ||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | |||||||||
Earnings per share - basic: | ||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | |||||||||
Earnings per share - diluted: | ||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | |||||||||
Weighted average shares outstanding: | ||||||||||||
Basic | ||||||||||||
Diluted |
LHC Group, Inc. | Noncontrolling interest -non- redeemable | Total equity | Non controlling interest - redeemable | Net income | ||||||||||||||||||||||||||||||||
Common Stock | Additional paid-in capital | Retained earnings | ||||||||||||||||||||||||||||||||||
Issued | Treasury | |||||||||||||||||||||||||||||||||||
Amount | Shares | Amount | Shares | |||||||||||||||||||||||||||||||||
Balances at December 31, 2016 | $ | $ | ( | ) | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||
Net income | — | — | — | — | — | ( | ) | |||||||||||||||||||||||||||||
Acquired noncontrolling interest | — | — | — | — | — | — | — | |||||||||||||||||||||||||||||
Purchase of additional controlling interest | — | — | — | — | ( | ) | — | — | ( | ) | ( | ) | ||||||||||||||||||||||||
Sale of noncontrolling interest | — | — | — | — | — | |||||||||||||||||||||||||||||||
Noncontrolling interest distributions | — | — | — | — | — | — | ( | ) | ( | ) | ( | ) | ||||||||||||||||||||||||
Nonvested stock compensation | — | — | — | — | — | — | — | |||||||||||||||||||||||||||||
Issuance of vested stock | — | — | ( | ) | — | — | — | — | ||||||||||||||||||||||||||||
Treasury shares redeemed to pay income tax | — | — | ( | ) | — | — | — | ( | ) | — | ||||||||||||||||||||||||||
Issuance of common stock under Employee Stock Purchase Plan | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Balances at December 31, 2017 | $ | $ | ( | ) | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||
Net income | — | — | — | — | — | |||||||||||||||||||||||||||||||
Acquired noncontrolling interest | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Purchase of additional controlling interest | — | — | — | ( | ) | ( | ) | |||||||||||||||||||||||||||||
Sale of noncontrolling interest | — | — | — | — | ( | ) | — | |||||||||||||||||||||||||||||
Noncontrolling interest distributions | — | — | — | — | — | — | ( | ) | ( | ) | ( | ) | ||||||||||||||||||||||||
Nonvested stock compensation | — | — | — | — | — | — | — | |||||||||||||||||||||||||||||
Issuance of vested stock | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Treasury shares redeemed to pay income tax | — | — | ( | ) | — | — | — | ( | ) | — | ||||||||||||||||||||||||||
Merger consideration | — | — | — | — | — | |||||||||||||||||||||||||||||||
Exercise of stock options | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Issuance of common stock under Employee Stock Purchase Plan | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Balances at December 31, 2018 | $ | $ | ( | ) | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||
Net Income | — | — | — | — | — | |||||||||||||||||||||||||||||||
Acquired noncontrolling interest | — | — | — | — | — | — | — | |||||||||||||||||||||||||||||
Purchase of additional controlling interest | — | — | — | — | ( | ) | — | ( | ) | ( | ) | — | ||||||||||||||||||||||||
Sale of noncontrolling interest | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Noncontrolling interest distributions | — | — | — | — | — | — | ( | ) | ( | ) | ( | ) | ||||||||||||||||||||||||
Nonvested stock compensation | — | — | — | — | — | — | — | |||||||||||||||||||||||||||||
Issuance of vested stock | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Treasury shares redeemed to pay income tax | — | — | ( | ) | — | — | ( | ) | — |
Exercise of stock options | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Issuance of common stock under Employee Stock Purchase Plan | — | — | — | — | — | — | ||||||||||||||||||||||||||||||
Balances at December 31, 2019 | $ | $ | ( | ) | $ | $ | $ | $ | $ |
For the Year Ended December 31, | ||||||||||||
2019 | 2018 | 2017 | ||||||||||
Operating activities: | ||||||||||||
Net income | $ | $ | $ | |||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||||
Depreciation and amortization expense | ||||||||||||
Amortization and impairment of operating lease right of use asset | ||||||||||||
Stock-based compensation expense | ||||||||||||
Deferred income taxes | ( | ) | ||||||||||
Loss on disposal of assets | ||||||||||||
Impairment of intangibles and other | ||||||||||||
Changes in operating assets and liabilities, net of acquisitions: | ||||||||||||
Receivables | ( | ) | ( | ) | ( | ) | ||||||
Prepaid expenses and other assets | ( | ) | ( | ) | ||||||||
Prepaid income taxes | ( | ) | ( | ) | ( | ) | ||||||
Accounts payable and accrued expenses | ( | ) | ( | ) | ||||||||
Operating lease payable | ( | ) | ||||||||||
Income tax payable | ( | ) | ( | ) | ||||||||
Net amounts due to/from governmental entities | ( | ) | ( | ) | ||||||||
Net cash provided by operating activities | ||||||||||||
Investing activities: | ||||||||||||
Cash paid for acquisitions, net of cash acquired | ( | ) | ( | ) | ||||||||
Purchases of property, building and equipment | ( | ) | ( | ) | ( | ) | ||||||
Net cash used in investing activities | ( | ) | ( | ) | ( | ) | ||||||
Financing activities: | ||||||||||||
Proceeds from line of credit | ||||||||||||
Payments on line of credit | ( | ) | ( | ) | ( | ) | ||||||
Proceeds from employee stock purchase plan | ||||||||||||
Payments on debt | ( | ) | ( | ) | ( | ) | ||||||
Payments on deferred financing fees | ( | ) | ||||||||||
Noncontrolling interest distributions | ( | ) | ( | ) | ( | ) | ||||||
Purchase of additional controlling interest | ( | ) | ( | ) | ( | ) | ||||||
Sale of noncontrolling interest | ||||||||||||
Withholding taxes paid on stock-based compensation | ( | ) | ( | ) | ( | ) | ||||||
Exercise of options | ||||||||||||
Net cash (used in) provided by financing activities | ( | ) | ( | ) | ||||||||
Change in cash | ( | ) | ( | ) | ||||||||
Cash at beginning of period | ||||||||||||
Cash at end of period | $ | $ | $ | |||||||||
Supplemental disclosures of cash flow information | ||||||||||||
Interest paid | $ | $ | $ | |||||||||
Income taxes paid | $ | $ | $ | |||||||||
Non-Cash Operating activity: | ||||||||||||
Operating right of use assets in exchange for lease obligations | — | — | ||||||||||
Non-Cash Investing activity: | ||||||||||||
Accrued capital expenditures | ||||||||||||
Consideration transferred for a business combination | ||||||||||||
Non-Cash Financing activity: | ||||||||||||
Purchase of additional controlling interest |
2019 | 2018 | 2017 | |||||||
Home Health: | |||||||||
Medicare | % | % | % | ||||||
Managed Care, Commercial, and Other | |||||||||
% | % | % | |||||||
Hospice: | |||||||||
Medicare | % | % | % | ||||||
Managed Care, Commercial, and Other | |||||||||
% | % | % | |||||||
Home and Community-Based: | |||||||||
Medicaid | % | % | % | ||||||
Managed Care, Commercial, and Other | |||||||||
% | % | % | |||||||
Facility-Based: | |||||||||
Medicare | % | % | % |
Managed Care, Commercial, and Other | |||||||||
% | % | % | |||||||
Healthcare Innovations: | |||||||||
Medicare | % | % | % | ||||||
Managed Care, Commercial, and Other | |||||||||
% | % | % |
2019 | 2018 | ||||
Medicare | % | % | |||
Medicaid | |||||
Managed Care, Commercial, and Other | |||||
Total patient accounts receivable | % | % |
2019 | 2018 | |||||||
Land | $ | $ | ||||||
Building and leasehold improvements | ||||||||
Transportation equipment | ||||||||
Fixed equipment | ||||||||
Office furniture and medical equipment | ||||||||
Construction in progress | ||||||||
Less accumulated depreciation | ||||||||
Property, building and equipment, net | $ | $ |
2019 | 2018 | 2017 | |||||||
Weighted average number of shares outstanding for basic per share calculation | |||||||||
Effect of dilutive potential shares: | |||||||||
Nonvested restricted stock | |||||||||
Adjusted weighted average shares for diluted per share calculation | |||||||||
Antidilutive shares |
Merger consideration | ||||
Stock | $ | |||
Fair value of total consideration transferred | ||||
Recognized amounts of identifiable assets acquired and liabilities assumed: | ||||
Cash and cash equivalents | ||||
Patient accounts receivable | ||||
Prepaid income taxes | ||||
Prepaid expenses and other current assets | ||||
Property and equipment | ||||
Trade names | ||||
Certificates of need/licenses | ||||
Customer relationships | ||||
Assets held for sale | ||||
Deferred income taxes | ||||
Accounts payable | ( | ) | ||
Accrued other liabilities | ( | ) | ||
Seller notes payable | ( | ) | ||
NCI - Redeemable | ( | ) | ||
Long term income taxes payable | ( | ) | ||
Line of credit | ( | ) | ||
NCI - Nonredeemable | ( | ) | ||
Other assets and (liabilities), net | ( | ) |
Total identifiable assets and liabilities | ||||
Goodwill | $ |
Consideration | ||||
Cash | $ | |||
Fair value of total consideration transferred | ||||
Recognized amounts of identifiable assets acquired and liabilities assumed | ||||
Trade name | ||||
Certificates of need/licenses | ||||
Other assets and (liabilities), net | ( | ) | ||
Total identifiable assets | ||||
Noncontrolling interest | ||||
Goodwill, including noncontrolling interest of $7,390 | $ |
Home Health | Hospice | Home and community- based | Facility-based | Healthcare Innovations | Total | |||||||||||||||||||
Goodwill | ||||||||||||||||||||||||
Balance as of December 31, 2017 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Acquisitions | — | |||||||||||||||||||||||
Noncontrolling interests | — | — | ||||||||||||||||||||||
Adjustments and disposals | ( | ) | — | — | ( | ) | ||||||||||||||||||
Balance as of December 31, 2018 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Acquisitions | ||||||||||||||||||||||||
Noncontrolling interests | — | |||||||||||||||||||||||
Adjustments and disposals | — | |||||||||||||||||||||||
Balance as of December 31, 2019 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Intangibles Assets | ||||||||||||||||||||||||
Balance as of December 31, 2017 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Acquisitions | — | |||||||||||||||||||||||
Amortization | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ||||||||||||||
Adjustments and disposals | ( | ) | ( | ) | ( | ) | ||||||||||||||||||
Balance as of December 31, 2018 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Acquisitions | ||||||||||||||||||||||||
Amortization | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ||||||||||||
Adjustments and disposals | ( | ) | ( | ) | ( | ) | ( | ) | ||||||||||||||||
Balance as of December 31, 2019 | $ | $ | $ | $ | $ | $ |
2019 | 2018 | |||||||
Indefinite-lived intangible assets: | ||||||||
Trade Names | $ | $ | ||||||
Certificates of Need/Licenses | ||||||||
Net total | $ | $ | ||||||
Definite-lived intangible assets: | ||||||||
Trade Names | ||||||||
Gross carrying amount | $ | $ | ||||||
Accumulated amortization | ( | ) | ( | ) | ||||
Net total | $ | $ | ||||||
Non-compete agreements | ||||||||
Gross carrying amount | $ | $ | ||||||
Accumulated amortization | ( | ) | ( | ) | ||||
Net total | $ | $ | ||||||
Customer relationships | ||||||||
Gross carrying amount | $ | $ | ||||||
Accumulated amortization | ( | ) | ( | ) | ||||
Net total | $ | $ | ||||||
Total definite-lived intangible assets | ||||||||
Gross carrying amount | $ | $ | ||||||
Accumulated amortization | ( | ) | ( | ) | ||||
Net total | $ | $ | ||||||
Total intangible assets: | ||||||||
Gross carrying amount | $ | $ | ||||||
Accumulated amortization | ( | ) | ( | ) | ||||
Net total | $ | $ |
Year | Amortization amount | |||
2020 | $ | |||
2021 | ||||
2022 | ||||
2023 | ||||
2024 | ||||
Total | $ |
2019 | 2018 | |||||||
Deferred tax assets: | ||||||||
Allowance for uncollectible accounts | $ | $ | ||||||
Accrued employee benefits | ||||||||
Stock compensation | ||||||||
Accrued self-insurance | ||||||||
Acquisition costs | ||||||||
Net operating loss carry forward | ||||||||
Intangible asset impairment | ||||||||
Lease payable | ||||||||
Other | ||||||||
Gross deferred tax assets | ||||||||
Less: valuation allowance | ( | ) | ( | ) | ||||
Net deferred tax assets | $ | $ | ||||||
Deferred tax liabilities: | ||||||||
Amortization of intangible assets | ( | ) | ( | ) | ||||
Tax depreciation in excess of book depreciation | ( | ) | ( | ) | ||||
Prepaid expenses | ( | ) | ( | ) | ||||
Non-accrual experience accounting method | ( | ) | ( | ) | ||||
Right of use asset | ( | ) | ||||||
Other | ( | ) | ( | ) | ||||
Deferred tax liabilities | ( | ) | ( | ) | ||||
Net deferred tax liability | $ | ( | ) | $ | ( | ) |
2019 | 2018 | 2017 | ||||||||||
Current: | ||||||||||||
Federal | $ | $ | $ | |||||||||
State | ||||||||||||
Deferred: | ||||||||||||
Federal | ( | ) | ||||||||||
State | ||||||||||||
( | ) | |||||||||||
Total income tax expense | $ | $ | $ |
2019 | 2018 | 2017 | |||||||
Federal statutory tax rate | % | % | % | ||||||
State income taxes, net of federal benefit | |||||||||
Nondeductible expenses | |||||||||
Uncertain tax position | ( | ) | ( | ) | — | ||||
Tax Cut and Jobs Act Enactment | ( | ) | |||||||
Excess tax benefit | ( | ) | ( | ) | ( | ) | |||
Credits and other | ( | ) | ( | ) | |||||
Effective tax rate | % | % | % |
Unrecognized tax benefits | ||||
As of January 1, 2018 | $ | |||
Acquired unrecognized tax position | ||||
Increased (decreases) in unrecognized tax benefits as a result of: | ||||
Tax positions taken in the current year | ||||
Lapse of statute of limitations | ( | ) | ||
As of December 31, 2018 | $ | |||
Increased (decreases) in unrecognized tax benefits as a result of: | ||||
Tax positions taken in the current year | ||||
Lapse of statute of limitations | ( | ) | ||
As of December 31, 2019 | $ |
Year | Principal payment amount | |||
2020 | $ | |||
2021 | ||||
2022 | ||||
2023 | ||||
2024 | ||||
Total | $ |
Nonvested stock | Options | |||||||||||||
Number of Shares | Weighted average grant date fair value | Number of Shares | Weighted average grant date fair value | |||||||||||
Share grants outstanding at December 31, 2018 | $ | $ | ||||||||||||
Granted | ||||||||||||||
Vested or exercised | ( | ) | ( | ) | ||||||||||
Share grants outstanding at December 31, 2019 | $ | $ |
Range of Exercise Price | Shares | Wtd. Avg. Remaining Contractual Life | Wtd. Avg. Exercise Price | |||
$0.00 - 30.00 | $ | |||||
$30.01 - 40.00 | $ |
Over $40.00 | $ | |||||
$ |
• | An additional |
• | The term of the Employee Stock Purchase Plan was extended from January 1, 2016 to January 1, 2023. |
Number of Shares | Weighted Average Per Share Price | ||||||
Shares available as of December 31, 2016 | |||||||
Shares issued in 2017 | $ | ||||||
Shares issued in 2018 | $ | ||||||
Shares issued in 2019 | $ | ||||||
Shares available as of December 31, 2019 |
December 31, 2019 | ||||
Cash paid for operating lease payables | $ | |||
Right-of-use assets obtained in exchange for new operating lease payables | $ | |||
Weighted-average remaining lease term | ||||
Weighted-average discount rate | % |
Year | Total | |||
2020 | $ | |||
2021 | ||||
2022 | ||||
2023 | ||||
2024 | ||||
Thereafter | ||||
Total future minimum lease payments | ||||
Less: Imputed interest | ( | ) | ||
Total | $ |
Year Ended December 31, 2019 | ||||||||||||||||||||||||
Home Health | Hospice | Home and Community-Based | Facility-Based | HCI | Total | |||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Cost of service revenue (excluding depreciation and amortization) | ||||||||||||||||||||||||
General and administrative expenses | ||||||||||||||||||||||||
Impairment of intangibles and other | ||||||||||||||||||||||||
Operating income (loss) | ( | ) | ||||||||||||||||||||||
Interest expense | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ||||||||||||
Income (loss) before income taxes and noncontrolling interests | ( | ) | ( | ) | ||||||||||||||||||||
Income tax expense (benefit) | ( | ) | ( | ) | ||||||||||||||||||||
Net income (loss) | ( | ) | ( | ) | ||||||||||||||||||||
Less net income (loss) attributable to noncontrolling interests | ( | ) | ( | ) | ||||||||||||||||||||
Net income (loss) attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | $ | ( | ) | $ | ( | ) | $ | ||||||||||||||
Total assets | $ | $ | $ | $ | $ | $ |
Year Ended December 31, 2018 | ||||||||||||||||||||||||
Home Health | Hospice | Home and Community-Based | Facility-Based | HCI | Total | |||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Cost of service revenue (excluding depreciation and amortization) | ||||||||||||||||||||||||
General and administrative expenses |
Impairment of intangibles and other | ( | ) | ||||||||||||||||||||||
Operating income (loss) | ( | ) | ( | ) | ||||||||||||||||||||
Interest expense | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ||||||||||||
Income (loss) before income taxes and noncontrolling interests | ( | ) | ( | ) | ||||||||||||||||||||
Income tax expense (benefit) | ( | ) | ( | ) | ||||||||||||||||||||
Net income (loss) | ( | ) | ( | ) | ||||||||||||||||||||
Less net income (loss) attributable to noncontrolling interests | ( | ) | ( | ) | ||||||||||||||||||||
Net income (loss) attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | $ | ( | ) | $ | ( | ) | $ | ||||||||||||||
Total assets | $ | $ | $ | $ | $ | $ |
Year Ended December 31, 2017 | ||||||||||||||||||||||||
Home Health | Hospice | Home and Community-Based | Facility-Based | HCI | Total | |||||||||||||||||||
Net service revenue | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Cost of service revenue (excluding depreciation and amortization) | ||||||||||||||||||||||||
General and administrative expenses | ||||||||||||||||||||||||
Impairment of intangibles and other | ( | ) | ||||||||||||||||||||||
Operating income | ||||||||||||||||||||||||
Interest expense | ( | ) | ( | ) | ( | ) | ( | ) | ( | ) | ||||||||||||||
Income before income taxes and noncontrolling interests | ||||||||||||||||||||||||
Income tax expense | ||||||||||||||||||||||||
Net income | ||||||||||||||||||||||||
Less net income attributable to noncontrolling interests | ( | ) | ||||||||||||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | $ | $ | $ | ||||||||||||||||||
Total assets | $ | $ | $ | $ | $ | $ |
First Quarter 2019 | Second Quarter 2019 | Third Quarter 2019 | Fourth Quarter 2019 | |||||||||||||
Net service revenue | $ | $ | $ | $ | ||||||||||||
Gross margin | ||||||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | ||||||||||||||||
Net income attributable to LHC Group' Inc.'s common stockholders | ||||||||||||||||
Basic earnings per share: | $ | $ | $ | $ | ||||||||||||
Diluted earnings per share: | $ | $ | $ | $ | ||||||||||||
Weighted average shares outstanding: | ||||||||||||||||
Basic | ||||||||||||||||
Diluted |
First Quarter 2018 | Second Quarter 2018 | Third Quarter 2018 | Fourth Quarter 2018 | |||||||||||||
Net service revenue | $ | $ | $ | $ | ||||||||||||
Gross margin | ||||||||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | ||||||||||||||||
Net income attributable to LHC Group' Inc.'s common stockholders | ||||||||||||||||
Basic earnings per share: | $ | $ | $ | $ | ||||||||||||
Diluted earnings per share: | $ | $ | $ | $ | ||||||||||||
Weighted average shares outstanding: | ||||||||||||||||
Basic | ||||||||||||||||
Diluted |
LHC GROUP, INC. | ||
February 27, 2020 | /s/ KEITH G. MYERS | |
Keith G. Myers | ||
Chief Executive Officer |
Signature | Title | Date | ||
/s/ KEITH G. MYERS Keith G. Myers | Chief Executive Officer and Chairman of the Board of Directors | February 27, 2020 | ||
/s/ JOSHUA L. PROFFITT Joshua L. Proffitt | Chief Financial Officer, Principal Accounting Officer | February 27, 2020 | ||
/s/ COLLIN MCQUIDDY Collin McQuiddy | Senior Vice President of Accounting, Chief Accounting Officer | February 27, 2020 | ||
/s/ MONICA F. AZARE Monica F. Azare | Director | February 27, 2020 | ||
/s/ TERI G. FONTENOT Teri G. Fontenot | Director | February 27, 2020 | ||
/s/ JONATHAN D. GOLDBERG Jonathan D. Goldberg | Director | February 27, 2020 | ||
/s/ CLIFFORD S. HOLTZ Clifford S. Holtz | Director | February 27, 2020 | ||
/s/ JOHN L. INDEST John L. Indest | Director | February 27, 2020 | ||
/s/ RONALD T. NIXON Ronald T. Nixon | Director | February 27, 2020 | ||
/s/ W. EARL REED III W. Earl Reed III | Director | February 27, 2020 | ||
/s/ W.J. “BILLY” TAUZIN W.J. “Billy” Tauzin | Director | February 27, 2020 | ||
/s/ BRENT TURNER Brent Turner | Director | February 27, 2020 |
Exhibit Number | Description of Exhibits | |
2.1 | ||
3.1 | ||
3.2 | ||
4.1 | ||
4.2 | ||
10.1+ | ||
10.2+ | ||
10.3+ | ||
10.4+ | ||
10.5+ | ||
10.6+ | ||
10.7 | ||
10.8+ | ||
10.9+ |
10.10+ | ||
10.11+ | ||
10.12+ | ||
10.13+ |
21.1 | ||
23.1 | ||
31.1 | ||
31.2 | ||
32.1* | ||
101.INS | XBRL Instance Document | |
101.SCH | ||
101.CAL | ||
101.DEF | ||
101.LAB | ||
101.PRE |
+ | Indicates a management contract or compensatory plan. |
* | This exhibit is furnished to the SEC as an accompanying document and is not deemed to be "filed" for purposes of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the liabilities of that Section, and the document will not be deemed incorporated by reference into any filing under the Securities Act of 1933. |
• | Undesignated Preferred Stock. Our board of directors has the ability to authorize undesignated preferred stock, which allows the board of directors to issue preferred stock with voting or other rights or preferences that could impede the success of any unsolicited attempt to change control of the Company. This ability may have the effect of deferring hostile takeovers or delaying changes in control or management of the Company. |
• | Election and Removal of Directors. Our board of directors is classified into three classes serving staggered terms of office of three years. With a classified board of directors, it would generally take a majority stockholder two annual meetings of stockholders to elect a majority of the board of directors. As a result, a classified board may discourage proxy contests for the election of directors or purchases of a substantial block of stock because it could operate to prevent obtaining control of the board in a relatively short period of time. Additionally, our directors may be removed from office at any time by a vote of the holders of a majority of the outstanding shares of stock entitled to vote in an election of directors, other than in connection with a properly-convened election of directors, but only for cause. |
• | Elimination of Stockholder Action by Written Consent. Stockholder action by written consent of our stockholders is prohibited. Action by written consent may, in some circumstances, permit the taking of stockholders’ action opposed by the board of directors more rapidly than would be possible if a meeting of stockholders were required. The prohibition contained in the amended and restated certificate of incorporation will restrict the ability of controlling stockholders to take action at any time other than at an annual meeting and will generally force a takeover bidder to negotiate directly with the board of directors. |
• | Stockholder Meetings. Only the Company’s board of directors, a duly authorized committee of the board of directors, the chairman or the vice chairman of our board of directors, or the chief executive officer is permitted to call a special meeting of the Company’s stockholders. This provision could prevent a stockholder from, among other things, calling a special meeting of stockholders to consider the stockholder’s proposed slate of directors or a transaction that might result in a change of control of the corporation. |
• | Requirements for Advance Notification of Stockholder Nominations and Proposals. Compliance with an advance notice procedure is required for stockholder nomination of candidates for election as directors and other proposals to be brought before an annual meeting of our stockholders. Although our amended and restated bylaws will not give our board of directors any power to approve or disapprove stockholder nominations for the election of directors or other proposals for action, these advance notice procedures may have the effect of precluding a contest for the election of directors or the consideration of other stockholder proposals if the established procedures are not followed and of discouraging or deterring a third party from conducting a solicitation of proxies to elect its own slate of directors or to approve another proposal without regard to whether consideration of those nominees or proposals might be harmful or beneficial to the Company and our stockholders. |
• | Elimination of Company Directors’ Personal Liability. No Company director shall be personally liable to the Company or our stockholders for monetary damages for breach of fiduciary duties by such director as a director, subject to the exceptions set forth in the DGCL and described herein. Our amended and restated certificate of incorporation eliminates or limits the personal liability of a director except for (i) any breach of the director’s duty of loyalty to the Company or our stockholders, (ii) acts or omissions not in good faith or which involve intentional misconduct or a knowing violation of law, (iii) unlawful corporate distributions, or (iv) any transaction from which such director derives an improper personal benefit. This provision of our amended and restated certificate of incorporation will limit the remedies available to a stockholder who is dissatisfied with a decision of the board of directors protected by this provision, and such stockholder’s only remedy in that circumstance may be to bring a suit to prevent the action of the board. In many situations, this remedy may not be effective, as for example when stockholders are not aware of a transaction or an event prior to board action in respect of such transaction or event. In these cases, the stockholders and the corporation could be injured by the board’s decision and have no effective remedy. |
• | Permitting the board of directors, in evaluating any takeover offer, to consider all relevant factors, including the potential economic and social impact of the offer on our stockholders, employees, customers, creditors, the communities in which the Company operates and any other factors the directors consider pertinent. Once the board, in exercising its business judgment, has determined that a proposed action is not in the best interests of the Company, it has no duty to remove any barriers to the success of the action, including a shareholder rights plan. |
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Advanced Care House Calls of Alabama, LLC | Alabama | |
Alabama Health Care Group, LLC | Alabama | |
Athens-Limestone HomeCare, LLC | Alabama | |
Baptist Home Health, LLC | Alabama | |
Camden HomeCare, LLC | Alabama | |
Centre Home Care, LLC | Alabama | |
Clay County Hospital Home Care, LLC | Alabama | |
Coosa Valley HomeCare, LLLC | Alabama | |
East Alabama Medical Center HomeCare, LLC | Alabama | |
Fayette Medical Center HomeCare, LLC | Alabama | |
Fort Payne Home Care, LLC | Alabama | |
Gulf Homecare, Inc. | Alabama | |
HGA HomeCare, LLC | Alabama | |
Infirmary Home Health Agency, Inc. | Alabama | |
LHCG CXXVIII, LLC | Alabama | |
LHCG LI, LLC | Alabama | |
LHCG LXIV, LLC | Alabama | |
LHCG LXXIX, LLC | Alabama | |
LHCG LXXXIV, LLC | Alabama | |
LHCG XXII, LLC | Alabama | |
LHCG XXIX, LLC | Alabama | |
LHCG XXXIV, LLC | Alabama | |
Marion Regional HomeCare, LLC | Alabama | |
Medical Centers HomeCare, LLC | Alabama | |
Mizell Memorial Hospital HomeCare, LLC | Alabama | |
Princeton Home Health, LLC | Alabama | |
Southeast Alabama HomeCare, LLC | Alabama | |
SunCrest Home Health of AL, Inc. | Alabama | |
Thomas Home Health, LLC | Alabama | |
Advanced Care House Calls of Arizona, LLC | Arizona | |
Arizona Health Care Group, LLC | Arizona | |
Arizona In-Home Healthcare Partnership-I, LLC | Arizona | |
Arizona In-Home Healthcare Partnership-II, LLC | Arizona | |
Arizona In-Home Healthcare Partnership-III, LLC | Arizona | |
Arizona In-Home Partner-I, LLC | Arizona | |
Arizona In-Home Partner-II, LLC | Arizona | |
Arizona In-Home Partner-III, LLC | Arizona | |
LHCG LVI, LLC | Arizona | |
LHCG LXXVII, LLC | Arizona | |
Western Arizona Regional Home Health and Hospice, LLC | Arizona | |
AHCG Management, LLC | Arkansas | |
Arkansas Extended Care, LLC | Arkansas | |
Arkansas Health Care Group, LLC | Arkansas | |
Arkansas Healthcare Partners, LLC | Arkansas | |
Arkansas Home Health Providers-III, LLC | Arkansas |
Arkansas Home Health Providers-IV, LLC | Arkansas | |
Arkansas Home Hospice, LLC | Arkansas | |
Arkansas HomeCare of Forrest City, LLC | Arkansas | |
Arkansas HomeCare of Fulton, LLC | Arkansas | |
Arkansas HomeCare of Hot Springs, LLC | Arkansas | |
Arkansas In-Home Healthcare Partnership-I, LLC | Arkansas | |
Arkansas In-Home Healthcare Partnership-II, LLC | Arkansas | |
Arkansas In-Home Partner-I, LLC | Arkansas | |
Arkansas In-Home Partner-II, LLC | Arkansas | |
Arkansas Nursing Providers, LLC | Arkansas | |
CMC Home Health and Hospice, LLC | Arkansas | |
Dallas County Medical Center HomeCare, LLC | Arkansas | |
East Arkansas Health Holdings, LLC | Arkansas | |
Elite Physical Therapy Services, LLC | Arkansas | |
Eureka Springs Hospital HomeCare, LLC | Arkansas | |
Eureka Springs Hospital Hospice, LLC | Arkansas | |
Fort Smith HMA Home Health, LLC | Arkansas | |
Hospice of Central Arkansas, LLC | Arkansas | |
Jefferson Regional HomeCare, LLC | Arkansas | |
LHCG CII, LLC | Arkansas | |
LHCG CIV, LLC | Arkansas | |
LHCG CV, LLC | Arkansas | |
LHCG CXIX, LLC | Arkansas | |
LHCG CXVIII, LLC | Arkansas | |
LHCG CXXV, LLC | Arkansas | |
LHCG CXXXX, LLC | Arkansas | |
LHCG CXXXXI, LLC | Arkansas | |
LHCG CXXXXII, LLC | Arkansas | |
LHCG LXVIII, LLC | Arkansas | |
LHCG LXXXIII, LLC | Arkansas | |
LHCG LXXXV, LLC | Arkansas | |
LHCG LXXXVI, LLC | Arkansas | |
LHCG XLII, LLC | Arkansas | |
Mena Medical Center Home Health, LLC | Arkansas | |
Mena Medical Center Hospice, LLC | Arkansas | |
Midwest Hospice, LLC | Arkansas | |
Northeast Arkansas Partnership, LLC | Arkansas | |
Patient’s Choice Hospice, LLC | Arkansas | |
Southwest Arkansas HomeCare, LLC | Arkansas | |
Advanced Care House Calls of California, LLC | California | |
California Health Care Group, LLC | California | |
LHCG XXXVIII, LLC | California | |
Advanced Care House Calls of Colorado, LLC | Colorado | |
Colorado Health Care Group, LLC | Colorado | |
Colorado In-Home Healthcare Partnership-I, LLC | Colorado | |
Colorado In-Home Partner-I, LLC | Colorado | |
LHCG LVII, LLC | Colorado | |
Advanced Care House Calls of Connecticut, LLC | Connecticut | |
Connecticut Home Health Care, Inc. | Connecticut | |
Patient Care Connecticut, LLC | Connecticut | |
Patient Care HHA, LLC | Connecticut | |
Patient's Choice Homecare, LLC | Connecticut | |
Priority Care, Inc. | Connecticut | |
Adult Day Care of America, Inc. | Delaware | |
AF-CH-HH, LLC | Delaware |
AFAM Holding Co, LLC | Delaware | |
AFAM Sub I, LLC | Delaware | |
Almost Family, Inc. | Delaware | |
Altus Hospice of Georgia, LLC | Delaware | |
Augusta Home Care Services, LLC | Delaware | |
Berwick Home Care Services, LLC | Delaware | |
Birmingham Home Care Services, LLC | Delaware | |
Blue Island Home Care Services, LLC | Delaware | |
Cambridge Home Health Care Holdings, Inc. | Delaware | |
Clarksville Home Care Services, LLC | Delaware | |
Cleveland Home Care Services, LLC | Delaware | |
Compassionate Hospice of Georgia, Inc. | Delaware | |
Crossroads Home Care Services, LLC | Delaware | |
Deming Home Care Services, LLC | Delaware | |
El Dorado Home Care Services, LLC | Delaware | |
Emporia Home Care Services, LLC | Delaware | |
Florence Home Care Services, LLC | Delaware | |
Franklin Home Care Services, LLC | Delaware | |
Fulton Home Care Services, LLC | Delaware | |
Gadsden Home Care Services, LLC | Delaware | |
Galesburg Home Care, LLC | Delaware | |
Granite City Home Care Services, LLC | Delaware | |
Halcyon Healthcare, LLC | Delaware | |
Hattiesburg Home Care Services, LLC | Delaware | |
Helena Home Care Services, LLC | Delaware | |
Ingenios Health Co | Delaware | |
Ingenios Health Holdings, Inc. | Delaware | |
In-Home Healthcare Partnership, LLC | Delaware | |
Jackson Home Care Services, LLC | Delaware | |
Jourdanton Home Care Services, LLC | Delaware | |
Knoxville Home Care Services, LLC | Delaware | |
Lakeland Home Care Services, LLC | Delaware | |
Lancaster Home Care Services, LLC | Delaware | |
La Porte Home Care Services, LLC | Delaware | |
LHC Group, Inc. | Delaware | |
LHCG Partner, LLC | Delaware | |
LHCG New York Holding, LLC | Delaware | |
Louisa Home Care Holdings, LLC | Delaware | |
Louisa Home Care Services, LLC | Delaware | |
Mooresville Home Caer Services, LLC | Delaware | |
Northampton Home Care, LLC | Delaware | |
Oklahoma City Home Care Services, LLC | Delaware | |
OMNI Home Health Holdings, Inc. | Delaware | |
OMNI Home Health Services, LLC | Delaware | |
Patient Care New Jersey, Inc. | Delaware | |
Patient Care Pennsylvania, Inc. | Delaware | |
Patient Care, Inc. | Delaware | |
Petersburg Home Care Services, LLC | Delaware | |
Pottstown Home Care Services, LLC | Delaware | |
Red Bud Home Care Services, LLC | Delaware | |
River West Home Care, LLC | Delaware | |
Scranton Quincy Home Care Services, LLC | Delaware | |
Sharon Home Care Services, LLC | Delaware | |
Shelbyville Home Care Services, LLC | Delaware | |
SJ Home Care, LLC | Delaware | |
Spokane Home Care Services, LLC | Delaware |
Springdale Home Care Services, LLC | Delaware | |
Tomball Texas Home Care Services, LLC | Delaware | |
Tucson Home Care Services, LLC | Delaware | |
Valparaiso Home Care Services, LLC | Delaware | |
Venice Home Care Services, LLC | Delaware | |
Victoria Texas Home Care Services, LLC | Delaware | |
Waukegan Hospice, LLC | Delaware | |
Weatherford Home Care Services, LLC | Delaware | |
West Grove Home Care, LLC | Delaware | |
Wilkes-Barre Home Care Services, LLC | Delaware | |
Woodward Home Care Services, LLC | Delaware | |
York Home Care Services, LLC | Delaware | |
Youngstown Home Care Services, LLC | Delaware | |
LHCG CXXXXV, LLC | District of Columbia | |
Washington D.C. Health Care Group, LLC | District of Columbia | |
Advanced Care House Calls of Florida, LLC | Florida | |
Almost Family ACO Services of South Florida, LLC | Florida | |
Almost Family PC of Ft. Lauderdale, LLC | Florida | |
Almost Family PC of SW Florida, LLC | Florida | |
Almost Family PC of West Palm, LLC | Florida | |
Bayfront HMA Home Health, LLC | Florida | |
BGR Acquisition, LLC | Florida | |
Brevard HMA Home Health, LLC | Florida | |
Brevard HMA Hospice, LLC | Florida | |
Caretenders of Jacksonville, LLC | Florida | |
Caretenders Visiting Services of District 6, LLC | Florida | |
Caretenders Visiting Services of District 7, LLC | Florida | |
Caretenders Visiting Services of Gainesville, LLC | Florida | |
Caretenders Visiting Services of Hernando County, LLC | Florida | |
Caretenders Visiting Services of Ocala, LLC | Florida | |
Caretenders Visiting Services of Pinellas County, LLC | Florida | |
Caretenders Visiting Services of St. Augustine, LLC | Florida | |
Florida Physical Therapy Services of Pensacola, LLC | Florida | |
Home Health Agency - Central Pennsylvania, LLC | Florida | |
Home Health Agency - Collier, LLC | Florida | |
Home Health Agency - Hillsborough, LLC | Florida | |
Home Health Agency - Indiana, LLC | Florida | |
Home Health Agency - Pennsylvania, LLC | Florida | |
Home Health Agency - Philadelphia, LLC | Florida | |
Home Health Agency - Pinellas, LLC | Florida | |
Key West HHA, LLC | Florida | |
Key West PD, LLC | Florida | |
LHC Health Care Group of Florida, LLC | Florida | |
LHCG LXXXII, LLC | Florida | |
LHCG XIX, LLC | Florida | |
Lifeline Home Health Care of Lady Lake, LLC | Florida | |
Lifeline Home Health Care of Lakeland, LLC | Florida | |
Lifeline Home Health Care of Marathon, LLC | Florida | |
Lifeline Home Health Care of Port Charlotte, LLC | Florida | |
Mederi Caretenders VS of Broward, LLC | Florida | |
Mederi Caretenders VS of SE FL, LLC | Florida | |
Mederi Caretenders VS of SW FL, LLC | Florida | |
Mederi Caretenders VS of Tampa, LLC | Florida |
Merderi Private Care, LLC | Florida | |
Munroe Regional HomeCare, LLC | Florida | |
North Okaloosa Home Health, LLC | Florida | |
OMNI Health Management, LLC | Florida | |
OMNI Home Health - District 1, LLC | Florida | |
OMNI Home Health - District 2, LLC | Florida | |
OMNI Home Health – District 4, LLC | Florida | |
OMNI Home Health - Hernando, LLC | Florida | |
OMNI Home Health - Jacksonville, LLC | Florida | |
SunCrest Home Health of Tampa, LLC | Florida | |
SWF Home Care Services, LLC | Florida | |
Advanced Care House Calls of Georgia, LLC | Georgia | |
Compassionate Healthcare Management Group, Inc. | Georgia | |
Floyd HomeCare, LLC | Georgia | |
Georgia Health Care Group, LLC | Georgia | |
Georgia HomeCare of Harris, LLC | Georgia | |
Grace Hospice, LLC | Georgia | |
LHCG CXXIII, LLC | Georgia | |
LHCG LXXIV, LLC | Georgia | |
LHCG LXXV, LLC | Georgia | |
LHCG XL, LLC | Georgia | |
Northwest Georgia Home Health, LLC | Georgia | |
SunCrest Healthcare, Inc. | Georgia | |
Suncrest Home Health-Southside, LLC | Georgia | |
SunCrest Home Health of Georgia, Inc. | Georgia | |
SunCrest Home Health of South GA, Inc. | Georgia | |
Advanced Care House Calls of Idaho, LLC | Idaho | |
Idaho Health Care Group, LLC | Idaho | |
Idaho In-Home Healthcare Partnership-I, LLC | Idaho | |
Idaho In-Home Partner-I, LLC | Idaho | |
LHCG XVII, LLC | Idaho | |
LHCG XXI, LLC | Idaho | |
Advanced Care House Calls of Illinois, LLC | Illinois | |
Caretenders Visiting Services of Southern Illinois, LLC | Illinois | |
Illinois Health Care Group, LLC | Illinois | |
Illinois Home Care Holdings, LLC | Illinois | |
Illinois Home Health Care, LLC | Illinois | |
Illinois LIV, LLC | Illinois | |
LHCG XXXVII, LLC | Illinois | |
IN HomeCare Network Central, LLC | Indiana | |
IN HomeCare Network North, LLC | Indiana | |
NP Services of IN, LLC | Indiana | |
ACHC ACO, LLC | Kentucky | |
ACO Clinical Partners, LLC | Kentucky | |
Advanced Care House Calls of Kentucky, LLC | Kentucky | |
AFAM Acquisition, LLC | Kentucky | |
Almost Family ACO Services of Kentucky, LLC | Kentucky | |
Almost Family PC of Kentucky, LLC | Kentucky | |
Bluegrass Accountable Care, LLC | Kentucky | |
Caretenders of Cleveland, Inc. | Kentucky | |
Caretenders of Columbus, Inc. | Kentucky | |
Caretenders Visiting Services Employment Company, Inc. | Kentucky | |
Caretenders Visiting Services of Kentuckiana, LLC | Kentucky | |
Caretenders Visiting Services of Orlando, LLC | Kentucky |
Caretenders VS of Central KY, LLC | Kentucky | |
Caretenders VS of Lincoln Trail, LLC | Kentucky | |
Caretenders VS of Louisville, LLC | Kentucky | |
Caretenders VS of Western KY, LLC | Kentucky | |
Home Health of Jefferson Co, LLC | Kentucky | |
Imperium Health Management, LLC | Kentucky | |
Kentuckiana Clinical Partners, LLC | Kentucky | |
Kentucky Accountable Care, LLC | Kentucky | |
Kentucky Clinical Partners, LLC | Kentucky | |
Kentucky Health Care Group, LLC | Kentucky | |
Kentucky Home Health Care, LLC | Kentucky | |
Kentucky HomeCare of Henderson, LLC | Kentucky | |
Kentucky In-Home Healthcare Partnership-I, LLC | Kentucky | |
Kentucky In-Home Healthcare Partnership-II, LLC | Kentucky | |
Kentucky In-Home Partner-I, LLC | Kentucky | |
Kentucky In-Home Partner-II, LLC | Kentucky | |
Kentucky LV, LLC | Kentucky | |
LHC HomeCare-Lifeline, LLC | Kentucky | |
LHCG LXX, LLC | Kentucky | |
LHCG LXXI, LLC | Kentucky | |
LHCG XLVI, LLC | Kentucky | |
LHCG XXIII, LLC | Kentucky | |
Lifeline Home Health Care of Bowling Green, LLC | Kentucky | |
Lifeline Home Health Care of Fulton, LLC | Kentucky | |
Lifeline Home Health Care of Hopkinsville, LLC | Kentucky | |
Lifeline Home Health Care of Lexington, LLC | Kentucky | |
Lifeline Home Health Care of Russellville, LLC | Kentucky | |
Lifeline Home Health Care of Somerset, LLC | Kentucky | |
Lifeline HomeCare of Salem, LLC | Kentucky | |
Lifeline Private Duty Services of Kentucky, LLC | Kentucky | |
Lifeline Rockcastle Home Health, LLC | Kentucky | |
NP Services of KY, LLC | Kentucky | |
Physicians Accountable Care, LLC | Kentucky | |
Physicians Accountable Care of Kentucky, LLC | Kentucky | |
Trigg County Home Health, LLC | Kentucky | |
Twin Lakes Home Health Agency, LLC | Kentucky | |
AAA Home Health, Inc. | Louisiana | |
Acadian Home Health Care Services, LLC | Louisiana | |
Acadian HomeCare of New Iberia, LLC | Louisiana | |
Acadian HomeCare, LLC | Louisiana | |
Acadian Physical Therapy Services, LLC | Louisiana | |
Baton Rouge HomeCare, LLC | Louisiana | |
Beauregard Memorial Hospital HomeCare, LLC | Louisiana | |
Egan Health Care Corporation | Louisiana | |
Egan Healthcare of Northshore, Inc | Louisiana | |
Egan Healthcare of Plaquemines, Inc | Louisiana | |
Egan Hospice Services of Northshore, LLC | Louisiana | |
Feliciana Physical Therapy Services, LLC | Louisiana | |
Hood Home Health Service, LLC | Louisiana | |
LHC Group Employee Hardship Relief Fund | Louisiana | |
LHC Group Pharmaceutical Services II, LLC | Louisiana | |
LHC Group Pharmaceutical Services III, LLC | Louisiana | |
LHC Group Pharmaceutical Services, LLC | Louisiana | |
LHC Physician Services, LLC | Louisiana | |
LHC Real Estate I, LLC | Louisiana | |
LHC Real Estate II, LLC | Louisiana |
LHCG CIX, LLC. | Louisiana | |
LHCG CVI, LLC | Louisiana | |
LHCG CVII, LLC | Louisiana | |
LHCG CVIII, LLC | Louisiana | |
LHCG CX, LLC | Louisiana | |
LHCG CXX, LLC | Louisiana | |
LHCG CXXVI, LLC | Louisiana | |
LHCG LXVII, LLC | Louisiana | |
LHCG LXXII, LLC | Louisiana | |
LHCG LXXVI, LLC | Louisiana | |
LHCG LXXVIII, LLC | Louisiana | |
LHCG V, LLC | Louisiana | |
LHCG VI, LLC | Louisiana | |
LHCG VIII, LLC | Louisiana | |
LHCG X, LLC | Louisiana | |
LHCG XII, LLC | Louisiana | |
LHCG XIII, LLC | Louisiana | |
LHCG XIV, LLC | Louisiana | |
LHCG XLIII, LLC | Louisiana | |
LHCG XLIV, LLC | Louisiana | |
LHCG XV, LLC | Louisiana | |
LHCG XVI, LLC | Louisiana | |
LLC-I, LLC | Louisiana | |
LLC-II, LLC | Louisiana | |
Louisiana Extended Care Hospital of Kenner, LLC | Louisiana | |
Louisiana Health Care Group, LLC | Louisiana | |
Louisiana Home Health of Feliciana, LLC | Louisiana | |
Louisiana Home Health of Hammond, LLC | Louisiana | |
Louisiana Home Health of Houma, LLC | Louisiana | |
Louisiana HomeCare of Delhi, LLC | Louisiana | |
Louisiana HomeCare of Kenner, LLC | Louisiana | |
Louisiana HomeCare of Lutcher, LLC | Louisiana | |
Louisiana HomeCare of Minden, LLC | Louisiana | |
Louisiana HomeCare of Miss-Lou, LLC | Louisiana | |
Louisiana HomeCare of Monroe, LLC | Louisiana | |
Louisiana HomeCare of North Louisiana, LLC | Louisiana | |
Louisiana HomeCare of Northwest Louisiana, LLC | Louisiana | |
Louisiana HomeCare of Plaquemine, LLC | Louisiana | |
Louisiana HomeCare of Raceland, LLC | Louisiana | |
Louisiana HomeCare of Slidell, LLC | Louisiana | |
Louisiana Hospice and Palliative Care, LLC | Louisiana | |
Louisiana Hospice Group, LLC | Louisiana | |
Louisiana In-Home Healthcare Partnership - I, LLC | Louisiana | |
Louisiana in-Home Partner - I, LLC | Louisiana | |
Louisiana Physical Therapy Services of Bossier City, LLC | Louisiana | |
Louisiana Physical Therapy, LLC | Louisiana | |
Northshore Extended Care Hospital, LLC | Louisiana | |
Oak Shadows of Jennings, LLC | Louisiana | |
Palmetto Express, LLC | Louisiana | |
Patient’s Choice Hospice and Palliative Care of Louisiana, LLC | Louisiana | |
Primary Care at Home of Louisiana II, LLC | Louisiana | |
Primary Care at Home of Louisiana III, LLC | Louisiana | |
Primary Care at Home of Louisiana IV, LLC | Louisiana | |
Primary Care at Home of Louisiana, LLC | Louisiana | |
Richardson Medical Center HomeCare, LLC | Louisiana | |
Southeast Louisiana HomeCare, LLC | Louisiana | |
Specialty Extended Care Hospital of Monroe, LLC | Louisiana |
St. James HomeCare, LLC | Louisiana | |
St. Landry Family Healthcare, LLC | Louisiana | |
Texas Health Care Group Holdings, LLC | Louisiana | |
The Hospice Promise Foundation | Louisiana | |
Tri-Parish Community HomeCare, LLC | Louisiana | |
Vital Hospice, Inc. | Louisiana | |
Advanced Care House Calls of Maryland, LLC | Maryland | |
FirstCall Health Services, Inc. | Maryland | |
HomeCall, Inc. | Maryland | |
LHCG CL, LLC | Maryland | |
LHCG CXLIX, LLC | Maryland | |
LHCG LXXXI, LLC | Maryland | |
Maryland Health Care Group, LLC | Maryland | |
Primary Care at Home of Maryland, LLC | Maryland | |
Advanced Care House Calls of Massachusetts, LLC | Massachusetts | |
Caretenders VS of Boston, LLC | Massachusetts | |
LHCG LVIII, LLC | Massachusetts | |
Long Term Solutions, Inc. | Massachusetts | |
Massachusetts Health Care Group, LLC | Massachusetts | |
Advanced Care House Calls of Michigan, LLC | Michigan | |
Michigan In-Home Healthcare Partnership-I, LLC | Michigan | |
Michigan In-Home Healthcare Partnership-II, LLC | Michigan | |
Michigan In-Home Healthcare Partnership-III, LLC | Michigan | |
Michigan In-Home Healthcare Partnership-IV, LLC | Michigan | |
Michigan In-Home Partner-I, LLC | Michigan | |
Michigan In-Home Partner-II, LLC | Michigan | |
Michigan In-Home Partner-III, LLC | Michigan | |
Michigan In-Home Partner-IV, LLC | Michigan | |
LHCG XLVIII, LLC | Minnesota | |
Minnesota Health Care Group, LLC | Minnesota | |
Able Home Health, Inc. | Mississippi | |
Advanced Care House Calls of Mississippi, LLC | Mississippi | |
Community Hospice, LLC | Mississippi | |
Cornerstone Palliative and Hospice, LLC | Mississippi | |
Covenant Palliative and Hospice, LLC | Mississippi | |
Leaf River Health Care, LLC | Mississippi | |
LHCG C, LLC | Mississippi | |
LHCG XCIX, LLC | Mississippi | |
LHCG XCVIII, LLC | Mississippi | |
LHCG XXVI, LLC | Mississippi | |
Mississippi Health Care Group, LLC | Mississippi | |
Mississippi HomeCare of Jackson II, LLC | Mississippi | |
Mississippi HomeCare, LLC | Mississippi | |
Picayune HomeCare, LLC | Mississippi | |
South Mississippi Home Health, Inc. | Mississippi | |
South Mississippi Home Health, Inc. - Region I | Mississippi | |
South Mississippi Home Health, Inc. - Region II | Mississippi | |
South Mississippi Home Health, Inc. - Region III | Mississippi | |
Access Hospice, LLC | Missouri | |
Caretenders Visiting Services of St. Louis, LLC | Missouri | |
Kirksville Home Care Services, LLC | Missouri | |
LHCG CXLVI, LLC | Missouri | |
LHCG CXLVII, LLC | Missouri | |
LHCG CXLVIII, LLC | Missouri | |
LHCG CXXXXIII, LLC | Missouri | |
LHCG LXIX, LLC | Missouri |
LHCG LXV, LLC | Missouri | |
LHCG XXV, LLC | Missouri | |
Missouri Health Care Group, LLC | Missouri | |
Southwest Missouri HomeCare, LLC | Missouri | |
SunCrest Home Health of MO, Inc. | Missouri | |
Nebraska Health Care Group, LLC | Nebraska | |
Advanced Care House Calls of Nevada, LLC | Nevada | |
Assured Capital Partners, Inc. | Nevada | |
LHCG CXXXIX, LLC | Nevada | |
LHCG CXXXVIII, LLC | Nevada | |
LHCG CXXXXIV, LLC | Nevada | |
LHCG XXXIX, LLC | Nevada | |
Nevada Health Care Group, LLC. | Nevada | |
Advanced Care House Calls of New Hampshire, LLC | New Hampshire | |
New Hampshire Health Care Group, LLC | New Hampshire | |
LHCG CXLIV, LLC | New Jersey | |
LHCG CXLV, LLC | New Jersey | |
Patient Care Medical Services, Inc. | New Jersey | |
Patient Care of Hudson County, LLC | New Jersey | |
Advanced Care House Calls of New Mexico, LLC | New Mexico | |
Advanced Care House Calls of New York, LLC | New York | |
BHC Services, Inc. | New York | |
BRACOR, Inc. | New York | |
Litson Certified Care, Inc. | New York | |
Litson Health Care, Inc. | New York | |
National Health Industries, Inc. | New York | |
Western Region Health Corporation | New York | |
Willcare, Inc. | New York | |
Cape Fear Valley HomeCare and Hospice, LLC | North Carolina | |
LHCG CXXXXVI, LLC | North Carolina | |
LHCG L, LLC | North Carolina | |
North Carolina Health Care Group, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-I, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-II, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-III, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-IV, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-IX, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-V, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-VI, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-VII, LLC | North Carolina | |
North Carolina In-Home Healthcare Partnership-VIII, LLC | North Carolina | |
North Carolina In-Home Partner-I, LLC | North Carolina | |
North Carolina In-Home Partner-II, LLC | North Carolina | |
North Carolina In-Home Partner-III, LLC | North Carolina | |
North Carolina In-Home Partner-IV, LLC | North Carolina | |
North Carolina In-Home Partner-IX, LLC | North Carolina | |
North Carolina In-Home Partner-V, LLC | North Carolina | |
North Carolina In-Home Partner-VI, LLC | North Carolina | |
North Carolina In-Home Partner-VII, LLC | North Carolina | |
North Carolina In-Home Partner-VIII, LLC | North Carolina | |
NP Services of NC, LLC | North Carolina | |
Advance Geriatric Education and Consulting, LLC | Ohio | |
Assisted Care by Black Stone of Central Ohio, LLC | Ohio |
Assisted Care by Black Stone of Cincinnati, LLC | Ohio | |
Assisted Care by Black Stone of Dayton, LLC | Ohio | |
Assisted Care by Black Stone of Northwest Ohio, LLC | Ohio | |
Assisted Care by Black Stone of Toledo, LLC | Ohio | |
Black Stone of Central Ohio, LLC | Ohio | |
Black Stone of Cincinnati, LLC | Ohio | |
Black Stone of Dayton, LLC | Ohio | |
Black Stone of Northeast Ohio, LLC | Ohio | |
Black Stone of Northwest Ohio, LLC | Ohio | |
Black Stone Operations, LLC | Ohio | |
Blackstone Group, LLC | Ohio | |
Blackstone Health Care, LLC | Ohio | |
Cambridge Home Health Care, Inc. | Ohio | |
Cambridge Home Health Care, Inc. / Private | Ohio | |
Cambridge Personal Care, LLC | Ohio | |
Care Advisors by Black Stone, LLC | Ohio | |
Caretenders VNA of Ohio, LLC | Ohio | |
Caretenders VS of Ohio, LLC | Ohio | |
Caretenders VS of SE Ohio, LLC | Ohio | |
Home Health Care by Black Stone of Central Ohio, LLC | Ohio | |
Home Health Care by Black Stone of Cincinnati, LLC | Ohio | |
Home Health Care by Black Stone of Dayton, LLC | Ohio | |
Home Health Care by Black Stone of Northwest Ohio, LLC | Ohio | |
LHCG XCI, LLC | Ohio | |
LHCG XCII, LLC | Ohio | |
MJ Nursing at Blackstone, LLC | Ohio | |
NP Services of OH, LLC | Ohio | |
Ohio Health Care Group, LLC | Ohio | |
Ohio HomeCare, LLC | Ohio | |
Ohio In-Home Healthcare Partnership-I, LLC | Ohio | |
Ohio In-Home Partnership-I, LLC | Ohio | |
S&B Health Care, LLC | Ohio | |
Clinton Home Health & Hospice, LLC | Oklahoma | |
Mayes County HMA Home Health, LLC | Oklahoma | |
OHHP, LLC | Oklahoma | |
Oklahoma Health Care Group, LLC | Oklahoma | |
Ponca City Home Care Services, LLC | Oklahoma | |
Summit Properties - Muskogee, LLC | Oklahoma | |
LHCG LXXIII, LLC | Oregon | |
Oregon Health Care Group, LLC | Oregon | |
Salem HomeCare, LLC | Oregon | |
Three Rivers HomeCare, LLC | Oregon | |
Keystone Healthcare Partnership, LLC | Pennsylvania | |
LHCG CXL, LLC | Pennsylvania | |
LHCG CXLI, LLC | Pennsylvania | |
LHCG CXLII, LLC | Pennsylvania | |
LHCG CXLIII, LLC | Pennsylvania | |
LHCG XXVII, LLC | Pennsylvania | |
Pennsylvania Health Care Group Holdings, LLC | Pennsylvania | |
Pennsylvania In-Home Healthcare Partnership-I, LLC | Pennsylvania | |
Pennsylvania In-Home Healthcare Partnership-II, LLC | Pennsylvania | |
Pennsylvania In-Home Healthcare Partnership-III, LLC | Pennsylvania | |
Pennsylvania In-Home Partner-I, LLC | Pennsylvania | |
Pennsylvania In-Home Partner-II, LLC | Pennsylvania | |
Pennsylvania In-Home Partner-III, LLC | Pennsylvania |
Advanced Care House Calls of Rhode Island, LLC | Rhode Island | |
LHCG LIX, LLC | Rhode Island | |
Rhode Island Health Care Group, LLC | Rhode Island | |
Advanced Care House Calls of South Carolina, LLC | South Carolina | |
Halcyon Hospice of Aiken, LLC | South Carolina | |
LHCG XLI, LLC | South Carolina | |
South Carolina Health Care Group, LLC | South Carolina | |
South Carolina In-Home Healthcare Partnership-I, LLC | South Carolina | |
South Caroline In-Home Partner-I, LLC | South Carolina | |
Advanced Care House Calls of Tennessee, LLC | Tennessee | |
Almost Family ACO Services of Tennessee, LLC | Tennessee | |
Cedar Creek Home Health Care Agency, LLC | Tennessee | |
Elk Valley Health Services, LLC | Tennessee | |
Elk Valley Home Health Care Agency, LLC | Tennessee | |
Elk Valley Professional Affiliates, Inc. | Tennessee | |
Gericare, LLC | Tennessee | |
HMC Home Health, LLC | Tennessee | |
LHC HomeCare of Tennessee, LLC | Tennessee | |
LHCG CXXXII, LLC | Tennessee | |
LHCG CXXXIII, LLC | Tennessee | |
LHCG CXXXIV, LLC | Tennessee | |
LHCG CXXXV, LLC | Tennessee | |
LHCG CXXXVI, LLC | Tennessee | |
LHCG LXII, LLC | Tennessee | |
LHCG LXXXVIII, LLC | Tennessee | |
LHCG XCIII, LLC | Tennessee | |
LHCG XCIV, LLC | Tennessee | |
LHCG XCV, LLC | Tennessee | |
LHCG XCVI, LLC | Tennessee | |
LHCG XCVII, LLC | Tennessee | |
Lifeline Home Health Care of Springfield, LLC | Tennessee | |
Lifeline Home Health Care of Union City, LLC | Tennessee | |
Lifeline of West Tennessee, LLC | Tennessee | |
Medical Center Home Health, LLC | Tennessee | |
Morristown-Hamblen HomeCare & Hospice, LLC | Tennessee | |
Primary Care at Home of Tennessee, LLC | Tennessee | |
SunCrest Companion Services, LLC | Tennessee | |
SunCrest Healthcare of East Tennessee, LLC | Tennessee | |
SunCrest Healthcare of Middle TN, LLC | Tennessee | |
SunCrest Healthcare of West Tennessee, LLC | Tennessee | |
SunCrest Home Health of Claiborne County, Inc. | Tennessee | |
SunCrest Home Health of Manchester, Inc. | Tennessee | |
SunCrest Home Health of Nashville, Inc. | Tennessee | |
SunCrest LBL Holdings, Inc. | Tennessee | |
SunCrest Outpatient Rehab Services of TN, LLC | Tennessee | |
SunCrest Outpatient Rehab Services, LLC | Tennessee | |
SunCrest Telehealth Services, Inc. | Tennessee | |
Tennessee Health Care Group, LLC | Tennessee | |
Tennessee In-Home Healthcare Partnership-I, LLC | Tennessee | |
Tennessee In-Home Healthcare Partnership-II, LLC | Tennessee | |
Tennessee In-Home Healthcare Partnership-III, LLC | Tennessee | |
Tennessee In-Home Partner-I, LLC | Tennessee | |
Tennessee In-Home Partner-II, LLC | Tennessee | |
Tennessee In-Home Partner-III, LLC | Tennessee | |
Tennessee Nursing Services of Morristown, Inc. | Tennessee | |
Tennessee Physical Therapy Services of Kingsport, LLC | Tennessee |
Tennessee Physical Therapy Services of Knoxville, LLC | Tennessee | |
University of TN Medical Center Home Care Services, LLC | Tennessee | |
West Tennessee HomeCare, LLC | Tennessee | |
Woods Home Health, LLC | Tennessee | |
GSHS Home Health, LP. | Texas | |
Home Care Connections, Inc. | Texas | |
In-Home Healthcare Partnership-I, LLC | Texas | |
In-Home Partner of Texas-I, LLC | Texas | |
LHCG CXI, LLC | Texas | |
LHCG CXII, LLC | Texas | |
LHCG CXIII, LLC | Texas | |
LHCG CXIV, LLC | Texas | |
LHCG CXV, LLC | Texas | |
LHCG CXVI, LLC | Texas | |
LHCG CXVII, LLC | Texas | |
LHCG CXXI, LLC | Texas | |
LHCG CXXII, LLC | Texas | |
LHCG CXXIV, LLC | Texas | |
LHCG CXXX, LLC | Texas | |
LHCG CXXXI, LLC | Texas | |
LHCG CXXXVII, LLC | Texas | |
LHCG Partner II, LLC | Texas | |
LHCG XXXIII, LLC | Texas | |
Marshall HomeCare, LLC | Texas | |
Red River HomeCare, LLC | Texas | |
Rivercrest Home Health Care, Inc. | Texas | |
Southwet Post-Acute Care Partnership, LLC | Texas | |
Texas Health Care Group of Texarkana, LLC | Texas | |
Texas Health Care Group of The Golden Triangle, LLC | Texas | |
Texas Health Care Group, LLC | Texas | |
Wichita Falls Texas Home Care, LLC | Texas | |
LHCG LX, LLC | Utah | |
Utah Health Care Group, LLC | Utah | |
Advanced Care House Calls Virginia, LLC | Virginia | |
LHCG CXXVII, LLC | Virginia | |
LHCG LXXX, LLC | Virginia | |
Virginia Health Care Group, LLC | Virginia | |
Virginia HomeCare, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-I, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-II, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-III, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-IV, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-IX, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-V, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-VI, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-VII, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-VIII, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-X, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-XI, LLC | Virginia | |
Virginia In-Home Healthcare Partnership-XII, LLC | Virginia | |
Virginia In-Home Partner-I, LLC | Virginia | |
Virginia In-Home Partner-II, LLC | Virginia | |
Virginia In-Home Partner-III, LLC | Virginia | |
Virginia In-Home Partner-IV, LLC | Virginia | |
Virginia In-Home Partner-IX, LLC | Virginia | |
Virginia In-Home Partner-V, LLC | Virginia |
Virginia In-Home Partner-VI, LLC | Virginia | |
Virginia In-Home Partner-VII, LLC | Virginia | |
Virginia In-Home Partner-VIII, LLC | Virginia | |
Virginia In-Home Partner-X, LLC | Virginia | |
Virginia In-Home Partner-XI, LLC | Virginia | |
Virginia In-Home Partner-XII, LLC | Virginia | |
Advanced Care House Calls of Washington, LLC | Washington | |
LHCG LXIII, LLC | Washington | |
Northeast Washington Home Health, Inc. | Washington | |
Northwest Healthcare Alliance, Inc. | Washington | |
Washington Health Care Group, LLC | Washington | |
Washington HomeCare and Hospice of Central Basin, LLC | Washington | |
Boone Memorial HomeCare, LLC | West Virginia | |
Grant Memorial HomeCare and Hospice, LLC | West Virginia | |
Home Care Plus, Inc. | West Virginia | |
Housecalls Home Health & Hospice, LLC | West Virginia | |
Jackson County Home Health, LLC | West Virginia | |
LHC HomeCare of West Virginia, LLC | West Virginia | |
LHC Physician Services of West Virginia, LLC | West Virginia | |
LHCG LII, LLC | West Virginia | |
LHCG LXXXIX, LLC | West Virginia | |
LHCG LXXXVII, LLC | West Virginia | |
LHCG XC, LLC | West Virginia | |
Mountaineer HomeCare, LLC | West Virginia | |
Preston Memorial HomeCare, LLC | West Virginia | |
Primary Care at Home of West Virginia, LLC | West Virginia | |
Princeton Community HomeCare, LLC | West Virginia | |
Roane HomeCare, LLC | West Virginia | |
St. Mary’s Medical Center Home Health Services, LLC | West Virginia | |
West Virginia Health Care Group, LLC | West Virginia | |
West Virginia HomeCare, LLC | West Virginia | |
West Virginia Physical Therapy Services of Charleston, LLC | West Virginia | |
Wetzel County HomeCare, LLC | West Virginia | |
Advanced Care House Calls of Wisconsin, LLC | Wisconsin | |
HHA of Wisconsin, LLC | Wisconsin | |
LHCG XLVII, LLC | Wisconsin | |
Wisconsin Health Care Group, LLC | Wisconsin |
/s/ Keith G. Myers |
Keith G. Myers Chief Executive Officer (Principal executive officer) |
/s/ Joshua L. Proffitt |
Joshua L. Proffitt Chief Financial Officer (Principal financial officer) |
1. | The Report fully complies with the requirements of section 13(a) or 15(d) of the Securities Exchange Act of 1934; and |
2. | The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company. |
/s/ Keith G. Myers |
Keith G. Myers Chief Executive Officer (Principal executive officer) |
/s/ Joshua L. Proffitt |
Joshua L. Proffitt Chief Financial Officer (Principal financial officer) |
Summary of Significant Accounting Policies - Reclassification (Details) - USD ($) $ in Thousands |
Dec. 31, 2019 |
Dec. 31, 2018 |
---|---|---|
Error Corrections and Prior Period Adjustments Restatement [Line Items] | ||
Increase in common stock value | $ 361 | $ 358 |
Decrease in treasury stock | $ (60,060) | $ (49,373) |
Increase in treasury shares (in shares) | 5,136,890 | 5,029,429 |
Prior Year Adjustments | ||
Error Corrections and Prior Period Adjustments Restatement [Line Items] | ||
Increase in common stock value | $ 2,000 | |
Increase in shares issued (in shares) | 198,934 | |
Decrease in treasury stock | $ 1,000 | |
Increase in treasury shares (in shares) | 70,708 | |
Decrease in additional paid in capital | $ 3,000 |
Fair Value of Financial Instruments |
12 Months Ended |
---|---|
Dec. 31, 2019 | |
Fair Value Disclosures [Abstract] | |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying amounts of the Company’s cash, receivables, accounts payable, accrued liabilities, and operating lease right of use assets and liabilities approximate their fair values. The estimated fair value of intangible assets acquired was calculated using level 3 inputs based on the present value of anticipated future benefits. For the year ended December 31, 2019, the carrying value of the Company’s long-term debt approximates fair value as the interest rates approximates current rates.
|
Leases |
12 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Dec. 31, 2019 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Leases [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Leases | Leases The Company determines if a contract contains a lease at inception date. The Company's leases are operating leases, primarily for office and office equipment, that expire at various dates over the next nine years. The office leases have renewal options for periods ranging from one to five years. As it is not reasonably certain these renewal options will be exercised, the options were not considered in the lease term, and payments associated with the option years are excluded from lease payments. The office leases also generally have termination options, which allow for early termination of the lease; however, as the exercise of such options is not reasonably certain, the options were not considered in determining the lease term; payments for the full lease term are included in the lease payments. Additionally, the leases do not contain any material residual value guarantees. Payments due under operating leases include fixed and variable payments. These variable payments for the Company's office leases can include operating expenses, utilities, property taxes, insurance, common area maintenance, and other facility-related expense. Additionally, any leases with terms less than one year were not recognized as operating lease right of use assets or payables for short term leases in accordance with the election of ‘package of practical expedient’ under ASU 2016-02 and recognizes operating lease right of use assets and operating lease payable based on the present value of the future minimum lease payments at the lease commencement date. The Company's leases do not provide implicit rates. Therefore, the Company used an incremental borrowing rate based on the information available at the lease commencement date in determining the present value of future payments. During the year ended December 31, 2019, the Company incurred $44.0 million associated with operating lease costs, $0.7 million associated with impairments of operating lease right of use assets, and $4.2 million for abandonments for a total of $48.9 million. Abandonment expenses were recorded in general and administrative expenses. Expenses associated with lease expense was $47.6 million, and $25.1 million for the years ended December 31, 2018 and 2017 respectively. Information related to the Company's operating lease right of use assets and related lease payables for the office and office equipment leases were as follows (amounts in thousands):
Maturities of operating lease payables as of December 31, 2019 were as follows (amounts in thousands):
|
Goodwill and Other Intangibles, Net |
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Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill and Other Intangibles, Net | Goodwill and Other Intangibles, Net The following table summarizes changes in goodwill and other intangibles assets by segment during the twelve months ended December 31, 2019 and 2018 (amounts in thousands):
The Company determined that there was no impairment for the goodwill of any reporting units as of December 31, 2019, 2018 and 2017 based on the Company's annual impairment testing. The Company did record $0.6 million, $0.6 million and $1.5 million of impairment of goodwill during the years ended December 31, 2019, 2018 and 2017 due to the closure of underperforming locations. The amount of disposal of goodwill was determined using prices of comparable business in the market. This was recorded in impairment of intangibles and other on the Company's consolidated statements of income and disclosed in adjustments and disposals. The Company performed an impairment analysis on its indefinite-lived intangible assets related to the Company's trade names, licenses and certificates of need and determined that it is not more likely than not that the fair values of the indefinite-lived intangible assets are less than its carrying amount as of November 30, 2019; however, the Company did record $7.1 million related to impairments of other intangibles related to the lifting of a moratoria and closure of underperforming locations. The Medicare license impairment was a result of CMS action to remove all federal moratoria with regard to Medicare provider enrollment in four states. This was recorded in impairment of intangibles and other on the Company's consolidated statements of income and disclosed in adjustments and disposals. The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2019 and 2018 (amounts in thousands):
Remaining useful lives of trade names, customer relationships, and non-compete agreements were 9.8, 18.2, and 2.8 years, respectively at December 31, 2019. Similar amounts at December 31, 2018 were 8.8 and 19.3 and 2.8 years, respectively. Amortization expense for the Company's intangible assets was $1.3 million for the year ended December 31, 2019 and $2.1 million for the years ended December 31, 2018 and 2017, which was recorded in general and administrative expenses. The estimated intangible asset amortization expense for each of the five years subsequent to December 31, 2019 is as follows (amounts in thousands):
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Stockholders' Equity - Shares of Common Stock Issued Under Employee Stock Purchase Plan (Details) - $ / shares |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||
Number of shares available, beginning balance (in shares) | 189,611 | ||
Shares issued during period (in shares) | 19,895 | 18,725 | 18,542 |
Number of shares available, ending balance (in shares) | 132,449 | ||
Weighted average per share price of shares issued (in dollars per share) | $ 103.84 | $ 71.12 | $ 55.40 |
Debt - Schedule of Principal Payments on Long-Term Debt (Detail) $ in Thousands |
Dec. 31, 2019
USD ($)
|
---|---|
Debt Disclosure [Abstract] | |
2020 | $ 0 |
2021 | 0 |
2022 | 0 |
2023 | 253,000 |
2024 | 0 |
Total | $ 253,000 |
Unaudited Summarized Quarterly Financial Information (Details) - USD ($) $ / shares in Units, $ in Thousands |
3 Months Ended | 12 Months Ended | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2019 |
Sep. 30, 2019 |
Jun. 30, 2019 |
Mar. 31, 2019 |
Dec. 31, 2018 |
Sep. 30, 2018 |
Jun. 30, 2018 |
Mar. 31, 2018 |
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Quarterly Financial Information Disclosure [Abstract] | |||||||||||
Net service revenue | $ 531,315 | $ 528,499 | $ 517,842 | $ 502,585 | $ 509,842 | $ 507,043 | $ 502,024 | $ 291,054 | $ 2,080,241 | $ 1,809,963 | $ 1,062,602 |
Gross margin | 188,048 | 193,731 | 191,982 | 181,593 | 185,303 | 184,847 | 181,020 | 102,436 | 755,354 | 653,606 | 386,792 |
Net Income Attributable to LHC Group Inc.'s Common Stockholders | $ 21,803 | $ 30,067 | $ 25,000 | $ 18,856 | $ 20,552 | $ 21,230 | $ 16,797 | $ 4,995 | $ 95,726 | $ 63,574 | $ 50,112 |
Net income attributable to LHC Group' Inc.'s common stockholders | |||||||||||
Basic earnings per share (in dollars per share) | $ 0.70 | $ 0.97 | $ 0.81 | $ 0.61 | $ 0.67 | $ 0.69 | $ 0.55 | $ 0.28 | $ 3.09 | $ 2.31 | $ 2.83 |
Diluted earnings per share (in dollars per share) | $ 0.70 | $ 0.96 | $ 0.80 | $ 0.60 | $ 0.66 | $ 0.68 | $ 0.55 | $ 0.28 | $ 3.07 | $ 2.29 | $ 2.79 |
Weighted average shares outstanding: | |||||||||||
Basic (in shares) | 30,977,812 | 30,970,589 | 30,960,468 | 30,837,290 | 30,777,556 | 30,750,227 | 30,497,501 | 17,789,863 | 30,932,607 | 27,498,351 | 17,715,992 |
Diluted (in shares) | 31,270,149 | 31,247,196 | 31,200,930 | 31,187,098 | 31,142,061 | 31,083,815 | 30,742,293 | 18,039,345 | 31,209,824 | 27,773,396 | 17,961,018 |
Employee Benefit Plan - Additional Information (Detail) - USD ($) |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Share-based Payment Arrangement [Abstract] | |||
Participants contribution | $ 19,000 | ||
Employer contribution as a percentage of employee contributions | 2.00% | ||
Employer contribution | 25.00% | ||
Full vesting period of employer contribution | 4 years | ||
Contribution expenses | $ 12,200,000 | $ 10,100,000 | $ 7,900,000 |
Goodwill and Other Intangibles, Net - Additional Information (Detail) - USD ($) |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
|
Indefinite-lived Intangible Assets [Line Items] | |||
Goodwill impairment loss | $ 0 | $ 0 | $ 0 |
Disposal related to goodwill associated with closure of underperforming locations | 600,000 | 600,000 | 1,500,000 |
Disposal related to intangible assets | 7,100,000 | 3,700,000 | 0 |
Total intangible assets, Net total | 305,556,000 | 297,379,000 | 134,611,000 |
Amortization expense | $ 1,300,000 | $ 2,100,000 | $ 2,100,000 |
Trade name | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Intangible asset estimated useful life | 9 years 9 months 18 days | 8 years 9 months 18 days | |
Customer Relationships | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Intangible asset estimated useful life | 18 years 2 months 12 days | 19 years 3 months 18 days | |
Non-compete | |||
Indefinite-lived Intangible Assets [Line Items] | |||
Intangible asset estimated useful life | 2 years 9 months 18 days | 2 years 9 months 18 days |
Income Taxes - Income Tax Expense (Benefit) from Continuing Operations, Less Noncontrolling Interest (Detail) - USD ($) $ in Thousands |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Current: | |||
Federal | $ 4,678 | $ 892 | $ 12,798 |
State | 3,528 | 3,382 | 2,621 |
Total Current | 8,206 | 4,274 | 15,419 |
Deferred: | |||
Federal | 14,549 | 15,383 | (6,273) |
State | 3,852 | 2,742 | 1,798 |
Total Deferred | 18,401 | 18,125 | (4,475) |
Total income tax expense | $ 26,607 | $ 22,399 | $ 10,944 |
Income Taxes (Tables) |
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Income Tax Disclosure [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Significant Components of Deferred Tax Assets and Liabilities | Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2019 and 2018 were as follows (amounts in thousands):
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Income Tax Expense (Benefit) from Continuing Operations, Less Noncontrolling Interest | The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, were as follows (amounts in thousands):
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Statutory Rate and Provisions for Income Taxes | A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each period is as follows:
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Schedule of Unrecognized Tax Benefits | A reconciliation of the total amounts of unrecognized tax benefits follows:
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Summary of Significant Accounting Policies (Policies) |
12 Months Ended |
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Dec. 31, 2019 | |
Accounting Policies [Abstract] | |
Use of Estimates | Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles (“US GAAP”) requires management to make estimates and assumptions that affect the reported amounts in the Company's accompanying consolidated financial statements and notes to the consolidated financial statements. Actual results could differ from those estimates.
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Reclassification and Immaterial Correction of an Error | Reclassification and Immaterial Correction of an Error The Company has reclassified certain amounts relating to its prior year results to conform to its current period presentation. These reclassifications have not changed the results of operations of prior years.
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Revenue Recognition | Medicare Home Health Services The home nursing Medicare patients are classified into one of 153 home health resource groups prior to receiving services. Based on the patient's home health resource group, the Company is entitled to receive a standard prospective Medicare payment for delivering care over a 60-day period referred to as an episode. Revenue is recognized based on the number of days elapsed during an episode of care within the reporting period. Final payments from Medicare will reflect base payment adjustments for case-mix and geographic wage differences and 2% sequestration reduction. In addition, final payments may also reflect, but are not limited to, one of four retroactive adjustments to the total reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or transferred from another provider before completing the episode; or (d) a payment adjustment based upon the level of therapy services required. Medicare rates are based on the severity of the patient's condition, service needs and goals, and other factors relating to the cost of providing services and supplies, bundled into an episode of care, not to exceed 60 days. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave their home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services, and receive treatment under a plan of care established and periodically reviewed by a physician. All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprising of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, the Company accounts for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. Expected Medicare revenue per episode is recognized based on the number of days elapsed during an episode of care within the reporting period. The base episode payment can be adjusted based on each patient's health including clinical condition, functional abilities, and service needs, as well as for the applicable geographic wage index, low utilization, patient transfers and other factors. The services covered by the episode payment include all disciplines of care in addition to medical supplies. Medicare can also make various adjustments to payments received resulting from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of such adjustments based our historical experience, and records this estimate during the period in which services are rendered as an estimated price concession and a corresponding reduction to patient accounts receivable. A portion of reimbursement from each Medicare episode is billed near the start of each episode, and cash is typically received before all services are rendered. The amount of revenue recognized for episodes of care which are incomplete at period end is based on the number of days elapsed during the episode of care within the reporting period. As of December 31, 2019 and 2018, the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding patient accounts receivable in our consolidated balance sheets for such periods. Hospice Services The Company records revenue on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are predetermined daily or hourly rates for each of the four levels of care delivered. The Company receives one of four predetermined daily rates based upon the level of care the Company furnishes. The four levels of care are routine care, general inpatient care, continuous home care, and respite care. There are two separate payment rates for routine care: payment for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, the Company may also receive a service intensity add-on ("SIA"). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. Adjustments to Medicare revenue are made from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of these adjustments based on our historical experience. Hospice payments are subject to variable consideration through an inpatient cap and an overall Medicare payment cap. The inpatient cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from inpatient care services and the overall Medicare payment cap relates to individual programs receiving reimbursements in excess of a “cap amount,” determined by Medicare to be payment equal to six months of hospice care for the aggregate base of hospice patients, indexed for inflation. The determination for each cap is made annually based on the 12-month period ending on October 31 of each year. The Company monitors its limits on a provider-by-provider basis and records an estimate of its liability for reimbursements received in excess of the cap amount, if any, in the reporting period. Facility-Based Services Gross revenue is recorded as services are provided under the long-term acute care hospital (“LTACH”) prospective payment system. Each patient is assigned a long-term care diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare LTACH patient classified in that particular long-term care diagnosis-related group. For selected LTACH patients, the amount may be further adjusted based on length-of-stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for LTACH claims paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Net service revenue adjustments resulting from reviews and audits of Medicare cost report settlements are considered implicit price concessions for LTACHs and are measured at expected value. Non-Medicare Revenue Other sources of net service revenue for all segments fall into Medicaid, managed care or other payers of the Company's services. Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized for Medicaid services as services are provided based on this fee schedule. The Company's managed care and other payors reimburse the Company based upon a predetermined fee schedule or an episodic basis, depending on the terms of the applicable contract. Accordingly, the Company recognizes revenue from managed care and other payors as services are provided, such costs are incurred, and estimates of expected payments are known for each different payer, thus the Company's revenue is recorded at the estimated transaction price. Contingent Service Revenues The Company's Healthcare Innovations ("HCI") segment provides strategic health management services to Affordable Care Organizations ("ACOs") that have been approved to participate in the Medicare Shared Savings Program ("MSSP"). The HCI segment has service agreements with ACOs that provide for sharing of MSSP payments received by the ACO, if any. ACOs are legal entities that contract with Centers for Medicare and Medicaid Services ("CMS") to provide services to the Medicare fee-for-service population for a specified annual period with the goal of providing better care for the individual, improving health for populations and lowering costs. ACOs share savings with CMS to the extent that the actual costs of serving assigned beneficiaries are below certain trended benchmarks of such beneficiaries and certain quality performance measures are achieved. The generation of shared savings is the performance obligation of each ACO, which only become certain upon the final issuance of unembargoed calculations by CMS, generally in the third quarter of each year. During the years ended December 31, 2019 and 2018, the HCI segment recorded net service revenue of $2.9 million and $3.7 million, respectively, related to the 2018 and 2017 ACO respective service periods, as certain ACOs served by the HCI segment received a MSSP payment from CMS confirming the performance obligation has been met. Revenue Recognition Basis of Presentation Net service revenue from contracts with customers is recognized in the period the performance obligations are satisfied under the Company's contracts by transferring the requested services to patients in amounts that reflect the consideration to which is expected to be received in exchange for providing patient care, which is the transaction price allocated to the services provided in accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"). Net service revenue is recognized as performance obligations are satisfied, which can vary depending on the type of services provided. The performance obligation is the delivery of patient care in accordance with the requested services outlined in physicians' orders, which are based on specific goals for each patient. The performance obligations are associated with contracts in duration of less than one year; therefore, the optional exemption provided by ASC 606 was elected resulting in the Company not being required to disclose the aggregate amount of the transaction price allocated to the performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The Company's unsatisfied or partially unsatisfied performance obligations are primarily completed when the patients are discharged and typically occur within days or weeks of the end of the period. The Company determines the transaction price based on gross charges for services provided, reduced by estimates for explicit and implicit price concessions. Explicit price concessions include contractual adjustments provided to patients and third-party payors. Implicit price concessions include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from regulatory reviews, audits, billing reviews and other matters. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (i.e. change in credit risk) are recorded as a provision for doubtful accounts within general and administrative expenses. Explicit price concessions are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Implicit price concessions are recorded for self-pay, uninsured patients and other payors by major payor class based on historical collection experience, aged accounts receivable by payor, and current economic conditions. The implicit price concession represents the difference between amounts billed and amounts expected to be collected based on collection history with similar payors. The Company assesses the ability to collect for the healthcare services provided at the time of patient admission based on the verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and reviews. The Company has determined estimates for price concessions related to regulatory reviews based on historical experience and success rates in the claim appeals and adjudication process. Revenue is recorded at amounts estimated to be realizable for services provided.
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Accounts Receivable | Accounts Receivable The Company reports patient accounts receivable from services rendered at their estimated transaction price, which includes price concessions based on the amounts expected to be due from payors. The Company's patient accounts receivable is uncollateralized and primarily consist of amounts due from Medicare, Medicaid, other third-party payors, and to a lesser degree patients. The credit risk from other payors is limited due to the significance of Medicare as the primary payor. The Company believes the credit risk associated with its Medicare accounts is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The Company does not believe that there are any other significant concentrations from any particular payor that would subject it to any significant credit risk in the collection of patient accounts receivable. A portion of the estimated Medicare prospective payment system reimbursement from each submitted home nursing episode is received in the form of a request for anticipated payment (“RAP”). The Company submits a RAP for 60% of the estimated reimbursement for the initial episode at the start of care. The full amount of the episode is billed after the episode has been completed. The RAP received for that particular episode is recouped prior to receiving final payment in full. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAP received for that episode will be recouped by Medicare from any other Medicare claims in process for that particular provider. The RAP and final claim must then be resubmitted. For subsequent episodes of care contiguous with the first episode for a particular patient, the Company submits a RAP for 50% of the estimated reimbursement.
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Business Combinations | Business Combinations The Company accounts for its acquisitions in accordance with ASC 805, "Business Combinations" ("ASC 805") using the acquisition method of accounting. Assets typically acquired consist primarily of Medicare licenses, trade names, certificates of need, and/or non-compete agreements. The assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is also measured and recorded at fair value as of the acquisition date. Goodwill represents the excess of the cost of an acquired entity over the net amounts assigned to assets acquired and liabilities assumed. The operations of the acquisitions are included in the consolidated financial statements from their respective dates of acquisition.
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Insurance Programs | Insurance Programs The Company bears significant risk under its large-deductible workers’ compensation insurance program and its self-insured employee health program. Under the workers’ compensation insurance program, the Company bears risk up to $1.0 million per incident, after which stop-loss coverage is maintained. The Company purchases stop-loss insurance for the employee health plan and bear risk up to $0.3 million per incident. Malpractice and general patient liability claims for incidents which may give rise to litigation have been asserted against the Company by various claimants. The claims are in various stages of processing and some may ultimately be brought to trial. The Company currently carries professional liability insurance coverage on a claims made basis and general liability insurance coverage on an occurrence basis for this exposure with a $0.1 million. The Company also carries Directors and Officers coverage (also on a claims made basis) for potential claims against the Company’s directors and officers, including securities actions, with deductibles ranging from $0.5 million to $1.0 million per claim. The Company records estimated liabilities for its insurance programs based on information provided by the third-party plan administrators, historical claims experience, the life cycle of claims, expected costs of claims incurred but not paid, and expected costs to settle unpaid claims. The Company monitors its estimated insurance-related liabilities and recoveries, if any, on a monthly basis and records amounts due under insurance policies in other current assets, while recording the estimated carrier liability in self-insurance reserves. As facts change, it may become necessary to make adjustments that could be material to the Company’s results of operations and financial condition.
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Goodwill and Intangible Assets | Goodwill and Intangible Assets In accordance with ASC 350, "Intangibles - Goodwill and Other" ("ASC 350") goodwill and intangible assets with indefinite lives are reviewed by the Company at least annually for impairment. The Company performs its annual impairment review of goodwill at November 30, and when a triggering event occurs between annual impairment tests. For 2019 and 2018, the Company performed a qualitative assessment of goodwill and determined that it is not more likely than not that the fair values of its reporting units are less than the carrying amounts. The Company has not recognized any goodwill impairment charges in 2019, 2018 or 2017 related to the annual impairment testing. Components of the Company's reporting units are collections of markets of similar service offerings that operate collaboratively under a house of brands, i.e. multiple brands are used across markets, states, and segments. During the years ended December 31, 2019, 2018, and 2017, the Company recognized an impairment of $0.6 million, $0.6 million, and $1.5 million related to goodwill associated with the closure of underperforming locations. The impairments were calculated using a market approach. Included in intangible assets are definite-lived assets subject to amortization such as non-compete agreements, customer relationships, and defensive assets, which are defined as trade names that are not actively used. Amortization of definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets, ranging from two to nineteen years. Amortization expense for the Company's definite-lived intangible assets for the year ended December 31, 2019, was $1.3 million, and for each of the years ended December 31, 2018 and 2017 was $2.1 million, which was recorded in general and administrative expenses. The Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need, and Medicare licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need, and licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the useful lives of these intangible assets and the Company intends to renew and operate the certificates of need and licenses and use the trade names indefinitely. In some cases, the value of licenses and certificates of need is increased by moratoriums in effect. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. To determine whether an indefinite-lived intangible asset is impaired, the Company performs a qualitative assessment to support the conclusion that the indefinite-lived intangible asset is not impaired. Based on the results of that qualitative assessment, the Company may perform a quantitative test. The Company utilizes a relief-from-royalty method in its quantitative impairment test of trade names. Under this method, the fair value of the trade name is determined by calculating the present value of the after-tax cost savings associated with owning the trade names and, therefore, not having to pay royalties for use over its estimated useful life. The Company utilizes the replacement cost approach in its quantitative impairment test for certificates of need and licenses. Under this method, assumptions are made about the cost to replace the certificates of need and licenses.
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Due to/from Governmental Entities | Due to/from Governmental Entities The Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. Additionally, reimbursements received in excess of hospice cap amounts are recorded in this account, if any.
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Property, Plant and Equipment | Property, Building and Equipment Property, building and equipment are recorded at cost. Property, building and equipment acquired in connection with business combinations are recorded at estimated fair value in accordance with the acquisition method of accounting in accordance with ASC 805. Expenditures that increase capacities or extend useful lives are capitalized to the appropriate property, building and equipment accounts. Costs and related accumulated depreciation associated with assets that are sold or retired are written off and any gain or losses are recorded in operating income. Routine repairs and maintenance costs are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the individual assets. The estimated useful life of buildings is 39 years, while the estimated useful lives of transportation equipment, fixed equipment, and office furniture and equipment range from 3 to 10 years. The useful life for leasehold improvements is the shorter of the lease term or the expected life of the leasehold improvement. In accordance with ASC 360, "Property, Plant, and Equipment", the Company evaluates its long-lived assets for possible impairment whenever events or changes in circumstances occur that indicate that the carrying amount of the asset may not be recoverable.
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Noncontrolling Interest | Noncontrolling Interest The Company classifies noncontrolling interests of its joint ventures based upon a review of the legal provisions governing the redemption of such interests. In each of the Company’s joint ventures, those provisions are embodied within the joint venture’s operating agreement. For joint ventures with operating agreement provisions that establish an obligation for the Company to purchase the third party partners’ noncontrolling interests other than as a result of events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as redeemable noncontrolling interests in temporary equity. For joint ventures with operating agreement provisions that establish an obligation that the Company purchase the third party partners’ noncontrolling interests, but which obligation is triggered by events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. Additionally, for joint ventures with operating agreement provisions that do not establish an obligation for the Company to purchase the third party partners’ noncontrolling interests (e.g., where the Company has the option, but not the obligation, to purchase the third party partners’ noncontrolling interests), such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. The Company’s equity joint ventures that are classified as redeemable noncontrolling interests are subject to operating agreement provisions that require the Company to purchase the noncontrolling partner’s interest upon the occurrence of certain triggering events, which are defined as the bankruptcy of the partner or the partner’s exclusion from the Medicare or Medicaid programs. These triggering events and the related repurchase provisions are specific to each redeemable equity joint venture, since the triggering of a repurchase obligation for any one redeemable noncontrolling interest in an equity joint venture does not necessarily impact any of the other redeemable noncontrolling interests in other equity joint ventures. Upon the occurrence of a triggering event requiring the purchase of a redeemable noncontrolling interest, the Company would be required to purchase the noncontrolling partner’s interest based upon a valuation methodology set forth in the applicable joint venture agreement. Redeemable noncontrolling interests and nonredeemable noncontrolling interests are initially recorded at their fair value as of the closing date of the transaction establishing the joint venture. Such fair values are determined using various accepted valuation methods, including the income approach, the market approach, the cost approach, and a combination of one or more of these approaches. A number of facts and circumstances concerning the operation of the joint venture are evaluated for each transaction, including (but not limited to) the ability to choose management, control over acquiring or liquidating assets, and control over the joint venture’s strategy and direction, in order to determine the fair value of the noncontrolling interest. Subsequent to the closing date of the transaction establishing the joint venture, recorded values for both redeemable and nonredeemable noncontrolling interests are adjusted at the end of each reporting period for (a) comprehensive income (loss) that is attributed to the noncontrolling interest, which is calculated by multiplying the noncontrolling interest percentage by the comprehensive income (loss) of the joint venture’s operations during the reporting period, (b) dividends paid to the noncontrolling interest partner during the reporting period, and (c) any other transactions that increase or decrease the Company’s ownership interest in the joint venture, as a result of which the Company retains its controlling interest. If the Company determines based upon its analysis as of the end of each reporting period in accordance with authoritative accounting guidance, that it is not probable that an event would occur to otherwise require the redemption of a redeemable noncontrolling interest (i.e., the date for such event is not set or such event is not certain to occur), then the Company does not adjust the recorded amount of such redeemable noncontrolling interest. The carrying amount of each redeemable equity instrument presented in temporary equity as of December 31, 2019 is not less than the initial amount reported for each instrument. The activity of noncontrolling interest-redeemable for the twelve months ended December 31, 2019, 2018 and 2017 is summarized in the Company’s statements of changes in equity. Based upon the Company’s evaluation of the redemption provisions concerning redeemable noncontrolling interests as of December 31, 2019, the Company determined in accordance with authoritative accounting guidance that it was not probable that an event otherwise requiring redemption of any redeemable noncontrolling interest would occur (i.e., the date for such event was not set or such event is not certain to occur). Therefore, none of the redeemable noncontrolling interests were identified as mandatorily redeemable interests at such times, and the Company did not record any values in respect of any mandatorily redeemable interests.
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Share-Based Compensation | Stock-Based Compensation The Company accounts for its stock-based awards in accordance with provisions of ASC 718, "Compensation - Stock Compensation" ("ASC 718"). The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of compensation. In accordance with ASC 718, the expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis over the requisite service period. See Note 7 to the Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information.
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Recently Adopted and Issued Accounting Pronouncements | Recently Adopted Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases, ("ASU 2016-02"), as modified by ASUs 2018-01, 2018-10, 2018-11 and 2018-20 (collectively, ASU 2016-02), which requires lessees to recognize leases with terms exceeding 12 months on the Company's consolidated balance sheet. Qualifying leases were classified as finance or operating right-of-use ("ROU") operating assets and lease payables. The Company adopted this new standard on January 1, 2019 using the modified retrospective transition approach, which required the new standard to be applied to all leases existing at the date of initial application. ASU 2016-02 provides a number of optional practical expedients in transition and the Company (a) elected the 'package of practical expedients', which permitted the Company not to reassess under the new standard the Company's prior conclusions about lease identification, lease classification and initial direct costs, (b) elected all the use-of-hindsight or the practical expedient pertaining to land easements; the latter not being applicable to the Company, and (c) elected all the new standard's available transition practical expedients. The adoption had a material impact to the Company's consolidated balance sheets but did not materially impact the Consolidated statements of income. Adoption of this standard increased total assets and total payables by $89.7 million on January 1, 2019, primarily for the Company's operating leased office space for locations in each segment. The adoption did not change the Company's leasing activities. ASU 2016-02 also provides practical expedients for an entity's ongoing accounting. The Company has elected the practical expedient that allows us not to separate lease and non-lease components for all leases. The Company elected the short-term recognition exemption for certain medical devices and storage space leases that qualify, which means it did not recognize ROU assets or lease payables, including not recognizing ROU assets or lease liabilities for existing short-term leases of these assets in transition. See Note 8 of the Notes to Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information. Recently Issued Accounting Pronouncements In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment, which requires an entity to no longer perform a hypothetical purchase price allocation to measure goodwill impairment. Instead, impairment will be measured using the difference between the carrying amount and the fair value of the reporting unit. This ASU is effective for annual and interim periods in fiscal years beginning after December 15, 2019, and is not expected to significantly impact the Company. In June 2016, the FASB issued ASU 2016-13, Measurement of Credit Losses on Financial Instruments which amends Financial Instruments - Credit Losses ("Topic 326"). ASU 2016-13 provides guidance for measuring credit losses on financial instruments. Early adoption is permitted. The amendments in this ASU should be applied retrospectively. This ASU is effective for annual and interim periods in fiscal years beginning after December 15, 2019, and is not expected to significantly impact the Company.
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CONSOLIDATED STATEMENTS OF INCOME - USD ($) $ in Thousands |
3 Months Ended | 12 Months Ended | |||||||||
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Dec. 31, 2019 |
Sep. 30, 2019 |
Jun. 30, 2019 |
Mar. 31, 2019 |
Dec. 31, 2018 |
Sep. 30, 2018 |
Jun. 30, 2018 |
Mar. 31, 2018 |
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Income Statement [Abstract] | |||||||||||
Net service revenue | $ 531,315 | $ 528,499 | $ 517,842 | $ 502,585 | $ 509,842 | $ 507,043 | $ 502,024 | $ 291,054 | $ 2,080,241 | $ 1,809,963 | $ 1,062,602 |
Cost of service revenue (excluding depreciation and amortization) | 1,324,887 | 1,156,357 | 675,810 | ||||||||
Gross margin | 188,048 | 193,731 | 191,982 | 181,593 | 185,303 | 184,847 | 181,020 | 102,436 | 755,354 | 653,606 | 386,792 |
General and administrative expenses | 596,006 | 537,916 | 310,539 | ||||||||
Impairment of intangibles and other | 7,734 | 4,689 | 1,571 | ||||||||
Operating income | 151,614 | 111,001 | 74,682 | ||||||||
Interest expense | (11,155) | (9,679) | (3,352) | ||||||||
Income before income taxes and noncontrolling interests | 140,459 | 101,322 | 71,330 | ||||||||
Income tax expense | 26,607 | 22,399 | 10,944 | ||||||||
Net income | 113,852 | 78,923 | 60,386 | ||||||||
Less net income attributable to noncontrolling interests | 18,126 | 15,349 | 10,274 | ||||||||
Net income attributable to LHC Group, Inc.’s common stockholders | $ 21,803 | $ 30,067 | $ 25,000 | $ 18,856 | $ 20,552 | $ 21,230 | $ 16,797 | $ 4,995 | $ 95,726 | $ 63,574 | $ 50,112 |
Earnings per share - basic: | |||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders (in dollars per share) | $ 0.70 | $ 0.97 | $ 0.81 | $ 0.61 | $ 0.67 | $ 0.69 | $ 0.55 | $ 0.28 | $ 3.09 | $ 2.31 | $ 2.83 |
Earnings per share - diluted: | |||||||||||
Net income attributable to LHC Group, Inc.’s common stockholders (in dollars per share) | $ 0.70 | $ 0.96 | $ 0.80 | $ 0.60 | $ 0.66 | $ 0.68 | $ 0.55 | $ 0.28 | $ 3.07 | $ 2.29 | $ 2.79 |
Weighted average shares outstanding: | |||||||||||
Basic (in shares) | 30,977,812 | 30,970,589 | 30,960,468 | 30,837,290 | 30,777,556 | 30,750,227 | 30,497,501 | 17,789,863 | 30,932,607 | 27,498,351 | 17,715,992 |
Diluted (in shares) | 31,270,149 | 31,247,196 | 31,200,930 | 31,187,098 | 31,142,061 | 31,083,815 | 30,742,293 | 18,039,345 | 31,209,824 | 27,773,396 | 17,961,018 |
Summary of Significant Accounting Policies |
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Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Significant Accounting Policies | Summary of Significant Accounting Policies Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles (“US GAAP”) requires management to make estimates and assumptions that affect the reported amounts in the Company's accompanying consolidated financial statements and notes to the consolidated financial statements. Actual results could differ from those estimates. A description of the significant accounting policies and a discussion of the significant estimates and judgments associated with such policies are described below. Principles of Consolidation The consolidated financial statements include all subsidiaries and entities controlled by the Company through direct ownership of majority interest or controlling member ownership of such entities. Third party equity interests in the consolidated joint ventures are reflected as noncontrolling interests in the Company’s consolidated financial statements. All significant intercompany accounts and transactions have been eliminated in consolidation. All business combinations accounted for under the acquisition method have been included in the consolidated financial statements from the respective dates of acquisition. The Company consolidates equity joint venture entities as the Company has controlling interests, has voting control over these entities, or has ability to exercise significant influence in these entities. The members of the Company's equity joint ventures participate in profits and losses in proportion to their equity interests. The Company, through wholly owned subsidiaries, leases home health licenses necessary to operate certain of its home nursing and hospice agencies. As with wholly owned subsidiaries, the Company owns 100% of the equity of these entities and consolidates them based on such ownership. Reclassification and Immaterial Correction of an Error The Company has reclassified certain amounts relating to its prior year results to conform to its current period presentation. These reclassifications have not changed the results of operations of prior years. During the year ended December 31, 2019, the Company increased the reported balance of common stock by $2,000, increased the reported number of common shares issued by 198,934 shares, decreased the reported balance of treasury stock by $1,000, increased the reported number of treasury shares by 70,708, and decreased the reported balances of Additional paid-in-capital by $3,000 for the year ended December 31, 2018 due to (1) the exclusion of reporting the number of common shares issued in conjunction with the Company's purchase of an additional controlling interest in a joint venture and (2) the exclusion of reporting the number of common shares issued as a result of the exercise of certain outstanding stock options and the number of treasury shares redeemed to pay income tax associated with such stock option exercises. The Company has evaluated the effects both qualitatively and quantitatively, and concluded that they did not have a material impact on previously issued financial statements for the year ended December 31, 2018. Revenue Recognition Basis of Presentation Net service revenue from contracts with customers is recognized in the period the performance obligations are satisfied under the Company's contracts by transferring the requested services to patients in amounts that reflect the consideration to which is expected to be received in exchange for providing patient care, which is the transaction price allocated to the services provided in accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers (Topic 606) and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"). Net service revenue is recognized as performance obligations are satisfied, which can vary depending on the type of services provided. The performance obligation is the delivery of patient care in accordance with the requested services outlined in physicians' orders, which are based on specific goals for each patient. The performance obligations are associated with contracts in duration of less than one year; therefore, the optional exemption provided by ASC 606 was elected resulting in the Company not being required to disclose the aggregate amount of the transaction price allocated to the performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The Company's unsatisfied or partially unsatisfied performance obligations are primarily completed when the patients are discharged and typically occur within days or weeks of the end of the period. The Company determines the transaction price based on gross charges for services provided, reduced by estimates for explicit and implicit price concessions. Explicit price concessions include contractual adjustments provided to patients and third-party payors. Implicit price concessions include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from regulatory reviews, audits, billing reviews and other matters. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (i.e. change in credit risk) are recorded as a provision for doubtful accounts within general and administrative expenses. Explicit price concessions are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Implicit price concessions are recorded for self-pay, uninsured patients and other payors by major payor class based on historical collection experience, aged accounts receivable by payor, and current economic conditions. The implicit price concession represents the difference between amounts billed and amounts expected to be collected based on collection history with similar payors. The Company assesses the ability to collect for the healthcare services provided at the time of patient admission based on the verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and reviews. The Company has determined estimates for price concessions related to regulatory reviews based on historical experience and success rates in the claim appeals and adjudication process. Revenue is recorded at amounts estimated to be realizable for services provided. The following table sets forth the percentage of net service revenue earned by category of payor for each segment for the years ending December 31:
Medicare Home Health Services The home nursing Medicare patients are classified into one of 153 home health resource groups prior to receiving services. Based on the patient's home health resource group, the Company is entitled to receive a standard prospective Medicare payment for delivering care over a 60-day period referred to as an episode. Revenue is recognized based on the number of days elapsed during an episode of care within the reporting period. Final payments from Medicare will reflect base payment adjustments for case-mix and geographic wage differences and 2% sequestration reduction. In addition, final payments may also reflect, but are not limited to, one of four retroactive adjustments to the total reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment if the number of visits was fewer than five; (c) a partial payment if the patient transferred to another provider or transferred from another provider before completing the episode; or (d) a payment adjustment based upon the level of therapy services required. Medicare rates are based on the severity of the patient's condition, service needs and goals, and other factors relating to the cost of providing services and supplies, bundled into an episode of care, not to exceed 60 days. An episode starts the first day a billable visit is performed and ends 60 days later or upon discharge, if earlier, with multiple continuous episodes allowed. The Medicare home health benefit requires that beneficiaries be homebound (meaning that the beneficiary is unable to leave their home without a considerable and taxing effort), require intermittent skilled nursing, physical therapy or speech therapy services, and receive treatment under a plan of care established and periodically reviewed by a physician. All Medicare contracts are required to have a signed plan of care which represents a single performance obligation, comprising of the delivery of a series of distinct services that are substantially similar and have a similar pattern of transfer to the customer. Accordingly, the Company accounts for the series of services ("episode") as a single performance obligation satisfied over time, as the customer simultaneously receives and consumes the benefits of the goods and services provided. Expected Medicare revenue per episode is recognized based on the number of days elapsed during an episode of care within the reporting period. The base episode payment can be adjusted based on each patient's health including clinical condition, functional abilities, and service needs, as well as for the applicable geographic wage index, low utilization, patient transfers and other factors. The services covered by the episode payment include all disciplines of care in addition to medical supplies. Medicare can also make various adjustments to payments received resulting from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of such adjustments based our historical experience, and records this estimate during the period in which services are rendered as an estimated price concession and a corresponding reduction to patient accounts receivable. A portion of reimbursement from each Medicare episode is billed near the start of each episode, and cash is typically received before all services are rendered. The amount of revenue recognized for episodes of care which are incomplete at period end is based on the number of days elapsed during the episode of care within the reporting period. As of December 31, 2019 and 2018, the difference between the cash received from Medicare for a request for anticipated payment (“RAP”) on episodes in progress and the associated estimated revenue was immaterial and, therefore, the resulting credits were recorded as a reduction to our outstanding patient accounts receivable in our consolidated balance sheets for such periods. Hospice Services The Company records revenue on an accrual basis based upon the date of service at amounts equal to the estimated payment rates. The estimated payment rates are predetermined daily or hourly rates for each of the four levels of care delivered. The Company receives one of four predetermined daily rates based upon the level of care the Company furnishes. The four levels of care are routine care, general inpatient care, continuous home care, and respite care. There are two separate payment rates for routine care: payment for the first 60 days of care and care beyond 60 days. In addition to the two routine rates, the Company may also receive a service intensity add-on ("SIA"). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. Adjustments to Medicare revenue are made from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of these adjustments based on our historical experience. Hospice payments are subject to variable consideration through an inpatient cap and an overall Medicare payment cap. The inpatient cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from inpatient care services and the overall Medicare payment cap relates to individual programs receiving reimbursements in excess of a “cap amount,” determined by Medicare to be payment equal to six months of hospice care for the aggregate base of hospice patients, indexed for inflation. The determination for each cap is made annually based on the 12-month period ending on October 31 of each year. The Company monitors its limits on a provider-by-provider basis and records an estimate of its liability for reimbursements received in excess of the cap amount, if any, in the reporting period. Facility-Based Services Gross revenue is recorded as services are provided under the long-term acute care hospital (“LTACH”) prospective payment system. Each patient is assigned a long-term care diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare LTACH patient classified in that particular long-term care diagnosis-related group. For selected LTACH patients, the amount may be further adjusted based on length-of-stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for LTACH claims paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Net service revenue adjustments resulting from reviews and audits of Medicare cost report settlements are considered implicit price concessions for LTACHs and are measured at expected value. Non-Medicare Revenue Other sources of net service revenue for all segments fall into Medicaid, managed care or other payers of the Company's services. Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized for Medicaid services as services are provided based on this fee schedule. The Company's managed care and other payors reimburse the Company based upon a predetermined fee schedule or an episodic basis, depending on the terms of the applicable contract. Accordingly, the Company recognizes revenue from managed care and other payors as services are provided, such costs are incurred, and estimates of expected payments are known for each different payer, thus the Company's revenue is recorded at the estimated transaction price. Contingent Service Revenues The Company's Healthcare Innovations ("HCI") segment provides strategic health management services to Affordable Care Organizations ("ACOs") that have been approved to participate in the Medicare Shared Savings Program ("MSSP"). The HCI segment has service agreements with ACOs that provide for sharing of MSSP payments received by the ACO, if any. ACOs are legal entities that contract with Centers for Medicare and Medicaid Services ("CMS") to provide services to the Medicare fee-for-service population for a specified annual period with the goal of providing better care for the individual, improving health for populations and lowering costs. ACOs share savings with CMS to the extent that the actual costs of serving assigned beneficiaries are below certain trended benchmarks of such beneficiaries and certain quality performance measures are achieved. The generation of shared savings is the performance obligation of each ACO, which only become certain upon the final issuance of unembargoed calculations by CMS, generally in the third quarter of each year. During the years ended December 31, 2019 and 2018, the HCI segment recorded net service revenue of $2.9 million and $3.7 million, respectively, related to the 2018 and 2017 ACO respective service periods, as certain ACOs served by the HCI segment received a MSSP payment from CMS confirming the performance obligation has been met. Patient Accounts Receivable The Company reports patient accounts receivable from services rendered at their estimated transaction price, which includes price concessions based on the amounts expected to be due from payors. The Company's patient accounts receivable is uncollateralized and primarily consist of amounts due from Medicare, Medicaid, other third-party payors, and to a lesser degree patients. The credit risk from other payors is limited due to the significance of Medicare as the primary payor. The Company believes the credit risk associated with its Medicare accounts is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The Company does not believe that there are any other significant concentrations from any particular payor that would subject it to any significant credit risk in the collection of patient accounts receivable. A portion of the estimated Medicare prospective payment system reimbursement from each submitted home nursing episode is received in the form of a request for anticipated payment (“RAP”). The Company submits a RAP for 60% of the estimated reimbursement for the initial episode at the start of care. The full amount of the episode is billed after the episode has been completed. The RAP received for that particular episode is recouped prior to receiving final payment in full. If a final bill is not submitted within the greater of 120 days from the start of the episode, or 60 days from the date the RAP was paid, any RAP received for that episode will be recouped by Medicare from any other Medicare claims in process for that particular provider. The RAP and final claim must then be resubmitted. For subsequent episodes of care contiguous with the first episode for a particular patient, the Company submits a RAP for 50% of the estimated reimbursement. The following table sets forth the percentage of patient accounts receivable by payor for the years ended December 31:
Business Combinations The Company accounts for its acquisitions in accordance with ASC 805, "Business Combinations" ("ASC 805") using the acquisition method of accounting. Assets typically acquired consist primarily of Medicare licenses, trade names, certificates of need, and/or non-compete agreements. The assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is also measured and recorded at fair value as of the acquisition date. Goodwill represents the excess of the cost of an acquired entity over the net amounts assigned to assets acquired and liabilities assumed. The operations of the acquisitions are included in the consolidated financial statements from their respective dates of acquisition. Acquisition transactions that occurred in 2019 and 2018 are further described in Note 3 and Note 4 to the Consolidated Financial Statements included in this Annual Report on Form 10-K. Insurance Programs The Company bears significant risk under its large-deductible workers’ compensation insurance program and its self-insured employee health program. Under the workers’ compensation insurance program, the Company bears risk up to $1.0 million per incident, after which stop-loss coverage is maintained. The Company purchases stop-loss insurance for the employee health plan and bear risk up to $0.3 million per incident. Malpractice and general patient liability claims for incidents which may give rise to litigation have been asserted against the Company by various claimants. The claims are in various stages of processing and some may ultimately be brought to trial. The Company currently carries professional liability insurance coverage on a claims made basis and general liability insurance coverage on an occurrence basis for this exposure with a $0.1 million. The Company also carries Directors and Officers coverage (also on a claims made basis) for potential claims against the Company’s directors and officers, including securities actions, with deductibles ranging from $0.5 million to $1.0 million per claim. The Company records estimated liabilities for its insurance programs based on information provided by the third-party plan administrators, historical claims experience, the life cycle of claims, expected costs of claims incurred but not paid, and expected costs to settle unpaid claims. The Company monitors its estimated insurance-related liabilities and recoveries, if any, on a monthly basis and records amounts due under insurance policies in other current assets, while recording the estimated carrier liability in self-insurance reserves. As facts change, it may become necessary to make adjustments that could be material to the Company’s results of operations and financial condition. Goodwill and Intangible Assets In accordance with ASC 350, "Intangibles - Goodwill and Other" ("ASC 350") goodwill and intangible assets with indefinite lives are reviewed by the Company at least annually for impairment. The Company performs its annual impairment review of goodwill at November 30, and when a triggering event occurs between annual impairment tests. For 2019 and 2018, the Company performed a qualitative assessment of goodwill and determined that it is not more likely than not that the fair values of its reporting units are less than the carrying amounts. The Company has not recognized any goodwill impairment charges in 2019, 2018 or 2017 related to the annual impairment testing. Components of the Company's reporting units are collections of markets of similar service offerings that operate collaboratively under a house of brands, i.e. multiple brands are used across markets, states, and segments. During the years ended December 31, 2019, 2018, and 2017, the Company recognized an impairment of $0.6 million, $0.6 million, and $1.5 million related to goodwill associated with the closure of underperforming locations. The impairments were calculated using a market approach. Included in intangible assets are definite-lived assets subject to amortization such as non-compete agreements, customer relationships, and defensive assets, which are defined as trade names that are not actively used. Amortization of definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets, ranging from two to nineteen years. Amortization expense for the Company's definite-lived intangible assets for the year ended December 31, 2019, was $1.3 million, and for each of the years ended December 31, 2018 and 2017 was $2.1 million, which was recorded in general and administrative expenses. The Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need, and Medicare licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need, and licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the useful lives of these intangible assets and the Company intends to renew and operate the certificates of need and licenses and use the trade names indefinitely. In some cases, the value of licenses and certificates of need is increased by moratoriums in effect. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. To determine whether an indefinite-lived intangible asset is impaired, the Company performs a qualitative assessment to support the conclusion that the indefinite-lived intangible asset is not impaired. Based on the results of that qualitative assessment, the Company may perform a quantitative test. The Company utilizes a relief-from-royalty method in its quantitative impairment test of trade names. Under this method, the fair value of the trade name is determined by calculating the present value of the after-tax cost savings associated with owning the trade names and, therefore, not having to pay royalties for use over its estimated useful life. The Company utilizes the replacement cost approach in its quantitative impairment test for certificates of need and licenses. Under this method, assumptions are made about the cost to replace the certificates of need and licenses. During the twelve months ended December 31, 2019, 2018 or 2017, the Company did not record an impairment charge related to indefinite-lived intangible assets in the annual impairment testing. During the year ended December 31, 2019, the Company did record $7.1 million related to impairments, of which $6.1 million was related to impairment due to changes in moratorium regulations and $1.0 million was related to the closure of underperforming locations. During 2019, CMS removed all federal moratoria with regard to Medicare provider enrollments in four states. The Medicare licenses were deemed impaired upon the notice of removal. During the year ended December 31, 2018, the Company recognized a disposal of $3.7 million related to intangible assets associated with closures of underperforming locations. The Company did not recognize any such costs during the year ended December 31, 2017. Due to/from Governmental Entities The Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. Additionally, reimbursements received in excess of hospice cap amounts are recorded in this account, if any. Property, Building and Equipment Property, building and equipment are recorded at cost. Property, building and equipment acquired in connection with business combinations are recorded at estimated fair value in accordance with the acquisition method of accounting in accordance with ASC 805. Expenditures that increase capacities or extend useful lives are capitalized to the appropriate property, building and equipment accounts. Costs and related accumulated depreciation associated with assets that are sold or retired are written off and any gain or losses are recorded in operating income. Routine repairs and maintenance costs are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful lives of the individual assets. The estimated useful life of buildings is 39 years, while the estimated useful lives of transportation equipment, fixed equipment, and office furniture and equipment range from 3 to 10 years. The useful life for leasehold improvements is the shorter of the lease term or the expected life of the leasehold improvement. In accordance with ASC 360, "Property, Plant, and Equipment", the Company evaluates its long-lived assets for possible impairment whenever events or changes in circumstances occur that indicate that the carrying amount of the asset may not be recoverable. There were no impairment charges recognized during the periods ended December 31, 2019, 2018 and 2017. The following table describes the Company’s components of property, building and equipment for the years ended December 31, 2019 and 2018 (amounts in thousands):
Depreciation expense for the years ended December 31, 2019, 2018 and 2017 was $17.0 million, $14.1 million and $11.3 million, respectively, which was recorded in general and administrative expenses. In addition, the Company capitalized $0.2 million in interest costs related to the construction of its home office expansion project. Noncontrolling Interest The Company classifies noncontrolling interests of its joint ventures based upon a review of the legal provisions governing the redemption of such interests. In each of the Company’s joint ventures, those provisions are embodied within the joint venture’s operating agreement. For joint ventures with operating agreement provisions that establish an obligation for the Company to purchase the third party partners’ noncontrolling interests other than as a result of events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as redeemable noncontrolling interests in temporary equity. For joint ventures with operating agreement provisions that establish an obligation that the Company purchase the third party partners’ noncontrolling interests, but which obligation is triggered by events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. Additionally, for joint ventures with operating agreement provisions that do not establish an obligation for the Company to purchase the third party partners’ noncontrolling interests (e.g., where the Company has the option, but not the obligation, to purchase the third party partners’ noncontrolling interests), such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. The Company’s equity joint ventures that are classified as redeemable noncontrolling interests are subject to operating agreement provisions that require the Company to purchase the noncontrolling partner’s interest upon the occurrence of certain triggering events, which are defined as the bankruptcy of the partner or the partner’s exclusion from the Medicare or Medicaid programs. These triggering events and the related repurchase provisions are specific to each redeemable equity joint venture, since the triggering of a repurchase obligation for any one redeemable noncontrolling interest in an equity joint venture does not necessarily impact any of the other redeemable noncontrolling interests in other equity joint ventures. Upon the occurrence of a triggering event requiring the purchase of a redeemable noncontrolling interest, the Company would be required to purchase the noncontrolling partner’s interest based upon a valuation methodology set forth in the applicable joint venture agreement. Redeemable noncontrolling interests and nonredeemable noncontrolling interests are initially recorded at their fair value as of the closing date of the transaction establishing the joint venture. Such fair values are determined using various accepted valuation methods, including the income approach, the market approach, the cost approach, and a combination of one or more of these approaches. A number of facts and circumstances concerning the operation of the joint venture are evaluated for each transaction, including (but not limited to) the ability to choose management, control over acquiring or liquidating assets, and control over the joint venture’s strategy and direction, in order to determine the fair value of the noncontrolling interest. Subsequent to the closing date of the transaction establishing the joint venture, recorded values for both redeemable and nonredeemable noncontrolling interests are adjusted at the end of each reporting period for (a) comprehensive income (loss) that is attributed to the noncontrolling interest, which is calculated by multiplying the noncontrolling interest percentage by the comprehensive income (loss) of the joint venture’s operations during the reporting period, (b) dividends paid to the noncontrolling interest partner during the reporting period, and (c) any other transactions that increase or decrease the Company’s ownership interest in the joint venture, as a result of which the Company retains its controlling interest. If the Company determines based upon its analysis as of the end of each reporting period in accordance with authoritative accounting guidance, that it is not probable that an event would occur to otherwise require the redemption of a redeemable noncontrolling interest (i.e., the date for such event is not set or such event is not certain to occur), then the Company does not adjust the recorded amount of such redeemable noncontrolling interest. The carrying amount of each redeemable equity instrument presented in temporary equity as of December 31, 2019 is not less than the initial amount reported for each instrument. The activity of noncontrolling interest-redeemable for the twelve months ended December 31, 2019, 2018 and 2017 is summarized in the Company’s statements of changes in equity. Based upon the Company’s evaluation of the redemption provisions concerning redeemable noncontrolling interests as of December 31, 2019, the Company determined in accordance with authoritative accounting guidance that it was not probable that an event otherwise requiring redemption of any redeemable noncontrolling interest would occur (i.e., the date for such event was not set or such event is not certain to occur). Therefore, none of the redeemable noncontrolling interests were identified as mandatorily redeemable interests at such times, and the Company did not record any values in respect of any mandatorily redeemable interests. Stock-Based Compensation The Company accounts for its stock-based awards in accordance with provisions of ASC 718, "Compensation - Stock Compensation" ("ASC 718"). The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of compensation. In accordance with ASC 718, the expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis over the requisite service period. See Note 7 to the Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information. Earnings Per Share The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31, 2019, 2018 and 2017:
Recently Adopted Accounting Pronouncements In February 2016, the FASB issued ASU No. 2016-02, Leases, ("ASU 2016-02"), as modified by ASUs 2018-01, 2018-10, 2018-11 and 2018-20 (collectively, ASU 2016-02), which requires lessees to recognize leases with terms exceeding 12 months on the Company's consolidated balance sheet. Qualifying leases were classified as finance or operating right-of-use ("ROU") operating assets and lease payables. The Company adopted this new standard on January 1, 2019 using the modified retrospective transition approach, which required the new standard to be applied to all leases existing at the date of initial application. ASU 2016-02 provides a number of optional practical expedients in transition and the Company (a) elected the 'package of practical expedients', which permitted the Company not to reassess under the new standard the Company's prior conclusions about lease identification, lease classification and initial direct costs, (b) elected all the use-of-hindsight or the practical expedient pertaining to land easements; the latter not being applicable to the Company, and (c) elected all the new standard's available transition practical expedients. The adoption had a material impact to the Company's consolidated balance sheets but did not materially impact the Consolidated statements of income. Adoption of this standard increased total assets and total payables by $89.7 million on January 1, 2019, primarily for the Company's operating leased office space for locations in each segment. The adoption did not change the Company's leasing activities. ASU 2016-02 also provides practical expedients for an entity's ongoing accounting. The Company has elected the practical expedient that allows us not to separate lease and non-lease components for all leases. The Company elected the short-term recognition exemption for certain medical devices and storage space leases that qualify, which means it did not recognize ROU assets or lease payables, including not recognizing ROU assets or lease liabilities for existing short-term leases of these assets in transition. See Note 8 of the Notes to Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information. Recently Issued Accounting Pronouncements In January 2017, the FASB issued ASU 2017-04, Intangibles - Goodwill and Other: Simplifying the Test for Goodwill Impairment, which requires an entity to no longer perform a hypothetical purchase price allocation to measure goodwill impairment. Instead, impairment will be measured using the difference between the carrying amount and the fair value of the reporting unit. This ASU is effective for annual and interim periods in fiscal years beginning after December 15, 2019, and is not expected to significantly impact the Company. In June 2016, the FASB issued ASU 2016-13, Measurement of Credit Losses on Financial Instruments which amends Financial Instruments - Credit Losses ("Topic 326"). ASU 2016-13 provides guidance for measuring credit losses on financial instruments. Early adoption is permitted. The amendments in this ASU should be applied retrospectively. This ASU is effective for annual and interim periods in fiscal years beginning after December 15, 2019, and is not expected to significantly impact the Company.
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Subsequent Event (Details) $ in Millions |
Jan. 01, 2020
USD ($)
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Subsequent Event | |
Subsequent Event [Line Items] | |
Consideration for acquisition | $ 23.6 |
Commitments and Contingencies - Additional Information (Detail) $ in Millions |
12 Months Ended |
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Dec. 31, 2019
USD ($)
complaint
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Commitments and Contingencies Disclosure [Abstract] | |
Other assets from government payors related to disputed findings | $ | $ 16.9 |
Additional complaints filed | complaint | 2 |
Joint venture buy/sell option period | 30 days |
Income Taxes - Deferred Tax Assets and Liabilities (Detail) - USD ($) $ in Thousands |
Dec. 31, 2019 |
Dec. 31, 2018 |
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Deferred tax assets: | ||
Allowance for uncollectible accounts | $ 8,181 | $ 8,645 |
Accrued employee benefits | 7,404 | 6,038 |
Stock compensation | 2,037 | 2,322 |
Accrued self-insurance | 6,688 | 8,656 |
Acquisition costs | 1,569 | 1,413 |
Net operating loss carry forward | 6,661 | 9,147 |
Intangible asset impairment | 14 | 18 |
Lease payable | 24,751 | 0 |
Other | 332 | 1,021 |
Gross deferred tax assets | 57,637 | 37,260 |
Less: valuation allowance | (3,850) | (3,574) |
Net deferred tax assets | 53,787 | 33,686 |
Deferred tax liabilities: | ||
Amortization of intangible assets | (73,512) | (64,001) |
Tax depreciation in excess of book depreciation | (9,247) | (7,693) |
Prepaid expenses | (1,287) | (1,134) |
Non-accrual experience accounting method | (1,468) | (602) |
Right of use asset | (24,044) | 0 |
Other | (4,727) | (3,562) |
Deferred tax liabilities | (114,285) | (76,992) |
Net deferred tax liability | $ (60,498) | $ (43,306) |
Debt (Tables) |
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Schedule of Principal Payments on Long-Term Debt | The scheduled principal payments on long-term debt for each of the five years subsequent to December 31, 2019 is as follows (amounts in thousands):
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Summary of Significant Accounting Policies (Tables) |
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Percentage of Net Service Revenue Earned by Category of Payor | The following table sets forth the percentage of net service revenue earned by category of payor for each segment for the years ending December 31:
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Schedules of Percentage of Patient Accounts Receivable by Payor | The following table sets forth the percentage of patient accounts receivable by payor for the years ended December 31:
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Property, Plant and Equipment | The following table describes the Company’s components of property, building and equipment for the years ended December 31, 2019 and 2018 (amounts in thousands):
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Shares Used in Computation of Basic and Diluted per Share Information | The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31, 2019, 2018 and 2017:
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Acquisitions and Joint Venture Activities |
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Business Combinations [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acquisitions and Joint Venture Activities | Acquisitions and Joint Venture Activities The Merger On April 1, 2018, the Company completed the Merger with Almost Family. At the effective time of the Merger on April 1, 2018, each outstanding share of common stock of Almost Family, other than certain canceled shares, was converted into the right to receive 0.9150 shares of the Company’s common stock and cash in lieu of any fractional shares of any Company common stock that Almost Family shareholders would otherwise have been entitled to receive. As a result, the Company issued approximately 12.8 million shares of its common stock to former stockholders of Almost Family, while also converting outstanding employee share awards, which resulted in total merger consideration of approximately $795.4 million. The Company was determined to be the accounting acquirer in the Merger. The Company's final valuation analysis of identifiable assets and liabilities assumed for the Merger in accordance with the requirements of ASC Topic 805, Business Combinations, are presented in the table below (amounts in thousands):
2019 Acquisitions The Company acquired the majority-ownership of 16 home health agencies, eight hospice agencies, two home and community-based agencies, and one LTACH location during the twelve months ended December 31, 2019. The total aggregate purchase price for these transactions was $61.8 million, of which $57.9 million was paid in cash. In addition, the Company paid $16.4 million for acquisitions effective January 1, 2020, which was included in other assets. The purchase prices were determined based on the Company’s analysis of comparable acquisitions and the target market’s potential future cash flows. Goodwill generated from the acquisitions was recognized based on the expected contributions of each acquisition to the overall corporate strategy. The Company expects its portion of goodwill to be fully tax deductible. The acquisitions were accounted for under the acquisition method of accounting. Accordingly, the accompanying financial information includes the results of operations of the acquired entities from the date of acquisition. The following table summarizes the aggregate consideration paid for the acquisitions and the amounts of the assets acquired and liabilities assumed at the acquisition dates, as well as their provisional fair value at the acquisition dates and the noncontrolling interest acquired during the twelve months ended December 31, 2019:
The Company conducted preliminary assessments and recognized provisional amounts in its initial accounting for these acquisitions for all identified assets in accordance with the requirements of ASC 805. The Company is continuing its review of these matters during the measurement period. If new information about facts and circumstances that existed at the acquisition date is obtained and indicates adjustments are necessary, the acquisition accounting will be revised to adjust to the provisional amounts initially recognized. Trade names, certificates of need and licenses are indefinite-lived assets and, therefore, not subject to amortization. Acquired trade names that are not being used actively are amortized over the estimated useful life on the straight line basis. Trade names are valued using the relief from royalty method, a form of the income approach. Certificates of need are valued using the replacement cost approach based on registration fees and opportunity costs. Licenses are valued based on the estimated direct costs associated with recreating the asset, including opportunity costs based on an income approach. In the case of states with a moratorium in place, the licenses are valued using the multi-period excess earnings method. Joint Venture Activities During the twelve months ended December 31, 2019, the Company acquired the minority ownership interests associated with certain agencies previously operated within four of its equity joint ventures. The total consideration for the purchase of such ownership interests was $19.7 million, which was paid in cash. These transactions were accounted for as equity transactions. During the twelve months ended December 31, 2019, the Company sold minority ownership interests associated with three home health agencies. The total consideration for the sale of such ownership interests was $4.2 million. The transaction was accounted for as an equity transaction. Other 2018 Acquisitions and Joint Venture Activities The Company acquired the majority-ownership of seven home health agencies and one hospice agency during the year ended December 31, 2018. The total aggregate purchase price for these transactions was $9.4 million, of which $8.8 million was paid in cash. The purchase prices were determined based on the Company's analysis of comparable acquisitions and the target market's potential future cash flows. Substantially all of the allocation of the purchase price for the acquisitions were allocated to goodwill of $11.0 million, indefinite lived intangibles trade names of $1.5 million and certificates of need/licenses of $1.4 million. Acquired noncontrolling interest was $5.0 million. During the year ended December 31, 2018, the Company sold ownership interests in five of its wholly-owned subsidiaries. The total sales prices of such ownership interests were $4.2 million, all of which were accounted for as equity transactions, resulting in the Company reducing additional paid in capital by $2.2 million. During the year ended December 31, 2018, the Company purchased additional ownership interests in two of its equity joint venture subsidiaries. The total consideration of such ownership was $8.1 million, of which $7.7 million was paid in shares of the Company's common stock. These transactions were accounted for as equity transactions, resulting in the Company increasing additional paid in capital by $7.7 million.
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Organization (Details) |
12 Months Ended |
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Dec. 31, 2019
ServiceProvider
State
segment
| |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Number of segments | segment | 5 |
Number of service providers | ServiceProvider | 811 |
Number of states in which entity operates | State | 35 |
Summary of Significant Accounting Policies - Percentage of Patient Accounts Receivable by Payor (Details) - Product Concentration Risk - Accounts Receivable |
12 Months Ended | |
---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
|
Concentration Risk [Line Items] | ||
Concentration risk percentage | 100.00% | 100.00% |
Medicare | ||
Concentration Risk [Line Items] | ||
Concentration risk percentage | 48.30% | 51.30% |
Medicaid | ||
Concentration Risk [Line Items] | ||
Concentration risk percentage | 9.40% | 8.60% |
Managed Care, Commercial, and Other | ||
Concentration Risk [Line Items] | ||
Concentration risk percentage | 42.30% | 40.10% |
Employee Benefit Plan |
12 Months Ended |
---|---|
Dec. 31, 2019 | |
Share-based Payment Arrangement [Abstract] | |
Employee Benefit Plan | Employee Benefit Plan Defined Contribution Plan The Company sponsors a 401(k) plan for all eligible employees. The plan allows participants to contribute up to $19,000 in 2019, tax deferred (subject to IRS guidelines). The plan also allows discretionary Company contributions as determined by the Company’s Board of Directors. Effective January 1, 2006, the Company implemented a discretionary match of up to two percent of participating employee contributions. The employer contribution will vest 25% in an employee's account for each year of service with the Company and 25% each additional year until it is fully vested in year four. Contribution expense to the Company was $12.2 million, $10.1 million and $7.9 million in the years ended December 31, 2019, 2018 and 2017, respectively.
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Income Taxes |
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Income Tax Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Income Taxes | Income Taxes The Company accounts for income taxes using the asset and liability method. Under the asset and liability method, deferred taxes are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax laws that will be in effect when the differences are expected to reverse. Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2019 and 2018 were as follows (amounts in thousands):
Based on the Company’s historical pattern of taxable income, the Company believes it will produce sufficient income in the future to realize its deferred income tax assets. Management provides a valuation allowance for any net deferred tax assets when it is more likely than not that a portion of such net deferred tax assets will not be recovered. The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, were as follows (amounts in thousands):
A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each period is as follows:
The Company is subject to both federal tax and state income tax for jurisdictions within which it operates. Within these jurisdictions, the Company is open to examination for tax years ended after December 31, 2014. As of December 31, 2019, the Company has U.S. operating loss carry forwards of $6.2 million that are available to reduce future taxable income. If not used to offset taxable income, a portion of these losses will expire between 2031 and 2034. Losses generated in years ending after December 31, 2017 have an unlimited carryforward under the Tax Cut and Jobs Act. Due to U.S. limitations on acquired operating losses, a valuation allowance has been established on $1.6 million of these losses. State operating loss carryforwards totaling $102.0 million at December 31, 2019 are being carried forward in jurisdictions where the Company is permitted to use tax losses from prior periods to reduce future taxable income. If not used to offset future taxable income, these losses will expire between 2020 and 2039. Due to uncertainty regarding the Company's ability to use some of the carryforwards, a valuation allowance has been established on $58.6 million of state net operating loss carryforwards. Based on the Company's historical record of producing taxable income and expectations for the future, the Company has concluded that future operating income will be sufficient to give rise to taxable income sufficient to utilize the remaining state net operating loss carryforwards. US GAAP prescribes a recognition threshold and measurement attribute for the accounting and financial statement disclosure of tax positions taken or expected to be taken in a tax return. The evaluation of a tax position is a two-step process. The first step requires the Company to determine whether it is more likely than not that a tax position will be sustained upon examination based on the technical merits of the position. The second step requires the Company to recognize in the financial statements each tax position that meets the more likely than not criteria, measured at the amount of benefit that has a greater than 50% likelihood of being realized. The Company's unrecognized tax benefits would affect the tax rate, if recognized. The Company includes the full amount of unrecognized tax benefits in other noncurrent liabilities in the consolidated balance sheets. The Company anticipates it is reasonably possible an increase or decrease in the amount of unrecognized tax benefits could be made in the next twelve months. However, the Company does not presently anticipate that any increase or decrease in unrecognized tax benefits will be material to the consolidated financial statements. The amount recognized as of December 31, 2019 was $3.9 million. A reconciliation of the total amounts of unrecognized tax benefits follows:
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Concentration of Risk |
12 Months Ended |
---|---|
Dec. 31, 2019 | |
Risks and Uncertainties [Abstract] | |
Concentration of Risk | Concentration of Risk The Company operates in 35 states within the continental United States and the District of Columbia. The Company's facilities in Louisiana, Tennessee, Arkansas, Mississippi, Kentucky, Florida, and Alabama accounted for approximately 53.0%, 54.2% and 63.0% of net service revenue during the years ended December 31, 2019, 2018 and 2017, respectively. Any material change in the current economic or competitive conditions in these states could have a disproportionate effect on the Company’s overall business results.
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Leases - Additional information (Detail) - USD ($) $ in Millions |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
|
Lessee, Lease, Description [Line Items] | |||
Operating lease term | 9 years | ||
Operating lease, cost | $ 44.0 | ||
Operating lease, impairment loss | 0.7 | ||
Abandonment, lease cost | 4.2 | ||
Lease cost | $ 48.9 | ||
Operating leases, rent expense | $ 47.6 | $ 25.1 | |
Minimum | |||
Lessee, Lease, Description [Line Items] | |||
Renewal term | 1 year | ||
Maximum | |||
Lessee, Lease, Description [Line Items] | |||
Renewal term | 5 years |
Income Taxes - Statutory Rate and Provisions for Income Taxes Percent (Detail) |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
|
Income Tax Disclosure [Abstract] | |||
Federal statutory tax rate | 21.00% | 21.00% | 35.00% |
State income taxes, net of federal benefit | 4.80% | 5.70% | 4.40% |
Nondeductible expenses | 1.80% | 2.60% | 3.20% |
Uncertain tax position | (0.90%) | (1.30%) | |
Tax Cut and Jobs Act Enactment | 0.00% | 0.00% | (22.90%) |
Excess tax benefit | (2.50%) | (2.60%) | (1.60%) |
Credits and other | (2.50%) | 0.70% | (0.10%) |
Effective tax rate | 21.70% | 26.10% | 18.00% |
Concentration of Risk - Additional Information (Detail) - State |
12 Months Ended | ||
---|---|---|---|
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Concentration Risk [Line Items] | |||
Number of states in which entity operates | 35 | ||
Louisiana, Tennessee, Arkansas, Mississippi, Kentucky, Florida, and Alabama | Net Service Revenue | Geographic Concentration Risk | |||
Concentration Risk [Line Items] | |||
Concentration risk percentage | 53.00% | 54.20% | 63.00% |
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands |
Dec. 31, 2019 |
Dec. 31, 2018 |
---|---|---|
Statement of Financial Position [Abstract] | ||
Property, building and equipment, accumulated depreciation | $ 69,441 | $ 55,253 |
Intangible assets, accumulated amortization | $ 16,431 | $ 15,176 |
Preferred stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
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) | 60,000,000 | 60,000,000 |
Common stock, shares issued (in shares) | 36,129,280 | 35,835,348 |
Common stock, shares outstanding (in shares) | 30,992,390 | 30,805,919 |
Treasury stock at cost, shares (in shares) | (5,136,890) | (5,029,429) |
Organization |
12 Months Ended |
---|---|
Dec. 31, 2019 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Organization | Organization LHC Group, Inc. (the “Company”) is a health care provider specializing in the post-acute continuum of care. The Company provides services through five segments: home health, hospice, home and community-based services, facility-based services, the latter primarily through long-term acute care hospitals ("LTACHs"), and healthcare innovations ("HCI"). On April 1, 2018, the Company completed its "merger of equals" business combination (the "Merger") with Almost Family, Inc. ("Almost Family"). Almost Family's operating results are included in the Company's operating results from the date of acquisition. See Note 3 of the Notes to the Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information. As of December 31, 2019, the Company, through its wholly and majority-owned subsidiaries, equity joint ventures, controlled affiliates, and management agreements, operated 811 service providers in 35 states within the continental United States and the District of Columbia.
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Leases (Tables) |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Leases [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Assets And Liabilities, Lessee | Information related to the Company's operating lease right of use assets and related lease payables for the office and office equipment leases were as follows (amounts in thousands):
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Lessee, Operating Lease, Liability, Maturity | Maturities of operating lease payables as of December 31, 2019 were as follows (amounts in thousands):
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Goodwill and Other Intangibles, Net (Tables) |
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Goodwill and Intangible Assets Disclosure [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Goodwill and Other Intangibles | The following table summarizes changes in goodwill and other intangibles assets by segment during the twelve months ended December 31, 2019 and 2018 (amounts in thousands):
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Schedule of Acquired Finite and Indefinite Lived Intangible Assets by Major Class Table | The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2019 and 2018 (amounts in thousands):
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Schedule of Intangible Asset Future Amortization Expense | The estimated intangible asset amortization expense for each of the five years subsequent to December 31, 2019 is as follows (amounts in thousands):
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Subsequent Event |
12 Months Ended |
---|---|
Dec. 31, 2019 | |
Subsequent Events [Abstract] | |
Subsequent Event | Subsequent Event Effective January 1, 2020, the Company purchased a portion of the noncontrolling membership interest in one of our equity joint venture partnerships, which prior to the purchase was classified as a nonredeemable noncontrolling interest in permanent equity. As a result of the purchase, the Company retained its controlling financial interests in the joint venture partnership and the noncontrolling interest of our partner will continue to be classified as a nonredeemable noncontrolling interest in permanent equity. Total consideration for this noncontrolling interest purchase was $23.6 million. |
Segment Information |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Information | Segment Information The Company's reporting segments include (1) home health services, (2) hospice services, (3) home and community-based services, (4) facility-based services and (5) healthcare innovations (“HCI”). The accounting policies of the segments are the same as those described in the summary of significant accounting policies, as described in Note 2 to the Consolidated Financial Statements included in this Annual Report on Form 10-K. Reportable segments have been identified based upon how management has organized the business by services provided to customers and how the chief operating decision maker manages the business and allocates resources, consistent with the criteria in ASC 280, Segment Reporting. The following tables summarize the Company’s segment information for the twelve months ended December 31, 2019, 2018 and 2017 (amounts in thousands):
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Stockholders' Equity |
12 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Equity [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Stockholders' Equity | Stockholders’ Equity Equity Based Awards The 2018 Incentive Plan is administered by the Compensation Committee of the Company’s Board of Directors. The total number of shares of the Company's common stock originally reserved were 2,210,544 shares of our common stock and a total of 2,009,444 shares are currently available for issuance. A variety of discretionary awards for employees, officers, directors, and consultants are authorized under the 2018 Incentive Plan, including incentive or non-qualified stock options and restricted stock, restricted stock units and performance-based awards. All awards must be evidenced by a written award certificate which will include the provisions specified by the Compensation Committee of the Board of Directors. The Compensation Committee determines the exercise price for stock options, which cannot be less than the fair market value of the Company’s common stock as of the date of grant. Almost Family had Stock and Incentive Compensation Plans that provided for stock awards of the Company's common stock to employees, non-employee directors, or independent contractors. Almost Family issued restricted shares and/or option awards to employees and non-employee directors. Under the change of control provisions of the Almost Family plans, all outstanding restricted stock, performance restricted stock, and options became non-forfeitable in conjunction with the Merger. Share Based Compensation Nonvested Stock The Company issues stock-based compensation to employees in the form of nonvested stock, which is an award of common stock subject to certain restrictions. The awards, which the Company calls nonvested shares, generally vest over a five years period, conditioned on continued employment for the full incentive period. Compensation expense for the nonvested stock is recognized for the awards that are expected to vest. The expense is based on the fair value of the awards on the date of grant recognized on a straight-line basis over the requisite service period, which generally relates to the vesting period. The Company estimates forfeitures at the time of grant and revises the estimate in subsequent periods if actual forfeitures differ to ensure that total compensation expense recognized is at least equal to the value of vested awards. During 2019, 2018, and 2017, respectively, 163,250, 213,105, and 139,310 nonvested shares were granted to employees, which will vest over a five year period. The Company also issues nonvested stock to its independent directors of the Company’s Board of Directors. During 2019, 2018 and 2017, respectively, 17,880, 13,600 and 11,700 nonvested shares of stock were granted to the independent directors. The shares fully vest one year from the date of the grant. During the twelve months ended December 31, 2019, one new director was granted 3,500 nonvested shares of common stock. The shares vest 33% at the grant date, then 33% each year on the anniversary date until the third year. The fair value of nonvested shares is determined based on the closing trading price of the Company’s shares on the grant date. The weighted average grant date fair values of nonvested shares granted during the years ended December 31, 2019, 2018 and 2017 were $110.56, $64.11 and $48.52, respectively. The following table represents the share grants stock activity for the year ended December 31, 2019:
As of December 31, 2019, there was $26.5 million of total unrecognized compensation cost related to nonvested shares granted. That cost is expected to be recognized over the weighted average period of 3.07 years. The total fair value of shares vested in the year ended December 31, 2019, 2018, and 2017 were $9.4 million, $8.0 million, and $5.6 million, respectively. The Company recorded $9.6 million, $9.4 million and $6.0 million in compensation expense related to non-vested stock grants in the years ended December 31, 2019, 2018 and 2017, respectively. Options acquired in connection with the Merger are fully vested and non-forfeitable. Aggregate intrinsic value for options represents the estimated value of the Company's common stock at the end of the period in excess of the weighted average exercise price multiplied by the number of options exercisable. The aggregate intrinsic value of options outstanding at December 31, 2019 was $5.5 million. The total intrinsic value of options exercised during the year ended December 31, 2019 was $1.5 million. The following table summarizes information about stock options outstanding and exercisable at December 31, 2019:
Employee Stock Purchase Plan In 2006, the Company adopted the Employee Stock Purchase Plan allowing eligible employees to purchase the Company’s common stock at 95% of the market price on the last day of each calendar quarter. There were 250,000 shares reserved for the plan. On June 20, 2013, the Amended and Restated Employee Stock Purchase Plan was approved by the Company’s stockholders. As a result of the amendment, the Employee Stock Purchase Plan was modified as follows:
The following table represents the shares issued during 2019, 2018, and 2017, under the Employee Stock Purchase Plan:
Treasury Stock In conjunction with the vesting of the nonvested shares of stock or exercise of options, recipients incur personal income tax obligations. The Company allows the recipients to turn in shares of common stock to satisfy those personal tax obligations. The Company redeemed 107,461, 138,925 and 61,825 shares of common stock related to these tax obligations during the years ended December 31, 2019, 2018 and 2017, respectively. Such shares are held as treasury stock and are available for reissuance by the Company. Additionally, shares were submitted by employees in lieu of paying the stock option exercise price that would have otherwise been due on exercise. Such shares are held in treasury stock and are available for reissuance by the Company.
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Segment Information (Tables) |
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Segment Information | The following tables summarize the Company’s segment information for the twelve months ended December 31, 2019, 2018 and 2017 (amounts in thousands):
|
Summary of Significant Accounting Policies - Shares Used in Computation of Basic and Diluted Per Share Information (Detail) - shares |
3 Months Ended | 12 Months Ended | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2019 |
Sep. 30, 2019 |
Jun. 30, 2019 |
Mar. 31, 2019 |
Dec. 31, 2018 |
Sep. 30, 2018 |
Jun. 30, 2018 |
Mar. 31, 2018 |
Dec. 31, 2019 |
Dec. 31, 2018 |
Dec. 31, 2017 |
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Weighted average shares outstanding: | |||||||||||
Weighted average number of shares outstanding for basic per share calculation (in shares) | 30,977,812 | 30,970,589 | 30,960,468 | 30,837,290 | 30,777,556 | 30,750,227 | 30,497,501 | 17,789,863 | 30,932,607 | 27,498,351 | 17,715,992 |
Effect of dilutive potential shares: | |||||||||||
Nonvested restricted stock (in shares) | 277,217 | 275,045 | 245,026 | ||||||||
Adjusted weighted average shares for diluted per share calculation (in shares) | 31,270,149 | 31,247,196 | 31,200,930 | 31,187,098 | 31,142,061 | 31,083,815 | 30,742,293 | 18,039,345 | 31,209,824 | 27,773,396 | 17,961,018 |
Antidilutive shares (in shares) | 157,608 | 46,002 | 0 |
Leases - Future Minimum Rental Commitments Under Non-cancelable Operating Leases (Detail) $ in Thousands |
Dec. 31, 2019
USD ($)
|
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Leases [Abstract] | |
2020 | $ 34,457 |
2021 | 26,197 |
2022 | 17,797 |
2023 | 11,780 |
2024 | 6,340 |
Thereafter | 12,966 |
Total future minimum lease payments | 109,537 |
Less: Imputed interest | (11,280) |
Total | $ 98,257 |
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