10-Q

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

WASHINGTON, D.C. 20549

Form 10-Q

(Mark One)

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended September 30, 2016

OR

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from to

Commission File Number: 333-176790

Aurora Diagnostics Holdings, LLC

(Exact Name of Registrant as Specified in Its Charter)

Delaware	20-4918072
(State or Other Jurisdiction of Incorporation or Organization)	(I.R.S. Employer Identification Number)

11025 RCA Center Drive, Suite 300

Palm Beach Gardens, Florida 33410

(Address of Principal Executive Offices) (Zip Code)

(866) 420-5512

(Registrant’s Telephone Number, Including Area Code)

None

(Former Name, Former Address and Former Fiscal Year, if Changed Since Last Report)

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    Yes  ☐    No  ☒ (Note: The registrant is a voluntary filer and for the preceding 12 months has filed all reports pursuant to the Securities Exchange Act of 1934 that would have been required to have been filed by it had it been subject to such sections.)

Indicate by check mark whether the registrant has submitted electronically and posted on its corporate Web site, if any, every Interactive Data File required to be submitted and posted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit and post such files).    Yes  ☒    No  ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer or a smaller reporting company. See the definitions of “large accelerated filer,” “accelerated filer” and “smaller reporting company” in Rule 12b-2 of the Exchange Act.:

Large accelerated filer	☐	Accelerated filer	☐
Non-accelerated filer	☒ (Do not check if a smaller reporting company)	Smaller reporting company	☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    Yes  ☐    No   ☒

We are an “emerging growth company” as defined in the Jumpstart Our Business Startups Act of 2012 (JOBS Act).

TABLE OF CONTENTS

		Page
PART I — FINANCIAL INFORMATION
Item 1.	Financial Statements	- 3 -
	Condensed Consolidated Balance Sheets as of September 30, 2016 (unaudited) and December 31, 2015	- 3 -
	Condensed Consolidated Statements of Operations for the Three and Nine Months Ended September 30, 2016 and 2015 (unaudited)	- 4 -
	Condensed Consolidated Statements of Cash Flows for the Nine Months Ended September 30, 2016 and 2015 (unaudited)	- 5 -
	Notes to Condensed Consolidated Financial Statements (unaudited)	- 7 -
Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	- 25 -
Item 3.	Quantitative and Qualitative Disclosures About Market Risk	- 37 -
Item 4.	Controls and Procedures	- 38 -
PART II — OTHER INFORMATION
Item 1.	Legal Proceedings	- 39 -
Item 1A.	Risk Factors	- 39 -
Item 6.	Exhibits	- 39 -
Signatures		- 40 -

- 2 -

PART I – FINANCIAL INFORMATION

Item 1. Financial Statements.

Aurora Diagnostics Holdings, LLC

Condensed Consolidated Balance Sheets

(in thousands)

	September 30,			December 31,
	2016			2015
Assets	(unaudited)
Current Assets
Cash and cash equivalents	$	12,062		$	19,085
Accounts receivable, net		38,846			32,851
Prepaid expenses and other assets		5,098			4,321
Prepaid income taxes		441			175
Total current assets		56,447			56,432
Property and equipment, net		8,004			8,646
Other Assets:
Deferred debt issue costs, net		358			453
Deferred financing costs, deposits and other noncurrent assets		2,103			596
Goodwill		127,473			125,188
Intangible assets, net		56,621			65,694
		186,555			191,931
	$	251,006		$	257,009
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	3,251		$	2,147
Current portion of fair value of contingent consideration		5,569			4,820
Accounts payable, accrued expenses and other current liabilities		18,346			16,839
Accrued compensation		8,559			7,030
Accrued interest		8,805			14,228
Total current liabilities		44,530			45,064
Long-term debt, net of current portion		387,283			377,617
Deferred tax liabilities		5,990			6,473
Accrued management fees, related parties		10,780			8,633
Fair value of contingent consideration, net of current portion		6,410			8,320
Other liabilities		2,702			1,685
Members' Deficit		(206,689	)		(190,783	)
	$	251,006		$	257,009

See Notes to Condensed Consolidated Financial Statements.

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Aurora Diagnostics Holdings, LLC

Condensed Consolidated Statements of Operations

Three and Nine Months Ended September 30, 2016 and 2015

Unaudited

(in thousands)

	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2016			2015			2016			2015
Net revenue	$	73,235		$	69,683		$	214,776		$	193,722
Operating costs and expenses:
Cost of services		38,748			36,925			114,370			106,164
Selling, general and administrative expenses		16,855			16,747			53,730			49,495
Provision for doubtful accounts		3,978			4,228			12,107			12,731
Intangible asset amortization expense		4,964			4,807			14,933			14,168
Management fees, related parties		733			697			2,148			1,914
Impairment of goodwill		—			—			—			39,641
Merger and acquisition transaction costs		762			297			1,338			694
Change in fair value of contingent consideration		166			180			1,146			686
Total operating costs and expenses		66,206			63,881			199,772			225,493
Income (loss) from operations		7,029			5,802			15,004			(31,771	)
Other income (expense):
Interest expense		(10,544	)		(10,490	)		(31,494	)		(30,434	)
Other income		(5	)		(2	)		—			4
Total other expense, net		(10,549	)		(10,492	)		(31,494	)		(30,430	)
Loss before income taxes		(3,520	)		(4,690	)		(16,490	)		(62,201	)
Provision (benefit) for income taxes		550			10			(473	)		(812	)
Net loss	$	(4,070	)	$	(4,700	)	$	(16,017	)	$	(61,389	)

See Notes to Condensed Consolidated Financial Statements.

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Aurora Diagnostics Holdings, LLC

Condensed Consolidated Statements of Cash Flows

Nine Months Ended September 30, 2016 and 2015

Unaudited

(in thousands)

	2016			2015
Cash Flows From Operating Activities
Net loss	$	(16,017	)	$	(61,389	)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization		17,792			17,371
Amortization of deferred debt issue costs		1,584			1,542
Amortization of original issue discount on debt		841			818
Deferred income taxes		(483	)		(1,553	)
Equity compensation costs		111			193
Change in fair value of contingent consideration		1,146			686
Impairment of goodwill		—			39,641
Loss on abandonment of lease		1,171			—
Changes in assets and liabilities, net of effects of acquisitions:
(Increase) decrease in:
Accounts receivable		(5,171	)		(1,724	)
Prepaid expenses and other assets		(978	)		(1,449	)
Increase (decrease) in:
Accounts payable, accrued expenses and other current liabilities		1,659			2,440
Accrued compensation		1,220			1,428
Accrued interest		(5,423	)		(4,755	)
Net cash used in operating activities		(2,548	)		(6,751	)
Cash Flows From Investing Activities
Purchases of property and equipment		(1,991	)		(1,093	)
Increase in deposits and other noncurrent assets		(6	)		(40	)
Payment of contingent notes		(3,407	)		(2,296	)
Businesses acquired, net of cash acquired		(7,250	)		(8,813	)
Net cash used in investing activities		(12,654	)		(12,242	)
Cash Flows From Financing Activities
Payments of capital lease obligations		(60	)		(59	)
Repayments under term loan facility		(1,500	)		(500	)
Borrowings under term loan facility		10,000			15,070
Payments of subordinated notes payable		—			(500	)
Net repayments under revolver		—			—
Payment of financing transaction costs		(261	)		(942	)
Net cash provided by financing activities		8,179			13,069
Net decrease in cash and cash equivalents		(7,023	)		(5,924	)
Cash and cash equivalents, beginning of period		19,085			26,422
Cash and cash equivalents, end of period	$	12,062		$	20,498

(Continued)

- 5 -

Aurora Diagnostics Holdings, LLC

Condensed Consolidated Statements of Cash Flows - (Continued)

Nine Months Ended September 30, 2016 and 2015

Unaudited

(in thousands)

	2016		2015
Supplemental Disclosures of Cash Flow Information
Cash interest payments	$	34,494	$	32,884
Cash tax payments	$	384	$	918
Supplemental Schedule of Noncash Investing and Financing Activities
Fair value of contingent consideration issued in acquisitions	$	1,100	$	5,110
Capital assets recorded under non-cash transactions	$	355	$	503

See Notes to Condensed Consolidated Financial Statements.

- 6 -

Aurora Diagnostics Holdings, LLC

Notes to Condensed Consolidated Financial Statements (unaudited)

Note 1. Nature of Business and Significant Accounting Policies

Nature of Business

Aurora Diagnostics Holdings, LLC (together with its subsidiaries, the “Company”) was organized in the State of Delaware as a limited liability company on June 2, 2006 to operate as a diagnostic services company. The Company providesintegrated diagnosticconsultations,informationservicesand personalizedmedicineservicestailoredto thepatientsof its referringphysicians,hospitalsand hospitalsystems.The Company also provides research services to pharmaceutical companies and other research entities. The Company’s operations consist of one reportable segment.

The Company operates in a highly regulated industry. The manner in which licensed physicians can organize to perform and bill for medical services is governed by state laws and regulations. Businesses like the Company often are not permitted to employ physicians or to own corporations that employ physicians or to otherwise exercise control over the medical judgments or decisions of physicians.

In states where the Company is not permitted to directly own a medical services provider or for other commercial reasons, it performs only non-medical administrative and support services, does not represent to the public or its clients that it offers medical services and does not exercise influence or control over the practice of medicine. In those states, the Company conducts business through entities that it controls, and it is these affiliated entities that employ the physicians who practice medicine. In such states, the Company generally enters into a contract that restricts the owners of the affiliated entity from transferring their ownership interests in the affiliated entity and otherwise provides the Company or its designee with a controlling voting or financial interest in the affiliated entity and its laboratory operations. This controlling financial interest generally is obtained pursuant to a long-term management services agreement between the Company and the affiliated entity. Under the management services agreement, the Company exclusively manages all aspects of the operation other than the provision of medical services. Generally, the affiliated entity has no operating assets because the Company acquired all of its operating assets at the time it acquired the related laboratory operations. In accordance with the relevant accounting guidance, these affiliated entities are included in the condensed consolidated financial statements of Aurora Diagnostics Holdings, LLC.

The accompanying condensed consolidated balance sheet as of December 31, 2015, which was derived from the audited consolidated financial statements as of December 31, 2015 of Aurora Diagnostics Holdings, LLC, and the accompanying unaudited condensed consolidated financial statements as of and for the three and nine months ended September 30, 2016 and 2015 have been prepared by the Company in accordance with accounting principles generally accepted in the United States of America for interim financial reporting. Accordingly, they do not include all of the information and related footnotes that would normally be required by accounting principles generally accepted in the United States of America for complete financial reporting. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements for the year ended December 31, 2015.

The accompanying unaudited condensed consolidated financial statements include all adjustments (consisting of a normal and recurring nature) that management considers necessary for a fair statement of financial information for the interim periods. Interim results are not necessarily indicative of the results that may be expected for the remainder of the year ending December 31, 2016.

Working Capital

The Company requires significant cash flow to service its debt obligations. Reductions in reimbursement from Medicare and other payors in recent years have had a significant negative impact on the Company’s cash flows. As of September 30, 2016, the Company had $30.0 million available under its revolving credit facility for general operations. The Company may not achieve all of its business goals and objectives and events beyond its control could affect its ability to meet financial tests and ratios under the Company’s credit facility and limit its ability to access the amounts otherwise available under its revolving credit facility.

- 7 -

Revenue Recognition and Accounts Receivable

The Company recognizes revenue at the time services are performed. Unbilled receivables are recorded for services rendered during, but billed subsequent to, the reporting period. Revenue is reported at the estimated realizable amounts from patients, third-party payors and others for services rendered. Revenue under certain third-party payor agreements is subject to audit and retroactive adjustments. Provisions for estimated third-party payor settlements and adjustments are estimated in the period the related services are rendered and adjusted in future periods as final settlements are determined. The provision for doubtful accounts and the related allowance are adjusted periodically based upon an evaluation of historical collection experience with specific payors for particular services, anticipated collection levels with specific payors for new services, industry reimbursement trends, and other relevant factors. Changes in these factors in future periods could result in increases or decreases in the Company’s provision for doubtful accounts and impact its results of operations, financial position and cash flows.

Recent Accounting Standards Updates

In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (“ASU”) 2014-09, “Revenue from Contracts with Customers (Topic 606),” which will replace numerous requirements in U.S. GAAP and provide companies with a single revenue recognition model for recognizing revenue from contracts with customers. The core principle of the new standard is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. ASU 2014-09 will be effective for interim and annual reporting periods beginning after December 15, 2017. The two permitted transition methods under the new standard are the full retrospective method, in which case the standard would be applied to each prior reporting period presented, or the modified retrospective method, in which case the cumulative effect of applying the standard would be recognized at the date of initial application. The Company has not yet selected a transition method under ASU 2014-09.

In March 2016, the FASB issued ASU No. 2016-08, “Principal versus Agent Considerations (Reporting Revenue Gross versus Net).” The amendments in ASU 2016-08 affect ASU 2014-09 and are related to the principal versus agent considerations implementation guidance in ASU 2014-09. In April 2016, the FASB issued ASU No. 2016-10, “Identifying Performance Obligations and Licensing.” The amendments in ASU 2016-10 clarify the following two aspects in ASU 2014-09: identifying performance obligations and the licensing implementation guidance, while retaining the related principles for those areas. In May 2016, the FASB issued ASU No. 2016-11, “Rescission of SEC Guidance Because of Accounting Standards Updates 2014-09 and 2014-16 Pursuant to Staff Announcements at the March 3, 2016 EITF Meeting.” The amendments in ASU 2016-11 rescinded certain SEC Staff Observer comments that are codified, effective upon the adoption of ASU 2014-09. In May 2016, the FASB issued ASU No. 2016-12, “Narrow-Scope Improvements and Practical Expedients.” The amendments in ASU 2016-12 address certain issues identified in ASU 2014-09 in the guidance on assessing collectability, presentation of sales taxes, non-cash consideration, and completed contracts and contract modifications at transition. These ASU’s are effective concurrently with the adoption of ASU 2014-09. The Company is evaluating the impact of the adoption of these updates on its consolidated financial statements and related disclosures.

In August 2014, the FASB issued ASU 2014-15, “Presentation of Financial Statements—Going Concern (Subtopic 205-40): Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern.”  Under the new guidance, management will be required to assess an entity’s ability to continue as a going concern, and to provide related footnote disclosures in certain circumstances. The provisions of this ASU are effective for annual periods ending after December 15, 2016 and interim periods beginning after December 15, 2016.  The adoption of ASU 2014-15 is not expected to have a material effect on the Company’s financial position, results of operations or cash flows and the Company is evaluating the impact of the adoption on our related disclosures.

In April 2015, the FASB issued ASU 2015-03, “Interest—Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs.”  The amendments in this update require that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. The recognition and measurement guidance for debt issuance costs are not affected by the amendments in this standards update.  The new guidance is effective for annual reporting periods beginning after December 15, 2015, including interim periods within that reporting period. An entity should apply the guidance either retrospectively to each prior reporting period presented or retrospectively with the cumulative adjustment at the date of the initial application. In connection with the Company’s adoption of ASU 2015-03, the deferred debt issue costs related to the issuance of the Company’s Senior Notes, as further described in Note 6, and term loans were reclassified to long-term debt.  The net unamortized deferred debt issue costs reflected in long-term debt were approximately $4.1 million and $5.6 million as of September 30, 2016 and December 31, 2015, respectively. Deferred debt issue costs related to the Company’s revolving credit facility continue to be reflected as non-current assets in the Company’s condensed consolidated financial statements.

- 8 -

In February 2016, the FASB issued ASU 2016-02, “Leases” (topic 842). The FASB issued this update to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. The updated guidance is effective for annual periods beginning after December 15, 2018, including interim periods within those fiscal years. Early adoption of the update is permitted. The Company is evaluating the impact of the adoption of this update on its consolidated financial statements and related disclosures.

In March 2016, the FASB issued ASU 2016-09, “Improvements to Employee Share-Based Payment Accounting,” which amends Accounting Standards Codification Topic 718, Compensation – Stock Compensation.  ASU 2016-09 simplifies several aspects of the accounting for share-based payment transactions, including the income tax consequences, classification of awards as either equity or liabilities, and classification on the statement of cash flows. ASU 2016-09 is effective for the Company’s fiscal years beginning after December 15, 2016, and interim periods within those fiscal years and early adoption is permitted. The Company is evaluating the impact of the adoption of this update on its consolidated financial statements and related disclosures.

In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments”. ASU 2016-13 introduces a new forward-looking approach, based on expected losses, to estimate credit losses on certain types of financial instruments, including trade receivables and held-to-maturity debt securities, which will require entities to incorporate considerations of historical information, current information and reasonable and supportable forecasts. This ASU also expands disclosure requirements. ASU 2016-13 is effective for the Company beginning the first quarter of 2020 with early adoption permitted. The guidance will be applied using the modified-retrospective approach. The Company is currently evaluating the impact of adoption of ASU 2016-13 on its consolidated financial statements and related disclosures.

In August 2016, the FASB issued ASU No. 2016-15, “Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments,” which clarifies how certain cash receipts and cash payments are presented and classified in the statement of cash flows. ASU No. 2016-15 is effective for the Company in the first quarter of 2018 with early adoption permitted and must be applied retrospectively to all periods presented. The Company is currently evaluating the impact of adoption of ASU 2016-13 on the presentation and classification of the Company’s statements of cash flows.

Note 2. Acquisitions

The Company has made strategic acquisitions of local laboratories to achieve greater economies of scale and expand or augment its geographic presence.

2015 Acquisitions

On July 15, 2015, the Company acquired the assets of two pathology practices and a billing service, all located in Texas. On October 29, 2015, the Company acquired 100% of the equity of a pathology practice in Ohio. The Company paid a combined total of $15.4 million of cash in the aggregate at closing for the two acquisitions and issued contingent notes payable over from three to six years. Payments under the contingent notes will be paid annually, up to a maximum of $11.9 million over the term of the notes, subject to the retention of certain key facility contracts, future financial results and the cash received under specified client contracts. The Company used cash available under its $25.0 million delayed draw term loan to pay the $15.4 million cash portion of the purchase price for the acquisitions.

2016 Acquisitions

On March 31, 2016, the Company acquired 100% of the equity of a hospital-based pathology practice located in Oregon. On April 8, 2016, the Company acquired 100% of the equity of a second hospital-based pathology practice in Florida. In connection with these 2016 acquisitions, the Company paid total net cash of $7.2 million and issued contingent notes payable over three years. Payments under the contingent notes will be paid annually, up to a maximum of $1.5 million over the term of the notes, subject to the future financial performance of the acquired practice and the retention of a key facility contract. The Company used cash available under its $40.0 million delayed draw term loan B to pay the $7.2 million cash portion of the purchase price for the acquisition.

- 9 -

The following table summarizes the preliminary estimated aggregate fair value of the assets acquired and liabilities assumed in connection with the 2016 acquisitions (in thousands):

Cash	$	602
Accounts receivable		849
Other assets		65
Intangible assets		5,860
Goodwill		2,140
Assets acquired		9,516
Accounts payable and accrued expenses		282
Accrued compensation		282
Liabilities assumed		564
Net assets acquired	$	8,952
Net assets acquired	$	8,952
Less:
Fair value of contingent consideration issued		(1,100	)
Cash acquired		(602	)
Net cash paid for acquisitions, net of cash acquired	$	7,250

Intangible assets acquired as the result of a business combination are recognized at fair value as an asset apart from goodwill if the asset arises from contractual or other legal rights or if it is separable. The Company’s intangible assets, which principally consist of the fair value of customer relationships, health care facility agreements and key physician agreements acquired in connection with the acquisition of diagnostic companies, are capitalized and amortized on the straight-line method over their useful life, which generally ranges from 3 to 15 years.  The Company’s preliminary estimate is that approximately $2.1 million of goodwill recognized in the 2016 acquisitions will be deductible over 15 years for federal income tax purposes.

Pro-forma information (unaudited)

The accompanying historical condensed consolidated financial statements include the results of operations of the 2015 and 2016 acquisitions from the date acquired through September 30, 2016. The 2015 and 2016 acquisitions contributed $7.2 million and $19.5 million of revenue for the three months and nine months ended September 30, 2016, respectively, and $1.4 million and $3.5 million of net income for the three months and nine months ended September 30, 2016. The July 15, 2015 acquisitions contributed revenue of $2.9 million and net income of $0.6 million for both of the three months and nine months ended September 30, 2015.  

The following unaudited pro forma information presents the consolidated results of the Company’s operations and the results of the 2015 and 2016 acquisitions for the three and nine months ended September 30, 2016 and 2015, after giving effect to amortization, depreciation, income tax, and the reduced level of certain specific operating expenses (primarily compensation and related expenses attributable to former owners) as if the 2015 acquisitions had been consummated on January 1, 2014 and the 2016 acquisitions had been consummated on January 1, 2015. Such unaudited pro forma information is based on historical unaudited financial information with respect to the 2015 and 2016 acquisitions and does not include operational or other changes which might have been effected by the Company. The unaudited pro forma information for the three and nine months ended September 30, 2016 and 2015 presented below is for illustrative purposes only and is not necessarily indicative of results which would have been achieved or results which may be achieved in the future (in thousands):

	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2016			2015			2016			2015
Net revenue	$	73,235		$	74,002		$	216,743		$	211,862
Net loss	$	(4,070	)	$	(3,989	)	$	(15,618	)	$	(58,531	)

- 10 -

Note 3. Accounts Receivable

Accounts receivable consist of the following as of September 30, 2016 and December 31, 2015 (in thousands):

	September 30,			December 31,
	2016			2015
Accounts Receivable	$	55,874		$	49,142
Less: Allowance for doubtful accounts		(17,028	)		(16,291	)
Accounts receivable, net	$	38,846		$	32,851

Note 4. Goodwill and Intangible Assets

The following table presents adjustments to goodwill during the nine months ended September 30, 2016 and the year ended December 31, 2015 (in thousands):

	September 30,		December 31,
	2016		2015
Goodwill, beginning of period	$	125,188	$	177,774
Acquisitions		2,285		4,139
Goodwill impairment		—		(56,725	)
Goodwill, end of period	$	127,473	$	125,188

The Company’s balances for intangible assets as of September 30, 2016 and December 31, 2015 and the related accumulated amortization are set forth in the table below (in thousands):

		Weighted Average	September 30, 2016
	Range	Amortization			Accumulated
	(Years)	Period (Years)	Cost		Amortization			Net
Amortizing intangible assets:
Customer relationships	7 – 10	8	$	130,748	$	(111,506	)	$	19,242
Health care facility agreements	15	15		48,970		(12,897	)		36,073
Noncompete agreements	3 – 5	4		6,199		(4,893	)		1,306
Total intangible assets			$	185,917	$	(129,296	)	$	56,621
		Weighted Average	December 31, 2015
	Range	Amortization			Accumulated
	(Years)	Period (Years)	Cost		Amortization			Net
Amortizing intangible assets:
Customer relationships	7 – 10	8	$	130,748	$	(99,516	)	$	31,232
Health care facility agreements	15	15		43,580		(10,303	)		33,277
Noncompete agreements	3 – 5	4		5,729		(4,544	)		1,185
Total intangible assets			$	180,057	$	(114,363	)	$	65,694

The Company recorded amortization expense related to its intangible assets of $5.0 million and $4.8 million for the three months ended September 30, 2016 and 2015, respectively, and $14.9 million and $14.2 million for the nine months ended September 30, 2016 and 2015, respectively. As of September 30, 2016, estimated future amortization expense is as follows (in thousands):

Year Ending December 31,
Remainder of 2016	$	4,767
2017		14,081
2018		6,676
2019		4,848
2020		4,727
Thereafter		21,522
	$	56,621

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Note 5. Accounts Payable, Accrued Expenses and Other Current Liabilities

Accounts payable, accrued expenses and other current liabilities as of September 30, 2016 and December 31, 2015 consist of the following (in thousands):

	September 30,		December 31,
	2016		2015
Accounts payable and accrued payables	$	11,930	$	11,513
Reserve for future medical claims		1,997		2,200
Other accrued expenses		4,419		3,126
	$	18,346	$	16,839

Note 6. Long-Term Debt  

On December 20, 2010, the Company issued $200.0 million in unsecured senior notes that mature on January 15, 2018, which are referred to as the Senior Notes. The Senior Notes bear interest at an annual rate of 10.75%, which is payable each January 15 and July 15. In accordance with the Senior Notes indenture, the Company is subject to certain limitations on issuing additional debt and is required to submit quarterly and annual financial reports. The Senior Notes are currently redeemable at the Company’s option at 102.688% of par, plus accrued interest. The redemption price decreases to 100% of par on January 15, 2017. The Senior Notes rank equally in right of repayment with all of the Company’s other senior indebtedness, but are subordinated to the Company’s secured indebtedness to the extent of the value of the assets securing that indebtedness.

On July 31, 2014, the Company entered into a $220.0 million senior secured credit facility with Cerberus Business Finance, LLC. The credit facility consists of a $165.0 million initial term loan, $30.0 million revolving credit line and $25.0 million delayed draw term loan. Prior to the amendments discussed below, the delayed draw term loan facility was available through July 31, 2015 to pay the consideration for acquisitions, as permitted under the credit facility, including acquisition related fees and expenses. The Company used $145.6 million of the $165.0 million proceeds to retire a previous revolving credit facility due May 2015 and term loan facility due May 2016, including accrued interest and fees.  

Each of the term loan, revolving credit line and delayed draw term loan under the credit facility has a maturity of five years but is subject to a maturity date of October 14, 2017 if the Senior Notes are not refinanced or their maturity is not extended prior to such date. Under the outstanding term loans, quarterly principal repayments of $0.5 million became due commencing September 30, 2015 and continuing through December 31, 2016. Quarterly principal repayments increase to $0.9 million on March 31, 2017 through June 30, 2018 and to $1.3 million on September 30, 2018 and each quarter end thereafter, with the balance due at maturity. As of September 30, 2016, the balance outstanding under the initial term loan was $162.5 million and the balance outstanding under the delayed draw term loans was $35.0 million. As of September 30, 2016, no amounts were outstanding and the Company had $30.0 million available under its revolving credit facility.  

The proceeds under the credit facility were reduced by discounts of $5.1 million. Additionally, the Company used $3.9 million of the proceeds to pay issuance costs in connection with the credit facility. The remaining $10.4 million balance of the proceeds under the credit facility initial term loan and the funds available under the $30.0 million revolving credit line were intended to be used to execute future acquisitions and for the Company’s general working capital and operational needs.  

Prior to the second amendment executed on April 10, 2015 discussed below, at the Company’s option, interest under the credit facility was at LIBOR, with a 1.25% floor, plus 7%, or at a base rate, with a 2.25% floor, plus 6%.

On April 10, 2015, the Company entered into a second amendment to the credit facility. The second amendment to the credit facility added a $40 million delayed draw term loan B facility which was available through April 10, 2016, which was subsequently extended to April 25, 2016 pursuant to a fifth amendment to the credit facility, to pay consideration for acquisitions, as permitted under the credit facility, including acquisition related fees and expenses.  The Company borrowed $10.0 million in March 2016 and the $30.0 million of unused availability under the delayed draw term loan B facility expired on April 25, 2016. The second amendment also increased the interest rate under the credit facility to LIBOR, with a 1.25% floor, plus 7.125%, or to the base rate, with a 2.25% floor, plus 6.125%. The senior secured credit facility is subject to a 2.25% per annum fee on the undrawn amount thereof, payable quarterly in arrears.

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In connection with the acquisitions consummated by the Company on July 15, 2015, the Company borrowed the remaining $15.3 million available under the delayed draw term loan. The amount borrowed exceeded the total paid by the Company for eligible acquisitions, inclusive of related expenses, by $5.4 million. The Company entered into third and fourth amendments to its credit facility that extended the period in which the Company was able to use the remaining $5.4 million availability under the $25.0 million delayed draw term loan from July 31, 2015, to October 31, 2015. The Company used the remaining $5.4 million for an acquisition completed on October 29, 2015.

The credit facility is secured by essentially all of the Company’s assets and unconditionally guaranteed by the Company and certain of the Company’s existing and subsequently acquired or organized domestic subsidiaries and is subject to certain financial covenants.The credit facility requires the Company to maintain certain levels of liquidity and comply on a quarterly basis with certain financial covenants, including a leverage ratio calculation, which generally becomes more restrictive over time, and an interest coverage ratio. Also, on an annual basis the Company must not exceed a specified maximum amount of consolidated capital expenditures. In addition, the credit facility includes negative covenants restricting or limiting the Company’s ability to, among other things, incur, assume or permit to exist additional indebtedness or guarantees; incur liens and engage in sale leaseback transactions; make loans and investments; declare dividends, make payments or redeem or repurchase capital stock; engage in mergers, acquisitions and other business combinations; prepay, redeem or purchase certain indebtedness; amend or otherwise alter terms of its indebtedness; sell assets; enter into transactions with affiliates and alter the business it conducts without prior approval of the lenders.

Long-term debt consists of the following as of September 30, 2016 and December 31, 2015 (in thousands):

	September 30,			December 31,
	2016			2015
Senior Notes	$	200,000		$	200,000
Initial term loan		162,500			164,000
Delayed draw term loans		35,000			25,000
Notes payable		133			133
Capital lease obligations		69			129
		397,702			389,262
Less:
Original issue discount, net		(3,036	)		(3,877	)
Debt issuance costs, net		(4,132	)		(5,621	)
Current portion		(3,251	)		(2,147	)
Long-term debt, net of current portion	$	387,283		$	377,617

As of September 30, 2016, estimated future debt principal payments are as follows (in thousands):

Year Ending December 31,
Remainder of 2016	$	589
2017		3,608
2018		204,255
2019 *		189,250
	$	397,702

* The estimated future debt principal payments in 2019 reflect the five-year maturity of the Company’s credit facility, which is subject to an earlier maturity date of October 14, 2017 if the Company’s Senior Notes are not refinanced or their maturity is not extended prior to October 14, 2017.

Note 7. Contingent Consideration

In connection with certain of its acquisitions, the Company agreed to pay additional consideration in future periods based upon the attainment of stipulated levels of operating results by each of the acquired entities, as defined in their respective agreements. The Company records liabilities for contingent consideration issued in acquisitions at fair value as of the acquisition date. Payments under contingent notes issued in acquisitions are reflected in the change in fair value of contingent consideration.

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As described in Note 2, in connection with the 2015 and 2016 acquisitions the Company issued contingent notes payable annually over three to six years, up to a maximum of $13.4 million, subject to the future financial performance of the acquired practices and the retention of a key facility contracts. The aggregate fair value of the contingent notes issued was estimated at $8.0 million as of the acquisition dates.

During the three and nine months ended September 30, 2016, the Company made payments under contingent notes of $1.6 million and $3.4 million, respectively. During the three and nine months ended September 30, 2015, the Company made payments under contingent notes of $1.0 million and $2.3 million, respectively. The total fair value of the contingent consideration reflected in the accompanying condensed consolidated balance sheets as of September 30, 2016 and December 31, 2015 is $12.0 million and $13.1 million, respectively.

Note 8. Related Party Transactions

Acquisition Target Consulting Agreement

The Company has a professional services agreement with an entity owned by two of the Company’s members. Under this agreement, the entity provides certain acquisition target identification consulting services to the Company. In exchange for these services the Company pays to the entity a monthly retainer of $12,000, plus reimbursable expenses. The entity also earns a success fee of $65,000 for each identified acquisition consummated by the Company. The entity also will be paid a fee of 8% of revenue for certain new business development efforts as outlined in the professional services agreement.

During the three and nine months ended September 30, 2016, the Company paid the entity $38,000 and $0.2 million during the three and nine months ended September 30, 2016, respectively, and $0.1 million and $0.2 million during the three and nine months ended September 30, 2015, respectively.

As of September 30, 2016, the Company owed to the entity $15,000, and no balance was owed to the entity as of December 31, 2015, under this arrangement.  

Management and Financial Advisory Agreement

On June 2, 2006, the Company, through its wholly-owned subsidiary, and two members of the Company entered into a management services agreement. On June 12, 2009, the management agreement was amended to substitute a new member for one of the original members. The agreement calls for the members and their affiliates to provide certain financial and management advisory services in connection with the general business planning and forecasting and acquisition and divestiture strategies of the Company. In exchange for the services, the Company is required to pay fees equal to 1.0% of revenues plus expenses to the members.

In connection with an amendment to the Company’s previous credit facility in April 2013, the Company agreed to not make any payments of management or similar fees until payment in full of all loans under the credit facility, provided that such management fees continue to accrue. Management fees to the Company’s members up to 1% of net revenue are permitted under the current credit facility but may not be paid until payment in full of all loans thereunder and the Company continues to accrue management fees. The Company expects to not pay management fees through September 30, 2017. As of September 30, 2016 and December 31, 2015, $10.8 million and $8.6 million, respectively, of these management fees are reflected in long-term liabilities in the accompanying condensed consolidated balance sheets. The condensed consolidated statements of operations include management fees of$0.7 million for each of the three month periods ended September 30, 2016 and 2015, respectively, and $2.1 million and $1.9 million for the nine months ended September 30, 2016 and 2015, respectively. The Company paid no management fees under the management services agreement during the three and six month periods ended September 30, 2016 and 2015.  

Facilities Lease Agreements

The Company leases certain of its facilities from entities owned by physician employees or affiliated physicians who are also former owners of the acquired practices. The Company currently leases six of its facilities from affiliated physicians or entities. One of these six leases is on a month to month basis and the others terminate in April 2017, January 2018, December 2019, October 2020 and June 2022. In aggregate, the six leases provide for monthly aggregate base payments of approximately $90,000. Rent paid to the related entities was $0.3 million for each of the three month periods ended September 30, 2016 and 2015, and $0.8 million and $0.7 million for the nine months ended September 30, 2016 and 2015, respectively.

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Management and Financial Consultancy Services Agreement

On March 12, 2013, Daniel D. Crowley was appointed as the Chief Executive Officer and President of the Company. In connection with the appointment of Mr. Crowley, the Company entered into an agreement with Dynamic Healthcare Solutions (“DHS”), of which Mr. Crowley is the founder, sole owner and a principal. Pursuant to the agreement, the Company pays DHS a monthly fee of $100,000, plus reasonable out of pocket expenses and hourly fees for DHS staff (other than Mr. Crowley) that provide services under the agreement. The agreement may be terminated by the board of managers of the Company with thirty days notice with or without cause and without the payment of termination fees. In addition, the agreement requires the Company to pay DHS a success fee in the event that a change of control of the Company occurs at any time during the term of the agreement or the one-year period following the termination of the agreement. The amount of the success fee would be based on the aggregate transaction value received by the Company at the time of the change of control event. Other than the agreement with DHS, Mr. Crowley does not receive any direct or indirect compensation or benefits from the Company. The Company paid $0.6 million and $0.8 million to DHS during the three months ended September 30, 2016 and 2015, respectively, and $1.6 million and $2.4 million during the nine months ended September 30, 2016 and 2015, respectively. A retainer of $0.2 million is included in deposits and other non-current assets as of September 30, 2016 and December 31, 2015.

Healthcare Administration Services

Effective December 1, 2013 the Company entered into an agreement with HealthSmart Benefit Solutions, Inc. (“HBS”), of which Mr. Crowley served as the Executive Chairman and President through July 2014. Mr. Crowley has not been affiliated with HBS since that time Pursuant to the agreement, the Company paid fees to HBS of approximately $20,000 per month to process claims under its self-insured health benefits plan and to perform other health plan related services. Premiums for the Company’s stop loss coverage were collected by HBS and remitted to the coverage provider. Effective June 1, 2015, the Company transitioned the administration of its health plan benefits to another provider, however HBS continued to process claims through May 31, 2016, for dates of service prior to June 1, 2015. The Company paid, inclusive of the stop loss premiums, to HBS $14,000, during the three months ended September 30, 2015, and $27,000 and $1.2 million during the nine months ended September 30, 2016 and 2015, respectively.  The Company made no payments to HBS during the three months ended September 30, 2016.  No balance was owed by the Company to HBS as of September 30, 2016 and December 31, 2015.  

Acquisition Consulting Services

The Company has engaged Crowley Corporate Legal Strategy (“CCLS”), on an as needed basis, to provide legal services. Matt Crowley is a principal of CCLS and son of Daniel D. Crowley, the Company’s Chief Executive Officer. The Company paid to CCLS $16,000 and $45,000, during the three months ended September 30, 2016 and 2015, respectively, and $59,000 and $91,000 for the nine months ended September 30, 2016 and 2015, respectively.

Executive Consulting Agreement

The Company had a consulting agreement through February 2016 with Mr. James New, a current Board member and an owner of the Company’s limited liability company units and former CEO of the Company. Pursuant to the consulting agreement, Mr. New provided consulting services as requested by the Company for a fee of $12,500 per month.  Inclusive of travel reimbursement for Board meetings, the Company paid to Mr. New $2,000 and $28,000 during the three months ended September 30, 2016 and 2015, respectively, and $29,000 and $108,000 during the nine months ended September 30, 2016 and 2015, respectively. No amounts were owed by the Company to Mr. New as of September 30, 2016 or December 31, 2015.

Broker of Record

OmegaComp acted as broker of record to the Company with respect to health coverage in 2015. Daniel D. Crowley is Executive Chairman and majority owner of OmegaComp. OmegaComp received commissions from carriers of $77,000 and $26,000, during the three months ended September 30, 2016 and 2015, respectively, and $226,000 and $118,000, during the nine months ended September 30, 2016 and 2015, respectively, which amounts were included in premiums paid by the Company for insurances, benefits and services OmegaComp arranged on the Company’s behalf.

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Chief Medical Officer

On October 29, 2015, prior to his appointment as the Company’s Chief Medical Officer, the Company issued a non-negotiable unsecured subordinated contingent note to Dr. F. Michael Walsh in connection with the acquisition of the pathology practice he owned. Pursuant to the contingent note, the Company agreed to pay to Dr. Walsh up to a maximum amount of $2.7 million if the acquired pathology practice met certain financial measures within certain periods of time. On June 13, 2016, the contingent note was amended to reduce the maximum amount payable thereunder to $2.4 million, and on June 15, 2016, the Company made a first payment of $650,000 under the note.

Client Interface Services

One of the Company’s members holds a minority ownership interest in an entity that the Company has engaged, from time to time, to provide client interface services.  The Company paid the entity $22,000 and $0.2 million during the three and nine months ended September 30, 2016, respectively, and $17,000 and $0.1 million during the three and nine months ended September 30, 2015, respectively. As of September 30, 2016, the Company owed to the entity $16,000, and no balance was owed to the entity as of December 31, 2015 for these services.

Note 9. Equity-Based Compensation

On July 6, 2011, the Company adopted the Aurora Diagnostics Holdings, LLC 2011 Equity Incentive Plan for the grant of options to purchase units of Aurora Diagnostics Holdings, LLC to employees, officers, managers, consultants and advisors of the Company and its affiliates. As of September 30, 2016, the Company has authorized the grant of up to 1,931,129 options and reserved the equivalent number of units for issuance upon the future exercise of awards pursuant to the plan. As of September 30, 2016, 1,510,500 options were outstanding and an additional 420,629 options were available for grant. Out of the total 1,510,500 options outstanding as of September 30, 2016, 974,725 were vested and 535,775 were unvested.

No options were granted or exercised and 34,500 options were forfeited during the nine months ended September 30, 2016. Selling, general and administrative expenses included equity compensation expense of $28,000 and $55,000 for the three months ended September 30, 2016 and 2015, respectively, and $0.1 million and $0.2 million for the nine months ended September 30, 2016 and 2015, respectively. As of September 30, 2016, the total remaining unamortized equity compensation cost was approximately $0.1 million.

Note 10. Commitments and Contingencies

During the ordinary course of business, the Company has become and may in the future become subject to pending and threatened legal actions and proceedings. The Company may have liability with respect to its employees and its pathologists. Medical malpractice claims are generally covered by insurance. While the Company believes the outcome of any such pending legal actions and proceedings, individually or in the aggregate, will not have a material adverse effect on the Company’s financial condition, results of operations or liquidity, if the Company is ultimately found liable under any medical malpractice claims, there can be no assurance the Company’s medical malpractice insurance coverage will be adequate to cover any such liability. The Company had accrued approximately $2.0 million and $2.2 million as of September 30, 2016 and December 31, 2015, respectively, for future medical malpractice claims.  

The Company may also, from time to time, be involved with legal actions related to the acquisition of and affiliation with physician practices, the prior conduct of such practices, or the employment (and restriction on competition) of its physicians. There can be no assurance any costs or liabilities for which the Company becomes responsible in connection with such claims or actions will not be material or will not exceed the limitations of any applicable indemnification provisions or the financial resources of the indemnifying parties. Certain sellers have asserted the Company owes an aggregate of $2.7 million in connection with a contingent note issued in an acquisition. The Company has asserted the sellers owe the Company a repayment of $2.8 million. The Company’s management believes its calculations are correct, but at this time cannot estimate what additional amount will ultimately be paid or recovered, if any, in connection with these contingent notes.

In January 2016, the Company vacated two of its leased facilities.  The Company has not reached a settlement with the landlord of one of the leased facilities and recorded a non-cash charge of approximately $1.1 million in the first quarter of 2016 for the abandoned leasehold improvements and to accrue the present value of the future lease payments stipulated under the lease agreement.

- 16 -

In August 2015, the Company received a notice of non-compliance for payroll tax withholding related to a reorganization of two of its subsidiaries during 2011.  The Company believes its Form 941 filings for these subsidiaries in 2011 were appropriate and formally appealed approximately $0.5 million of additional taxes, interest and penalties accessed by the IRS in November 2015.  The Company cannot currently determine whether or not its appeal will be successful. If the Company’s appeal is unsuccessful, it may incur a charge of approximately $0.5 million for the additional taxes, interest and penalties.

During 2011, the Company received claims of overpayments from the U.S. Veterans Administration, or VA, for a total of $1.6 million. In August 2015, the Company and the VA entered into a final settlement, under which the Company will pay $1.2 million to the VA in twelve monthly installments of $100,000. As of December 31, 2015, the Company had recorded an accrued liability for the settlement of $0.8 million. As of September 30, 2016 the settlement had been paid in full.

Contingent Notes

As discussed in Note 7, in connection with certain of its acquisitions, the Company agreed to pay additional consideration in future periods based upon the attainment of stipulated levels of operating results by each of the acquired entities, as defined in their respective agreements. The computation of the annual operating results is subject to review and approval by the sellers prior to payment. In the event there is a dispute, the Company will pay the undisputed amount and then take reasonable efforts to resolve the dispute with the sellers. If the sellers are successful in asserting their dispute, the Company could be required to make additional payments in future periods.

Future payments under contingent notes will be made if the practices achieve stipulated levels of results and contract retention as outlined in their respective agreements. Any future payments of contingent consideration will be reflected in the change in the fair value of the contingent consideration. As of September 30, 2016, the fair value of contingent consideration related to acquisitions was $12.0 million, representing the present value of approximately $16.1 million in estimated future payments through 2021.

Purchase Obligations

The Company has entered into non-cancelable commitments to purchase reagents and other laboratory supplies. Under these agreements, the Company must purchase minimum amounts of reagents and other laboratory supplies through 2021.

At September 30, 2016, the remaining minimum purchase commitments are as follows:

Year Ending December 31,
Remainder of 2016	$	634
2017		2,025
2018		834
2019		794
2020		787
Thereafter		97
	$	5,171

In connection with certain of these commitments, the Company received lab testing equipment, to which the Company has either received title, or will receive title upon fulfillment of its purchase obligations under the respective commitment. The Company recorded the obligation under purchase commitment for the fair market value of the equipment, reduced by the cash paid. The remaining obligations under purchase commitments included in other liabilities in the accompanying condensed consolidated balance sheets were $1.5 million and $1.6 million as of September 30, 2016 and December 31, 2015, respectively.

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Note 11. Fair Value of Financial Instruments

Recurring Fair Value Measurements

As of September 30, 2016 and December 31, 2015, the fair value of contingent consideration related to acquisitions was $12.0 million and $13.1 million, respectively. The fair value of contingent consideration is derived using valuation techniques that incorporate unobservable inputs and are considered Level 3 items. The Company utilizes a present value of estimated future payments approach to estimate the fair value of the contingent consideration. Estimates for fair value of contingent consideration primarily involve two inputs, which are (i) the projections of the financial performance of the acquired practices that are used to calculate the amount of the payments and (ii) the discount rates used to calculate the present value of future payments. Changes in either of these inputs will impact the estimated fair value of contingent consideration. At September 30, 2016 the discount rates ranged from 14% to 19%.

The following is a summary of the Company’s fair value instruments categorized by their fair value input level as of September 30, 2016 (in thousands):

					Significant Other		Significant
			Quoted Prices		Observable		Unobservable
			inActive Markets		Inputs		Inputs
	Fair Value		Level 1		Level 2		Level 3
Liabilities:
Current portion of fair value of contingent consideration	$	5,569	$	—	$	—	$	5,569
Fair value of contingent consideration, net of current    portion	$	6,410	$	—	$	—	$	6,410

The following is a summary of the Company’s fair value instruments categorized by their fair value input level as of December 31, 2015 (in thousands):

					Significant Other		Significant
			Quoted Prices		Observable		Unobservable
			in Active Markets		Inputs		Inputs
	Fair Value		Level 1		Level 2		Level 3
Liabilities:
Current portion of fair value of contingent consideration	$	4,820	$	—	$	—	$	4,820
Fair value of contingent consideration, net of current    portion	$	8,320	$	—	$	—	$	8,320

The following is a roll-forward of the Company’s Level 3 fair value instruments for the nine months ended September 30, 2016 (in thousands):

	Beginning		Total (Gains) /							Ending
	Balance		Losses Realized							Balance
	January 1,2016		and Unrealized		Issuances		Settlements			September30, 2016
Contingent consideration	$	13,140	$	1,146	$	1,100	$	(3,407	)	$	11,979

Non-Recurring Fair Value Measurements

Certain assets that are measured at fair value on a non-recurring basis, including property and equipment and intangible assets, are adjusted to fair value only when the carrying values are greater than their fair values. The Company completed its latest annual impairment evaluations as of November 30, 2015 and recorded write-offs of goodwill to reflect the then current estimated fair value of the impaired reporting units. The fair values were derived with fair value models utilizing unobservable inputs that therefore are considered Level 3 items.

As of September 30, 2016 and December 31, 2015, the carrying amounts of cash and cash equivalents, accounts receivable, accounts payable, accrued interest and accrued expenses approximate fair value based on the short maturity of these instruments. As of September 30, 2016 and December 31, 2015, the fair value of the Company’s debt was $357.7 million and $332.1 million, respectively. The Company uses quoted market prices and yields for the same or similar types of borrowings in active markets when available to determine the fair value of the Company’s debt. These fair values are considered Level 2 items.

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Note 12. Income Taxes

The Company is a Delaware limited liability company. For federal income tax purposes, the Company is treated as a partnership. Accordingly, the Company is generally not subject to income taxes and the income attributable to the limited liability company is distributed to the members in accordance with the terms of the operating agreement. However, certain of the Company’s subsidiaries are structured as corporations and therefore are subject to federal and state income taxes. The provision for income taxes for these subsidiaries is reflected in the Company’s condensed consolidated financial statements and includes federal and state taxes currently payable and changes in deferred tax assets and liabilities, excluding the establishment of deferred tax assets and liabilities related to acquisitions. The provision for federal and state taxes was $0.6 million and $10,000 for the three months ended September 30, 2016 and 2015, respectively.  The benefit for federal and state taxes was $0.5 million and $0.8 million for the nine months ended September 30, 2016 and 2015, respectively.

Note 13. Guarantor Subsidiaries

The following information is presented as required by regulations of the Securities and Exchange Commission in connection with the Company’s 10.75% Senior Notes due 2018. This information is not routinely prepared for use by management. The operating and investing activities of the separate legal entities included in the Company’s consolidated financial statements are fully interdependent and integrated. Accordingly, consolidating the operating results of those separate legal entities is not representative of what the actual operating results of those entities would be on a stand-alone basis. Operating expenses of those separate legal entities include intercompany charges for management fees and other services. Certain expense items that are applicable to the Company’s subsidiaries are typically recorded in the books and records of Aurora Diagnostics Holdings, LLC. For purposes of this footnote disclosure, such balances and amounts have been “pushed down” to the respective subsidiaries either on a specific identification basis, or when such items cannot be specifically attributed to an individual subsidiary, have been allocated on an incremental or proportional cost basis to Aurora Diagnostics Holdings, LLC and the Company’s subsidiaries.

The following tables present consolidating financial information as of September 30, 2016 and December 31, 2015 and for the three months and nine months ended September 30, 2016 and 2015 for (i) Aurora Diagnostics Holdings, LLC, (ii) on a combined basis, the subsidiaries of the Company that are guarantors of the Company’s Senior Notes (the “Subsidiary Guarantors”) and (iii) on a combined basis, the subsidiaries of the Company that are not guarantors of the Company’s Senior Notes (the “Non-Guarantor Subsidiaries”). For presentation in the following tables, Subsidiary Guarantors includes revenue and expenses and assets and liabilities for those subsidiaries directly or indirectly 100% owned by the Company, including those entities that have contractual arrangements with affiliated physician groups. Essentially, all property and equipment reflected in the accompanying condensed consolidated balance sheets collateralize the Company’s credit facility. As such, as of September 30, 2016 and December 31, 2015, $2.1 million and $2.2 million, respectively, of property and equipment held by Non-Guarantor Subsidiaries are reflected under Subsidiary Guarantors in the following tables.

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Condensed Consolidating Balance Sheets (in thousands):

	Aurora						Non-
	Diagnostics			Subsidiary			Guarantor			Consolidating			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Adjustments			Total
Assets
Current Assets
Cash and cash equivalents	$	11,683		$	44		$	335		$	—		$	12,062
Accounts receivable, net		—			18,769			20,077			—			38,846
Prepaid expenses and other assets		2,354			1,530			1,214			—			5,098
Prepaid income taxes		24			295			122			—			441
Total current assets		14,061			20,638			21,748			—			56,447
Property and equipment, net		1,971			6,033			—			—			8,004
Other Assets:
Intercompany receivable		364,335			—			—			(364,335	)		—
Deferred debt issue costs, net		358			—			—			—			358
Deferred financing costs, deposits and other noncurrent    assets		1,846			167			90			—			2,103
Goodwill		—			77,440			50,033			—			127,473
Intangible assets, net		—			25,511			31,110			—			56,621
		366,539			103,118			81,233			(364,335	)		186,555
	$	382,571		$	129,789		$	102,981		$	(364,335	)	$	251,006
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	3,147		$	104		$	—		$	—		$	3,251
Current portion of fair value of contingent    consideration		—			1,025			4,544			—			5,569
Accounts payable, accrued expenses and other current    liabilities		11,985			2,593			3,768			—			18,346
Accrued compensation		2,132			3,405			3,022			—			8,559
Accrued interest		8,805			—			—			—			8,805
Total current liabilities		26,069			7,127			11,334			—			44,530
Intercompany payable		—			153,960			210,375			(364,335	)		—
Long-term debt, net of current portion		387,234			49			—			—			387,283
Deferred tax liabilities		—			2,391			3,599			—			5,990
Accrued management fees, related parties		10,780			—			—			—			10,780
Fair value of contingent consideration, net of current    portion		—			875			5,535			—			6,410
Other liabilities		1,550			—			1,152			—			2,702
Members' Deficit		(43,062	)		(34,613	)		(129,014	)		—			(206,689	)
	$	382,571		$	129,789		$	102,981		$	(364,335	)	$	251,006

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	Aurora						Non-
	Diagnostics			Subsidiary			Guarantor			Consolidating			Consolidated
December 31, 2015	Holdings, LLC			Guarantors			Subsidiaries			Adjustments			Total
Assets
Current Assets
Cash and cash equivalents	$	17,833		$	1,198		$	54		$	—		$	19,085
Accounts receivable, net		759			16,317			15,775			—			32,851
Prepaid expenses and other assets		1,890			1,292			1,139			—			4,321
Prepaid income taxes		—			60			115			—			175
Total current assets		20,482			18,867			17,083			—			56,432
Property and equipment, net		2,453			6,193			—			—			8,646
Other Assets:
Intercompany receivable		373,041			—			—			(373,041	)		—
Deferred debt issue costs, net		453			—			—			—			453
Deposits and other noncurrent assets		345			143			108			—			596
Goodwill		—			77,110			48,078			—			125,188
Intangible assets, net		118			34,450			31,126			—			65,694
		373,957			111,703			79,312			(373,041	)		191,931
	$	396,892		$	136,763		$	96,395		$	(373,041	)	$	257,009
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	2,021		$	126		$	—		$	—		$	2,147
Current portion of fair value of contingent    consideration		—			1,013			3,807			—			4,820
Accounts payable, accrued expenses and other current    liabilities		9,979			2,543			4,317			—			16,839
Accrued compensation		2,784			2,378			1,868			—			7,030
Accrued interest		14,228			—			—			—			14,228
Total current liabilities		29,012			6,060			9,992			—			45,064
Intercompany payable		—			170,121			202,920			(373,041	)		—
Long-term debt, net of current portion		377,562			55			—			—			377,617
Deferred tax liabilities		—			2,443			4,030			—			6,473
Accrued management fees, related parties		8,633			—			—			—			8,633
Fair value of contingent consideration, net of current    portion		—			1,367			6,953			—			8,320
Other liabilities		1,603			—			82			—			1,685
Members' Deficit		(19,918	)		(43,283	)		(127,582	)		—			(190,783	)
	$	396,892		$	136,763		$	96,395		$	(373,041	)	$	257,009

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Condensed Consolidating Statements of Operations (in thousands):

	Aurora
For the Three Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	42,401		$	30,834		$	73,235
Operating costs and expenses:
Cost of services		—			14,783			23,965			38,748
Selling, general and administrative expenses		5,252			6,749			4,854			16,855
Provision for doubtful accounts		—			1,905			2,073			3,978
Intangible asset amortization expense		—			3,188			1,776			4,964
Management fees, related parties		(3,804	)		9,783			(5,246	)		733
Merger and acquisition costs		762			—			—			762
Change in fair value of contingent consideration		—			79			87			166
Total operating costs and expenses		2,210			36,487			27,509			66,206
Income (loss) from operations		(2,210	)		5,914			3,325			7,029
Other (expense) income:
Interest expense		(6,901	)		(711	)		(2,932	)		(10,544	)
Other income		—			—			(5	)		(5	)
Total other expense, net		(6,901	)		(711	)		(2,937	)		(10,549	)
Income (loss) before income taxes		(9,111	)		5,203			388			(3,520	)
Provision for income taxes		—			162			388			550
Net (loss) income	$	(9,111	)	$	5,041		$	—		$	(4,070	)
	Aurora
For the Three Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	39,330		$	30,353		$	69,683
Operating costs and expenses:
Cost of services		—			15,809			21,116			36,925
Selling, general and administrative expenses		5,682			6,495			4,570			16,747
Provision for doubtful accounts		—			2,300			1,928			4,228
Intangible asset amortization expense		—			3,111			1,696			4,807
Management fees, related parties		2,772			—			(2,075	)		697
Merger and acquisition costs		297			—			—			297
Change in fair value of contingent consideration		—			40			140			180
Total operating costs and expenses		8,751			27,755			27,375			63,881
Income (loss) from operations		(8,751	)		11,575			2,978			5,802
Other expense:
Interest expense		(7,309	)		(479	)		(2,702	)		(10,490	)
Other expense		(2	)		—			—			(2	)
Total other expense		(7,311	)		(479	)		(2,702	)		(10,492	)
Income (loss) before income taxes		(16,062	)		11,096			276			(4,690	)
Income tax provision (benefit)		—			(266	)		276			10
Net (loss) income	$	(16,062	)	$	11,362		$	—		$	(4,700	)

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Condensed Consolidating Statements of Operations (in thousands):

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	122,238		$	92,538		$	214,776
Operating costs and expenses:
Cost of services		—			47,919			66,451			114,370
Selling, general and administrative expenses		16,822			21,166			15,742			53,730
Provision for doubtful accounts		—			6,356			5,751			12,107
Intangible asset amortization expense		—			9,677			5,256			14,933
Management fees		2,162			9,783			(9,797	)		2,148
Merger and acquisition costs		1,338			—			—			1,338
Change in fair value of contingent consideration		—			169			977			1,146
Total operating costs and expenses		20,322			95,070			84,380			199,772
Income (loss) from operations		(20,322	)		27,168			8,158			15,004
Other (expense) income:
Interest expense		(20,811	)		(2,098	)		(8,585	)		(31,494	)
Other income		—			—			-			-
Total other expense, net		(20,811	)		(2,098	)		(8,585	)		(31,494	)
Income (loss) before income taxes		(41,133	)		25,070			(427	)		(16,490	)
Benefit for income taxes		—			(46	)		(427	)		(473	)
Net loss	$	(41,133	)	$	25,116		$	—		$	(16,017	)
	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	110,217		$	83,505		$	193,722
Operating costs and expenses:
Cost of services		—			45,582			60,582			106,164
Selling, general and administrative expenses		16,384			19,662			13,449			49,495
Provision for doubtful accounts		—			7,206			5,525			12,731
Intangible asset amortization expense		—			9,398			4,770			14,168
Management fees		14,077			—			(12,163	)		1,914
Impairment of goodwill and other intangible assets		—			36,001			3,640			39,641
Merger and acquisition costs		694			—			—			694
Change in fair value of contingent consideration		—			110			576			686
Total operating costs and expenses		31,155			117,959			76,379			225,493
Income (loss) from operations		(31,155	)		(7,742	)		7,126			(31,771	)
Other (expense) income:
Interest expense		(21,097	)		(1,556	)		(7,781	)		(30,434	)
Other income		—			1			3			4
Total other expense, net		(21,097	)		(1,555	)		(7,778	)		(30,430	)
Loss before income taxes		(52,252	)		(9,297	)		(652	)		(62,201	)
Benefit for income taxes		—			(160	)		(652	)		(812	)
Net loss	$	(52,252	)	$	(9,137	)	$	—		$	(61,389	)

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Condensed Consolidating Statements of Cash Flows (in thousands):

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net (loss) income	$	(41,133	)	$	25,116		$	—		$	(16,017	)
Adjustments to reconcile net (loss) income to net cash    (used in) provided by operating activities		3,299			11,890			6,973			22,162
Changes in assets and liabilities		31,189			(35,947	)		(3,935	)		(8,693	)
Net cash (used in) provided by operating activities		(6,645	)		1,059			3,038			(2,548	)
Net cash used in investing activities		(7,730	)		(2,167	)		(2,757	)		(12,654	)
Net cash provided by (used in) financing activities		8,225			(46	)		—			8,179
Net decrease in cash and cash equivalents		(6,150	)		(1,154	)		281			(7,023	)
Cash and cash equivalents, beginning of period		17,833			1,198			54			19,085
Cash and cash equivalents, end of period	$	11,683		$	44		$	335		$	12,062

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net loss	$	(52,252	)	$	(9,137	)	$	—		$	(61,389	)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities		3,493			46,926			8,279			58,698
Changes in assets and liabilities		39,115			(37,248	)		(5,927	)		(4,060	)
Net cash provided by (used in) operating activities		(9,644	)		541			2,352			(6,751	)
Net cash used in investing activities		(9,300	)		(646	)		(2,296	)		(12,242	)
Net cash provided by (used in) financing activities		13,110			(41	)		—			13,069
Net increase (decrease) in cash and cash equivalents		(5,834	)		(146	)		56			(5,924	)
Cash and cash equivalents, beginning of period		26,209			192			21			26,422
Cash and cash equivalents, end of period	$	20,375		$	46		$	77		$	20,498

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Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations.

You should read the following discussion and analysis of our financial condition and results of operations together with our financial statements and related notes included in Part I, Item 1 of this Quarterly Report on Form 10-Q. Some of the statements made in this Quarterly Report on Form 10-Q are “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, or the Exchange Act. All statements other than statements of historical facts contained in this Quarterly Report, including statements regarding our future results of operations and financial position, or that describe our plans, goals, intentions, objectives, strategies, expectations, beliefs and assumptions, are forward-looking statements. The words “believe,” “may,” “might,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “expect,” “project,” “plan,” “objective,” “could,” “would,” “should” and similar expressions are intended to identify forward-looking statements. We have based these forward-looking statements largely on our current expectations and projections about future events and financial trends that we believe may affect our financial condition, results of operations, business strategy, short-term and long-term business operations and objectives, and financial needs. We caution that the forward-looking statements in this Quarterly Report on Form 10-Q are subject to a number of known and unknown risks, uncertainties and assumptions that may cause our actual results, performance or achievements to be materially different from any future results, performances or achievements expressed or implied by the forward-looking statements. Factors that could contribute to these differences include, among other things:  

• changes in governmental and non-governmental reimbursement rates for our diagnostic services;

• internalization of testing functions and technologies by our clients;

• competition in our industry from existing or new companies;

• disruptions or failures of our IT solutions or infrastructure;

• the introduction of new diagnostic technologies or products which could reduce demand for our services;

• our inability to acquire rights to new technologies and products, or recalls or discontinuations of existing technologies or products;

• loss of key executives, pathologists or technical personnel;

• changes in the mix of diagnostic testing services we perform;

• changes in the percentage of services we perform for certain subspecialties;

• failure to successfully integrate or fully realize the anticipated benefits from our acquisitions;

• the discovery of unknown or contingent liabilities from acquired businesses;

• failure to manage our growth effectively;

• changes in reimbursement rates due to consolidation in the health insurance industry;

• the loss of in-network status with, or our the inability to collect from, health care insurers;

• the failure to successfully collect for our services;

• changes in the dermatopathology market;

• changes in our payor mix;

• the impact of high deductible health plans on demand for our services and our ability to collect for our services;

• the availability of additional capital resources;

• the failure of our acquired assets to generate the level of expected returns;

• growth in demand for our services that exceeds our ability to adequately scale our infrastructure;

• general economic, business or regulatory conditions affecting the health care and diagnostic testing services industries;

• violation of, failure to comply with, or changes in federal and state laws and regulations related to, submission of claims for our services, fraud and abuse, patient privacy, corporate practice of medicine, billing arrangements for our services and environmental, health and safety;

• our substantial level of indebtedness and our upcoming debt maturities; and

• the other risks and uncertainties referenced under the heading “Risk Factors” in Part II, Item 1A of this Quarterly Report and in other documents filed by the Company with the Securities and Exchange Commission, including the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2015.

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Moreover, we operate in a very competitive and rapidly changing environment, and new risks emerge from time-to-time. It is not possible for our management to predict all risks, nor can we assess the impact of all factors on our business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements we may make. In light of these risks, uncertainties and assumptions, the forward-looking events and circumstances discussed in this Quarterly Report may not occur, and actual results could differ materially and adversely from those anticipated or implied in the forward-looking statements.

You should not rely upon forward-looking statements as predictions of future events. Although we believe that the expectations reflected in the forward-looking statements are reasonable, we cannot guarantee that the future results, levels of activity, performance or events and circumstances reflected in the forward-looking statements will be achieved or occur. Moreover, neither we nor any other person assumes responsibility for the accuracy and completeness of the forward-looking statements. We undertake no obligation to update publicly any forward-looking statements for any reason after the date of this Quarterly Report on Form 10-Q to conform these statements to actual results or changes in our expectations, unless otherwise required by law.

Overview

We area leadingindependentpathologyservicesand cancerdiagnosticscompany.We provideintegrated diagnosticconsultations,informationservicesand personalizedmedicineservicestailoredto thepatientsof our referringphysicians,hospitalsand hospitalsystems.We alsoprovideresearchservicesto pharmaceutical companiesand otherresearchentities.Our highly-trained, subspecializedpathologistsdelivercomprehensive diagnosticopinionsof a patient’sconditionand work collaborativelywith referringphysiciansto determine appropriatetreatments.We have establishedlong-standingrelationshipswith our referringphysiciansas a result of our locallyprovideddiagnosticservices,frequentdiagnosticconsultationsand flexibleIT solutionsthatare customizableto our clients’needs.Our client-centeredapproachto providingdiagnosticservicesisdrivenby our beliefthatthepracticeof medicineand thedeliveryof healthcareareboth personaland bestdeliveredlocally.

Through organicgrowth and a seriesof strategicacquisitions,we have achieveda largegeographicfootprintand a leadingpresencein our localmarkets.As of September 30, 2016, we operated26 community-basedpathology practiceswith over 160 board-certifiedpathologistson staff, and our clientsincludedover13,000 referring physiciansand 99 hospitalsacross45 states.Our referringphysiciansincludedermatologists,obstetriciansand gynecologists,familypractitioners,gastroenterologists,urologists,generalsurgeonsand oncologists.We also serveas laboratorymedicaldirectorfor362 laboratorysitesacrossthecountry,includingour 99 hospitalclients, reflecting the recent addition of two new hospital clients in the Northeast and one on the West Coast.

In 2013, we established the Aurora Research Institute (“ARI”), a revenue-generatingservicesplatformthatleveragestheexpertiseof our pathologists,laboratoryresourcesand sizeablelibraryof biospecimensforthedevelopmentof therapeuticsand companiondiagnosticsforleadingglobalpharmaceuticaland biotechnologycompanies. For theyearended December31, 2015, ARI contributednetrevenueof $3.5 million,or approximately1.3% of our totalnetrevenue.

For theyearended December31, 2015 and thenine monthsended September 30, 2016, we processedapproximately 2.1 millionand 1.6 million accessions,respectively.An accessionmayincludeone or morespecimensreceivedby our pathologypracticesoriginatedfroma singlepatientvisitto a referringphysicianconcerninga particular condition.For theyearended December31, 2015 and thenine monthsended September 30, 2016, we generatednet revenueof $263.7 millionand $214.8 million,respectively.

Key Factors Affecting Our Results of Operations

Services Mix

An importantfactoraffectingour financialperformanceistheimpactof changesin our servicesmix,including theconversionof globalfeearrangementsto technicalcomponentor professionalcomponentarrangementsand changesin theaccessionvolumeacrossour varioussubspecialties.Under a globalfeearrangement, we provide both technicaland professionalservices. The technicalcomponentrepresentsthecostof preparinga specimenfor interpretation, whiletheprofessionalcomponentrepresentsthecostof supervisionand interpretationby our pathologists.We generallypreferglobalfeearrangementsin which we provideboth theprofessionaland technicalservicescomponents, as opposed to arrangementswhere we only performeithertechnicalor professionalservices,becauseglobalarrangementsresultin higherrevenueperaccession. Additionally,changes in testvolumeacrossour varioussubspecialtiescan impactour revenue.For example,moleculartesting, hematopathology,dermatopathology,gastrointestinaland genitourinaryallhave higherrevenueperaccession thanwomen’shealthpathologyservicesand clinicaltests.Women’shealthservicesand clinicaltestsgenerally have lowerrevenueperaccession.Therefore,increasesin the percentageof accessionsrelatedto women’shealth pathologyservicesrelativeto the percentagesof accessionsgeneratedby othersubspecialtieswould generally decreaseour averagerevenueperaccession.Conversely,a highervolumeof moleculartestingwould generally increaseour averagerevenueperaccession.

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Payor Mix

Changes in our payormix,as wellas changesin thepayorsused by our referringphysicians,can affectour revenueperaccessionand impactour financialresults.We generallyprovideserviceson an in-networkbasis, where we performservicesforpatientswithinthenetworksof payorswith which we have contracts.Services performedon an out-of-networkbasiscomprisedapproximately10% of our 2015 revenue.Our payorsinclude governmentalpayors,such as Medicareand Medicaid;privateinsurance,includingmanagedcareorganizations and commercialpayors;and privatepayors,such as physiciansand individualpatients.Becausewe aregenerally obligatedto billforour servicesin thespecificmannerprescribedby eachpayor,who mayeachhave different billingrequirements,thesedifferencescan impactour financialresults.Therefore,ifmoreof our referring physiciansuse governmentalpayorswho have historicallyhad lowerreimbursementratesas opposed to commercialpayorswho have historicallyhad higherreimbursementrates,our revenueperaccessionmay decrease.For theyearended December31, 2015, basedon cashcollections,we estimateapproximately58% of our revenuewas paidby privateinsurance,includingmanagedcareorganizationsand commercialpayors; approximately22% of our revenuewas paidby Medicare;approximately2% of our revenuewas paidby Medicaid;and approximately18% was paidby physiciansand individualpatients.

Reimbursement Rates

Changes to the reimbursement rates paid by our payors impact our net revenue per accession. When we bill our services to third party payors and uninsured patients, we use a company-generated fee schedule that is generally set at billing rates that are higher than our anticipated reimbursement rates. Our billings for services to third party payors are then reimbursed in accordance with the set or negotiated reimbursement rates of the applicable payor. On the other hand, when we bill our services to physicians, which are not reimbursed by third party payors, we use a negotiated fee schedule, and when we bill Medicare for specialized diagnostic services, we are subject to a Medicare physician fee schedule and, to a lesser degree, a clinical laboratory fee schedule, both of which are updated annually. Our revenue is recorded net of the estimated differences between the amount billed in accordance with the prescribed fee schedule and the estimated payment to be received from third party payors, including Medicare. As a result, any changes to the reimbursements rates for our services or the fee schedules at which we bill our services will impact our financial results. We have historically faced, and expect to continue to face, pressure on reimbursement rates as government payors and private insurers take steps to control the cost, use and delivery of health care services, including diagnostic testing services. Government regulations can impact our reimbursement rates and financial results.

On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its 2017 Physician Fee Schedule, which we refer to as the 2017 Fee Schedule.  In the 2017 Fee Schedule, CMS effectuated reductions to CPT Code 88305, which is the CPT Code we bill most frequently, of approximately 6.8%. Reimbursement rates for flow cytometry codes were also reduced by approximately 19%.  Based on our current level of reimbursement from Medicare, we estimate the changes to the 2017 Fee Schedule would result in a reduction of our annualized Medicare revenue of approximately $3.3 million.

In addition, we are currently in negotiation with a regional private insurance company that has notified us of their intent to reduce their reimbursement for our services.  At this time, we are unable to predict the ultimate impact of these negotiations.

In response to the reductions by CMS, as well as potential reductions from private insurance companies, we have undertaken a program to increase efficiencies and reduce costs, including a reduction in our staffing.  We estimate the implementation of this program, which is expected to be fully implemented by January 1, 2017, will reduce our expenses by approximately $3.9 million annually.

Acquisitions

Sinceour formationin 2006, we have acquired31 diagnosticservicescompaniesthroughouttheUnitedStates.As a resultof thesignificantnumberand sizeof our acquisitions,manyof thechangesin our consolidatedresults of operationsand financialpositiondiscussedfromperiodto periodreflectrevenuegeneratedby thebusinesses we have acquiredand costsrelatedto theseacquisitions. For additionalinformationrelatingto recent acquisitions,see“—RecentAcquisitions.”

Seasonality

Our resultsarealsoaffectedby seasonaltrendsand generallydeclineduringthesummer,winterand holiday periods.Furthermore,our resultsaresubjectto declinesdue to weatherconditions,such as severesnow storms and floodingor excessivelyhot or coldspells,as wellas generaleconomicconditions,which can deterpatients fromvisitinghospitalsand our referringphysicians.Seasonalfluctuationstendto varyby region,and, for example,we experiencea greaterdecreasein our accessionvolumeduringthewintermonthsin thenortheastas comparedto thesoutheast.In addition,we tendto experiencea decreasein our accessionvolumeatthe beginningof eachyearas a resultof theannualresetof healthplandeductibles.

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Emerging Growth Company

We qualify as an “emerging growth company” as defined in the Jumpstart Our Business Startups Act of 2012 (JOBS Act). As an emerging growth company, we have elected to provide reduced reporting and are not subject to other obligations generally applicable to public companies, including disclosure about our executive compensation arrangements and the auditor attestation requirement in the assessment of our internal control over financial reporting. In addition, we may take advantage of an extended transition period for complying with new or revised accounting standards under the JOBS Act. This election allows us to delay the adoption of new or revised accounting standards that have different effective dates for public and private companies until those standards apply to private companies.

The information that we provide may be different than what is available with respect to other public companies due to these reduced reporting obligations.

Results of Operations

The following table outlines our results of operations as a percentage of net revenue for the three and nine months ended September 30, 2016 and 2015.

	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2016			2015			2016			2015
Net revenue		100.0	%		100.0	%		100.0	%		100.0	%
Operating costs and expenses:
Cost of services		52.9	%		53.0	%		53.3	%		54.8	%
Selling, general and administrative expenses		23.0	%		24.0	%		25.0	%		25.5	%
Provision for doubtful accounts		5.4	%		6.1	%		5.6	%		6.6	%
Intangible asset amortization expense		6.8	%		6.9	%		7.0	%		7.3	%
Management fees		1.0	%		1.0	%		1.0	%		1.0	%
Impairment of goodwill		0.0	%		0.0	%		0.0	%		20.5	%
Merger and acquisition transaction costs		1.0	%		0.4	%		0.6	%		0.4	%
Change in fair value of contingent consideration		0.2	%		0.3	%		0.5	%		0.4	%
Total operating costs and expenses		90.4	%		91.7	%		93.0	%		116.4	%
Income (loss) from operations		9.6	%		8.3	%		7.0	%		(16.4	)%
Other income (expense):
Interest expense		(14.4	)%		(15.1	)%		(14.7	)%		(15.7	)%
Other income / (expense)		0.0	%		0.0	%		0.0	%		0.0	%
Total other expense, net		(14.4	)%		(15.1	)%		(14.7	)%		(15.7	)%
Loss before income taxes		(4.8	)%		(6.7	)%		(7.7	)%		(32.1	)%
Provision (benefit) for income taxes		0.8	%		0.0	%		(0.2	)%		(0.4	)%
Net Loss		(5.6	)%		(6.7	)%		(7.5	)%		(31.7	)%

Our historical consolidated operating results do not reflect the results of operations of our 2015 and 2016 acquisitions prior to the effective date of those acquisitions. As a result, our historical consolidated operating results may not be indicative of what our results of operations will be for future periods.

Comparison of the Three Months Ended September 30, 2016 and 2015

Net revenue

Net revenue for the quarter ended September 30, 2016 was $73.2 million on accession volume of 540,000, inclusive of approximately $7.2 million of revenue and 39,000 accessions from the practices acquired in 2015 and 2016. Net revenue at the practices we have operated for the full periods in both 2016 and 2015, which we refer to herein as our existing practices, decreased by approximately 1%, or $0.7 million, to approximately $66.1 million for the quarter ended September 30, 2016, compared to $66.8 million for the quarter ended September 30, 2015. Existing practice accession volume was 501,000, a decrease of approximately 5% for the quarter ended September 30, 2016, compared to 529,000 for the quarter ended September 30, 2015. The average revenue per accession for our existing practices for the quarter ended September 30, 2016 increased by about 5%, to $132, compared to $126 for the same period in 2015. The decrease in existing practice revenue was primarily related to lower volume from certain continuing clients as well as client attrition, partially offset by changes in service mix and higher Medicare reimbursement under the 2016 Physician Fee Schedule.

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Cost of services

Cost of services for the quarter ended September 30, 2016 was $38.7 million, including $3.7 million for practices acquired in 2015 and 2016. Cost of services at existing practices decreased approximately $0.6 million, or 2%, to $35.0 million for the quarter ended September 30, 2016, from $35.6 million for the quarter ended September 30, 2015, primarily as a result of lower practice supplies costs which correlate to lower volume, lower personnel related costs and reductions in medical liability.

As a result of the preceding factors, cost of services was 52.9% of net revenue for the quarter ended September 30, 2016, compared to 53.0% for the quarter ended September 30, 2015. Gross margin was 47.1% for the quarter ended September 30, 2016, compared to 47.0% for the quarter ended September 30, 2015.

Selling, general and administrative expenses

Selling, general and administrative expenses increased approximately $0.2 million, or less than 1%, to $16.9 million for the quarter ended September 30, 2016, including approximately $0.6 million related to practices acquired in 2015 and 2016, from approximately $16.7 million for the quarter ended September 30, 2015. Selling, general and administrative expenses for the quarter ended September 30, 2016, compared to the corresponding period in the prior year, was approximately $0.3 million higher at practices acquired in 2015 and 2016 and approximately $0.1 million higher at our existing practices. Compared to the corresponding period in the prior year, selling, general and administrative expenses at corporate decreased by approximately $0.2 million due to lower personnel related costs.

As a result of the preceding factors, selling, general and administrative expenses were approximately 23.0% of net revenue for the quarter ended September 30, 2016, compared to 24.0% for the quarter ended September 30, 2015.

Provision for doubtful accounts

Our provision for doubtful accounts decreased approximately $0.2 million, or 6%, to $4.0 million for the quarter ended September 30, 2016, from $4.2 million for the quarter ended September 30, 2015. As a percentage of net revenue, the provision for doubtful accounts decreased to 5.4% for the quarter ended September 30, 2016, compared to 6.1% for the quarter ended September 30, 2015. The decrease in the provision for doubtful accounts for the quarter ended September 30, 2016 primarily related to changes in our collections processes which have improved our collections results.  

The Company’s consolidated provision for doubtful accounts could be positively or negatively impacted by various factors including, among other things, changes in payor mix and the provision for doubtful accounts for practices that we acquire.

Intangible asset amortization expense

Amortization expense increased to $5.0 million for the quarter ended September 30, 2016, from $4.8 million for the quarter ended September 30, 2015, as a result of amortization of finite lived intangible assets recorded for practices acquired in 2015 and 2016. We generally amortize our intangible assets over lives ranging from 3 to 15 years.

Management fees, related parties

Management fees to related parties were approximately $0.7 million for each of the quarters ended September 30, 2016 and September 30, 2015. Management fees are based on 1.0% of net revenue plus expenses.

Merger and acquisition transaction costs

Merger and acquisition transaction costs increased by approximately $0.5 million, to $0.8 million for the quarter ended September 30, 2016, compared to $0.3 million the quarter ended September 30, 2015, reflecting a higher level of transaction activity.

Change in fair value of contingent consideration

For each of the quarters ended September 30, 2016 and September 30, 2015, we recorded expense of $0.2 million for changes in the fair value of contingent consideration issued in connection with our acquisitions. The change in fair value of contingent consideration results from revisions in our projections to reflect recent results, as well as other variables such as the discount rate, the valuation date and actual payments made.

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Interest expense

Interest expense was approximately $10.5 million for each of the quarters ended September 30, 2016 and September 30, 2015.

Provision (benefit) for income taxes

We are a Delaware limited liability company for federal and state income tax purposes, in accordance with the applicable provisions of the Internal Revenue Code. Accordingly, we generally have not been subject to income taxes, and the income attributable to us has been allocated to the members of Aurora Diagnostics Holdings, LLC in accordance with the terms of the Aurora Diagnostics Holdings, LLC Limited Liability Company Agreement. However, certain of our subsidiaries are structured as corporations and therefore are subject to federal and state income taxes. The provision for federal and state income taxes for these subsidiaries, as reflected in our condensed consolidated financial statements, amounted to approximately $0.6 million for the quarter ended September 30, 2016, compared to $10,000 for the quarter ended September 30, 2015, as a result of taxable income recognized for certain of our subsidiaries structured as corporations.

Comparison of the Nine months Ended September 30, 2016 and 2015

Net revenue

Net revenue for the nine months ended September 30, 2016 was $214.8 million on accession volume of 1,604,000, inclusive of approximately $19.5 million of revenue and 107,000 accessions from the practices acquired in 2015 and 2016. Net revenue at our existing practices, increased by approximately 2%, or $4.5 million, to approximately $195.3 million for the nine months ended September 30, 2016, compared to $190.8 million for the nine months ended September 30, 2015. Existing practice accession volume was 1,497,000, a decrease of approximately 2% for the nine months ended September 30, 2016, compared to 1,533,000 for the nine months ended September 30, 2015. The average revenue per accession for our existing practices for the nine months ended September 30, 2016 increased by about 5% to $130, compared to $124 for the same period in 2015. The increase in existing practice revenue was primarily related to changes in service mix, higher Medicare reimbursement under the 2016 Physician Fee Schedule, and higher revenue from ARI, partially offset by lower volume from certain continuing clients as well as client attrition.

Cost of services

Cost of services for the nine months ended September 30, 2016 was $114.4 million, including $10.2 million for practices acquired in 2015 and 2016. Cost of services at existing practices decreased approximately $0.8 million, or less than 1%, to $104.1 million for the nine months ended September 30, 2016, from $104.9 million for the nine months ended September 30, 2015, primarily as a result of lower labs supplies and personnel related costs.  As a result of the preceding factors, cost of services was 53.3% of net revenue for the nine months ended September 30, 2016, compared to 54.8% for the nine months ended September 30, 2015. Gross margin was 46.7% for the nine months ended September 30, 2016, compared to 45.2% for the nine months ended September 30, 2015.

Selling, general and administrative expenses

Selling, general and administrative expenses increased approximately $4.2 million, or 9%, to $53.7 million for the nine months ended September 30, 2016, including approximately $1.8 million related to practices acquired in 2015 and 2016, from $49.5 million for the nine months ended September 30, 2015. Compared to the corresponding period in the prior year, selling, general and administrative expenses at corporate increased by approximately $0.5 million due to higher professional fees, including legal and accounting services. Selling, general and administrative expenses at our existing practices for the nine months ended September 30, 2016, compared to the nine months ended September 30, 2015, increased by $2.2 million. Selling, general and administrative expenses for our existing practices increased approximately $1.2 million for non-cash charges related to two leased locations vacated in the nine months ended September 30, 2016, as well as higher personnel related and billing and collections costs. Despite the preceding factors, selling, general and administrative expenses decreased to approximately 25.0% of net revenue for the nine months ended September 30, 2016, compared to 25.5% for the nine months ended September 30, 2015.

Provision for doubtful accounts

Our provision for doubtful accounts decreased approximately $0.6 million, or 5%, to $12.1 million for the nine months ended September 30, 2016, from $12.7 million for the nine months ended September 30, 2015. As a percentage of net revenue, the provision for doubtful accounts decreased to 5.6% for the nine months ended September 30, 2016, compared to 6.6% for the nine months ended September 30, 2015. The decrease in the provision for doubtful accounts for the nine months ended September 30, 2016 primarily related to changes in our collections processes which have improved our collections results.

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Intangible asset amortization expense

Amortization expense increased to $14.9 million for the nine months ended September 30, 2016, from $14.2 million for the nine months ended September 30, 2015, as a result of amortization of finite lived intangible assets recorded for practices acquired in 2015 and 2016. We generally amortize our intangible assets over lives ranging from 3 to 15 years.

Management fees, related parties

Management fees to related parties increased to approximately $2.1 million for the nine months ended September 30, 2016 from $1.9 million for the nine months ended September 30, 2015 as a result of the increase in revenue for the same period. Management fees are based on 1.0% of net revenue plus expenses.

Impairment of goodwill

During nine months ended September 30, 2015, we identified indications of impairment at two of our reporting units. One of the reporting units exhibited lower margins and both of the reporting units experienced lower volume as a result of competition to such an extent as to indicate potential impairment. Regarding these reporting units, we believe the reduction in volume due to attrition in the client base resulted in a reduction in the fair values of the reporting units below their carrying values. As of September 30, 2015, we tested goodwill for impairment at these two reporting units and recorded non-cash impairment charges of $39.6 million to write down the carrying value of goodwill. There were no goodwill impairments for the nine months ended September 30, 2016.

Merger and acquisition transaction costs

Merger and acquisition transaction costs increased to approximately $1.3 million for the nine months ended September 30, 2016, from $0.7 million for the nine months ended September 30, 2015, reflecting a higher level of transaction activity.

Change in fair value of contingent consideration

For the nine months ended September 30, 2016, we recorded non-cash expense of $1.1 million for changes in the fair value of contingent consideration issued in connection with our acquisitions, compared to $0.7 million for the nine months ended September 30, 2015. The change in fair value of contingent consideration results from revisions in our projections to reflect recent results, as well as other variables such as the discount rate, the valuation date and actual payments made.

Interest expense

Interest expense increased by $1.1 million, to approximately $31.5 million for the nine months ended September 30, 2016, compared to $30.4 million for the nine months ended September 30, 2015. The increase in interest expense primarily resulted from approximately $17.0 million average total debt as a result of additional borrowings under the delayed draw term loans to fund acquisitions.

Benefit from income taxes

We are a Delaware limited liability company for federal and state income tax purposes, in accordance with the applicable provisions of the Internal Revenue Code. Accordingly, we generally have not been subject to income taxes, and the income attributable to us has been allocated to the members of Aurora Diagnostics Holdings, LLC in accordance with the terms of the Aurora Diagnostics Holdings, LLC Limited Liability Company Agreement. However, certain of our subsidiaries are structured as corporations and therefore are subject to federal and state income taxes. The benefit from federal and state income taxes for these subsidiaries, as reflected in our condensed consolidated financial statements, amounted to $0.5 million and $0.8 million for the nine months ended September 30, 2016 and September 30, 2015, respectively, as a result of the taxable income of our subsidiaries are structured as corporations.

Liquidity and Capital Resources

Since inception, we have primarily financed operations through capital contributions from our equityholders, long-term debt financing and cash flow from operations.

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On December 20, 2010, we issued $200.0 million in unsecured senior notes that mature on January 15, 2018, which we refer to as our Senior Notes. The Senior Notes bear interest at an annual rate of 10.75%, which is payable each January 15^th and July 15^th. In accordance with the indenture governing our Senior Notes, we are subject to certain limitations on issuing additional debt and are subject to other customary affirmative and negative covenants. The Senior Notes are currently redeemable at our option at 102.688% of par, plus accrued interest. The redemption price decreases to 100% of par on January 15, 2017. The Senior Notes rank equally in right of repayment with all of our other senior indebtedness, but are subordinated to our secured indebtedness to the extent of the value of the assets securing that indebtedness.  

On July 31, 2014 we entered into a $220.0 million credit facility with Cerberus Business Finance, LLC, which facility, as subsequently amended, we refer to as our senior secured credit facility. Our senior secured credit facility initially consisted of a $165.0 million initial term loan, $30.0 million revolving credit line and $25.0 million delayed draw term loan.  The delayed draw term loan facility was available through October 31, 2015 to pay for acquisitions, including acquisition related fees and expenses. Each of the term loan, revolving credit line and delayed draw term loan under the senior secured credit facility has a maturity of five years but is subject to a maturity date of October 14, 2017 if our Senior Notes are not refinanced or their maturity is not extended, or if the credit facility is not amended and extended, prior to such date.  

Under the outstanding term loans, quarterly principal repayments of $0.5 million became due commencing on September 30, 2015 through December 31, 2016.  Quarterly principal repayments increase to $0.9 million on March 31, 2017 through June 30, 2018 and to $1.3 million on September 30, 2018 and each quarter end thereafter, with the balance due at maturity. Prior to the second amendment on April 10, 2015, at our option, interest under the credit facility was either LIBOR, with a 1.25% floor, plus 7%, or at a base rate, with a 2.25% floor, plus 6%.

On April 10, 2015 we entered into a second amendment to our senior secured credit facility. This amendment added a $40.0 million delayed draw term loan B facility that was available through April 10, 2016 to pay for acquisitions, including acquisition related fees and expenses. The second amendment also increased the interest rate under the credit facility to LIBOR, with a 1.25% floor, plus 7.125%, or to the base rate, with a 2.25% floor, plus 6.125%. The senior secured credit facility is subject to a 2.25% per annum fee on the undrawn amount thereof, payable quarterly in arrears.

In connection with the acquisitions we consummated on July 15, 2015, we borrowed the remaining $15.3 million available under the delayed draw term loan. The amount we borrowed exceeded the total we paid for eligible acquisitions, inclusive of related expenses, by $5.4 million. Subsequent amendments extended the remaining $5.4 million availability under the $25.0 million delayed draw term loan from July 31, 2015 to October 31, 2015. We used the remaining $5.4 million for an acquisition completed on October 29, 2015.

As of September 30, 2016, we owed $162.5 million under the term loan, $25.0 million under the delayed draw term loan and $10.0 million under the delayed draw term loan B facility. As of September 30, 2016, no amounts were outstanding and we had $30.0 million available under our revolving credit facility.

The senior secured credit facility is secured by essentially all of our assets and unconditionally guaranteed by us and certain of the Company’s and subsequently acquired or organized domestic subsidiaries and is subject to certain financial covenants. The senior secured credit facility requires us to maintain a maximum leverage ratio (based upon the ratio of total funded debt to consolidated EBITDA, net of agreed cash amounts) and a minimum interest coverage ratio (based upon the ratio of consolidated EBITDA to net cash interest expense), each quarter based on the last four fiscal quarters. The maximum leverage ratio as of September 30, 2016 was 10.10:1.00 and becomes more restrictive each quarter through maturity. The minimum interest coverage ratio was 1.00:1.00 as of September 30, 2016 and increases to 1.05:1.00 on December 31, 2017. In addition, we are required to maintain liquidity (defined as availability under the revolving credit facility plus amounts in bank accounts that are subject to the agent’s perfected first priority liens) of at least $5.0 million at any time and $10.0 million on the last business day of each month. We are also subject to other restrictive covenants set forth in our senior secured credit facility.  Generally, we are permitted to make voluntary prepayments under our senior secured credit facility and to reduce the revolving loan commitments at any time. However, subject to certain exceptions, prepayments and commitment reductions are currently subject to a premium equal to 2.0%, which will be reduced to 1.0% effective August 1, 2017 and eliminated entirely after July 31, 2018.

Contingent consideration for acquisitions

In connection with the majority of our acquisitions, we have agreed to pay additional consideration annually over future periods of three to six years, based upon contract retention and the attainment of stipulated levels of operating results by each of the acquired entities, as defined in their respective agreements. The computation of the annual operating results is subject to review and approval by sellers prior to payment. In the event there is a dispute, the Company will pay the undisputed amount and then take reasonable efforts to resolve the dispute with the sellers. If the sellers are successful in asserting their dispute, the Company could be required to make additional payments in future periods. We made contingent note payments of $3.4 million and $2.3 million in the nine months ended September 30, 2016 and the nine months ended September 30, 2015, respectively.  

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As of September 30, 2016, the total maximum future payments of contingent consideration issued in acquisitions was $19.7 million. Lesser amounts will be paid or no payments will be made for earnings below the maximum level of stipulated earnings or if the stipulated contracts are not retained. We utilize a present value of estimated future payments approach to estimate the fair value of the contingent consideration. These estimates involve significant projections regarding future performance of the acquired practices. If actual future results differ significantly from current estimates, the actual payments for contingent consideration will differ correspondingly. As of September 30, 2016, the fair value of contingent consideration related to acquisitions was $12.0 million, representing the present value of approximately $16.1 million in estimated future payments through 2021.

In April 2015, we finalized a settlement agreement with the sellers in one of our acquisitions. As a result of the settlement, we recorded a charge of approximately $5.4 million in the change in fair value of contingent consideration in the year ended December 31, 2014. In connection with the settlement, we paid cash of $0.9 million to the sellers within five days of settlement and modified the contingent notes to extend payments for an additional two years.  

Medical Malpractice Insurance

We are insured on a claims-made basis up to our policy limits through a third party malpractice insurance policy. We establish reserves, on an undiscounted basis, for self-insured deductibles, claims incurred and reported and claims incurred but not reported (“IBNR”) during the policy period. We had recorded medical malpractice liabilities of $2.0 million as of September 30, 2016, which were included in accounts payable, accrued expenses and other current liabilities. We also record a receivable from our insurance carrier for expected recoveries. Expected insurance recoveries, which are included in prepaid expenses and other current assets, were $0.3 million as of September 30, 2016. So long as we maintain third party malpractice insurance policies, the IBNR claims will be covered by such third party policy up to the policy limits.

Cash and Working Capital

We require significant cash flow to service our debt obligations, including contingent notes. In addition to servicing our debt, we use cash to make acquisitions, purchase property and equipment and otherwise fund our operations. Cash used to fund our operations excludes the impact of non-cash items, such as the allowance for doubtful accounts, depreciation, impairments of goodwill and other intangible assets, changes in the fair value of the contingent consideration and non-cash stock-based compensation, and is impacted by the timing of our payments of accounts payable and accrued expenses and collections of accounts receivable.

As of September 30, 2016, we had cash and cash equivalents of $12.1 million and working capital of $11.9 million, and we had $30.0 million available under our revolving credit facility. Our primary uses of cash are to fund our operations, service debt, including payments due under our contingent notes, make acquisitions and purchase property and equipment. Cash used to fund our operations excludes the impact of non-cash items, such as the allowance for doubtful accounts, depreciation, impairments of goodwill and other intangible assets, changes in the fair value of the contingent consideration and non-cash stock-based compensation, and is impacted by the timing of our payments of accounts payable and accrued expenses and collections of accounts receivable.

We believe our current cash and cash equivalents together with cash from operations and the amount available under our revolving credit facility will enable us to meet our working capital, capital expenditure, debt service and other funding requirements through September 30, 2017. In order to access the amounts available under our revolving credit facility, we must meet the financial tests and ratios contained in our senior secured credit facility. We currently expect to meet these financial tests and ratios at least through that date. Nonetheless, we may not meet these financial tests and ratios and therefore our ability to access the amounts otherwise available under our revolving credit facility may be limited. Our ability to meet our working capital, capital expenditure, debt service and other funding requirements in the longer term is subject to several factors, including, our ability to refinance our Senior Notes and/or our credit facility prior to October 14, 2017, our ability to raise additional debt or equity capital in a timely manner and on terms acceptable to us, our continued access to amounts available under our revolving credit facility, our ability to implement our business strategy and the absence of material adverse developments in our business, liquidity or capital requirements.  

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Net Cash Used In Operating Activities

Net cash used in operating activities during the nine months ended September 30, 2016 was $2.5 million, compared to $6.8 million net cash used in operating activities during the nine months ended September 30, 2015. Net cash provided by operating activities for the nine months ended September 30, 2016 reflected a net loss of $16.0 million and certain adjustments for non-cash items, including $17.8 million of depreciation and amortization, $2.4 million of amortization of original issue discount and debt issue costs, $0.5 million of deferred tax benefit, $1.1 million of non-cash charges for the change in fair value of contingent consideration and $1.2 million non-cash charge for the abandonment of leased facilities. Net cash used in operating activities for the nine months ended September 30, 2016 also reflected increases and decreases in working capital, excluding acquisitions, including a $5.2 million increase in accounts receivable, a $1.0 million increase in prepaid expenses and other current assets, a $1.7 million increase in accounts payable, accrued expenses and other current liabilities, a $1.2 million increase in accrued compensation and a $5.4 million decrease in accrued interest. As of September 30, 2016 our DSO (Days Sales Outstanding) was 48 days, compared to 43 days of September 30, 2015, and 43 days as of December 31, 2015.  Various factors contributed to the increase in DSOs, including Medicare denials currently under appeal, delays in billing due to conversion of billing systems at four of our locations, longer collection cycles on accounts receivable for acquired hospital-based practices and delays in collections by one payor for a credentialing issue resolved in October 2016.

Net Cash Used In Investing Activities

Net cash used in investing activities during the nine months ended September 30, 2016 was $12.7 million compared to $12.2 million during the nine months ended September 30, 2015. Net cash used in investing activities during the nine months ended September 30, 2016 primarily consisted of $7.3 million net cash paid for business  acquisitions, $3.4 million for contingent note payments and $2.0 million for purchases of property and equipment.

Net Cash Provided By Financing Activities

Net cash provided by financing activities for the nine months ended September 30, 2016 was $8.2 million compared to $13.1 million for the nine months ended September 30, 2015. For the nine months ended September 30, 2016, we borrowed $10.0 million under the delayed draw term loan, repaid $1.5 million under the initial term loan and paid $0.3 million of financing transaction costs.

Adjusted Earnings Before Interest, Taxes, Depreciation and Amortization (Adjusted EBITDA)

We define EBITDA as earnings before interest, taxes, depreciation and amortization, and Adjusted EBITDA as EBITDA further adjusted for impairment of goodwill, management fees, equity-based compensation, changes in fair value of contingent consideration, abandoned facility costs, merger and acquisition transaction costs, cost savings for reductions in force, implementation of a laboratory systems upgrade, pro forma acquired EBITDA, and certain other charges. We believe that disclosing EBITDA and Adjusted EBITDA provides additional information to investors, enhancing their understanding of our financial performance and providing them an important financial metric used to evaluate performance in the health care industry.

EBITDA and Adjusted EBITDA do not represent net income or cash flow from operating activities as those terms are defined by generally accepted accounting principles in the United States (“GAAP”) and do not necessarily indicate whether cash flows will be sufficient to fund cash needs. Further, they may not be comparable to the measures for any subsequent four-quarter period or any complete fiscal year.

EBITDA and Adjusted EBITDA are not determined in accordance with GAAP and should not be considered in isolation or as substitutes for measures of our financial performance as determined in accordance with GAAP, such as net income and operating income. Because other companies may calculate EBITDA and Adjusted EBITDA differently than we do, EBITDA and Adjusted EBITDA may not be comparable to similarly titled measures reported by other companies. EBITDA and Adjusted EBITDA have other limitations as analytical tools when compared to the use of net income, which we believe is the most directly comparable GAAP financial measure, including:

• EBITDA and Adjusted EBITDA do not reflect the provision of income tax expense of our subsidiaries;

• EBITDA and Adjusted EBITDA do not reflect the interest expense we incur;

• EBITDA and Adjusted EBITDA do not reflect any attribution of costs to our operations related to our investments and capital expenditures through depreciation and amortization charges; and

• Adjusted EBITDA does not reflect the cost of compensation we provide to our employees in the form of stock option awards.

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The following is a reconciliation of net loss to Adjusted EBITDA (in thousands):

	Three Months Ended September 30,						Nine Months Ended September 30,
	2016 (I)			2015 (I)			2016 (I)			2015 (I)
Net loss	$	(4,070	)	$	(4,700	)	$	(16,017	)	$	(61,389	)
Interest expense		10,544			10,490			31,494			30,434
Income taxes		550			10			(473	)		(812	)
Depreciation and amortization		5,887			5,884			17,792			17,371
EBITDA		12,911			11,684			32,796			(14,396	)
Impairment of goodwill		—			—			—			39,641
Management fees (A)		733			697			2,148			1,914
Equity-based compensation		28			55			111			193
Changes in fair value of contingent consideration (B)		166			180			1,146			686
Abandoned facility costs (C)		—			—			1,139			—
Merger and acquisition transaction costs (D)		762			297			1,338			694
Cost savings for reductions in force (E)		93			155			375			1,525
Implementation of laboratory systems upgrade (F)		227			164			417			296
Pro forma acquired EBITDA (G)		—			130			501			2,130
Other charges(H)		26			(436	)		227			687
Adjusted EBITDA	$	14,946		$	12,926		$	40,198		$	33,370

(A) Represents fees for management services provided by Summit Partners and KRG Capital Partners pursuant to a management services agreement.  Since April 2013, we have accrued but not paid management fees to comply with the terms of the senior secured credit facility.

(B) Represents non-cash changes in the fair value of contingent consideration payable by us in connection with our acquisitions.  The changes related to numerous variables, including discount rate, remaining pay out period and the projected performance for each acquisition.

(C) Represents $1.0 million of non-cash charges to accrue the present value of contractual rent and $43,000 of non-cash charges to write off equipment in connection with the Company’s decision to vacate a facility in Las Vegas, Nevada in January 2016 and $86,000 of non-cash charges to write off equipment in connection with the Company’s decision to vacate a facility in Tampa, Florida in March 2016.

(D) Amounts represent merger and acquisition transaction costs, including legal fees, of $0.8 million and $0.3 million for the three months ended September 30, 2016 and 2015, respectively, and $1.3 million and $0.7 million, for the nine months ended September 30, 2016 and 2015, respectively.

(E) Represents payments made in three and nine months ended September 2015 and 2016 to employees whose positions were permanently eliminated in those periods to improve profitability and margin in response to rate pressure specific to those periods, in each case assuming the employees had been terminated at the beginning of the relevant period.

(F) Represents one-time expenses relating to a company-wide initiative to standardize our laboratory procedures and implement a common LIS system in our existing laboratories. As of September 30, 2016, we had standardized approximately 40% of the laboratories included in this initiative We are in the process of standardizing the remaining laboratories and we do not expect these expenses to recur once all our existing laboratories have been standardized.

(G) Amounts represent the incremental Adjusted EBITDA that we estimate would have been contributed by acquired practices for the period, assuming the acquisitions occurred on the first day of the period. For the three months ended September 30, 2015, represents the incremental Adjusted EBITDA of $0.1 million that we estimate would have been contributed by the two pathology practices we acquired in Texas on July 15, 2015. For the nine months ended September 30, 2016, represents the incremental Adjusted EBITDA of approximately $0.5 million that we estimate would have been contributed by the pathology practice we acquired in Oregon on March 31, 2016 and the incremental Adjusted EBITDA of $51,000 that we estimate would have been contributed by the pathology practice we acquired in Florida on April 8, 2016. For the nine months ended September 30, 2015, represents the incremental Adjusted EBITDA of approximately $2.1 million that we estimate would have been contributed by the two pathology practices we acquired in Texas on July 15, 2015. In each case, our estimates of incremental Adjusted EBITDA are based on due diligence quality of earnings reports prepared for us in connection with the applicable acquisitions.

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(H) Includes (i) costs and expenses paid to Dynamic Healthcare Solutions, LLC (“DHS”) for support services of $26,000 and $79,000 and for the three months ended September 30, 2016 and 2015, respectively, and $0.2 million and $0.4 million, for the nine months ended September 30, 2016 and 2015, respectively, for project-specific support services that in future periods will be performed by company employees with no incremental cost to the Company, (ii) separation costs of $39,000 for the three months ended September 30, 2015, and $25,000 and $114,000 for the nine months ended September 30, 2016 and 2015, respectively, paid to a former chief executive officer following his retirement in 2011 pursuant to a consulting agreement that terminated on March 1, 2016, and (iii) a gain of ($0.5 million) and costs of $0.2 million for the three and nine months ended September 30, 2015, respectively, in connection with our auditor transition in 2015, consisting of $0.7 million of costs incurred in the first half of 2015, subsequently offset by a payment of approximately $0.5 million received from our former auditor in the three months ended September 30, 2015.

(I) The Adjusted EBITDA presented in this table does not reflect adjustments of other amounts that may be added back pursuant to our credit facility and the indenture governing our Senior Notes of $0.2 million and $0.9 million for the three months ended September 30, 2016 and 2015, respectively, and $0.9 million for each of the nine month periods ended September 30, 2016 and 2015, respectively.

Off-Balance Sheet Arrangements

The Company does not have any off-balance sheet arrangements.

Contractual Obligations

During the nine months ended September 30, 2016, there were no material changes in our commitments or contractual liabilities outside of the ordinary course of business.

Health Care Regulatory and Reimbursement Changes

In the 2014 Final Physician Fee Schedule Rule, CMS calculated the 2014 conversion factor using the SGR method. The new conversion factor for 2014 represented a 20.1% reduction from the 2013 conversion factor. On December 18, 2013, Congress passed legislation that enacted a 0.5% increase in the conversion factor, which was effective through March 31, 2014. On April 1, 2014, President Obama signed the Protecting Access to Medicare Act of 2014 (“PAMA”). PAMA extended the 0.5% increase through March 31, 2015 and made other changes to laboratory reimbursement discussed below.

On April 16, 2015, President Obama signed the Medicare and CHIP Reauthorization Act (“MACRA”). MACRA repealed the provisions related to the Medicare SGR formula and implemented a new physician payment system that is designed to reward the quality of care. In addition, it extended the then-current Medicare Physician Fee Schedule rates through June 2015, and then increased them by 0.5% for the remainder of 2015. Furthermore, the rates are to be increased annually by 0.5%, beginning January 1, 2016 through 2019. For 2020 through 2025, the rates will be frozen, although payments will be adjusted beginning in 2019 to account for performance on certain quality metrics under the Merit-Based Incentive Payment Systems (“MIPS”) or to reflect physician participation in alternative payment models (“APMs”). For 2026 and subsequent years, qualified APM participants receive an annual 0.75% increase on Medicare physician payment rates, while those not participating receive a 0.25% annual payment increase, plus any applicable MIPS-based payment adjustments. In April 2016 CMS issued a proposed rule that would implement the requirements of MACRA. At this time, it is too early to determine how these changes may impact our business.

In the 2014 Physician Fee Schedule Rule, CMS also changed CPT codes for certain stains we commonly use and reduced the RVUs related to those codes. These changes, as well as other limits on other commonly-used CPT codes, resulted in decreased Medicare reimbursement for some of our services. We estimated the changes to the 2014 Physician Fee Schedule resulted in a reduction of our annualized Medicare revenue of approximately $3 million. We have experienced isolated reductions in reimbursement from non-governmental third-party payors tied to the Medicare reductions. However, at this time we are unable to predict the extent to which non-governmental third-party payors will seek to reduce our reimbursement rates as a result of reductions in Medicare’s Physician Fee Schedule.

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In the 2015 Physician Fee Rule, CMS enacted additional payment changes. Although it had indicated previously that it considered flow cytometry, a test that we commonly bill, to be potentially misvalued and overpaid, CMS did not change the payment for that code in the Final Rule. CMS did, however, change how it pays for prostate biopsy codes, which is also a test that we bill relatively often, and stated that it did consider that code to be potentially misvalued. In addition, it made substantial reductions in certain other codes, including the codes applicable to FISH (fluorescent in situ hybridization), which we also bill; however, those cuts were offset by increases in other codes, including CPT 88305, which is the most common code that we bill. Additional changes to these, and other codes that we bill, could also be implemented in the future. CMS also stated that it does not intend to implement the policy that it proposed in the 2014 Proposed Fee Schedule Rule that would have limited certain physician payments to the amounts paid in the hospital setting. Finally, CMS announced that it is withdrawing its authority to amend laboratory rates to reflect technological changes as mandated by PAMA.

On October 30, 2015, CMS issued its Final Physician Fee Schedule Rule for 2016, which adopted new policies that went into effect in January 2016. Our review of the Final Rule suggests that the impact of the changes could be an increase of approximately $2.0 million in our annualized Medicare revenue, inclusive of acquisitions completed in 2014 and 2015. However, our product mix, payor mix and volume may change and the actual impact of the changes to the 2016 Physician Fee Rule may vary significantly from our estimates. This does not reflect any potential change that Congress might make in the future with regard to the conversion factor.

On November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued its 2017 Physician Fee Schedule, which we refer to as the 2017 Fee Schedule.  In the 2017 Fee Schedule, CMS effectuated reductions to CPT Code 88305, which is the CPT Code we bill most frequently, of approximately 7%. Reimbursement rates for flow cytometry codes were also reduced by approximately 19%. Based on our current Medicare business mix, we estimate the changes to the 2017 Fee Schedule would result in a reduction of our annualized Medicare revenue of approximately $3.3 million.

The Budget Control Act of 2011 created a Joint Select Committee on Deficit Reduction, which was tasked with recommending proposals to reduce spending. Under the law, the Joint Committee’s failure to achieve a targeted deficit reduction, or Congress’ failure to pass the Committee’s recommendations without amendment by December 23, 2011, would result in automatic across-the-board cuts to most discretionary programs. Automatic cuts also would be made to Medicare and would result in aggregate reductions in Medicare payments to providers of up to 2% per fiscal year, starting in 2013 and continuing through 2021. Because the Joint Committee was not able to agree on a set of deficit reduction recommendations on which Congress could vote, cuts went into effect in April 2013. This reduction was extended by PAMA through 2024. We have estimated that sequestration has resulted in a decline of approximately $1.1 million in our annual Medicare revenue

Recent Acquisitions

The followingsummarizestheacquisitionswe have completedsinceJanuary1, 2015.

2015 Acquisitions

On July 15, 2015, we acquired the assets of two pathology practices and a billing service, all located in Texas. On October 29, 2015, we acquired 100% of the equity of a pathology practice in Ohio. We paid a combined total of $15.4 million of cash in the aggregate at closing for the two acquisitions and issued contingent notes payable over from three to six years. Payments under the contingent notes will be paid annually, up to a maximum of $11.9 million over the term of the notes, subject to the retention of certain key facility contracts, future financial results and the cash received under specified client contracts. We used the available cash under our $25.0 million delayed draw term loan to pay the $15.4 million cash portion of the purchase price for the acquisitions.

2016 Acquisitions

On March 31, 2016, we acquired 100% of the equity of a hospital-based pathology practice located in Oregon. On April 8, 2016, we acquired 100% of the equity of a second hospital-based pathology practice in Florida. In connection with these 2016 acquisitions, we paid total net cash of $7.2 million and issued contingent notes payable over three years. Payments under the contingent notes will be paid annually, up to a maximum of $1.5 million over the term of the note, subject to the future financial performance of the acquired practice and the retention of a key facility contract. We used the available cash under its $40.0 million delayed draw term loan B to pay the $7.2 million cash portion of the purchase price for the acquisition.

Item 3. Quantitative and Qualitative Disclosures About Market Risk.

Our exposure to market risks results primarily from fluctuations in interest rates. There have been no material changes to our exposure to market risks from those disclosed in our Annual Report on Form 10-K for the fiscal year ended December 31, 2015.

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Item 4. Controls and Procedures.

Evaluation of Disclosure Controls and Procedures

We maintain disclosure controls and procedures (as defined in Rule 13a-15(e) and 15d-15(e) under the Exchange Act) that are designed to ensure that the information required to be disclosed by the Company in the reports that it files or submits under the Exchange Act is recorded, processed, summarized and reported within the time periods specified in the Securities and Exchange Commission’s rules and forms, and that such information is accumulated and communicated to the Company’s management, including its principal executive and principal financial officer, as appropriate to allow timely decisions regarding required disclosure. As of the end of the period covered by this report, the Company’s management carried out an evaluation, under the supervision and with the participation of its principal executive officer and principal financial officer, of the effectiveness of the Company’s disclosure controls and procedures. Based upon that evaluation, the Company’s principal executive officer and principal financial officer concluded that the Company’s disclosure controls and procedures, as defined by Rule 13a-15(e) and Rule 15d-15(e) under the Exchange Act, were effective as of September 30, 2016.

Changes in Internal Control Over Financial Reporting

There have been no changes in our internal control over financial reporting (as defined in Rule 13a-15(f) and 15d-15(f) under the Securities Exchange Act) during the fiscal quarter ended September 30, 2016 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

Inherent Limitations on Effectiveness of Controls

Our disclosure controls and procedures include components of our internal control over financial reporting. Our management, including our principal executive officer and principal financial officer, does not expect that our disclosure controls and procedures or our internal control over financial reporting will necessarily prevent all errors and all fraud. A control system, no matter how well conceived and operated, can provide only reasonable, not absolute, assurance that the objectives of the control system are met. Further, the design of a control system must reflect the fact that there are resource constraints, and the benefits of controls must be considered relative to their costs. Because of the inherent limitations in all control systems, no evaluation of controls can provide absolute assurance that we will detect all control issues and instances of fraud, if any exist.

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PART II

Item 1. Legal Proceedings.

We are from time to time involved in litigation that we consider to be ordinary and incidental to our business. We may be named in various claims, disputes, legal actions and other proceedings involving malpractice, employment and other matters. A negative outcome in certain of the ongoing litigation could harm our business, financial condition, liquidity or results of operations. Further, prolonged litigation, regardless of which party prevails, could be costly, divert management’s attention or result in increased costs of doing business. While the outcome of pending legal actions cannot be predicted with certainty, we believe the outcome of these proceedings will not have a material adverse effect on our consolidated financial position, results of operations or liquidity.

Item 1A. Risk Factors.

In addition to the other information set forth in this report, you should carefully consider the factors discussed in the “Risk Factors” section of our Annual Report on Form 10-K for the fiscal year ended December 31, 2015, which could materially affect our business, financial condition, or results of operations. The risks described in our Annual Report on Form 10-K filed with the Securities and Exchange Commission for the fiscal year ended December 31, 2015 are not the only risks that we face. In addition, risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely affect our business, financial condition, and/or results of operations. There have been no material changes in or additions to the risk factors included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2015.

Item 6. Exhibits.

31.1	Certification of Principal Executive Officer pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934, as amended.*
31.2	Certification of Principal Financial Officer pursuant to Rule 13a-14(a) of the Securities Exchange Act of 1934, as amended.*
32.1	Certification of Principal Executive Officer Pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.**
32.2	Certification of Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.**
101.INS	XBRL Instance Document*
101.SCH	XBRL Taxonomy Extension Schema Document*
101.CAL	XBRL Taxonomy Extension Calculation Linkbase Document*
101.DEF	XBRL Taxonomy Extension Definition Linkbase Document*
101.LAB	XBRL Taxonomy Extension Label Linkbase Document*
101.PRE	XBRL Taxonomy Extension Presentation Linkbase Document*

* Filed herewith

** Furnished herewith

- 39 -

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.

		AURORA DIAGNOSTICS HOLDINGS, LLC
Date: November 10, 2016	By:	/s/ Michael C. Grattendick
		Michael C. Grattendick
		Chief Financial Officer
		(Principal Financial Officer and Duly Authorized Officer)

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EX-31.1

Exhibit 31.1

Certification

I, Daniel D. Crowley, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q for the period ended September 30, 2016 of Aurora Diagnostics Holdings, LLC;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: November 10, 2016	/s/ Daniel D. Crowley
	Daniel D. Crowley President and Chief Executive Officer (Principal Executive Officer)

EX-31.2

Exhibit 31.2

Certification

I, Michael C. Grattendick, certify that:

1. I have reviewed this Quarterly Report on Form 10-Q for the period ended September 30, 2016 of Aurora Diagnostics Holdings, LLC;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: November 10, 2016	/s/ Michael C. Grattendick
	Michael C. Grattendick Chief Financial Officer (Principal Financial Officer)

EX-32.1

Exhibit 32.1

Certification of Principal Executive Officer

Pursuant to 18 U.S.C. Section 1350

(As adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002)

I, Daniel D. Crowley, Chief Executive Officer (Principal Executive Officer) of Aurora Diagnostics Holdings, LLC (the “Registrant”), certify, based upon a review of the Quarterly Report on Form 10-Q for the period ended September 30, 2016 of the Registrant (the “Report”), that:

(1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Registrant.

/s/ Daniel D. Crowley
Name:	Daniel D. Crowley
Title:	Chief Executive Officer (Principal Executive Officer)
Date:	November 10, 2016

EX-32.2

Exhibit 32.2

Certification of Principal Financial Officer

Pursuant to 18 U.S.C. Section 1350

(As adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002)

I, Michael C. Grattendick, Vice President, Controller and Treasurer (Principal Financial Officer) of Aurora Diagnostics Holdings, LLC (the “Registrant”), certify, based upon a review of the Quarterly Report on Form 10-Q for the period ended September 30, 2016 of the Registrant (the “Report”), that:

(1) The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended; and

(2) The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Registrant.

/s/ Michael C. Grattendick
Name:	Michael C. Grattendick
Title:	Chief Financial Officer (Principal Financial Officer)
Date:	November 10, 2016

XML

Document and Entity Information	9 Months Ended
	Sep. 30, 2016 shares
Document And Entity Information [Abstract]
Entity Registrant Name	AURORA DIAGNOSTICS HOLDINGS LLC
Entity Central Index Key	0001367832
Document Type	10-Q
Document Period End Date	Sep. 30, 2016
Amendment Flag	false
Document Fiscal Year Focus	2016
Document Fiscal Period Focus	Q3
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Common Stock, Shares Outstanding	0

XML

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015	Sep. 30, 2015	Dec. 31, 2014
Current Assets
Cash and cash equivalents	$ 12,062	$ 19,085	$ 20,498	$ 26,422
Accounts receivable, net	38,846	32,851
Prepaid expenses and other assets	5,098	4,321
Prepaid income taxes	441	175
Total current assets	56,447	56,432
Property and equipment, net	8,004	8,646
Other Assets:
Deferred debt issue costs, net	358	453
Deferred financing costs, deposits and other noncurrent assets	2,103	596
Goodwill	127,473	125,188		$ 177,774
Intangible assets, net	56,621	65,694
Total other assets	186,555	191,931
Total Assets	251,006	257,009
Current Liabilities
Current portion of long-term debt	3,251	2,147
Current portion of fair value of contingent consideration	5,569	4,820
Accounts payable, accrued expenses and other current liabilities	18,346	16,839
Accrued compensation	8,559	7,030
Accrued interest	8,805	14,228
Total current liabilities	44,530	45,064
Long-term debt, net of current portion	387,283	377,617
Deferred tax liabilities	5,990	6,473
Accrued management fees, related parties	10,780	8,633
Fair value of contingent consideration, net of current portion	6,410	8,320
Other liabilities	2,702	1,685
Members' Deficit	(206,689)	(190,783)
Total Liabilities and Members' Deficit	$ 251,006	$ 257,009

XML

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Income Statement [Abstract]
Net revenue	$ 73,235	$ 69,683	$ 214,776	$ 193,722
Operating costs and expenses:
Cost of services	38,748	36,925	114,370	106,164
Selling, general and administrative expenses	16,855	16,747	53,730	49,495
Provision for doubtful accounts	3,978	4,228	12,107	12,731
Intangible asset amortization expense	4,964	4,807	14,933	14,168
Management fees, related parties	733	697	2,148	1,914
Impairment of goodwill				39,641	$ 56,725
Merger and acquisition transaction costs	762	297	1,338	694
Change in fair value of contingent consideration	166	180	1,146	686
Total operating costs and expenses	66,206	63,881	199,772	225,493
Income (loss) from operations	7,029	5,802	15,004	(31,771)
Other income (expense):
Interest expense	(10,544)	(10,490)	(31,494)	(30,434)
Other income	(5)	(2)		4
Total other expense, net	(10,549)	(10,492)	(31,494)	(30,430)
Loss before income taxes	(3,520)	(4,690)	(16,490)	(62,201)
Provision (benefit) for income taxes	550	10	(473)	(812)
Net (loss) income	$ (4,070)	$ (4,700)	$ (16,017)	$ (61,389)

XML

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015
Cash Flows From Operating Activities
Net loss	$ (16,017)	$ (61,389)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	17,792	17,371
Amortization of deferred debt issue costs	1,584	1,542
Amortization of original issue discount on debt	841	818
Deferred income taxes	(483)	(1,553)
Equity compensation costs	111	193
Change in fair value of contingent consideration	1,146	686
Impairment of goodwill		39,641
Loss on abandonment of lease	1,171
(Increase) decrease in:
Accounts receivable	(5,171)	(1,724)
Prepaid expenses and other assets	(978)	(1,449)
Increase (decrease) in:
Accounts payable, accrued expenses and other current liabilities	1,659	2,440
Accrued compensation	1,220	1,428
Accrued interest	(5,423)	(4,755)
Net cash used in operating activities	(2,548)	(6,751)
Cash Flows From Investing Activities
Purchases of property and equipment	(1,991)	(1,093)
Increase in deposits and other noncurrent assets	(6)	(40)
Payment of contingent notes	(3,407)	(2,296)
Businesses acquired, net of cash acquired	(7,250)	(8,813)
Net cash used in investing activities	(12,654)	(12,242)
Cash Flows From Financing Activities
Payments of capital lease obligations	(60)	(59)
Repayments under term loan facility	(1,500)	(500)
Borrowings under term loan facility	10,000	15,070
Payments of subordinated notes payable		(500)
Payment of financing transaction costs	(261)	(942)
Net cash provided by financing activities	8,179	13,069
Net decrease in cash and cash equivalents	(7,023)	(5,924)
Cash and cash equivalents, beginning of period	19,085	26,422
Cash and cash equivalents, end of period	12,062	20,498
Supplemental Disclosures of Cash Flow Information
Cash interest payments	34,494	32,884
Cash tax payments	384	918
Supplemental Schedule of Noncash Investing and Financing Activities
Fair value of contingent consideration issued in acquisitions	1,100	5,110
Capital assets recorded under non-cash transactions	$ 355	$ 503

XML

Nature of Business and Significant Accounting Policies

9 Months Ended

Sep. 30, 2016

Accounting Policies [Abstract]

Nature of Business and Significant Accounting Policies

Note 1. Nature of Business and Significant Accounting Policies

Nature of Business

Aurora Diagnostics Holdings, LLC (together with its subsidiaries, the “Company”) was organized in the State of Delaware as a limited liability company on June 2, 2006 to operate as a diagnostic services company. The Company providesintegrated diagnosticconsultations,informationservicesand personalizedmedicineservicestailoredto thepatientsof its referringphysicians,hospitalsand hospitalsystems.The Company also provides research services to pharmaceutical companies and other research entities. The Company’s operations consist of one reportable segment.

The Company operates in a highly regulated industry. The manner in which licensed physicians can organize to perform and bill for medical services is governed by state laws and regulations. Businesses like the Company often are not permitted to employ physicians or to own corporations that employ physicians or to otherwise exercise control over the medical judgments or decisions of physicians.

In states where the Company is not permitted to directly own a medical services provider or for other commercial reasons, it performs only non-medical administrative and support services, does not represent to the public or its clients that it offers medical services and does not exercise influence or control over the practice of medicine. In those states, the Company conducts business through entities that it controls, and it is these affiliated entities that employ the physicians who practice medicine. In such states, the Company generally enters into a contract that restricts the owners of the affiliated entity from transferring their ownership interests in the affiliated entity and otherwise provides the Company or its designee with a controlling voting or financial interest in the affiliated entity and its laboratory operations. This controlling financial interest generally is obtained pursuant to a long-term management services agreement between the Company and the affiliated entity. Under the management services agreement, the Company exclusively manages all aspects of the operation other than the provision of medical services. Generally, the affiliated entity has no operating assets because the Company acquired all of its operating assets at the time it acquired the related laboratory operations. In accordance with the relevant accounting guidance, these affiliated entities are included in the condensed consolidated financial statements of Aurora Diagnostics Holdings, LLC.

The accompanying condensed consolidated balance sheet as of December 31, 2015, which was derived from the audited consolidated financial statements as of December 31, 2015 of Aurora Diagnostics Holdings, LLC, and the accompanying unaudited condensed consolidated financial statements as of and for the three and nine months ended September 30, 2016 and 2015 have been prepared by the Company in accordance with accounting principles generally accepted in the United States of America for interim financial reporting. Accordingly, they do not include all of the information and related footnotes that would normally be required by accounting principles generally accepted in the United States of America for complete financial reporting. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements for the year ended December 31, 2015.

The accompanying unaudited condensed consolidated financial statements include all adjustments (consisting of a normal and recurring nature) that management considers necessary for a fair statement of financial information for the interim periods. Interim results are not necessarily indicative of the results that may be expected for the remainder of the year ending December 31, 2016.

Working Capital

The Company requires significant cash flow to service its debt obligations. Reductions in reimbursement from Medicare and other payors in recent years have had a significant negative impact on the Company’s cash flows. As of September 30, 2016, the Company had $30.0 million available under its revolving credit facility for general operations. The Company may not achieve all of its business goals and objectives and events beyond its control could affect its ability to meet financial tests and ratios under the Company’s credit facility and limit its ability to access the amounts otherwise available under its revolving credit facility.

Revenue Recognition and Accounts Receivable

The Company recognizes revenue at the time services are performed. Unbilled receivables are recorded for services rendered during, but billed subsequent to, the reporting period. Revenue is reported at the estimated realizable amounts from patients, third-party payors and others for services rendered. Revenue under certain third-party payor agreements is subject to audit and retroactive adjustments. Provisions for estimated third-party payor settlements and adjustments are estimated in the period the related services are rendered and adjusted in future periods as final settlements are determined. The provision for doubtful accounts and the related allowance are adjusted periodically based upon an evaluation of historical collection experience with specific payors for particular services, anticipated collection levels with specific payors for new services, industry reimbursement trends, and other relevant factors. Changes in these factors in future periods could result in increases or decreases in the Company’s provision for doubtful accounts and impact its results of operations, financial position and cash flows.

Recent Accounting Standards Updates

In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (“ASU”) 2014-09, “Revenue from Contracts with Customers (Topic 606),” which will replace numerous requirements in U.S. GAAP and provide companies with a single revenue recognition model for recognizing revenue from contracts with customers. The core principle of the new standard is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. ASU 2014-09 will be effective for interim and annual reporting periods beginning after December 15, 2017. The two permitted transition methods under the new standard are the full retrospective method, in which case the standard would be applied to each prior reporting period presented, or the modified retrospective method, in which case the cumulative effect of applying the standard would be recognized at the date of initial application. The Company has not yet selected a transition method under ASU 2014-09.

In March 2016, the FASB issued ASU No. 2016-08, “Principal versus Agent Considerations (Reporting Revenue Gross versus Net).” The amendments in ASU 2016-08 affect ASU 2014-09 and are related to the principal versus agent considerations implementation guidance in ASU 2014-09. In April 2016, the FASB issued ASU No. 2016-10, “Identifying Performance Obligations and Licensing.” The amendments in ASU 2016-10 clarify the following two aspects in ASU 2014-09: identifying performance obligations and the licensing implementation guidance, while retaining the related principles for those areas. In May 2016, the FASB issued ASU No. 2016-11, “Rescission of SEC Guidance Because of Accounting Standards Updates 2014-09 and 2014-16 Pursuant to Staff Announcements at the March 3, 2016 EITF Meeting.” The amendments in ASU 2016-11 rescinded certain SEC Staff Observer comments that are codified, effective upon the adoption of ASU 2014-09. In May 2016, the FASB issued ASU No. 2016-12, “Narrow-Scope Improvements and Practical Expedients.” The amendments in ASU 2016-12 address certain issues identified in ASU 2014-09 in the guidance on assessing collectability, presentation of sales taxes, non-cash consideration, and completed contracts and contract modifications at transition. These ASU’s are effective concurrently with the adoption of ASU 2014-09. The Company is evaluating the impact of the adoption of these updates on its consolidated financial statements and related disclosures.

In August 2014, the FASB issued ASU 2014-15, “Presentation of Financial Statements—Going Concern (Subtopic 205-40): Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern.”  Under the new guidance, management will be required to assess an entity’s ability to continue as a going concern, and to provide related footnote disclosures in certain circumstances. The provisions of this ASU are effective for annual periods ending after December 15, 2016 and interim periods beginning after December 15, 2016.  The adoption of ASU 2014-15 is not expected to have a material effect on the Company’s financial position, results of operations or cash flows and the Company is evaluating the impact of the adoption on our related disclosures.

In April 2015, the FASB issued ASU 2015-03, “Interest—Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs.”  The amendments in this update require that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. The recognition and measurement guidance for debt issuance costs are not affected by the amendments in this standards update.  The new guidance is effective for annual reporting periods beginning after December 15, 2015, including interim periods within that reporting period. An entity should apply the guidance either retrospectively to each prior reporting period presented or retrospectively with the cumulative adjustment at the date of the initial application. In connection with the Company’s adoption of ASU 2015-03, the deferred debt issue costs related to the issuance of the Company’s Senior Notes, as further described in Note 6, and term loans were reclassified to long-term debt.  The net unamortized deferred debt issue costs reflected in long-term debt were approximately $4.1 million and $5.6 million as of September 30, 2016 and December 31, 2015, respectively. Deferred debt issue costs related to the Company’s revolving credit facility continue to be reflected as non-current assets in the Company’s condensed consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02, “Leases” (topic 842). The FASB issued this update to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. The updated guidance is effective for annual periods beginning after December 15, 2018, including interim periods within those fiscal years. Early adoption of the update is permitted. The Company is evaluating the impact of the adoption of this update on its consolidated financial statements and related disclosures.

In March 2016, the FASB issued ASU 2016-09, “Improvements to Employee Share-Based Payment Accounting,” which amends Accounting Standards Codification Topic 718, Compensation – Stock Compensation.  ASU 2016-09 simplifies several aspects of the accounting for share-based payment transactions, including the income tax consequences, classification of awards as either equity or liabilities, and classification on the statement of cash flows. ASU 2016-09 is effective for the Company’s fiscal years beginning after December 15, 2016, and interim periods within those fiscal years and early adoption is permitted. The Company is evaluating the impact of the adoption of this update on its consolidated financial statements and related disclosures.

In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments”. ASU 2016-13 introduces a new forward-looking approach, based on expected losses, to estimate credit losses on certain types of financial instruments, including trade receivables and held-to-maturity debt securities, which will require entities to incorporate considerations of historical information, current information and reasonable and supportable forecasts. This ASU also expands disclosure requirements. ASU 2016-13 is effective for the Company beginning the first quarter of 2020 with early adoption permitted. The guidance will be applied using the modified-retrospective approach. The Company is currently evaluating the impact of adoption of ASU 2016-13 on its consolidated financial statements and related disclosures.

In August 2016, the FASB issued ASU No. 2016-15, “Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments,” which clarifies how certain cash receipts and cash payments are presented and classified in the statement of cash flows. ASU No. 2016-15 is effective for the Company in the first quarter of 2018 with early adoption permitted and must be applied retrospectively to all periods presented. The Company is currently evaluating the impact of adoption of ASU 2016-13 on the presentation and classification of the Company’s statements of cash flows.

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Acquisitions

9 Months Ended

Sep. 30, 2016

Business Combinations [Abstract]

Acquisitions

Note 2. Acquisitions

The Company has made strategic acquisitions of local laboratories to achieve greater economies of scale and expand or augment its geographic presence.

2015 Acquisitions

On July 15, 2015, the Company acquired the assets of two pathology practices and a billing service, all located in Texas. On October 29, 2015, the Company acquired 100% of the equity of a pathology practice in Ohio. The Company paid a combined total of $15.4 million of cash in the aggregate at closing for the two acquisitions and issued contingent notes payable over from three to six years. Payments under the contingent notes will be paid annually, up to a maximum of $11.9 million over the term of the notes, subject to the retention of certain key facility contracts, future financial results and the cash received under specified client contracts. The Company used cash available under its $25.0 million delayed draw term loan to pay the $15.4 million cash portion of the purchase price for the acquisitions.

2016 Acquisitions

On March 31, 2016, the Company acquired 100% of the equity of a hospital-based pathology practice located in Oregon. On April 8, 2016, the Company acquired 100% of the equity of a second hospital-based pathology practice in Florida. In connection with these 2016 acquisitions, the Company paid total net cash of $7.2 million and issued contingent notes payable over three years. Payments under the contingent notes will be paid annually, up to a maximum of $1.5 million over the term of the notes, subject to the future financial performance of the acquired practice and the retention of a key facility contract. The Company used cash available under its $40.0 million delayed draw term loan B to pay the $7.2 million cash portion of the purchase price for the acquisition.

The following table summarizes the preliminary estimated aggregate fair value of the assets acquired and liabilities assumed in connection with the 2016 acquisitions (in thousands):

Cash	$	602
Accounts receivable		849
Other assets		65
Intangible assets		5,860
Goodwill		2,140
Assets acquired		9,516
Accounts payable and accrued expenses		282
Accrued compensation		282
Liabilities assumed		564
Net assets acquired	$	8,952
Net assets acquired	$	8,952
Less:
Fair value of contingent consideration issued		(1,100	)
Cash acquired		(602	)
Net cash paid for acquisitions, net of cash acquired	$	7,250

Intangible assets acquired as the result of a business combination are recognized at fair value as an asset apart from goodwill if the asset arises from contractual or other legal rights or if it is separable. The Company’s intangible assets, which principally consist of the fair value of customer relationships, health care facility agreements and key physician agreements acquired in connection with the acquisition of diagnostic companies, are capitalized and amortized on the straight-line method over their useful life, which generally ranges from 3 to 15 years.  The Company’s preliminary estimate is that approximately $2.1 million of goodwill recognized in the 2016 acquisitions will be deductible over 15 years for federal income tax purposes.

Pro-forma information (unaudited)

The accompanying historical condensed consolidated financial statements include the results of operations of the 2015 and 2016 acquisitions from the date acquired through September 30, 2016. The 2015 and 2016 acquisitions contributed $7.2 million and $19.5 million of revenue for the three months and nine months ended September 30, 2016, respectively, and $1.4 million and $3.5 million of net income for the three months and nine months ended September 30, 2016. The July 15, 2015 acquisitions contributed revenue of $2.9 million and net income of $0.6 million for both of the three months and nine months ended September 30, 2015.  

The following unaudited pro forma information presents the consolidated results of the Company’s operations and the results of the 2015 and 2016 acquisitions for the three and nine months ended September 30, 2016 and 2015, after giving effect to amortization, depreciation, income tax, and the reduced level of certain specific operating expenses (primarily compensation and related expenses attributable to former owners) as if the 2015 acquisitions had been consummated on January 1, 2014 and the 2016 acquisitions had been consummated on January 1, 2015. Such unaudited pro forma information is based on historical unaudited financial information with respect to the 2015 and 2016 acquisitions and does not include operational or other changes which might have been effected by the Company. The unaudited pro forma information for the three and nine months ended September 30, 2016 and 2015 presented below is for illustrative purposes only and is not necessarily indicative of results which would have been achieved or results which may be achieved in the future (in thousands):

	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2016			2015			2016			2015
Net revenue	$	73,235		$	74,002		$	216,743		$	211,862
Net loss	$	(4,070	)	$	(3,989	)	$	(15,618	)	$	(58,531	)

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Accounts Receivable

9 Months Ended

Sep. 30, 2016

Receivables [Abstract]

Accounts Receivable

Note 3. Accounts Receivable

Accounts receivable consist of the following as of September 30, 2016 and December 31, 2015 (in thousands):

	September 30,			December 31,
	2016			2015
Accounts Receivable	$	55,874		$	49,142
Less: Allowance for doubtful accounts		(17,028	)		(16,291	)
Accounts receivable, net	$	38,846		$	32,851

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Goodwill and Intangible Assets

9 Months Ended

Sep. 30, 2016

Goodwill And Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

Note 4. Goodwill and Intangible Assets

The following table presents adjustments to goodwill during the nine months ended September 30, 2016 and the year ended December 31, 2015 (in thousands):

	September 30,		December 31,
	2016		2015
Goodwill, beginning of period	$	125,188	$	177,774
Acquisitions		2,285		4,139
Goodwill impairment		—		(56,725	)
Goodwill, end of period	$	127,473	$	125,188

The Company’s balances for intangible assets as of September 30, 2016 and December 31, 2015 and the related accumulated amortization are set forth in the table below (in thousands):

		Weighted Average	September 30, 2016
	Range	Amortization			Accumulated
	(Years)	Period (Years)	Cost		Amortization			Net
Amortizing intangible assets:
Customer relationships	7 – 10	8	$	130,748	$	(111,506	)	$	19,242
Health care facility agreements	15	15		48,970		(12,897	)		36,073
Noncompete agreements	3 – 5	4		6,199		(4,893	)		1,306
Total intangible assets			$	185,917	$	(129,296	)	$	56,621
		Weighted Average	December 31, 2015
	Range	Amortization			Accumulated
	(Years)	Period (Years)	Cost		Amortization			Net
Amortizing intangible assets:
Customer relationships	7 – 10	8	$	130,748	$	(99,516	)	$	31,232
Health care facility agreements	15	15		43,580		(10,303	)		33,277
Noncompete agreements	3 – 5	4		5,729		(4,544	)		1,185
Total intangible assets			$	180,057	$	(114,363	)	$	65,694

The Company recorded amortization expense related to its intangible assets of $5.0 million and $4.8 million for the three months ended September 30, 2016 and 2015, respectively, and $14.9 million and $14.2 million for the nine months ended September 30, 2016 and 2015, respectively. As of September 30, 2016, estimated future amortization expense is as follows (in thousands):

Year Ending December 31,
Remainder of 2016	$	4,767
2017		14,081
2018		6,676
2019		4,848
2020		4,727
Thereafter		21,522
	$	56,621

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Accounts Payable, Accrued Expenses and Other Current Liabilities

9 Months Ended

Sep. 30, 2016

Payables And Accruals [Abstract]

Accounts Payable, Accrued Expenses and Other Current Liabilities

Note 5. Accounts Payable, Accrued Expenses and Other Current Liabilities

Accounts payable, accrued expenses and other current liabilities as of September 30, 2016 and December 31, 2015 consist of the following (in thousands):

	September 30,		December 31,
	2016		2015
Accounts payable and accrued payables	$	11,930	$	11,513
Reserve for future medical claims		1,997		2,200
Other accrued expenses		4,419		3,126
	$	18,346	$	16,839

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Long-Term Debt

9 Months Ended

Sep. 30, 2016

Long Term Debt [Abstract]

Long-Term Debt

Note 6. Long-Term Debt  

On December 20, 2010, the Company issued $200.0 million in unsecured senior notes that mature on January 15, 2018, which are referred to as the Senior Notes. The Senior Notes bear interest at an annual rate of 10.75%, which is payable each January 15 and July 15. In accordance with the Senior Notes indenture, the Company is subject to certain limitations on issuing additional debt and is required to submit quarterly and annual financial reports. The Senior Notes are currently redeemable at the Company’s option at 102.688% of par, plus accrued interest. The redemption price decreases to 100% of par on January 15, 2017. The Senior Notes rank equally in right of repayment with all of the Company’s other senior indebtedness, but are subordinated to the Company’s secured indebtedness to the extent of the value of the assets securing that indebtedness.

On July 31, 2014, the Company entered into a $220.0 million senior secured credit facility with Cerberus Business Finance, LLC. The credit facility consists of a $165.0 million initial term loan, $30.0 million revolving credit line and $25.0 million delayed draw term loan. Prior to the amendments discussed below, the delayed draw term loan facility was available through July 31, 2015 to pay the consideration for acquisitions, as permitted under the credit facility, including acquisition related fees and expenses. The Company used $145.6 million of the $165.0 million proceeds to retire a previous revolving credit facility due May 2015 and term loan facility due May 2016, including accrued interest and fees.  

Each of the term loan, revolving credit line and delayed draw term loan under the credit facility has a maturity of five years but is subject to a maturity date of October 14, 2017 if the Senior Notes are not refinanced or their maturity is not extended prior to such date. Under the outstanding term loans, quarterly principal repayments of $0.5 million became due commencing September 30, 2015 and continuing through December 31, 2016. Quarterly principal repayments increase to $0.9 million on March 31, 2017 through June 30, 2018 and to $1.3 million on September 30, 2018 and each quarter end thereafter, with the balance due at maturity. As of September 30, 2016, the balance outstanding under the initial term loan was $162.5 million and the balance outstanding under the delayed draw term loans was $35.0 million. As of September 30, 2016, no amounts were outstanding and the Company had $30.0 million available under its revolving credit facility.  

The proceeds under the credit facility were reduced by discounts of $5.1 million. Additionally, the Company used $3.9 million of the proceeds to pay issuance costs in connection with the credit facility. The remaining $10.4 million balance of the proceeds under the credit facility initial term loan and the funds available under the $30.0 million revolving credit line were intended to be used to execute future acquisitions and for the Company’s general working capital and operational needs.  

Prior to the second amendment executed on April 10, 2015 discussed below, at the Company’s option, interest under the credit facility was at LIBOR, with a 1.25% floor, plus 7%, or at a base rate, with a 2.25% floor, plus 6%.

On April 10, 2015, the Company entered into a second amendment to the credit facility. The second amendment to the credit facility added a $40 million delayed draw term loan B facility which was available through April 10, 2016, which was subsequently extended to April 25, 2016 pursuant to a fifth amendment to the credit facility, to pay consideration for acquisitions, as permitted under the credit facility, including acquisition related fees and expenses.  The Company borrowed $10.0 million in March 2016 and the $30.0 million of unused availability under the delayed draw term loan B facility expired on April 25, 2016. The second amendment also increased the interest rate under the credit facility to LIBOR, with a 1.25% floor, plus 7.125%, or to the base rate, with a 2.25% floor, plus 6.125%. The senior secured credit facility is subject to a 2.25% per annum fee on the undrawn amount thereof, payable quarterly in arrears.

In connection with the acquisitions consummated by the Company on July 15, 2015, the Company borrowed the remaining $15.3 million available under the delayed draw term loan. The amount borrowed exceeded the total paid by the Company for eligible acquisitions, inclusive of related expenses, by $5.4 million. The Company entered into third and fourth amendments to its credit facility that extended the period in which the Company was able to use the remaining $5.4 million availability under the $25.0 million delayed draw term loan from July 31, 2015, to October 31, 2015. The Company used the remaining $5.4 million for an acquisition completed on October 29, 2015.

The credit facility is secured by essentially all of the Company’s assets and unconditionally guaranteed by the Company and certain of the Company’s existing and subsequently acquired or organized domestic subsidiaries and is subject to certain financial covenants.The credit facility requires the Company to maintain certain levels of liquidity and comply on a quarterly basis with certain financial covenants, including a leverage ratio calculation, which generally becomes more restrictive over time, and an interest coverage ratio. Also, on an annual basis the Company must not exceed a specified maximum amount of consolidated capital expenditures. In addition, the credit facility includes negative covenants restricting or limiting the Company’s ability to, among other things, incur, assume or permit to exist additional indebtedness or guarantees; incur liens and engage in sale leaseback transactions; make loans and investments; declare dividends, make payments or redeem or repurchase capital stock; engage in mergers, acquisitions and other business combinations; prepay, redeem or purchase certain indebtedness; amend or otherwise alter terms of its indebtedness; sell assets; enter into transactions with affiliates and alter the business it conducts without prior approval of the lenders.

Long-term debt consists of the following as of September 30, 2016 and December 31, 2015 (in thousands):

	September 30,			December 31,
	2016			2015
Senior Notes	$	200,000		$	200,000
Initial term loan		162,500			164,000
Delayed draw term loans		35,000			25,000
Notes payable		133			133
Capital lease obligations		69			129
		397,702			389,262
Less:
Original issue discount, net		(3,036	)		(3,877	)
Debt issuance costs, net		(4,132	)		(5,621	)
Current portion		(3,251	)		(2,147	)
Long-term debt, net of current portion	$	387,283		$	377,617

As of September 30, 2016, estimated future debt principal payments are as follows (in thousands):

Year Ending December 31,
Remainder of 2016	$	589
2017		3,608
2018		204,255
2019 *		189,250
	$	397,702

* The estimated future debt principal payments in 2019 reflect the five-year maturity of the Company’s credit facility, which is subject to an earlier maturity date of October 14, 2017 if the Company’s Senior Notes are not refinanced or their maturity is not extended prior to October 14, 2017.

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Contingent Consideration

9 Months Ended

Sep. 30, 2016

Fair Value Disclosures [Abstract]

Contingent Consideration

Note 7. Contingent Consideration

In connection with certain of its acquisitions, the Company agreed to pay additional consideration in future periods based upon the attainment of stipulated levels of operating results by each of the acquired entities, as defined in their respective agreements. The Company records liabilities for contingent consideration issued in acquisitions at fair value as of the acquisition date. Payments under contingent notes issued in acquisitions are reflected in the change in fair value of contingent consideration.

As described in Note 2, in connection with the 2015 and 2016 acquisitions the Company issued contingent notes payable annually over three to six years, up to a maximum of $13.4 million, subject to the future financial performance of the acquired practices and the retention of a key facility contracts. The aggregate fair value of the contingent notes issued was estimated at $8.0 million as of the acquisition dates.

During the three and nine months ended September 30, 2016, the Company made payments under contingent notes of $1.6 million and $3.4 million, respectively. During the three and nine months ended September 30, 2015, the Company made payments under contingent notes of $1.0 million and $2.3 million, respectively. The total fair value of the contingent consideration reflected in the accompanying condensed consolidated balance sheets as of September 30, 2016 and December 31, 2015 is $12.0 million and $13.1 million, respectively.

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Related Party Transactions

9 Months Ended

Sep. 30, 2016

Related Party Transactions [Abstract]

Related Party Transactions

Note 8. Related Party Transactions

Acquisition Target Consulting Agreement

The Company has a professional services agreement with an entity owned by two of the Company’s members. Under this agreement, the entity provides certain acquisition target identification consulting services to the Company. In exchange for these services the Company pays to the entity a monthly retainer of $12,000, plus reimbursable expenses. The entity also earns a success fee of $65,000 for each identified acquisition consummated by the Company. The entity also will be paid a fee of 8% of revenue for certain new business development efforts as outlined in the professional services agreement.

During the three and nine months ended September 30, 2016, the Company paid the entity $38,000 and $0.2 million during the three and nine months ended September 30, 2016, respectively, and $0.1 million and $0.2 million during the three and nine months ended September 30, 2015, respectively.

As of September 30, 2016, the Company owed to the entity $15,000, and no balance was owed to the entity as of December 31, 2015, under this arrangement.  

Management and Financial Advisory Agreement

On June 2, 2006, the Company, through its wholly-owned subsidiary, and two members of the Company entered into a management services agreement. On June 12, 2009, the management agreement was amended to substitute a new member for one of the original members. The agreement calls for the members and their affiliates to provide certain financial and management advisory services in connection with the general business planning and forecasting and acquisition and divestiture strategies of the Company. In exchange for the services, the Company is required to pay fees equal to 1.0% of revenues plus expenses to the members.

In connection with an amendment to the Company’s previous credit facility in April 2013, the Company agreed to not make any payments of management or similar fees until payment in full of all loans under the credit facility, provided that such management fees continue to accrue. Management fees to the Company’s members up to 1% of net revenue are permitted under the current credit facility but may not be paid until payment in full of all loans thereunder and the Company continues to accrue management fees. The Company expects to not pay management fees through September 30, 2017. As of September 30, 2016 and December 31, 2015, $10.8 million and $8.6 million, respectively, of these management fees are reflected in long-term liabilities in the accompanying condensed consolidated balance sheets. The condensed consolidated statements of operations include management fees of$0.7 million for each of the three month periods ended September 30, 2016 and 2015, respectively, and $2.1 million and $1.9 million for the nine months ended September 30, 2016 and 2015, respectively. The Company paid no management fees under the management services agreement during the three and six month periods ended September 30, 2016 and 2015.  

Facilities Lease Agreements

The Company leases certain of its facilities from entities owned by physician employees or affiliated physicians who are also former owners of the acquired practices. The Company currently leases six of its facilities from affiliated physicians or entities. One of these six leases is on a month to month basis and the others terminate in April 2017, January 2018, December 2019, October 2020 and June 2022. In aggregate, the six leases provide for monthly aggregate base payments of approximately $90,000. Rent paid to the related entities was $0.3 million for each of the three month periods ended September 30, 2016 and 2015, and $0.8 million and $0.7 million for the nine months ended September 30, 2016 and 2015, respectively.

Management and Financial Consultancy Services Agreement

On March 12, 2013, Daniel D. Crowley was appointed as the Chief Executive Officer and President of the Company. In connection with the appointment of Mr. Crowley, the Company entered into an agreement with Dynamic Healthcare Solutions (“DHS”), of which Mr. Crowley is the founder, sole owner and a principal. Pursuant to the agreement, the Company pays DHS a monthly fee of $100,000, plus reasonable out of pocket expenses and hourly fees for DHS staff (other than Mr. Crowley) that provide services under the agreement. The agreement may be terminated by the board of managers of the Company with thirty days notice with or without cause and without the payment of termination fees. In addition, the agreement requires the Company to pay DHS a success fee in the event that a change of control of the Company occurs at any time during the term of the agreement or the one-year period following the termination of the agreement. The amount of the success fee would be based on the aggregate transaction value received by the Company at the time of the change of control event. Other than the agreement with DHS, Mr. Crowley does not receive any direct or indirect compensation or benefits from the Company. The Company paid $0.6 million and $0.8 million to DHS during the three months ended September 30, 2016 and 2015, respectively, and $1.6 million and $2.4 million during the nine months ended September 30, 2016 and 2015, respectively. A retainer of $0.2 million is included in deposits and other non-current assets as of September 30, 2016 and December 31, 2015.

Healthcare Administration Services

Effective December 1, 2013 the Company entered into an agreement with HealthSmart Benefit Solutions, Inc. (“HBS”), of which Mr. Crowley served as the Executive Chairman and President through July 2014. Mr. Crowley has not been affiliated with HBS since that time Pursuant to the agreement, the Company paid fees to HBS of approximately $20,000 per month to process claims under its self-insured health benefits plan and to perform other health plan related services. Premiums for the Company’s stop loss coverage were collected by HBS and remitted to the coverage provider. Effective June 1, 2015, the Company transitioned the administration of its health plan benefits to another provider, however HBS continued to process claims through May 31, 2016, for dates of service prior to June 1, 2015. The Company paid, inclusive of the stop loss premiums, to HBS $14,000, during the three months ended September 30, 2015, and $27,000 and $1.2 million during the nine months ended September 30, 2016 and 2015, respectively.  The Company made no payments to HBS during the three months ended September 30, 2016.  No balance was owed by the Company to HBS as of September 30, 2016 and December 31, 2015.  

Acquisition Consulting Services

The Company has engaged Crowley Corporate Legal Strategy (“CCLS”), on an as needed basis, to provide legal services. Matt Crowley is a principal of CCLS and son of Daniel D. Crowley, the Company’s Chief Executive Officer. The Company paid to CCLS $16,000 and $45,000, during the three months ended September 30, 2016 and 2015, respectively, and $59,000 and $91,000 for the nine months ended September 30, 2016 and 2015, respectively.

Executive Consulting Agreement

The Company had a consulting agreement through February 2016 with Mr. James New, a current Board member and an owner of the Company’s limited liability company units and former CEO of the Company. Pursuant to the consulting agreement, Mr. New provided consulting services as requested by the Company for a fee of $12,500 per month.  Inclusive of travel reimbursement for Board meetings, the Company paid to Mr. New $2,000 and $28,000 during the three months ended September 30, 2016 and 2015, respectively, and $29,000 and $108,000 during the nine months ended September 30, 2016 and 2015, respectively. No amounts were owed by the Company to Mr. New as of September 30, 2016 or December 31, 2015.

Broker of Record

OmegaComp acted as broker of record to the Company with respect to health coverage in 2015. Daniel D. Crowley is Executive Chairman and majority owner of OmegaComp. OmegaComp received commissions from carriers of $77,000 and $26,000, during the three months ended September 30, 2016 and 2015, respectively, and $226,000 and $118,000, during the nine months ended September 30, 2016 and 2015, respectively, which amounts were included in premiums paid by the Company for insurances, benefits and services OmegaComp arranged on the Company’s behalf.

Chief Medical Officer

On October 29, 2015, prior to his appointment as the Company’s Chief Medical Officer, the Company issued a non-negotiable unsecured subordinated contingent note to Dr. F. Michael Walsh in connection with the acquisition of the pathology practice he owned. Pursuant to the contingent note, the Company agreed to pay to Dr. Walsh up to a maximum amount of $2.7 million if the acquired pathology practice met certain financial measures within certain periods of time. On June 13, 2016, the contingent note was amended to reduce the maximum amount payable thereunder to $2.4 million, and on June 15, 2016, the Company made a first payment of $650,000 under the note.

Client Interface Services

One of the Company’s members holds a minority ownership interest in an entity that the Company has engaged, from time to time, to provide client interface services.  The Company paid the entity $22,000 and $0.2 million during the three and nine months ended September 30, 2016, respectively, and $17,000 and $0.1 million during the three and nine months ended September 30, 2015, respectively. As of September 30, 2016, the Company owed to the entity $16,000, and no balance was owed to the entity as of December 31, 2015 for these services.

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Equity-Based Compensation

9 Months Ended

Sep. 30, 2016

Share Based Compensation [Abstract]

Equity-Based Compensation

Note 9. Equity-Based Compensation

On July 6, 2011, the Company adopted the Aurora Diagnostics Holdings, LLC 2011 Equity Incentive Plan for the grant of options to purchase units of Aurora Diagnostics Holdings, LLC to employees, officers, managers, consultants and advisors of the Company and its affiliates. As of September 30, 2016, the Company has authorized the grant of up to 1,931,129 options and reserved the equivalent number of units for issuance upon the future exercise of awards pursuant to the plan. As of September 30, 2016, 1,510,500 options were outstanding and an additional 420,629 options were available for grant. Out of the total 1,510,500 options outstanding as of September 30, 2016, 974,725 were vested and 535,775 were unvested.

No options were granted or exercised and 34,500 options were forfeited during the nine months ended September 30, 2016. Selling, general and administrative expenses included equity compensation expense of $28,000 and $55,000 for the three months ended September 30, 2016 and 2015, respectively, and $0.1 million and $0.2 million for the nine months ended September 30, 2016 and 2015, respectively. As of September 30, 2016, the total remaining unamortized equity compensation cost was approximately $0.1 million.

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Commitments and Contingencies

9 Months Ended

Sep. 30, 2016

Commitments And Contingencies Disclosure [Abstract]

Commitments and Contingencies

Note 10. Commitments and Contingencies

During the ordinary course of business, the Company has become and may in the future become subject to pending and threatened legal actions and proceedings. The Company may have liability with respect to its employees and its pathologists. Medical malpractice claims are generally covered by insurance. While the Company believes the outcome of any such pending legal actions and proceedings, individually or in the aggregate, will not have a material adverse effect on the Company’s financial condition, results of operations or liquidity, if the Company is ultimately found liable under any medical malpractice claims, there can be no assurance the Company’s medical malpractice insurance coverage will be adequate to cover any such liability. The Company had accrued approximately $2.0 million and $2.2 million as of September 30, 2016 and December 31, 2015, respectively, for future medical malpractice claims.  

The Company may also, from time to time, be involved with legal actions related to the acquisition of and affiliation with physician practices, the prior conduct of such practices, or the employment (and restriction on competition) of its physicians. There can be no assurance any costs or liabilities for which the Company becomes responsible in connection with such claims or actions will not be material or will not exceed the limitations of any applicable indemnification provisions or the financial resources of the indemnifying parties. Certain sellers have asserted the Company owes an aggregate of $2.7 million in connection with a contingent note issued in an acquisition. The Company has asserted the sellers owe the Company a repayment of $2.8 million. The Company’s management believes its calculations are correct, but at this time cannot estimate what additional amount will ultimately be paid or recovered, if any, in connection with these contingent notes.

In January 2016, the Company vacated two of its leased facilities.  The Company has not reached a settlement with the landlord of one of the leased facilities and recorded a non-cash charge of approximately $1.1 million in the first quarter of 2016 for the abandoned leasehold improvements and to accrue the present value of the future lease payments stipulated under the lease agreement.

In August 2015, the Company received a notice of non-compliance for payroll tax withholding related to a reorganization of two of its subsidiaries during 2011.  The Company believes its Form 941 filings for these subsidiaries in 2011 were appropriate and formally appealed approximately $0.5 million of additional taxes, interest and penalties accessed by the IRS in November 2015.  The Company cannot currently determine whether or not its appeal will be successful. If the Company’s appeal is unsuccessful, it may incur a charge of approximately $0.5 million for the additional taxes, interest and penalties.

During 2011, the Company received claims of overpayments from the U.S. Veterans Administration, or VA, for a total of $1.6 million. In August 2015, the Company and the VA entered into a final settlement, under which the Company will pay $1.2 million to the VA in twelve monthly installments of $100,000. As of December 31, 2015, the Company had recorded an accrued liability for the settlement of $0.8 million. As of September 30, 2016 the settlement had been paid in full.

Contingent Notes

As discussed in Note 7, in connection with certain of its acquisitions, the Company agreed to pay additional consideration in future periods based upon the attainment of stipulated levels of operating results by each of the acquired entities, as defined in their respective agreements. The computation of the annual operating results is subject to review and approval by the sellers prior to payment. In the event there is a dispute, the Company will pay the undisputed amount and then take reasonable efforts to resolve the dispute with the sellers. If the sellers are successful in asserting their dispute, the Company could be required to make additional payments in future periods.

Future payments under contingent notes will be made if the practices achieve stipulated levels of results and contract retention as outlined in their respective agreements. Any future payments of contingent consideration will be reflected in the change in the fair value of the contingent consideration. As of September 30, 2016, the fair value of contingent consideration related to acquisitions was $12.0 million, representing the present value of approximately $16.1 million in estimated future payments through 2021.

Purchase Obligations

The Company has entered into non-cancelable commitments to purchase reagents and other laboratory supplies. Under these agreements, the Company must purchase minimum amounts of reagents and other laboratory supplies through 2021.

At September 30, 2016, the remaining minimum purchase commitments are as follows:

Year Ending December 31,
Remainder of 2016	$	634
2017		2,025
2018		834
2019		794
2020		787
Thereafter		97
	$	5,171

In connection with certain of these commitments, the Company received lab testing equipment, to which the Company has either received title, or will receive title upon fulfillment of its purchase obligations under the respective commitment. The Company recorded the obligation under purchase commitment for the fair market value of the equipment, reduced by the cash paid. The remaining obligations under purchase commitments included in other liabilities in the accompanying condensed consolidated balance sheets were $1.5 million and $1.6 million as of September 30, 2016 and December 31, 2015, respectively.

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Fair Value of Financial Instruments

9 Months Ended

Sep. 30, 2016

Fair Value Disclosures [Abstract]

Fair Value of Financial Instruments

Note 11. Fair Value of Financial Instruments

Recurring Fair Value Measurements

As of September 30, 2016 and December 31, 2015, the fair value of contingent consideration related to acquisitions was $12.0 million and $13.1 million, respectively. The fair value of contingent consideration is derived using valuation techniques that incorporate unobservable inputs and are considered Level 3 items. The Company utilizes a present value of estimated future payments approach to estimate the fair value of the contingent consideration. Estimates for fair value of contingent consideration primarily involve two inputs, which are (i) the projections of the financial performance of the acquired practices that are used to calculate the amount of the payments and (ii) the discount rates used to calculate the present value of future payments. Changes in either of these inputs will impact the estimated fair value of contingent consideration. At September 30, 2016 the discount rates ranged from 14% to 19%.

The following is a summary of the Company’s fair value instruments categorized by their fair value input level as of September 30, 2016 (in thousands):

					Significant Other		Significant
			Quoted Prices		Observable		Unobservable
			inActive Markets		Inputs		Inputs
	Fair Value		Level 1		Level 2		Level 3
Liabilities:
Current portion of fair value of contingent consideration	$	5,569	$	—	$	—	$	5,569
Fair value of contingent consideration, net of current    portion	$	6,410	$	—	$	—	$	6,410

The following is a summary of the Company’s fair value instruments categorized by their fair value input level as of December 31, 2015 (in thousands):

					Significant Other		Significant
			Quoted Prices		Observable		Unobservable
			in Active Markets		Inputs		Inputs
	Fair Value		Level 1		Level 2		Level 3
Liabilities:
Current portion of fair value of contingent consideration	$	4,820	$	—	$	—	$	4,820
Fair value of contingent consideration, net of current    portion	$	8,320	$	—	$	—	$	8,320

The following is a roll-forward of the Company’s Level 3 fair value instruments for the nine months ended September 30, 2016 (in thousands):

	Beginning		Total (Gains) /							Ending
	Balance		Losses Realized							Balance
	January 1,2016		and Unrealized		Issuances		Settlements			September30, 2016
Contingent consideration	$	13,140	$	1,146	$	1,100	$	(3,407	)	$	11,979

Non-Recurring Fair Value Measurements

Certain assets that are measured at fair value on a non-recurring basis, including property and equipment and intangible assets, are adjusted to fair value only when the carrying values are greater than their fair values. The Company completed its latest annual impairment evaluations as of November 30, 2015 and recorded write-offs of goodwill to reflect the then current estimated fair value of the impaired reporting units. The fair values were derived with fair value models utilizing unobservable inputs that therefore are considered Level 3 items.

As of September 30, 2016 and December 31, 2015, the carrying amounts of cash and cash equivalents, accounts receivable, accounts payable, accrued interest and accrued expenses approximate fair value based on the short maturity of these instruments. As of September 30, 2016 and December 31, 2015, the fair value of the Company’s debt was $357.7 million and $332.1 million, respectively. The Company uses quoted market prices and yields for the same or similar types of borrowings in active markets when available to determine the fair value of the Company’s debt. These fair values are considered Level 2 items.

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Income Taxes

9 Months Ended

Sep. 30, 2016

Income Tax Disclosure [Abstract]

Income Taxes

Note 12. Income Taxes

The Company is a Delaware limited liability company. For federal income tax purposes, the Company is treated as a partnership. Accordingly, the Company is generally not subject to income taxes and the income attributable to the limited liability company is distributed to the members in accordance with the terms of the operating agreement. However, certain of the Company’s subsidiaries are structured as corporations and therefore are subject to federal and state income taxes. The provision for income taxes for these subsidiaries is reflected in the Company’s condensed consolidated financial statements and includes federal and state taxes currently payable and changes in deferred tax assets and liabilities, excluding the establishment of deferred tax assets and liabilities related to acquisitions. The provision for federal and state taxes was $0.6 million and $10,000 for the three months ended September 30, 2016 and 2015, respectively.  The benefit for federal and state taxes was $0.5 million and $0.8 million for the nine months ended September 30, 2016 and 2015, respectively.

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Guarantor Subsidiaries

9 Months Ended

Sep. 30, 2016

Guarantor Subsidiaries [Abstract]

Guarantor Subsidiaries

Note 13. Guarantor Subsidiaries

The following information is presented as required by regulations of the Securities and Exchange Commission in connection with the Company’s 10.75% Senior Notes due 2018. This information is not routinely prepared for use by management. The operating and investing activities of the separate legal entities included in the Company’s consolidated financial statements are fully interdependent and integrated. Accordingly, consolidating the operating results of those separate legal entities is not representative of what the actual operating results of those entities would be on a stand-alone basis. Operating expenses of those separate legal entities include intercompany charges for management fees and other services. Certain expense items that are applicable to the Company’s subsidiaries are typically recorded in the books and records of Aurora Diagnostics Holdings, LLC. For purposes of this footnote disclosure, such balances and amounts have been “pushed down” to the respective subsidiaries either on a specific identification basis, or when such items cannot be specifically attributed to an individual subsidiary, have been allocated on an incremental or proportional cost basis to Aurora Diagnostics Holdings, LLC and the Company’s subsidiaries.

The following tables present consolidating financial information as of September 30, 2016 and December 31, 2015 and for the three months and nine months ended September 30, 2016 and 2015 for (i) Aurora Diagnostics Holdings, LLC, (ii) on a combined basis, the subsidiaries of the Company that are guarantors of the Company’s Senior Notes (the “Subsidiary Guarantors”) and (iii) on a combined basis, the subsidiaries of the Company that are not guarantors of the Company’s Senior Notes (the “Non-Guarantor Subsidiaries”). For presentation in the following tables, Subsidiary Guarantors includes revenue and expenses and assets and liabilities for those subsidiaries directly or indirectly 100% owned by the Company, including those entities that have contractual arrangements with affiliated physician groups. Essentially, all property and equipment reflected in the accompanying condensed consolidated balance sheets collateralize the Company’s credit facility. As such, as of September 30, 2016 and December 31, 2015, $2.1 million and $2.2 million, respectively, of property and equipment held by Non-Guarantor Subsidiaries are reflected under Subsidiary Guarantors in the following tables.

Condensed Consolidating Balance Sheets (in thousands):

	Aurora						Non-
	Diagnostics			Subsidiary			Guarantor			Consolidating			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Adjustments			Total
Assets
Current Assets
Cash and cash equivalents	$	11,683		$	44		$	335		$	—		$	12,062
Accounts receivable, net		—			18,769			20,077			—			38,846
Prepaid expenses and other assets		2,354			1,530			1,214			—			5,098
Prepaid income taxes		24			295			122			—			441
Total current assets		14,061			20,638			21,748			—			56,447
Property and equipment, net		1,971			6,033			—			—			8,004
Other Assets:
Intercompany receivable		364,335			—			—			(364,335	)		—
Deferred debt issue costs, net		358			—			—			—			358
Deferred financing costs, deposits and other noncurrent    assets		1,846			167			90			—			2,103
Goodwill		—			77,440			50,033			—			127,473
Intangible assets, net		—			25,511			31,110			—			56,621
		366,539			103,118			81,233			(364,335	)		186,555
	$	382,571		$	129,789		$	102,981		$	(364,335	)	$	251,006
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	3,147		$	104		$	—		$	—		$	3,251
Current portion of fair value of contingent    consideration		—			1,025			4,544			—			5,569
Accounts payable, accrued expenses and other current    liabilities		11,985			2,593			3,768			—			18,346
Accrued compensation		2,132			3,405			3,022			—			8,559
Accrued interest		8,805			—			—			—			8,805
Total current liabilities		26,069			7,127			11,334			—			44,530
Intercompany payable		—			153,960			210,375			(364,335	)		—
Long-term debt, net of current portion		387,234			49			—			—			387,283
Deferred tax liabilities		—			2,391			3,599			—			5,990
Accrued management fees, related parties		10,780			—			—			—			10,780
Fair value of contingent consideration, net of current    portion		—			875			5,535			—			6,410
Other liabilities		1,550			—			1,152			—			2,702
Members' Deficit		(43,062	)		(34,613	)		(129,014	)		—			(206,689	)
	$	382,571		$	129,789		$	102,981		$	(364,335	)	$	251,006

	Aurora						Non-
	Diagnostics			Subsidiary			Guarantor			Consolidating			Consolidated
December 31, 2015	Holdings, LLC			Guarantors			Subsidiaries			Adjustments			Total
Assets
Current Assets
Cash and cash equivalents	$	17,833		$	1,198		$	54		$	—		$	19,085
Accounts receivable, net		759			16,317			15,775			—			32,851
Prepaid expenses and other assets		1,890			1,292			1,139			—			4,321
Prepaid income taxes		—			60			115			—			175
Total current assets		20,482			18,867			17,083			—			56,432
Property and equipment, net		2,453			6,193			—			—			8,646
Other Assets:
Intercompany receivable		373,041			—			—			(373,041	)		—
Deferred debt issue costs, net		453			—			—			—			453
Deposits and other noncurrent assets		345			143			108			—			596
Goodwill		—			77,110			48,078			—			125,188
Intangible assets, net		118			34,450			31,126			—			65,694
		373,957			111,703			79,312			(373,041	)		191,931
	$	396,892		$	136,763		$	96,395		$	(373,041	)	$	257,009
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	2,021		$	126		$	—		$	—		$	2,147
Current portion of fair value of contingent    consideration		—			1,013			3,807			—			4,820
Accounts payable, accrued expenses and other current    liabilities		9,979			2,543			4,317			—			16,839
Accrued compensation		2,784			2,378			1,868			—			7,030
Accrued interest		14,228			—			—			—			14,228
Total current liabilities		29,012			6,060			9,992			—			45,064
Intercompany payable		—			170,121			202,920			(373,041	)		—
Long-term debt, net of current portion		377,562			55			—			—			377,617
Deferred tax liabilities		—			2,443			4,030			—			6,473
Accrued management fees, related parties		8,633			—			—			—			8,633
Fair value of contingent consideration, net of current    portion		—			1,367			6,953			—			8,320
Other liabilities		1,603			—			82			—			1,685
Members' Deficit		(19,918	)		(43,283	)		(127,582	)		—			(190,783	)
	$	396,892		$	136,763		$	96,395		$	(373,041	)	$	257,009

Condensed Consolidating Statements of Operations (in thousands):

	Aurora
For the Three Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	42,401		$	30,834		$	73,235
Operating costs and expenses:
Cost of services		—			14,783			23,965			38,748
Selling, general and administrative expenses		5,252			6,749			4,854			16,855
Provision for doubtful accounts		—			1,905			2,073			3,978
Intangible asset amortization expense		—			3,188			1,776			4,964
Management fees, related parties		(3,804	)		9,783			(5,246	)		733
Merger and acquisition costs		762			—			—			762
Change in fair value of contingent consideration		—			79			87			166
Total operating costs and expenses		2,210			36,487			27,509			66,206
Income (loss) from operations		(2,210	)		5,914			3,325			7,029
Other (expense) income:
Interest expense		(6,901	)		(711	)		(2,932	)		(10,544	)
Other income		—			—			(5	)		(5	)
Total other expense, net		(6,901	)		(711	)		(2,937	)		(10,549	)
Income (loss) before income taxes		(9,111	)		5,203			388			(3,520	)
Provision for income taxes		—			162			388			550
Net (loss) income	$	(9,111	)	$	5,041		$	—		$	(4,070	)
	Aurora
For the Three Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	39,330		$	30,353		$	69,683
Operating costs and expenses:
Cost of services		—			15,809			21,116			36,925
Selling, general and administrative expenses		5,682			6,495			4,570			16,747
Provision for doubtful accounts		—			2,300			1,928			4,228
Intangible asset amortization expense		—			3,111			1,696			4,807
Management fees, related parties		2,772			—			(2,075	)		697
Merger and acquisition costs		297			—			—			297
Change in fair value of contingent consideration		—			40			140			180
Total operating costs and expenses		8,751			27,755			27,375			63,881
Income (loss) from operations		(8,751	)		11,575			2,978			5,802
Other expense:
Interest expense		(7,309	)		(479	)		(2,702	)		(10,490	)
Other expense		(2	)		—			—			(2	)
Total other expense		(7,311	)		(479	)		(2,702	)		(10,492	)
Income (loss) before income taxes		(16,062	)		11,096			276			(4,690	)
Income tax provision (benefit)		—			(266	)		276			10
Net (loss) income	$	(16,062	)	$	11,362		$	—		$	(4,700	)

Condensed Consolidating Statements of Operations (in thousands):

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	122,238		$	92,538		$	214,776
Operating costs and expenses:
Cost of services		—			47,919			66,451			114,370
Selling, general and administrative expenses		16,822			21,166			15,742			53,730
Provision for doubtful accounts		—			6,356			5,751			12,107
Intangible asset amortization expense		—			9,677			5,256			14,933
Management fees		2,162			9,783			(9,797	)		2,148
Merger and acquisition costs		1,338			—			—			1,338
Change in fair value of contingent consideration		—			169			977			1,146
Total operating costs and expenses		20,322			95,070			84,380			199,772
Income (loss) from operations		(20,322	)		27,168			8,158			15,004
Other (expense) income:
Interest expense		(20,811	)		(2,098	)		(8,585	)		(31,494	)
Other income		—			—			-			-
Total other expense, net		(20,811	)		(2,098	)		(8,585	)		(31,494	)
Income (loss) before income taxes		(41,133	)		25,070			(427	)		(16,490	)
Benefit for income taxes		—			(46	)		(427	)		(473	)
Net loss	$	(41,133	)	$	25,116		$	—		$	(16,017	)
	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	110,217		$	83,505		$	193,722
Operating costs and expenses:
Cost of services		—			45,582			60,582			106,164
Selling, general and administrative expenses		16,384			19,662			13,449			49,495
Provision for doubtful accounts		—			7,206			5,525			12,731
Intangible asset amortization expense		—			9,398			4,770			14,168
Management fees		14,077			—			(12,163	)		1,914
Impairment of goodwill and other intangible assets		—			36,001			3,640			39,641
Merger and acquisition costs		694			—			—			694
Change in fair value of contingent consideration		—			110			576			686
Total operating costs and expenses		31,155			117,959			76,379			225,493
Income (loss) from operations		(31,155	)		(7,742	)		7,126			(31,771	)
Other (expense) income:
Interest expense		(21,097	)		(1,556	)		(7,781	)		(30,434	)
Other income		—			1			3			4
Total other expense, net		(21,097	)		(1,555	)		(7,778	)		(30,430	)
Loss before income taxes		(52,252	)		(9,297	)		(652	)		(62,201	)
Benefit for income taxes		—			(160	)		(652	)		(812	)
Net loss	$	(52,252	)	$	(9,137	)	$	—		$	(61,389	)

Condensed Consolidating Statements of Cash Flows (in thousands):

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net (loss) income	$	(41,133	)	$	25,116		$	—		$	(16,017	)
Adjustments to reconcile net (loss) income to net cash    (used in) provided by operating activities		3,299			11,890			6,973			22,162
Changes in assets and liabilities		31,189			(35,947	)		(3,935	)		(8,693	)
Net cash (used in) provided by operating activities		(6,645	)		1,059			3,038			(2,548	)
Net cash used in investing activities		(7,730	)		(2,167	)		(2,757	)		(12,654	)
Net cash provided by (used in) financing activities		8,225			(46	)		—			8,179
Net decrease in cash and cash equivalents		(6,150	)		(1,154	)		281			(7,023	)
Cash and cash equivalents, beginning of period		17,833			1,198			54			19,085
Cash and cash equivalents, end of period	$	11,683		$	44		$	335		$	12,062

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net loss	$	(52,252	)	$	(9,137	)	$	—		$	(61,389	)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities		3,493			46,926			8,279			58,698
Changes in assets and liabilities		39,115			(37,248	)		(5,927	)		(4,060	)
Net cash provided by (used in) operating activities		(9,644	)		541			2,352			(6,751	)
Net cash used in investing activities		(9,300	)		(646	)		(2,296	)		(12,242	)
Net cash provided by (used in) financing activities		13,110			(41	)		—			13,069
Net increase (decrease) in cash and cash equivalents		(5,834	)		(146	)		56			(5,924	)
Cash and cash equivalents, beginning of period		26,209			192			21			26,422
Cash and cash equivalents, end of period	$	20,375		$	46		$	77		$	20,498

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Nature of Business and Significant Accounting Policies (Policies)

9 Months Ended

Sep. 30, 2016

Accounting Policies [Abstract]

Nature of Business

Nature of Business

Aurora Diagnostics Holdings, LLC (together with its subsidiaries, the “Company”) was organized in the State of Delaware as a limited liability company on June 2, 2006 to operate as a diagnostic services company. The Company providesintegrated diagnosticconsultations,informationservicesand personalizedmedicineservicestailoredto thepatientsof its referringphysicians,hospitalsand hospitalsystems.The Company also provides research services to pharmaceutical companies and other research entities. The Company’s operations consist of one reportable segment.

The Company operates in a highly regulated industry. The manner in which licensed physicians can organize to perform and bill for medical services is governed by state laws and regulations. Businesses like the Company often are not permitted to employ physicians or to own corporations that employ physicians or to otherwise exercise control over the medical judgments or decisions of physicians.

In states where the Company is not permitted to directly own a medical services provider or for other commercial reasons, it performs only non-medical administrative and support services, does not represent to the public or its clients that it offers medical services and does not exercise influence or control over the practice of medicine. In those states, the Company conducts business through entities that it controls, and it is these affiliated entities that employ the physicians who practice medicine. In such states, the Company generally enters into a contract that restricts the owners of the affiliated entity from transferring their ownership interests in the affiliated entity and otherwise provides the Company or its designee with a controlling voting or financial interest in the affiliated entity and its laboratory operations. This controlling financial interest generally is obtained pursuant to a long-term management services agreement between the Company and the affiliated entity. Under the management services agreement, the Company exclusively manages all aspects of the operation other than the provision of medical services. Generally, the affiliated entity has no operating assets because the Company acquired all of its operating assets at the time it acquired the related laboratory operations. In accordance with the relevant accounting guidance, these affiliated entities are included in the condensed consolidated financial statements of Aurora Diagnostics Holdings, LLC.

The accompanying condensed consolidated balance sheet as of December 31, 2015, which was derived from the audited consolidated financial statements as of December 31, 2015 of Aurora Diagnostics Holdings, LLC, and the accompanying unaudited condensed consolidated financial statements as of and for the three and nine months ended September 30, 2016 and 2015 have been prepared by the Company in accordance with accounting principles generally accepted in the United States of America for interim financial reporting. Accordingly, they do not include all of the information and related footnotes that would normally be required by accounting principles generally accepted in the United States of America for complete financial reporting. These unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements for the year ended December 31, 2015.

The accompanying unaudited condensed consolidated financial statements include all adjustments (consisting of a normal and recurring nature) that management considers necessary for a fair statement of financial information for the interim periods. Interim results are not necessarily indicative of the results that may be expected for the remainder of the year ending December 31, 2016.

Working Capital

Working Capital

The Company requires significant cash flow to service its debt obligations. Reductions in reimbursement from Medicare and other payors in recent years have had a significant negative impact on the Company’s cash flows. As of September 30, 2016, the Company had $30.0 million available under its revolving credit facility for general operations. The Company may not achieve all of its business goals and objectives and events beyond its control could affect its ability to meet financial tests and ratios under the Company’s credit facility and limit its ability to access the amounts otherwise available under its revolving credit facility.

Revenue Recognition And Accounts Receivable

Revenue Recognition and Accounts Receivable

The Company recognizes revenue at the time services are performed. Unbilled receivables are recorded for services rendered during, but billed subsequent to, the reporting period. Revenue is reported at the estimated realizable amounts from patients, third-party payors and others for services rendered. Revenue under certain third-party payor agreements is subject to audit and retroactive adjustments. Provisions for estimated third-party payor settlements and adjustments are estimated in the period the related services are rendered and adjusted in future periods as final settlements are determined. The provision for doubtful accounts and the related allowance are adjusted periodically based upon an evaluation of historical collection experience with specific payors for particular services, anticipated collection levels with specific payors for new services, industry reimbursement trends, and other relevant factors. Changes in these factors in future periods could result in increases or decreases in the Company’s provision for doubtful accounts and impact its results of operations, financial position and cash flows.

Recent Accounting Standards Updates

Recent Accounting Standards Updates

In May 2014, the Financial Accounting Standards Board (FASB) issued Accounting Standards Update (“ASU”) 2014-09, “Revenue from Contracts with Customers (Topic 606),” which will replace numerous requirements in U.S. GAAP and provide companies with a single revenue recognition model for recognizing revenue from contracts with customers. The core principle of the new standard is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the company expects to be entitled in exchange for those goods or services. ASU 2014-09 will be effective for interim and annual reporting periods beginning after December 15, 2017. The two permitted transition methods under the new standard are the full retrospective method, in which case the standard would be applied to each prior reporting period presented, or the modified retrospective method, in which case the cumulative effect of applying the standard would be recognized at the date of initial application. The Company has not yet selected a transition method under ASU 2014-09.

In March 2016, the FASB issued ASU No. 2016-08, “Principal versus Agent Considerations (Reporting Revenue Gross versus Net).” The amendments in ASU 2016-08 affect ASU 2014-09 and are related to the principal versus agent considerations implementation guidance in ASU 2014-09. In April 2016, the FASB issued ASU No. 2016-10, “Identifying Performance Obligations and Licensing.” The amendments in ASU 2016-10 clarify the following two aspects in ASU 2014-09: identifying performance obligations and the licensing implementation guidance, while retaining the related principles for those areas. In May 2016, the FASB issued ASU No. 2016-11, “Rescission of SEC Guidance Because of Accounting Standards Updates 2014-09 and 2014-16 Pursuant to Staff Announcements at the March 3, 2016 EITF Meeting.” The amendments in ASU 2016-11 rescinded certain SEC Staff Observer comments that are codified, effective upon the adoption of ASU 2014-09. In May 2016, the FASB issued ASU No. 2016-12, “Narrow-Scope Improvements and Practical Expedients.” The amendments in ASU 2016-12 address certain issues identified in ASU 2014-09 in the guidance on assessing collectability, presentation of sales taxes, non-cash consideration, and completed contracts and contract modifications at transition. These ASU’s are effective concurrently with the adoption of ASU 2014-09. The Company is evaluating the impact of the adoption of these updates on its consolidated financial statements and related disclosures.

In August 2014, the FASB issued ASU 2014-15, “Presentation of Financial Statements—Going Concern (Subtopic 205-40): Disclosure of Uncertainties about an Entity’s Ability to Continue as a Going Concern.”  Under the new guidance, management will be required to assess an entity’s ability to continue as a going concern, and to provide related footnote disclosures in certain circumstances. The provisions of this ASU are effective for annual periods ending after December 15, 2016 and interim periods beginning after December 15, 2016.  The adoption of ASU 2014-15 is not expected to have a material effect on the Company’s financial position, results of operations or cash flows and the Company is evaluating the impact of the adoption on our related disclosures.

In April 2015, the FASB issued ASU 2015-03, “Interest—Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs.”  The amendments in this update require that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. The recognition and measurement guidance for debt issuance costs are not affected by the amendments in this standards update.  The new guidance is effective for annual reporting periods beginning after December 15, 2015, including interim periods within that reporting period. An entity should apply the guidance either retrospectively to each prior reporting period presented or retrospectively with the cumulative adjustment at the date of the initial application. In connection with the Company’s adoption of ASU 2015-03, the deferred debt issue costs related to the issuance of the Company’s Senior Notes, as further described in Note 6, and term loans were reclassified to long-term debt.  The net unamortized deferred debt issue costs reflected in long-term debt were approximately $4.1 million and $5.6 million as of September 30, 2016 and December 31, 2015, respectively. Deferred debt issue costs related to the Company’s revolving credit facility continue to be reflected as non-current assets in the Company’s condensed consolidated financial statements.

In February 2016, the FASB issued ASU 2016-02, “Leases” (topic 842). The FASB issued this update to increase transparency and comparability among organizations by recognizing lease assets and lease liabilities on the balance sheet and disclosing key information about leasing arrangements. The updated guidance is effective for annual periods beginning after December 15, 2018, including interim periods within those fiscal years. Early adoption of the update is permitted. The Company is evaluating the impact of the adoption of this update on its consolidated financial statements and related disclosures.

In March 2016, the FASB issued ASU 2016-09, “Improvements to Employee Share-Based Payment Accounting,” which amends Accounting Standards Codification Topic 718, Compensation – Stock Compensation.  ASU 2016-09 simplifies several aspects of the accounting for share-based payment transactions, including the income tax consequences, classification of awards as either equity or liabilities, and classification on the statement of cash flows. ASU 2016-09 is effective for the Company’s fiscal years beginning after December 15, 2016, and interim periods within those fiscal years and early adoption is permitted. The Company is evaluating the impact of the adoption of this update on its consolidated financial statements and related disclosures.

In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments—Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments”. ASU 2016-13 introduces a new forward-looking approach, based on expected losses, to estimate credit losses on certain types of financial instruments, including trade receivables and held-to-maturity debt securities, which will require entities to incorporate considerations of historical information, current information and reasonable and supportable forecasts. This ASU also expands disclosure requirements. ASU 2016-13 is effective for the Company beginning the first quarter of 2020 with early adoption permitted. The guidance will be applied using the modified-retrospective approach. The Company is currently evaluating the impact of adoption of ASU 2016-13 on its consolidated financial statements and related disclosures.

In August 2016, the FASB issued ASU No. 2016-15, “Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments,” which clarifies how certain cash receipts and cash payments are presented and classified in the statement of cash flows. ASU No. 2016-15 is effective for the Company in the first quarter of 2018 with early adoption permitted and must be applied retrospectively to all periods presented. The Company is currently evaluating the impact of adoption of ASU 2016-13 on the presentation and classification of the Company’s statements of cash flows.

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Acquisitions (Tables)

9 Months Ended

Sep. 30, 2016

Business Combinations [Abstract]

Schedule of Estimated Aggregate Fair Value Assets Acquired and Liabilities Assumed

The following table summarizes the preliminary estimated aggregate fair value of the assets acquired and liabilities assumed in connection with the 2016 acquisitions (in thousands):

Cash	$	602
Accounts receivable		849
Other assets		65
Intangible assets		5,860
Goodwill		2,140
Assets acquired		9,516
Accounts payable and accrued expenses		282
Accrued compensation		282
Liabilities assumed		564
Net assets acquired	$	8,952
Net assets acquired	$	8,952
Less:
Fair value of contingent consideration issued		(1,100	)
Cash acquired		(602	)
Net cash paid for acquisitions, net of cash acquired	$	7,250

Business Acquisition Pro Forma Information

The following unaudited pro forma information presents the consolidated results of the Company’s operations and the results of the 2015 and 2016 acquisitions for the three and nine months ended September 30, 2016 and 2015, after giving effect to amortization, depreciation, income tax, and the reduced level of certain specific operating expenses (primarily compensation and related expenses attributable to former owners) as if the 2015 acquisitions had been consummated on January 1, 2014 and the 2016 acquisitions had been consummated on January 1, 2015. Such unaudited pro forma information is based on historical unaudited financial information with respect to the 2015 and 2016 acquisitions and does not include operational or other changes which might have been effected by the Company. The unaudited pro forma information for the three and nine months ended September 30, 2016 and 2015 presented below is for illustrative purposes only and is not necessarily indicative of results which would have been achieved or results which may be achieved in the future (in thousands):

	Three Months Ended						Nine Months Ended
	September 30,						September 30,
	2016			2015			2016			2015
Net revenue	$	73,235		$	74,002		$	216,743		$	211,862
Net loss	$	(4,070	)	$	(3,989	)	$	(15,618	)	$	(58,531	)

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Accounts Receivable (Tables)

9 Months Ended

Sep. 30, 2016

Receivables [Abstract]

Summary of Accounts Receivable

Accounts receivable consist of the following as of September 30, 2016 and December 31, 2015 (in thousands):

	September 30,			December 31,
	2016			2015
Accounts Receivable	$	55,874		$	49,142
Less: Allowance for doubtful accounts		(17,028	)		(16,291	)
Accounts receivable, net	$	38,846		$	32,851

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Goodwill and Intangible Assets (Tables)

9 Months Ended

Sep. 30, 2016

Goodwill And Intangible Assets Disclosure [Abstract]

Adjustments to Goodwill

The following table presents adjustments to goodwill during the nine months ended September 30, 2016 and the year ended December 31, 2015 (in thousands):

	September 30,		December 31,
	2016		2015
Goodwill, beginning of period	$	125,188	$	177,774
Acquisitions		2,285		4,139
Goodwill impairment		—		(56,725	)
Goodwill, end of period	$	127,473	$	125,188

Intangible Assets and the Related Accumulated Amortization

The Company’s balances for intangible assets as of September 30, 2016 and December 31, 2015 and the related accumulated amortization are set forth in the table below (in thousands):

		Weighted Average	September 30, 2016
	Range	Amortization			Accumulated
	(Years)	Period (Years)	Cost		Amortization			Net
Amortizing intangible assets:
Customer relationships	7 – 10	8	$	130,748	$	(111,506	)	$	19,242
Health care facility agreements	15	15		48,970		(12,897	)		36,073
Noncompete agreements	3 – 5	4		6,199		(4,893	)		1,306
Total intangible assets			$	185,917	$	(129,296	)	$	56,621
		Weighted Average	December 31, 2015
	Range	Amortization			Accumulated
	(Years)	Period (Years)	Cost		Amortization			Net
Amortizing intangible assets:
Customer relationships	7 – 10	8	$	130,748	$	(99,516	)	$	31,232
Health care facility agreements	15	15		43,580		(10,303	)		33,277
Noncompete agreements	3 – 5	4		5,729		(4,544	)		1,185
Total intangible assets			$	180,057	$	(114,363	)	$	65,694

Estimated Future Amortization Expense

As of September 30, 2016, estimated future amortization expense is as follows (in thousands):

Year Ending December 31,
Remainder of 2016	$	4,767
2017		14,081
2018		6,676
2019		4,848
2020		4,727
Thereafter		21,522
	$	56,621

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Accounts Payable, Accrued Expenses and Other Current Liabilities (Tables)

9 Months Ended

Sep. 30, 2016

Payables And Accruals [Abstract]

Summary of Accounts Payable, Accrued Expenses and Other Current Liabilities

Accounts payable, accrued expenses and other current liabilities as of September 30, 2016 and December 31, 2015 consist of the following (in thousands):

	September 30,		December 31,
	2016		2015
Accounts payable and accrued payables	$	11,930	$	11,513
Reserve for future medical claims		1,997		2,200
Other accrued expenses		4,419		3,126
	$	18,346	$	16,839

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Long-Term Debt (Tables)

9 Months Ended

Sep. 30, 2016

Long Term Debt [Abstract]

Long-Term Debt

Long-term debt consists of the following as of September 30, 2016 and December 31, 2015 (in thousands):

	September 30,			December 31,
	2016			2015
Senior Notes	$	200,000		$	200,000
Initial term loan		162,500			164,000
Delayed draw term loans		35,000			25,000
Notes payable		133			133
Capital lease obligations		69			129
		397,702			389,262
Less:
Original issue discount, net		(3,036	)		(3,877	)
Debt issuance costs, net		(4,132	)		(5,621	)
Current portion		(3,251	)		(2,147	)
Long-term debt, net of current portion	$	387,283		$	377,617

Estimated Future Debt Principal Payments

As of September 30, 2016, estimated future debt principal payments are as follows (in thousands):

Year Ending December 31,
Remainder of 2016	$	589
2017		3,608
2018		204,255
2019 *		189,250
	$	397,702

* The estimated future debt principal payments in 2019 reflect the five-year maturity of the Company’s credit facility, which is subject to an earlier maturity date of October 14, 2017 if the Company’s Senior Notes are not refinanced or their maturity is not extended prior to October 14, 2017.

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Commitments and Contingencies (Tables)

9 Months Ended

Sep. 30, 2016

Commitments And Contingencies Disclosure [Abstract]

Schedule of Remaining Minimum Purchase Commitments

At September 30, 2016, the remaining minimum purchase commitments are as follows:

Year Ending December 31,
Remainder of 2016	$	634
2017		2,025
2018		834
2019		794
2020		787
Thereafter		97
	$	5,171

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Fair Value of Financial Instruments (Tables)

9 Months Ended

Sep. 30, 2016

Fair Value Disclosures [Abstract]

Summary of the Company's Fair Value Instruments Categorized by their Fair Value

The following is a summary of the Company’s fair value instruments categorized by their fair value input level as of September 30, 2016 (in thousands):

					Significant Other		Significant
			Quoted Prices		Observable		Unobservable
			inActive Markets		Inputs		Inputs
	Fair Value		Level 1		Level 2		Level 3
Liabilities:
Current portion of fair value of contingent consideration	$	5,569	$	—	$	—	$	5,569
Fair value of contingent consideration, net of current    portion	$	6,410	$	—	$	—	$	6,410

The following is a summary of the Company’s fair value instruments categorized by their fair value input level as of December 31, 2015 (in thousands):

					Significant Other		Significant
			Quoted Prices		Observable		Unobservable
			in Active Markets		Inputs		Inputs
	Fair Value		Level 1		Level 2		Level 3
Liabilities:
Current portion of fair value of contingent consideration	$	4,820	$	—	$	—	$	4,820
Fair value of contingent consideration, net of current    portion	$	8,320	$	—	$	—	$	8,320

Roll-forward of the Company's Level 3 Fair Value Instruments

The following is a roll-forward of the Company’s Level 3 fair value instruments for the nine months ended September 30, 2016 (in thousands):

	Beginning		Total (Gains) /							Ending
	Balance		Losses Realized							Balance
	January 1,2016		and Unrealized		Issuances		Settlements			September30, 2016
Contingent consideration	$	13,140	$	1,146	$	1,100	$	(3,407	)	$	11,979

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Guarantor Subsidiaries (Tables)

9 Months Ended

Sep. 30, 2016

Guarantor Subsidiaries [Abstract]

Condensed Consolidating Balance Sheets

Condensed Consolidating Balance Sheets (in thousands):

	Aurora						Non-
	Diagnostics			Subsidiary			Guarantor			Consolidating			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Adjustments			Total
Assets
Current Assets
Cash and cash equivalents	$	11,683		$	44		$	335		$	—		$	12,062
Accounts receivable, net		—			18,769			20,077			—			38,846
Prepaid expenses and other assets		2,354			1,530			1,214			—			5,098
Prepaid income taxes		24			295			122			—			441
Total current assets		14,061			20,638			21,748			—			56,447
Property and equipment, net		1,971			6,033			—			—			8,004
Other Assets:
Intercompany receivable		364,335			—			—			(364,335	)		—
Deferred debt issue costs, net		358			—			—			—			358
Deferred financing costs, deposits and other noncurrent    assets		1,846			167			90			—			2,103
Goodwill		—			77,440			50,033			—			127,473
Intangible assets, net		—			25,511			31,110			—			56,621
		366,539			103,118			81,233			(364,335	)		186,555
	$	382,571		$	129,789		$	102,981		$	(364,335	)	$	251,006
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	3,147		$	104		$	—		$	—		$	3,251
Current portion of fair value of contingent    consideration		—			1,025			4,544			—			5,569
Accounts payable, accrued expenses and other current    liabilities		11,985			2,593			3,768			—			18,346
Accrued compensation		2,132			3,405			3,022			—			8,559
Accrued interest		8,805			—			—			—			8,805
Total current liabilities		26,069			7,127			11,334			—			44,530
Intercompany payable		—			153,960			210,375			(364,335	)		—
Long-term debt, net of current portion		387,234			49			—			—			387,283
Deferred tax liabilities		—			2,391			3,599			—			5,990
Accrued management fees, related parties		10,780			—			—			—			10,780
Fair value of contingent consideration, net of current    portion		—			875			5,535			—			6,410
Other liabilities		1,550			—			1,152			—			2,702
Members' Deficit		(43,062	)		(34,613	)		(129,014	)		—			(206,689	)
	$	382,571		$	129,789		$	102,981		$	(364,335	)	$	251,006

	Aurora						Non-
	Diagnostics			Subsidiary			Guarantor			Consolidating			Consolidated
December 31, 2015	Holdings, LLC			Guarantors			Subsidiaries			Adjustments			Total
Assets
Current Assets
Cash and cash equivalents	$	17,833		$	1,198		$	54		$	—		$	19,085
Accounts receivable, net		759			16,317			15,775			—			32,851
Prepaid expenses and other assets		1,890			1,292			1,139			—			4,321
Prepaid income taxes		—			60			115			—			175
Total current assets		20,482			18,867			17,083			—			56,432
Property and equipment, net		2,453			6,193			—			—			8,646
Other Assets:
Intercompany receivable		373,041			—			—			(373,041	)		—
Deferred debt issue costs, net		453			—			—			—			453
Deposits and other noncurrent assets		345			143			108			—			596
Goodwill		—			77,110			48,078			—			125,188
Intangible assets, net		118			34,450			31,126			—			65,694
		373,957			111,703			79,312			(373,041	)		191,931
	$	396,892		$	136,763		$	96,395		$	(373,041	)	$	257,009
Liabilities and Members' Deficit
Current Liabilities
Current portion of long-term debt	$	2,021		$	126		$	—		$	—		$	2,147
Current portion of fair value of contingent    consideration		—			1,013			3,807			—			4,820
Accounts payable, accrued expenses and other current    liabilities		9,979			2,543			4,317			—			16,839
Accrued compensation		2,784			2,378			1,868			—			7,030
Accrued interest		14,228			—			—			—			14,228
Total current liabilities		29,012			6,060			9,992			—			45,064
Intercompany payable		—			170,121			202,920			(373,041	)		—
Long-term debt, net of current portion		377,562			55			—			—			377,617
Deferred tax liabilities		—			2,443			4,030			—			6,473
Accrued management fees, related parties		8,633			—			—			—			8,633
Fair value of contingent consideration, net of current    portion		—			1,367			6,953			—			8,320
Other liabilities		1,603			—			82			—			1,685
Members' Deficit		(19,918	)		(43,283	)		(127,582	)		—			(190,783	)
	$	396,892		$	136,763		$	96,395		$	(373,041	)	$	257,009

Condensed Consolidating Statements of Operations

Condensed Consolidating Statements of Operations (in thousands):

	Aurora
For the Three Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	42,401		$	30,834		$	73,235
Operating costs and expenses:
Cost of services		—			14,783			23,965			38,748
Selling, general and administrative expenses		5,252			6,749			4,854			16,855
Provision for doubtful accounts		—			1,905			2,073			3,978
Intangible asset amortization expense		—			3,188			1,776			4,964
Management fees, related parties		(3,804	)		9,783			(5,246	)		733
Merger and acquisition costs		762			—			—			762
Change in fair value of contingent consideration		—			79			87			166
Total operating costs and expenses		2,210			36,487			27,509			66,206
Income (loss) from operations		(2,210	)		5,914			3,325			7,029
Other (expense) income:
Interest expense		(6,901	)		(711	)		(2,932	)		(10,544	)
Other income		—			—			(5	)		(5	)
Total other expense, net		(6,901	)		(711	)		(2,937	)		(10,549	)
Income (loss) before income taxes		(9,111	)		5,203			388			(3,520	)
Provision for income taxes		—			162			388			550
Net (loss) income	$	(9,111	)	$	5,041		$	—		$	(4,070	)
	Aurora
For the Three Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	39,330		$	30,353		$	69,683
Operating costs and expenses:
Cost of services		—			15,809			21,116			36,925
Selling, general and administrative expenses		5,682			6,495			4,570			16,747
Provision for doubtful accounts		—			2,300			1,928			4,228
Intangible asset amortization expense		—			3,111			1,696			4,807
Management fees, related parties		2,772			—			(2,075	)		697
Merger and acquisition costs		297			—			—			297
Change in fair value of contingent consideration		—			40			140			180
Total operating costs and expenses		8,751			27,755			27,375			63,881
Income (loss) from operations		(8,751	)		11,575			2,978			5,802
Other expense:
Interest expense		(7,309	)		(479	)		(2,702	)		(10,490	)
Other expense		(2	)		—			—			(2	)
Total other expense		(7,311	)		(479	)		(2,702	)		(10,492	)
Income (loss) before income taxes		(16,062	)		11,096			276			(4,690	)
Income tax provision (benefit)		—			(266	)		276			10
Net (loss) income	$	(16,062	)	$	11,362		$	—		$	(4,700	)

Condensed Consolidating Statements of Operations (in thousands):

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	122,238		$	92,538		$	214,776
Operating costs and expenses:
Cost of services		—			47,919			66,451			114,370
Selling, general and administrative expenses		16,822			21,166			15,742			53,730
Provision for doubtful accounts		—			6,356			5,751			12,107
Intangible asset amortization expense		—			9,677			5,256			14,933
Management fees		2,162			9,783			(9,797	)		2,148
Merger and acquisition costs		1,338			—			—			1,338
Change in fair value of contingent consideration		—			169			977			1,146
Total operating costs and expenses		20,322			95,070			84,380			199,772
Income (loss) from operations		(20,322	)		27,168			8,158			15,004
Other (expense) income:
Interest expense		(20,811	)		(2,098	)		(8,585	)		(31,494	)
Other income		—			—			-			-
Total other expense, net		(20,811	)		(2,098	)		(8,585	)		(31,494	)
Income (loss) before income taxes		(41,133	)		25,070			(427	)		(16,490	)
Benefit for income taxes		—			(46	)		(427	)		(473	)
Net loss	$	(41,133	)	$	25,116		$	—		$	(16,017	)
	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net revenue	$	—		$	110,217		$	83,505		$	193,722
Operating costs and expenses:
Cost of services		—			45,582			60,582			106,164
Selling, general and administrative expenses		16,384			19,662			13,449			49,495
Provision for doubtful accounts		—			7,206			5,525			12,731
Intangible asset amortization expense		—			9,398			4,770			14,168
Management fees		14,077			—			(12,163	)		1,914
Impairment of goodwill and other intangible assets		—			36,001			3,640			39,641
Merger and acquisition costs		694			—			—			694
Change in fair value of contingent consideration		—			110			576			686
Total operating costs and expenses		31,155			117,959			76,379			225,493
Income (loss) from operations		(31,155	)		(7,742	)		7,126			(31,771	)
Other (expense) income:
Interest expense		(21,097	)		(1,556	)		(7,781	)		(30,434	)
Other income		—			1			3			4
Total other expense, net		(21,097	)		(1,555	)		(7,778	)		(30,430	)
Loss before income taxes		(52,252	)		(9,297	)		(652	)		(62,201	)
Benefit for income taxes		—			(160	)		(652	)		(812	)
Net loss	$	(52,252	)	$	(9,137	)	$	—		$	(61,389	)

Condensed Consolidating Statements of Cash Flows

Condensed Consolidating Statements of Cash Flows (in thousands):

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2016	Holdings, LLC			Guarantors			Subsidiaries			Total
Net (loss) income	$	(41,133	)	$	25,116		$	—		$	(16,017	)
Adjustments to reconcile net (loss) income to net cash    (used in) provided by operating activities		3,299			11,890			6,973			22,162
Changes in assets and liabilities		31,189			(35,947	)		(3,935	)		(8,693	)
Net cash (used in) provided by operating activities		(6,645	)		1,059			3,038			(2,548	)
Net cash used in investing activities		(7,730	)		(2,167	)		(2,757	)		(12,654	)
Net cash provided by (used in) financing activities		8,225			(46	)		—			8,179
Net decrease in cash and cash equivalents		(6,150	)		(1,154	)		281			(7,023	)
Cash and cash equivalents, beginning of period		17,833			1,198			54			19,085
Cash and cash equivalents, end of period	$	11,683		$	44		$	335		$	12,062

	Aurora
For the Nine Months Ended	Diagnostics			Subsidiary			Non-Guarantor			Consolidated
September 30, 2015	Holdings, LLC			Guarantors			Subsidiaries			Total
Net loss	$	(52,252	)	$	(9,137	)	$	—		$	(61,389	)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities		3,493			46,926			8,279			58,698
Changes in assets and liabilities		39,115			(37,248	)		(5,927	)		(4,060	)
Net cash provided by (used in) operating activities		(9,644	)		541			2,352			(6,751	)
Net cash used in investing activities		(9,300	)		(646	)		(2,296	)		(12,242	)
Net cash provided by (used in) financing activities		13,110			(41	)		—			13,069
Net increase (decrease) in cash and cash equivalents		(5,834	)		(146	)		56			(5,924	)
Cash and cash equivalents, beginning of period		26,209			192			21			26,422
Cash and cash equivalents, end of period	$	20,375		$	46		$	77		$	20,498

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Nature of Business and Significant Accounting Policies (Details Textual)	9 Months Ended
	Sep. 30, 2016 USD ($) Segment	Dec. 31, 2015 USD ($)
Nature Of Business And Significant Accounting Policies [Line Items]
Number of reportable segment | Segment	1
Business acquisition, operating assets	$ 0
Unamortized deferred debt issuance cost reflected in long-term debt	4,132,000	$ 5,621,000
Accounting Standards Update 2015-03
Nature Of Business And Significant Accounting Policies [Line Items]
Unamortized deferred debt issuance cost reflected in long-term debt	4,100,000	$ 5,600,000
Revolving Credit Facility
Nature Of Business And Significant Accounting Policies [Line Items]
Amount available under revolving credit facility	$ 30,000,000

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Acquisitions (Details Textual)								3 Months Ended		9 Months Ended
	Sep. 30, 2016 USD ($)	Apr. 08, 2016 Hospital_Pathology_Practice	Mar. 31, 2016 Hospital_Pathology_Practice	Jul. 15, 2015 USD ($)	Jul. 15, 2015 USD ($)	Jul. 15, 2015 USD ($) Pathology_Practice	Jul. 15, 2015 USD ($) Billing_Service	Sep. 30, 2016 USD ($)	Sep. 30, 2015 USD ($)	Sep. 30, 2016 USD ($)	Sep. 30, 2015 USD ($)	Oct. 29, 2015	Apr. 10, 2015 USD ($)
Business Acquisition [Line Items]
Aggregate net cash consideration paid										$ 7,250,000	$ 8,813,000
Average useful life amortized										15 years
Minimum
Business Acquisition [Line Items]
Average useful life amortized										3 years
Maximum
Business Acquisition [Line Items]
Average useful life amortized										15 years
Delayed Draw Term Loan B
Business Acquisition [Line Items]
Line of credit facility, maximum borrowing capacity													$ 40,000,000
Subordinated Unsecured Contingent Note
Business Acquisition [Line Items]
Contingent consideration payable, period	3 years
Subordinated Unsecured Contingent Note | Minimum
Business Acquisition [Line Items]
Contingent consideration payable, period				3 years
Subordinated Unsecured Contingent Note | Maximum
Business Acquisition [Line Items]
Contingent consideration payable, period				6 years
2015 Acquisitions
Business Acquisition [Line Items]
Number of businesses acquired						2	1
Aggregate net cash consideration paid					$ 15,400,000
Revenue contributed by acquisition									$ 2,900,000		2,900,000
Net income contributed by acquisition									$ 600,000		$ 600,000
2015 Acquisitions | Delayed Draw Term Loan
Business Acquisition [Line Items]
Line of credit facility, maximum borrowing capacity				$ 25,000,000	25,000,000	$ 25,000,000	$ 25,000,000
2015 Acquisitions | Subordinated Unsecured Contingent Note
Business Acquisition [Line Items]
Maximum amount of contingent consideration				$ 11,900,000	$ 11,900,000	$ 11,900,000	$ 11,900,000
2015 Acquisitions | Subordinated Unsecured Contingent Note | Minimum
Business Acquisition [Line Items]
Contingent consideration payable, period				3 years
2015 Acquisitions | Subordinated Unsecured Contingent Note | Maximum
Business Acquisition [Line Items]
Contingent consideration payable, period				6 years
Ohio Based Pathology Practice
Business Acquisition [Line Items]
Percentage of equity acquired												100.00%
Oregon Hospital Based Pathology Practice
Business Acquisition [Line Items]
Percentage of equity acquired			100.00%
2016 Acquisitions
Business Acquisition [Line Items]
Number of businesses acquired | Hospital_Pathology_Practice		1	1
Aggregate net cash consideration paid										$ 7,250,000
Goodwill recognized in the acquisition	$ 2,100,000							$ 2,100,000		2,100,000
2016 Acquisitions | Delayed Draw Term Loan B
Business Acquisition [Line Items]
Line of credit facility, maximum borrowing capacity	40,000,000							40,000,000		$ 40,000,000
2016 Acquisitions | Subordinated Unsecured Contingent Note
Business Acquisition [Line Items]
Contingent consideration payable, period										3 years
Maximum amount of contingent consideration	$ 1,500,000							1,500,000		$ 1,500,000
Florida Hospital Based Pathology Practice
Business Acquisition [Line Items]
Percentage of equity acquired		100.00%
2015 and 2016 Acquisitions
Business Acquisition [Line Items]
Revenue contributed by acquisition								7,200,000		19,500,000
Net income contributed by acquisition								$ 1,400,000		$ 3,500,000

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Acquisitions (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015	Dec. 31, 2014
Business Acquisition [Line Items]
Goodwill	$ 127,473		$ 125,188	$ 177,774
Fair value of contingent consideration issued	(1,100)	$ (5,110)
Net cash paid for acquisitions, net of cash acquired	7,250	$ 8,813
2016 Acquisitions
Business Acquisition [Line Items]
Cash	602
Accounts receivable	849
Other assets	65
Intangible assets	5,860
Goodwill	2,140
Assets acquired	9,516
Accounts payable and accrued expenses	282
Accrued compensation	282
Liabilities assumed	564
Net assets acquired	8,952
Net assets acquired	8,952
Fair value of contingent consideration issued	(1,100)
Cash acquired	(602)
Net cash paid for acquisitions, net of cash acquired	$ 7,250

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Acquisitions (Details 1) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Business acquisition pro forma information
Net revenue	$ 73,235	$ 74,002	$ 216,743	$ 211,862
Net loss	$ (4,070)	$ (3,989)	$ (15,618)	$ (58,531)

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Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Receivables [Abstract]
Accounts Receivable	$ 55,874	$ 49,142
Less: Allowance for doubtful accounts	(17,028)	(16,291)
Accounts receivable, net	$ 38,846	$ 32,851

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Goodwill and Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended		12 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Adjustments to Goodwill
Goodwill, beginning of period	$ 125,188	$ 177,774	$ 177,774
Acquisitions	2,285		4,139
Goodwill impairment		$ (39,641)	(56,725)
Goodwill, end of period	$ 127,473		$ 125,188

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Goodwill and Intangible Assets (Details 1) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2016	Dec. 31, 2015
Intangible assets and related accumulated amortization
Amortization Period (Years)	15 years
Cost	$ 185,917	$ 180,057
Accumulated Amortization	(129,296)	(114,363)
Intangible assets, net	$ 56,621	65,694
Minimum
Intangible assets and related accumulated amortization
Amortization Period (Years)	3 years
Maximum
Intangible assets and related accumulated amortization
Amortization Period (Years)	15 years
Customer Relationships
Intangible assets and related accumulated amortization
Cost	$ 130,748	130,748
Accumulated Amortization	(111,506)	(99,516)
Intangible assets, net	$ 19,242	$ 31,232
Customer Relationships | Minimum
Intangible assets and related accumulated amortization
Amortization Period (Years)	7 years	7 years
Customer Relationships | Maximum
Intangible assets and related accumulated amortization
Amortization Period (Years)	10 years	10 years
Customer Relationships | Weighted Average
Intangible assets and related accumulated amortization
Amortization Period (Years)	8 years	8 years
Health Care Facility Agreements
Intangible assets and related accumulated amortization
Amortization Period (Years)	15 years	15 years
Cost	$ 48,970	$ 43,580
Accumulated Amortization	(12,897)	(10,303)
Intangible assets, net	$ 36,073	$ 33,277
Health Care Facility Agreements | Weighted Average
Intangible assets and related accumulated amortization
Amortization Period (Years)	15 years	15 years
Noncompete Agreements
Intangible assets and related accumulated amortization
Cost	$ 6,199	$ 5,729
Accumulated Amortization	(4,893)	(4,544)
Intangible assets, net	$ 1,306	$ 1,185
Noncompete Agreements | Minimum
Intangible assets and related accumulated amortization
Amortization Period (Years)	3 years	3 years
Noncompete Agreements | Maximum
Intangible assets and related accumulated amortization
Amortization Period (Years)	5 years	5 years
Noncompete Agreements | Weighted Average
Intangible assets and related accumulated amortization
Amortization Period (Years)	4 years	4 years

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Goodwill and Intangible Assets (Details Textual) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Goodwill And Intangible Assets Disclosure [Abstract]
Intangible asset amortization expense	$ 4,964	$ 4,807	$ 14,933	$ 14,168

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Goodwill and Intangible Assets (Details 2) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Estimated future amortization expense
Remainder of 2016	$ 4,767
2017	14,081
2018	6,676
2019	4,848
2020	4,727
Thereafter	21,522
Intangible assets, net	$ 56,621	$ 65,694

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Accounts Payable, Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Summary of accounts payable and accrued expenses and other current liabilities
Accounts payable and accrued payables	$ 11,930	$ 11,513
Reserve for future medical claims	1,997	2,200
Other accrued expenses	4,419	3,126
Accounts payable, accrued expenses and other current liabilities, Total	$ 18,346	$ 16,839

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Long-Term Debt (Details Textual) - USD ($)					9 Months Ended
	Jan. 15, 2017	Apr. 10, 2015	Jul. 31, 2014	Dec. 20, 2010	Sep. 30, 2016	Dec. 31, 2015	Jul. 15, 2015
Debt Instrument [Line Items]
Discounts under credit facility					$ 3,036,000	$ 3,877,000
Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Line of credit facility interest rate description					Prior to the second amendment executed on April 10, 2015 discussed below, at the Company’s option, interest under the credit facility was at LIBOR, with a 1.25% floor, plus 7%, or at a base rate, with a 2.25% floor, plus 6%.
Fee on undrawn amount, per annum		2.25%
Cerberus Business Finance, LLC | Debt Instrument Installment Period One [Member]
Debt Instrument [Line Items]
Line of credit facility periodic principal payment			$ 500,000
Cerberus Business Finance, LLC | Debt Instrument Installment Period Two [Member]
Debt Instrument [Line Items]
Line of credit facility periodic principal payment			900,000
Cerberus Business Finance, LLC | Debt Instrument Installment Period Three [Member]
Debt Instrument [Line Items]
Line of credit facility periodic principal payment			1,300,000
New Senior Secured Credit Facility
Debt Instrument [Line Items]
Line of credit facility interest rate description					The second amendment also increased the interest rate under the credit facility to LIBOR, with a 1.25% floor, plus 7.125%, or to the base rate, with a 2.25% floor, plus 6.125%.
New Senior Secured Credit Facility | London Interbank Offered Rate L I B O R
Debt Instrument [Line Items]
Interest rate		1.25%
Debt instrument variable rate		7.125%
New Senior Secured Credit Facility | Base Rate
Debt Instrument [Line Items]
Interest rate		2.25%
Debt instrument variable rate		6.125%
New Senior Secured Credit Facility | Before Second Amendment | London Interbank Offered Rate L I B O R
Debt Instrument [Line Items]
Interest rate					1.25%
Debt instrument variable rate					7.00%
New Senior Secured Credit Facility | Before Second Amendment | Base Rate
Debt Instrument [Line Items]
Interest rate					2.25%
Debt instrument variable rate					6.00%
New Senior Secured Credit Facility | Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity			$ 220,000,000
Credit facility maturity period			5 years
New Credit Facility, earlier maturity date					Oct. 14, 2017
Discounts under credit facility			$ 5,100,000
Payment of debt issuance costs			3,900,000
Utilization of proceeds from credit facility initial term loan for future acquisition and other			10,400,000
Utilization of funds from revolving credit line for future acquisition and other			30,000,000
Delayed Draw Term Loan
Debt Instrument [Line Items]
Unpaid principal balance					$ 35,000,000	25,000,000
Delayed draw term loan outstanding amount							$ 15,300,000
Delayed draw term loan facility amount borrowed in excess of acquisition cost inclusive of related expenses							5,400,000
Extension date of line of credit borrowing capacity					Oct. 31, 2015
Delayed draw term loan, maximum borrowing capacity							$ 25,000,000
Delayed Draw Term Loan | Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Unpaid principal balance			25,000,000
Last date of draw availability					Jul. 31, 2015
Initial Term Loan
Debt Instrument [Line Items]
Unpaid principal balance					$ 162,500,000	$ 164,000,000
Initial Term Loan | Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Unpaid principal balance					162,500,000
Senior secured term loan facility included in new credit facility			165,000,000
Revolving Credit Facility
Debt Instrument [Line Items]
Amount available under revolving credit facility					30,000,000
Revolving Credit Facility | Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity			30,000,000
Repayments of term loan facility			$ 145,600,000
Amount available under revolving credit facility					30,000,000
Line of credit facility outstanding amount					0
Senior Secured First Lien Revolving Credit Facility | Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Debt instrument maturity year and month			2015-05
Senior Secured First Lien Term Loan Facility | Cerberus Business Finance, LLC
Debt Instrument [Line Items]
Debt instrument maturity year and month			2016-05
Delayed Draw Term Loan B
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity		$ 40,000,000
Unpaid principal balance					10,000,000
Amount available under revolving credit facility					$ 30,000,000
Line of credit facility available through date					Apr. 25, 2016
Line of credit facility expired date					Apr. 25, 2016
Unsecured Debt
Debt Instrument [Line Items]
Unsecured senior notes, maturity date				Jan. 15, 2018
Unsecured senior notes				$ 200,000,000
Interest rate				10.75%
Debt instrument, redemption percentage					102.688%
Unsecured Debt | Scenario, Forecast
Debt Instrument [Line Items]
Debt instrument, redemption percentage	100.00%

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Long-Term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Long-Term Debt
Notes payable	$ 133	$ 133
Capital lease obligations	69	129
Long term debt and capital lease obligations	397,702	389,262
Less:
Original issue discount, net	(3,036)	(3,877)
Debt issuance costs, net	(4,132)	(5,621)
Current portion	(3,251)	(2,147)
Long-term debt, net of current portion	387,283	377,617
Senior Notes
Long-Term Debt
Gross debt	200,000	200,000
Initial Term Loan
Long-Term Debt
Gross debt	162,500	164,000
Delayed Draw Term Loan
Long-Term Debt
Gross debt	$ 35,000	$ 25,000

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Long-Term Debt (Details 1) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Estimated future debt principal payments
Remainder of 2016	$ 589
2017	3,608
2018	204,255
2019	189,250
Long term debt and capital lease obligations	$ 397,702	$ 389,262

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Contingent Consideration (Details Textual) - USD ($)			3 Months Ended		9 Months Ended
	Sep. 30, 2016	Jul. 15, 2015	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Business Acquisition Contingent Consideration [Line Items]
Fair value of contingent consideration	$ 12,000,000		$ 12,000,000		$ 12,000,000		$ 13,100,000
Payment of consideration under contingent notes			1,600,000	$ 1,000,000	3,407,000	$ 2,296,000
Subordinated Unsecured Contingent Note
Business Acquisition Contingent Consideration [Line Items]
Contingent consideration payable, period	3 years
Fair value of contingent consideration	$ 8,000,000		8,000,000		8,000,000
Subordinated Unsecured Contingent Note | Minimum
Business Acquisition Contingent Consideration [Line Items]
Contingent consideration payable, period		3 years
Subordinated Unsecured Contingent Note | Maximum
Business Acquisition Contingent Consideration [Line Items]
Contingent consideration payable, period		6 years
Fair value of contingent consideration	$ 13,400,000		$ 13,400,000		$ 13,400,000

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Related Party Transactions (Details Textual) - Acquisition Target Consulting Agreement - Affiliated Entity	3 Months Ended		9 Months Ended
	Sep. 30, 2016 USD ($)	Sep. 30, 2015 USD ($)	Sep. 30, 2016 USD ($) Person	Sep. 30, 2015 USD ($)	Dec. 31, 2015 USD ($)
Related Party Transaction [Line Items]
Agreement monthly retainer			$ 12,000
Agreement success fee			$ 65,000
Number of members in related party transaction | Person			2
Related party transaction target identification consulting service	$ 38,000	$ 100,000	$ 200,000	$ 200,000
Percent of revenue paid by entity for certain new business development			8.00%
Amount owed to related party	$ 15,000		$ 15,000		$ 0

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Related Party Transactions (Details Textual 1) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Related Party Transaction [Line Items]
Accrued management fees, related party	$ 10,780,000		$ 10,780,000		$ 8,633,000
Management fees, related party	733,000	$ 697,000	$ 2,148,000	$ 1,914,000
Management And Financial Advisory Agreement
Related Party Transaction [Line Items]
Percentage of revenues			1.00%
Accrued management fees, related party	10,800,000		$ 10,800,000		$ 8,600,000
Payment of management fees	$ 0	$ 0	$ 0	$ 0
Date through which company expects to not pay management fees			Sep. 30, 2017

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Related Party Transactions (Details Textual 2)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2016 USD ($)	Sep. 30, 2015 USD ($)	Sep. 30, 2016 USD ($) Facilities	Sep. 30, 2015 USD ($)	Dec. 31, 2015 USD ($)
Facilities Lease Agreements | Affiliated Entity
Related Party Transaction [Line Items]
Number of currently lease facilities | Facilities			6
Related party transaction lease aggregate monthly base payments			$ 90,000
Payments for rent	$ 300,000	$ 300,000	800,000	$ 700,000
Management and Financial Consultancy Services Agreement
Related Party Transaction [Line Items]
Monthly service fee			100,000
Paid to related party	$ 600,000	$ 800,000	1,600,000	$ 2,400,000
Prepaid retainer			$ 200,000		$ 200,000

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Related Party Transactions (Details Textual 3) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Healthcare Administration Services
Related Party Transaction [Line Items]
Fees paid to related party			$ 20,000
Paid to related party including stop loss coverage premium	$ 0	$ 14,000	27,000	$ 1,200,000
Amount owed to related party	0		0		$ 0
Crowley Corporate Legal Strategy
Related Party Transaction [Line Items]
Consulting fees	$ 16,000	$ 45,000	$ 59,000	$ 91,000

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Related Party Transactions (Details Textual 4) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015	Dec. 31, 2015
Related Party Transaction [Line Items]
Consulting fees inclusive of travel reimbursement for board meetings	$ 733,000	$ 697,000	$ 2,148,000	$ 1,914,000
Executive Consulting Agreement
Related Party Transaction [Line Items]
Monthly consulting service fee			12,500
Consulting fees inclusive of travel reimbursement for board meetings	2,000	$ 28,000	29,000	$ 108,000
Amount owed to related party	$ 0		$ 0		$ 0

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Related Party Transactions (Details Textual 5) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
OmegaComp.
Related Party Transaction [Line Items]
Commissions paid	$ 77,000	$ 26,000	$ 226,000	$ 118,000

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Related Party Transactions (Details Textual 6) - USD ($)		3 Months Ended		9 Months Ended
	Jun. 15, 2016	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015	Jun. 13, 2016	Oct. 29, 2015
Related Party Transaction [Line Items]
Payment of consideration under contingent notes		$ 1,600,000	$ 1,000,000	$ 3,407,000	$ 2,296,000
Subordinated Unsecured Contingent Note | Chief Medical Officer | Pathology Practice
Related Party Transaction [Line Items]
Maximum amount of contingent consideration						$ 2,400,000	$ 2,700,000
Payment of consideration under contingent notes	$ 650,000

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Related Party Transactions (Details Textual 7) - Client Interface Services - Affiliated Entity	3 Months Ended		9 Months Ended
	Sep. 30, 2016 USD ($)	Sep. 30, 2015 USD ($)	Sep. 30, 2016 USD ($) Person	Sep. 30, 2015 USD ($)	Dec. 31, 2015 USD ($)
Related Party Transaction [Line Items]
Number of members in related party transaction | Person			1
Related party transaction payments	$ 22,000	$ 17,000	$ 200,000	$ 100,000
Amount owed to related party	$ 16,000		$ 16,000		$ 0

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Equity-Based Compensation (Details Textual) - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Issuance options	1,931,129		1,931,129
Options outstanding	1,510,500		1,510,500
Options available for future grants	420,629		420,629
Options outstanding vested	974,725		974,725
Options outstanding unvested	535,775		535,775
Options granted			0
Options exercised			0
Options forfeited			34,500
Total remaining unamortized equity compensation cost	$ 100,000		$ 100,000
Selling, General and Administrative Expenses
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Equity compensation costs	$ 28,000	$ 55,000	$ 100,000	$ 200,000

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Commitments and Contingencies (Details Textual) - USD ($)	1 Months Ended		3 Months Ended	9 Months Ended	12 Months Ended
	Nov. 30, 2015	Aug. 31, 2015	Mar. 31, 2016	Sep. 30, 2016	Dec. 31, 2011	Dec. 31, 2015
Loss Contingencies [Line Items]
Reserve for future medical claims				$ 1,997,000		$ 2,200,000
Amount claimed due by Company				2,800,000
Non-cash charge for abandoned leasehold improvements			$ 1,100,000
Additional taxes, interest and penalties	$ 500,000
Claims of overpayments received by the Company					$ 1,600,000
Company offered to settle claims from VA		$ 1,200,000
Monthly equal Installment payment				100,000
Accrued liability recorded for settlement						800,000
Fair value of contingent consideration				12,000,000		13,100,000
Estimated total amount of future contingent note payments as of the balance sheet date				16,100,000
Remaining obligations under purchase commitments included in other liabilities				1,500,000		$ 1,600,000
Maximum
Loss Contingencies [Line Items]
Amount claimed due by seller				$ 2,700,000

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Commitments and Contingencies (Details) $ in Thousands	Sep. 30, 2016 USD ($)
Unrecorded Unconditional Purchase Obligation [Abstract]
Remainder of 2016	$ 634
2017	2,025
2018	834
2019	794
2020	787
Thereafter	97
Total	$ 5,171

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Fair Value of Financial Instruments (Details Textual) - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2016	Dec. 31, 2015
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of contingent consideration	$ 12.0	$ 13.1
Fair value of the debt	357.7	332.1
Fair Value Measurements Recurring
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value of contingent consideration	$ 12.0	$ 13.1
Minimum | Fair Value, Inputs, Level 3
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value assumption, discount rate	14.00%
Maximum | Fair Value, Inputs, Level 3
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Fair value assumption, discount rate	19.00%

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Fair Value of Financial Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015
Summary of the Company's fair value instruments categorized by their fair value
Current portion of fair value of contingent consideration	$ 5,569	$ 4,820
Fair value of contingent consideration, net of current portion	6,410	8,320
Fair Value Measurements Recurring
Summary of the Company's fair value instruments categorized by their fair value
Current portion of fair value of contingent consideration	5,569	4,820
Fair value of contingent consideration, net of current portion	6,410	8,320
Significant Unobservable Inputs Level 3 | Fair Value Measurements Recurring
Summary of the Company's fair value instruments categorized by their fair value
Current portion of fair value of contingent consideration	5,569	4,820
Fair value of contingent consideration, net of current portion	$ 6,410	$ 8,320

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Fair Value of Financial Instruments (Details 1) - Fair Value Measurements Recurring - Contingent Consideration $ in Thousands	9 Months Ended
	Sep. 30, 2016 USD ($)
Roll-forward of the Company's level 3 fair value instruments
Beginning Balance	$ 13,140
Total (Gains) / Losses-Realized and Unrealized	1,146
Issuances	1,100
Settlements	(3,407)
Ending Balance	$ 11,979

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Income Taxes (Details Textual) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Income Tax Disclosure [Abstract]
Provision (benefit) for federal and state taxes	$ 550	$ 10	$ (473)	$ (812)

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Guarantor Subsidiaries (Details Textual) - USD ($) $ in Millions	Sep. 30, 2016	Dec. 31, 2015
Subsidiary Guarantors
Condensed Financial Statements Captions [Line Items]
Property and equipment held by Non-Guarantor Subsidiaries	$ 2.1	$ 2.2
Subsidiaries owned by the Company	100.00%
Senior Notes
Condensed Financial Statements Captions [Line Items]
Interest rate	10.75%

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Guarantor Subsidiaries (Details) - USD ($) $ in Thousands	Sep. 30, 2016	Dec. 31, 2015	Sep. 30, 2015	Dec. 31, 2014
Current Assets
Cash and cash equivalents	$ 12,062	$ 19,085	$ 20,498	$ 26,422
Accounts receivable, net	38,846	32,851
Prepaid expenses and other assets	5,098	4,321
Prepaid income taxes	441	175
Total current assets	56,447	56,432
Property and equipment, net	8,004	8,646
Other Assets:
Deferred debt issue costs, net	358	453
Deferred financing costs, deposits and other noncurrent assets	2,103	596
Deposits and other noncurrent assets		596
Goodwill	127,473	125,188		177,774
Intangible assets, net	56,621	65,694
Total other assets	186,555	191,931
Total Assets	251,006	257,009
Current Liabilities
Current portion of long-term debt	3,251	2,147
Current portion of fair value of contingent consideration	5,569	4,820
Accounts payable, accrued expenses and other current liabilities	18,346	16,839
Accrued compensation	8,559	7,030
Accrued interest	8,805	14,228
Total current liabilities	44,530	45,064
Long-term debt, net of current portion	387,283	377,617
Deferred tax liabilities	5,990	6,473
Accrued management fees, related parties	10,780	8,633
Fair value of contingent consideration, net of current portion	6,410	8,320
Other liabilities	2,702	1,685
Members' Deficit	(206,689)	(190,783)
Total Liabilities and Members' Deficit	251,006	257,009
Consolidating Adjustments
Other Assets:
Intercompany receivable	(364,335)	(373,041)
Total other assets	(364,335)	(373,041)
Total Assets	(364,335)	(373,041)
Current Liabilities
Intercompany payable	(364,335)	(373,041)
Total Liabilities and Members' Deficit	(364,335)	(373,041)
Aurora Diagnostics Holdings, LLC
Current Assets
Cash and cash equivalents	11,683	17,833	20,375	26,209
Accounts receivable, net		759
Prepaid expenses and other assets	2,354	1,890
Prepaid income taxes	24
Total current assets	14,061	20,482
Property and equipment, net	1,971	2,453
Other Assets:
Intercompany receivable	364,335	373,041
Deferred debt issue costs, net	358	453
Deferred financing costs, deposits and other noncurrent assets	1,846
Deposits and other noncurrent assets		345
Intangible assets, net		118
Total other assets	366,539	373,957
Total Assets	382,571	396,892
Current Liabilities
Current portion of long-term debt	3,147	2,021
Accounts payable, accrued expenses and other current liabilities	11,985	9,979
Accrued compensation	2,132	2,784
Accrued interest	8,805	14,228
Total current liabilities	26,069	29,012
Long-term debt, net of current portion	387,234	377,562
Accrued management fees, related parties	10,780	8,633
Other liabilities	1,550	1,603
Members' Deficit	(43,062)	(19,918)
Total Liabilities and Members' Deficit	382,571	396,892
Subsidiary Guarantors
Current Assets
Cash and cash equivalents	44	1,198	46	192
Accounts receivable, net	18,769	16,317
Prepaid expenses and other assets	1,530	1,292
Prepaid income taxes	295	60
Total current assets	20,638	18,867
Property and equipment, net	6,033	6,193
Other Assets:
Deferred financing costs, deposits and other noncurrent assets	167
Deposits and other noncurrent assets		143
Goodwill	77,440	77,110
Intangible assets, net	25,511	34,450
Total other assets	103,118	111,703
Total Assets	129,789	136,763
Current Liabilities
Current portion of long-term debt	104	126
Current portion of fair value of contingent consideration	1,025	1,013
Accounts payable, accrued expenses and other current liabilities	2,593	2,543
Accrued compensation	3,405	2,378
Total current liabilities	7,127	6,060
Intercompany payable	153,960	170,121
Long-term debt, net of current portion	49	55
Deferred tax liabilities	2,391	2,443
Fair value of contingent consideration, net of current portion	875	1,367
Members' Deficit	(34,613)	(43,283)
Total Liabilities and Members' Deficit	129,789	136,763
Non-Guarantor Subsidiaries
Current Assets
Cash and cash equivalents	335	54	$ 77	$ 21
Accounts receivable, net	20,077	15,775
Prepaid expenses and other assets	1,214	1,139
Prepaid income taxes	122	115
Total current assets	21,748	17,083
Other Assets:
Deferred financing costs, deposits and other noncurrent assets	90
Deposits and other noncurrent assets		108
Goodwill	50,033	48,078
Intangible assets, net	31,110	31,126
Total other assets	81,233	79,312
Total Assets	102,981	96,395
Current Liabilities
Current portion of fair value of contingent consideration	4,544	3,807
Accounts payable, accrued expenses and other current liabilities	3,768	4,317
Accrued compensation	3,022	1,868
Total current liabilities	11,334	9,992
Intercompany payable	210,375	202,920
Deferred tax liabilities	3,599	4,030
Fair value of contingent consideration, net of current portion	5,535	6,953
Other liabilities	1,152	82
Members' Deficit	(129,014)	(127,582)
Total Liabilities and Members' Deficit	$ 102,981	$ 96,395

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Guarantor Subsidiaries (Details 1) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Condensed Financial Statements Captions [Line Items]
Net revenue	$ 73,235	$ 69,683	$ 214,776	$ 193,722
Operating costs and expenses:
Cost of services	38,748	36,925	114,370	106,164
Selling, general and administrative expenses	16,855	16,747	53,730	49,495
Provision for doubtful accounts	3,978	4,228	12,107	12,731
Intangible asset amortization expense	4,964	4,807	14,933	14,168
Management fees, related parties	733	697	2,148	1,914
Impairment of goodwill and other intangible assets				39,641
Merger and acquisition costs	762	297	1,338	694
Change in fair value of contingent consideration	166	180	1,146	686
Total operating costs and expenses	66,206	63,881	199,772	225,493
Income (loss) from operations	7,029	5,802	15,004	(31,771)
Other (expense) income:
Interest expense	(10,544)	(10,490)	(31,494)	(30,434)
Other income	(5)	(2)		4
Total other expense, net	(10,549)	(10,492)	(31,494)	(30,430)
Loss before income taxes	(3,520)	(4,690)	(16,490)	(62,201)
Provision (benefit) for income taxes	550	10	(473)	(812)
Net (loss) income	(4,070)	(4,700)	(16,017)	(61,389)
Aurora Diagnostics Holdings, LLC
Operating costs and expenses:
Selling, general and administrative expenses	5,252	5,682	16,822	16,384
Management fees, related parties	(3,804)	2,772	2,162	14,077
Merger and acquisition costs	762	297	1,338	694
Total operating costs and expenses	2,210	8,751	20,322	31,155
Income (loss) from operations	(2,210)	(8,751)	(20,322)	(31,155)
Other (expense) income:
Interest expense	(6,901)	(7,309)	(20,811)	(21,097)
Other income		(2)
Total other expense, net	(6,901)	(7,311)	(20,811)	(21,097)
Loss before income taxes	(9,111)	(16,062)	(41,133)	(52,252)
Net (loss) income	(9,111)	(16,062)	(41,133)	(52,252)
Subsidiary Guarantors
Condensed Financial Statements Captions [Line Items]
Net revenue	42,401	39,330	122,238	110,217
Operating costs and expenses:
Cost of services	14,783	15,809	47,919	45,582
Selling, general and administrative expenses	6,749	6,495	21,166	19,662
Provision for doubtful accounts	1,905	2,300	6,356	7,206
Intangible asset amortization expense	3,188	3,111	9,677	9,398
Management fees, related parties	9,783		9,783
Impairment of goodwill and other intangible assets				36,001
Change in fair value of contingent consideration	79	40	169	110
Total operating costs and expenses	36,487	27,755	95,070	117,959
Income (loss) from operations	5,914	11,575	27,168	(7,742)
Other (expense) income:
Interest expense	(711)	(479)	(2,098)	(1,556)
Other income				1
Total other expense, net	(711)	(479)	(2,098)	(1,555)
Loss before income taxes	5,203	11,096	25,070	(9,297)
Provision (benefit) for income taxes	162	(266)	(46)	(160)
Net (loss) income	5,041	11,362	25,116	(9,137)
Non-Guarantor Subsidiaries
Condensed Financial Statements Captions [Line Items]
Net revenue	30,834	30,353	92,538	83,505
Operating costs and expenses:
Cost of services	23,965	21,116	66,451	60,582
Selling, general and administrative expenses	4,854	4,570	15,742	13,449
Provision for doubtful accounts	2,073	1,928	5,751	5,525
Intangible asset amortization expense	1,776	1,696	5,256	4,770
Management fees, related parties	(5,246)	(2,075)	(9,797)	(12,163)
Impairment of goodwill and other intangible assets				3,640
Change in fair value of contingent consideration	87	140	977	576
Total operating costs and expenses	27,509	27,375	84,380	76,379
Income (loss) from operations	3,325	2,978	8,158	7,126
Other (expense) income:
Interest expense	(2,932)	(2,702)	(8,585)	(7,781)
Other income	(5)			3
Total other expense, net	(2,937)	(2,702)	(8,585)	(7,778)
Loss before income taxes	388	276	(427)	(652)
Provision (benefit) for income taxes	$ 388	$ 276	$ (427)	$ (652)

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Guarantor Subsidiaries (Details 2) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2016	Sep. 30, 2015	Sep. 30, 2016	Sep. 30, 2015
Condensed Financial Statements Captions [Line Items]
Net (loss) income	$ (4,070)	$ (4,700)	$ (16,017)	$ (61,389)
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities			22,162	58,698
Changes in assets and liabilities			(8,693)	(4,060)
Net cash used in operating activities			(2,548)	(6,751)
Net cash used in investing activities			(12,654)	(12,242)
Net cash provided by (used in) financing activities			8,179	13,069
Net decrease in cash and cash equivalents			(7,023)	(5,924)
Cash and cash equivalents, beginning of period			19,085	26,422
Cash and cash equivalents, end of period	12,062	20,498	12,062	20,498
Aurora Diagnostics Holdings, LLC
Condensed Financial Statements Captions [Line Items]
Net (loss) income	(9,111)	(16,062)	(41,133)	(52,252)
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities			3,299	3,493
Changes in assets and liabilities			31,189	39,115
Net cash used in operating activities			(6,645)	(9,644)
Net cash used in investing activities			(7,730)	(9,300)
Net cash provided by (used in) financing activities			8,225	13,110
Net decrease in cash and cash equivalents			(6,150)	(5,834)
Cash and cash equivalents, beginning of period			17,833	26,209
Cash and cash equivalents, end of period	11,683	20,375	11,683	20,375
Subsidiary Guarantors
Condensed Financial Statements Captions [Line Items]
Net (loss) income	5,041	11,362	25,116	(9,137)
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities			11,890	46,926
Changes in assets and liabilities			(35,947)	(37,248)
Net cash used in operating activities			1,059	541
Net cash used in investing activities			(2,167)	(646)
Net cash provided by (used in) financing activities			(46)	(41)
Net decrease in cash and cash equivalents			(1,154)	(146)
Cash and cash equivalents, beginning of period			1,198	192
Cash and cash equivalents, end of period	44	46	44	46
Non-Guarantor Subsidiaries
Condensed Financial Statements Captions [Line Items]
Adjustments to reconcile net (loss) income to net cash (used in) provided by operating activities			6,973	8,279
Changes in assets and liabilities			(3,935)	(5,927)
Net cash used in operating activities			3,038	2,352
Net cash used in investing activities			(2,757)	(2,296)
Net decrease in cash and cash equivalents			281	56
Cash and cash equivalents, beginning of period			54	21
Cash and cash equivalents, end of period	$ 335	$ 77	$ 335	$ 77