QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
(State or other jurisdiction of incorporation or organization) | (I.R.S. Employer Identification No.) |
( | ||
(Address, Including Zip Code, and Telephone Number, Including Area Code, of Registrant’s Principal Executive Offices) |
Title of each class | Trading Symbol | Name of each exchange on which registered | ||||||
Common Stock, $0.01 par value per share | AKUMQ* | OTC Pink Open Market* | ||||||
Common Stock, $0.01 par value per share | AKU | The Toronto Stock Exchange |
Large accelerated filer | o | Accelerated filer | o | |||||||||||
x | Smaller reporting company | |||||||||||||
Emerging growth company |
Page | ||||||||
September 30, 2023 | December 31, 2022 | ||||||||||
ASSETS | |||||||||||
Current assets: | |||||||||||
Cash and cash equivalents | $ | $ | |||||||||
Accounts receivable | |||||||||||
Prepaid expenses | |||||||||||
Other current assets | |||||||||||
Total current assets | |||||||||||
Property and equipment, net | |||||||||||
Operating lease right-of-use assets | |||||||||||
Goodwill | |||||||||||
Other intangible assets, net | |||||||||||
Other assets | |||||||||||
Total assets | $ | $ | |||||||||
LIABILITIES, REDEEMABLE NONCONTROLLING INTERESTS AND EQUITY | |||||||||||
Current liabilities: | |||||||||||
Accounts payable | $ | $ | |||||||||
Current portion of long-term debt | |||||||||||
Current portion of obligations under finance leases | |||||||||||
Current portion of obligations under operating leases | |||||||||||
Accrued liabilities | |||||||||||
Total current liabilities | |||||||||||
Long-term debt, net of current portion | |||||||||||
Obligations under finance leases, net of current portion | |||||||||||
Obligations under operating leases, net of current portion | |||||||||||
Other liabilities | |||||||||||
Total liabilities | |||||||||||
Redeemable noncontrolling interests | |||||||||||
Stockholders’ deficit: | |||||||||||
Preferred stock, $ | |||||||||||
Common stock, $ | |||||||||||
Additional paid-in capital | |||||||||||
Accumulated other comprehensive income | |||||||||||
Accumulated deficit | ( | ( | |||||||||
Total stockholders’ deficit | ( | ( | |||||||||
Noncontrolling interests | |||||||||||
Total (deficit) equity | ( | ||||||||||
Total liabilities, redeemable noncontrolling interests and equity | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
2023 | 2022 | 2023 | 2022 | ||||||||||||||||||||
Revenues | $ | $ | $ | $ | |||||||||||||||||||
Operating expenses: | |||||||||||||||||||||||
Cost of operations, excluding depreciation and amortization | |||||||||||||||||||||||
Depreciation and amortization | |||||||||||||||||||||||
Impairment charges | |||||||||||||||||||||||
Restructuring charges | |||||||||||||||||||||||
Severance and related costs | |||||||||||||||||||||||
Settlements, recoveries and related costs | ( | ||||||||||||||||||||||
Other operating income, net | ( | ( | ( | ( | |||||||||||||||||||
Total operating expenses | |||||||||||||||||||||||
Loss from operations | ( | ( | ( | ( | |||||||||||||||||||
Other expense (income): | |||||||||||||||||||||||
Interest expense | |||||||||||||||||||||||
Other non-operating expense (income), net | ( | ( | |||||||||||||||||||||
Total other expense, net | |||||||||||||||||||||||
Loss before income taxes | ( | ( | ( | ( | |||||||||||||||||||
Income tax expense (benefit) | ( | ( | |||||||||||||||||||||
Net loss | ( | ( | ( | ( | |||||||||||||||||||
Less: Net income (loss) attributable to noncontrolling and redeemable noncontrolling interests | ( | ||||||||||||||||||||||
Net loss attributable to common stockholders | $ | ( | $ | ( | $ | ( | $ | ( | |||||||||||||||
Comprehensive loss, net of taxes: | |||||||||||||||||||||||
Net loss | $ | ( | $ | ( | $ | ( | $ | ( | |||||||||||||||
Other comprehensive income (loss): | |||||||||||||||||||||||
Unrealized gain (loss) on hedging transactions, net of taxes | ( | ( | |||||||||||||||||||||
Reclassification adjustment for gains (losses) included in net loss, net of taxes | ( | ( | ( | ||||||||||||||||||||
Other comprehensive income (loss) | ( | ( | |||||||||||||||||||||
Comprehensive loss, net of taxes | ( | ( | ( | ( | |||||||||||||||||||
Less: Comprehensive income (loss) attributable to noncontrolling and redeemable noncontrolling interests | ( | ||||||||||||||||||||||
Comprehensive loss attributable to common stockholders | $ | ( | $ | ( | $ | ( | $ | ( | |||||||||||||||
Net loss per share attributable to common stockholders: | |||||||||||||||||||||||
Basic and diluted | $ | ( | $ | ( | $ | ( | $ | ( |
Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit | Total Stockholders’ Equity (Deficit) | Noncontrolling Interests | Total Equity | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, June 30, 2022 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Net income (loss), net of the net income attributable to redeemable noncontrolling interests | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||
Settlement of restricted share units | ( | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | |||||||||||||||||||||||||||||||||||||||
Purchase accounting adjustments | — | — | — | — | — | — | ( | ( | |||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2022 | $ | $ | $ | $ | ( | $ | ( | $ | $ |
Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit | Total Stockholders’ Equity (Deficit) | Noncontrolling Interests | Total Equity (Deficit) | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, June 30, 2023 | $ | $ | $ | $ | ( | $ | ( | $ | $ | ( | |||||||||||||||||||||||||||||||||||||
Net income (loss), net of the net loss attributable to redeemable noncontrolling interests | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||
Settlement of restricted share units | ( | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive loss | — | — | — | ( | — | ( | — | ( | |||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | |||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2023 | $ | $ | $ | $ | ( | $ | ( | $ | $ | ( |
Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit | Total Stockholders’ Equity (Deficit) | Noncontrolling Interests | Total Equity | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, December 31, 2021 | $ | $ | $ | $ | ( | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Net income (loss), net of the net income attributable to redeemable noncontrolling interests | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||
Settlement of restricted share units | ( | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | |||||||||||||||||||||||||||||||||||||||
Purchase accounting adjustments | — | — | — | — | — | — | ( | ( | |||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2022 | $ | $ | $ | $ | ( | $ | ( | $ | $ |
Common Stock | Additional Paid-In Capital | Accumulated Other Comprehensive Income (Loss) | Accumulated Deficit | Total Stockholders’ Equity (Deficit) | Noncontrolling Interests | Total Equity (Deficit) | |||||||||||||||||||||||||||||||||||||||||
Shares | Amount | ||||||||||||||||||||||||||||||||||||||||||||||
Balance, December 31, 2022 | $ | $ | $ | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||||||||||
Net income (loss), net of the net loss attributable to redeemable noncontrolling interests | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||
Settlement of restricted share units | ( | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Stock-based compensation | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||
Other comprehensive loss | — | — | — | ( | — | ( | — | ( | |||||||||||||||||||||||||||||||||||||||
Distributions paid to noncontrolling interests | — | — | — | — | — | — | ( | ( | |||||||||||||||||||||||||||||||||||||||
Balance, September 30, 2023 | $ | $ | $ | $ | ( | $ | ( | $ | $ | ( |
Nine Months Ended September 30, | |||||||||||
2023 | 2022 | ||||||||||
Operating activities: | |||||||||||
Net loss | $ | ( | $ | ( | |||||||
Adjustments to reconcile net loss to net cash provided by operating activities: | |||||||||||
Depreciation and amortization | |||||||||||
Impairment charges | |||||||||||
Stock-based compensation | |||||||||||
Non-cash interest expense | |||||||||||
Amortization of deferred financing costs and accretion of discount/premium on long-term debt | |||||||||||
Deferred income taxes | ( | ||||||||||
Distributions from unconsolidated investees | |||||||||||
Earnings from unconsolidated investees | ( | ( | |||||||||
Loss (gain) on sale of accounts receivable | ( | ||||||||||
Other non-cash items, net | ( | ( | |||||||||
Changes in operating assets and liabilities: | |||||||||||
Accounts receivable | ( | ||||||||||
Prepaid expenses and other assets | ( | ( | |||||||||
Accounts payable and other liabilities | |||||||||||
Operating lease liabilities and right-of-use assets | ( | ||||||||||
Net cash provided by operating activities | |||||||||||
Investing activities: | |||||||||||
Purchases of property and equipment | ( | ( | |||||||||
Other investing activities | |||||||||||
Net cash used in investing activities | $ | ( | $ | ( |
Nine Months Ended September 30, | |||||||||||
2023 | 2022 | ||||||||||
Financing activities: | |||||||||||
Proceeds from revolving loan | $ | $ | |||||||||
Principal payments on revolving loan | ( | ( | |||||||||
Proceeds from long-term debt | |||||||||||
Principal payments on long-term debt | ( | ( | |||||||||
Principal payments on finance leases | ( | ( | |||||||||
Contributions received from redeemable noncontrolling interests | |||||||||||
Distributions paid to noncontrolling and redeemable noncontrolling interests | ( | ( | |||||||||
Net cash used in financing activities | ( | ( | |||||||||
Net (decrease) increase in cash and cash equivalents | ( | ||||||||||
Cash and cash equivalents, beginning of period | |||||||||||
Cash and cash equivalents, end of period | $ | $ | |||||||||
Supplemental disclosure of cash flow information: | |||||||||||
Interest paid | $ | $ | |||||||||
Income taxes paid, net of refunds | |||||||||||
Supplemental disclosure of non-cash investing and financing activities: | |||||||||||
Property and equipment purchases in accounts payable and accrued liabilities | |||||||||||
Derecognition of operating lease right-of-use assets and lease liabilities associated with lease terminations | |||||||||||
Equipment acquired in exchange for finance lease obligations | |||||||||||
Operating lease right-of-use assets obtained in exchange for operating lease liabilities |
(in thousands) | September 30, 2023 | December 31, 2022 | |||||||||
Medical equipment | $ | $ | |||||||||
Leasehold improvements | |||||||||||
Equipment under finance leases | |||||||||||
Office and computer equipment | |||||||||||
Transportation and service equipment | |||||||||||
Furniture and fixtures | |||||||||||
Construction in progress | |||||||||||
Less accumulated depreciation | |||||||||||
$ | $ |
(in thousands) | Radiology | Oncology | Total | ||||||||||||||
Balance, December 31, 2022 | $ | $ | $ | ||||||||||||||
Impairment | ( | ( | ( | ||||||||||||||
Goodwill written off in connection with site closures | ( | ( | |||||||||||||||
Balance, September 30, 2023 | $ | $ | $ |
Discount rate | |||||
Perpetual growth rate | |||||
Tax rate | |||||
Risk-free interest rate | |||||
Revenue multiple | |||||
EBITDA multiple |
(dollars in thousands) | Weighted Average Useful Life (in years) | September 30, 2023 | December 31, 2022 | ||||||||||||||||||||||||||||||||||||||
Gross Carrying Amount | Accumulated Amortization | Other Intangible Assets, Net | Gross Carrying Amount | Accumulated Amortization | Other Intangible Assets, Net | ||||||||||||||||||||||||||||||||||||
Finite-lived intangible assets: | |||||||||||||||||||||||||||||||||||||||||
Customer contracts | $ | $ | ( | $ | $ | $ | ( | $ | |||||||||||||||||||||||||||||||||
Trade names | ( | ( | |||||||||||||||||||||||||||||||||||||||
Management agreements | ( | ( | |||||||||||||||||||||||||||||||||||||||
Other | ( | ( | |||||||||||||||||||||||||||||||||||||||
Total | $ | $ | ( | $ | $ | ( | |||||||||||||||||||||||||||||||||||
Certificates of Need | |||||||||||||||||||||||||||||||||||||||||
Total other intangible assets | $ | $ |
(in thousands) | September 30, 2023 | December 31, 2022 | |||||||||
2028 Senior Notes | $ | $ | |||||||||
2025 Senior Notes | |||||||||||
Subordinated Notes | |||||||||||
Equipment Debt | |||||||||||
Revolving Facility | |||||||||||
Debt discount/premium and deferred issuance costs | ( | ( | |||||||||
Less current portion | |||||||||||
Long-term debt, net of current portion | $ | $ |
(in thousands) | September 30, 2023 | December 31, 2022 | |||||||||
Accrued compensation and related expenses | $ | $ | |||||||||
Accrued interest expense | |||||||||||
Other | |||||||||||
$ | $ |
(in thousands) | |||||
Balance, December 31, 2022 | $ | ||||
Net loss attributable to redeemable noncontrolling interests | ( | ||||
Contributions received from redeemable noncontrolling interests | |||||
Distributions paid to redeemable noncontrolling interests | ( | ||||
Balance, September 30, 2023 | $ |
Fair Value as of September 30, 2023 | Fair Value as of December 31, 2022 | ||||||||||||||||||||||||||||||||||||||||||||||
(in thousands) | Level 1 | Level 2 | Level 3 | Total | Level 1 | Level 2 | Level 3 | Total | |||||||||||||||||||||||||||||||||||||||
Current and long-term assets: | |||||||||||||||||||||||||||||||||||||||||||||||
Interest rate and fuel option contracts | $ | $ | $ | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
Long-term liabilities: | |||||||||||||||||||||||||||||||||||||||||||||||
Derivative in subordinated notes | $ | $ | $ | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||
(in thousands) | |||||
Balance, December 31, 2022 | $ | ||||
Change in fair value | ( | ||||
Balance, September 30, 2023 | $ |
(in thousands) | September 30, 2023 | December 31, 2022 | |||||||||
2028 Senior Notes | $ | $ | |||||||||
2025 Senior Notes | |||||||||||
Subordinated Notes | |||||||||||
Equipment Debt | |||||||||||
Revolving Facility | |||||||||||
$ | $ |
(in thousands) | September 30, 2023 | December 31, 2022 | |||||||||
Financial assets measured at amortized cost: | |||||||||||
Cash and cash equivalents | $ | $ | |||||||||
Accounts receivable | |||||||||||
$ | $ | ||||||||||
Financial liabilities measured at amortized cost: | |||||||||||
Accounts payable | $ | $ | |||||||||
Current portion of long-term debt | |||||||||||
Current portion of leases | |||||||||||
Non-current portion of long-term debt | |||||||||||
Non-current portion of leases | |||||||||||
Accrued liabilities | |||||||||||
$ | $ | ||||||||||
Financial assets measured at fair value through earnings: | |||||||||||
Fuel option contract | $ | $ | |||||||||
Financial liabilities measured at fair value through earnings: | |||||||||||
Derivative in subordinated notes | $ | $ | |||||||||
Financial assets measured at fair value through other comprehensive income: | |||||||||||
Interest rate contracts | $ | $ | |||||||||
Number of RSUs | Weighted- Average Grant Date Fair Value | Aggregate Fair Value (in thousands) | |||||||||||||||
Outstanding and unvested at December 31, 2022 | $ | ||||||||||||||||
Granted | $ | ||||||||||||||||
Vested | ( | $ | |||||||||||||||
Cancelled | ( | $ | ( | ||||||||||||||
Outstanding and unvested at September 30, 2023 | $ | $ |
Number of Options | Weighted- Average Exercise price | Weighted- Average Remaining Contractual Term (Years) | Aggregate Intrinsic Value (in thousands) | ||||||||||||||||||||
Outstanding at December 31, 2022 | $ | $ | |||||||||||||||||||||
Outstanding at September 30, 2023 | $ | $ | |||||||||||||||||||||
Exercisable at September 30, 2023 | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Patient fee payors: | |||||||||||||||||||||||
Commercial | $ | $ | $ | $ | |||||||||||||||||||
Medicare | |||||||||||||||||||||||
Medicaid | |||||||||||||||||||||||
Other patient revenue | |||||||||||||||||||||||
Hospitals and healthcare providers | |||||||||||||||||||||||
Other revenue | |||||||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Employee compensation | $ | $ | $ | $ | |||||||||||||||||||
Third-party services and professional fees | |||||||||||||||||||||||
Rent and utilities | |||||||||||||||||||||||
Reading fees | |||||||||||||||||||||||
Administrative | |||||||||||||||||||||||
Stock-based compensation | |||||||||||||||||||||||
Medical supplies and other | |||||||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Goodwill (Note 5) | $ | $ | $ | $ | |||||||||||||||||||
Property and equipment | |||||||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Transformation costs | $ | $ | $ | $ | |||||||||||||||||||
Lease termination costs | |||||||||||||||||||||||
Domestication and related costs | |||||||||||||||||||||||
Other | |||||||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Loss (gain) on sale of accounts receivable | $ | $ | ( | $ | $ | ( | |||||||||||||||||
Gain from insurance proceeds | ( | ( | |||||||||||||||||||||
Loss (gain) on disposal of property and equipment, net | ( | ( | |||||||||||||||||||||
Other, net | ( | ( | |||||||||||||||||||||
$ | ( | $ | ( | $ | ( | $ | ( |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Capital structure initiatives | $ | $ | $ | $ | |||||||||||||||||||
Acquisition-related costs | |||||||||||||||||||||||
Fair value adjustment on derivative in subordinated notes | ( | ( | ( | ( | |||||||||||||||||||
Earnings from unconsolidated investees | ( | ( | ( | ( | |||||||||||||||||||
Other, net | ( | ||||||||||||||||||||||
$ | $ | ( | $ | $ | ( |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands, except share and per share amounts) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Net loss attributable to common stockholders | $ | ( | $ | ( | $ | ( | $ | ( | |||||||||||||||
Weighted average common shares outstanding: | |||||||||||||||||||||||
Basic and diluted | |||||||||||||||||||||||
Net loss per share attributable to common stockholders: | |||||||||||||||||||||||
Basic and diluted | $ | ( | $ | ( | $ | ( | $ | ( | |||||||||||||||
Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Radiology | $ | $ | $ | $ | |||||||||||||||||||
Oncology | |||||||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Adjusted EBITDA: | |||||||||||||||||||||||
Radiology | $ | $ | $ | $ | |||||||||||||||||||
Oncology | |||||||||||||||||||||||
Corporate | ( | ( | ( | ( | |||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Net loss | $ | ( | $ | ( | $ | ( | $ | ( | |||||||||||||||
Interest expense | |||||||||||||||||||||||
Income tax expense (benefit) | ( | ( | |||||||||||||||||||||
Depreciation and amortization | |||||||||||||||||||||||
Impairment charges | |||||||||||||||||||||||
Restructuring charges | |||||||||||||||||||||||
Severance and related costs | |||||||||||||||||||||||
Settlements, recoveries and related costs | ( | ||||||||||||||||||||||
Stock-based compensation | |||||||||||||||||||||||
Loss (gain) on sale of accounts receivable | ( | ( | |||||||||||||||||||||
Loss (gain) on disposal of property and equipment, net | ( | ( | |||||||||||||||||||||
Capital structure initiatives | |||||||||||||||||||||||
Acquisition-related costs | |||||||||||||||||||||||
Fair value adjustment on derivative | ( | ( | ( | ( | |||||||||||||||||||
Deferred rent expense | |||||||||||||||||||||||
Other, net | ( | ||||||||||||||||||||||
Adjusted EBITDA | $ | $ | $ | $ |
(in thousands) | September 30, 2023 | December 31, 2022 | |||||||||
Identifiable assets: | |||||||||||
Radiology | $ | $ | |||||||||
Oncology | |||||||||||
Corporate | |||||||||||
$ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Capital expenditures: | |||||||||||||||||||||||
Radiology | $ | $ | $ | $ | |||||||||||||||||||
Oncology | |||||||||||||||||||||||
Corporate | |||||||||||||||||||||||
$ | $ | $ | $ |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
2023 | 2022 | 2023 | 2022 | ||||||||||||||||||||
Radiology | 85 | % | 83 | % | 85 | % | 83 | % | |||||||||||||||
Oncology | 15 | % | 17 | % | 15 | % | 17 | % | |||||||||||||||
100 | % | 100 | % | 100 | % | 100 | % |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Patient fee payors: | |||||||||||||||||||||||
Commercial | $ | 64,748 | $ | 66,760 | $ | 195,336 | $ | 207,470 | |||||||||||||||
Medicare | 17,980 | 20,304 | 59,482 | 62,478 | |||||||||||||||||||
Medicaid | 3,286 | 3,111 | 9,947 | 9,560 | |||||||||||||||||||
Other patient revenue | 2,278 | 3,053 | 7,602 | 9,540 | |||||||||||||||||||
88,292 | 93,228 | 272,367 | 289,048 | ||||||||||||||||||||
Hospitals and healthcare providers | 90,292 | 91,092 | 274,267 | 269,202 | |||||||||||||||||||
Other revenue | 2,040 | 2,285 | 6,422 | 6,746 | |||||||||||||||||||
$ | 180,624 | $ | 186,605 | $ | 553,056 | $ | 564,996 |
September 30, 2023 | December 31, 2022 | ||||||||||
Radiology sites | 178 | 181 | |||||||||
Oncology sites | 28 | 30 | |||||||||
206 | 211 |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands, except per share amounts) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Revenues | $ | 180,624 | $ | 186,605 | $ | 553,056 | $ | 564,996 | |||||||||||||||
Operating expenses: | |||||||||||||||||||||||
Cost of operations, excluding depreciation and amortization | 158,047 | 151,230 | 472,949 | 462,784 | |||||||||||||||||||
Depreciation and amortization | 20,942 | 25,079 | 78,950 | 75,010 | |||||||||||||||||||
Impairment charges | 42,041 | 20,369 | 95,501 | 20,702 | |||||||||||||||||||
Restructuring charges | 23 | 4,042 | 6,703 | 11,366 | |||||||||||||||||||
Severance and related costs | 538 | 2,485 | 511 | 10,282 | |||||||||||||||||||
Settlements, recoveries and related costs | 1,561 | (576) | 3,474 | 101 | |||||||||||||||||||
Other operating income, net | (347) | (7,574) | (621) | (7,328) | |||||||||||||||||||
Total operating expenses | 222,805 | 195,055 | 657,467 | 572,917 | |||||||||||||||||||
Loss from operations | (42,181) | (8,450) | (104,411) | (7,921) | |||||||||||||||||||
Other expense (income): | |||||||||||||||||||||||
Interest expense | 33,872 | 29,679 | 95,733 | 87,650 | |||||||||||||||||||
Other non-operating expense (income), net | 7,522 | (422) | 9,736 | (2,433) | |||||||||||||||||||
Total other expense, net | 41,394 | 29,257 | 105,469 | 85,217 | |||||||||||||||||||
Loss before income taxes | (83,575) | (37,707) | (209,880) | (93,138) | |||||||||||||||||||
Income tax expense (benefit) | (80) | 12,038 | (784) | 9,118 | |||||||||||||||||||
Net loss | (83,495) | (49,745) | (209,096) | (102,256) | |||||||||||||||||||
Less: Net income (loss) attributable to noncontrolling and redeemable noncontrolling interests | (1,110) | 4,126 | 5,089 | 12,895 | |||||||||||||||||||
Net loss attributable to common stockholders | $ | (82,385) | $ | (53,871) | $ | (214,185) | $ | (115,151) | |||||||||||||||
Net loss per share attributable to common stockholders: | |||||||||||||||||||||||
Basic and diluted | $ | (0.90) | $ | (0.60) | $ | (2.37) | $ | (1.29) |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||||||||||||||||||||||||||
(in thousands) | 2023 | 2022 | Change | % Change | 2023 | 2022 | Change | % Change | |||||||||||||||||||||||||||||||||||||||
MRI scans | 211 | 220 | (9) | (4) | % | 649 | 659 | (10) | (2) | % | |||||||||||||||||||||||||||||||||||||
PET/CT scans | 36 | 34 | 2 | 6 | % | 109 | 99 | 10 | 10 | % | |||||||||||||||||||||||||||||||||||||
Oncology patient starts | 2.353 | 2.589 | (0.236) | (9) | % | 7.486 | 7.721 | (0.235) | (3) | % |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Radiology | $ | 153,930 | $ | 155,062 | $ | 467,622 | $ | 471,269 | |||||||||||||||
Oncology | 26,694 | 31,543 | 85,434 | 93,727 | |||||||||||||||||||
$ | 180,624 | $ | 186,605 | $ | 553,056 | $ | 564,996 |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Employee compensation | $ | 68,679 | $ | 67,278 | $ | 208,508 | $ | 214,426 | |||||||||||||||
Third-party services and professional fees | 31,427 | 30,233 | 94,347 | 89,271 | |||||||||||||||||||
Rent and utilities | 12,858 | 12,894 | 37,979 | 38,114 | |||||||||||||||||||
Reading fees | 11,830 | 11,379 | 35,382 | 34,665 | |||||||||||||||||||
Administrative | 11,440 | 12,473 | 34,805 | 35,621 | |||||||||||||||||||
Stock-based compensation | 505 | — | 556 | — | 1,345 | — | 2,375 | ||||||||||||||||
Medical supplies and other | 21,308 | 16,417 | 60,583 | 48,312 | |||||||||||||||||||
$ | 158,047 | $ | 151,230 | $ | 472,949 | $ | 462,784 |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Net loss | $ | (83,495) | $ | (49,745) | $ | (209,096) | $ | (102,256) | |||||||||||||||
Interest expense | 33,872 | 29,679 | 95,733 | 87,650 | |||||||||||||||||||
Income tax expense (benefit) | (80) | 12,038 | (784) | 9,118 | |||||||||||||||||||
Depreciation and amortization | 20,942 | 25,079 | 78,950 | 75,010 | |||||||||||||||||||
Impairment charges | 42,041 | 20,369 | 95,501 | 20,702 | |||||||||||||||||||
Restructuring charges | 23 | 4,042 | 6,703 | 11,366 | |||||||||||||||||||
Severance and related costs | 538 | 2,485 | 511 | 10,282 | |||||||||||||||||||
Settlements, recoveries and related costs | 1,561 | (576) | 3,474 | 101 | |||||||||||||||||||
Stock-based compensation | 505 | 556 | 1,345 | 2,375 | |||||||||||||||||||
Loss (gain) on sale of accounts receivable | — | (7,603) | 1,046 | (7,603) | |||||||||||||||||||
Loss (gain) on disposal of property and equipment, net | (344) | 26 | (761) | 398 | |||||||||||||||||||
Capital structure initiatives | 7,604 | — | 9,516 | — | |||||||||||||||||||
Acquisition-related costs | 27 | 99 | 325 | 567 | |||||||||||||||||||
Fair value adjustment on derivative | (121) | (271) | (422) | (1,110) | |||||||||||||||||||
Deferred rent expense | 221 | 325 | 363 | 904 | |||||||||||||||||||
Other, net | 188 | 18 | 746 | (783) | |||||||||||||||||||
Adjusted EBITDA | $ | 23,482 | $ | 36,521 | $ | 83,150 | $ | 106,721 |
Three Months Ended September 30, | Nine Months Ended September 30, | ||||||||||||||||||||||
(in thousands) | 2023 | 2022 | 2023 | 2022 | |||||||||||||||||||
Adjusted EBITDA: | |||||||||||||||||||||||
Radiology | $ | 18,790 | $ | 31,218 | $ | 74,565 | $ | 95,832 | |||||||||||||||
Oncology | 7,876 | 11,048 | 25,796 | 31,383 | |||||||||||||||||||
Corporate | (3,184) | (5,745) | (17,211) | (20,494) | |||||||||||||||||||
$ | 23,482 | $ | 36,521 | $ | 83,150 | $ | 106,721 |
Nine Months Ended September 30, | ||||||||||||||
(in thousands) | 2023 | 2022 | ||||||||||||
Cash and cash equivalents at beginning of period | $ | 59,424 | $ | 48,419 | ||||||||||
Net cash provided by operating activities | 17,394 | 55,936 | ||||||||||||
Net cash used in investing activities | (17,593) | (31,626) | ||||||||||||
Net cash used in financing activities | (27,584) | (13,373) | ||||||||||||
Cash and cash equivalents at end of period | $ | 31,641 | $ | 59,356 |
Exhibit Number | Description of Exhibit | ||||
4.1 | |||||
4.2 | |||||
4.3 | |||||
10.1 | |||||
10.2 | |||||
10.3 | |||||
31.1 | |||||
31.2 | |||||
32.1 | |||||
101.INS | Inline XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document | ||||
101.SCH | Inline XBRL Taxonomy Extension Schema Document | ||||
101.CAL | Inline XBRL Taxonomy Extension Calculation Linkbase Document | ||||
101.DEF | Inline XBRL Taxonomy Extension Definition Linkbase Document | ||||
101.LAB | Inline XBRL Taxonomy Extension Label Linkbase Document | ||||
101.PRE | Inline XBRL Taxonomy Extension Presentation Linkbase Document | ||||
104 | Cover Page Interactive Data File (formatted in iXBRL and contained in Exhibit 101) |
AKUMIN INC. | ||||||||
By: | /s/ Riadh Zine | |||||||
Riadh Zine Chairman, Chief Executive Officer and Director |
Akumin Inc. | ||||||||
Date: December 12, 2023 | By: | /s/ Riadh Zine | ||||||
Riadh Zine | ||||||||
Chief Executive Officer |
Akumin Inc. | ||||||||
Date: December 12, 2023 | By: | /s/ David Kretschmer | ||||||
David Kretschmer | ||||||||
Chief Financial Officer |
Date: December 12, 2023 | By: | /s/ Riadh Zine | ||||||
Riadh Zine | ||||||||
Chief Executive Officer |
Date: December 12, 2023 | By: | /s/ David Kretschmer | ||||||
David Kretschmer | ||||||||
Chief Financial Officer |
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares |
Sep. 30, 2023 |
Dec. 31, 2022 |
---|---|---|
Statement of Financial Position [Abstract] | ||
Preferred stock, par or stated value per share (in USD per share) | $ 0.01 | $ 0.01 |
Preferred stock, shares authorized (in shares) | 50,000,000 | 50,000,000 |
Preferred stock, shares issued (in shares) | 0 | 0 |
Preferred stock, shares outstanding (in shares) | 0 | 0 |
Common stock, par or stated value per share (in USD per share) | $ 0.01 | $ 0.01 |
Common stock, shares authorized (in shares) | 300,000,000 | 300,000,000 |
Common stock issued (in shares) | 91,173,491 | 89,811,513 |
Common stock outstanding (in shares) | 91,173,491 | 89,811,513 |
Basis of Presentation |
9 Months Ended |
---|---|
Sep. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation | Basis of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared by Akumin Inc. (together with its subsidiaries, the “Company” or “Akumin”) and do not include all of the information and disclosures required by accounting principles generally accepted in the U.S. (“GAAP”). In the opinion of management, all normal recurring accruals and adjustments considered necessary for a fair presentation have been included. The results for the three and nine months ended September 30, 2023 are not necessarily indicative of the results that may be expected for the year ending December 31, 2023. The accompanying condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes to the consolidated financial statements for the year ended December 31, 2022. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Actual results could differ from those estimates. Certain reclassifications have been made to prior period condensed consolidated financial statements to conform to the current period presentation. Going Concern As of the date the accompanying unaudited condensed consolidated financial statements were issued, management evaluated the significance of the following adverse conditions in accordance with ASC 205-40, Going Concern. As disclosed in Note 20, Subsequent Events, on October 20, 2023, the Company entered into a Restructuring Support Agreement (including all exhibits thereto, collectively, the “RSA”) with the other Company Parties (as defined below) and certain Consenting Stakeholders. Under the terms of the RSA, the Company (together with its debtor affiliates, the "Debtors") and certain Consenting Stakeholders agreed to the terms of a restructuring of the Company (the “Restructuring”) pursuant to the terms set forth in the Joint Prepackaged Chapter 11 Plan of Reorganization of the Debtors (as amended, supplemented or otherwise modified from time to time, the “Prepackaged Plan”). In connection therewith, on October 22, 2023, the Debtors filed voluntary petitions under chapter 11 of title 11 of the United States Code, 11 U.S.C. §§ 101-1532 (the “Bankruptcy Code”) in the United States Bankruptcy Court for the Southern District of Texas (the “Bankruptcy Court”), thereby commencing chapter 11 cases for the Debtors (the “Chapter 11 Cases”). In the Chapter 11 Cases, on October 22, 2023, the Debtors filed with the Bankruptcy Court a variety of “first day” relief motions to ensure their ability to continue operating in the ordinary course, including authority to pay employee wages and benefits, taxes, and insurance in the ordinary course of business. On October 23, 2023, the Bankruptcy Court granted these motions, allowing the Debtors to continue to operate as “debtors-in-possession” under the jurisdiction of the Bankruptcy Court and in accordance with the applicable provisions of the Bankruptcy Code and orders of the Bankruptcy Court. Based on, among other things, (1) the DIP Financing (as defined below), (2) the confirmation of the Prepackaged Plan on November 30, 2023, and (3) management’s expectation that the Restructuring will be consummated in the first quarter of 2024, management contemplates that the Company will be able to settle liabilities and commitments in the normal course of business for twelve months following the issuance date of the accompanying unaudited condensed consolidated financial statements. Accordingly, the accompanying unaudited condensed consolidated financial statements have been prepared on the basis that the Company will continue to operate as a going concern. The filing of the Chapter 11 Cases constituted an event of default under Akumin’s 2025 Senior Notes and 2028 Senior Notes, the Revolving Facility, and the Subordinated Notes (each as defined below in Note 20), for which enforcement of any remedies by the Debtors’ creditors have been automatically stayed as a result of the pendency of the Chapter 11 Cases. However, management can provide no assurance that the Debtors’ creditors will ultimately not be able to exercise their remedies, which may include, among others, the cessation of the Debtors’ operations and liquidation of their assets. While management believes the Restructuring will position the Company for sustainable growth opportunities upon its emergence from the Chapter 11 Cases and enable the Company to continue to operate as a viable going concern, due to the event of default under the Company’s Debt Instruments (as defined below) and to other risks and uncertainties associated with the Chapter 11 Cases, management can provide no assurance that the Restructuring will be successfully completed under the terms set forth in the Prepackaged Plan, or at all. The risks and uncertainties associated with the Chapter 11 Cases include, but are not limited to: (a) the risk that the Prepackaged Plan may never become effective, (b) the risk that the RSA may be terminated by one or more of the parties thereto, and (c) the risk that the Bankruptcy Court may grant or deny motions in a manner that is adverse to the Debtors. Based on the consideration of the risks and uncertainties associated with the Chapter 11 Cases and of the events of default under the Company’s Debt Instruments, management has concluded that there is a substantial doubt regarding the Company’s ability to continue as a going concern within one year from the issuance of the accompanying unaudited condensed consolidated financial statements. The Company’s ability to continue as a going concern is contingent upon, among other things, its ability to implement the Restructuring, to successfully emerge from the Chapter 11 Cases, and to generate sufficient liquidity following the Restructuring to meet its obligations and operating needs as they arise.
|
New Accounting Standards |
9 Months Ended |
---|---|
Sep. 30, 2023 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
New Accounting Standards | New Accounting Standards Recently Adopted Accounting Standards ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the U.S. Securities and Exchange Commission (the "SEC"), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings. Recently Issued Accounting Standards Not Yet Effective ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, creating an exception to the recognition and measurement principles in ASC 805, Business Combinations. The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers, rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets, fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company is currently evaluating the impact of the standard on its consolidated financial statements.
|
Variable Interest Entities |
9 Months Ended |
---|---|
Sep. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | Variable Interest Entities In accordance with consolidation guidance, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenues and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. A reporting entity is considered to have a controlling financial interest in a variable interest entity (“VIE”) if (i) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (ii) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. As a result of the financial relationship established between the Company and certain entities (the “Revenue Practices”) through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenues and expenses of the Revenue Practices are included in the condensed consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. As of September 30, 2023 and December 31, 2022, the Revenue Practices’ assets included in the Company’s condensed consolidated balance sheets were $44.1 million and $36.0 million, respectively, and liabilities included in the Company’s condensed consolidated balance sheets were $1.7 million and $1.4 million, respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the nine months ended September 30, 2023 and 2022, the Revenue Practices’ revenues were $129.0 million and $137.2 million, respectively, and the net cash provided by operating activities was $114.9 million and $161.0 million, respectively.
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Property and Equipment |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Property, Plant and Equipment [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Property and Equipment | Property and Equipment Property and equipment consists of the following:
Depreciation expense was $16.4 million and $19.5 million for the three months ended September 30, 2023 and 2022, respectively, and $52.9 million and $59.4 million for the nine months ended September 30, 2023 and 2022, respectively. As of September 30, 2023 and December 31, 2022, the equipment under finance leases had a net book value of $23.8 million and $26.3 million, respectively.
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Goodwill |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill | Goodwill Changes in the carrying amount of goodwill are as follows:
The Company tests its goodwill and indefinite-lived intangible assets annually or more frequently depending on certain impairment indicators. Such indicators include a significant decline in expected future cash flows due to changes in company-specific factors or the broader business climate. During the three months ended September 30, 2023, the Company determined that potential indicators of impairment existed and thus performed a quantitative test for impairment at the reporting unit level as of September 30, 2023. In connection with the impairment tests for both the Radiology and Oncology reporting units, the Company concluded that the reporting units' carrying values exceeded their estimated fair values based on management's assessment of the outlook and long-term business plans for the divisions. Consequently, the Company recorded impairment charges of $30.6 million and $11.0 million related to the Radiology and Oncology reporting units, respectively. These charges were recorded in the condensed consolidated statements of operations and comprehensive loss for the three and nine months ended September 30, 2023. During the three months ended June 30, 2023, the Company recorded a goodwill impairment charge of $53.5 million related to the Radiology reporting unit, as its carrying value exceeded its estimated fair value based on management's assessment of the outlook and long-term business plans for the division. The impairment charge is included in the condensed consolidated statements of operations and comprehensive loss for the nine months ended September 30, 2023. In estimating fair values, the Company gave equal weight to an income approach (the DCF method) and a market approach (the GPC method). Specifically, the Company utilized the following Level 3 estimates and assumptions in its analyses during the three and nine months ended September 30, 2023:
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Other Intangible Assets |
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Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other Intangible Assets | Other Intangible Assets Other intangible assets consist of the following:
The Company performs an impairment test when indicators of impairment are present. As of September 30, 2023, there were no indications of impairment of the Company's other intangible assets balances. The aggregate amortization expense for the Company’s finite-lived intangible assets was $4.5 million and $5.6 million for the three months ended September 30, 2023 and 2022, respectively, and $26.1 million and $15.6 million for the nine months ended September 30, 2023 and 2022, respectively. Amortization expense for the nine months ended September 30, 2023 includes $12.1 million of accelerated amortization related to the closure of two sites in the Oncology segment.
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Debt |
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Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debt | Debt Debt consists of the following:
During the nine months ended September 30, 2023, the Company elected to pay interest in-kind on the Subordinated Notes pursuant to the original agreement and, accordingly, $37.7 million of accrued interest was added to the principal balance of the Subordinated Notes. On September 29, 2023, Akumin Operating Corp., a wholly owned indirect subsidiary of the Company, and Stonepeak entered into a Temporary Waiver Agreement in connection with the Subordinated Notes. The Temporary Waiver Agreement, as amended by the First Amendment to Temporary Waiver Agreement, dated October 16, 2023, and as further amended on October 20, 2023, extended to October 23, 2023 the due date for the payment to Stonepeak of $3.9 million in cash interest which became due under the Subordinated Notes on September 29, 2023 and provided that no trigger event occurred upon the Company’s failure to pay Stonepeak $3.9 million in cash interest on September 29, 2023. Certain of the debt obligations are subject to covenants with which the Company must comply on a quarterly or annual basis. The Company was in compliance with, or had received waivers for, all such covenants as of September 30, 2023. As disclosed in Note 20, Subsequent Events, the Company commenced the Chapter 11 Cases on October 22, 2023. The commencement of the Chapter 11 Cases constituted an event of default that accelerated the Company’s obligations under the 2028 Senior Notes, 2025 Senior Notes, Subordinated Notes and Revolving Facility. Accordingly, all long-term debt associated with these obligations was classified as current on the accompanying unaudited condensed consolidated balance sheet as of September 30, 2023. However, any efforts to enforce payment obligations under the debt instruments are automatically stayed as a result of the Chapter 11 proceedings. See Note 20, Subsequent Events, for further information.
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Accrued Liabilities |
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Payables and Accruals [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Accrued Liabilities | Accrued Liabilities Accrued liabilities consist of the following:
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Redeemable Noncontrolling Interests |
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Noncontrolling Interest [Abstract] | |||||||||||||||||||||||||||||||||||||||||||
Redeemable Noncontrolling Interests | Redeemable Noncontrolling Interests The Company has noncontrolling interests with redemption features. These redemption features could require the Company to make an offer to purchase the noncontrolling interests in the case of certain events, including (i) the expiration or termination of certain operating agreements of the joint venture, or (ii) the noncontrolling interests’ tax-exempt status is jeopardized by the joint venture. As of September 30, 2023, the Company holds redeemable noncontrolling interests of $24.5 million, which are not currently redeemable or probable of becoming redeemable. The redemption of these noncontrolling interests is not solely within the Company’s control, therefore, they are presented in the temporary equity section of the Company’s condensed consolidated balance sheets. The Company does not believe it is probable the redemption features related to these noncontrolling interests will be triggered as the triggering events are generally not probable until they occur. As such, these noncontrolling interests have not been remeasured to redemption value. The following is a rollforward of the activity in the redeemable noncontrolling interests for the nine months ended September 30, 2023:
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Financial Instruments |
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Financial Instruments [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Financial Instruments | Financial Instruments Assets and Liabilities that are Measured at Fair Value on a Recurring Basis The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis:
The derivative in Subordinated Notes relates to the Change of Control Redemption Election included in the Subordinated Notes (see Note 7). The fair value of the Change of Control Redemption Election liability was determined using a probability weighted scenario analysis regarding a potential change of control during the seven years from initiation date. The estimated fair values of the Change of Control Redemption Election as of September 30, 2023 and December 31, 2022 use unobservable inputs for probability weighted time until an exit event of 3.1 years and 3.5 years, respectively, and an exit event probability weighting of 20.9% and 22.9%, respectively. The following is a reconciliation of the opening and closing balances for the derivative in Subordinated Notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the nine months ended September 30, 2023:
The decrease in the fair value of the derivative in Subordinated Notes liability was recorded as a gain and included in other non-operating expense (income), net in the Company's condensed consolidated statements of operations and comprehensive loss for the nine months ended September 30, 2023. The Company’s interest rate contracts are primarily pay-fixed, receive-variable interest rate swaps related to certain of the Company’s equipment debt. The amount that the Company expects to reclassify from accumulated other comprehensive income to interest expense over the next twelve months is immaterial. During the second quarter of 2023, the Company entered into a fuel call option contract to hedge against fluctuations in fuel prices through April 2024. Assets and Liabilities for which Fair Value is only Disclosed The estimated fair values of other current and non-current liabilities are as follows:
As of September 30, 2023 and December 31, 2022, the estimated fair values of the 2028 Senior Notes and 2025 Senior Notes were determined using Level 2 inputs and the estimated fair values of the Subordinated Notes and Equipment Debt were determined using Level 3 inputs. The carrying value of cash and cash equivalents, accounts receivable, accounts payable, accrued liabilities, and the current portion of lease liabilities approximates their fair value given their short-term nature. The carrying value of the non-current portion of lease liabilities approximates their fair value given the difference between the discount rates used to recognize the liabilities in the condensed consolidated balance sheets and the normalized expected market rates of interest is insignificant. The carrying value of the Revolving Facility is equal to its fair value as the Company has the ability to repay the outstanding principal at par value at any time. Financial instruments are classified into one of the following categories: amortized cost, fair value through earnings and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments:
Assets and Liabilities that are Measured at Fair Value on a Nonrecurring Basis The Company measures certain non-financial assets at fair value on a nonrecurring basis, primarily intangible assets, goodwill and long-lived assets in connection with acquisitions and periodic evaluations for potential impairment. The Company estimates the fair value of these assets using primarily unobservable inputs; therefore, these are considered Level 3 fair value measurements. See disclosure of Level 3 measurements related to the goodwill impairment analysis in Note 5. Interest Rate Risk Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. Certain of the Company’s equipment debt arrangements have interest rate swap agreements to hedge the future variable cash interest payments in order to avoid volatility in operating results due to fluctuations in interest rates. As of September 30, 2023 and December 31, 2022, the Company had $0.2 million and $0.4 million, respectively, of variable interest rate equipment debt that is not hedged. In addition, the Company is exposed to variable interest rates related to the Revolving Facility, which had an outstanding balance of $16.0 million and $0 as of September 30, 2023 and December 31, 2022, respectively. The Company’s exposure to interest rate risk from a 1% increase or decrease in the variable interest rates is not material.
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Stockholders' Equity |
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Stockholders' Equity | Stockholders' Equity In connection with the Company's change of jurisdiction of incorporation from the province of Ontario, Canada, to the State of Delaware (the "Domestication") in 2022, the Company amended its Certificate of Incorporation to provide for the issuance of up to 300,000,000 shares of common stock, par value $0.01 per share, and 50,000,000 shares of undesignated preferred stock, par value $0.01 per share. The effect of the change in the common stock from no par value to $0.01 par value per share has been reflected in the condensed consolidated financial statements on a retroactive basis for all periods presented. Stock-Based Awards The Company may grant stock-based awards to employees, directors and consultants under the Amended and Restated Restricted Share Unit Plan, adopted as of April 18, 2023 (the “RSU Plan”) and the Amended and Restated Stock Option Plan, adopted as of April 18, 2023 (the “Stock Option Plan” and together with the RSU Plan, the “2023 Stock Plans”). Under the 2023 Stock Plans, the collective maximum number of shares reserved for issuance is equal to 10% of the number of capital shares of the Company that are outstanding from time to time. As of September 30, 2023 and December 31, 2022, shares of common stock reserved for issuance under the 2023 Stock Plans were 9,117,349 and 8,981,151, respectively. The 2023 Stock Plans are administered by the Board of Directors, which has authority to select eligible persons to receive awards and to determine the terms and conditions of the awards. Restricted Share Units Restricted share units (“RSUs”) represent a right to receive a share of common stock at a future vesting date with no cash payment from the holder. RSUs granted vest over two years from the date of grant. A summary of RSU activity is as follows:
Stock Options Stock options are awarded as consideration in exchange for services rendered to the Company. Stock options granted generally have terms of 7 years, but in no event more than 10 years after the date of grant, and vest over 3 years. A summary of the stock option activity is as follows:
Aggregate intrinsic value for outstanding and exercisable stock options in the table above represents the difference between the closing stock price on September 30, 2023 and the exercise price multiplied by the number of in-the-money options. No stock options were granted during the nine months ended September 30, 2023.
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Commitments and Contingencies |
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Sep. 30, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies Purchase Commitments The Company has certain binding purchase commitments primarily for the purchase of equipment from various suppliers. As of September 30, 2023, the obligations for these future purchase commitments totaled $32.7 million, of which $9.2 million is expected to be paid during the remaining three months of 2023 and $23.5 million is expected to be paid thereafter. Guarantees and Indemnities In the normal course of business, the Company has made certain guarantees and indemnities, under which it may be required to make payments to a guaranteed or indemnified party, in relation to certain transactions. The Company indemnifies other parties, including customers, lessors, and parties to other transactions with the Company, with respect to certain matters. The Company has agreed to hold the other party harmless against losses arising from certain events as defined within the particular contract, which may include, for example, litigation or claims arising from a breach of representations or covenants. In addition, the Company has entered into indemnification agreements with its executive officers and directors and the Company’s bylaws contain similar indemnification obligations. Under these arrangements, the Company is obligated to indemnify, to the fullest extent permitted under applicable law, its current or former officers and directors for various amounts incurred with respect to actions, suits or proceedings in which they were made, or threatened to be made, a party as a result of acting as an officer or director. It is not possible to determine the maximum potential amount under these indemnification agreements due to the limited history of prior indemnification claims and the unique facts and circumstances involved in each particular agreement. Historically, payments made related to these indemnifications have been immaterial. As of September 30, 2023, the Company has determined that no liability is necessary related to these guarantees and indemnities. Legal Matters On December 20, 2021, an alleged shareholder of the Company filed a putative class action claim with the Ontario Superior Court of Justice against the Company and certain of its directors and officers alleging violations of Securities Act (Ontario), negligent misrepresentation and other related claims relating to the restatement of the Company’s financial statements that were filed in 2021. On February 17, 2023, the plaintiff delivered a motion record for certification and for leave to commence action under Part XXIII.1 of the Securities Act (Ontario). The Company plans to defend the claim and the motion. Given the preliminary stages of this matter, the Company is unable to estimate the potential impact of this matter, if any. Other Matters The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, management evaluates the developments on a regular basis and accrues a liability when it believes a loss is probable and the amount can be reasonably estimated. Management believes that the amount or any estimable range of reasonably possible or probable loss will not, either individually or in the aggregate, have a material adverse effect on the Company’s business and condensed consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management’s expectations, the Company’s results of operations and financial condition could be materially and adversely affected.
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Supplemental Revenue Information |
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Revenue from Contract with Customer [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplemental Revenue Information | Supplemental Revenue Information Revenues consist primarily of net patient fees received from various payors and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. Revenues are also derived directly from hospitals and healthcare providers. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third-party payors, management fees, government grants and fees for other services provided to third parties. The following table summarizes the components of the Company’s revenues by payor category:
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Cost of Operations, excluding Depreciation and Amortization |
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Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cost of Operations, excluding Depreciation and Amortization | Cost of Operations, excluding Depreciation and Amortization The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization:
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Supplemental Statement of Operations Information |
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other Income and Expenses [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplemental Statement of Operations Information | Supplemental Statement of Operations Information Impairment Charges Impairment charges relate to the following assets:
Restructuring Charges Restructuring charges consist of the following:
Transformation costs consist of third-party consulting fees associated with a significant project to identify, plan, and implement various business improvement initiatives designed to enhance growth opportunities and improve operations. The consulting agreement provides for fixed fees totaling $12.5 million, milestone fees totaling up to $7.0 million that are earned upon the achievement of certain milestones, and performance fees totaling up to $15.0 million that are earned based on the achievement of certain performance results during the period of the contract. The Company recognizes the fixed fees over the contract period as the services are rendered. Milestone and performance fees that are probable of ultimately being paid (subject to the Company's rights and defenses to dispute such charges) are recognized based on a percentage of achievement of the related milestone or performance result. The project is expected to conclude in 2023. As of September 30, 2023, the accounts payable and accrued liability balance for unpaid transformation consulting costs was $5.6 million and $1.1 million, respectively. Severance and Related Costs Severance and related costs represent costs associated with employees whose employment with the Company has been terminated and are generally paid in the year recorded. In connection with certain terminated employees, severance benefits are being paid over periods of 12 to 18 months. As of September 30, 2023, the unpaid balance of severance and related costs totaled $1.0 million, which will be paid during the next twelve months. Other Operating and Non-Operating Expense (Income) Other operating income, net consists of the following:
Other non-operating expense (income), net consists of the following:
Capital structure initiatives represent costs associated with the Company’s initiative to restructure its debt.
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Investments in Unconsolidated Investees |
9 Months Ended |
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Sep. 30, 2023 | |
Other Investments [Abstract] | |
Investments in Unconsolidated Investees | Investments in Unconsolidated Investees Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business (“AI business”) as part of a private placement offering for $4.6 million. The AI business develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the AI business to the Company in May 2020 converted to common equity. The Company’s total common equity investment has a carrying value of $7.9 million as of September 30, 2023 and represents a 34.5% interest in the AI business on a non-diluted basis. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events and certain assumptions, and the payment of $0.4 million, would entitle the Company to acquire an additional 2.4% ownership interest in the AI business common equity. The Company has a 15% direct ownership in an unconsolidated investee and provides management services under a management agreement with the investee. The Company provides services as part of its ongoing operations for and on behalf of the unconsolidated investee, which reimburses the Company for the actual amount of the expenses incurred. The Company records the expenses in cost of operations and the reimbursement as revenue in the condensed consolidated statements of operations and comprehensive loss. Both of these investees are accounted for under the equity method because the Company exercises significant influence but does not exercise control over the operations of these investees. The financial position and results of operations of these unconsolidated investees are not material to the Company’s condensed consolidated financial statements.
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Income Taxes |
9 Months Ended |
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Sep. 30, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes The Company is subject to U.S. federal income tax as well as income tax of multiple state jurisdictions. The Company is no longer subject to Canadian tax after the Domestication on September 30, 2022. The effective tax rate for the three and nine months ended September 30, 2023 differs from the U.S. federal statutory rate of 21.0% primarily due to the impact of valuation allowances applied against losses in jurisdictions for which no tax benefit is recognized.
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Basic and Diluted Loss per Share |
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Earnings Per Share [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Basic and Diluted Loss per Share | Basic and Diluted Loss per Share The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period.
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Segment Information |
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Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Information | Segment Information Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company operates in two reportable segments: Radiology and Oncology. All intercompany revenues, expenses, receivables and payables are eliminated in consolidation and are not reviewed when evaluating segment performance. Each segment’s performance is evaluated based on revenue and adjusted earnings before interest, taxes, depreciation and amortization ("Adjusted EBITDA"). The following table summarizes the Company’s revenues by segment:
Adjusted EBITDA is defined as net loss before interest expense, income tax benefit, depreciation and amortization, impairment charges, restructuring charges, severance and related costs, settlements and related costs, stock-based compensation, loss on sale of accounts receivable, capital structure initiatives, fair value adjustment on derivative, deferred rent expense, and items that we do not consider to be indicative of our core/ongoing operations. The following table summarizes the Company’s Adjusted EBITDA by segment:
A reconciliation of the net loss to total Adjusted EBITDA is shown below:
The following table summarizes the Company’s total assets by segment:
The following table summarizes the Company’s capital expenditures by segment:
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Subsequent Events |
9 Months Ended |
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Sep. 30, 2023 | |
Subsequent Events [Abstract] | |
Subsequent Events | Subsequent Events Ransomware Incident On October 11, 2023, the Company identified suspicious activity in its information technology network, which was the result of a ransomware incident (the "Ransomware Incident"). The incident disrupted the Company’s ability to provide services to its business partners starting on October 11, 2023. The Company began restoring services to its oncology, mobile, and fixed radiology units in a rolling fashion beginning on October 12, 2023. As of October 17, 2023, all of the Company's cancer centers had resumed treating patients with pre-defined plans and as of November 10, 2023, the Company had restored the majority of its systems and resumed scheduling patient appointments at most of its locations. While the Company has resumed patient-facing operations, some systems have not yet been restored and remain temporarily unavailable. As a result of the Ransomware Incident, the Company has incurred approximately $6.6 million in costs since October 11, 2023. The full scope of the costs and related financial impacts of this incident to the Company has not yet been determined. Restructuring Support Agreement On October 20, 2023, Akumin Inc. entered into the RSA with (i) certain of its affiliates and subsidiaries as set forth in the RSA (together with Akumin Inc., the “Company Parties”); (ii) Stonepeak Magnet Holdings LP (“Stonepeak”); (iii) certain Consenting 2025 Noteholders (as defined in the RSA); (iv) certain Consenting 2028 Noteholders (as defined in the RSA) (together with the Consenting 2025 Noteholders, the “Consenting Noteholders”); (v) certain Consenting RCF Lenders (as defined in the RSA); (vi) certain Consenting Equityholders (as defined in the RSA); (vii) certain Consenting Non-Debtor Hospital Partner Entities (as defined in the RSA); and (viii) certain Consenting Physician-Owned Entities (as defined in the RSA, and collectively with Stonepeak, the Consenting Noteholders, the Consenting RCF Lenders, the Consenting Equityholders and the Consenting Non-Debtor Partner Entities, the “Consenting Stakeholders”). Although the Company intends to pursue the Restructuring in accordance with the terms set forth in the RSA, there can be no assurance that the Company will be successful in completing the transactions contemplated by the RSA, whether on the same or different terms than those provided in the RSA and the Prepackaged Plan. As set forth in the RSA, the Company and the Consenting Stakeholders have agreed to the principal terms of the Restructuring through the Prepackaged Plan. The transactions contemplated by the RSA include, among other things, (i) the cancellation of the 2025 Senior Notes and the issuance of the New 2027 Notes (as defined in the RSA) to holders of the 2025 Senior Notes to the extent such 2025 Senior Notes are not repurchased in the Reverse Dutch Election Opportunity (as defined and described below); (ii) the cancellation of the 2028 Senior Notes and the issuance of the New 2028 Notes (as defined in the RSA) to holders of the 2028 Senior Notes to the extent the 2028 Senior Notes are not repurchased in the Reverse Dutch Election Opportunity; (iii) the cancellation of the Revolving Facility in exchange for the New RCF Exit Facility (as defined in the RSA); (iv) a capital investment by Stonepeak (in such capacity, the “Consenting Investor”) in the Company in the aggregate amount of $130 million (the “Consenting Investor Direct Investment”); and (v) a payment to all holders of Existing Common Stock Interests (as defined in the Prepackaged Plan) (other than the Consenting Investor) in an aggregate amount of $25 million in cash and certain contingent value rights (the “CVRs”). Additionally, $60 million of the Consenting Investor Direct Investment shall be made available for a Reverse Dutch Election Opportunity, pursuant to which holders of the 2025 Senior Notes and the 2028 Senior Notes shall have the opportunity to receive cash in lieu of the New 2027 Notes and/or New 2028 Notes, as applicable, on the terms set forth in the Prepackaged Plan. Further, in connection with the Restructuring, Stonepeak shall receive 100% of the common stock of the Reorganized Parent (as defined below) pursuant to the Prepackaged Plan upon emergence from the Chapter 11 Cases. The RSA may be mutually terminated by Stonepeak, the Required Consenting Noteholders (as defined in the RSA), and each Company Party. If not terminated earlier, the RSA will automatically terminate after the effective date of the Prepackaged Plan (the “Effective Date”). Moreover, Stonepeak, the Consenting Noteholders, the Consenting RCF Lenders, the Consenting Equityholders, the Consenting Physician-Owned Entities, the Company Parties and the Consenting Non-Debtor Hospital Partner Entities each have termination rights if certain conditions, including milestones set forth in the RSA, as applicable, are not met. Voluntary Petition for Bankruptcy On October 22, 2023, the Debtors filed voluntary petitions for relief under the Bankruptcy Code in the Bankruptcy Court to implement the Restructuring pursuant to the Prepackaged Plan. On October 21, 2023, the Debtors commenced solicitation of the Prepackaged Plan to creditors entitled to vote, including mailing certain bankruptcy disclosures related thereto (the “Disclosure Statement”). The Chapter 11 Cases have been jointly administered by the Bankruptcy Court under the case caption, In re Akumin Inc., et al. (Case No. 23-90827). In the Chapter 11 Cases, on October 22, 2023, the Debtors filed with the Bankruptcy Court a variety of “first day” relief motions to ensure their ability to continue operating in the ordinary course, including authority to pay employee wages and benefits, taxes, and insurance in the ordinary course of business. On October 23, 2023, the Bankruptcy Court granted these motions, allowing the Debtors to continue to operate as “debtors-in-possession” under the jurisdiction of the Bankruptcy Court and in accordance with the applicable provisions of the Bankruptcy Code and orders of the Bankruptcy Court. In addition, and as discussed below, on October 23, 2023, the Bankruptcy Court approved interim relief for the Debtors’ DIP Facility. On November 17, 2023, the Bankruptcy Court also granted relief relating to the Debtors’ request to waive the appointment of a patient care ombudsman and rejection of certain unexpired leases of non-residential real property. On November 29, 2023, the DIP Facility was approved on a final basis, as amended (as discussed below). On November 30, 2023, the Bankruptcy Court issued an order (the “Confirmation Order”) confirming the Prepackaged Plan and approving on a final basis the adequacy of the Disclosure Statement. The Confirmation Order was filed as Exhibit 10.2 to the Company’s Current Report on Form 8-K filed with the SEC on December 5, 2023, and is filed as Exhibit 4.4 to this Quarterly Report on Form 10-Q and incorporated herein by reference. Debt Default The filing of the Chapter 11 Cases triggered events of default under the following debt instruments of the Company (the “Debt Instruments”): •that certain Revolving Credit Agreement, dated as of November 2, 2020, as amended by that certain Amendment No. 1, dated as of February 8, 2021, Amendment No. 2, dated as of July 26, 2021, Amendment No. 3 & Waiver, dated as of September 11, 2021 and Amendment No. 4 & Waiver, dated as of October 22, 2021 (as has been and may be further amended, supplemented, or otherwise modified from time to time), by and among the Company, as borrower, certain subsidiaries of the Company as guarantors (the “Guarantors”), PNC Bank, National Association, as successor to BBVA USA, as administrative agent and collateral agent, and the lenders from time to time party thereto, which is comprised of a revolving credit facility in an aggregate principal amount of $55 million (the “Revolving Facility”, and such agreement, the "2020 Revolving Credit Agreement"); •that certain Indenture dated November 2, 2020, as supplemented by that certain First Supplemental Indenture, dated as of February 11, 2021, that certain Second Supplemental Indenture, dated as of July 30, 2021, and that certain Third Supplemental Indenture, dated as of September 1, 2021 (as may be further amended, restated, supplemented, or otherwise modified from time to time), by and among the Company, as issuer, the Guarantors, as guarantors, the holders party thereto, and UMB Bank, National Association, in its capacity as trustee and collateral agent and the related prepetition security agreements, collateral agreements, pledge agreements, and guarantees, in the initial aggregate principal amount of $400 million, with an additional aggregate principal amount of $75 million issued through a private offering on February 11, 2021 (the “2025 Senior Notes”); •that certain Indenture dated August 9, 2021, as supplemented by that certain First Supplemental Indenture, dated as of September 1, 2021 (as may be further amended, restated, supplemented, or otherwise modified from time to time), by and among Akumin Escrow Inc. (whose obligations were assumed by the Company on closing of the acquisition of Alliance Healthcare Service on September 1, 2021), as issuer, the Guarantors, the holders party thereto, and UMB Bank, National Association, in its capacity as trustee and collateral agent, and the related prepetition security agreements, collateral agreements, pledge agreements, and guarantees, in the aggregate principal amount of $375 million (the “2028 Senior Notes”); and •that certain unsecured payment-in-kind toggle series A note, dated September 1, 2021 (as amended, restated, supplemented, or otherwise modified from time to time), issued by Akumin Operating Corp., a wholly owned indirect subsidiary of the Company, to Stonepeak with a face value of $357.0 million (including the 5% repayment premium of $17.0 million) as of September 1, 2021 (the “Subordinated Notes”). The Debt Instruments provide that, as a result of the Chapter 11 Cases, the principal and interest due thereunder shall be immediately due and payable without notice from the lenders thereunder. Any efforts to enforce such payment obligations under the Debt Instruments are automatically stayed as a result of the Chapter 11 Cases, and the lenders’ rights to enforce the Debt Instruments are subject to the applicable provisions of the Bankruptcy Code. Debtor-in-Possession Financing On October 23, 2023, the Bankruptcy Court entered an interim order (the “Interim DIP Order”) in the Chapter 11 Cases authorizing the Debtors to obtain up to $75 million of junior secured postpetition financing (the “DIP Financing,” and such facility, the “DIP Facility”) from Stonepeak (in such capacity, the “DIP Lender”) in accordance with the Interim DIP Order and on the terms and conditions set forth in the Summary of Proposed Terms and Conditions for DIP Financing and Use of Cash Collateral, dated October 20, 2023, which was attached as an exhibit to the Interim DIP Order (as amended, the “DIP Term Sheet”). On November 29, 2023, the Bankruptcy Court entered a final order (the “Final DIP Order”) authorizing the Debtors to obtain DIP Financing on a final basis, with an increase of the commitment under the DIP Facility to $130 million, in accordance with the Final DIP Order and on the terms and conditions set forth in the DIP Term Sheet attached thereto. Pursuant to the DIP Term Sheet and Final DIP Order, the Debtors unconditionally guaranteed, on a joint and several basis, the Company’s obligations in connection with the DIP Financing. The loans made under the DIP Facility (the “DIP Facility Loans”) accrue interest at 8.00% per annum payable in kind. Unless otherwise provided in accordance with the terms of the RSA, the DIP Facility Loans will convert to equity on the Effective Date on the same terms as the Consenting Investor Direct Investment and shall reduce the aggregate principal amount to be invested by Stonepeak as the Consenting Investor Direct Investment on a dollar-for-dollar basis. Approval of Disclosure Statement and Confirmation of Plan On November 30, 2023, the Bankruptcy Court entered the Confirmation Order, which approved the adequacy of the Disclosure Statement on a final basis and confirmed the Prepackaged Plan. After the satisfaction or waiver of the conditions precedent of the Prepackaged Plan, the Debtors intend to effect the transactions contemplated by the Prepackaged Plan and emerge from the Chapter 11 Cases. Treatment of Claims and Interests The Prepackaged Plan provides for the following treatment of Claims against and Interests in the Debtors upon the effectiveness of the Prepackaged Plan if Allowed (each capitalized term in this sentence as defined in the Prepackaged Plan): •Other Secured Claims (as defined in the Prepackaged Plan) shall receive (i) payment in full in cash; (ii) collateral securing such Claim; (iii) reinstatement of its Claim; or (iv) such other treatment that renders the Claim unimpaired. •Other Priority Claims (as defined in the Prepackaged Plan) shall receive payment in full in cash. •Each Holder of Prepetition RCF Claims (as defined in the Prepackaged Plan) shall receive its pro rata share of the New RCF Exit Facility. •Each Holder of Prepetition 2025 Notes Claims (as defined in the Prepackaged Plan) shall receive its pro rata share of (a)(x) the New 2027 Notes; provided that, for the avoidance of doubt, any Allowed (as defined in the Prepackaged Plan) Prepetition 2025 Notes Claims arising on account of Selected Reverse Dutch Election Participating Notes (as defined in the Prepackaged Plan) shall not receive any portion of the New 2027 Notes that such Holder would have otherwise been entitled to receive on account of such Claims; and (b)(y) the opportunity to voluntarily participate in the Reverse Dutch Election Opportunity by submitting a Reverse Dutch Election Form (as defined in the Prepackaged Plan) prior to the Reverse Dutch Election Deadline (as defined in the Prepackaged Plan). •Each Holder of Prepetition 2028 Notes Claims (as defined in the Prepackaged Plan) shall receive its pro rata share of (a)(x) the New 2028 Notes; provided that, for the avoidance of doubt, any Allowed 2028 Notes Claims (as defined in the Prepackaged Plan) arising on account of Selected Reverse Dutch Election Participating Notes shall not receive any portion of the New 2028 Notes that such Holder would have otherwise been entitled to receive on account of such Claims; and (b)(y) the opportunity to voluntarily participate in the Reverse Dutch Election Opportunity by submitting a Reverse Dutch Election Form prior to the Reverse Dutch Election Deadline. •The Holder of the Prepetition Series A Note Claims (as defined in the Prepackaged Plan) shall receive 100% of the new common stock of the reorganized Akumin Inc. (“Reorganized Parent”), subject to dilution (i) in accordance with the new corporate governance documents and (ii) for any common stock of the Reorganized Parent issued to Stonepeak as the DIP Lender. •Except to the extent that such holder agrees to different treatment, the Debtors shall continue to pay or dispute each General Unsecured Claim (as defined in the Prepackaged Plan) in the ordinary course of business as if the Chapter 11 Cases had never been commenced. •All Existing Common Stock Interests shall be canceled, released, and extinguished and will be of no further force or effect. Notwithstanding the foregoing, on the Effective Date, each Holder of an Existing Common Stock Interest (other than the Consenting Investor) shall receive its pro rata share (not taking into account the Existing Common Stock Interest held by the Consenting Investor) of $25 million in cash to be paid by the Consenting Investor to the Holders of Existing Common Stock Interests other than the Consenting Investor and, subject to meeting certain terms and conditions, CVRs; provided that no Holder of Existing Common Stock Interests shall be entitled to receive any interest in the CVRs to be distributed pursuant to the Prepackaged Plan if (A) the receipt of such CVRs by a particular holder (together with the other holders of CVRs) will prevent Reorganized Parent from becoming or remaining a privately held company whose securities are not required to be registered under the Securities Exchange Act of 1934, as amended, (B) the receipt of such CVRs by a particular holder will prevent Reorganized Parent from ceasing to be a reporting issuer under applicable Canadian securities laws on the Effective Date, or (C) such recipient has not satisfied the CVR Distribution Conditions (as defined in the Prepackaged Plan). •Other Equity Interests (as defined in the Prepackaged Plan) will not receive any distribution on account of such Interests (as defined in the Prepackaged Plan), which will be canceled, released, and extinguished as of the Effective Date, and will be of no further force or effect. For the avoidance of doubt, the Consenting Investor shall not receive any recovery on account of the Prepetition Consenting Investor Warrants (as defined in the Prepackaged Plan), which will be canceled, released, and extinguished as of the Effective Date, and will be of no further force or effect. Third Party Releases Upon the Effective Date of the Prepackaged Plan, the Debtors and certain Holders of Claims and Interests (as such terms are defined in the Prepackaged Plan), except as otherwise specified in the Prepackaged Plan or Confirmation Order, are deemed to release and discharge the Released Parties (as defined in the Prepackaged Plan) from certain claims, obligations, rights, suits, damages, causes of action and liabilities in connection with the Chapter 11 Cases.
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New Accounting Standards (Policies) |
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Sep. 30, 2023 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
Recently Adopted Accounting Standards and Recently Issued Accounting Standards Not Yet Effective | Recently Adopted Accounting Standards ASU 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments In June 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") 2016-13, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments, and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by the U.S. Securities and Exchange Commission (the "SEC"), which gave the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company adopted this standard on January 1, 2023 using the modified retrospective approach and it did not have a material impact on the Company's condensed consolidated financial statements, resulting in no adjustments to prior year earnings. Recently Issued Accounting Standards Not Yet Effective ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers (Topic 805) In October 2021, the FASB issued ASU 2021-08, Business Combinations (Topic 805): Accounting for Contract Assets and Contract Liabilities from Contracts with Customers, creating an exception to the recognition and measurement principles in ASC 805, Business Combinations. The amendments require an acquirer to use the guidance in ASC 606, Revenue from Contracts with Customers, rather than using fair value, when recognizing and measuring contract assets and contract liabilities related to customer contracts assumed in a business combination. In addition, the amendments clarify that all contracts requiring the recognition of assets and liabilities in accordance with the guidance in ASC 606, such as contract liabilities derived from the sale of nonfinancial assets within the scope of ASC 610-20, Gains and Losses from the Derecognition of Nonfinancial Assets, fall within the scope of the amended guidance in ASC 805. The amendments do not affect the accounting for other assets or liabilities arising from revenue contracts with customers in a business combination, such as customer-related intangible assets and contract-based intangible assets, including off-market contract terms. This ASU is effective for public entities for fiscal years beginning after December 15, 2022, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2023. The Company is considered an Emerging Growth Company as classified by the SEC, which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company is currently evaluating the impact of the standard on its consolidated financial statements.
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Property and Equipment (Tables) |
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Schedule of Detailed Information of Property and Equipment | Property and equipment consists of the following:
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Goodwill (Tables) |
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Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Goodwill | Changes in the carrying amount of goodwill are as follows:
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Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill | Specifically, the Company utilized the following Level 3 estimates and assumptions in its analyses during the three and nine months ended September 30, 2023:
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Other Intangible Assets - (Tables) |
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Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Intangible Assets Excluding Goodwill | Other intangible assets consist of the following:
The Company performs an impairment test when indicators of impairment are present. As of September 30, 2023, there were no indications of impairment of the Company's other intangible assets balances. The aggregate amortization expense for the Company’s finite-lived intangible assets was $4.5 million and $5.6 million for the three months ended September 30, 2023 and 2022, respectively, and $26.1 million and $15.6 million for the nine months ended September 30, 2023 and 2022, respectively. Amortization expense for the nine months ended September 30, 2023 includes $12.1 million of accelerated amortization related to the closure of two sites in the Oncology segment.
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Debt (Tables) |
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Schedule of Debt Instruments | Debt consists of the following:
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Accrued Liabilities (Tables) |
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Payables and Accruals [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Other Accrued Liabilities | Accrued liabilities consist of the following:
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Redeemable Noncontrolling Interests (Tables) |
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Schedule of Redeemable Noncontrolling Interests | The following is a rollforward of the activity in the redeemable noncontrolling interests for the nine months ended September 30, 2023:
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Financial Instruments (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Financial Instruments [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Fair Value Measurements, Recurring and Nonrecurring | The following table summarizes the valuation of the Company’s financial instruments that are reported at fair value on a recurring basis:
|
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Schedule of Reconciliation of Liability Related to the Embedded Derivative | The following is a reconciliation of the opening and closing balances for the derivative in Subordinated Notes liability measured at fair value on a recurring basis using significant unobservable inputs (Level 3) during the nine months ended September 30, 2023:
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||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Fair Value Of Other Current And Non Current Liabilities | The estimated fair values of other current and non-current liabilities are as follows:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Information Regarding The Carrying Value Of Financial Instruments | The following table summarizes information regarding the carrying value of the Company’s financial instruments:
|
Stockholders' Equity (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Equity [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of RSU Activity | A summary of RSU activity is as follows:
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Schedule of the Stock Option Activity | A summary of the stock option activity is as follows:
|
Supplemental Revenue Information (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenue from Contract with Customer [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Revenue Information | The following table summarizes the components of the Company’s revenues by payor category:
|
Cost of Operations, excluding Depreciation and Amortization (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Cost of Goods and Service Excluding Depletion Depreciation and Amortization | The following table summarizes the components of the Company’s cost of operations, excluding depreciation and amortization:
|
Supplemental Statement of Operations Information (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Other Income and Expenses [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Restructuring Charges | Restructuring charges consist of the following:
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Schedule of Other Operating Income, Net | Other operating income, net consists of the following:
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Schedule Of Other Non-operating Losses (gains) | Other non-operating expense (income), net consists of the following:
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Basic and Diluted Loss per Share (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Earnings Per Share [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Earnings Per Share Basic and Diluted | The loss per share is calculated by dividing the net loss attributable to common stockholders by the weighted average common shares outstanding during the period.
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Segment Information (Tables) |
9 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Sep. 30, 2023 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Revenue By Segment | The following table summarizes the Company’s revenues by segment:
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Schedule of Company's Adjusted EBITDA | The following table summarizes the Company’s Adjusted EBITDA by segment:
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Schedule of Net Income (Loss) to Total Adjusted EBITDA | A reconciliation of the net loss to total Adjusted EBITDA is shown below:
|
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Schedule of Segment Reporting Information By Segment | The following table summarizes the Company’s total assets by segment:
The following table summarizes the Company’s capital expenditures by segment:
|
Variable Interest Entities (Details) - USD ($) $ in Thousands |
9 Months Ended | ||
---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Dec. 31, 2022 |
|
Variable Interest Entity [Line Items] | |||
Assets | $ 1,590,830 | $ 1,765,115 | |
Liabilities | 1,680,959 | 1,623,824 | |
Net cash provided by operating activities | 17,394 | $ 55,936 | |
Variable Interest Entity, Primary Beneficiary | |||
Variable Interest Entity [Line Items] | |||
Assets | 44,100 | 36,000 | |
Liabilities | 1,700 | $ 1,400 | |
Revenues | 129,000 | 137,200 | |
Net cash provided by operating activities | $ 114,900 | $ 161,000 |
Property and Equipment - Additional Information (Details) - USD ($) $ in Millions |
3 Months Ended | 9 Months Ended | |||
---|---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Dec. 31, 2022 |
|
Property, Plant and Equipment [Abstract] | |||||
Depreciation expense | $ 16.4 | $ 19.5 | $ 52.9 | $ 59.4 | |
Net book value of equipment under finance leases | $ 23.8 | $ 23.8 | $ 26.3 |
Goodwill - Changes in the Carrying Amount of Goodwill (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | |||
---|---|---|---|---|---|
Sep. 30, 2023 |
Jun. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Goodwill [Roll Forward] | |||||
Balance - Beginning of period | $ 769,110 | ||||
Impairment | $ (41,669) | $ (20,000) | (95,129) | $ (20,000) | |
Goodwill written off in connection with site closures | (653) | ||||
Balance - End of period | 673,328 | 673,328 | |||
Radiology | |||||
Goodwill [Roll Forward] | |||||
Balance - Beginning of period | 682,725 | ||||
Impairment | (30,600) | $ (53,500) | (84,129) | ||
Goodwill written off in connection with site closures | 0 | ||||
Balance - End of period | 598,596 | 598,596 | |||
Oncology | |||||
Goodwill [Roll Forward] | |||||
Balance - Beginning of period | 86,385 | ||||
Impairment | (11,000) | (11,000) | |||
Goodwill written off in connection with site closures | (653) | ||||
Balance - End of period | $ 74,732 | $ 74,732 |
Goodwill - Schedule Of Significant Unobservable Inputs Used In The Fair Value Measurement Of Goodwill (Details) |
Sep. 30, 2023 |
Jun. 30, 2023 |
---|---|---|
Discount rate | Minimum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 0.095 | 0.095 |
Discount rate | Maximum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 0.105 | 0.105 |
Perpetual growth rate | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 0.030 | 0.030 |
Tax rate | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 0.260 | 0.260 |
Risk-free interest rate | Minimum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 0.035 | 0.035 |
Risk-free interest rate | Maximum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 0.049 | 0.049 |
Revenue multiple | Minimum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 1.7 | 1.7 |
Revenue multiple | Maximum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 2.2 | 2.2 |
EBITDA multiple | Minimum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 7.5 | 7.5 |
EBITDA multiple | Maximum | ||
Goodwill [Line Items] | ||
Goodwill measurement input | 11.0 | 11.0 |
Goodwill - Additional Information (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | |||
---|---|---|---|---|---|
Sep. 30, 2023 |
Jun. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Goodwill [Line Items] | |||||
Impairment | $ 41,669 | $ 20,000 | $ 95,129 | $ 20,000 | |
Radiology | |||||
Goodwill [Line Items] | |||||
Impairment | $ 30,600 | $ 53,500 | $ 84,129 |
Other Intangible Assets - Additional Information (Details) $ in Millions |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023
USD ($)
|
Sep. 30, 2022
USD ($)
|
Sep. 30, 2023
USD ($)
site
|
Sep. 30, 2022
USD ($)
|
|
Finite-Lived Intangible Assets [Line Items] | ||||
Amortization of Intangible Assets | $ 4.5 | $ 5.6 | $ 26.1 | $ 15.6 |
Oncology | ||||
Finite-Lived Intangible Assets [Line Items] | ||||
Amortization of Intangible Assets | $ 12.1 | |||
Number of sites closed | site | 2 |
Debt - Additional Information (Details) - Subordinated Notes - USD ($) $ in Millions |
9 Months Ended | |
---|---|---|
Sep. 29, 2023 |
Sep. 30, 2023 |
|
Debt Instrument [Line Items] | ||
Accrued interest added to the principal balance | $ 37.7 | |
Cash interest failure to pay | $ 3.9 |
Accrued Liabilities (Details) - USD ($) $ in Thousands |
Sep. 30, 2023 |
Dec. 31, 2022 |
---|---|---|
Payables and Accruals [Abstract] | ||
Accrued compensation and related expenses | $ 17,621 | $ 25,655 |
Accrued interest expense | 23,091 | 18,183 |
Other | 53,365 | 43,078 |
Total accrued liabilities | $ 94,077 | $ 86,916 |
Redeemable Noncontrolling Interests - Additional Information (Detail) - USD ($) $ in Thousands |
Sep. 30, 2023 |
Dec. 31, 2022 |
---|---|---|
Noncontrolling Interest [Abstract] | ||
Redeemable noncontrolling interests | $ 24,549 | $ 30,337 |
Redeemable Noncontrolling Interest - Summary of Redeemable Noncontrolling Interests (Detail) $ in Thousands |
9 Months Ended |
---|---|
Sep. 30, 2023
USD ($)
| |
Stockholders' Equity Attributable to Noncontrolling Interest [Roll Forward] | |
Balance, December 31, 2022 | $ 30,337 |
Net loss attributable to redeemable noncontrolling interests | (509) |
Contributions received from redeemable noncontrolling interests | 721 |
Distributions paid to redeemable noncontrolling interests | (6,000) |
Balance, September 30, 2023 | $ 24,549 |
Financial Instruments - Additional Information (Details) $ in Thousands |
Sep. 01, 2021 |
Sep. 30, 2023
USD ($)
yr
|
Dec. 31, 2022
USD ($)
yr
|
---|---|---|---|
Financial Instruments [Line Items] | |||
Long-term debt | $ 1,385,745 | $ 1,346,057 | |
Revolving Facility | |||
Financial Instruments [Line Items] | |||
Long-term debt | $ 16,000 | $ 0 | |
Revolving Facility | Interest Rate Contract | |||
Financial Instruments [Line Items] | |||
Increase decrease in the variable rate of interest | 1.00% | 1.00% | |
Equipment Debt | |||
Financial Instruments [Line Items] | |||
Long term debt unhedged | $ 200 | $ 400 | |
Level 3 | Measurement Input Probability Weighted Time | |||
Financial Instruments [Line Items] | |||
Embedded derivative liability measurement input | yr | 3.1 | 3.5 | |
Level 3 | Measurement Input Probability Of Exit Event Percentage | |||
Financial Instruments [Line Items] | |||
Embedded derivative liability measurement input | 0.209 | 0.229 | |
Subordinated Notes | Stone Peak Magnet | |||
Financial Instruments [Line Items] | |||
Debt covenant, redemption option, change of control period (in years) | 7 years |
Financial Instruments - Summary of Reconciliation of Liability Related to the Embedded Derivative (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward] | ||||
Change in fair value | $ 121 | $ 271 | $ 422 | $ 1,110 |
Subordinated Notes | Stone Peak Magnet | Level 3 | ||||
Disclosure Of Movement In Embedded Derivative Liabilities [Roll Forward] | ||||
Balance, December 31, 2022 | 6,132 | |||
Change in fair value | (422) | |||
Balance, September 30, 2023 | $ 5,710 | $ 5,710 |
Stockholders' Equity - Summary of RSU Activity (Detail) $ / shares in Units, $ in Thousands |
9 Months Ended |
---|---|
Sep. 30, 2023
USD ($)
$ / shares
shares
| |
Number of RSUs | |
Beginning balance (in shares) | shares | 2,143,601 |
Granted (in shares) | shares | 2,467,213 |
Vested (in shares) | shares | (1,361,978) |
Cancelled (in shares) | shares | (57,078) |
Ending balance (in shares) | shares | 3,191,758 |
Weighted- Average Grant Date Fair Value | |
Beginning balance (in dollars per share) | $ / shares | $ 1.77 |
Granted (in dollars per share) | $ / shares | 0.62 |
Vested (in dollars per share) | $ / shares | 1.89 |
Cancelled (in dollars per share) | $ / shares | 1.10 |
Ending balance (in dollars per share) | $ / shares | $ 0.84 |
Aggregate Grant Date Fair Value, Granted | $ | $ 1,530 |
Aggregate Grant Date Fair Value, Vested | $ | 2,581 |
Aggregate Grant Date Fair Value, Cancelled | $ | (63) |
Aggregate Grant Date Fair Value, Outstanding and unvested | $ | $ 2,671 |
Stockholders' Equity - Summary of the Stock Option Activity (Detail) - Stock Options - USD ($) $ / shares in Units, $ in Thousands |
9 Months Ended | 12 Months Ended |
---|---|---|
Sep. 30, 2023 |
Dec. 31, 2022 |
|
Number of Options | ||
Beginning balance (in share) | 5,348,120 | |
Ending balance (in share) | 5,348,120 | 5,348,120 |
Weighted- Average Exercise price | ||
Beginning balance (in USD per share) | $ 2.56 | |
Ending balance (in USD per share) | $ 2.56 | $ 2.56 |
Stock Options Additional Disclosures | ||
Number of Options, Exercisable (in shares) | 5,325,020 | |
Weighted-Average Exercise price, Exercisable (in dollars per share) | $ 2.55 | |
Weighted- Average Remaining Contractual Term (Years) | 2 years 7 months 6 days | 3 years 3 months 18 days |
Weighted-Average Remaining Contractual Term, Exercisable | 2 years 7 months 6 days | |
Aggregate Intrinsic Value (in thousands) | $ 0 | $ 378 |
Aggregate Intrinsic Value, Exercisable | $ 0 |
Commitments and Contingencies (Details) - Commitement For The Purchase Of Equipment $ in Millions |
Sep. 30, 2023
USD ($)
|
---|---|
Loss Contingencies [Line Items] | |
Purchase commitments | $ 32.7 |
Remaining Three Months of Current Year | |
Loss Contingencies [Line Items] | |
Purchase commitments | 9.2 |
Greater than Three Months in Current Year | |
Loss Contingencies [Line Items] | |
Purchase commitments | $ 23.5 |
Supplemental Statement of Operations Information - Schedule of Restructuring Charges (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | $ 23 | $ 4,042 | $ 6,703 | $ 11,366 |
Transformation costs | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | 0 | 3,363 | 6,659 | 7,388 |
Lease termination costs | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | 0 | 0 | 7 | 1,840 |
Domestication and related costs | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | 0 | 350 | 0 | 1,413 |
Other | ||||
Restructuring Cost and Reserve [Line Items] | ||||
Restructuring charges | $ 23 | $ 329 | $ 37 | $ 725 |
Supplemental Statement of Operations Information - Schedule of Other Operating Expense (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Other Income and Expenses [Abstract] | ||||
Loss (gain) on sale of accounts receivable | $ 0 | $ (7,603) | $ 1,046 | $ (7,603) |
Gain from insurance proceeds | (45) | 0 | (821) | 0 |
Loss (gain) on disposal of property and equipment, net | (344) | 26 | (761) | 398 |
Other, net | 42 | 3 | (85) | (123) |
Other operating income, net | $ (347) | $ (7,574) | $ (621) | $ (7,328) |
Supplemental Statement of Operations Information - Schedule of Other Non-operating Losses (gains) (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Other Income and Expenses [Abstract] | ||||
Capital structure initiatives | $ 7,604 | $ 0 | $ 9,516 | $ 0 |
Acquisition-related costs | 27 | 99 | 325 | 567 |
Fair value adjustment on derivative in subordinated notes | (121) | (271) | (422) | (1,110) |
Earnings from unconsolidated investees | (135) | (250) | (414) | (738) |
Other, net | 147 | 0 | 731 | (1,152) |
Other non-operating expense (income), net | $ 7,522 | $ (422) | $ 9,736 | $ (2,433) |
Supplemental Statement of Operations Information - Schedule of Impairment of Assets (Details) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Other Income and Expenses [Abstract] | ||||
Goodwill | $ 41,669 | $ 20,000 | $ 95,129 | $ 20,000 |
Property and equipment | 372 | 369 | 372 | 702 |
Impairment charges | $ 42,041 | $ 20,369 | $ 95,501 | $ 20,702 |
Investments in Unconsolidated Investees (Detail) - USD ($) $ in Millions |
Mar. 01, 2021 |
Sep. 30, 2023 |
---|---|---|
Other Investments [Line Items] | ||
Payments to acquire Investments | $ 4.6 | |
Equity method investments | $ 7.9 | |
Common Equity | Share Purchase Warrants | ||
Other Investments [Line Items] | ||
Payments to acquire Investments | $ 0.4 | |
AI Business | ||
Other Investments [Line Items] | ||
Equity method investment, ownership percentage | 34.50% | 15.00% |
AI Business | Common Equity | Share Purchase Warrants | ||
Other Investments [Line Items] | ||
Equity method investment, ownership percentage | 2.40% |
Basic and Diluted Loss per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Earnings Per Share [Abstract] | ||||
Net loss attributable to common stockholders | $ (82,385) | $ (53,871) | $ (214,185) | $ (115,151) |
Weighted average common shares outstanding: | ||||
Basic (in shares) | 91,044,143 | 89,540,046 | 90,460,245 | 89,378,653 |
Diluted (in shares) | 91,044,143 | 89,540,046 | 90,460,245 | 89,378,653 |
Net loss per share attributable to common stockholders: | ||||
Basic (in USD per share) | $ (0.90) | $ (0.60) | $ (2.37) | $ (1.29) |
Diluted (in USD per share) | $ (0.90) | $ (0.60) | $ (2.37) | $ (1.29) |
Employee stock options, warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive (in shares) | 1,988,559 | 2,571,041 | 2,086,216 | 2,548,000 |
Segment Information - Additional Information (Details) |
9 Months Ended |
---|---|
Sep. 30, 2023
segment
| |
Segment Reporting [Abstract] | |
Number of reportable segments | 2 |
Segment Information - Summary of Company's Revenues By Segment (Detail) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | $ 180,624 | $ 186,605 | $ 553,056 | $ 564,996 |
Radiology | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | 153,930 | 155,062 | 467,622 | 471,269 |
Oncology | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Revenues | $ 26,694 | $ 31,543 | $ 85,434 | $ 93,727 |
Segment Information - Summary of Company's Adjusted EBITDA (Detail) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | $ 23,482 | $ 36,521 | $ 83,150 | $ 106,721 |
Corporate | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | (3,184) | (5,745) | (17,211) | (20,494) |
Radiology | Operating Segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | 18,790 | 31,218 | 74,565 | 95,832 |
Oncology | Operating Segments | ||||
Segment Reporting, Revenue Reconciling Item [Line Items] | ||||
Adjusted EBITDA | $ 7,876 | $ 11,048 | $ 25,796 | $ 31,383 |
Segment Information - Summary of Net Income (Loss) to Total Adjusted EBITDA (Detail) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | ||
---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
|
Segment Reporting [Abstract] | ||||
Net loss | $ (83,495) | $ (49,745) | $ (209,096) | $ (102,256) |
Interest expense | 33,872 | 29,679 | 95,733 | 87,650 |
Income tax expense (benefit) | (80) | 12,038 | (784) | 9,118 |
Depreciation and amortization | 20,942 | 25,079 | 78,950 | 75,010 |
Impairment charges | 42,041 | 20,369 | 95,501 | 20,702 |
Restructuring charges | 23 | 4,042 | 6,703 | 11,366 |
Severance and related costs | 538 | 2,485 | 511 | 10,282 |
Settlements, recoveries and related costs | 1,561 | (576) | 3,474 | 101 |
Stock-based compensation | 505 | 556 | 1,345 | 2,375 |
Loss (gain) on sale of accounts receivable | 0 | (7,603) | 1,046 | (7,603) |
Loss (gain) on disposal of property and equipment, net | (344) | 26 | (761) | 398 |
Capital structure initiatives | 7,604 | 0 | 9,516 | 0 |
Acquisition-related costs | 27 | 99 | 325 | 567 |
Fair value adjustment on derivative | (121) | (271) | (422) | (1,110) |
Deferred rent expense | 221 | 325 | 363 | 904 |
Other, net | 188 | 18 | 746 | (783) |
Adjusted EBITDA | $ 23,482 | $ 36,521 | $ 83,150 | $ 106,721 |
Segment Information - Schedule Of Segment Reporting Information By Segment (Detail) - USD ($) $ in Thousands |
3 Months Ended | 9 Months Ended | |||
---|---|---|---|---|---|
Sep. 30, 2023 |
Sep. 30, 2022 |
Sep. 30, 2023 |
Sep. 30, 2022 |
Dec. 31, 2022 |
|
Segment Reporting Information [Line Items] | |||||
Identifiable assets | $ 1,590,830 | $ 1,590,830 | $ 1,765,115 | ||
Capital expenditures | 8,033 | $ 17,299 | 19,493 | $ 32,765 | |
Corporate | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 17,223 | 17,223 | 17,840 | ||
Capital expenditures | 65 | 11 | 658 | 183 | |
Radiology | Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 1,269,014 | 1,269,014 | 1,400,938 | ||
Capital expenditures | 6,844 | 16,081 | 16,711 | 29,541 | |
Oncology | Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Identifiable assets | 304,593 | 304,593 | $ 346,337 | ||
Capital expenditures | $ 1,124 | $ 1,207 | $ 2,124 | $ 3,041 |
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