Accounts and Notes Receivable

12 Months Ended

Dec. 31, 2019

Note 7— Accounts and Notes Receivable

The Company’s accounts and notes receivable balances consisted of the following as of December 31, 2019 and 2018:


	December 31, 2019		December 31, 2018
	(in thousands)
Short-term
Accounts and notes receivable	$	386,656	$	389,047
Allowance for doubtful accounts	(45,726)		(47,209)
Total net short-term accounts and notes receivable	$	340,930	$	341,838
Long-term
Notes receivable	53,659		53,043
Allowance for doubtful accounts	(6,667)		(10,000)
Total net long-term notes receivable	$	46,992	$	43,043
Total net accounts and notes receivable	$	387,922	$	384,881

The Company makes credit decisions on a case-by-case basis after reviewing a number of qualitative and quantitative factors related to the specific client as well as current industry variables that may impact that client. There are a variety of factors that impact a client’s ability to pay in accordance with the Company’s contracts. These factors include, but are not limited to, fluctuating census numbers, litigation costs and the client’s participation in programs funded by federal and state governmental agencies. Deviations in the timing or amounts of reimbursements under those programs can impact the client’s cash flows and their ability to make timely payments. However, the client's obligation to pay the Company in accordance with the contracts are not contingent upon the client’s cash flow. Notwithstanding the Company’s efforts to minimize its credit risk exposure, the aforementioned factors, as well as other factors that impact client cash flows or ability to make timely payments, could have an indirect, yet material adverse effect on the Company’s results of operations and financial condition.

Fluctuations in net accounts and notes receivable are generally attributable to a variety of factors including, but not limited to, the timing of cash receipts from customers and the inception, transition, modification or termination of client relationships. The Company deploys significant resources and has invested in tools and processes to optimize Management’s credit and collections efforts. When appropriate, the Company utilizes interest-bearing promissory notes to enhance the collectability of amounts due, by instituting definitive repayment plans and providing a means by which to further evidence the amounts owed. As of December 31, 2019 and 2018, the Company's promissory notes outstanding were $70.4 million and $63.3 million, respectively, inclusive of reserves of $12.5 million and $13.5 million, respectively. In addition, the Company may amend contracts from full service to management-only arrangements, or adjust contractual payment terms, to accommodate clients who have in good faith established clearly-defined plans for addressing cash flow issues. These efforts are intended to minimize the Company’s collection risk.