Aveanna Healthcare Holdings, Inc.
For the period ended Mar 29, 2025. Filed May 8, 2025.
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A company's report for each of its first three quarters. The financial statements are not audited. It shows how the business has moved since the last annual report, and what management says changed.
Mar 29, 2025 · Filed May 8, 2025
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Notes to Consolidated Financial Statements (Unaudited)
- DESCRIPTION OF BUSINESS
Aveanna Healthcare Holdings Inc. (together with its consolidated subsidiaries, the “Company”) is headquartered in Atlanta, Georgia and has locations in 34 states with concentrations in Texas, Pennsylvania, and California, providing a broad range of pediatric and adult healthcare services, including nursing, hospice, rehabilitation services, occupational nursing in schools, therapy services, day treatment centers for medically fragile and chronically ill children and adults, as well as delivery of enteral nutrition and other products to patients. In addition, the Company provides respite healthcare services, which are temporary care provider services provided in relief of the patient’s normal caregiver. The Company’s services are designed to provide a high quality, lower cost alternative to prolonged hospitalization.
- SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Principles of Consolidation
The accompanying interim unaudited consolidated financial statements include the accounts of Aveanna Healthcare Holdings Inc. and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in the interim unaudited consolidated financial statements, and business combinations accounted for as purchases have been included in the interim unaudited consolidated financial statements from their respective dates of acquisition.
Basis of Presentation
The accompanying interim consolidated financial statements are unaudited and have been prepared by the Company in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and in accordance with the rules and regulations of the Securities and Exchange Commission (the “SEC”). Accordingly, these interim unaudited consolidated financial statements do not include all the information and disclosures required by U.S. GAAP for complete financial statements. In the opinion of management, these interim unaudited consolidated financial statements reflect all adjustments, consisting of normal recurring adjustments, necessary to present fairly the Company’s financial position as of March 29, 2025 and the results of operations for the three-month periods ended March 29, 2025 and March 30, 2024. The results reported in these interim unaudited consolidated financial statements should not be regarded as indicative of results that may be expected for any future period or the year ending January 3, 2026. These interim unaudited consolidated financial statements and related notes should be read in conjunction with the audited consolidated financial statements and related notes for the fiscal year ended December 28, 2024 included in the Company’s Annual Report on Form 10-K filed with the SEC on March 13, 2025.
Our fiscal year ends on the Saturday that is closest to December 31 of a given year, resulting in either a 52 or 53-week fiscal year. The interim unaudited consolidated balance sheets reflect the accounts of the Company as of March 29, 2025 and December 28, 2024. For the three-month periods ended March 29, 2025 and March 30, 2024, the interim unaudited consolidated statements of operations, stockholders' deficit, and cash flows reflect the accounts of the Company from December 29, 2024 through March 29, 2025 and December 31, 2023 through March 30, 2024, respectively, each of which include 13 weeks.
Use of Estimates
The Company’s accounting and reporting policies conform with U.S. GAAP. In preparing the interim unaudited consolidated financial statements, the Company is required to make estimates and assumptions that impact the amounts reported in these interim unaudited consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.
Recently Issued Accounting Pronouncements
In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard enhances income tax disclosure requirements for all entities by requiring specified categories and greater disaggregation within the rate reconciliation table, disclosure of income taxes paid by jurisdiction, and providing clarification on uncertain tax positions and related financial statement impacts. The standard will be effective for the fiscal year 2025 annual financial statements with early adoption permitted. The Company plans to adopt the standard when it becomes effective beginning with the Company's fiscal year 2025 annual financial statements, and the Company expects the adoption of the standard will impact certain of its income tax disclosures.
- REVENUE
The Company evaluates the nature, amount, timing and uncertainty of revenue and cash flows using the five-step process. The Company uses a portfolio approach to group contracts with similar characteristics and analyze historical cash collection trends.
Revenue is primarily derived from (i) pediatric healthcare services provided to patients, including private duty nursing and therapy services; (ii) adult home health and hospice services (collectively “patient revenue”); and (iii) the delivery of enteral nutrition and other products to patients (“product revenue”). The services provided by the Company have no fixed duration and can be terminated by the patient or the facility at any time; therefore, each service provided is its own stand-alone contract. Incremental costs of obtaining a contract are expensed as incurred due to the short-term nature of the contracts.
Services ordered by a healthcare provider in an episode of care are not separately identifiable and therefore have been combined into a single performance obligation for each contract. The Company recognizes revenue as its performance obligations are completed. For patient revenue, the performance obligation is satisfied over time as the customer simultaneously receives and consumes the benefits of the healthcare services provided. For product revenue, the performance obligation is satisfied at the point in time of delivery of the product to the patient. The Company recognizes patient revenue equally over the number of treatments provided in a single episode of care. Typically, patients and third-party payers are billed within several days of the service being performed, and payments are due based on contract terms.
The Company’s lines of business are generally classified into the following categories: private duty services; home health and hospice; and medical solutions.
Private Duty Services (“PDS”). The PDS business includes a broad range of pediatric and adult healthcare services, including private duty skilled nursing, non-clinical services, which include support services and personal care services, pediatric therapy services, rehabilitation services, and nursing services in schools and pediatric day healthcare centers.
Home Health & Hospice (“HHH”). The HHH business provides home health, hospice, and personal care services to predominately elderly patients.
Medical Solutions (“MS”). The MS business includes the delivery of enteral nutrition and other products to patients.
For the PDS, HHH, and MS businesses, the Company receives payments from the following sources for services rendered: (i) state governments under their respective Medicaid programs (“Medicaid”); (ii) Managed Care providers of state government Medicaid programs (“Medicaid MCO”); (iii) commercial insurers; (iv) other government programs including Medicare, Tricare and ChampVA (collectively, “Medicare”); and (v) individual patients. As the period between the time of service and time of payment is typicallyone year or less, the Company does not adjust for the effects of a significant financing component.
Most contracts contain variable consideration; however, it is unlikely that a significant reversal of revenue will occur when the uncertainty is resolved, and therefore, the Company has included the variable consideration in the estimated transaction price. The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third-party payers and by implicit price concessions which the Company estimates based on its historical collection experience. Management estimates the transaction price on a payer-specific basis given its interpretation of the applicable regulations or contract terms. Updated regulations and contract negotiations occur frequently, necessitating regular review and assessment by management. There were no material revenue adjustments recognized from performance obligations satisfied or partially satisfied in previous periods for either of the three-month periods ended March 29, 2025 or March 30, 2024.
As of March 29, 2025 and December 28, 2024, estimated contractual adjustments and implicit price concessions of$97.4 million and$90.6 million, respectively, were recorded as reductions to patient accounts receivable balances to arrive at the estimated collectible revenue and patient accounts receivable. Subsequent changes resulting from a patient’s ability to pay are recorded as bad debt expense, which is included as a component of operating expenses in the consolidated statements of operations. The Company didnot record any bad debt expense for thethree-month periods ended March 29, 2025 or March 30, 2024, respectively.
The following table presents revenue by payer type as a percentage of total revenue for thethree-month periods ended March 29, 2025 and March 30, 2024:
| For the three-month periods ended | ||
|---|---|---|
| March 29, 2025 | March 30, 2024 | |
| Medicaid MCO | 58.5% | 56.0% |
| Medicaid | 22.8% | 22.3% |
| Commercial | 8.8% | 10.9% |
| Medicare | 9.8% | 10.7% |
| Self-pay | 0.1% | 0.1% |
| Total revenue | 100.0% | 100.0% |
- LONG-TERM OBLIGATIONS
Long-term obligations consisted of the following as of March 29, 2025 and December 28, 2024 (dollar amounts in thousands):
| Instrument | StatedMaturityDate | Contractual Interest Rate | Interest Rateas of March 29, 2025 | March 29, 2025 | December 28, 2024 |
|---|---|---|---|---|---|
| 2021 Extended Term Loan (1) | 07/2028 | S + 3.75% | 8.16% | $888,250 | $890,550 |
| Second Lien Term Loan (1) | 12/2029 | S + 7.00% | 11.46% | 415,000 | 415,000 |
| Revolving Credit Facility (1) | 04/2026 | S + 3.75% | 8.16% | - | - |
| Total principal amount of long-term obligations | 1,303,250 | 1,305,550 | |||
| Less: unamortized debt issuance costs | (23,491) | (24,694) | |||
| Total amount of long-term obligations, net of unamortized debt issuance costs | 1,279,759 | 1,280,856 | |||
| Less: current portion of long-term obligations | (9,200) | (9,200) | |||
| Total amount of long-term obligations, net of unamortized debt issuance costs, less current portion | $1,270,559 | $1,271,656 | |||
| (1) S = Greater of 0.50% or one-month SOFR, plus a credit spread adjustment | |||||
The 2021 Extended Term Loan bears interest, at the Company’s election, at a variable interest rate based on either SOFR (subject to a minimum of 0.50%), or an alternative base rate ("ABR") (subject to a minimum of 2.00%) for the interest period relevant to such borrowing, plus a credit spread adjustment ("CSA") of 0.10% and an applicable margin of 3.75% for loans accruing interest based on SOFR, and an applicable margin of 2.75% for loans accruing interest based on ABR. The Revolving Credit Facility bears interest, at the Company’s election, at a variable interest rate based on either SOFR (subject to a minimum of 0.50%), or ABR (subject to a minimum of 2.00%), for the interest period relevant to such borrowing, plus a CSA of 0.10% and an applicable margin of 3.75% for loans accruing interest based on SOFR, and an applicable margin of 2.75% for loans accruing interest based on ABR. As of March 29, 2025, the principal amount of the 2021 Extended Term Loan and borrowings under the Revolving Credit Facility each accrued interest at a rate of 8.16%.
The Second Lien Term Loan bears interest at a rate per annum equal to, at the Company’s election, either (1) an applicable margin (equal to 6.00%) plus a base rate determined by reference to the highest of (a)0.50% per annum plus the Federal Funds Effective Rate, (b) the Prime Rate and (c) the SOFR rate for an interest period of one month plus a CSA depending on the interest period plus 1.00%; or (2) an applicable margin (equal to 7.00%) plus SOFR and a CSA depending on the interest period; provided that such rate is not lower than a floor of 0.50%. As of March 29, 2025, the principal amount of the Second Lien Term Loan accrued interest at a rate of 11.46%.
Debt issuance costs related to the term loans are recorded as a direct deduction from the carrying amount of the debt. The balances for debt issuance costs related to the term loans as of March 29, 2025 and December 28, 2024 were$23.5 million and$24.7 million, respectively. Debt issuance costs related to the Revolving Credit Facility are recorded within other long-term assets. The balances for debt issuance costs related to the Revolving Credit Facility as of March 29, 2025 and December 28, 2024 were$1.3 million and$1.6 million, respectively. The Company recognized interest expense related to the amortization of debt issuance costs of$1.5 million for the three-month period ended March 29, 2025 and$1.1 million for the three-month period ended March 30, 2024.
Issued letters of credit as of March 29, 2025 and December 28, 2024 were$32.3 million and $32.3 million, respectively. There wereno swingline loans outstanding as of March 29, 2025 or December 28, 2024. Borrowing capacity under the Company's Revolving Credit Facility was approximately$138.0 million as of March 29, 2025 and $138.0 million as of December 28, 2024. Available borrowing capacity under the Revolving Credit Facility is subject to a maintenance leverage covenant that becomes effective if more than 30% of the total commitment is utilized.
The fair value of the Company's long-term obligations was estimated using market-observable inputs from the Company’s comparable peers with public debt, including quoted prices in active markets, which are considered Level 2 inputs. The aggregate fair value of the Company's long-term obligations was $1,264.7 million at March 29, 2025.
The Company was in compliance with all financial covenants and restrictions under the foregoing instruments at March 29, 2025.
- SECURITIZATION FACILITY
On November 12, 2021, the Company (through a wholly owned special purpose entity, Aveanna SPV I, LLC) (the “special purpose entity”) and a lending institution entered into a Receivables Financing Agreement, which, as amended, has a maturity date of July 31, 2026 (as amended, the “Securitization Facility”). On May 31, 2024, the Company amended the Securitization Facility to increase the maximum amount available thereunder from $175.0 million to $225.0 million, subject to certain borrowing base requirements. The balances for debt issuance costs related to the Securitization Facility as of March 29, 2025 and December 28, 2024 were$0.9 million and $1.1 million, respectively andincluded in other long-term assets. The Company recognized interest expense related to the amortization of debt issuance costs of$0.1 million for the three-month period ended March 29, 2025, and $0.1 million for the three-month period ended March 30, 2024.
Pursuant to two separate sale agreements, each of which is among Aveanna Healthcare, LLC, as initial servicer, certain of the Company's subsidiaries and the special purpose entity, the subsidiaries sold substantially all of their existing and future accounts receivable balances to the special purpose entity. The special purpose entity uses the accounts receivable balances to collateralize loans made under the Securitization Facility. The Company retains the responsibility of servicing the accounts receivable balances pledged as collateral under the Securitization Facility and provides a performance guaranty.
The outstanding balance under the Securitization Facility was$168.8 million and$168.8 million at March 29, 2025 and December 28, 2024, respectively. The balance accrues interest at a rate equal to the SOFR rate, plus a CSA, plus an applicable margin. The interest rate under the Securitization Facility was 7.57% at March 29, 2025.
The Securitization Facility is accounted for as a collateralized financing activity, rather than a sale of assets; therefore: (i) accounts receivable balances pledged as collateral are presented as assets and the borrowings are presented as liabilities in the interim unaudited consolidated balance sheets; (ii) the consolidated statements of operations reflect the interest expense associated with the collateralized borrowings; and (iii) receipts from customers related to the underlying accounts receivable are reflected as operating cash flows and borrowings and repayments under the collateralized loans are reflected as financing cash flows within the consolidated statements of cash flows. The Securitization Facility is included within current liabilities on the interim unaudited consolidated balance sheets as it is collateralized by current patient accounts receivable and not because payments are due within one year of the balance sheet date.
- FAIR VALUE MEASUREMENTS
The carrying amounts of cash and cash equivalents, patient accounts receivable, accounts payable, accrued expenses and other current liabilities approximate their fair values due to the short-term maturities of the instruments.
The Company’s other assets measured at fair value were as follows (amounts in thousands):
| Level 1 · Level 2 · Level 3 · Total | ||||||
|---|---|---|---|---|---|---|
| Assets: | ||||||
| Interest rate cap agreements | $ | - | $15,073 | $ | - | $15,073 |
| Interest rate swap agreements | - | 11,605 | - | 11,605 | ||
| Total derivative assets | $ | - | $26,678 | $ | - | $26,678 |
| Level 1 · Level 2 · Level 3 · Total | ||||||
| Assets: | ||||||
| Interest rate cap agreements | $ | - | $22,543 | $ | - | $22,543 |
| Interest rate swap agreements | - | 15,737 | - | 15,737 | ||
| Total derivative assets | $ | - | $38,280 | $ | - | $38,280 |
The fair values of the interest rate swap and cap agreements are based on the estimated net proceeds or costs to settle the transactions as of the respective balance sheet dates. The valuations are based on commercially reasonable industry and market practices for valuing similar financial instruments. See Note 7 –Derivative Financial Instruments for further details on the Company’s interest rate swap and cap agreements.
- DERIVATIVE FINANCIAL INSTRUMENTS
The Company’s earnings and cash flows are subject to fluctuations due to changes in interest rates, and the Company seeks to mitigate a portion of this risk by entering into derivative contracts. The derivatives the Company currently uses are interest rate swaps and interest rate caps. The Company recognizes derivatives as either assets or liabilities at fair value on the interim unaudited consolidated balance sheets and does not designate the derivatives as hedging instruments. Changes in the fair value of derivatives are therefore recorded in earnings throughout the terms of the respective derivatives.
The Company currently hastwo interest rate swap agreements intended to limit its exposure to interest rate risk on its variable rate debt. These swaps expire on June 30, 2026. Since July 1, 2023, the interest rate swap agreements have paid a fixed rate of 2.03% and received the one-month SOFR rate, subject to a 0.50% floor. The aggregate notional amount of the interest rate swaps remained unchanged at$520.0 million at both March 29, 2025 and December 28, 2024. The fair value of the interest rate swaps was$11.6 million at March 29, 2025 and$15.7 million at December 28, 2024 and is included in other long-term assets in the interim unaudited consolidated balance sheets. The Company does not apply hedge accounting to these agreements and records all mark-to-market adjustments directly to other (expense) income in the consolidated statements of operations, which are included within cash flows from operating activities in the consolidated statements of cash flows. The net settlements incurred with swap counterparties under the swap agreements are recognized through cash flows from financing activities in the consolidated statements of cash flows due to an other-than-insignificant financing element on the interest rate swaps.
The Company has interest rate cap agreements with an aggregate notional amount of $880.0 million and a cap rate of 2.96%. The cap agreements have an expiration date of February 28, 2027. The cap agreements provide that the counterparty pays the Company the amount by which SOFR exceeds 2.96%. The fair value of the interest rate cap agreements was$15.1 million at March 29, 2025 and$22.5 million at December 28, 2024 and is included in other long-term assets on the interim unaudited consolidated balance sheets. The Company does not apply hedge accounting to interest rate cap agreements and records all mark-to-market adjustments directly to other (expense) income in the consolidated statements of operations, which are included within cash flows from operating activities in the consolidated statement of cash flows. The proceeds received from cap counterparties under the cap agreements are recognized through cash flows from operating activities in the consolidated statements of cash flows.
The following losses and gains from these derivatives not designated as hedging instruments were recognized in the Company’s consolidated statements of operations for thethree-month periods ended March 29, 2025 and March 30, 2024 (amounts in thousands):
| Statement of Operations · For the three-month periods ended | |||
|---|---|---|---|
| Classification | March 29, 2025 | March 30, 2024 | |
| Interest rate cap agreements | Other (expense) income | $(7,470) | $4,838 |
| Interest rate swap agreements | Other (expense) income | $(4,132) | $3,438 |
The Company does not utilize financial instruments for trading or other speculative purposes.
- INCOME TAXES
The Company records its provision for income taxes on an interim basis based upon the estimate of the annual effective income tax rate for the full year applied to “ordinary” income or loss, adjusted each quarter for discrete items. The Company analyzes various factors to determine the estimated annual effective income tax rate, including projections of annual earnings, the impact of state and local income taxes, its ability to use tax credits and net operating loss carryforwards, and available tax planning alternatives.
The Company recorded income tax expense of$5.0 million for the three-month period ended March 29, 2025, and income tax expense of$12.7 million for the three-month period ended March 30, 2024.
The Company’s effective tax rate was 48.8% for the three-month period ended March 29, 2025, and 849.8% for the three-month period ended March 30, 2024. The effective tax rates for the three-month periods ended March 29, 2025 and March 30, 2024 differed from the statutory rate of 21% primarily due to certain non-deductible expenses, most notably interest expense, and the changes in the valuation allowance recorded against certain deferred tax assets.
For the three-month period ended March 29, 2025, there were no material changes to the Company's uncertain tax positions. There has been no change to the Company’s policy that recognizes potential interest and penalties related to uncertain tax positions in income tax expense in the accompanying consolidated statements of operations.
- SHARE-BASED COMPENSATION
Pre-IPO Options and Management Restricted Units
The Company recorded compensation expense, net of forfeitures, of$0.7 million for the three-month period ended March 29, 2025, and$0.8 million for the three-month period ended March 30, 2024, which is included in corporate and branch and regional administrative expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense as of March 29, 2025 associated with these outstanding awards was$2.2 million.
Director Restricted Stock Units
In February 2025, the Compensation Committee of the Company's Board of Directors (the "Compensation Committee") approved grants of 173,914 restricted stock units, with a grant date per share fair value of$4.26, to certain independent Directors ("Director RSUs") under the Company's 2021 Omnibus Stock Incentive Plan. Director RSUs vest over aone-year period, and each RSU settles forone share of common stock upon vesting. The Company recorded compensation expense of$0.2 million for the three-month period ended March 29, 2025 and$0.2 million for the three-month period ended March 30, 2024, which is included in corporate expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense as of March 29, 2025 associated with outstanding director restricted stock units was$0.7 million.
Long-Term Incentive Plan ("LTIP")
During the three-month period ended March 29, 2025, the Compensation Committee approved grants of restricted stock units ("RSUs") and performance stock units ("PSUs") under the Company's 2021 Omnibus Stock Incentive Plan. Annual grants of RSUs and PSUs have been awarded since fiscal year 2022. Upon vesting, each RSU and each PSU settles for one share of common stock.
The RSUs are subject to a three-year service-based cliff vesting schedule commencing on the date of grant. Compensation cost for the RSUs is measured based on the grant date fair value of each underlying share of common stock and the number of RSUs granted and is recognized over the applicable vesting period on a straight-line basis. During the three-month period ended March 29, 2025, the Company granted 1,649,109 RSUs with a grant date per share fair value of$4.26. The Company recorded compensation expense, net of forfeitures, of$1.5 million for the three-month period ended March 29, 2025, and$1.0 million for the three-month period ended March 30, 2024, which is included in corporate and branch and regional administrative expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense was$12.4 million as of March 29, 2025.
The PSUs contain performance criterion based on adjusted EBITDA targets for each of the three years during the vesting period. Achievement of any annual target during the three years subsequent to the grant date results in a cumulative achievement event for the target year and any prior year award not previously achieved. Additionally, the PSUs are subject to a three-year service-based cliff vesting schedule commencing on the date of grant. The PSUs have service and performance conditions, and compensation cost is initially measured based on the grant date fair value of each underlying share of common stock. Cumulative compensation cost is subsequently adjusted at the end of each reporting period to reflect the current estimation of achieving the performance condition. During the three-month period ended March 29, 2025, the Company granted 1,649,014 PSUs with a weighted average grant date per share fair value of$4.26. Further, during three-month period ended March 29, 2025, the Compensation Committee modified PSUs originally issued during the three-month period ended April 2, 2022. The previous performance criterion were replaced with an Adjusted EBITDA target for the fiscal year ending January 3, 2026. Effects of the modification are reflected in compensation expense, net of forfeitures for the three-month period ended March 29, 2025. The Company recorded compensation expense, net of forfeitures, of$0.5 million for the three-month period ended March 29, 2025 and$0.7 million for the three-month period ended March 30, 2024, which is included in corporate and branch and regional administrative expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense was$14.6 million as of March 29, 2025.
Senior Management Retention Plan ("SMRP")
In the second quarter of 2023, the Compensation Committee approved SMRP awards to certain members of management to be paid in the form of RSUs under the 2021 Omnibus Stock Incentive Plan. The awards were granted based on a fixed dollar value for each member of senior management included in the plan. The performance condition related to the SMRP was achieved during the three-month period ended March 29, 2025, resulting in the acceleration of the related compensation expense of the awards. The Company recorded compensation expense, net of forfeitures, of$7.6 million during the three-month period ended March 29, 2025, and$1.0 million during the three-month period ended March 30, 2024, which is included in corporate expenses and branch and regional administrative expenses in the accompanying consolidated statements of operations. There wasno unrecognized compensation expense as of March 29, 2025.
Total compensation expense, net of forfeitures, for all awards under the Amended and Restated 2017 Stock Incentive Plan and 2021 Omnibus Incentive Plan was $10.5 million for thethree-month period ended March 29, 2025 and $3.7 million for thethree-month period ended March 30, 2024. Total unrecognized compensation expense for all awards under such plans was $29.9 million as of March 29, 2025.
Employee Stock Purchase Plan
During the three-month period ended March 29, 2025, participants in the Company's Employee Stock Purchase Plan purchased a total of 847,673 shares of common stock at a weighted average price of approximately$2.11 per share. During the three-month period ended March 30, 2024, participants purchased 1,010,635 shares of common stock at a weighted average price of approximately $1.33 per share.
The Company recorded compensation expense of$0.5 million for the three-month period ended March 29, 2025 and$0.4 million for the three-month period ended March 30, 2024, which is included in corp orate expenses, branch and regional administrative expenses and cost of revenue, excluding depreciation and amortization in the accompanying consolidated statements of operations.
- COMMITMENTS AND CONTINGENCIES
Insurance Reserves
As is typical in the healthcare industry, the Company is subject to claims that its services have resulted in patient injury or other adverse effects.
The accrued professional liability insurance reserves included in the interim unaudited consolidated balance sheets include estimates of the ultimate costs, including third-party legal defense costs, in the event the Company was unable to receive funds from claims made under commercial insurance policies, for claims that have been reported but not paid and claims that have been incurred but not reported at the balance sheet dates. Although substantially all reported claims are paid directly by the Company’s commercial insurance carriers (after the Company satisfies the applicable policy deductible and/or retention), the Company is ultimately responsible for payment of these claims in the event its insurance carriers become insolvent or otherwise do not honor the contractual obligations under the liability policies. The Company is required under U.S. GAAP to recognize these estimated liabilities in its consolidated financial statements on a gross basis; with a corresponding receivable from the insurance carriers reflecting the contractual indemnity provided by the carriers under the related liability policies.
Since October 1, 2024, the Company has maintained primary commercial insurance coverage on a claims-made basis for professional liability claims with a $2.0 millionper claim deductible, a $2.0 million aggregate buffer retention, and $5.0 million per claim and annual aggregate limits. Prior to October 1, 2024, the Company maintained primary commercial insurance coverage on a claims made basis for professional liability claims with varying deductibles by policy year from$0.5 million to $2.0 million on a per claim basis and $4.5 million to$6.0 million per claim and annual aggregate limits. Moreover, the Company maintains excess insurance coverage for professional liability claims to cover any claims over the aggregate limits. In addition, the Company maintains workers’ compensation insurance with$0.5 million per claim deductible and statutory limits. The Company reimburses insurance carriers for deductible losses under these policies. The Company’s insurance carriers require collateral to secure the Company’s obligation to reimburse insurance carriers for these deductible payments. Collateral as of both March 29, 2025 and December 28, 2024 was comprised of$23.1 million of issued letters of credit and$0.7 million in cash collateral.
As of March 29, 2025, insurance reserves totaling$93.8 million were included on the interim unaudited consolidated balance sheets, representing$41.0 million and$52.8 million of reserves for professional liability claims and workers’ compensation claims, respectively. At December 28, 2024, insurance reserves totaling$97.8 million were included on the consolidated balance sheets, representing$42.7 million and$55.1 million of reserves for professional liability claims and workers’ compensation claims, respectively.
Litigation and Other Current Liabilities
On January 18, 2023, an arbitration award in the amount of $7.9 million was rendered against the Company related to a claim under the Company's Texas non-subscriber benefit plan. After the trial court entered a judgment to enforce the arbitration award, the Company promptly obtained a $9.1 million collateralized appellate bond and intends to avail itself of all appellate options. The ultimate resolution of this litigated matter is not expected to have a material impact on the consolidated financial statements.
The Company is currently a party to various routine litigation incidental to the business. While management currently believes that the ultimate outcome of such proceedings, individually and in the aggregate, will not have a material adverse effect on the Company’s financial position or overall trends in results of operations, litigation is subject to inherent uncertainties. Management has established provisions within other current liabilities in the accompanying consolidated balance sheets, which in the opinion of management represents the best estimate of exposure and adequately provides for such losses that may occur from asserted claims related to the provision of professional services and which may not be covered by the Company’s insurance policies. Management believes that any additional unfavorable provisions would not be material to the Company’s results of operations or financial position; however, if an unfavorable ruling on any asserted or unasserted claim were to occur, there exists the possibility of a material adverse impact on the Company’s net earnings or financial position. The estimate of the potential impact from legal proceedings on the Company’s financial position or overall results of operations could change in the future.
Healthcare Regulatory Matters
Starting on October 30, 2019 the Company has received grand jury subpoenas issued by the U.S. Department of Justice, Antitrust Division (the “Antitrust Division”), requiring the production of documents and information pertaining to nurse wages, reimbursement rates, and hiring activities in a few of its local markets. The Company is fully cooperating with the Antitrust Division with respect to this investigation, and management believes that a loss event is not probable and that this matter will not materially impact the Company’s business, results of operations or financial condition. However, based on the information currently available to the Company, management cannot predict the timing or outcome of this investigation or predict the possible loss or range of loss, if any, associated with the resolution of this matter.
On July 19, 2023, the Company received a Civil Investigation Demand issued by the U.S. Department of Justice, United States Attorney’s Office, Middle District of Alabama (the “AUSA”), requiring the production of documents and information pertaining to Comfort Care Hospice, LLC, an indirect wholly owned subsidiary of the Company, regarding issues of (1) improper submission of claims to Medicare and other federal healthcare programs for service to patients who were ineligible or not properly certified for said healthcare services and (2) improper remuneration to medical directors and skilled nursing facilities for patient referrals in violation of certain federal regulations. The Company is fully cooperating with the AUSA with respect to this investigation, and management believes that a loss event is not probable and that this matter will not materially impact the Company’s business, results of operations or financial condition. However, based on the information currently available to the Company, management cannot predict the timing or outcome of this investigation or predict the possible loss or range of loss, if any, associated with the resolution of this matter.
Laws and regulations governing the government payer programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation as well as significant regulatory action. From time to time, governmental regulatory agencies conduct inquiries and audits of the Company’s practices. It is the Company’s practice to cooperate fully with such inquiries. In addition to laws and regulations governing the Medicaid, Medicaid Managed Care, and Tricare programs, there are a number of federal and state laws and regulations governing matters such as the corporate practice of medicine, fee splitting arrangements, anti-kickback statues, physician self-referral laws, false or fraudulent claims filing and patient privacy requirements. Failure to comply with any such laws or regulations could have an adverse impact on the Company’s operations and financial results. The Company believes that it is in material compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of wrongdoing.
- RELATED PARTY TRANSACTIONS
As of March 29, 2025, one of the Company’s significant shareholders owned 9.0% of the 2021 Extended Term Loan.
- SEGMENT INFORMATION
The Company’s operating segments have been identified based upon how management has organized the business by services provided to customers and how the chief operating decision maker ("CODM") manages the business and allocates resources. The CODM for the Company is the Chief Executive Officer. The Company hasthree operating segments andthree reportable segments, Private Duty Services, Home Health & Hospice, and Medical Solutions. The PDS segment predominantly includes private duty skilled nursing services, non-clinical and personal care services, and pediatric therapy services. The HHH segment provides home health and hospice services to predominately elderly patients. Through the MS segment, the Company provides enteral nutrition and other products to adults and children, delivered on a periodic or as-needed basis.
The CODM evaluates segment performance using gross margin (and gross margin percentage). Gross margin includes revenue less all costs of revenue, excluding depreciation and amortization, but excludes branch and regional administrative expenses, corporate expenses and other non-field expenses. Revenue and cost presented below for the PDS and HHH segments primarily relate to patient services, while the MS segment’s revenue and cost are primarily from products. The CODM does not evaluate a measure of assets when assessing performance. The CODM uses gross margin and gross margin percentage to assess the performance of each segment compared to historical trends, forecasted performance, and industry peers, as well as ensure that each segment has appropriate operational support to manage performance.
Results shown for the three-month periods ended March 29, 2025 and March 30, 2024 are not necessarily those which would be achieved if each segment was an unaffiliated business enterprise. There are no intersegment transactions.
The following tables summarize the Company’s segment information for thethree-month periods ended March 29, 2025 and March 30, 2024 (amounts in thousands):
| PDS | HHH | MS | Total | |
|---|---|---|---|---|
| Revenue | $459,998 | $56,733 | $42,493 | $559,224 |
| Cost of revenue, excluding depreciation and amortization | 325,313 | 25,993 | 24,360 | 375,666 |
| Gross margin | $134,685 | $30,740 | $18,133 | $183,558 |
| Gross margin percentage | 29.3% | 54.2% | 42.7% | 32.8% |
| PDS | HHH | MS | Total | |
| Revenue | $395,009 | $54,613 | $41,031 | $490,653 |
| Cost of revenue, excluding depreciation and amortization | 294,874 | 25,639 | $24,286 | 344,799 |
| Gross margin | $100,135 | $28,974 | $16,745 | $145,854 |
| Gross margin percentage | 25.4% | 53.1% | 40.8% | 29.7% |
| For the three-month periods ended | ||
|---|---|---|
| Segment Reconciliation: | March 29, 2025 | March 30, 2024 |
| Total segment gross margin | $183,558 | $145,854 |
| Branch and regional administrative expenses | 91,387 | 87,914 |
| Corporate expenses | 37,505 | 29,842 |
| Depreciation and amortization | 2,594 | 2,912 |
| Acquisition-related costs | 106 | - |
| Other operating expense | 165 | 2,320 |
| Operating income | 51,801 | 22,866 |
| Interest income | 132 | 102 |
| Interest expense | (36,335) | (39,647) |
| Other (expense) income | (5,450) | 18,169 |
| Income before income taxes | $10,148 | $1,490 |
- NET INCOME (LOSS) PER SHARE
Basic net income (loss) per share is calculated by dividing net income (loss) by the weighted average number of shares of common stock outstanding for the period. Diluted net income (loss) per share is calculated by dividing net income (loss) by the diluted weighted average number of shares of common stock outstanding for the period. For purposes of this calculation, outstanding stock options, RSUs and PSUs are considered potential dilutive shares of common stock. The following is a computation of basic and diluted net income (loss) per share (amounts in thousands, except per share amounts):
| For the three-month periods ended | ||
|---|---|---|
| March 29, 2025 | March 30, 2024 | |
| Numerator: | ||
| Net income (loss) | $5,193 | $(11,172) |
| Denominator: | ||
| Weighted average shares of common stock outstanding (1), basic | 194,671 | 192,241 |
| Net income (loss) per share, basic | $0.03 | $(0.06) |
| Weighted average shares of common stock outstanding (1), diluted | 206,238 | 192,241 |
| Net income (loss) per share, diluted | $0.03 | $(0.06) |
| Dilutive securities outstanding not included in the computation of diluted net income (loss) per share, as their effect is antidilutive: | ||
| RSUs | - | 9,709 |
| PSUs | - | 6,558 |
| Stock options | 13,001 | 13,153 |
(1)
The calculation of weighted average shares of common stock outstanding includes all vested deferred restricted stock units.
- SUBSEQUENT EVENT
On April 1, 2025, the Company, and Thrive Skilled Pediatric Care, LLC, a Delaware limited liability company (“Thrive”), entered into an Agreement and Plan of Merger (the "Merger"). Upon completion of the Merger, Thrive will continue as a wholly-owned subsidiary of the Company. The Company will pay approximately $75.0 million, primarily in the form of shares of Common Stock of the Company, as consideration for the Merger, subject to customary purchase price adjustments.
The text of this filing, as the company filed it with the SEC, without its images or exhibits. This is not investment advice.