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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
FORM 10-Q
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☒ |
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
For the quarterly period ended March 31, 2024
OR
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☐ |
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
Commission File Number: 001-39391
CareMax, Inc.
(Exact Name of Registrant as Specified in its Charter)
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Delaware |
85-0992224 |
( State or other jurisdiction of incorporation or organization) |
(I.R.S. Employer Identification No.) |
1000 NW 57th Court, Suite 400 Miami, FL |
33126 |
(Address of principal executive offices) |
(Zip Code) |
Registrant’s telephone number, including area code: (786) 360-4768
Securities registered pursuant to Section 12(b) of the Act:
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Title of each class |
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Trading Symbol(s) |
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Name of each exchange on which registered |
Class A common stock, par value $0.0001 per share |
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CMAX |
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The Nasdaq Stock Market LLC |
Warrants, each whole warrant exercisable for 1/30th of one share of Class A common stock |
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CMAXW |
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The Nasdaq Stock Market LLC |
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
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Large accelerated filer |
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☐ |
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Accelerated filer |
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☒ |
Non-accelerated filer |
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☐ |
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Smaller reporting company |
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☒ |
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Emerging growth company |
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☒ |
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒
Indicate by check mark whether the registrant has filed all documents and reports required to be filed by Sections 12, 13 or 15(d) of the Securities Exchange Act of 1934 subsequent to the distribution of securities under a plan confirmed by a court. Yes ☒ No ☐
As of May 6, 2024, the registrant had 3,802,883 shares of Class A common stock, $0.0001 par value per share, and no shares of Class B common stock, $0.0001 par value per share issued and outstanding.
CareMax, Inc.
Quarterly Report on Form 10-Q
For the Quarter Ended March 31, 2024
Table of Contents
PART I – FINANCIAL INFORMATION
ITEM 1. FINANCIAL STATEMENTS
CAREMAX, INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
(Unaudited)
(in thousands, except share and per share data)
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March 31, 2024 |
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December 31, 2023 |
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ASSETS |
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Current Assets |
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Cash and cash equivalents |
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$ |
41,479 |
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$ |
65,528 |
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Accounts receivable, net |
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107,985 |
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114,754 |
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Other current assets |
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6,650 |
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3,066 |
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Total Current Assets |
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156,113 |
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183,348 |
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Property and equipment, net |
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47,243 |
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47,918 |
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Operating lease right-of-use assets |
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109,947 |
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109,215 |
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Goodwill, net |
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156,841 |
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156,841 |
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Intangible assets, net |
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96,092 |
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101,243 |
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Other assets |
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47,965 |
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24,737 |
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Total Assets |
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$ |
614,202 |
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$ |
623,301 |
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LIABILITIES AND STOCKHOLDERS' EQUITY |
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Current Liabilities |
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Accounts payable |
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$ |
6,704 |
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$ |
6,275 |
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Accrued expenses |
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20,172 |
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16,224 |
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Risk settlement liabilities |
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53,599 |
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42,602 |
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Related party liabilities |
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1,229 |
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190 |
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Current portion of third-party debt, net |
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390,995 |
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364,380 |
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Current portion of operating lease liabilities |
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32,062 |
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8,975 |
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Other current liabilities |
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2,354 |
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165 |
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Total Current Liabilities |
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507,114 |
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438,812 |
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Derivative liabilities |
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49 |
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22 |
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Long-term debt, net |
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1,879 |
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21,443 |
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Long-term operating lease liabilities |
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78,417 |
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97,136 |
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Other liabilities |
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6,340 |
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4,443 |
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Total Liabilities |
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593,800 |
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561,856 |
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COMMITMENTS AND CONTINGENCIES (NOTE 14) |
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STOCKHOLDERS' EQUITY |
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Preferred stock (1,000,000 shares authorized; one share issued and outstanding as of March 31, 2024 and December 31, 2023) |
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— |
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— |
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Class A common stock ($0.0001 par value; 8,333,333 shares authorized; 3,802,883 and 3,744,732 shares issued and outstanding as of March 31, 2024 and December 31, 2023, respectively) |
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11 |
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11 |
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Additional paid-in-capital |
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784,736 |
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782,371 |
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Accumulated deficit |
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(764,345 |
) |
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(720,938 |
) |
Total Stockholders' Equity |
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20,403 |
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61,444 |
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Total Liabilities and Stockholders' Equity |
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$ |
614,202 |
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$ |
623,301 |
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The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.
CAREMAX, INC.
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
(Unaudited)
(in thousands, except share and per share data)
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Three Months Ended March 31, |
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2024 |
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2023 |
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Revenue |
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Medicare risk-based revenue |
$ |
168,502 |
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$ |
121,593 |
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Medicaid risk-based revenue |
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37,653 |
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25,626 |
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Government value-based care revenue |
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18,815 |
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10,010 |
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Other revenue |
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7,276 |
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15,754 |
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Total revenue |
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232,246 |
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172,983 |
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Operating expenses |
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|
External provider costs |
|
180,941 |
|
|
|
110,673 |
|
Cost of care |
|
43,133 |
|
|
|
38,627 |
|
Sales and marketing |
|
3,064 |
|
|
|
3,765 |
|
Corporate, general and administrative |
|
20,108 |
|
|
|
23,965 |
|
Depreciation and amortization |
|
6,705 |
|
|
|
6,576 |
|
Goodwill impairment |
|
— |
|
|
|
98,000 |
|
Total operating expenses |
|
253,951 |
|
|
|
281,606 |
|
Operating loss |
|
(21,705 |
) |
|
|
(108,623 |
) |
Nonoperating (expenses) income |
|
|
|
|
|
Interest expense |
|
(19,756 |
) |
|
|
(10,711 |
) |
Change in fair value of derivative liabilities |
|
(2,381 |
) |
|
|
1,107 |
|
Gain on remeasurement of contingent earnout liabilities |
|
— |
|
|
|
36,136 |
|
Other income, net |
|
610 |
|
|
|
187 |
|
Total nonoperating (expenses) income |
|
(21,526 |
) |
|
|
26,718 |
|
Loss before income tax |
|
(43,231 |
) |
|
|
(81,904 |
) |
Income tax expense |
|
(177 |
) |
|
|
(177 |
) |
Net loss |
$ |
(43,408 |
) |
|
$ |
(82,082 |
) |
|
|
|
|
|
|
Weighted-average basic shares outstanding |
|
3,778,600 |
|
|
|
3,712,027 |
|
Weighted-average diluted shares outstanding |
|
3,778,600 |
|
|
|
3,712,027 |
|
Net loss per share |
|
|
|
|
|
Basic |
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
Diluted |
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.
CAREMAX, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY
(Unaudited)
(in thousands, except share data)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, 2024 and 2023 |
|
|
|
Class A Common Stock |
|
|
Preferred |
|
|
Additional |
|
|
Retained Earnings |
|
|
Total Stockholders' |
|
|
|
Shares |
|
|
Amount |
|
|
Stock |
|
|
Paid-in-capital |
|
|
(Deficit) |
|
|
Equity |
|
BALANCE - DECEMBER 31, 2023 |
|
|
3,744,732 |
|
|
$ |
11 |
|
|
$ |
— |
|
|
$ |
782,371 |
|
|
$ |
(720,938 |
) |
|
$ |
61,444 |
|
Stock-based compensation expense |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,365 |
|
|
|
— |
|
|
|
2,365 |
|
Net loss |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(43,408 |
) |
|
|
(43,408 |
) |
Fractional shares issued upon Reverse Split |
|
|
58,151 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
BALANCE - MARCH 31, 2024 |
|
|
3,802,883 |
|
|
$ |
11 |
|
|
$ |
— |
|
|
$ |
784,736 |
|
|
$ |
(764,345 |
) |
|
$ |
20,403 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
BALANCE - DECEMBER 31, 2022 |
|
|
3,711,086 |
|
|
$ |
11 |
|
|
$ |
— |
|
|
$ |
657,126 |
|
|
$ |
(37,590 |
) |
|
$ |
619,547 |
|
Stock-based compensation expense |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
2,298 |
|
|
|
— |
|
|
|
2,298 |
|
Issuance of shares upon vesting of stock-based compensation awards |
|
|
941 |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Net loss |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
(82,082 |
) |
|
|
(82,082 |
) |
BALANCE - MARCH 31, 2023 |
|
|
3,712,027 |
|
|
$ |
11 |
|
|
$ |
— |
|
|
$ |
659,424 |
|
|
$ |
(119,672 |
) |
|
$ |
539,763 |
|
|
|
The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.
CAREMAX, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(Unaudited)
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
CASH FLOWS FROM OPERATING ACTIVITIES |
|
|
|
|
|
|
Net loss |
|
$ |
(43,408 |
) |
|
$ |
(82,082 |
) |
Adjustments to reconcile net loss to cash and cash equivalents: |
|
|
|
|
|
|
Depreciation and amortization expense |
|
|
6,705 |
|
|
|
6,576 |
|
Amortization of debt issuance costs and discounts |
|
|
931 |
|
|
|
1,839 |
|
Stock-based compensation expense |
|
|
2,365 |
|
|
|
2,298 |
|
Income tax expense |
|
|
177 |
|
|
|
177 |
|
Change in fair value of derivative liabilities |
|
|
2,381 |
|
|
|
(1,107 |
) |
Gain on remeasurement of contingent earnout liabilities |
|
|
— |
|
|
|
(36,136 |
) |
Payment-in-kind interest expense |
|
|
5,915 |
|
|
|
2,453 |
|
Non-cash finance lease expense |
|
|
156 |
|
|
|
— |
|
Provision for credit losses |
|
|
(302 |
) |
|
|
(104 |
) |
Goodwill impairment |
|
|
— |
|
|
|
98,000 |
|
Amortization of right-of-use assets |
|
|
2,675 |
|
|
|
2,725 |
|
Other non-cash, net |
|
|
134 |
|
|
|
1,080 |
|
Changes in operating assets and liabilities: |
|
|
|
|
|
|
Accounts receivable |
|
|
7,072 |
|
|
|
(7,850 |
) |
Other current assets |
|
|
(3,583 |
) |
|
|
(1,961 |
) |
Risk settlement liabilities |
|
|
10,997 |
|
|
|
(454 |
) |
Other assets |
|
|
(23,332 |
) |
|
|
(9,735 |
) |
Operating lease liabilities |
|
|
962 |
|
|
|
(1,280 |
) |
Accounts payable |
|
|
(188 |
) |
|
|
(500 |
) |
Accrued expenses |
|
|
3,948 |
|
|
|
(29 |
) |
Related party liabilities |
|
|
1,039 |
|
|
|
— |
|
Other liabilities |
|
|
1,555 |
|
|
|
4,343 |
|
Net cash used in operating activities |
|
|
(23,802 |
) |
|
|
(21,746 |
) |
|
|
|
|
|
|
|
CASH FLOWS FROM INVESTING ACTIVITIES |
|
|
|
|
|
|
Purchases of property and equipment |
|
|
(126 |
) |
|
|
(2,286 |
) |
Net cash used in investing activities |
|
|
(126 |
) |
|
|
(2,286 |
) |
|
|
|
|
|
|
|
CASH FLOWS FROM FINANCING ACTIVITIES |
|
|
|
|
|
|
Proceeds from borrowings, net |
|
|
— |
|
|
|
27,000 |
|
Principal payments of debt |
|
|
(119 |
) |
|
|
(25 |
) |
Payments of debt issuance costs |
|
|
— |
|
|
|
(348 |
) |
Net cash (used in) provided by financing activities |
|
|
(119 |
) |
|
|
26,627 |
|
|
|
|
|
|
|
|
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS |
|
|
(24,047 |
) |
|
|
2,596 |
|
Cash and cash equivalents - beginning of period |
|
|
65,528 |
|
|
|
41,626 |
|
CASH AND CASH EQUIVALENTS - END OF PERIOD |
|
$ |
41,479 |
|
|
$ |
44,222 |
|
The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.
CAREMAX, INC.
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Continued)
(Unaudited)
(in thousands)
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
SUPPLEMENTAL SCHEDULE OF NON-CASH ACTIVITIES: |
|
|
|
|
|
|
Additions to property and equipment funded through accounts payable |
|
$ |
617 |
|
|
$ |
947 |
|
Financed property and equipment purchases |
|
|
168 |
|
|
|
— |
|
Decrease in right-of-use assets and lease liabilities due to lease remeasurements |
|
|
145 |
|
|
|
— |
|
Right-of-use assets obtained in exchange for operating lease obligations |
|
|
4,388 |
|
|
|
— |
|
SUPPLEMENTAL CASH FLOW INFORMATION: |
|
|
|
|
|
|
Cash paid for interest |
|
|
8,915 |
|
|
|
6,375 |
|
The accompanying notes are an integral part of these unaudited condensed consolidated financial statements.
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
Note 1. DESCRIPTION of business and going concern
CareMax, Inc. (“CareMax” or the “Company”), formerly Deerfield Healthcare Technology Acquisitions Corp. (“DFHT”), is a Delaware corporation, which announced its initial public offering in July 2020 (the "IPO") as a publicly traded special purpose acquisition company for the purpose of effecting a merger, capital stock exchange, asset acquisition, stock purchase, reorganization, or similar business combination involving one or more businesses. CareMax provides high-quality, value-based care and chronic disease management through physicians and health care professionals committed to the overall health and wellness continuum of care for its patients. As of March 31, 2024, the Company operated 55 centers and managed affiliated providers across 10 states that offer a comprehensive suite of healthcare and social services, and a proprietary software and services platform that provides data, analytics, and rules-based decision tools/workflows for physicians across the United States.
The Business Combination and Acquisitions
On December 18, 2020, DFHT entered into a Business Combination Agreement (the “Business Combination Agreement”) with CareMax Medical Group, L.L.C., a Florida limited liability company (“CMG”), and entities listed in the Business Combination Agreement, IMC Medical Group Holdings, LLC, a Delaware limited liability company (“IMC”), IMC Holdings, LP, a Delaware limited partnership, and Deerfield Partners, L.P. The Business Combination (as defined below) closed on June 8, 2021 (the “Closing Date”), whereby DFHT acquired 100% of the equity interests in CMG and 100% of the equity interests in IMC, with CMG and IMC becoming wholly owned subsidiaries of DFHT. Immediately upon completion (the “Closing”) of the transactions contemplated by the Business Combination Agreement and the related financing transactions (the “Business Combination”), the name of the combined company was changed to CareMax, Inc.
Unless the context otherwise requires, “the Company,” “we,” “us,” and “our” refer, for periods prior to the completion of the Business Combination, to CMG and its subsidiaries, and, for periods upon or after the completion of the Business Combination, to CareMax, Inc. and its subsidiaries.
Subsequent to consummation of the Business Combination, primarily during the second half of 2021, the Company acquired Senior Medical Associates, LLC, Stallion Medical Management, LLC, Unlimited Medical Services of Florida, LLC, Advantis Physician Alliance, LLC, Business Intelligence & Analytics LLC, and three additional businesses. In November 2022, the Company acquired the Medicare value-based care business of Steward Health Care System (“Steward Value Based Care”, and such transaction the “Steward Acquisition”).
Going Concern
The Company’s condensed consolidated financial statements have been prepared assuming the Company will continue as a going concern, which contemplates the realization of assets and the settlement of liabilities and commitments in the normal course of business. The Company has generated recurring losses and negative cash flows from operations since completion of the Business Combination, and believes that, absent the Company successfully taking certain measures to reduce operating expenses and/or divest certain assets or businesses, as set forth below, the Company will continue to incur net losses and negative cash flows for the foreseeable future. The Company obtained a limited waiver of certain breaches of financial and administrative covenants under the Credit Agreement (as defined below) through May 15, 2024, subject to an earlier termination of the waiver upon the occurrence of certain specified events, as further explained in Note 7, Debt and Related Party Debt. Further, as of March 31, 2024, the Company was in breach of certain financial and administrative covenants (such as the failure to pay rent when it came due) under certain of its lease agreements, as further explained in Note 12, Leases. Although the Company had $41.5 million in cash and cash equivalents and $108.0 million of current accounts receivable, net, at March 31, 2024, absent the Company successfully implementing management’s plans as set forth below, the Company believes it will not be able to comply with the minimum liquidity requirement and maximum leverage ratio covenants contained in its Credit Agreement once the current limited waiver expires, nor will it be able to comply with certain financial covenants under certain of the Company’s leases. These conditions raise substantial doubt regarding the Company’s ability to continue as a going concern for one year after the date these condensed consolidated financial statements are issued, and these financial statements do not include any adjustments that may result from the outcome of this uncertainty.
To address the Company’s capital needs, the Company is undergoing efforts to reduce operating expenses and pursuing various equity and debt refinancing and other strategic alternatives, including the possibility of a restructuring under Chapter 11 of the US Bankruptcy Code if the Company is unable to successfully implement its plans. Management’s plans that are intended to mitigate the conditions that raise substantial doubt about the Company’s ability to continue as a going concern include selling
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
certain assets, exiting certain markets and reducing operating expenses. The Company’s efforts to reduce operating expenses may include lowering external provider costs, exiting unprofitable centers, consolidating certain medical centers, delaying capital expenditures and reducing non-essential spending. The Company may also seek to raise additional capital or refinance its indebtedness to provide additional liquidity to fund its losses until its operations become cash flow positive. There is no guarantee that the Company will be able to implement its operational plans or raise additional equity or debt financing on acceptable terms, if at all.
Reverse Stock Split
On January 31, 2024 (the “Effective Date”), the Company effected a 1-for-30 reverse stock split (the “Reverse Split”) of the Company’s Class A common stock, par value $0.0001 per share (“Class A Common Stock”). As a result of the Reverse Split, every thirty shares of the Class A Common Stock issued and outstanding as of the Effective Date automatically converted into one share of Class A Common Stock. No fractional shares were issued in connection with the Reverse Split. In lieu of issuing fractional shares, stockholders of record who otherwise would have been entitled to receive fractional shares were entitled to rounding up of the fractional share to the nearest whole number. The Reverse Split automatically and proportionately adjusted, based on a 1-for-30 split ratio, all issued and outstanding shares of the Company’s common stock, as well as the terms of warrants outstanding at the time of the effectiveness of the Reverse Split. Proportionate adjustments were made to the per share exercise price and the number of shares issuable upon the exercise of all outstanding stock options and warrants to purchase shares of common stock. There was no change in the par value of our Common Stock or Preferred Stock.
References to number of shares of Class A Common Stock and per share data (except par value) in the financial statements and notes thereto for all periods presented have been adjusted to reflect the Reverse Split.
Note 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Basis of Presentation and Principles of Consolidation
The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and in accordance with the instructions to Form 10-Q and Article 8 of Regulation S-X of the Securities and Exchange Commission (the “SEC”). The condensed consolidated financial statements include the accounts and operations of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions are eliminated upon consolidation. Certain amounts in the prior year's unaudited condensed consolidated financial statements have been reclassified to conform to the current year presentation.
There is no comprehensive income (loss) so the statements of comprehensive income (loss) are not presented.
Segment Financial Information
The Company’s chief operating decision maker (“CODM”), who is the Company’s Chief Executive Officer, regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating financial performance. The Company identifies operating segments based on this review by its CODM and operates in and reports as a single operating segment. For the periods presented, materially all of the Company’s long-lived assets were located in the United States, and all revenue was earned in the United States.
Significant Accounting Policies
There have been no changes to our significant accounting policies and estimates as described in our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed with the SEC on March 18, 2024.
Use of Estimates
The preparation of the condensed consolidated 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. The areas where significant estimates are used in the financial statements include, but are not limited to, revenues and related receivables from risk adjustments, costs of our services and related liabilities, purchase price allocations, including fair value estimates of intangibles and contingent consideration, the valuation and related impairment testing of
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
long-lived assets, including goodwill and intangible assets, the valuation of derivative liabilities, and the estimated useful lives of fixed assets and intangible assets, including internally developed software. Actual results could differ from those estimates.
Emerging Growth Company
Section 102(b)(1) of the Jumpstart Our Business Startups Act (the “JOBS Act”) exempts emerging growth companies from being required to comply with new or revised financial accounting standards until private companies (that is, those that have not had a Securities Act registration statement declared effective or do not have a class of securities registered under the Securities Exchange Act of 1934, as amended (the “Exchange Act”)) are required to comply with the new or revised financial accounting standards. The JOBS Act provides that a company can elect to opt out of the extended transition period and comply with the requirements that apply to non-emerging growth companies, but any such election to opt out is irrevocable. The Company has elected not to opt out of such extended transition period, which means that when a standard is issued or revised and it has different application dates for public or private companies, the Company, as an emerging growth company, can adopt the new or revised standard at the time private companies adopt the new or revised standard. This may make comparison of the Company’s condensed consolidated financial statements with another public company which is neither an emerging growth company nor an emerging growth company that has opted out of using the extended transition period difficult or impossible because of the potential differences in accounting standards used. Additionally, as an emerging growth company, the Company is exempt from the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act of 2002, as amended, and the Company’s independent registered public accounting firm is not required to evaluate and report on the effectiveness of internal control over financial reporting.
Accounting Pronouncements Not Yet Adopted
In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, which is intended to simplify the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. The guidance allows for either full retrospective adoption or modified retrospective adoption. The guidance is effective for the Company in the first quarter of fiscal year 2025 and early adoption is permitted. The Company is evaluating the impact the adoption of this guidance will have on its condensed consolidated financial statements.
In November 2023, the FASB issued ASU 2023-07, Improvements to Reportable Segment Disclosures. This guidance requires annual and interim disclosure of significant segment expenses that are provided to the CODM as well as interim disclosures for all reportable segment’s profit or loss and assets. This guidance also requires disclosure of the title and position of the CODM and an explanation of how the CODM uses the reported measures of segment profit or loss in assessing segment performance and deciding how to allocate resources. This guidance is expected to improve financial reporting by providing additional information about a public company’s significant segment expenses and more timely and detailed segment information reporting throughout the fiscal period. The ASU is effective for the Company’s fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company does not expect adoption of ASU 2023-07 will have a significant impact on the disclosures within our consolidated financial statements.
In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”). ASU 2023-09 requires disaggregated information about a reporting entity’s effective tax rate reconciliation as well as information on income taxes paid. The ASU is effective for the Company’s fiscal year beginning January 1, 2025. The guidance will be applied on a prospective basis with the option to apply the standard retrospectively. Early adoption is permitted. The Company does not expect adoption of ASU 2023-09 will have a significant impact on the disclosures within our consolidated financial statements.
NOTE 3. ACCOUNTS RECEIVABLE
The Company’s accounts receivable are presented net of the unpaid external provider costs. A right of offset exists when all of the following conditions are met: 1) each of the two parties owed the other determinable amounts; 2) the reporting party has the right to offset the amount owed with the amount owed to the other party; 3) the reporting party intends to offset; and 4) the right of offset is enforceable by law. The Company believes all of the aforementioned conditions existed as of March 31, 2024 and December 31, 2023.
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
As of March 31, 2024 and December 31, 2023, $26.0 million and $8.9 million of accounts receivable were included in other assets in the Company’s condensed consolidated balance sheets.
Composition of the Company’s current accounts receivable, net, and risk settlement liabilities was as follows (in thousands):
|
|
|
|
|
|
|
|
|
As of March 31, 2024 |
|
|
As of December 31, 2023 |
|
Risk-based accounts receivable |
$ |
161,619 |
|
|
$ |
170,397 |
|
Incurred but not reported claims liability |
|
(56,471 |
) |
|
|
(58,027 |
) |
Other receivables |
|
2,837 |
|
|
|
2,384 |
|
Accounts receivable, net |
$ |
107,985 |
|
|
$ |
114,754 |
|
|
|
|
|
|
|
|
As of March 31, 2024 |
|
|
As of December 31, 2023 |
|
Risk-based accounts receivable |
$ |
21,042 |
|
|
$ |
381 |
|
Incurred but not reported claims liability |
|
(69,440 |
) |
|
|
(37,401 |
) |
Distribution liabilities |
|
(5,201 |
) |
|
|
(5,583 |
) |
Risk settlement liabilities |
$ |
(53,599 |
) |
|
$ |
(42,602 |
) |
|
|
|
|
|
|
The Company re-evaluated key assumptions and estimates and based on this analysis, the Company identified changes in estimates to revenue, external provider costs, short-term and long-term accounts receivable, net, and risk settlement liabilities. Accordingly, the Company recognized the following changes in prior year estimates in each respective period (in thousands):
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
Increase (decrease) |
2024 |
|
|
2023 |
|
Revenue |
$ |
(540 |
) |
|
$ |
(26,913 |
) |
External provider costs |
|
(7,363 |
) |
|
|
(12,413 |
) |
Short-term and long-term accounts receivable, net |
|
(2,680 |
) |
|
|
(14,500 |
) |
Risk settlement liabilities |
|
(9,503 |
) |
|
|
— |
|
For the three months ended March 31, 2024, the decreases were mostly driven by favorable development in provider costs from Medicare full risk plans, partially offset by unfavorable development in provider costs from Medicaid full risk plans primarily from 2022 dates of service. For the three months ended March 31, 2023, the developments were primarily driven by new, updated information regarding MSO membership at one health plan, and an unseasonably early flu season.
Concentration of Credit Risk
Composition of the Company’s revenues and accounts receivable balances for the payors comprising 10% or more of revenue was as follows (n/a - indicates balance or activity that is less than 10%):
|
|
|
|
|
Revenue |
|
Three Months Ended March 31, |
|
2024 |
|
2023 |
Payor A |
19% |
|
31% |
Payor B |
13% |
|
n/a |
Payor C |
18% |
|
22% |
Payor D |
13% |
|
12% |
Payor E |
11% |
|
20% |
|
|
|
|
|
Short-Term and Long-Term Accounts Receivable, net |
|
As of March 31, 2024 |
|
As of December 31, 2023 |
Payor A |
10% |
|
10% |
Payor B |
n/a |
|
10% |
Payor C |
n/a |
|
n/a |
Payor D |
n/a |
|
n/a |
Payor E |
n/a |
|
n/a |
As of March 31, 2024 and December 31, 2023, the Company’s provision for credit losses was $2.8 million and $3.1 million, respectively.
NOTE 4. REINSURANCE
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
The Company purchases stop loss insurance on catastrophic costs to limit the exposure on patient losses. Premiums and policy recoveries are reported in external provider costs in the Company’s condensed consolidated statements of operations.
The intent of the Company’s stop loss coverage is to limit the benefits paid for any individual patient. The Company’s stop loss limits are defined within each respective health plan contract or other third-party contract and range typically from $30,000 to $300,000 per patient per year. Premium expense incurred was $7.9 million and $6.8 million for the three months ended March 31, 2024, and 2023, respectively. Physicians under capitation arrangements typically have stop loss coverage so that a physician’s financial risk for any single member is limited to a maximum amount on an annual basis. The Company monitors the financial performance and solvency of its stop loss providers. However, the Company remains financially responsible for health care services to its members in the event the health plans or other third parties are unable to fulfill their obligations under stop loss contractual terms.
Recoveries recognized were $7.8 million and $4.6 million for the three months ended March 31, 2024 and 2023, respectively. Estimated recoveries under stop loss policies are reported within accounts receivable, net, or risk settlement liabilities as the counterparty responsible for the payment of the claims and the stop loss is the respective health plan.
NOTE 5. GOODWILL AND OTHER INTANGIBLE ASSETS
Goodwill
The Company’s policy is to test goodwill for impairment annually on December 31, or on an interim basis if an event triggering impairment may have occurred. As of March 31, 2024, our total shareholders’ equity exceeded our market capitalization. Accordingly, we estimated the fair value of our single reporting unit primarily on the basis of the Company’s market capitalization after considering reasonable control premiums which could be expected in transactions with third-party market participants. Based on this analysis, no goodwill impairment was identified.
As of March 31, 2023, the economic uncertainty and market volatility resulting from the rising interest rate environment, the then-recent banking crisis and other industry developments resulted in a decrease in the Company’s stock price and market capitalization. Management believed that such decrease was a triggering event requiring an interim goodwill impairment quantitative analysis. The Company performed a market capitalization reconciliation to evaluate the Company’s estimated fair value balance and support the implied control premium. Based on the quantitative analysis performed, the Company’s estimated fair value as of March 31, 2023 was less than its carrying value as of March 31, 2023 by 17.9% or $98.0 million. The $98.0 million goodwill impairment charge was reflected in goodwill impairment in the Company’s statements of operations for the three months ended March 31, 2023.
The Company’s cumulative goodwill impairment was $617.2 million as of March 31, 2024 and December 31, 2023.
Other Intangible Assets
The following tables summarize the gross carrying amounts, accumulated amortization and net carrying amounts of intangible assets by major class (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross Carrying Amount |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
March 31, 2024 |
|
|
|
|
|
|
|
|
|
Risk contracts |
|
$ |
102,070 |
|
|
$ |
(42,734 |
) |
|
$ |
59,336 |
|
Provider network |
|
|
42,900 |
|
|
|
(8,512 |
) |
|
|
34,388 |
|
Non-compete agreements |
|
|
4,170 |
|
|
|
(2,548 |
) |
|
|
1,622 |
|
Trademarks |
|
|
1,862 |
|
|
|
(1,526 |
) |
|
|
336 |
|
Other |
|
|
693 |
|
|
|
(284 |
) |
|
|
410 |
|
Total |
|
$ |
151,695 |
|
|
$ |
(55,603 |
) |
|
$ |
96,092 |
|
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross Carrying Amount |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
December 31, 2023 |
|
|
|
|
|
|
|
|
|
Risk contracts |
|
$ |
102,070 |
|
|
$ |
(39,394 |
) |
|
$ |
62,676 |
|
Provider network |
|
|
42,900 |
|
|
|
(6,980 |
) |
|
|
35,920 |
|
Non-compete agreements |
|
|
4,170 |
|
|
|
(2,343 |
) |
|
|
1,827 |
|
Trademarks |
|
|
1,862 |
|
|
|
(1,491 |
) |
|
|
371 |
|
Other |
|
|
693 |
|
|
|
(244 |
) |
|
|
449 |
|
Total |
|
$ |
151,695 |
|
|
$ |
(50,452 |
) |
|
$ |
101,243 |
|
Amortization expense, excluding amortization related to the finance lease right-of-use asset, totaled $5.2 million and $5.4 million for the three months ended March 31, 2024 and 2023, respectively.
NOTE 6. PROPERTY AND EQUIPMENT
Property and equipment at March 31, 2024 and December 31, 2023 consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Leasehold improvements |
|
$ |
21,082 |
|
|
$ |
19,200 |
|
Vehicles |
|
|
2,779 |
|
|
|
2,892 |
|
Furniture and equipment |
|
|
12,949 |
|
|
|
12,765 |
|
Software |
|
|
3,865 |
|
|
|
3,865 |
|
Assets under finance leases (1) |
|
|
18,312 |
|
|
|
18,552 |
|
Construction in progress |
|
|
3,853 |
|
|
|
5,074 |
|
Total |
|
|
62,841 |
|
|
|
62,349 |
|
Less: Accumulated depreciation and amortization (2) |
|
|
(15,598 |
) |
|
|
(14,431 |
) |
Total Property and equipment, net |
|
$ |
47,243 |
|
|
$ |
47,918 |
|
(1) Refer to Note 12, Leases, for information.
(2) Includes accumulated amortization related to finance lease right-of-use assets of $0.9 million and $0.6 million as of March 31, 2024 and December 31, 2023, respectively.
Construction in progress primarily consists of leasehold improvements at the Company’s centers, which have not opened.
Depreciation expense, including amortization related to finance lease right-of-use assets, totaled $1.6 million and $1.2 million for the three months ended March 31, 2024 and 2023, respectively.
NOTE 7. DEBT AND RELATED PARTY DEBT
Credit Agreement
In May 2022, the Company entered into a credit agreement (the “Credit Agreement”) that provided for an aggregate of up to $300.0 million in term loans, comprised of (i) initial term loans in the aggregate principal amount of $190.0 million (the “Initial Term Loans”) and (ii) a delayed term loan facility in the aggregate principal amount of $110.0 million (the “Delayed Draw Term Loans”). The Credit Agreement permits the Company to enter into certain incremental facilities subject to compliance with the terms, conditions and covenants set forth therein. In May 2022, the Company drew $190.0 million of the Initial Term Loans and used approximately $121 million of the net proceeds from this borrowing to repay its outstanding obligations under the credit agreement dated June 8, 2021, as amended and recognized related debt extinguishment losses of $6.2 million.
The Credit Agreement contains certain covenants that limit, among other things, the ability of the Company and its subsidiaries to incur additional indebtedness, liens or encumbrances, to make certain investments, to enter into sale-leaseback transactions or sell certain assets, to make certain restricted payments or pay dividends, to enter into consolidations, to transact with affiliates and to amend certain agreements, subject in each case to the exceptions and other qualifications as provided in the Credit Agreement. The Credit Agreement also contains covenants that require the Company to satisfy a minimum liquidity requirement of $50.0 million, which may be decreased to $25.0 million if the Company achieves a certain adjusted EBITDA, and maintain a maximum total leverage ratio based on the Company’s consolidated EBITDA, as defined in the Credit Agreement, with de novo losses excluded from the calculation of such ratio for up to 36 months after the opening of a de novo center, which maximum total leverage ratio was initially 8.50 to 1.00, commencing with the fiscal quarter ended September
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
30, 2022 and is subject to a series of step-downs. For the fiscal quarters ending September 30, 2026 and thereafter the Company must maintain a maximum total leverage ratio no greater than 5.50 to 1.00.
The Credit Agreement contains embedded derivatives related to optional and mandatory prepayments, default interest and the impact of potential legislative changes. Embedded derivatives are separated from the host contract, and are carried at fair value when: (a) the embedded derivative possesses economic characteristics that are not clearly and closely related to the economic characteristics of the host contract; and (b) a separate, stand-alone instrument with the same terms would qualify as a derivative instrument. The Company has concluded that mandatory prepayment and default interest features within the Credit Agreement meet these criteria and, as such, are valued separately and apart from the Credit Agreement and are recorded at fair value each reporting period. While such embedded features did not have material value prior to this period, the value of these bifurcated derivatives as of March 31, 2024 is approximately $2.4 million. Changes in the fair value of these derivatives are reflected in the Change in fair value of derivative liabilities within the condensed consolidated statements of operations and the fair value of the derivatives as of March 31, 2024 is reflected in other current liabilities within the condensed consolidated balance sheets. Refer to Note 10, Fair Value Measurements, for information about the valuation of the embedded derivatives.
On March 8, 2023 (the “Amendment Closing Date”), the Company entered into a Second Amendment (the “Second Amendment”) to the Credit Agreement. The Second Amendment amended the Credit Agreement to, among other things, (i) provide for a new incremental delayed draw term loan B facility in an aggregate principal amount of $60.0 million (the “Delayed Draw Term Loan B Facility”); (ii) revise the commitment expiration date for the Company’s existing $110.0 million Delayed Draw Term Loan to forty-five days following the Amendment Closing Date; (iii) extend the commencement of amortization payments on loans under the Credit Agreement from March 31, 2024 to May 31, 2025; (iv) reduce the amount of interest that the Company may elect to capitalize from 4.00% to 3.50% beginning on the second anniversary of the execution date of the Credit Agreement, 3.00% beginning on the third anniversary of the execution date of the Credit Agreement, and 1.50% beginning on December 10, 2025; (v) increase the amount of the super-priority revolving credit facility that is permitted to be added to the Credit Agreement to $45.0 million and provide that the entirety of such facility may be used for general corporate purposes; and (vi) amend the prepayment provisions of the Credit Agreement, including to have such provisions run as of the Amendment Closing Date.
On March 15, 2024 (the “Third Amendment Effective Date”), the Company entered into a Waiver and Third Amendment to the Credit Agreement (the “Third Amendment”). The Third Amendment amended the Credit Agreement to, among other things, (i) waive certain events of default under the Credit Agreement in the limited manner set forth therein through May 15, 2024 (the “Third Amendment Specified Period”), subject to an earlier termination of the waiver upon the occurrence of certain specified events, (ii) increase the applicable margin rate by 2.00% during the Third Amendment Specified Period, which additional interest the Company may elect to capitalize as principal amount on the outstanding loans and (iii) modify certain covenants contained in the Credit Agreement, including, but not limited to, reducing the minimum liquidity requirement to $10 million during the Third Amendment Specified Period and providing for additional reporting to the lenders.
During the three months ended March 31, 2024 and 2023, the Company drew $0 and $30.0 million of the Delayed Draw Term Loans, respectively.
Based on the elections made by the Company, as of March 31, 2024, borrowings under the Credit Agreement bore interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus the applicable credit spread adjustment based on the elected interest period), plus an applicable margin rate of 11.00%. As permitted under the Credit Agreement, the Company elected to capitalize 6.00% of the interest as principal amount. As a result of this election, the cash interest component of the applicable margin increased by 0.50%.
Loan and Security Agreement - Related Party Debt
In November 2022, the Company entered into a Loan and Security Agreement (the “Loan and Security Agreement”), by and among Sparta Merger Sub I Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub I LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC I”), Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (together with Merger LLC I, the “Guarantors”), Steward Accountable Care Network, Inc. (n/k/a as Steward Accountable Care Network, LLC) and Steward National Care Network, Inc. (n/k/a Steward National Care Network, LLC), as borrowers (the “Borrowers”), CAJ Lending LLC (“CAJ”) and Deerfield Partners L.P., as lenders (the “Lenders”), and CAJ, as administrative agent and collateral agent (in such capacity, the “Agent”). Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr.
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ.
Pursuant to the Loan and Security Agreement, the Lenders provided the Borrowers a term loan (the “Term Loan”) in the aggregate principal amount of $35.5 million. The Company used the proceeds of the Term Loan to fund the payment for the estimated value of the accounts receivable attributable to Medicare value-based payments for the period between January 1, 2022 and the closing of the Steward Acquisition, minus the amount of such payments payable to the affiliate physicians of the acquired Steward entities (the “Financed Net Pre-Closing Medicare AR”).
The Term Loan bore fixed interest at a rate of 12.0% per annum. In addition, the Borrowers paid a facility fee equal to 3.0% of the aggregate principal amount of the Term Loan, which was accounted for as a debt discount. Any additional interest (if applicable) accrued and owing during the term of the Loan and Security Agreement was paid-in-kind and capitalized to principal monthly in arrears. Pursuant to the Agreement and Plan of Merger entered into in connection with the Steward Acquisition (the “Merger Agreement”), Sparta Holding Co. LLC agreed to pay the costs of financing the Financed Net Pre-Closing Medicare AR and, at the closing of the Steward Acquisition, paid to the Borrowers $6.8 million, representing all scheduled payments of interest and fees from the Steward Acquisition closing date up to and including November 30, 2023, which amount was then paid in advance by the Borrowers to the Lenders.
In October 2023, the Company paid off all outstanding indebtedness of $35.5 million due under the Loan and Security Agreement with the proceeds of the MSSP payment from the federal government, and the Loan and Security Agreement was terminated.
Elevance Health
In October 2022, in connection with the collaboration agreement with Elevance Health (formerly known as Anthem) the Company entered into a promissory note for $1.0 million due in October 2032. This borrowing bears a fixed interest rate of 6.25% per annum.
Finance Leases
Refer to Note 12, Leases, for information about the Company’s finance leases.
As of March 31, 2024 and December 31, 2023, debt consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Indebtedness under the Credit Agreement, weighted-average interest rate of 15.2% during the three months ended March 31, 2024. |
|
$ |
383,256 |
|
|
$ |
377,340 |
|
Finance lease obligations, interest averaging 13.5% and maturing at various dates through 2043 as of March 31, 2024 and December 31, 2023. |
|
|
19,768 |
|
|
|
19,612 |
|
Other |
|
|
2,297 |
|
|
|
2,220 |
|
Less: Unamortized discounts and debt issuance costs |
|
|
(12,447 |
) |
|
|
(13,349 |
) |
|
|
|
392,874 |
|
|
|
385,823 |
|
Less: Current portion |
|
|
(390,995 |
) |
|
|
(364,380 |
) |
Long-term portion |
|
$ |
1,879 |
|
|
$ |
21,443 |
|
Future maturities of the indebtedness outstanding at March 31, 2024 were as follows (in thousands):
|
|
|
|
|
Year |
|
Amount |
|
Remainder of 2024 |
|
$ |
322 |
|
2025 |
|
|
3,566 |
|
2026 |
|
|
4,172 |
|
2027 |
|
|
376,564 |
|
2028 |
|
|
769 |
|
Thereafter |
|
|
160 |
|
Total |
|
$ |
385,553 |
|
In the table above, the future maturities are presented consistent with the contractual terms. As of March 31, 2024, we were in compliance with all of the financial covenants under the Credit Agreement, as amended through the Third Amendment; however, we do not expect to be in compliance during the subsequent quarterly testing dates. A breach of any of the covenants under the Credit Agreement or the occurrence of other events specified in the Credit Agreement could result in an event of
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
default under the same and give rise to the lenders’ right to accelerate our debt obligations thereunder and pursue other remedial actions under such agreement and/or trigger a cross default under our long-term leases. Accordingly, as of March 31, 2024, the full balance of the outstanding indebtedness related to the Credit Agreement was classified as a current liability in our condensed consolidated balance sheet.
Refer to Note 1, Description of Business and Going Concern, for going concern considerations.
NOTE 8. STOCK-BASED COMPENSATION
The Company’s 2021 Long-Term Incentive Plan (the “2021 Plan”) permits the grant of equity-based awards to officers, directors, employees and other service providers. The 2021 Plan permits the grant of an initial share pool of 233,333 shares of Class A Common Stock and will be increased automatically, without further action of the Company’s board of directors, on January 1st of each calendar year commencing after the Closing Date and ending on (and including) January 1, 2031, by a number of shares of Class A Common Stock equal to the lesser of (i) four percent of the aggregate number of shares of Class A Common Stock outstanding on December 31st of the immediately preceding calendar year, excluding for this purpose any such outstanding shares of Class A Common Stock that were granted under the 2021 Plan and remain unvested and subject to forfeiture as of the relevant December 31st, or (ii) a lesser number of shares of Class A Common Stock as determined by the Company’s board of directors or the Compensation Committee of the board of directors prior to the relevant January 1st.
Our outstanding stock-based compensation awards consist of time-based share awards, performance-based share awards and options. Our equity awards generally vest over a three-year period, subject to continued provision of services to the Company through the applicable vesting date.
During the three months ended March 31, 2024 and 2023, no equity awards were granted under the 2021 Plan and there was no vesting of previously issued awards.
During the three months ended March 31, 2024 and 2023, the Company recognized stock-based compensation expense totaling $2.4 million and $2.3 million, respectively. As of March 31, 2024 and 2023, total unrecognized compensation expense related to unvested equity awards was $11.8 million and $16.4 million, respectively, expected to be recognized over a weighted-average period of 1.6 years and 1.9 years, respectively.
NOTE 9. NET LOSS PER SHARE
The following table sets forth the calculation of basic and diluted net loss per share for the periods indicated based on the weighted-average number of common shares outstanding (in thousands, except share and per share data):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
Net loss attributable to CareMax, Inc. Class A common stockholders |
|
$ |
(43,408 |
) |
|
$ |
(82,082 |
) |
|
|
|
|
|
|
|
Weighted-average basic shares outstanding |
|
|
3,778,600 |
|
|
|
3,712,027 |
|
Weighted-average diluted shares outstanding |
|
|
3,778,600 |
|
|
|
3,712,027 |
|
|
|
|
|
|
|
|
Net loss per share: |
|
|
|
|
|
|
Basic |
|
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
Diluted |
|
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
The following potentially dilutive outstanding securities were excluded from the computation of diluted net loss per share because their effect would have been anti-dilutive or because issuance of shares underlying such securities is contingent upon the satisfaction of certain conditions which were not satisfied by the end of the period:
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
Series A and Series B warrants |
|
|
266,667 |
|
|
|
266,667 |
|
Public and private placement warrants |
|
|
193,055 |
|
|
|
193,055 |
|
Contingent consideration |
|
|
1,250,000 |
|
|
|
1,356,667 |
|
Unvested restricted stock units |
|
|
111,969 |
|
|
|
84,928 |
|
Unvested performance stock units (assumes 100% target payout) |
|
|
15,050 |
|
|
|
6,972 |
|
Unvested options |
|
|
25,012 |
|
|
|
12,452 |
|
Total |
|
|
1,861,753 |
|
|
|
1,920,740 |
|
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
NOTE 10. FAIR VALUE MEASUREMENTS
Financial Instruments that are Measured at Fair Value on a Recurring Basis
The following tables present information about the Company’s assets and liabilities that are measured at fair value on a recurring basis and indicate the fair value hierarchy of the valuation techniques that the Company utilized to determine such fair value (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
March 31, 2024 |
|
|
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
Description |
|
Carrying Value |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Derivative warrant liabilities - public warrants |
|
$ |
49 |
|
|
$ |
49 |
|
|
$ |
— |
|
|
$ |
— |
|
Derivative warrant liabilities - private placement warrants |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Embedded derivative liabilities - Credit Agreement |
|
|
2,354 |
|
|
|
— |
|
|
|
— |
|
|
|
2,354 |
|
Total liabilities measured at fair value |
|
$ |
2,403 |
|
|
$ |
49 |
|
|
$ |
— |
|
|
$ |
2,354 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
December 31, 2023 |
|
|
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
Description |
|
Carrying Value |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Derivative warrant liabilities - public warrants |
|
$ |
22 |
|
|
$ |
22 |
|
|
$ |
— |
|
|
$ |
— |
|
Derivative warrant liabilities - private placement warrants |
|
|
1 |
|
|
|
— |
|
|
|
— |
|
|
|
1 |
|
Embedded derivative liabilities - Credit Agreement |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Total liabilities measured at fair value |
|
$ |
22 |
|
|
$ |
22 |
|
|
$ |
— |
|
|
$ |
1 |
|
Derivative Warrant Liabilities
Fair value of public warrants is measured using the listed market price of such warrants.
Fair value of the private placement warrants is estimated using a Monte Carlo simulation model at each measurement date. Inherent in a Monte Carlo simulation are assumptions related to expected stock price volatility, expected life, risk-free interest rate and dividend yield. The Company estimates the volatility of its common stock based on historical volatility of select peer companies that matches the expected remaining life of the warrants. The risk-free interest rate is based on the U.S. Treasury zero-coupon yield curve on the grant date for a maturity similar to the expected remaining life of the warrants. The expected life of the warrants is assumed to be equivalent to their remaining contractual term. The dividend rate is based on the historical rate, which the Company anticipates remaining at zero.
During the three months ended March 31, 2024 and 2023, the Company recognized a loss of less than $0.1 million and a gain of $1.1 million, respectively, related to the change in the fair value of the derivative warrant liabilities.
Credit Agreement Embedded Derivatives
Fair value of the embedded derivatives contained in the Credit Agreement is estimated using the discounted cash flow model. This involves significant Level 3 inputs and assumptions including the probability of occurrence of the respective triggering events and our risk-adjusted discount rate. During the three months ended March 31, 2024 and 2023, the Company recognized a loss of $2.4 million and $0, respectively, related to the change in the fair value of the Credit Agreement embedded derivatives. As of March 31, 2024, the carrying value of the embedded derivatives is recorded in other current liabilities in the Company’s condensed consolidated balance sheet.
Transfers between level 1, 2 and 3 are recognized at the end of the reporting period. There were no transfers between levels for the three months ended March 31, 2024 or 2023.
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
Activity of the Level 3 liabilities during the three months ended March 31, 2024 measured at fair value was as follows (in thousands):
|
|
|
|
Balance as of December 31, 2023 |
$ |
1 |
|
Change in fair value of Credit Agreement embedded derivative liabilities |
|
2,354 |
|
Change in fair value of derivative warrant liabilities |
|
(1 |
) |
Balance as of March 31, 2024 |
$ |
2,354 |
|
Activity of the Level 3 liabilities during the three months ended March 31, 2023 measured at fair value was as follows (in thousands):
|
|
|
|
Balance as of December 31, 2022 |
$ |
138,535 |
|
Change in fair value of derivative warrant liabilities |
|
(1,107 |
) |
Change in fair value of contingent consideration |
|
(36,136 |
) |
Balance as of March 31, 2023 |
$ |
101,293 |
|
Financial Instruments that are not Measured at Fair Value on a Recurring Basis
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
March 31, 2024 |
|
Carrying Value |
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
(in thousands) |
|
|
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Liabilities |
|
|
|
|
|
|
|
|
|
|
|
|
Fixed rate debt (a) |
|
$ |
893 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
625 |
|
Floating rate debt (a) |
|
|
383,256 |
|
|
|
— |
|
|
|
— |
|
|
|
354,841 |
|
Total |
|
$ |
384,149 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
355,466 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
December 31, 2023 |
|
Carrying Value |
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
(in thousands) |
|
|
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Liabilities |
|
|
|
|
|
|
|
|
|
|
|
|
Fixed rate debt (a) |
|
$ |
913 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
747 |
|
Floating rate debt (a) |
|
|
377,340 |
|
|
|
— |
|
|
|
— |
|
|
|
375,240 |
|
Total |
|
$ |
378,253 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
375,987 |
|
(a) The debt amounts above do not include the impact of debt issuance costs or discounts.
NOTE 11. RELATED PARTY TRANSACTIONS
The Related Companies
In 2021, the Company entered into an exclusive real estate advisory agreement (the “Advisory Agreement”) with Related CM Advisor, LLC (the “Advisor”), a Delaware limited liability company and a subsidiary of The Related Companies, L.P. (“Related”) (the “Advisory Agreement”), pursuant to which the Advisor has agreed to provide certain real estate advisory services to the Company on an exclusive basis. In connection with the Advisory Agreement, the Company issued certain warrants to the Advisor which vested at the time of issuance, and additional 5,000,000 warrants, which will vest and become exercisable from time to time upon the opening of each center under the Advisory Agreement for which the Advisor provides services. As of March 31, 2024 and December 31, 2023, 3,500,000 Advisory Agreement warrants remained unvested.
During the three months ended March 31, 2024 and 2023, the Company recognized $0.1 million of expense related to the amortization of the vested Advisory Agreement warrants, in corporate, general and administrative expenses.
As of March 31, 2024 and December 31, 2023, the Company recorded $0.4 million and $0.6 million in other current assets, respectively, related to the Advisory Agreement warrants.
On July 13, 2021, the Board appointed Mr. Bryan Cho, Executive Vice President of Related, to serve as a Class III director of the Company. The appointment of Mr. Cho was made in connection with the Advisory Agreement, which provides the Advisor with the right to designate a director to serve on the Board, subject to the continuing satisfaction of certain conditions, including
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
that the Advisor and its affiliates maintain ownership of at least 16,667 shares of Class A Common Stock. As a director of the Company, Mr. Cho receives compensation in the same manner as the Company’s other non-employee directors.
Steward Health Care System, LLC
In November 2022, as part of the Steward Acquisition, the Board appointed Dr. Ralph de la Torre, Chairman, Chief Executive Officer and principal equity holder of Steward Health Care System, LLC (“Steward Health Care System”) as a director of the Company. Dr. de la Torre receives compensation in the same manner as the Company’s other non-employee directors.
As part of the Steward Acquisition, the aggregate consideration to the Seller included contingent earnout consideration. The earnout has not been achieved as of March 31, 2024. Refer to Note 4, Acquisitions, in the notes of the financial statements in the Company’s 2023 Form 10-K for details related to the contingent earnout consideration.
During the three months ended March 31, 2024 and 2023, the Company incurred expenses related to transition services agreement with Steward Health Care System of $0.2 million and $1.2 million, respectively, within corporate, general and administrative expenses.
As of March 31, 2024 and December 31, 2023, the Company had liabilities due to Steward Health Care System, or its affiliates, of $1.2 million and $0.2 million, respectively.
CAJ and Deerfield
In November 2022, the Company entered into the Loan and Security Agreement, described in Note 7, Debt and Related Party Debt, whereby CAJ and Deerfield are the lenders.
Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ.
Mr. Kevin Berg, who is on the Board, is a Senior Advisor with Deerfield. As a director of the Company, Mr. Berg receives compensation in the same manner as the Company’s other non-employee directors.
NOTE 12. LEASES
The Company has entered into operating and finance lease agreements for centers and office space expiring at various times through 2043, inclusive of renewal options that the Company is reasonably certain to exercise. The exercise of such lease renewal options is at our sole discretion, and to the extent we are reasonably certain we will exercise a renewal option, the years related to that option are included in our determination of the lease term for purposes of classifying and measuring a given lease.
The following table presents the location of the finance lease right-of-use assets and lease liabilities in the Company’s condensed consolidated balance sheets (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Condensed Consolidated Balance Sheet Location |
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Finance lease right-of-use assets, net |
Property and equipment, net |
|
$ |
18,312 |
|
|
$ |
18,552 |
|
Current finance lease liabilities |
Current portion of third-party debt, net |
|
|
19,768 |
|
|
|
— |
|
Long-term finance lease liabilities |
Long-term debt, net |
|
|
— |
|
|
|
19,612 |
|
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
Lease costs were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
Condensed Consolidated Statements of Operations Location |
|
2024 |
|
|
2023 |
|
Operating lease cost |
Corporate, general and administrative |
|
$ |
3,904 |
|
|
$ |
4,284 |
|
Finance lease cost: |
|
|
|
|
|
|
|
Amortization of lease assets |
Depreciation and amortization |
|
|
240 |
|
|
|
— |
|
Interest on lease liabilities |
Interest expense |
|
|
656 |
|
|
|
— |
|
Variable lease cost |
Corporate, general and administrative |
|
|
1,169 |
|
|
|
669 |
|
Short-term lease cost |
Corporate, general and administrative |
|
|
278 |
|
|
|
281 |
|
Total lease cost |
|
|
$ |
6,247 |
|
|
$ |
5,234 |
|
As of March 31, 2024, maturities of operating and finance lease liabilities were as follows (in thousands):
|
|
|
|
|
|
|
|
|
Year |
|
Operating Leases |
|
|
Finance Leases |
|
Remainder of 2024 |
|
$ |
11,030 |
|
|
$ |
1,701 |
|
2025 |
|
|
16,212 |
|
|
|
2,499 |
|
2026 |
|
|
15,708 |
|
|
|
2,549 |
|
2027 |
|
|
14,743 |
|
|
|
2,625 |
|
2028 |
|
|
13,698 |
|
|
|
2,704 |
|
Thereafter |
|
|
112,855 |
|
|
|
48,944 |
|
Total undiscounted lease obligations |
|
|
184,246 |
|
|
|
61,021 |
|
Less: Present value discount |
|
|
(73,767 |
) |
|
|
(41,253 |
) |
Present value of lease liabilities |
|
$ |
110,479 |
|
|
$ |
19,768 |
|
In the table above, the future maturities of operating and finance lease liabilities are presented consistent with the contractual terms. As further explained below, as of March 31, 2024, we were in default under certain operating and finance lease agreements. Accordingly, as of March 31, 2024, total lease liabilities related to such leases were classified as current liability in our condensed consolidated balance sheet.
Other information related to lease agreements was as follows (in thousands):
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Weighted-average remaining lease term (years) |
|
|
|
|
|
Operating leases |
|
11.9 |
|
|
|
11.7 |
|
Finance leases |
|
19.1 |
|
|
|
19.3 |
|
Weighted-average discount rate |
|
|
|
|
|
Operating leases |
|
8.67 |
% |
|
|
8.16 |
% |
Finance leases |
|
13.46 |
% |
|
|
13.46 |
% |
Cash paid for amounts included in measurement of liabilities |
|
|
|
|
|
Operating cash flows for operating leases |
|
810 |
|
|
|
12,605 |
|
Operating cash flows for finance leases |
|
500 |
|
|
|
1,310 |
|
At March 31, 2024, the Company was party to leases that have not yet commenced with aggregated estimated future lease payments of approximately $43.2 million, which are not included in the above tables.
The Company’s finance leases, two of the operating leases, and two leases that have not yet commenced, contain various covenants, that require the Company, among other things, to maintain minimum consolidated stockholder's equity of $100.0 million and a minimum cash balance of $25.0 million. In addition, these leases are subject to provisions that provide for a cross default in the event any of covenant violations under the Company’s Credit Agreement or in the event that covenant violations occur in other lease agreements with the same landlord.
In March 2024, the Company failed to make rent payments due pursuant to certain of its center leases on centers that the Company generally does not intend to operate, which resulted in an event of default under the terms of the applicable lease agreements. Upon an event of default, remedies available to our landlords generally include, without limitation, terminating such lease agreement, repossessing and reletting the leased properties and requiring us to remain liable for all obligations under such lease agreement, including the difference between the rent under such lease agreement and the rent payable as a result of reletting the leased properties, or requiring us to pay the rent due for the balance of the term of such lease agreement, less proceeds from re-letting, if any. As of March 31, 2024, the Company continued to occupy each of the leased centers. The Company is currently negotiating a resolution with the landlords for certain of the leased centers, which may include the
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
Company’s continued occupancy and use of certain of the facilities that the Company intends to continue to operate. Lease liabilities related to such leases are classified as current as of March 31, 2024, as one of the remedies available to our landlords is the acceleration of rent due during the remaining lease term.
Refer to Note 16, Subsequent Events, for further information regarding lease activities that occurred subsequent to March 31, 2024.
NOTE 13. INCOME TAXES
Income tax expense was $0.2 million and $0.2 million during the three months ended March 31, 2024 and 2023, respectively. The effective tax rate was (0.4)% and (0.2)% during the three months ended March 31, 2024 and 2023, respectively, based on the assessment of a full valuation allowance, excluding a portion attributable to the “naked credit” deferred tax liability.
NOTE 14. COMMITMENTS AND CONTINGENCIES
Compliance
The health care industry is subject to numerous laws and regulations of federal, state, and local governments. These laws and regulations include, but are not limited to, matters such as licensure, accreditation, government healthcare program participation requirements, reimbursement for patient services, and Medicare and Medicaid fraud and abuse. Recently, government activity has increased with respect to investigations and allegations concerning possible violations of fraud and abuse statutes and regulations by healthcare providers. Violations of these laws and regulations could result in expulsion from government healthcare programs together with imposition of significant fines and penalties, as well as significant repayments for patient services billed. Compliance with these laws and regulations, specifically those related to the Medicare and Medicaid programs, can be subject to government review and interpretation, as well as regulatory actions unknown and not yet asserted at this time. Management believes that the Company is in substantial compliance with current laws and regulations.
Litigation
From time to time, the Company is involved in various legal actions, demands, claims, qui tam suits, governmental investigations and audits, and other legal matters arising in the normal course of business. Except as described below, management has not identified any legal actions during the three months ended March 31, 2024 or 2023 that were deemed to be material.
As described above in Note 12, Leases, in March 2024, the Company failed to make rent payments due pursuant to certain of its center leases on centers that the Company generally does not intend to operate, which resulted in an event of default under the terms of the related lease agreements. Landlords of certain of the Company’s leased centers for which the Company failed to pay rent have filed lawsuits against the Company for default on the lease payments. As of March 31, 2024, total lease liabilities related to such leases were classified as a current liability in the Company’s condensed consolidated balance sheet.
NOTE 15. VARIABLE INTEREST ENTITIES
The Company has Administrative Service Agreements (the “ASAs”) with Medical Care of NY, P.C., Medical Care of Tennessee, PLLC and Medical Care of Texas, PLLC (together, the “PCs”), which were established to employ healthcare providers to deliver healthcare services to patients in New York, Tennessee, and Texas, and with Care Optical, LLC (“Care Optical”), which provides optometry services in the state of Florida. The Company concluded that it has variable interest in the PCs and Care Optical on the basis of its ASAs which provide for a management fee payable to the Company from the PCs and Care Optical in exchange for providing management and administrative services which creates risk and a potential return to the Company. The PCs’ and Care Optical’s equity at risk, as defined by GAAP, is insufficient to finance their activities without additional support, and therefore, the PCs and Care Optical are considered to be VIEs.
In order to determine whether the Company has a controlling financial interest in the PCs and Care Optical, and, thus, is the PCs’ and Care Optical’s primary beneficiary, the Company considered whether it has (i) the power to direct the activities of PCs and Care Optical that most significantly impacts their economic performance and (ii) the obligation to absorb losses of the PCs and Care Optical or the right to receive benefits from the PCs and Care Optical that could potentially be significant to
CAREMAX, inc.
NOTES TO condensed consolidated FINANCIAL STATEMENTS
(Unaudited)
them. The Company concluded that the member and employees of the PCs and Care Optical have no individual power to direct activities of the PCs and Care Optical that most significantly impact their economic performance. Under the ASAs, the Company is responsible for providing services that impact the growth of the patient population of the PCs and Care Optical, the management of the respective population’s healthcare needs, the provision of required healthcare services to those patients, and the PCs’ and Care Optical’s ability to receive revenue from health plans. In addition, the Company’s variable interest in the PCs and Care Optical provides the Company with the right to receive benefits that could potentially be significant to them. The single members of the PCs and Care Optical are employees of the Company. Based on this analysis, the Company concluded that it is the primary beneficiary of the PCs and Care Optical and therefore consolidates the balance sheet, results of operations and cash flow of the PCs and Care Optical.
Furthermore, as a direct result of nominal initial equity contributions by the single members of the PCs and Care Optical, the financial support CareMax provides to the PCs and Care Optical (e.g. loans) and the provisions of the arrangements described above, the interest held by the single member lacks economic substance and does not provide the member with the ability to participate in the residual profits or losses generated by the PCs and Care Optical. Therefore, all income and expenses recognized by the PCs and Care Optical are allocated to CareMax.
The following tables summarize the financial position and operations of the PCs and Care Optical (in thousands):
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Total assets |
$ |
1,077 |
|
|
$ |
1,200 |
|
Total liabilities |
$ |
10,906 |
|
|
$ |
9,896 |
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
2024 |
|
|
2023 |
|
Revenues |
$ |
873 |
|
|
$ |
417 |
|
Operating expenses |
$ |
1,727 |
|
|
$ |
1,714 |
|
NOTE 16. SUBSEQUENT EVENTS
In April 2024, the Company entered into a lease termination agreement for one of its leases. As part of this termination, the Company expects to recognize an estimated reduction in its right-of-use assets of $2.6 million, reduction in operating lease liabilities of $2.7 million, and a nominal termination loss.
Additionally, in April 2024, the Company entered into an agreement with one of its landlords, which among other things, requires us to surrender six of our leased properties by June 30, 2024. The Company is evaluating the impact of this agreement on its condensed consolidated financial statements.
On May 6, 2024, Steward Health Care System and certain of its affiliates commenced an in-court restructuring process through the filing of voluntary petitions for relief under Chapter 11 of the U.S. Bankruptcy Code in the U.S. Bankruptcy Court for the Southern District of Texas. As previously disclosed, the Company entered into certain agreements with affiliates of Steward Health Care System in connection with the Steward Acquisition. The Company is currently evaluating the impact that Steward Health Care System’s restructuring may have on the Company’s business.
Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
Unless the context otherwise requires, references in this section to “CareMax,” “we,” “us,” “our,” and the “Company” refer to CareMax, Inc. together with its consolidated subsidiaries. The following discussion and analysis summarizes the significant factors affecting the consolidated operating results, financial condition, liquidity, capital resources and cash flows of our company as of and for the periods presented below. The following discussion and analysis should be read in conjunction with our condensed consolidated financial statements and the related notes thereto included elsewhere in this Quarterly Report on Form 10-Q (the “Report”).
Forward-Looking Statements
This Report contains forward-looking statements within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995. Such forward-looking statements, which represent our belief or current expectations, plans or forecasts of future events based on assumptions and information currently available to our management, involve a number of known and unknown risks, uncertainties, assumptions and other important factors, many of which are outside the Company’s control. The words “anticipate,” “believe,” “continue,” “plan,” “expect,” “estimate,” “may,” “could,” “should,” “project,” “will,” or the negative or other variations thereof and similar words or phrases or comparable terminology may identify forward-looking statements, but the absence of these words does not mean that a statement is not forward-looking. Actual results could differ materially from those discussed in these forward-looking statements due to a variety of risks and uncertainties and other factors, including but not limited to those contained in our Annual Report on Form 10-K for the year ended December 31, 2023 (the “Annual Report”), which was filed with the Securities and Exchange Commission (the “SEC”) on March 18, 2024, under the caption “Risk Factors” and, the following:
•our history of losses and our future profitability remains uncertain and our net losses, level of indebtedness and significant cash used in operating activities have raised substantial doubt regarding our ability to continue as a going concern;
•the execution of our growth strategy may include divesting certain assets or businesses, which we may be unable to successfully execute and we may be unable to achieve the benefits we expect from any such divestitures;
•we may be unable to successfully implement cost-saving measures or achieve expected benefits under our plans to optimize performance of the MSO network and our centers;
•the impact of our existing or future indebtedness and any associated debt covenants on our business and growth prospects;
•the impact of restrictions on our current and future operations contained in certain of our agreements;
•risks relating to lease termination, lease expense escalators, lease extensions, special charges and our inability to comply with provisions of our lease agreements;
•our ability to integrate acquired businesses, including Steward Value-Based Care, and realize the expected benefits of any such acquisitions;
•the viability of our growth strategy, including organic growth, and growth by acquisitions, and our ability to realize expected results, as well as our ability to access the capital necessary for such growth;
•our ability to manage our growth effectively, execute our business plan, maintain high levels of service and patient satisfaction and adequately address competitive challenges;
•our ability to attract new patients;
•the dependence of our revenue and operations on a limited number of key payors;
•the risk of termination, non-renewal or renegotiation of the MA contracts held by the health plans with which we contract, or the termination, non-renewal or renegotiation of our contracts with those plans;
•the impact on our business from changes in the payor mix of our patients and potential decreases in our reimbursement rates;
•competition from primary care facilities and other healthcare services providers;
•competition for physicians and nurses, and shortages of qualified personnel;
•the impact on our business of reductions in Medicare reimbursement rates or changes in the rules governing the Medicare program, including the MA program;
•the impact of the COVID-19 pandemic or any other pandemic, epidemic or outbreak of an infectious disease in the United States or worldwide on our business, financial condition and results of operation;
•the impact on our business of state and federal efforts to reduce Medicaid spending;
•a shift in payor mix to Medicaid payors as well as an increase in the number of Medicaid patients may result in a reduction in the average rate of reimbursement;
•our assumption under most of our agreements with health plans of some or all of the risk that the cost of providing services will exceed our compensation;
•risks associated with estimating the amount of revenues and refund liabilities that we recognize under our risk agreements with health plans;
•the impact on our business of security breaches, loss of data, or other disruptions causing the compromise of sensitive information or preventing us from accessing critical information;
•the impact on our business of disruptions in our disaster recovery systems or management continuity planning;
•the potential adverse impact of legal proceedings and litigation;
•the impact of reductions in the quality ratings of the health plans we serve;
•our ability to maintain and enhance our reputation and brand recognition;
•our ability to effectively invest in, implement improvements to and properly maintain the uninterrupted operation and data integrity of our information technology and other business systems;
•our ability to obtain, maintain and enforce intellectual property protection for our technology;
•the potential adverse impact of claims by third parties that we are infringing on or otherwise violating their intellectual property rights;
•our ability to protect the confidentiality of our trade secrets, know-how and other internally developed information;
•the impact of any restrictions on our use of or ability to license data or our failure to license data and integrate third-party technologies;
•our ability to protect data, including personal health data, and maintain our information technology systems from cybersecurity breaches and data leakage;
•our ability to adhere to all of the complex government laws and regulations that apply to our business;
•the impact on our business if we are unable to effectively adapt to changes in the healthcare industry, including changes to laws and regulations regarding or affecting U.S. healthcare reform;
•our ability to navigate rules and regulations that govern our licensing and certification, as well as credentialing processes with private payors, before we can receive reimbursement for their services;
•insolvency, credit problems or other financial difficulties that could confront our counterparties in strategic acquisitions, investments and other collaborations could expose us to significant financial risk and significantly impact our ability to expand our overall profitability;
•our reliance on strategic relationships with third-parties to implement our growth strategy;
•that our estimates of market opportunity and forecasts of market and revenue growth may prove to be inaccurate;
•our operating results and stock price may be volatile;
•our failure to comply with continued listing requirements of the Nasdaq Global Select Market;
•risks associated with estimating the amount of revenues that we recognize under our risk agreements with health plans;
•our ability to develop and maintain proper and effective internal control over financial reporting; and
•the impact of any prior period developments.
Due to the uncertain nature of these factors, management cannot assess the impact of each factor on the business or the extent to which any factor, or combination of factors, may cause actual results to differ materially from those contained in any forward-looking statements.
Any forward-looking statement speaks only as of the date on which statement is made, and we undertake no obligation to update any of these statements or circumstances occurring after the date of this Report. New factors may emerge, and it is not possible to predict all factors that may affect our business and prospects.
Our Business
As of March 31, 2024, CareMax operated 55 centers in Florida, New York, and Tennessee. CareMax offers a comprehensive range of medical services, including primary and preventative care, specialist services, diagnostic testing, chronic disease management and dental and optometry services under global capitation contracts.
CareMax’s comprehensive, high touch approach to health care delivery is powered by its CareOptimize technology platform. CareOptimize is a purpose-built end-to-end technology platform that aggregates data and analyzes that data using proprietary algorithms and machine learning to support more informed care delivery decisions and to focus care decisions on preventative chronic disease management and the social determinants of health. CareMax believes that CareOptimize is designed to drive better outcomes and lower costs. CareMax has shifted from selling the CareOptimize platform to new outside customers for a software subscription fee and is instead focused on providing the software to affiliated practices of its managed services organization (“MSO”) to further improve financial, clinical and quality outcomes from the affiliated providers.
CareMax’s centers offer 24/7 access to care through employed providers and provide a comprehensive suite of high-touch health care and social services to its patients, including primary care, specialty care, telemedicine, health & wellness, optometry, dental, pharmacy and transportation. CareMax’s differentiated healthcare delivery model is focused on care coordination with vertically integrated ambulatory care and community-centric services. The goal of CareMax is to intercede as early as possible to manage chronic conditions for its patient members in a proactive, holistic, and tailored manner to provide a positive influence on patient outcomes and a reduction in overall healthcare costs. CareMax focuses on providing access to high quality care in underserved communities.
While CareMax’s primary focus is providing care to Medicare eligible seniors who are mostly 65+ (approximately 81% and 76% of revenue for the three months ended March 31, 2024 and 2023, respectively, came from these patients), we also provide services to children and adults through Medicaid programs as well as through commercial insurance plans. Substantially all of the Medicare patients cared for in CareMax’s centers are enrolled in MA plans which are run by private insurance companies and are approved by and under contract with Medicare. With MA, patients get all of the same coverage as original Medicare, including emergency care, and most plans also include prescription drug coverage. In many cases, MA plans offer more benefits than original Medicare, including dental, vision, hearing and wellness programs. We contract with nearly all national and most regional, local Medicare Advantage plans.
In addition to Medicare Advantage contracts, through our MSO we service other Medicare patients through a variety of value-based contracts, such as Medicare Shared Savings Program (“MSSP”) and ACO REACH.
Reverse Stock Split
On January 31, 2024 (the “Effective Date”), the Company effected a 1-for-30 reverse stock split (the “Reverse Split”) of the Company’s Class A common stock, par value $0.0001 per share (“Class A Common Stock”). As a result of the Reverse Split, every thirty shares of the Class A Common Stock issued and outstanding as of the Effective Date automatically converted into one share of Class A Common Stock. No fractional shares were issued in connection with the Reverse Split. In lieu of issuing fractional shares, stockholders of record who otherwise would have been entitled to receive fractional shares were entitled to rounding up of the fractional share to the nearest whole number. The Reverse Split automatically and proportionately adjusted, based on a 1-for-30 split ratio, all issued and outstanding shares of the Company’s common stock, as well as the terms of warrants outstanding at the time of the effectiveness of the Reverse Split. Proportionate adjustments were made to the per share
exercise price and the number of shares issuable upon the exercise of all outstanding stock options and warrants to purchase shares of common stock. There was no change in the par value of our common stock or preferred stock.
References to number of shares of Class A Common Stock and per share data (except par value) in the accompanying financial statements and notes thereto for all periods presented have been adjusted to reflect the Reverse Split.
Steward Health Care Restructuring
On May 6, 2024, Steward Health Care System LLC (“Steward Health Care System”) and certain of its affiliates commenced an in-court restructuring process through the filing of voluntary petitions for relief under Chapter 11 of the U.S. Bankruptcy Code in the U.S. Bankruptcy Court for the Southern District of Texas. As previously disclosed, the Company entered into certain agreements with affiliates of Steward Health Care System in connection with the Company’s acquisition (the “Steward Acquisition”) of the Medicare value-based care business of Steward Health Care System (“Steward Value-Based Care”). The Company is currently evaluating the impact that Steward Health Care System’s restructuring may have on the Company’s business.
Key Factors Affecting Our Performance
Our Patients
As discussed above, the Company partners with Medicare, Medicaid, and commercial insurance plans. While CareMax currently services mostly Medicare patients, we also accept Medicare fee-for-service patients.
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Patient Count as of* |
Mar 31, 2022 |
|
Jun 30, 2022 |
|
Sep 30, 2022 |
|
Dec 31, 2022 |
|
Mar 31, 2023 |
|
Jun 30, 2023 |
|
Sep 30, 2023 |
|
Dec 31, 2023 |
|
Mar 31, 2024 |
|
Medicare Advantage |
|
34,000 |
|
|
37,000 |
|
|
39,500 |
|
|
93,500 |
|
|
95,500 |
|
|
102,500 |
|
|
107,000 |
|
|
111,500 |
|
|
107,000 |
|
Medicare Government VBC |
|
— |
|
|
— |
|
|
— |
|
|
109,500 |
|
|
107,000 |
|
|
101,000 |
|
|
99,500 |
|
|
97,500 |
|
|
95,000 |
|
Medicaid |
|
28,500 |
|
|
29,500 |
|
|
31,500 |
|
|
33,500 |
|
|
33,500 |
|
|
30,500 |
|
|
28,500 |
|
|
25,500 |
|
|
31,000 |
|
Commercial |
|
21,500 |
|
|
21,500 |
|
|
22,000 |
|
|
22,000 |
|
|
34,500 |
|
|
38,500 |
|
|
38,000 |
|
|
36,000 |
|
|
17,000 |
|
Total Count |
|
84,000 |
|
|
88,000 |
|
|
93,000 |
|
|
258,500 |
|
|
271,000 |
|
|
272,500 |
|
|
273,000 |
|
|
270,000 |
|
|
250,000 |
|
* Figures may not sum due to rounding
Because CareMax accepts multiple insurance types, it uses a Medicare-Equivalent Member (“MCREM”) value in reviewing key factors of its performance. To determine the Medicare-Equivalent, CareMax estimates the amount of support typically received by one Medicare patient as equivalent to the level of support received by three Medicaid or Commercial patients. This is due to Medicare patients on average having significantly higher levels of chronic and acute conditions that need higher levels of care. Due to this dynamic, a 3:1 ratio is applied to make year over year comparisons of total membership more comparable. The breakdown of membership for MCREM is below:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
MCREM Count as of* |
Mar 31, 2022 |
|
Jun 30, 2022 |
|
Sep 30, 2022 |
|
Dec 31, 2022 |
|
Mar 31, 2023 |
|
Jun 30, 2023 |
|
Sep 30, 2023 |
|
Dec 31, 2023 |
|
Mar 31, 2024 |
|
Medicare Advantage |
|
34,000 |
|
|
37,000 |
|
|
39,500 |
|
|
93,500 |
|
|
95,500 |
|
|
102,500 |
|
|
107,000 |
|
|
111,500 |
|
|
107,000 |
|
Medicare Government VBC |
|
— |
|
|
— |
|
|
— |
|
|
109,500 |
|
|
107,000 |
|
|
101,000 |
|
|
99,500 |
|
|
97,500 |
|
|
95,000 |
|
Medicaid |
|
9,400 |
|
|
9,900 |
|
|
10,600 |
|
|
11,100 |
|
|
11,200 |
|
|
10,100 |
|
|
9,500 |
|
|
8,400 |
|
|
10,300 |
|
Commercial |
|
7,200 |
|
|
7,100 |
|
|
7,300 |
|
|
7,400 |
|
|
11,400 |
|
|
12,900 |
|
|
12,700 |
|
|
11,900 |
|
|
5,700 |
|
Total Count |
|
50,600 |
|
|
54,000 |
|
|
57,400 |
|
|
221,500 |
|
|
225,100 |
|
|
226,500 |
|
|
228,700 |
|
|
229,300 |
|
|
218,000 |
|
* Figures may not sum due to rounding
Medicare Advantage Patients
As of March 31, 2024, CareMax had approximately 107,000 MA patients of which 99% were in value-based agreements. Approximately 41% of patients in the Medicare Advantage value-based care agreements were in full-risk contracts. This means CareMax has been selected as the patient’s primary care provider and is financially responsible for some or all of the patient’s medical costs. CareMax is attributed an agreed percentage of the premium the Medicare plan receives from the Centers for Medicare and Medicaid Services (“CMS”) (typically a substantial majority of such premium given the risk assumed by the Company). A reconciliation is performed periodically and if premiums exceed medical costs paid by the MA plan, CareMax receives payment from the Medicare plan. If medical costs paid by the Medicare plan exceed premiums, CareMax is responsible to reimburse the Medicare plan.
Medicare Government Value-Based Care (“VBC”) Programs
As of March 31, 2024, CareMax had approximately 95,000 patients enrolled in Medicare Government VBC Programs, of which approximately 92% were in the MSSP and 8% were in the ACO REACH program. The MSSP is sponsored by the CMS. The MSSP allows participating Accountable Care Organizations (“ACOs”) to receive a share of cost savings they generate in connection with the management of costs and quality of medical services rendered to Medicare beneficiaries. Payments to the ACO participants, if any, are calculated annually and paid once a year by CMS on cost savings generated by the ACO participant relative to the ACO participants’ CMS benchmark. Under the MSSP, the ACO must meet certain qualifications to receive the full amount of its allocable cost savings or they either receive nothing or are responsible for shared losses. The MSSP rules require CMS to develop a benchmark for savings to be achieved by each participant if the participant is to receive shared savings. An ACO that meets the MSSP’s quality performance standards will be eligible to receive a share of the savings to the extent its assigned beneficiary medical expenditures are below the medical expenditure benchmark provided by CMS. A Minimum Savings Rate (“MSR”), which varies depending on the number of beneficiaries assigned to the ACO, must be achieved before the ACO can receive up to a 75% share of the savings if quality performance standards are met; the ACO is also responsible for 40% of the deficit. Once the MSR is surpassed, all the savings below the benchmark provided by CMS will be shared with the ACO.
Medicaid Patients
As of March 31, 2024, CareMax had approximately 31,000 Medicaid patients of which 100% were in value-based agreements. Approximately 92% of patients in the Medicaid value-based care agreements were in full-risk contracts. Using the MCREM metric, the level of support required to manage these Medicaid patients equates to that of approximately 10,300 Medicare patients. In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program.
Similar to the risk it takes with Medicare, CareMax is attributed an agreed percentage of the premium the Medicaid plan receives from Florida’s Agency for Health Care Administration (“AHCA”) (typically a substantial majority of such premium given the risk assumed by the Company). A reconciliation is performed periodically and if premiums exceed medical costs paid by the Medicaid plan, CareMax receives payment from the Medicaid plan. If medical costs paid by the Medicaid plan exceed premiums, we are responsible to reimburse the Medicaid plan.
Commercial Patients
As of March 31, 2024, CareMax managed approximately 17,000 commercial patients of which 91% were under a value-based agreement that provided upside-only financial incentives for quality and utilization performance. Using the MCREM metric, the level of support required to manage these commercial patients equates to that of approximately 5,700 Medicare patients.
CareMax cares for a number of commercial patients (less than 1% of the Company's total patients) for whom it is reimbursed on a fee-for-service basis via their health plan in situations where it does not have a capitation relationship with that particular health plan.
CareMax fee for-service revenue, received directly from commercial plans, on a per patient basis is typically lower than its per patient revenue for at-risk patients based in part because its fee-for-service revenue covers only the primary care services that it directly provides to the patient, while the risk revenue is intended to compensate it for the services directly performed by CareMax as well as the financial risk that it assumes related to the third-party medical expenses of at-risk patients.
Contracts with Payors
Our economic model relies on its capitated partnerships with payors which manage and market Medicare plans across the United States. CareMax has established strategic value-based relationships with a number of different payors for Medicare Advantage patients, Medicaid patients, and ACA patients. During the three months ended March 31, 2024, our three largest payor relationships were Payor A, Payor C, and Payor D, which generated 19%, 18%, and 13%, of our revenue, respectively. During the three months ended March 31, 2023, our three largest payor relationships were Payor A, Payor B and Payor C, which generated 31%, 22% and 20% of our revenue, respectively. These existing contracts and relationships with our national partners and their understanding of the value of the CareMax model reduces the risk of entering into new markets as CareMax typically seeks to have payor contracts in place before entering a new market. Maintaining, supporting, and growing these relationships, particularly as CareMax enters new markets, are critical to our long-term success. We believe CareMax’s model is well-aligned with that of its payor partners - to drive better health outcomes for their patients, enhance patient satisfaction,
and drive incremental patient and revenue growth. This alignment of interests helps ensure our continued success with our payor partners.
Effectively Manage the Cost of Care for Our Patients
The capitated nature of our contracting with payors requires us to prudently manage the medical expense of our patients. Our external provider costs are our largest expense category, representing 71% of our total operating expenses for the three months ended March 31, 2024 and 39% of our total operating expenses for the three months ended March 31, 2023. Our care model focuses on leveraging the primary care setting as a means of avoiding costly downstream healthcare costs, such as acute hospital admissions. Our patients retain the freedom to seek care at emergency rooms or hospitals; we do not restrict their access to care. Therefore, we could be liable for potentially large medical claims should we not effectively manage our patients’ health. We utilize stop-loss insurance for our patients, protecting us from medical claims in excess of certain levels.
Seasonality to our Business
Due to the large number of dual-eligible patients (meaning eligible for both Medicare and Medicaid) we serve, the annual enrollment period does not materially affect our growth during the year. We typically see large increases in ACA patients during the first quarter as a result of the ACA annual enrollment period (October to December). However, this is not a large portion of our business.
Our operational and financial results will experience some variability depending upon the time of year in which they are measured. This variability is most notable in the following areas:
Per-Patient Revenue
The revenue derived from our at-risk patients is a function of the percentage of premium we have negotiated with our payor partners, as well as our ability to accurately and appropriately document the acuity of a patient. We experience some seasonality with respect to our per-patient revenue, as it will generally decline over the course of the year. In January of each year, CMS revises the risk adjustment factor for each patient based upon health conditions documented in the prior year, leading to changes in per-patient revenue. As the year progresses, our per-patient revenue declines as new patients join us, typically with less complete or accurate documentation (and therefore lower risk-adjustment scores), and patient mortality disproportionately impacts our higher-risk (and therefore greater revenue) patients.
External Provider Costs
External Provider Costs will vary seasonally depending on a number of factors, but most significantly the weather. Certain illnesses, such as the influenza virus, are far more prevalent during colder months of the year, which can result in an increase in medical expenses during these time periods. We would therefore expect to see higher levels of per-patient medical costs in the first and fourth quarters. Medical costs also depend upon the number of business days in a period. Shorter periods will have lesser medical costs due to fewer business days. Business days can also create year-over-year comparability issues if one year has a different number of business days compared to another. We would also expect to experience an impact in the future should there be another pandemic such as COVID-19, which may result in increased or decreased total medical costs depending upon the severity of the infection, the duration of the infection and the impact to the supply and availability of healthcare services for our patients.
Payor Settlements
As it relates to our MSSP contracts, settlements from the prior year from the CMS typically take place during the fourth quarter of each year, which results in variability of our accounts receivable, cash flow from operations, and cash balances throughout the year.
Investments in Centers
We have invested into new de novo centers both within and outside of Florida. De novo centers require upfront capital and operating expenditures, which typically are not fully offset by revenues in the near-term, as a result of which we expect a period of unprofitability in our de novo centers before they break even. Costs we incur prior to opening of a de novo center include (1) incremental payroll costs from employees specifically associated with the operational, contractual, physical, or regulatory
infrastructure for de novo centers, prior to their opening; (2) legal costs directly associated with the de novo centers, incurred prior to their opening, which includes services such as execution of leases, health plan contracts and other agreements; (3) other expenses related to diligence, design, permitting, and other “soft costs” at new sites; and (4) rent and facility expenses prior to center opening. Once a de novo center opens, we incur post-opening losses, which consist of center-level operating losses recognized at a de novo center until the center breaks even, up to 18 months after opening. The de novo post-opening losses consist of revenue, external provider costs and cost of care allocated to the de novo center. During the three months ended March 31, 2024 and 2023, we incurred de novo pre-opening costs and post-opening losses, on a combined basis, of $4.8 million and $6.4 million, respectively.
Key Business Metrics
In addition to our financial information which conforms with generally accepted accounting principles in the United States of America (“GAAP”), management reviews a number of operating and financial metrics, including the following key metrics, to evaluate its business, measure its performance, identify trends affecting its business, formulate business plans, and make strategic decisions.
Use of Non-GAAP Financial Information
Certain financial information and data contained in this Report is unaudited and does not conform to Regulation S-X. Accordingly, such information and data may not be included in, may be adjusted in, or may be presented differently in, any periodic filing, information or proxy statement, or prospectus or registration statement to be filed by the Company with the SEC. Some of the financial information and data contained in this Report, such as Adjusted EBITDA and Platform Contribution have not been prepared in accordance with GAAP. These non-GAAP measures of financial results are not GAAP measures of our financial results or liquidity and should not be considered as an alternative to net income (loss) as a measure of financial results, cash flows from operating activities as a measure of liquidity, or any other performance measure derived in accordance with GAAP. The Company believes these non-GAAP measures of financial results provide useful information to management and investors regarding certain financial and business trends relating to the Company’s financial condition and results of operations. Management uses these non-GAAP measures for trend analyses and for budgeting and planning purposes.
The Company believes that the use of these non-GAAP financial measures provides an additional tool for investors to use in evaluating projected operating results and trends in and in comparing the Company’s financial measures with other similar companies, many of which present similar non-GAAP financial measures to investors. Management does not consider these non-GAAP measures in isolation or as an alternative to financial measures determined in accordance with GAAP. The principal limitation of these non-GAAP financial measures is that they exclude significant expenses and income that are required by GAAP to be recorded in the Company’s financial statements. In addition, they are subject to inherent limitations as they reflect the exercise of judgment by management about which expense and income are excluded or included in determining these non-GAAP financial measures. In order to compensate for these limitations, management presents non-GAAP financial measures in connection with GAAP results. You should review the Company’s GAAP financial statements, which are included in this Report.
Adjusted EBITDA
Beginning with the Company’s Form 10-Q for the three months ended June 30, 2023, for all periods presented, the Company has updated its calculation of the reconciliation of Adjusted EBITDA on a retrospective basis to no longer add back certain compensation costs for stay-on bonuses and duplicative salaries previously included within the Business Combination integration costs adjustment.
Adjusted EBITDA is defined as net income or loss before interest expense, depreciation and amortization, remeasurement of derivative and contingent earnout liabilities, goodwill impairment, stock-based compensation, Business Combination integration costs, acquisition and disposition related costs, income tax expense or benefit, and other income or expenses that are considered one-time in nature as determined by management.
Adjusted EBITDA is intended to be used as a supplemental measure of our performance that is neither required by, nor presented in accordance with GAAP. Management believes that the use of Adjusted EBITDA provides an additional tool for investors to use in evaluating ongoing operating results and trends and in comparing its financial measure with those of comparable companies, which may present similar non-GAAP financial measures to investors. However, we may incur future expenses similar to those excluded when calculating these measures. In addition, our presentations of these measures should
not be construed as an inference that our future results will be unaffected by unusual or non-recurring items. Our computation of Adjusted EBITDA may not be comparable to other similarly titled measures computed by other companies, because all companies may not calculate Adjusted EBITDA in the same fashion. Due to these limitations, Adjusted EBITDA should not be considered in isolation or as a substitute for performance measures calculated in accordance with GAAP.
Reconciliation to Adjusted EBITDA
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
|
(in thousands) |
|
2024 |
|
|
2023 |
|
|
Y/Y Change |
|
Net loss |
|
$ |
(43,408 |
) |
|
$ |
(82,082 |
) |
|
$ |
38,674 |
|
Interest expense |
|
|
19,756 |
|
|
|
10,711 |
|
|
|
9,045 |
|
Depreciation and amortization |
|
|
6,705 |
|
|
|
6,576 |
|
|
|
129 |
|
Remeasurement of derivative and contingent earnout liabilities |
|
|
2,381 |
|
|
|
(37,242 |
) |
|
|
39,623 |
|
Goodwill impairment |
|
|
— |
|
|
|
98,000 |
|
|
|
(98,000 |
) |
Stock-based compensation |
|
|
2,365 |
|
|
|
2,298 |
|
|
|
68 |
|
Business Combination integration costs (1) |
|
|
381 |
|
|
|
716 |
|
|
|
(335 |
) |
Acquisition and disposition related costs (2) |
|
|
1,052 |
|
|
|
622 |
|
|
|
430 |
|
Other (3) |
|
|
109 |
|
|
|
(187 |
) |
|
|
296 |
|
Income tax expense |
|
|
177 |
|
|
|
177 |
|
|
|
— |
|
Adjusted EBITDA |
|
$ |
(10,482 |
) |
|
$ |
(411 |
) |
|
$ |
(10,071 |
) |
(1)Represents initial costs to set up public company processes, incremental vendor expenses identified as temporary or duplicative and expected to be rationalized in the short term, and legal and professional expenses outside of the ordinary course of business, which are being incurred as part of the Company’s efforts as it integrates the two privately held companies that were combined in the Business Combination. Significant components of Business Combination integration costs were as follows:
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
(in thousands) |
2024 |
|
2023 |
|
Consulting and legal fees (a) |
$ |
371 |
|
$ |
282 |
|
Other (b) |
|
10 |
|
|
434 |
|
|
$ |
381 |
|
$ |
716 |
|
(a) Represents consulting and legal costs directly associated with efforts related to integration of the two privately held companies that were combined in the Business Combination.
(b) Represents primarily vendor expenses identified as temporary or duplicative and/or expenses outside the ordinary course of business and not necessary to run the Company’s business.
(2)Represents legal and incremental compensation payroll costs directly associated with efforts to achieve synergies related to closed transactions and legal and advisory costs related to exploration of potential dispositions. Significant components of the acquisition and disposition related costs were as follows:
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
(in thousands) |
2024 |
|
2023 |
|
Advisor and other professional fees (a) |
$ |
524 |
|
$ |
42 |
|
Compensation costs (b) |
|
528 |
|
|
580 |
|
|
$ |
1,052 |
|
$ |
622 |
|
(a) Includes payments to our third-party transaction advisory firm associated with transaction contracts, including the Steward transaction that closed in November 2022. Also, costs include legal and accounting fees directly associated with contemplated or closed transactions or potential dispositions.
(b) Includes incremental payroll compensation expense for employees directly associated with services to achieve synergies related to closed transactions.
(3)Components of other were as follows:
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
(in thousands) |
2024 |
|
2023 |
|
Interest income |
$ |
(668 |
) |
$ |
(253 |
) |
Severance costs |
|
694 |
|
|
— |
|
Other |
|
83 |
|
|
66 |
|
|
$ |
109 |
|
$ |
(187 |
) |
Operating Metrics and Non-GAAP Platform Contribution
In addition to our GAAP financial information, we review a number of operating and financial metrics, including the following key metrics, to evaluate our business, measure our performance, identify trends affecting our business, formulate business plans and make strategic decisions.
The following metrics are as of the end of the indicated date, except for Platform Contribution, which is for the three month period ended as of the indicated date:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Non-GAAP Operating Metrics |
Mar 31, 2022 |
|
Jun 30, 2022 |
|
Sep 30, 2022 |
|
Dec 31, 2022 |
|
Mar 31, 2023 |
|
Jun 30, 2023 |
|
Sep 30, 2023 |
|
Dec 31, 2023 |
|
Mar 31, 2024 |
|
Centers |
|
48 |
|
|
48 |
|
|
51 |
|
|
62 |
|
|
62 |
|
|
62 |
|
|
62 |
|
|
56 |
|
|
55 |
|
Markets |
|
6 |
|
|
6 |
|
|
7 |
|
|
7 |
|
|
7 |
|
|
7 |
|
|
7 |
|
|
7 |
|
|
6 |
|
Patients (MCREM)* |
|
50,600 |
|
|
54,000 |
|
|
57,400 |
|
|
221,500 |
|
|
225,100 |
|
|
226,500 |
|
|
228,700 |
|
|
229,300 |
|
|
218,000 |
|
Patients in value-based care arrangements (MCREM) |
|
79.8 |
% |
|
81.0 |
% |
|
78.2 |
% |
|
97.6 |
% |
|
99.0 |
% |
|
99.4 |
% |
|
98.8 |
% |
|
98.8 |
% |
|
99.1 |
% |
Platform Contribution ($, millions) |
$ |
17.2 |
|
$ |
21.6 |
|
$ |
20.6 |
|
$ |
25.6 |
|
$ |
24.7 |
|
$ |
28.6 |
|
$ |
21.1 |
|
$ |
(55.6 |
) |
$ |
9.1 |
|
* MCREM defined as Medicare Equivalent Members, which assumes the level of support received by a Medicare patient is equivalent to that received by three Medicaid or Commercial patients. |
|
|
|
Centers
We define our centers as those primary care centers open for business and open for enrollment of patients at the end of a particular period.
Patients (MCREM)
MCREM patients include both at-risk MA patients (those patients for whom we are financially responsible for their total healthcare costs) as well as risk and non-risk, non-MA patients. We define our total at-risk patients as patients who have selected us as their provider of primary care medical services as of the end of a particular period and for whom we take responsibility for at least some degree of downside risk in capitated contracts. At-risk patient remains active in our system until we are informed by the health plan the patient is no longer active. As discussed above, CareMax calculates the amount of support typically received by one Medicare patient as equivalent to the level of support received by three Medicaid or Commercial patients.
Platform Contribution
We define Platform Contribution as gross profit plus depreciation and amortization, stock-based compensation recognized within cost of care and other adjustments, as disclosed below. Gross profit is defined as revenue less the sum of (i) external provider costs; (ii) cost of care, including stock-based compensation, and (iii) depreciation and amortization expense. We believe this metric best reflects the economics of our care model as it includes all medical claims expense associated with our patients’ care as well as the costs we incur to care for our patients at our centers. As a center matures, we expect the Platform Contribution from that center to increase both in terms of absolute dollars as well as a percentage of revenue. This increase will be driven by improving patient contribution economics over time, as well as our ability to generate operating leverage on the costs of our centers. Our aggregate Platform Contribution may not increase despite improving economics at our existing centers should we open new centers at a pace that skews our mix of centers towards newer centers.
The following table provides a reconciliation of gross profit, the most closely comparable GAAP financial measure, to Platform Contribution:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended |
|
(in millions) |
Mar 31, 2022 |
|
Jun 30, 2022 |
|
Sep 30, 2022 |
|
Dec 31, 2022 |
|
Mar 31, 2023 |
|
Jun 30, 2023 |
|
Sep 30, 2023 |
|
Dec 31, 2023 |
|
Mar 31, 2024 |
|
Gross profit (a) |
$ |
11.2 |
|
$ |
15.4 |
|
$ |
14.8 |
|
$ |
17.2 |
|
$ |
17.1 |
|
$ |
20.4 |
|
$ |
12.0 |
|
$ |
(63.5 |
) |
$ |
1.5 |
|
Depreciation and amortization |
|
5.1 |
|
|
4.9 |
|
|
4.6 |
|
|
7.2 |
|
|
6.6 |
|
|
6.8 |
|
|
6.8 |
|
|
7.6 |
|
|
6.7 |
|
Stock-based compensation |
|
0.4 |
|
|
1.3 |
|
|
1.2 |
|
|
1.2 |
|
|
1.0 |
|
|
1.3 |
|
|
1.2 |
|
|
0.1 |
|
|
0.7 |
|
Other adjustments (b) |
|
0.5 |
|
|
0.1 |
|
|
0.1 |
|
|
— |
|
|
— |
|
|
— |
|
|
1.0 |
|
|
0.2 |
|
|
0.2 |
|
Platform Contribution |
$ |
17.2 |
|
$ |
21.6 |
|
$ |
20.6 |
|
$ |
25.6 |
|
$ |
24.7 |
|
$ |
28.6 |
|
$ |
21.1 |
|
$ |
(55.6 |
) |
$ |
9.1 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
(a) Gross profit reflects the reclassification of stock-based compensation expense previously included in corporate, general and administrative expenses, which decreased gross profit by $0.4 million during the three months ended March 31, 2022, $1.3 million during the three months ended June 30, 2022, $1.2 million during the three months ended September 30, 2022, and $1.2 million during the three months ended December 31, 2022. |
|
(b) Other adjustments include incremental costs related to post-Business Combination integration initiatives and other one-time center-level costs. Other adjustments reflected during the three months ended March 31, 2022, include $0.3 million of costs for a pilot project regarding outsourcing. During the three months ended September 30, 2023, December 31, 2023, and March 31, 2024, other adjustments include $1.0 million, $0.2 million and $0.2 million, respectively, of severance costs related to center staff. |
|
Components of Results of Operations
Revenue
Medicare Risk-Based Revenue and Medicaid Risk-Based Revenue. Our Medicare and Medicaid risk-based revenue consists primarily of capitation fees for medical services provided by us or managed by our MSO under a global capitation arrangement made directly with various MA payors. Capitation is a fixed amount of money per patient per month paid in advance for the delivery of health care services, whereby we are generally liable for medical costs in excess of the fixed payment and are able to retain any surplus created if medical costs are less than the fixed payment. A portion of our capitated revenues are typically prepaid monthly to us based on the number of MA patients selecting us as their primary care provider. Our capitated rates are determined as a percentage of the premium the MA plan receives from CMS for our at-risk members. Those premiums are determined via a competitive bidding process with CMS and are based upon the cost of care in a local market and the average utilization of services by the patients enrolled. Medicare pays capitation using a “risk adjustment model,” which compensates providers based on the health status (acuity) of each individual patient. Payors with higher acuity patients receive more in premium, and those with lower acuity patients receive less in premium. Under the risk adjustment model, capitation is paid on an interim basis based on enrollee data submitted for the preceding year and is adjusted in subsequent periods after the final data is compiled. As premiums are adjusted via this risk adjustment model, our capitation payments will correlate with how our payor partners’ premiums change with CMS. Risk adjustment in future periods may be impacted by COVID-19 and our inability to accurately document the health needs of our patients, which may have an adverse impact on our revenue.
For Medicaid, premiums are determined by Florida’s AHCA and base rates are adjusted annually using historical utilization data projected forward by a third-party actuarial firm. The rates are established based on specific cohorts by age and sex and geographical location. AHCA uses a “zero sum” risk adjustment model that establishes acuity for certain cohorts of patients quarterly, and depending on the scoring of that acuity, may periodically shift premiums from health plans with lower acuity members to health plans with higher acuity members.
Government Value-Based Care Revenue. Government value-based care revenue consists primarily of revenue derived from the MSSP. The MSSP is sponsored by the CMS. The MSSP allows ACOs to receive a share in cost savings they generate in connection with the managing of costs and quality of medical services rendered to Medicare beneficiaries. Payments to ACO participants, if any, are calculated annually and paid once a year by CMS on cost savings generated by the ACO participant relative to the ACO participants’ CMS benchmark. Under the MSSP, an ACO must meet certain qualifications to receive the full amount of its allocable cost savings or they either receive nothing or are responsible for shared losses. The MSSP rules require CMS to develop a benchmark for savings to be achieved by each ACO if the ACO is to receive shared savings. An ACO that meets the MSSP’s quality performance standards will be eligible to receive a share of the savings to the extent its assigned beneficiary medical expenditures are below the medical expenditure benchmark provided by CMS. A Minimum Savings Rate (“MSR”) must be achieved before the ACO can receive a share of the savings. Once the MSR is surpassed, all the savings below the benchmark provided by CMS will be shared at a certain percentage with the ACO. The MSR varies depending on the number of beneficiaries assigned to the ACO.
Other Revenue. Other revenue consists primarily of professional capitation payments and pharmacy revenue. These revenues are a fixed amount of money per patient per month paid in advance for the delivery of primary care services only, whereby
CareMax is not liable for medical costs in excess of the fixed payment. Capitated revenues are typically paid monthly to CareMax based on the number of patients selecting us as their primary care provider. Our capitated rates are fixed, contractual rates. Incentive payments for Healthcare Effectiveness Data and Information Set (“HEDIS”) and any services paid on a fee-for-service basis by a health plan are also included in other revenue. Other revenue also includes ancillary fees earned under contracts with certain payors for the provision of certain care coordination and other care management services. These services are provided to patients covered by these payors regardless of whether those patients receive their care from our affiliated medical groups. Revenue for primary care service for patients in partial risk or upside-only contracts, pharmacy revenue and revenue generated from CareOptimize are reported in other revenue.
Operating Expenses
External Provider Costs. External provider costs include services at-risk patients utilize that are rendered by providers other than CareMax. These include claims paid by the health plan and estimates for unpaid claims. The estimated reserve for incurred but not paid claims is included as a reduction to accounts receivable as we do not pay medical claims. Actual claims expense will differ from the estimated liability due to differences in estimated and actual patient utilization of health care services, the amount of charges, and other factors. We typically reconcile our medical claims expense with our payor partners on a monthly basis and adjust our estimate of incurred but not paid claims if necessary. To the extent we revise our estimates of incurred but not paid claims for prior periods up or down, there would be a correspondingly favorable or unfavorable effect on our current period results that may or may not reflect changes in long term trends in our performance. We expect our medical claims expenses to increase in both absolute dollar terms as well as on a PMPM basis given the healthcare spending trends within the Medicare population and the increasing disease burden of patients as they age.
The Company re-evaluated key assumptions and estimates and based on this analysis, the Company identified changes in estimates to revenue, external provider costs, short-term and long-term accounts receivable, net, and risk settlement liabilities. Accordingly, the Company recognized the following changes in prior year estimates in each respective period (in thousands):
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
Increase (decrease) |
2024 |
|
|
2023 |
|
Revenue |
$ |
(540 |
) |
|
$ |
(26,913 |
) |
External provider costs |
|
(7,363 |
) |
|
|
(12,413 |
) |
Short-term and long-term accounts receivable, net |
|
(2,680 |
) |
|
|
(14,500 |
) |
Risk settlement liabilities |
|
(9,503 |
) |
|
|
— |
|
For the three months ended March 31, 2024, the decreases were mostly driven by favorable development in provider costs from Medicare full risk plans, partially offset by unfavorable development in provider costs from Medicaid full risk plans primarily from 2022 dates of service. For the three months ended March 31, 2023, the developments were primarily driven by new, updated information regarding MSO membership at one health plan, and an unseasonably early flu season.
Cost of Care. Cost of care includes the costs of additional medical services we provide to patients that are not paid by the plan. These services include patient transportation, medical supplies, auto insurance and other specialty costs, like dental or vision. In some instances, we have negotiated better rates than the health plans for these health plan covered services. In addition, cost of care includes rent, utilities and facilities costs required to maintain and operate our centers, and compensation of the clinic and support staff.
Cost of care also includes distributions to affiliate IPA physicians and physician groups. Expenses from our physician groups that contract with our MSO are consolidated with other clinical and MSO expenses to determine profitability for our at-risk and fee-for-service arrangements. Physician group economics are not evaluated on an individual provider basis, as MSO related medical expenses are consolidated at the contract level.
We measure the incremental cost of our capitation agreements by starting with our center-level expenses, which are calculated based upon actual expenses incurred at a specific center for a given period of time and expenses that are incurred centrally and allocated to centers on a ratable basis. These expenses are allocated to our at-risk patients based upon the number of visit slots these patients utilized compared to the total slots utilized by all of our patients. All visits, however, are not identical and do not require the same level of effort and expense on our part. Certain types of visits are more time and resource intensive and therefore result in higher expenses for services provided internally. Generally, patients who are earlier in their tenure with CareMax utilize a higher percentage of these more intensive visits, as we get to know the patient and properly assess and document such patient’s health condition.
Sales and Marketing Expenses. Sales and marketing expenses represent employee-related expenses, such as salaries, commissions and related benefits, including stock-based compensation for sales and marketing departments. These expenses also include marketing and community relations related costs, such as radio and television advertising, events and promotional items.
Corporate, General and Administrative Expenses. Corporate, general, and administrative expenses represent employee-related expenses, such as salaries and related benefits, including stock-based compensation for support functions like finance, legal, human resources, and business developments. In addition, these expenses include corporate technology, third party professional services and corporate occupancy costs.
Depreciation and Amortization Expenses. Depreciation and amortization expenses are primarily attributable to our capital investments and consist of fixed asset depreciation and amortization of intangibles considered to have definite lives.
Nonoperating Income (Expenses)
Interest expense. Interest expense consists primarily of interest payments, paid-in-kind interest, amortization of debt issuance costs and debt discount on our outstanding borrowings.
Change in fair value of derivative liabilities. Change in fair value of derivative liabilities consists of changes in fair value of the public warrants and private placement warrants and Credit Agreement embedded derivatives.
Gain on remeasurement of contingent earnout liabilities. Gain on remeasurement of contingent earnout liabilities consists of changes in the fair value of contingent earnout liabilities.
Other income (expense), net. Other income (expense), net, consists of miscellaneous non-operating corporate expenses and gains.
Results of Operations
Three Months Ended March 31, 2024 compared to Three Months Ended March 31, 2023
The following table sets forth our condensed consolidated statements of operations data for the periods indicated:
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
(in thousands) |
2024 |
|
2023 |
|
$ Change |
|
% Change |
|
Revenue |
|
|
|
|
|
|
|
|
Medicare risk-based revenue |
$ |
168,502 |
|
$ |
121,593 |
|
$ |
46,909 |
|
|
38.6 |
% |
Medicaid risk-based revenue |
|
37,653 |
|
|
25,626 |
|
|
12,028 |
|
|
46.9 |
% |
Government value-based care revenue |
|
18,815 |
|
|
10,010 |
|
|
8,805 |
|
|
88.0 |
% |
Other revenue |
|
7,276 |
|
|
15,754 |
|
|
(8,479 |
) |
|
(53.8 |
%) |
Total revenue |
|
232,246 |
|
|
172,983 |
|
|
59,262 |
|
|
34.3 |
% |
Operating expenses |
|
|
|
|
|
|
|
|
External provider costs |
|
180,941 |
|
|
110,673 |
|
|
70,268 |
|
|
63.5 |
% |
Cost of care |
|
43,133 |
|
|
38,627 |
|
|
4,507 |
|
|
11.7 |
% |
Sales and marketing |
|
3,064 |
|
|
3,765 |
|
|
(701 |
) |
|
(18.6 |
%) |
Corporate, general and administrative |
|
20,108 |
|
|
23,965 |
|
|
(3,857 |
) |
|
(16.1 |
%) |
Depreciation and amortization |
|
6,705 |
|
|
6,576 |
|
|
129 |
|
|
2.0 |
% |
Goodwill impairment |
|
— |
|
|
98,000 |
|
|
(98,000 |
) |
|
(100.0 |
%) |
Total operating expenses |
|
253,951 |
|
|
281,606 |
|
|
(27,655 |
) |
|
(9.8 |
%) |
Operating loss |
|
(21,705 |
) |
|
(108,623 |
) |
|
86,918 |
|
|
80.0 |
% |
Nonoperating (expenses) income |
|
|
|
|
|
|
|
|
Interest expense |
|
(19,756 |
) |
|
(10,711 |
) |
|
(9,045 |
) |
|
(84.4 |
%) |
Change in fair value of derivative liabilities |
|
(2,381 |
) |
|
1,107 |
|
|
(3,487 |
) |
|
(315.1 |
%) |
Gain on remeasurement of contingent earnout liabilities |
|
— |
|
|
36,136 |
|
|
(36,136 |
) |
|
(100.0 |
%) |
Other income, net |
|
610 |
|
|
187 |
|
|
424 |
|
|
227.2 |
% |
Total nonoperating (expenses) income |
|
(21,526 |
) |
|
26,718 |
|
|
(48,244 |
) |
|
(180.6 |
%) |
Loss before income taxes |
|
(43,231 |
) |
|
(81,904 |
) |
|
38,673 |
|
|
47.2 |
% |
Income tax expense |
|
(177 |
) |
|
(177 |
) |
|
— |
|
|
0.0 |
% |
Net loss |
$ |
(43,408 |
) |
$ |
(82,082 |
) |
$ |
38,674 |
|
|
47.1 |
% |
* Figures may not sum due to rounding
Medicare risk-based revenue. Medicare risk-based revenue was $168.5 million for the three months ended March 31, 2024, an increase of $46.9 million, or 38.6%, compared to $121.6 million for the three months ended March 31, 2023. This increase was driven primarily by a 23.5% increase in the total number of at-risk Medicare patients and a 12.2% increase in rates.
Medicaid risk-based revenue. Medicaid risk-based revenue was $37.7 million for the three months ended March 31, 2024, an increase of $12.0 million, or 46.9%, compared to $25.6 million for the three months ended March 31, 2023. This increase was driven primarily by a 64.8% increase in rates and $3.7 million of favorable net prior period development, partially offset by 10.8% decrease in the total number of at-risk Medicaid patients.
Government value-based care revenue. Government value-based care revenue was $18.8 million for the three months ended March 31, 2024, an increase of $8.8 million, or 88.0%, compared to $10.0 million for the three months ended March 31, 2023. The increase is the result of higher estimated MSSP shared savings, as compared to the prior year.
Other revenue. Other revenue was $7.3 million for the three months ended March 31, 2024, a decrease of $8.5 million, or 53.8%, compared to $15.8 million for the three months ended March 31, 2023. The decrease is primarily due to a decrease in capitation and partial risk revenue, as risk contracts are converted to full risk, and the impact of unfavorable net prior period development of $3.9 million, partially offset by an increase in pharmacy revenue.
External provider costs. External provider costs were $180.9 million for the three months ended March 31, 2024, an increase of $70.3 million, or 63.5%, compared to $110.7 million for the three months ended March 31, 2023. This increase was driven primarily by an increase in claim costs and a 15.7% increase in the total number of at-risk patients, partially offset by $7.4 million of favorable net prior period development.
Cost of care. Cost of care expenses were $43.1 million for the three months ended March 31, 2024, an increase of $4.5 million, or 11.7%, compared to $38.6 million for the three months ended March 31, 2023. The increase was due to increases in pharmacy costs, partially offset by a reduction in headcount and payroll related costs in the current period, as compared to the prior period.
Sales and marketing expenses. Sales and marketing expenses were $3.1 million for the three months ended March 31, 2024, a decrease of $0.7 million, or 18.6%, compared to $3.8 million for the three months ended March 31, 2023. The decrease is due to a reduction in our sales staff and marketing efforts in 2024 as compared to 2023, related to our effort to reduce operating expenses.
Corporate, general and administrative expenses. Corporate, general and administrative expenses were $20.1 million for the three months ended March 31, 2024, a decrease of $3.9 million, or 16.1%, compared to $24.0 million for the three months ended March 31, 2023. The decrease is primarily due to lower payroll-related expenses, related to our initiative to reduce operating expenses.
Depreciation and amortization expenses. Depreciation and amortization expenses were $6.7 million for the three months ended March 31, 2024, an increase of $0.1 million, or 2.0%, compared to $6.6 million for the three months ended March 31, 2023.
Goodwill impairment. During the three months ended March 31, 2024, the Company recognized a goodwill impairment of $0, a decrease of $98.0 million, or 100.0%, compared to $98.0 million for the three months ended March 31, 2023. This decrease is mainly driven by a reduction of the market value of the Company's Class A Common Stock in the prior period. Refer to Note 5, Goodwill And Other Intangibles Assets, in the Notes to the condensed financial statements within this report.
Interest expenses. Interest expenses were $19.8 million for the three months ended March 31, 2024, an increase of $9.0 million, or 84.4%, compared to $10.7 million for the three months ended March 31, 2023. This increase was due to the increased borrowings and higher weighted-average interest rate. Refer to Note 7, Debt and Related Party Debt, in our condensed consolidated financial statements included in this Report for additional information on the borrowings outstanding as of March 31, 2024.
Change in fair value of derivative liabilities. The Company recorded a loss on fair value of derivative liabilities of $2.4 million for the three months ended March 31, 2024, a decrease of $3.5 million, or 315.1%, compared to a gain of $1.1 million for the three months ended March 31, 2023. This decrease was driven by the increase in the fair value of Credit Agreement embedded derivative liabilities, partially offset by the decrease in market value of Company's Class A Common Stock, which caused the gain in the fair value of the derivative warrant liabilities during the three months ended March 31, 2023.
Gain on remeasurement of contingent earnout liabilities. We recorded a gain of $36.1 million for the three months ended March 31, 2023. This gain was driven by the decrease in the market value of the Company's Class A Common Stock from December 31, 2022. There was no activity during the three months ended March 31, 2024 due to the contingent earnout consideration being reclassified into additional paid-in-capital as of June 30, 2023.
Other income, net. Other income, net was $0.6 million for the three months ended March 31, 2024, an increase of $0.4 million, or 227.2%, as compared to other income, net of $0.2 million for the three months ended March 31, 2023. This increase was mainly due to interest income earned in 2024 on our money market investments.
Liquidity and Capital Resources
Overview
As of March 31, 2024, we had cash and cash equivalents of $41.5 million.
Our principal sources of liquidity have been cash generated by our centers and MSO operations, and borrowings under our credit facilities. We have used these funds to meet our capital requirements, which consist of salaries and labor, benefits and other employee-related costs, product and supply costs, third-party customer service, billing and collections and logistics costs, capital expenditures including patient equipment, center and office lease expenses, insurance premiums, acquisitions, and debt service.
Our future capital expenditures will depend on many factors, including patient volume, revenue growth rates, the pace and scale of our expansion in new and existing markets and any future acquisitions. Many of our capital expenditures are made in advance of patients beginning service. Certain operating costs are incurred at the beginning of the equipment service period and during initial patient set up. We may be required to seek additional equity or debt financing, in addition to cash on hand and borrowings under our credit facilities in connection with operating or growing our business, including debt financing that may be available to us from certain health plans for each new center that we open under the terms of our agreements with those health plans. In the event that additional financing is required from outside sources, we may not be able to raise it on acceptable terms or at all. If additional capital is unavailable when desired, our business, results of operations, and financial condition would be materially and adversely affected.
Refer to Note 1, Description of Business and Going Concern, to the condensed consolidated financial statements that appear elsewhere in this Quarterly Report on Form 10-Q for details regarding our going concern considerations. As a result of our recent financial performance and current projections, we do not expect to be in compliance with the maximum leverage ratio and minimum liquidity covenants specified in the Credit Agreement or with financial covenants on certain lease agreements for the twelve months from the date of issuance of the condensed consolidated financial statements that appear elsewhere in this Quarterly Report on Form 10-Q. As a result, the indebtedness outstanding under the Credit Agreement, and certain operating and finance lease liabilities related to agreements with which we were in default, were classified as current within the condensed consolidated balance sheets.
Credit Facilities
Credit Agreement
In May 2022, the Company entered into a credit agreement (the “Credit Agreement”) that provided for an aggregate of up to $300 million in term loans, comprised of (i) initial term loans in the aggregate principal amount of $190 million (the “Initial Term Loans”) and (ii) a delayed term loan facility in the aggregate principal amount of $110 million (the “Delayed Draw Term Loans”). The Credit Agreement permits the Company to enter into certain incremental facilities subject to compliance with the terms, conditions and covenants set forth therein. In May 2022, the Company drew $190.0 million of the Initial Term Loans and used approximately $121.0 million of the net proceeds from this borrowing to repay its outstanding obligations under Existing Credit Agreement and recognized related debt extinguishment losses of $6.2 million.
The Credit Agreement contains embedded derivatives related to optional and mandatory prepayments, default interest and the impact of potential legislative changes. Embedded derivatives are separated from the host contract, and are carried at fair value when: (a) the embedded derivative possesses economic characteristics that are not clearly and closely related to the economic characteristics of the host contract; and (b) a separate, stand-alone instrument with the same terms would qualify as a derivative
instrument. The Company has concluded that certain embedded derivatives within the Credit Agreement meet these criteria and, as such, are valued separate and apart from the Credit Agreement and are recorded at fair value each reporting period.
In March 2023, the Company entered into the Second Amendment to the Credit Agreement. The Second Amendment amended the Credit Agreement to, among other things, (i) provide for a new incremental delayed draw term loan B facility in an aggregate principal amount of $60.0 million; (ii) revise the commitment expiration date for the Company’s existing $110.0 million Delayed Draw Term Loan to forty-five days following the Amendment Closing Date, (iii) extend the commencement of amortization payments on loans under the Credit Agreement from March 31, 2024 to May 31, 2025; (iv) reduce the amount of interest that the Company may elect to capitalize from 4.00% to 3.50% beginning on the second anniversary of the execution date of the Credit Agreement, 3.00% beginning on the third anniversary of the execution date of the Credit Agreement, and 1.50% beginning on December 10, 2025; (v) increase the amount of the super-priority revolving credit facility that is permitted to be added to the Credit Agreement to $45.0 million and provide that the entirety of such facility may be used for general corporate purposes; and (vi) amend the prepayment provisions of the Credit Agreement, including to have such provisions run as of the Amendment Closing Date.
The Credit Agreement contains certain covenants that limit, among other things, the ability of the Company and its subsidiaries to incur additional indebtedness, liens or encumbrances, to make certain investments, to enter into sale-leaseback transactions or sell certain assets, to make certain restricted payments or pay dividends, to enter into consolidations, to transact with affiliates and to amend certain agreements, subject in each case to the exceptions and other qualifications as provided in the Credit Agreement. The Credit Agreement also contains covenants that require the Company to satisfy a minimum liquidity requirement of $50.0 million, which may be decreased to $25.0 million if the Company achieves a certain adjusted EBITDA, and maintain a maximum total net leverage ratio based on the Company’s consolidated EBITDA, as defined in the Credit Agreement, with de novo losses excluded from the calculation of such ratio for up to 36 months after the opening of a de novo center, which maximum total leverage ratio will initially be 8.50 to 1.00, commencing with the fiscal quarter ended September 30, 2022 and is subject to a series of step-downs. For the fiscal quarters ending September 30, 2026 and thereafter the Company must maintain a maximum total net leverage ratio no greater than 5.50 to 1.00.
On March 15, 2024 (the “Third Amendment Effective Date”), the Company entered into a Waiver and Third Amendment to Credit Agreement (the “Third Amendment”) among us, certain of our subsidiaries, as guarantors, the lenders party thereto and Jefferies Finance LLC, as administrative agent and collateral agent. The Third Amendment amended the Credit Agreement to, among other things, (i) waive certain events of default under the Credit Agreement in the limited manner set forth therein through May 15, 2024 (the “Third Amendment Specified Period”), subject to an earlier termination of the waiver upon the occurrence of certain specified events; (ii) increase the applicable margin rate by 2.00% during the Third Amendment Specified Period, which additional interest we may elect to capitalize as principal amount on the outstanding loans; and (iii) modify certain covenants contained in the Credit Agreement, including, but not limited to, reducing the minimum liquidity requirement to $10 million during the Third Amendment Specified Period and providing for additional reporting to the lenders.
During the three months ended March 31, 2024 and 2023, the Company drew $0 and $30.0 million of the Delayed Draw Term Loans, respectively. As of March 31, 2024, there was no remaining availability under the Delayed Draw Term Loans.
Based on the elections made by the Company, as of March 31, 2024, borrowings under the Credit Agreement bore interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus the applicable credit spread adjustment based on the elected interest period) plus an applicable margin rate of 11.00%. As permitted under the Credit Agreement, the Company elected to capitalize 6.00% of the interest as principal amount. As a result of this election, the cash interest component of the applicable margin increased by 0.50%. Amortization payments under the Credit Agreement are payable in quarterly installments, commencing on May 31, 2025, in aggregate principal amounts equal to 0.25% of the aggregate outstanding principal amount of Initial Term Loans and Delayed Draw Term Loans. All amounts owed under the Credit Agreement are due in May 2027.
As of March 31, 2024, the Company was in compliance with all of the financial covenants under the Credit Agreement, as amended through the Third Amendment.
Loan and Security Agreement
In November 2022, the Company entered into a Loan and Security Agreement (the “Loan and Security Agreement”), by and among Sparta Merger Sub I Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub I LLC, a Delaware limited
liability company and wholly-owned subsidiary of the Company (“Merger LLC I”), Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (together with Merger LLC I, the “Guarantors”), Steward Accountable Care Network, Inc. (n/k/a as Steward Accountable Care Network, LLC) and Steward National Care Network, Inc. (n/k/a Steward National Care Network, LLC), as borrowers (the “Borrowers”), CAJ Lending LLC (“CAJ”) and Deerfield Partners L.P., as lenders (the “Lenders”), and CAJ, as administrative agent and collateral agent (in such capacity, the “Agent”). Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ.
Pursuant to the Loan and Security Agreement, the Lenders provided the Borrowers a term loan (the “Term Loan”) in the aggregate principal amount of $35.5 million. The Company used the proceeds of the Term Loan to fund the Financed Net Pre-Closing Medicare AR acquired in connection with the Steward Acquisition.
The Term Loan bore an interest rate at 12.0% per annum. In addition, the Borrowers paid a facility fee equal to 3.0% of the aggregate principal amount of the Term Loan.
The Loan and Security Agreement matured on the earlier of November 30, 2023, or three business days after the Borrowers receive payment for the Financed Net Pre-Closing Medicare AR from the federal government. In October 2023, the Company paid off all outstanding indebtedness of $35.5 million due under the Loan and Security Agreement with the proceeds of the MSSP payment from the federal government, and the Loan and Security Agreement was terminated.
Elevance Health Collaboration Agreement
In connection with our collaboration agreement with Elevance Health, Elevance Health has agreed to provide debt financing of up to $1.0 million for each new center opened in partnership with Elevance Health.
In October 2022, in connection with the Elevance Health Collaboration Agreement we entered into a promissory note for an amount of $1.0 million due in October 2032. Funds received from Elevance Health pursuant to the aforementioned promissory note will be used to finance costs of one new center that was opened in partnership with Elevance Health.
Finance Leases
We lease certain of our center facilities under non-cancelable finance lease agreements. Refer to Note 12, Leases, in the Notes to the Condensed Consolidated Financial Statements for additional information, including the schedule of remaining lease payments. The remaining duration of such leases ranges from 19 to 20 years.
Our finance leases and two of our operating leases require us to satisfy certain financial maintenance tests, such as maintaining minimum stockholder’s equity of $100.0 million and a minimum cash balance of $25.0 million. Refer to Note 12, Leases, in the Notes to the Condensed Consolidated Financial Statements for information regarding events of default on certain of our leases. In addition, refer to Note 16, Subsequent Events, in the Notes to the Condensed Consolidated Financial Statements for additional activity related to our leases subsequent to March 31, 2024.
Cash Flows
The following table summarizes our cash flows for the periods presented:
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
(in thousands) |
2024 |
|
|
2023 |
|
Net cash used in operating activities |
$ |
(23,802 |
) |
|
$ |
(21,746 |
) |
Net cash used in investing activities |
|
(126 |
) |
|
|
(2,286 |
) |
Net cash (used in) provided by financing activities |
|
(119 |
) |
|
|
26,627 |
|
Operating Activities. Net cash used in operating activities for the three months ended March 31, 2024 was $23.8 million, an increase of $2.1 million, as compared to $21.7 million used in operating activities during the three months ended March 31, 2023. This increase is primarily the result of slower collections on receivables as compared to the prior year period, due to MSSP arrangements that have longer payment cycles, and due to the disbursement of a MSSP surety bond payment of $7.0 million during the three months ended March 31, 2024 (none in 2023).
Investing Activities. Net cash used in investing activities was $0.1 million and $2.3 million for the three months ended March 31, 2024 and 2023, respectively, driven by investments in leasehold improvements and medical equipment for our centers.
Financing Activities. Net cash used in financing activities was $0.1 million, during the three months ended March 31, 2024, which consisted of payments related to financed equipment purchases. Net cash provided by financing activities was $26.6 million during the three months ended March 31, 2023, driven mainly by the $27.0 million drawn on our Delayed Draw Term Facility, net of the related discount.
Contractual Obligations and Commitments
Our principal commitments consist of obligations under the Credit Agreement and operating and finance leases for our centers.
Off-Balance Sheet Arrangements
We did not have any off-balance sheet arrangements as of March 31, 2024, or 2023, other than operating or finance leases which have not yet commenced.
JOBS Act
Section 102(b)(1) of the JOBS Act exempts emerging growth companies from being required to comply with new or revised financial accounting standards until private companies (that is, those that have not had a Securities Act registration statement declared effective or do not have a class of securities registered under the Exchange Act) are required to comply with the new or revised financial accounting standards. The JOBS Act provides that a company can elect to opt out of the extended transition period and comply with the requirements that apply to non-emerging growth companies, but any such election to opt out is irrevocable. We have elected not to opt out of such extended transition period, which means that when a standard is issued or revised and it has different application dates for public or private companies, as an emerging growth company, we can adopt the new or revised standard at the time private companies adopt the new or revised standard. This may make comparison of our consolidated financial statements with a public company which is neither an emerging growth company, nor an emerging growth company that has opted out of using the extended transition period, difficult or impossible because of the potential differences in accounting standards used.
Critical Accounting Policies and Estimates
There have been no changes to our critical accounting policies and estimates as described in our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed with the SEC on March 18, 2024.
Interim Goodwill Assessment
The Company’s policy is to test goodwill for impairment annually on December 31, or on an interim basis if an event triggering impairment may have occurred. As of March 31, 2024, our total shareholders’ equity exceeded our market capitalization. Accordingly, we estimated the fair value of our single reporting unit primarily on the basis of the Company’s market capitalization after considering reasonable control premiums which could be expected in transactions with third-party market participants.
Based on this analysis, although there was no headroom, no goodwill impairment was identified. The Company estimates that a decrease of 1% in the control premium or a decrease of 1% in the value of the Company’s Class A common stock would result in goodwill impairment of approximately $0.2 million, with all other factors remaining constant.
Recent Accounting Pronouncements
Refer to Note 2, Summary of Significant Accounting Policies, to our condensed consolidated financial statements included in this Report, for additional information.
Item 3. Quantitative and Qualitative Disclosures About Market Risk
We are a smaller reporting company as defined by Rule 12b-2 of the Exchange Act and are not required to provide the information otherwise required under this item.
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures
We maintain disclosure controls and procedures that are designed to ensure that information required to be disclosed in the reports that we file or submit under the Exchange Act is recorded, processed, summarized, and reported within the time periods specified in the SEC’s rules and forms, and that such information is accumulated and communicated to our management, including our Chief Executive Officer and Chief Financial Officer, as appropriate, to allow timely decisions regarding required disclosures.
Under supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, we evaluated the effectiveness of our disclosure controls and procedures (as that term is defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act as of March 31, 2024. Based upon that evaluation, our Chief Executive Officer and Chief Financial Officer concluded that our disclosure controls were not effective as of March 31, 2024, based on the material weaknesses in internal control over financial reporting described below.
Notwithstanding the identified material weaknesses described further below, we believe the condensed consolidated financial statements included in this Form 10-Q fairly represent in all material respects the financial condition, results of operations and cash flows of the Company for the periods presented.
Internal Control over Financial Reporting
A material weakness is a deficiency, or combination of deficiencies, in internal control over financial reporting such that there is a reasonable possibility that a material misstatement of our annual or interim financial statements will not be prevented or detected on a timely basis.
The material weaknesses we identified include that we lack a sufficient complement of professionals with the appropriate level of knowledge, training and experience to appropriately analyze, record and disclose accounting matters commensurate with our accounting and reporting requirements as a public company. This material weakness contributed to the Company not designing and maintaining formal controls to analyze, account for and disclose complex transactions, including the accounting for financial instruments and contingent earnout liabilities. These material weaknesses resulted in:
•the restatement of the Company’s previously filed consolidated financial statements as of and for the year ended December 31, 2020, as well as the quarterly condensed consolidated financial information for the 2020 interim period ended September 30, 2020 related to derivative warrant liabilities, Class A ordinary shares subject to possible redemption, additional paid-in-capital, retained earnings/(deficit), fair value adjustment on derivative warrant liabilities, earnings per share and the related disclosures;
•the restatement of the Company’s previously filed quarterly condensed consolidated financial information for the 2021 interim periods ended June 30, 2021 and September 30, 2021 related to goodwill, contingent earnout liabilities, additional paid-in capital, retained earnings/(deficit), gain/(loss) on remeasurement of earnout liabilities, earnings per share and the related disclosures; and
•the restatement of the Company’s previously filed consolidated financial statements as of and for the year ended December 31, 2021, as well as the quarterly condensed consolidated financial information for the 2021 interim period ended September 30, 2021 and the 2022 interim periods ended March 31, 2022, June 30, 2022, and September 30, 2022 related to other current assets and other assets.
Additionally, these material weaknesses could result in misstatements of substantially all accounts or disclosures that would result in a material misstatement to the annual or interim consolidated financial statements that would not be prevented or detected.
Remediation Plan for the Material Weaknesses
Since identifying the material weaknesses, management has developed a remediation plan and implemented measures to address the underlying causes of each material weakness. Our efforts to date included the following:
•We engaged an external advisor to assist in evaluating and documenting the design and operating effectiveness of our internal control over financial reporting.
•In 2022, we hired a Vice President of Financial Reporting and Technical Accounting and a Chief Accounting Officer, both with technical public company accounting and financial reporting experience.
•We enhanced access to accounting training, literature, research materials and documents for our finance and accounting departments.
•During the second and third quarters of 2023, we performed a financial statement risk assessment and identified areas where new key controls are needed, or existing controls needed to be enhanced.
•During the second and third quarters of 2023, we designed and implemented controls to address the entity level and financial reporting risks identified, including those involving accounting for complex transactions, including financial instruments and contingent earnout liabilities.
•During the second and third quarters of 2023, together with our external advisor, we designed a formal testing program to evaluate the design and operating effectiveness of key controls and began executing the formal testing program.
•During the third and fourth quarters of 2023, our external advisor performed key control testing consistent with our formal testing program.
Although we have implemented controls as of March 31, 2024, the controls have not been in place and operating effectively for a sufficient period to evaluate if the material weaknesses have been remediated. Although no assurance can be made that such remediation will occur, or that additional material weaknesses will not be identified, we believe we are making progress toward achieving the effectiveness of our internal control over financial reporting and disclosure controls and procedures. The actions that we are taking are subject to ongoing senior management review, as well as Audit Committee oversight. We may also conclude that additional measures may be required to remediate the material weaknesses in our internal control over financial reporting, which may necessitate additional changes to the design and implementation of controls.
Changes in Internal Control over Financial Reporting
There have been no changes in our internal control over financial reporting during the quarter ended March 31, 2024 that have materially affected, or are reasonably likely to materially affect, the Company’s internal control over financial reporting.
PART II. – OTHER INFORMATION
Item 1. Legal Proceedings
From time to time, CareMax may be involved in various legal proceedings and subject to claims that arise in the ordinary course of business. Although the results of litigation and claims are inherently unpredictable and uncertain, CareMax is not currently a party to any legal proceedings the outcome of which, if determined adversely to CareMax, are believed to, either individually or taken together, have a material adverse effect on CareMax’s business, operating results, cash flows or financial condition, except as set forth in “Litigation” of Note 14, Commitments and Contingencies, to our condensed consolidated financial statements included in this Report. Regardless of the outcome, litigation has the potential to have an adverse impact on CareMax because of defense and settlement costs, diversion of management resources, and other factors.
Item 1A. Risk Factors
There have been no material changes to the principal risks that we believe to be material to our business, results of operations and financial condition, from the risk factors previously disclosed in our Annual Report on Form 10-K for the year ended December 31, 2023.
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds
None.
Item 3. Defaults Upon Senior Securities
None.
Item 4. Mine Safety Disclosures
None.
Item 5. Other Information
Securities trading plans of Directors and Executive Officers
During the last fiscal quarter, none of our directors or officers (as defined in Rule 16a-1(f) of the Exchange Act) informed us of the adoption and termination of a “Rule 10b5-1 trading arrangement” or “non-Rule 10b5-1 trading arrangement,” each as defined in Item 408 of Regulation S-K.
Item 6. Exhibits
The following exhibits are filed as part of, or incorporated by reference into, this Report.
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No. |
|
Description of Exhibit |
10.1* |
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Letter Agreement, dated March 14, 2024, by and between CareMax, Inc. and Kevin Wirges. |
10.2+* |
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Limited Waiver and Third Amendment to Credit Agreement, dated March 15, 2024 by and among CareMax, Inc., the subsidiary guarantors party thereto, the lenders party thereto and Jefferies Finance LLC, as administrative agent and collateral agent. |
31.1* |
|
Certification of Principal Executive Officer Pursuant to Securities Exchange Act Rules 13a-14(a) and 15(d)-14(a), as adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. |
31.2* |
|
Certification of Principal Financial Officer Pursuant to Securities Exchange Act Rules 13a-14(a) and 15(d)-14(a), as adopted Pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. |
32.1** |
|
Certification of Principal Executive Officer Pursuant to 18 U.S.C. Section 1350, as adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
32.2** |
|
Certification of Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. |
101.INS* |
|
Inline XBRL Instance Document |
101.CAL* |
|
Inline XBRL Taxonomy Extension Calculation Linkbase Document |
101.SCH* |
|
Inline XBRL Taxonomy Extension Schema Document |
101.DEF* |
|
Inline XBRL Taxonomy Extension Definition Linkbase Document |
101.LAB* |
|
Inline XBRL Taxonomy Extension Labels Linkbase Document |
101.PRE* |
|
Inline XBRL Taxonomy Extension Presentation Linkbase Document |
104* |
|
Cover Page Interactive Data File (embedded within the Inline XBRL document) |
* Filed herewith.
** Furnished herewith.
+ Certain portions of this exhibit have been omitted pursuant to Regulation S-K, Item (601)(b)(10).
Certain of the exhibits and schedules to this exhibit have been omitted in accordance with Regulation S-K Item 601(a)(5). The Registrant agrees to furnish a copy of all omitted exhibits and schedules to the SEC upon its request.
SIGNATURES
Pursuant to the requirements of Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
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CareMax Inc. |
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|
Date: May 9, 2024 |
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/s/ Carlos A. de Solo |
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Name: |
Carlos A. de Solo |
|
Title: |
President, Chief Executive Officer, and Director (Principal Executive Officer) |
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|
|
Date: May 9, 2024 |
|
/s/ Kevin Wirges |
|
Name: |
Kevin Wirges |
|
Title: |
Executive Vice President, Chief Financial Officer and Treasurer (Principal Financial and Principal Accounting Officer) |
EXHIBIT 10.1
CareMax, Inc.
1000 NW 57 Court, Suite 400
Miami, FL 33126
March 14, 2024
Mr. Kevin Wirges
Dear Kevin:
Given your position as Chief Financial Officer of CareMax, Inc. (the “Company”), you are key to the Company’s business and your continued employment is important to the Company’s future success. For purposes of this letter agreement (the “Agreement”), references to the “Company” should, to the extent applicable, be deemed to include the Company’s subsidiaries.
To encourage your continued employment with the Company, the Company wishes to provide you with a cash bonus payment equal to $700,000 (the “Bonus Payment”), less applicable tax withholdings and subject to the terms set forth in this Agreement. The Bonus Payment will be paid to you in a single lump sum as soon as administratively practicable following your execution of this Agreement (such payment date, the “Bonus Payment Date”). For the avoidance of doubt, the Bonus Payment is in addition to, rather than in lieu of, the payments and benefits contemplated by the employment agreement by and between you and Managed Healthcare Partners, LLC, dated December 13, 2021 (the “Employment Agreement”).
You hereby agree that if, prior to the earlier of (i) the one-year anniversary of the Bonus Payment Date (the “Anniversary Date”), (ii) the consummation of a restructuring of the Company, including, without limitation, any exchange, refinancing, equitization, repurchase, cancellation, or forgiveness of a material and significant portion of the Company’s existing secured indebtedness (as determined in the sole discretion of the Board of Directors of the Company, or a duly constituted committee thereof) and (iii) a Change in Control of the Company (as defined in the Company’s 2021 Long-Term Incentive Plan), your employment with the Company is terminated by the Company for “Cause” or due to your voluntarily resignation without “Good Reason” (each as defined in the Employment Agreement) (such date of termination or resignation, the “Termination Date”), then, within thirty (30) days following the Termination Date, you will repay to the Company the After-Tax Value of the Bonus Payment (as defined below). You hereby agree that any such repayment obligation may be satisfied, at the Company’s election, by offsetting any or all of such repayment obligation by amounts otherwise then due to you from the Company, other than from any amounts due to you from the Company that constitute “non-qualified deferred compensation” within the meaning of Section 409A of the Internal Revenue Code of 1986, as amended. For the avoidance of doubt, the foregoing repayment obligation will not apply upon a termination of your employment with the Company for any reason other than as specified in the first sentence of this paragraph, including a termination of employment due to your death or Disability (as defined in the Employment Agreement), a termination of your employment by the Company without Cause or your resignation for Good Reason.
For purposes of this Agreement, “After-Tax Value of the Bonus Payment” means the gross amount of the Bonus Payment net of any taxes you are required to pay in respect thereof and determined taking into account any tax benefit that may be available in respect of the repayment described above. The Company shall determine in good faith the After-Tax Value of the Bonus Payment, which determination shall be conclusive and binding.
This Agreement is not an agreement of employment and does not guarantee that the Company will employ you for any specific time period, nor does it modify in any respect the Company’s right to terminate or
modify your employment or compensation. This Agreement and the Employment Agreement constitute the entire understanding and agreement of the parties regarding the subject matter herein and supersede all prior discussions, negotiations, correspondence, communications, understandings and agreements between the parties relating to subject matter hereof. No amendment, waiver, modification or change of any provision of this Agreement will be valid unless in writing and signed by the parties hereto. This Agreement shall be governed by and construed in accordance with the terms of the Employment Agreement.
This Agreement will be null and void if it is not executed and delivered by you on or prior to March 20, 2024. Please feel free to contact me if you have any questions.
Sincerely,
CareMax, Inc.
By: /s/ Jose R. Rodriguez____________
Jose R. Rodriguez
Chairman of the Board
Acknowledged and Agreed:
_/s/ Kevin Wirges__________________
Kevin Wirges
_3/14/2024________________________
Date
Exhibit 31.1
CERTIFICATION OF CHIEF EXECUTIVE OFFICER
PURSUANT TO RULE 13A-14(A) UNDER THE SECURITIES EXCHANGE ACT OF 1934,
AS ADOPTED PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002
I, Carlos A. de Solo, certify that:
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1. |
I have reviewed this quarterly report on Form 10-Q of CareMax, Inc.; |
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2. |
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; |
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3. |
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; |
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4. |
The registrant's other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have: |
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a) |
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; |
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b) |
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles; |
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c) |
Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and |
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d) |
Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and |
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5. |
The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions): |
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a) |
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and |
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b) |
Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting. |
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/s/ Carlos A. de Solo |
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Name: Carlos A. de Solo |
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Title: President, Chief Executive Officer and Director |
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(Principal Executive Officer) |
Exhibit 31.2
CERTIFICATION OF CHIEF FINANCIAL OFFICER
PURSUANT TO RULE 13A-14(A) UNDER THE SECURITIES EXCHANGE ACT OF 1934,
AS ADOPTED PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002
I, Kevin Wirges, certify that:
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1. |
I have reviewed this quarterly report on Form 10-Q of CareMax, Inc.; |
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2. |
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report; |
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3. |
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report; |
|
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4. |
The registrant's other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have: |
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|
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a) |
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared; |
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b) |
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles; |
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c) |
Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and |
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d) |
Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and |
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5. |
The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions): |
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a) |
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and |
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b) |
Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting. |
Date: May 9, 2024
|
|
|
|
|
/s/ Kevin Wirges |
|
Name: Kevin Wirges |
|
Title: Executive Vice President, Chief Financial Officer and Treasurer |
|
(Principal Financial Officer) |
Exhibit 32.1
CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002
In connection with the Quarterly Report of CareMax, Inc. (the “Company”) on Form 10-Q for the quarterly period ended March 31, 2024, as filed with the Securities and Exchange Commission (the “Report”), I, Carlos A. de Solo, Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. §1350, as added by §906 of the Sarbanes-Oxley Act of 2002, that to my knowledge:
|
|
|
|
1. |
The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and |
|
|
|
|
2. |
The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company as of and for the period covered by the Report. |
Date: May 9, 2024
|
|
|
/s/ Carlos A. de Solo |
|
Name: Carlos A. de Solo |
|
Title: President, Chief Executive Officer and Director |
|
(Principal Executive Officer) |
Exhibit 32.2
CERTIFICATION PURSUANT TO
18 U.S.C. SECTION 1350
AS ADOPTED PURSUANT TO
SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002
In connection with the Quarterly Report of CareMax, Inc. (the “Company”) on Form 10-Q for the quarterly period ended March 31, 2024, as filed with the Securities and Exchange Commission (the “Report”), I, Kevin Wirges, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. §1350, as added by §906 of the Sarbanes-Oxley Act of 2002, that to my knowledge:
|
|
|
|
1. |
The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and |
|
|
|
|
2. |
The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company as of and for the period covered by the Report. |
Date: May 9, 2024
|
|
|
|
|
/s/ Kevin Wirges |
|
Name: Kevin Wirges |
|
Title: Executive Vice President, Chief Financial Officer and Treasurer |
|
(Principal Financial Officer) |
v3.24.1.u1
Document and Entity Information - shares
|
3 Months Ended |
|
Mar. 31, 2024 |
May 06, 2024 |
Document Information [Line Items] |
|
|
Document Type |
10-Q
|
|
Amendment Flag |
false
|
|
Document Period End Date |
Mar. 31, 2024
|
|
Document Fiscal Year Focus |
2024
|
|
Document Fiscal Period Focus |
Q1
|
|
Entity Registrant Name |
CareMax, Inc.
|
|
Entity Central Index Key |
0001813914
|
|
Current Fiscal Year End Date |
--12-31
|
|
Entity Filer Category |
Accelerated Filer
|
|
Entity File Number |
001-39391
|
|
Entity Incorporation, State or Country Code |
DE
|
|
Entity Tax Identification Number |
85-0992224
|
|
Entity Address, Address Line One |
1000 NW 57th Court
|
|
Entity Address, Address Line Two |
Suite 400
|
|
Entity Address, City or Town |
Miami
|
|
Entity Address, State or Province |
FL
|
|
Entity Address, Postal Zip Code |
33126
|
|
City Area Code |
786
|
|
Local Phone Number |
360-4768
|
|
Entity Current Reporting Status |
Yes
|
|
Entity Small Business |
true
|
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Entity Emerging Growth Company |
true
|
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Entity Ex Transition Period |
false
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Entity Shell Company |
false
|
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true
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Class A Common Stock |
|
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Document Information [Line Items] |
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Entity Common Stock, Shares Outstanding |
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3,802,883
|
Title of 12(b) Security |
Class A common stock, par value $0.0001 per share
|
|
Trading Symbol |
CMAX
|
|
Security Exchange Name |
NASDAQ
|
|
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0
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Document Information [Line Items] |
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v3.24.1.u1
CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Current Assets |
|
|
Cash and cash equivalents |
$ 41,479
|
$ 65,528
|
Accounts receivable, net |
107,985
|
114,754
|
Other current assets |
6,650
|
3,066
|
Total Current Assets |
156,113
|
183,348
|
Property and equipment, net |
47,243
|
47,918
|
Operating lease right-of-use assets |
109,947
|
109,215
|
Goodwill, net |
156,841
|
156,841
|
Intangible assets, net |
96,092
|
101,243
|
Other assets |
47,965
|
24,737
|
Total Assets |
614,202
|
623,301
|
Current Liabilities |
|
|
Accounts payable |
6,704
|
6,275
|
Accrued expenses |
20,172
|
16,224
|
Risk settlement liabilities |
53,599
|
42,602
|
Related party liabilities |
1,229
|
190
|
Current portion of third-party debt, net |
390,995
|
364,380
|
Current portion of operating lease liabilities |
32,062
|
8,975
|
Other current liabilities |
2,354
|
165
|
Total Current Liabilities |
507,114
|
438,812
|
Derivative liabilities |
49
|
22
|
Long-term debt, net |
1,879
|
21,443
|
Long-term operating lease liabilities |
78,417
|
97,136
|
Other liabilities |
6,340
|
4,443
|
Total Liabilities |
593,800
|
561,856
|
COMMITMENTS AND CONTINGENCIES (NOTE 14) |
|
|
STOCKHOLDERS' EQUITY |
|
|
Preferred stock (1,000,000 shares authorized; one share issued and outstanding as of March 31, 2024 and December 31, 2023) |
|
|
Class A common stock ($0.0001 par value; 8,333,333 shares authorized; 3,802,883 and 3,744,732 shares issued and outstanding as of March 31, 2024 and December 31, 2023, respectively) |
11
|
11
|
Additional paid-in-capital |
784,736
|
782,371
|
Accumulated deficit |
(764,345)
|
(720,938)
|
Total Stockholders' Equity |
20,403
|
61,444
|
Total Liabilities and Stockholders' Equity |
$ 614,202
|
$ 623,301
|
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v3.24.1.u1
CONDENSED CONSOLIDATED BALANCE SHEETS (Unaudited) (Parenthetical) - $ / shares
|
Mar. 31, 2024 |
Dec. 31, 2023 |
Preferred stock, shares authorized |
1,000,000
|
1,000,000
|
Preferred stock, shares issued |
1
|
1
|
Preferred stock, shares outstanding |
1
|
1
|
Class A Common Stock |
|
|
Common stock, par value |
$ 0.0001
|
$ 0.0001
|
Common stock, shares authorized |
8,333,333
|
8,333,333
|
Common stock, shares issued |
3,802,883
|
3,744,732
|
Common stock, shares outstanding |
3,802,883
|
3,744,732
|
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v3.24.1.u1
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Revenue |
|
|
Total revenue |
$ 232,246
|
$ 172,983
|
Operating Expenses |
|
|
External provider costs |
180,941
|
110,673
|
Cost of care |
43,133
|
38,627
|
Sales and marketing |
3,064
|
3,765
|
Corporate, general and administrative |
20,108
|
23,965
|
Depreciation and amortization |
6,705
|
6,576
|
Goodwill impairment |
0
|
98,000
|
Total operating expenses |
253,951
|
281,606
|
Operating loss |
(21,705)
|
(108,623)
|
Nonoperating (expenses) income |
|
|
Interest expense |
(19,756)
|
(10,711)
|
Change in fair value of derivative liabilities |
(2,381)
|
1,107
|
Gain on remeasurement of contingent earnout liabilities |
0
|
36,136
|
Other income, net |
610
|
187
|
Total nonoperating (expenses) income |
(21,526)
|
26,718
|
Loss before income tax |
(43,231)
|
(81,904)
|
Income tax expense |
(177)
|
(177)
|
Net loss |
$ (43,408)
|
$ (82,082)
|
Weighted average basic shares outstanding |
3,778,600
|
3,712,027
|
Weighted average diluted shares outstanding |
3,778,600
|
3,712,027
|
Net loss per share |
|
|
Basic |
$ (11.49)
|
$ (22.11)
|
Diluted |
$ (11.49)
|
$ (22.11)
|
Medicare |
|
|
Revenue |
|
|
Total revenue |
$ 168,502
|
$ 121,593
|
Medicaid |
|
|
Revenue |
|
|
Total revenue |
37,653
|
25,626
|
Government Value |
|
|
Revenue |
|
|
Total revenue |
18,815
|
10,010
|
Other Revenue |
|
|
Revenue |
|
|
Total revenue |
$ 7,276
|
$ 15,754
|
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v3.24.1.u1
CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS'/MEMBERS' EQUITY (Unaudited) - USD ($) $ in Thousands |
Total |
Common Stock |
Additional Paid-in-Capital |
Retained Earnings (Deficit) |
Beginning balance at Dec. 31, 2022 |
$ 619,547
|
$ 11
|
$ 657,126
|
$ (37,590)
|
Beginning balance (in shares) at Dec. 31, 2022 |
|
3,711,086
|
|
|
Stock-based compensation expense |
2,298
|
|
2,298
|
|
Issuance of shares upon vesting of stock-based compensation awards |
|
941
|
|
|
Net loss |
(82,082)
|
|
|
(82,082)
|
Ending balance at Mar. 31, 2023 |
539,763
|
$ 11
|
659,424
|
(119,672)
|
Ending balance (in shares) at Mar. 31, 2023 |
|
3,712,027
|
|
|
Beginning balance at Dec. 31, 2023 |
61,444
|
$ 11
|
782,371
|
(720,938)
|
Beginning balance (in shares) at Dec. 31, 2023 |
|
3,744,732
|
|
|
Stock-based compensation expense |
2,365
|
|
2,365
|
|
Net loss |
(43,408)
|
|
|
(43,408)
|
Fractional shares issued upon Reverse Split |
|
58,151
|
|
|
Ending balance at Mar. 31, 2024 |
$ 20,403
|
$ 11
|
$ 784,736
|
$ (764,345)
|
Ending balance (in shares) at Mar. 31, 2024 |
|
3,802,883
|
|
|
X |
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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
CASH FLOWS FROM OPERATING ACTIVITIES |
|
|
Net loss |
$ (43,408)
|
$ (82,082)
|
Adjustments to reconcile net loss to cash and cash equivalents: |
|
|
Depreciation and amortization expense |
6,705
|
6,576
|
Amortization of debt issuance costs and discounts |
931
|
1,839
|
Stock-based compensation expense |
2,365
|
2,298
|
Income tax expense |
177
|
177
|
Change in fair value of derivative liabilities |
2,381
|
(1,107)
|
Gain on remeasurement of contingent earnout liabilities |
0
|
(36,136)
|
Payment-in-kind interest expense |
5,915
|
2,453
|
Non-cash finance lease expense |
156
|
0
|
Provision for credit losses |
(302)
|
(104)
|
Goodwill impairment |
0
|
98,000
|
Amortization of right-of-use assets |
2,675
|
2,725
|
Other non-cash, net |
134
|
1,080
|
Changes in operating assets and liabilities: |
|
|
Accounts receivable |
7,072
|
(7,850)
|
Other current assets |
(3,583)
|
(1,961)
|
Risk settlement liabilities |
10,997
|
(454)
|
Other assets |
(23,332)
|
(9,735)
|
Operating lease liabilities |
962
|
(1,280)
|
Accounts payable |
(188)
|
(500)
|
Accrued expenses |
3,948
|
(29)
|
Related party liabilities |
1,039
|
0
|
Other liabilities |
1,555
|
4,343
|
Net cash used in operating activities |
(23,802)
|
(21,746)
|
CASH FLOWS FROM INVESTING ACTIVITIES |
|
|
Purchases of property and equipment |
(126)
|
(2,286)
|
Net cash used in investing activities |
(126)
|
(2,286)
|
CASH FLOWS FROM FINANCING ACTIVITIES |
|
|
Proceeds from borrowings, net |
0
|
27,000
|
Principal payments of debt |
(119)
|
(25)
|
Payments of debt issuance costs |
0
|
(348)
|
Net cash (used in) provided by financing activities |
(119)
|
26,627
|
NET (DECREASE) INCREASE IN CASH AND CASH EQUIVALENTS |
(24,047)
|
2,596
|
Cash and cash equivalents - beginning of period |
65,528
|
41,626
|
CASH AND CASH EQUIVALENTS - END OF PERIOD |
41,479
|
44,222
|
SUPPLEMENTAL SCHEDULE OF NON-CASH ACTIVITIES: |
|
|
Additions to property and equipment funded through accounts payable |
617
|
947
|
Financed property and equipment purchases |
168
|
0
|
Decrease in right-of-use assets and lease liabilities due to lease remeasurements |
145
|
0
|
Right-of-use assets obtained in exchange for operating lease obligations |
4,388
|
0
|
SUPPLEMENTAL CASH FLOW INFORMATION: |
|
|
Cash paid for interest |
$ 8,915
|
$ 6,375
|
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v3.24.1.u1
Description of Business and Going Concern
|
3 Months Ended |
Mar. 31, 2024 |
Organization, Consolidation and Presentation of Financial Statements [Abstract] |
|
Description of Business and Going Concern |
Note 1. DESCRIPTION of business and going concern CareMax, Inc. (“CareMax” or the “Company”), formerly Deerfield Healthcare Technology Acquisitions Corp. (“DFHT”), is a Delaware corporation, which announced its initial public offering in July 2020 (the "IPO") as a publicly traded special purpose acquisition company for the purpose of effecting a merger, capital stock exchange, asset acquisition, stock purchase, reorganization, or similar business combination involving one or more businesses. CareMax provides high-quality, value-based care and chronic disease management through physicians and health care professionals committed to the overall health and wellness continuum of care for its patients. As of March 31, 2024, the Company operated 55 centers and managed affiliated providers across 10 states that offer a comprehensive suite of healthcare and social services, and a proprietary software and services platform that provides data, analytics, and rules-based decision tools/workflows for physicians across the United States. The Business Combination and Acquisitions On December 18, 2020, DFHT entered into a Business Combination Agreement (the “Business Combination Agreement”) with CareMax Medical Group, L.L.C., a Florida limited liability company (“CMG”), and entities listed in the Business Combination Agreement, IMC Medical Group Holdings, LLC, a Delaware limited liability company (“IMC”), IMC Holdings, LP, a Delaware limited partnership, and Deerfield Partners, L.P. The Business Combination (as defined below) closed on June 8, 2021 (the “Closing Date”), whereby DFHT acquired 100% of the equity interests in CMG and 100% of the equity interests in IMC, with CMG and IMC becoming wholly owned subsidiaries of DFHT. Immediately upon completion (the “Closing”) of the transactions contemplated by the Business Combination Agreement and the related financing transactions (the “Business Combination”), the name of the combined company was changed to CareMax, Inc. Unless the context otherwise requires, “the Company,” “we,” “us,” and “our” refer, for periods prior to the completion of the Business Combination, to CMG and its subsidiaries, and, for periods upon or after the completion of the Business Combination, to CareMax, Inc. and its subsidiaries. Subsequent to consummation of the Business Combination, primarily during the second half of 2021, the Company acquired Senior Medical Associates, LLC, Stallion Medical Management, LLC, Unlimited Medical Services of Florida, LLC, Advantis Physician Alliance, LLC, Business Intelligence & Analytics LLC, and three additional businesses. In November 2022, the Company acquired the Medicare value-based care business of Steward Health Care System (“Steward Value Based Care”, and such transaction the “Steward Acquisition”). Going Concern The Company’s condensed consolidated financial statements have been prepared assuming the Company will continue as a going concern, which contemplates the realization of assets and the settlement of liabilities and commitments in the normal course of business. The Company has generated recurring losses and negative cash flows from operations since completion of the Business Combination, and believes that, absent the Company successfully taking certain measures to reduce operating expenses and/or divest certain assets or businesses, as set forth below, the Company will continue to incur net losses and negative cash flows for the foreseeable future. The Company obtained a limited waiver of certain breaches of financial and administrative covenants under the Credit Agreement (as defined below) through May 15, 2024, subject to an earlier termination of the waiver upon the occurrence of certain specified events, as further explained in Note 7, Debt and Related Party Debt. Further, as of March 31, 2024, the Company was in breach of certain financial and administrative covenants (such as the failure to pay rent when it came due) under certain of its lease agreements, as further explained in Note 12, Leases. Although the Company had $41.5 million in cash and cash equivalents and $108.0 million of current accounts receivable, net, at March 31, 2024, absent the Company successfully implementing management’s plans as set forth below, the Company believes it will not be able to comply with the minimum liquidity requirement and maximum leverage ratio covenants contained in its Credit Agreement once the current limited waiver expires, nor will it be able to comply with certain financial covenants under certain of the Company’s leases. These conditions raise substantial doubt regarding the Company’s ability to continue as a going concern for one year after the date these condensed consolidated financial statements are issued, and these financial statements do not include any adjustments that may result from the outcome of this uncertainty. To address the Company’s capital needs, the Company is undergoing efforts to reduce operating expenses and pursuing various equity and debt refinancing and other strategic alternatives, including the possibility of a restructuring under Chapter 11 of the US Bankruptcy Code if the Company is unable to successfully implement its plans. Management’s plans that are intended to mitigate the conditions that raise substantial doubt about the Company’s ability to continue as a going concern include selling certain assets, exiting certain markets and reducing operating expenses. The Company’s efforts to reduce operating expenses may include lowering external provider costs, exiting unprofitable centers, consolidating certain medical centers, delaying capital expenditures and reducing non-essential spending. The Company may also seek to raise additional capital or refinance its indebtedness to provide additional liquidity to fund its losses until its operations become cash flow positive. There is no guarantee that the Company will be able to implement its operational plans or raise additional equity or debt financing on acceptable terms, if at all. Reverse Stock Split On January 31, 2024 (the “Effective Date”), the Company effected a 1-for-30 reverse stock split (the “Reverse Split”) of the Company’s Class A common stock, par value $0.0001 per share (“Class A Common Stock”). As a result of the Reverse Split, every thirty shares of the Class A Common Stock issued and outstanding as of the Effective Date automatically converted into one share of Class A Common Stock. No fractional shares were issued in connection with the Reverse Split. In lieu of issuing fractional shares, stockholders of record who otherwise would have been entitled to receive fractional shares were entitled to rounding up of the fractional share to the nearest whole number. The Reverse Split automatically and proportionately adjusted, based on a 1-for-30 split ratio, all issued and outstanding shares of the Company’s common stock, as well as the terms of warrants outstanding at the time of the effectiveness of the Reverse Split. Proportionate adjustments were made to the per share exercise price and the number of shares issuable upon the exercise of all outstanding stock options and warrants to purchase shares of common stock. There was no change in the par value of our Common Stock or Preferred Stock. References to number of shares of Class A Common Stock and per share data (except par value) in the financial statements and notes thereto for all periods presented have been adjusted to reflect the Reverse Split.
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- DefinitionThe entire disclosure for the business description and basis of presentation concepts. Business description describes the nature and type of organization including but not limited to organizational structure as may be applicable to holding companies, parent and subsidiary relationships, business divisions, business units, business segments, affiliates and information about significant ownership of the reporting entity. Basis of presentation describes the underlying basis used to prepare the financial statements (for example, US Generally Accepted Accounting Principles, Other Comprehensive Basis of Accounting, IFRS).
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v3.24.1.u1
Summary of Significant Accounting Policies
|
3 Months Ended |
Mar. 31, 2024 |
Accounting Policies [Abstract] |
|
Summary of Significant Accounting Policies |
Note 2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of Presentation and Principles of Consolidation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and in accordance with the instructions to Form 10-Q and Article 8 of Regulation S-X of the Securities and Exchange Commission (the “SEC”). The condensed consolidated financial statements include the accounts and operations of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions are eliminated upon consolidation. Certain amounts in the prior year's unaudited condensed consolidated financial statements have been reclassified to conform to the current year presentation. There is no comprehensive income (loss) so the statements of comprehensive income (loss) are not presented. Segment Financial Information The Company’s chief operating decision maker (“CODM”), who is the Company’s Chief Executive Officer, regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating financial performance. The Company identifies operating segments based on this review by its CODM and operates in and reports as a single operating segment. For the periods presented, materially all of the Company’s long-lived assets were located in the United States, and all revenue was earned in the United States. Significant Accounting Policies There have been no changes to our significant accounting policies and estimates as described in our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed with the SEC on March 18, 2024. Use of Estimates The preparation of the condensed consolidated 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. The areas where significant estimates are used in the financial statements include, but are not limited to, revenues and related receivables from risk adjustments, costs of our services and related liabilities, purchase price allocations, including fair value estimates of intangibles and contingent consideration, the valuation and related impairment testing of long-lived assets, including goodwill and intangible assets, the valuation of derivative liabilities, and the estimated useful lives of fixed assets and intangible assets, including internally developed software. Actual results could differ from those estimates. Emerging Growth Company Section 102(b)(1) of the Jumpstart Our Business Startups Act (the “JOBS Act”) exempts emerging growth companies from being required to comply with new or revised financial accounting standards until private companies (that is, those that have not had a Securities Act registration statement declared effective or do not have a class of securities registered under the Securities Exchange Act of 1934, as amended (the “Exchange Act”)) are required to comply with the new or revised financial accounting standards. The JOBS Act provides that a company can elect to opt out of the extended transition period and comply with the requirements that apply to non-emerging growth companies, but any such election to opt out is irrevocable. The Company has elected not to opt out of such extended transition period, which means that when a standard is issued or revised and it has different application dates for public or private companies, the Company, as an emerging growth company, can adopt the new or revised standard at the time private companies adopt the new or revised standard. This may make comparison of the Company’s condensed consolidated financial statements with another public company which is neither an emerging growth company nor an emerging growth company that has opted out of using the extended transition period difficult or impossible because of the potential differences in accounting standards used. Additionally, as an emerging growth company, the Company is exempt from the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act of 2002, as amended, and the Company’s independent registered public accounting firm is not required to evaluate and report on the effectiveness of internal control over financial reporting. Accounting Pronouncements Not Yet Adopted In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, which is intended to simplify the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. The guidance allows for either full retrospective adoption or modified retrospective adoption. The guidance is effective for the Company in the first quarter of fiscal year 2025 and early adoption is permitted. The Company is evaluating the impact the adoption of this guidance will have on its condensed consolidated financial statements. In November 2023, the FASB issued ASU 2023-07, Improvements to Reportable Segment Disclosures. This guidance requires annual and interim disclosure of significant segment expenses that are provided to the CODM as well as interim disclosures for all reportable segment’s profit or loss and assets. This guidance also requires disclosure of the title and position of the CODM and an explanation of how the CODM uses the reported measures of segment profit or loss in assessing segment performance and deciding how to allocate resources. This guidance is expected to improve financial reporting by providing additional information about a public company’s significant segment expenses and more timely and detailed segment information reporting throughout the fiscal period. The ASU is effective for the Company’s fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company does not expect adoption of ASU 2023-07 will have a significant impact on the disclosures within our consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”). ASU 2023-09 requires disaggregated information about a reporting entity’s effective tax rate reconciliation as well as information on income taxes paid. The ASU is effective for the Company’s fiscal year beginning January 1, 2025. The guidance will be applied on a prospective basis with the option to apply the standard retrospectively. Early adoption is permitted. The Company does not expect adoption of ASU 2023-09 will have a significant impact on the disclosures within our consolidated financial statements.
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- DefinitionThe entire disclosure for all significant accounting policies of the reporting entity.
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v3.24.1.u1
Accounts Receivable
|
3 Months Ended |
Mar. 31, 2024 |
Receivables [Abstract] |
|
Accounts Receivable |
NOTE 3. ACCOUNTS RECEIVABLE The Company’s accounts receivable are presented net of the unpaid external provider costs. A right of offset exists when all of the following conditions are met: 1) each of the two parties owed the other determinable amounts; 2) the reporting party has the right to offset the amount owed with the amount owed to the other party; 3) the reporting party intends to offset; and 4) the right of offset is enforceable by law. The Company believes all of the aforementioned conditions existed as of March 31, 2024 and December 31, 2023. As of March 31, 2024 and December 31, 2023, $26.0 million and $8.9 million of accounts receivable were included in other assets in the Company’s condensed consolidated balance sheets. Composition of the Company’s current accounts receivable, net, and risk settlement liabilities was as follows (in thousands):
|
|
|
|
|
|
|
|
|
As of March 31, 2024 |
|
|
As of December 31, 2023 |
|
Risk-based accounts receivable |
$ |
161,619 |
|
|
$ |
170,397 |
|
Incurred but not reported claims liability |
|
(56,471 |
) |
|
|
(58,027 |
) |
Other receivables |
|
2,837 |
|
|
|
2,384 |
|
Accounts receivable, net |
$ |
107,985 |
|
|
$ |
114,754 |
|
|
|
|
|
|
|
|
As of March 31, 2024 |
|
|
As of December 31, 2023 |
|
Risk-based accounts receivable |
$ |
21,042 |
|
|
$ |
381 |
|
Incurred but not reported claims liability |
|
(69,440 |
) |
|
|
(37,401 |
) |
Distribution liabilities |
|
(5,201 |
) |
|
|
(5,583 |
) |
Risk settlement liabilities |
$ |
(53,599 |
) |
|
$ |
(42,602 |
) |
|
|
|
|
|
|
The Company re-evaluated key assumptions and estimates and based on this analysis, the Company identified changes in estimates to revenue, external provider costs, short-term and long-term accounts receivable, net, and risk settlement liabilities. Accordingly, the Company recognized the following changes in prior year estimates in each respective period (in thousands):
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
Increase (decrease) |
2024 |
|
|
2023 |
|
Revenue |
$ |
(540 |
) |
|
$ |
(26,913 |
) |
External provider costs |
|
(7,363 |
) |
|
|
(12,413 |
) |
Short-term and long-term accounts receivable, net |
|
(2,680 |
) |
|
|
(14,500 |
) |
Risk settlement liabilities |
|
(9,503 |
) |
|
|
— |
|
For the three months ended March 31, 2024, the decreases were mostly driven by favorable development in provider costs from Medicare full risk plans, partially offset by unfavorable development in provider costs from Medicaid full risk plans primarily from 2022 dates of service. For the three months ended March 31, 2023, the developments were primarily driven by new, updated information regarding MSO membership at one health plan, and an unseasonably early flu season. Concentration of Credit Risk Composition of the Company’s revenues and accounts receivable balances for the payors comprising 10% or more of revenue was as follows (n/a - indicates balance or activity that is less than 10%):
|
|
|
|
|
Revenue |
|
Three Months Ended March 31, |
|
2024 |
|
2023 |
Payor A |
19% |
|
31% |
Payor B |
13% |
|
n/a |
Payor C |
18% |
|
22% |
Payor D |
13% |
|
12% |
Payor E |
11% |
|
20% |
|
|
|
|
|
Short-Term and Long-Term Accounts Receivable, net |
|
As of March 31, 2024 |
|
As of December 31, 2023 |
Payor A |
10% |
|
10% |
Payor B |
n/a |
|
10% |
Payor C |
n/a |
|
n/a |
Payor D |
n/a |
|
n/a |
Payor E |
n/a |
|
n/a |
As of March 31, 2024 and December 31, 2023, the Company’s provision for credit losses was $2.8 million and $3.1 million, respectively.
|
X |
- DefinitionThe entire disclosure for accounts receivable, contract receivable, receivable held-for-sale, and nontrade receivable.
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v3.24.1.u1
Reinsurance
|
3 Months Ended |
Mar. 31, 2024 |
Reinsurance Disclosures [Abstract] |
|
Reinsurance |
NOTE 4. REINSURANCE The Company purchases stop loss insurance on catastrophic costs to limit the exposure on patient losses. Premiums and policy recoveries are reported in external provider costs in the Company’s condensed consolidated statements of operations. The intent of the Company’s stop loss coverage is to limit the benefits paid for any individual patient. The Company’s stop loss limits are defined within each respective health plan contract or other third-party contract and range typically from $30,000 to $300,000 per patient per year. Premium expense incurred was $7.9 million and $6.8 million for the three months ended March 31, 2024, and 2023, respectively. Physicians under capitation arrangements typically have stop loss coverage so that a physician’s financial risk for any single member is limited to a maximum amount on an annual basis. The Company monitors the financial performance and solvency of its stop loss providers. However, the Company remains financially responsible for health care services to its members in the event the health plans or other third parties are unable to fulfill their obligations under stop loss contractual terms. Recoveries recognized were $7.8 million and $4.6 million for the three months ended March 31, 2024 and 2023, respectively. Estimated recoveries under stop loss policies are reported within accounts receivable, net, or risk settlement liabilities as the counterparty responsible for the payment of the claims and the stop loss is the respective health plan.
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- DefinitionThe entire disclosure pertaining to the existence, magnitude and information about insurance that has been ceded to or assumed from another insurance company, including the methodologies and assumptions used in determining recorded amounts.
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v3.24.1.u1
Goodwill and Other Intangible Assets
|
3 Months Ended |
Mar. 31, 2024 |
Goodwill and Intangible Assets Disclosure [Abstract] |
|
Goodwill and Other Intangible Assets |
NOTE 5. GOODWILL AND OTHER INTANGIBLE ASSETS Goodwill The Company’s policy is to test goodwill for impairment annually on December 31, or on an interim basis if an event triggering impairment may have occurred. As of March 31, 2024, our total shareholders’ equity exceeded our market capitalization. Accordingly, we estimated the fair value of our single reporting unit primarily on the basis of the Company’s market capitalization after considering reasonable control premiums which could be expected in transactions with third-party market participants. Based on this analysis, no goodwill impairment was identified. As of March 31, 2023, the economic uncertainty and market volatility resulting from the rising interest rate environment, the then-recent banking crisis and other industry developments resulted in a decrease in the Company’s stock price and market capitalization. Management believed that such decrease was a triggering event requiring an interim goodwill impairment quantitative analysis. The Company performed a market capitalization reconciliation to evaluate the Company’s estimated fair value balance and support the implied control premium. Based on the quantitative analysis performed, the Company’s estimated fair value as of March 31, 2023 was less than its carrying value as of March 31, 2023 by 17.9% or $98.0 million. The $98.0 million goodwill impairment charge was reflected in goodwill impairment in the Company’s statements of operations for the three months ended March 31, 2023. The Company’s cumulative goodwill impairment was $617.2 million as of March 31, 2024 and December 31, 2023. Other Intangible Assets The following tables summarize the gross carrying amounts, accumulated amortization and net carrying amounts of intangible assets by major class (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross Carrying Amount |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
March 31, 2024 |
|
|
|
|
|
|
|
|
|
Risk contracts |
|
$ |
102,070 |
|
|
$ |
(42,734 |
) |
|
$ |
59,336 |
|
Provider network |
|
|
42,900 |
|
|
|
(8,512 |
) |
|
|
34,388 |
|
Non-compete agreements |
|
|
4,170 |
|
|
|
(2,548 |
) |
|
|
1,622 |
|
Trademarks |
|
|
1,862 |
|
|
|
(1,526 |
) |
|
|
336 |
|
Other |
|
|
693 |
|
|
|
(284 |
) |
|
|
410 |
|
Total |
|
$ |
151,695 |
|
|
$ |
(55,603 |
) |
|
$ |
96,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross Carrying Amount |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
December 31, 2023 |
|
|
|
|
|
|
|
|
|
Risk contracts |
|
$ |
102,070 |
|
|
$ |
(39,394 |
) |
|
$ |
62,676 |
|
Provider network |
|
|
42,900 |
|
|
|
(6,980 |
) |
|
|
35,920 |
|
Non-compete agreements |
|
|
4,170 |
|
|
|
(2,343 |
) |
|
|
1,827 |
|
Trademarks |
|
|
1,862 |
|
|
|
(1,491 |
) |
|
|
371 |
|
Other |
|
|
693 |
|
|
|
(244 |
) |
|
|
449 |
|
Total |
|
$ |
151,695 |
|
|
$ |
(50,452 |
) |
|
$ |
101,243 |
|
Amortization expense, excluding amortization related to the finance lease right-of-use asset, totaled $5.2 million and $5.4 million for the three months ended March 31, 2024 and 2023, respectively.
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v3.24.1.u1
Property and Equipment
|
3 Months Ended |
Mar. 31, 2024 |
Property, Plant and Equipment [Abstract] |
|
Property and Equipment |
NOTE 6. PROPERTY AND EQUIPMENT Property and equipment at March 31, 2024 and December 31, 2023 consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Leasehold improvements |
|
$ |
21,082 |
|
|
$ |
19,200 |
|
Vehicles |
|
|
2,779 |
|
|
|
2,892 |
|
Furniture and equipment |
|
|
12,949 |
|
|
|
12,765 |
|
Software |
|
|
3,865 |
|
|
|
3,865 |
|
Assets under finance leases (1) |
|
|
18,312 |
|
|
|
18,552 |
|
Construction in progress |
|
|
3,853 |
|
|
|
5,074 |
|
Total |
|
|
62,841 |
|
|
|
62,349 |
|
Less: Accumulated depreciation and amortization (2) |
|
|
(15,598 |
) |
|
|
(14,431 |
) |
Total Property and equipment, net |
|
$ |
47,243 |
|
|
$ |
47,918 |
|
(1) Refer to Note 12, Leases, for information. (2) Includes accumulated amortization related to finance lease right-of-use assets of $0.9 million and $0.6 million as of March 31, 2024 and December 31, 2023, respectively. Construction in progress primarily consists of leasehold improvements at the Company’s centers, which have not opened. Depreciation expense, including amortization related to finance lease right-of-use assets, totaled $1.6 million and $1.2 million for the three months ended March 31, 2024 and 2023, respectively.
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- DefinitionThe entire disclosure for long-lived, physical asset used in normal conduct of business and not intended for resale. Includes, but is not limited to, work of art, historical treasure, and similar asset classified as collections.
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v3.24.1.u1
Debt and Related Party Debt
|
3 Months Ended |
Mar. 31, 2024 |
Debt Disclosure [Abstract] |
|
Debt and Related Party Debt |
NOTE 7. DEBT AND RELATED PARTY DEBT Credit Agreement In May 2022, the Company entered into a credit agreement (the “Credit Agreement”) that provided for an aggregate of up to $300.0 million in term loans, comprised of (i) initial term loans in the aggregate principal amount of $190.0 million (the “Initial Term Loans”) and (ii) a delayed term loan facility in the aggregate principal amount of $110.0 million (the “Delayed Draw Term Loans”). The Credit Agreement permits the Company to enter into certain incremental facilities subject to compliance with the terms, conditions and covenants set forth therein. In May 2022, the Company drew $190.0 million of the Initial Term Loans and used approximately $121 million of the net proceeds from this borrowing to repay its outstanding obligations under the credit agreement dated June 8, 2021, as amended and recognized related debt extinguishment losses of $6.2 million. The Credit Agreement contains certain covenants that limit, among other things, the ability of the Company and its subsidiaries to incur additional indebtedness, liens or encumbrances, to make certain investments, to enter into sale-leaseback transactions or sell certain assets, to make certain restricted payments or pay dividends, to enter into consolidations, to transact with affiliates and to amend certain agreements, subject in each case to the exceptions and other qualifications as provided in the Credit Agreement. The Credit Agreement also contains covenants that require the Company to satisfy a minimum liquidity requirement of $50.0 million, which may be decreased to $25.0 million if the Company achieves a certain adjusted EBITDA, and maintain a maximum total leverage ratio based on the Company’s consolidated EBITDA, as defined in the Credit Agreement, with de novo losses excluded from the calculation of such ratio for up to 36 months after the opening of a de novo center, which maximum total leverage ratio was initially 8.50 to 1.00, commencing with the fiscal quarter ended September 30, 2022 and is subject to a series of step-downs. For the fiscal quarters ending September 30, 2026 and thereafter the Company must maintain a maximum total leverage ratio no greater than 5.50 to 1.00. The Credit Agreement contains embedded derivatives related to optional and mandatory prepayments, default interest and the impact of potential legislative changes. Embedded derivatives are separated from the host contract, and are carried at fair value when: (a) the embedded derivative possesses economic characteristics that are not clearly and closely related to the economic characteristics of the host contract; and (b) a separate, stand-alone instrument with the same terms would qualify as a derivative instrument. The Company has concluded that mandatory prepayment and default interest features within the Credit Agreement meet these criteria and, as such, are valued separately and apart from the Credit Agreement and are recorded at fair value each reporting period. While such embedded features did not have material value prior to this period, the value of these bifurcated derivatives as of March 31, 2024 is approximately $2.4 million. Changes in the fair value of these derivatives are reflected in the Change in fair value of derivative liabilities within the condensed consolidated statements of operations and the fair value of the derivatives as of March 31, 2024 is reflected in other current liabilities within the condensed consolidated balance sheets. Refer to Note 10, Fair Value Measurements, for information about the valuation of the embedded derivatives. On March 8, 2023 (the “Amendment Closing Date”), the Company entered into a Second Amendment (the “Second Amendment”) to the Credit Agreement. The Second Amendment amended the Credit Agreement to, among other things, (i) provide for a new incremental delayed draw term loan B facility in an aggregate principal amount of $60.0 million (the “Delayed Draw Term Loan B Facility”); (ii) revise the commitment expiration date for the Company’s existing $110.0 million Delayed Draw Term Loan to forty-five days following the Amendment Closing Date; (iii) extend the commencement of amortization payments on loans under the Credit Agreement from March 31, 2024 to May 31, 2025; (iv) reduce the amount of interest that the Company may elect to capitalize from 4.00% to 3.50% beginning on the second anniversary of the execution date of the Credit Agreement, 3.00% beginning on the third anniversary of the execution date of the Credit Agreement, and 1.50% beginning on December 10, 2025; (v) increase the amount of the super-priority revolving credit facility that is permitted to be added to the Credit Agreement to $45.0 million and provide that the entirety of such facility may be used for general corporate purposes; and (vi) amend the prepayment provisions of the Credit Agreement, including to have such provisions run as of the Amendment Closing Date. On March 15, 2024 (the “Third Amendment Effective Date”), the Company entered into a Waiver and Third Amendment to the Credit Agreement (the “Third Amendment”). The Third Amendment amended the Credit Agreement to, among other things, (i) waive certain events of default under the Credit Agreement in the limited manner set forth therein through May 15, 2024 (the “Third Amendment Specified Period”), subject to an earlier termination of the waiver upon the occurrence of certain specified events, (ii) increase the applicable margin rate by 2.00% during the Third Amendment Specified Period, which additional interest the Company may elect to capitalize as principal amount on the outstanding loans and (iii) modify certain covenants contained in the Credit Agreement, including, but not limited to, reducing the minimum liquidity requirement to $10 million during the Third Amendment Specified Period and providing for additional reporting to the lenders. During the three months ended March 31, 2024 and 2023, the Company drew $0 and $30.0 million of the Delayed Draw Term Loans, respectively. Based on the elections made by the Company, as of March 31, 2024, borrowings under the Credit Agreement bore interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus the applicable credit spread adjustment based on the elected interest period), plus an applicable margin rate of 11.00%. As permitted under the Credit Agreement, the Company elected to capitalize 6.00% of the interest as principal amount. As a result of this election, the cash interest component of the applicable margin increased by 0.50%. Loan and Security Agreement - Related Party Debt In November 2022, the Company entered into a Loan and Security Agreement (the “Loan and Security Agreement”), by and among Sparta Merger Sub I Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub II Inc., a Delaware corporation and wholly-owned subsidiary of the Company, Sparta Merger Sub I LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (“Merger LLC I”), Sparta Merger Sub II LLC, a Delaware limited liability company and wholly-owned subsidiary of the Company (together with Merger LLC I, the “Guarantors”), Steward Accountable Care Network, Inc. (n/k/a as Steward Accountable Care Network, LLC) and Steward National Care Network, Inc. (n/k/a Steward National Care Network, LLC), as borrowers (the “Borrowers”), CAJ Lending LLC (“CAJ”) and Deerfield Partners L.P., as lenders (the “Lenders”), and CAJ, as administrative agent and collateral agent (in such capacity, the “Agent”). Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ. Pursuant to the Loan and Security Agreement, the Lenders provided the Borrowers a term loan (the “Term Loan”) in the aggregate principal amount of $35.5 million. The Company used the proceeds of the Term Loan to fund the payment for the estimated value of the accounts receivable attributable to Medicare value-based payments for the period between January 1, 2022 and the closing of the Steward Acquisition, minus the amount of such payments payable to the affiliate physicians of the acquired Steward entities (the “Financed Net Pre-Closing Medicare AR”). The Term Loan bore fixed interest at a rate of 12.0% per annum. In addition, the Borrowers paid a facility fee equal to 3.0% of the aggregate principal amount of the Term Loan, which was accounted for as a debt discount. Any additional interest (if applicable) accrued and owing during the term of the Loan and Security Agreement was paid-in-kind and capitalized to principal monthly in arrears. Pursuant to the Agreement and Plan of Merger entered into in connection with the Steward Acquisition (the “Merger Agreement”), Sparta Holding Co. LLC agreed to pay the costs of financing the Financed Net Pre-Closing Medicare AR and, at the closing of the Steward Acquisition, paid to the Borrowers $6.8 million, representing all scheduled payments of interest and fees from the Steward Acquisition closing date up to and including November 30, 2023, which amount was then paid in advance by the Borrowers to the Lenders. In October 2023, the Company paid off all outstanding indebtedness of $35.5 million due under the Loan and Security Agreement with the proceeds of the MSSP payment from the federal government, and the Loan and Security Agreement was terminated. Elevance Health In October 2022, in connection with the collaboration agreement with Elevance Health (formerly known as Anthem) the Company entered into a promissory note for $1.0 million due in October 2032. This borrowing bears a fixed interest rate of 6.25% per annum. Finance Leases Refer to Note 12, Leases, for information about the Company’s finance leases. As of March 31, 2024 and December 31, 2023, debt consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Indebtedness under the Credit Agreement, weighted-average interest rate of 15.2% during the three months ended March 31, 2024. |
|
$ |
383,256 |
|
|
$ |
377,340 |
|
Finance lease obligations, interest averaging 13.5% and maturing at various dates through 2043 as of March 31, 2024 and December 31, 2023. |
|
|
19,768 |
|
|
|
19,612 |
|
Other |
|
|
2,297 |
|
|
|
2,220 |
|
Less: Unamortized discounts and debt issuance costs |
|
|
(12,447 |
) |
|
|
(13,349 |
) |
|
|
|
392,874 |
|
|
|
385,823 |
|
Less: Current portion |
|
|
(390,995 |
) |
|
|
(364,380 |
) |
Long-term portion |
|
$ |
1,879 |
|
|
$ |
21,443 |
|
Future maturities of the indebtedness outstanding at March 31, 2024 were as follows (in thousands):
|
|
|
|
|
Year |
|
Amount |
|
Remainder of 2024 |
|
$ |
322 |
|
2025 |
|
|
3,566 |
|
2026 |
|
|
4,172 |
|
2027 |
|
|
376,564 |
|
2028 |
|
|
769 |
|
Thereafter |
|
|
160 |
|
Total |
|
$ |
385,553 |
|
In the table above, the future maturities are presented consistent with the contractual terms. As of March 31, 2024, we were in compliance with all of the financial covenants under the Credit Agreement, as amended through the Third Amendment; however, we do not expect to be in compliance during the subsequent quarterly testing dates. A breach of any of the covenants under the Credit Agreement or the occurrence of other events specified in the Credit Agreement could result in an event of default under the same and give rise to the lenders’ right to accelerate our debt obligations thereunder and pursue other remedial actions under such agreement and/or trigger a cross default under our long-term leases. Accordingly, as of March 31, 2024, the full balance of the outstanding indebtedness related to the Credit Agreement was classified as a current liability in our condensed consolidated balance sheet. Refer to Note 1, Description of Business and Going Concern, for going concern considerations.
|
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- DefinitionThe entire disclosure for long-term debt.
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v3.24.1.u1
Stock-Based Compensation
|
3 Months Ended |
Mar. 31, 2024 |
Share-Based Payment Arrangement [Abstract] |
|
Stock-Based Compensation |
NOTE 8. STOCK-BASED COMPENSATION The Company’s 2021 Long-Term Incentive Plan (the “2021 Plan”) permits the grant of equity-based awards to officers, directors, employees and other service providers. The 2021 Plan permits the grant of an initial share pool of 233,333 shares of Class A Common Stock and will be increased automatically, without further action of the Company’s board of directors, on January 1st of each calendar year commencing after the Closing Date and ending on (and including) January 1, 2031, by a number of shares of Class A Common Stock equal to the lesser of (i) four percent of the aggregate number of shares of Class A Common Stock outstanding on December 31st of the immediately preceding calendar year, excluding for this purpose any such outstanding shares of Class A Common Stock that were granted under the 2021 Plan and remain unvested and subject to forfeiture as of the relevant December 31st, or (ii) a lesser number of shares of Class A Common Stock as determined by the Company’s board of directors or the Compensation Committee of the board of directors prior to the relevant January 1st. Our outstanding stock-based compensation awards consist of time-based share awards, performance-based share awards and options. Our equity awards generally vest over a three-year period, subject to continued provision of services to the Company through the applicable vesting date. During the three months ended March 31, 2024 and 2023, no equity awards were granted under the 2021 Plan and there was no vesting of previously issued awards. During the three months ended March 31, 2024 and 2023, the Company recognized stock-based compensation expense totaling $2.4 million and $2.3 million, respectively. As of March 31, 2024 and 2023, total unrecognized compensation expense related to unvested equity awards was $11.8 million and $16.4 million, respectively, expected to be recognized over a weighted-average period of 1.6 years and 1.9 years, respectively.
|
X |
- DefinitionThe entire disclosure for share-based payment arrangement.
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v3.24.1.u1
Net Loss Per Share
|
3 Months Ended |
Mar. 31, 2024 |
Earnings Per Share [Abstract] |
|
Net Loss Per Share |
NOTE 9. NET LOSS PER SHARE The following table sets forth the calculation of basic and diluted net loss per share for the periods indicated based on the weighted-average number of common shares outstanding (in thousands, except share and per share data):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
Net loss attributable to CareMax, Inc. Class A common stockholders |
|
$ |
(43,408 |
) |
|
$ |
(82,082 |
) |
|
|
|
|
|
|
|
Weighted-average basic shares outstanding |
|
|
3,778,600 |
|
|
|
3,712,027 |
|
Weighted-average diluted shares outstanding |
|
|
3,778,600 |
|
|
|
3,712,027 |
|
|
|
|
|
|
|
|
Net loss per share: |
|
|
|
|
|
|
Basic |
|
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
Diluted |
|
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
The following potentially dilutive outstanding securities were excluded from the computation of diluted net loss per share because their effect would have been anti-dilutive or because issuance of shares underlying such securities is contingent upon the satisfaction of certain conditions which were not satisfied by the end of the period:
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
Series A and Series B warrants |
|
|
266,667 |
|
|
|
266,667 |
|
Public and private placement warrants |
|
|
193,055 |
|
|
|
193,055 |
|
Contingent consideration |
|
|
1,250,000 |
|
|
|
1,356,667 |
|
Unvested restricted stock units |
|
|
111,969 |
|
|
|
84,928 |
|
Unvested performance stock units (assumes 100% target payout) |
|
|
15,050 |
|
|
|
6,972 |
|
Unvested options |
|
|
25,012 |
|
|
|
12,452 |
|
Total |
|
|
1,861,753 |
|
|
|
1,920,740 |
|
|
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v3.24.1.u1
Fair Value Measurements
|
3 Months Ended |
Mar. 31, 2024 |
Fair Value Disclosures [Abstract] |
|
Fair Value Measurements |
NOTE 10. FAIR VALUE MEASUREMENTS Financial Instruments that are Measured at Fair Value on a Recurring Basis The following tables present information about the Company’s assets and liabilities that are measured at fair value on a recurring basis and indicate the fair value hierarchy of the valuation techniques that the Company utilized to determine such fair value (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
March 31, 2024 |
|
|
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
Description |
|
Carrying Value |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Derivative warrant liabilities - public warrants |
|
$ |
49 |
|
|
$ |
49 |
|
|
$ |
— |
|
|
$ |
— |
|
Derivative warrant liabilities - private placement warrants |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Embedded derivative liabilities - Credit Agreement |
|
|
2,354 |
|
|
|
— |
|
|
|
— |
|
|
|
2,354 |
|
Total liabilities measured at fair value |
|
$ |
2,403 |
|
|
$ |
49 |
|
|
$ |
— |
|
|
$ |
2,354 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
December 31, 2023 |
|
|
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
Description |
|
Carrying Value |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Derivative warrant liabilities - public warrants |
|
$ |
22 |
|
|
$ |
22 |
|
|
$ |
— |
|
|
$ |
— |
|
Derivative warrant liabilities - private placement warrants |
|
|
1 |
|
|
|
— |
|
|
|
— |
|
|
|
1 |
|
Embedded derivative liabilities - Credit Agreement |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Total liabilities measured at fair value |
|
$ |
22 |
|
|
$ |
22 |
|
|
$ |
— |
|
|
$ |
1 |
|
Derivative Warrant Liabilities Fair value of public warrants is measured using the listed market price of such warrants. Fair value of the private placement warrants is estimated using a Monte Carlo simulation model at each measurement date. Inherent in a Monte Carlo simulation are assumptions related to expected stock price volatility, expected life, risk-free interest rate and dividend yield. The Company estimates the volatility of its common stock based on historical volatility of select peer companies that matches the expected remaining life of the warrants. The risk-free interest rate is based on the U.S. Treasury zero-coupon yield curve on the grant date for a maturity similar to the expected remaining life of the warrants. The expected life of the warrants is assumed to be equivalent to their remaining contractual term. The dividend rate is based on the historical rate, which the Company anticipates remaining at zero. During the three months ended March 31, 2024 and 2023, the Company recognized a loss of less than $0.1 million and a gain of $1.1 million, respectively, related to the change in the fair value of the derivative warrant liabilities. Credit Agreement Embedded Derivatives Fair value of the embedded derivatives contained in the Credit Agreement is estimated using the discounted cash flow model. This involves significant Level 3 inputs and assumptions including the probability of occurrence of the respective triggering events and our risk-adjusted discount rate. During the three months ended March 31, 2024 and 2023, the Company recognized a loss of $2.4 million and $0, respectively, related to the change in the fair value of the Credit Agreement embedded derivatives. As of March 31, 2024, the carrying value of the embedded derivatives is recorded in other current liabilities in the Company’s condensed consolidated balance sheet. Transfers between level 1, 2 and 3 are recognized at the end of the reporting period. There were no transfers between levels for the three months ended March 31, 2024 or 2023. Activity of the Level 3 liabilities during the three months ended March 31, 2024 measured at fair value was as follows (in thousands):
|
|
|
|
Balance as of December 31, 2023 |
$ |
1 |
|
Change in fair value of Credit Agreement embedded derivative liabilities |
|
2,354 |
|
Change in fair value of derivative warrant liabilities |
|
(1 |
) |
Balance as of March 31, 2024 |
$ |
2,354 |
|
Activity of the Level 3 liabilities during the three months ended March 31, 2023 measured at fair value was as follows (in thousands):
|
|
|
|
Balance as of December 31, 2022 |
$ |
138,535 |
|
Change in fair value of derivative warrant liabilities |
|
(1,107 |
) |
Change in fair value of contingent consideration |
|
(36,136 |
) |
Balance as of March 31, 2023 |
$ |
101,293 |
|
Financial Instruments that are not Measured at Fair Value on a Recurring Basis
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
March 31, 2024 |
|
Carrying Value |
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
(in thousands) |
|
|
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Liabilities |
|
|
|
|
|
|
|
|
|
|
|
|
Fixed rate debt (a) |
|
$ |
893 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
625 |
|
Floating rate debt (a) |
|
|
383,256 |
|
|
|
— |
|
|
|
— |
|
|
|
354,841 |
|
Total |
|
$ |
384,149 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
355,466 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
December 31, 2023 |
|
Carrying Value |
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
(in thousands) |
|
|
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Liabilities |
|
|
|
|
|
|
|
|
|
|
|
|
Fixed rate debt (a) |
|
$ |
913 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
747 |
|
Floating rate debt (a) |
|
|
377,340 |
|
|
|
— |
|
|
|
— |
|
|
|
375,240 |
|
Total |
|
$ |
378,253 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
375,987 |
|
(a) The debt amounts above do not include the impact of debt issuance costs or discounts.
|
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- DefinitionThe entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.
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v3.24.1.u1
Related Party Transactions
|
3 Months Ended |
Mar. 31, 2024 |
Related Party Transactions [Abstract] |
|
Related Party Transactions |
NOTE 11. RELATED PARTY TRANSACTIONS The Related Companies In 2021, the Company entered into an exclusive real estate advisory agreement (the “Advisory Agreement”) with Related CM Advisor, LLC (the “Advisor”), a Delaware limited liability company and a subsidiary of The Related Companies, L.P. (“Related”) (the “Advisory Agreement”), pursuant to which the Advisor has agreed to provide certain real estate advisory services to the Company on an exclusive basis. In connection with the Advisory Agreement, the Company issued certain warrants to the Advisor which vested at the time of issuance, and additional 5,000,000 warrants, which will vest and become exercisable from time to time upon the opening of each center under the Advisory Agreement for which the Advisor provides services. As of March 31, 2024 and December 31, 2023, 3,500,000 Advisory Agreement warrants remained unvested. During the three months ended March 31, 2024 and 2023, the Company recognized $0.1 million of expense related to the amortization of the vested Advisory Agreement warrants, in corporate, general and administrative expenses. As of March 31, 2024 and December 31, 2023, the Company recorded $0.4 million and $0.6 million in other current assets, respectively, related to the Advisory Agreement warrants. On July 13, 2021, the Board appointed Mr. Bryan Cho, Executive Vice President of Related, to serve as a Class III director of the Company. The appointment of Mr. Cho was made in connection with the Advisory Agreement, which provides the Advisor with the right to designate a director to serve on the Board, subject to the continuing satisfaction of certain conditions, including that the Advisor and its affiliates maintain ownership of at least 16,667 shares of Class A Common Stock. As a director of the Company, Mr. Cho receives compensation in the same manner as the Company’s other non-employee directors. Steward Health Care System, LLC In November 2022, as part of the Steward Acquisition, the Board appointed Dr. Ralph de la Torre, Chairman, Chief Executive Officer and principal equity holder of Steward Health Care System, LLC (“Steward Health Care System”) as a director of the Company. Dr. de la Torre receives compensation in the same manner as the Company’s other non-employee directors. As part of the Steward Acquisition, the aggregate consideration to the Seller included contingent earnout consideration. The earnout has not been achieved as of March 31, 2024. Refer to Note 4, Acquisitions, in the notes of the financial statements in the Company’s 2023 Form 10-K for details related to the contingent earnout consideration. During the three months ended March 31, 2024 and 2023, the Company incurred expenses related to transition services agreement with Steward Health Care System of $0.2 million and $1.2 million, respectively, within corporate, general and administrative expenses. As of March 31, 2024 and December 31, 2023, the Company had liabilities due to Steward Health Care System, or its affiliates, of $1.2 million and $0.2 million, respectively. CAJ and Deerfield In November 2022, the Company entered into the Loan and Security Agreement, described in Note 7, Debt and Related Party Debt, whereby CAJ and Deerfield are the lenders. Mr. Carlos A. de Solo, a director of the Company and the Company’s President and Chief Executive Officer, Mr. Alberto de Solo, the Company’s Executive Vice President and Chief Operating Officer, and Mr. Joseph N. De Vera, the Company’s Senior Vice President and Legal Counsel, have interests in CAJ. Mr. Kevin Berg, who is on the Board, is a Senior Advisor with Deerfield. As a director of the Company, Mr. Berg receives compensation in the same manner as the Company’s other non-employee directors.
|
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- DefinitionThe entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.
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v3.24.1.u1
Leases
|
3 Months Ended |
Mar. 31, 2024 |
Leases [Abstract] |
|
Leases |
NOTE 12. LEASES The Company has entered into operating and finance lease agreements for centers and office space expiring at various times through 2043, inclusive of renewal options that the Company is reasonably certain to exercise. The exercise of such lease renewal options is at our sole discretion, and to the extent we are reasonably certain we will exercise a renewal option, the years related to that option are included in our determination of the lease term for purposes of classifying and measuring a given lease. The following table presents the location of the finance lease right-of-use assets and lease liabilities in the Company’s condensed consolidated balance sheets (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Condensed Consolidated Balance Sheet Location |
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Finance lease right-of-use assets, net |
Property and equipment, net |
|
$ |
18,312 |
|
|
$ |
18,552 |
|
Current finance lease liabilities |
Current portion of third-party debt, net |
|
|
19,768 |
|
|
|
— |
|
Long-term finance lease liabilities |
Long-term debt, net |
|
|
— |
|
|
|
19,612 |
|
Lease costs were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
Condensed Consolidated Statements of Operations Location |
|
2024 |
|
|
2023 |
|
Operating lease cost |
Corporate, general and administrative |
|
$ |
3,904 |
|
|
$ |
4,284 |
|
Finance lease cost: |
|
|
|
|
|
|
|
Amortization of lease assets |
Depreciation and amortization |
|
|
240 |
|
|
|
— |
|
Interest on lease liabilities |
Interest expense |
|
|
656 |
|
|
|
— |
|
Variable lease cost |
Corporate, general and administrative |
|
|
1,169 |
|
|
|
669 |
|
Short-term lease cost |
Corporate, general and administrative |
|
|
278 |
|
|
|
281 |
|
Total lease cost |
|
|
$ |
6,247 |
|
|
$ |
5,234 |
|
As of March 31, 2024, maturities of operating and finance lease liabilities were as follows (in thousands):
|
|
|
|
|
|
|
|
|
Year |
|
Operating Leases |
|
|
Finance Leases |
|
Remainder of 2024 |
|
$ |
11,030 |
|
|
$ |
1,701 |
|
2025 |
|
|
16,212 |
|
|
|
2,499 |
|
2026 |
|
|
15,708 |
|
|
|
2,549 |
|
2027 |
|
|
14,743 |
|
|
|
2,625 |
|
2028 |
|
|
13,698 |
|
|
|
2,704 |
|
Thereafter |
|
|
112,855 |
|
|
|
48,944 |
|
Total undiscounted lease obligations |
|
|
184,246 |
|
|
|
61,021 |
|
Less: Present value discount |
|
|
(73,767 |
) |
|
|
(41,253 |
) |
Present value of lease liabilities |
|
$ |
110,479 |
|
|
$ |
19,768 |
|
In the table above, the future maturities of operating and finance lease liabilities are presented consistent with the contractual terms. As further explained below, as of March 31, 2024, we were in default under certain operating and finance lease agreements. Accordingly, as of March 31, 2024, total lease liabilities related to such leases were classified as current liability in our condensed consolidated balance sheet. Other information related to lease agreements was as follows (in thousands):
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Weighted-average remaining lease term (years) |
|
|
|
|
|
Operating leases |
|
11.9 |
|
|
|
11.7 |
|
Finance leases |
|
19.1 |
|
|
|
19.3 |
|
Weighted-average discount rate |
|
|
|
|
|
Operating leases |
|
8.67 |
% |
|
|
8.16 |
% |
Finance leases |
|
13.46 |
% |
|
|
13.46 |
% |
Cash paid for amounts included in measurement of liabilities |
|
|
|
|
|
Operating cash flows for operating leases |
|
810 |
|
|
|
12,605 |
|
Operating cash flows for finance leases |
|
500 |
|
|
|
1,310 |
|
At March 31, 2024, the Company was party to leases that have not yet commenced with aggregated estimated future lease payments of approximately $43.2 million, which are not included in the above tables. The Company’s finance leases, two of the operating leases, and two leases that have not yet commenced, contain various covenants, that require the Company, among other things, to maintain minimum consolidated stockholder's equity of $100.0 million and a minimum cash balance of $25.0 million. In addition, these leases are subject to provisions that provide for a cross default in the event any of covenant violations under the Company’s Credit Agreement or in the event that covenant violations occur in other lease agreements with the same landlord. In March 2024, the Company failed to make rent payments due pursuant to certain of its center leases on centers that the Company generally does not intend to operate, which resulted in an event of default under the terms of the applicable lease agreements. Upon an event of default, remedies available to our landlords generally include, without limitation, terminating such lease agreement, repossessing and reletting the leased properties and requiring us to remain liable for all obligations under such lease agreement, including the difference between the rent under such lease agreement and the rent payable as a result of reletting the leased properties, or requiring us to pay the rent due for the balance of the term of such lease agreement, less proceeds from re-letting, if any. As of March 31, 2024, the Company continued to occupy each of the leased centers. The Company is currently negotiating a resolution with the landlords for certain of the leased centers, which may include the Company’s continued occupancy and use of certain of the facilities that the Company intends to continue to operate. Lease liabilities related to such leases are classified as current as of March 31, 2024, as one of the remedies available to our landlords is the acceleration of rent due during the remaining lease term. Refer to Note 16, Subsequent Events, for further information regarding lease activities that occurred subsequent to March 31, 2024.
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- DefinitionThe entire disclosure for operating leases of lessee. Includes, but is not limited to, description of operating lease and maturity analysis of operating lease liability.
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v3.24.1.u1
Income Taxes
|
3 Months Ended |
Mar. 31, 2024 |
Income Tax Disclosure [Abstract] |
|
Income Taxes |
NOTE 13. INCOME TAXES Income tax expense was $0.2 million and $0.2 million during the three months ended March 31, 2024 and 2023, respectively. The effective tax rate was (0.4)% and (0.2)% during the three months ended March 31, 2024 and 2023, respectively, based on the assessment of a full valuation allowance, excluding a portion attributable to the “naked credit” deferred tax liability.
|
X |
- DefinitionThe entire disclosure for income taxes. Disclosures may include net deferred tax liability or asset recognized in an enterprise's statement of financial position, net change during the year in the total valuation allowance, approximate tax effect of each type of temporary difference and carryforward that gives rise to a significant portion of deferred tax liabilities and deferred tax assets, utilization of a tax carryback, and tax uncertainties information.
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v3.24.1.u1
Commitments and Contingencies
|
3 Months Ended |
Mar. 31, 2024 |
Commitments and Contingencies Disclosure [Abstract] |
|
Commitments and Contingencies |
NOTE 14. COMMITMENTS AND CONTINGENCIES Compliance The health care industry is subject to numerous laws and regulations of federal, state, and local governments. These laws and regulations include, but are not limited to, matters such as licensure, accreditation, government healthcare program participation requirements, reimbursement for patient services, and Medicare and Medicaid fraud and abuse. Recently, government activity has increased with respect to investigations and allegations concerning possible violations of fraud and abuse statutes and regulations by healthcare providers. Violations of these laws and regulations could result in expulsion from government healthcare programs together with imposition of significant fines and penalties, as well as significant repayments for patient services billed. Compliance with these laws and regulations, specifically those related to the Medicare and Medicaid programs, can be subject to government review and interpretation, as well as regulatory actions unknown and not yet asserted at this time. Management believes that the Company is in substantial compliance with current laws and regulations. Litigation From time to time, the Company is involved in various legal actions, demands, claims, qui tam suits, governmental investigations and audits, and other legal matters arising in the normal course of business. Except as described below, management has not identified any legal actions during the three months ended March 31, 2024 or 2023 that were deemed to be material. As described above in Note 12, Leases, in March 2024, the Company failed to make rent payments due pursuant to certain of its center leases on centers that the Company generally does not intend to operate, which resulted in an event of default under the terms of the related lease agreements. Landlords of certain of the Company’s leased centers for which the Company failed to pay rent have filed lawsuits against the Company for default on the lease payments. As of March 31, 2024, total lease liabilities related to such leases were classified as a current liability in the Company’s condensed consolidated balance sheet.
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v3.24.1.u1
Variable Interest Entities
|
3 Months Ended |
Mar. 31, 2024 |
Organization, Consolidation and Presentation of Financial Statements [Abstract] |
|
Variable Interest Entities |
NOTE 15. VARIABLE INTEREST ENTITIES The Company has Administrative Service Agreements (the “ASAs”) with Medical Care of NY, P.C., Medical Care of Tennessee, PLLC and Medical Care of Texas, PLLC (together, the “PCs”), which were established to employ healthcare providers to deliver healthcare services to patients in New York, Tennessee, and Texas, and with Care Optical, LLC (“Care Optical”), which provides optometry services in the state of Florida. The Company concluded that it has variable interest in the PCs and Care Optical on the basis of its ASAs which provide for a management fee payable to the Company from the PCs and Care Optical in exchange for providing management and administrative services which creates risk and a potential return to the Company. The PCs’ and Care Optical’s equity at risk, as defined by GAAP, is insufficient to finance their activities without additional support, and therefore, the PCs and Care Optical are considered to be VIEs. In order to determine whether the Company has a controlling financial interest in the PCs and Care Optical, and, thus, is the PCs’ and Care Optical’s primary beneficiary, the Company considered whether it has (i) the power to direct the activities of PCs and Care Optical that most significantly impacts their economic performance and (ii) the obligation to absorb losses of the PCs and Care Optical or the right to receive benefits from the PCs and Care Optical that could potentially be significant to them. The Company concluded that the member and employees of the PCs and Care Optical have no individual power to direct activities of the PCs and Care Optical that most significantly impact their economic performance. Under the ASAs, the Company is responsible for providing services that impact the growth of the patient population of the PCs and Care Optical, the management of the respective population’s healthcare needs, the provision of required healthcare services to those patients, and the PCs’ and Care Optical’s ability to receive revenue from health plans. In addition, the Company’s variable interest in the PCs and Care Optical provides the Company with the right to receive benefits that could potentially be significant to them. The single members of the PCs and Care Optical are employees of the Company. Based on this analysis, the Company concluded that it is the primary beneficiary of the PCs and Care Optical and therefore consolidates the balance sheet, results of operations and cash flow of the PCs and Care Optical. Furthermore, as a direct result of nominal initial equity contributions by the single members of the PCs and Care Optical, the financial support CareMax provides to the PCs and Care Optical (e.g. loans) and the provisions of the arrangements described above, the interest held by the single member lacks economic substance and does not provide the member with the ability to participate in the residual profits or losses generated by the PCs and Care Optical. Therefore, all income and expenses recognized by the PCs and Care Optical are allocated to CareMax. The following tables summarize the financial position and operations of the PCs and Care Optical (in thousands):
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Total assets |
$ |
1,077 |
|
|
$ |
1,200 |
|
Total liabilities |
$ |
10,906 |
|
|
$ |
9,896 |
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
2024 |
|
|
2023 |
|
Revenues |
$ |
873 |
|
|
$ |
417 |
|
Operating expenses |
$ |
1,727 |
|
|
$ |
1,714 |
|
|
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v3.24.1.u1
Subsequent Events
|
3 Months Ended |
Mar. 31, 2024 |
Subsequent Events [Abstract] |
|
Subsequent Events |
NOTE 16. SUBSEQUENT EVENTS In April 2024, the Company entered into a lease termination agreement for one of its leases. As part of this termination, the Company expects to recognize an estimated reduction in its right-of-use assets of $2.6 million, reduction in operating lease liabilities of $2.7 million, and a nominal termination loss. Additionally, in April 2024, the Company entered into an agreement with one of its landlords, which among other things, requires us to surrender six of our leased properties by June 30, 2024. The Company is evaluating the impact of this agreement on its condensed consolidated financial statements. On May 6, 2024, Steward Health Care System and certain of its affiliates commenced an in-court restructuring process through the filing of voluntary petitions for relief under Chapter 11 of the U.S. Bankruptcy Code in the U.S. Bankruptcy Court for the Southern District of Texas. As previously disclosed, the Company entered into certain agreements with affiliates of Steward Health Care System in connection with the Steward Acquisition. The Company is currently evaluating the impact that Steward Health Care System’s restructuring may have on the Company’s business.
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v3.24.1.u1
Summary of Significant Accounting Policies (Policies)
|
3 Months Ended |
Mar. 31, 2024 |
Accounting Policies [Abstract] |
|
Basis of Presentation and Principles of Consolidation |
Basis of Presentation and Principles of Consolidation The unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) and in accordance with the instructions to Form 10-Q and Article 8 of Regulation S-X of the Securities and Exchange Commission (the “SEC”). The condensed consolidated financial statements include the accounts and operations of the Company and its wholly owned subsidiaries. All intercompany accounts and transactions are eliminated upon consolidation. Certain amounts in the prior year's unaudited condensed consolidated financial statements have been reclassified to conform to the current year presentation. There is no comprehensive income (loss) so the statements of comprehensive income (loss) are not presented.
|
Segment Financial Information |
Segment Financial Information The Company’s chief operating decision maker (“CODM”), who is the Company’s Chief Executive Officer, regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating financial performance. The Company identifies operating segments based on this review by its CODM and operates in and reports as a single operating segment. For the periods presented, materially all of the Company’s long-lived assets were located in the United States, and all revenue was earned in the United States.
|
Significant Accounting Policies |
Significant Accounting Policies There have been no changes to our significant accounting policies and estimates as described in our Annual Report on Form 10-K for the year ended December 31, 2023, which was filed with the SEC on March 18, 2024.
|
Use of Estimates |
Use of Estimates The preparation of the condensed consolidated 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. The areas where significant estimates are used in the financial statements include, but are not limited to, revenues and related receivables from risk adjustments, costs of our services and related liabilities, purchase price allocations, including fair value estimates of intangibles and contingent consideration, the valuation and related impairment testing of long-lived assets, including goodwill and intangible assets, the valuation of derivative liabilities, and the estimated useful lives of fixed assets and intangible assets, including internally developed software. Actual results could differ from those estimates.
|
Emerging Growth Company |
Emerging Growth Company Section 102(b)(1) of the Jumpstart Our Business Startups Act (the “JOBS Act”) exempts emerging growth companies from being required to comply with new or revised financial accounting standards until private companies (that is, those that have not had a Securities Act registration statement declared effective or do not have a class of securities registered under the Securities Exchange Act of 1934, as amended (the “Exchange Act”)) are required to comply with the new or revised financial accounting standards. The JOBS Act provides that a company can elect to opt out of the extended transition period and comply with the requirements that apply to non-emerging growth companies, but any such election to opt out is irrevocable. The Company has elected not to opt out of such extended transition period, which means that when a standard is issued or revised and it has different application dates for public or private companies, the Company, as an emerging growth company, can adopt the new or revised standard at the time private companies adopt the new or revised standard. This may make comparison of the Company’s condensed consolidated financial statements with another public company which is neither an emerging growth company nor an emerging growth company that has opted out of using the extended transition period difficult or impossible because of the potential differences in accounting standards used. Additionally, as an emerging growth company, the Company is exempt from the auditor attestation requirements of Section 404(b) of the Sarbanes-Oxley Act of 2002, as amended, and the Company’s independent registered public accounting firm is not required to evaluate and report on the effectiveness of internal control over financial reporting.
|
Accounting Pronouncements Not Yet Adopted |
Accounting Pronouncements Not Yet Adopted In August 2020, the FASB issued ASU 2020-06, Debt—Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging-Contracts in Entity’s Own Equity (Subtopic 815-40): Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity, which is intended to simplify the accounting for certain financial instruments with characteristics of liabilities and equity, including convertible instruments and contracts on an entity’s own equity. The guidance allows for either full retrospective adoption or modified retrospective adoption. The guidance is effective for the Company in the first quarter of fiscal year 2025 and early adoption is permitted. The Company is evaluating the impact the adoption of this guidance will have on its condensed consolidated financial statements. In November 2023, the FASB issued ASU 2023-07, Improvements to Reportable Segment Disclosures. This guidance requires annual and interim disclosure of significant segment expenses that are provided to the CODM as well as interim disclosures for all reportable segment’s profit or loss and assets. This guidance also requires disclosure of the title and position of the CODM and an explanation of how the CODM uses the reported measures of segment profit or loss in assessing segment performance and deciding how to allocate resources. This guidance is expected to improve financial reporting by providing additional information about a public company’s significant segment expenses and more timely and detailed segment information reporting throughout the fiscal period. The ASU is effective for the Company’s fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The Company does not expect adoption of ASU 2023-07 will have a significant impact on the disclosures within our consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”). ASU 2023-09 requires disaggregated information about a reporting entity’s effective tax rate reconciliation as well as information on income taxes paid. The ASU is effective for the Company’s fiscal year beginning January 1, 2025. The guidance will be applied on a prospective basis with the option to apply the standard retrospectively. Early adoption is permitted. The Company does not expect adoption of ASU 2023-09 will have a significant impact on the disclosures within our consolidated financial statements.
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v3.24.1.u1
Accounts Receivable (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Receivables [Abstract] |
|
Schedule of Accounts Receivable Net, and Risk Settlement Liabilities |
Composition of the Company’s current accounts receivable, net, and risk settlement liabilities was as follows (in thousands):
|
|
|
|
|
|
|
|
|
As of March 31, 2024 |
|
|
As of December 31, 2023 |
|
Risk-based accounts receivable |
$ |
161,619 |
|
|
$ |
170,397 |
|
Incurred but not reported claims liability |
|
(56,471 |
) |
|
|
(58,027 |
) |
Other receivables |
|
2,837 |
|
|
|
2,384 |
|
Accounts receivable, net |
$ |
107,985 |
|
|
$ |
114,754 |
|
|
|
|
|
|
|
|
As of March 31, 2024 |
|
|
As of December 31, 2023 |
|
Risk-based accounts receivable |
$ |
21,042 |
|
|
$ |
381 |
|
Incurred but not reported claims liability |
|
(69,440 |
) |
|
|
(37,401 |
) |
Distribution liabilities |
|
(5,201 |
) |
|
|
(5,583 |
) |
Risk settlement liabilities |
$ |
(53,599 |
) |
|
$ |
(42,602 |
) |
|
|
|
|
|
|
|
Summary of Changes Recognized in Prior Year Estimates |
The Company re-evaluated key assumptions and estimates and based on this analysis, the Company identified changes in estimates to revenue, external provider costs, short-term and long-term accounts receivable, net, and risk settlement liabilities. Accordingly, the Company recognized the following changes in prior year estimates in each respective period (in thousands):
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
Increase (decrease) |
2024 |
|
|
2023 |
|
Revenue |
$ |
(540 |
) |
|
$ |
(26,913 |
) |
External provider costs |
|
(7,363 |
) |
|
|
(12,413 |
) |
Short-term and long-term accounts receivable, net |
|
(2,680 |
) |
|
|
(14,500 |
) |
Risk settlement liabilities |
|
(9,503 |
) |
|
|
— |
|
|
Schedule of Revenues and Short Term and Long Term Accounts Receivable, Net Balances for Payors Comprising 10% or More of Revenue |
Composition of the Company’s revenues and accounts receivable balances for the payors comprising 10% or more of revenue was as follows (n/a - indicates balance or activity that is less than 10%):
|
|
|
|
|
Revenue |
|
Three Months Ended March 31, |
|
2024 |
|
2023 |
Payor A |
19% |
|
31% |
Payor B |
13% |
|
n/a |
Payor C |
18% |
|
22% |
Payor D |
13% |
|
12% |
Payor E |
11% |
|
20% |
|
|
|
|
|
Short-Term and Long-Term Accounts Receivable, net |
|
As of March 31, 2024 |
|
As of December 31, 2023 |
Payor A |
10% |
|
10% |
Payor B |
n/a |
|
10% |
Payor C |
n/a |
|
n/a |
Payor D |
n/a |
|
n/a |
Payor E |
n/a |
|
n/a |
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v3.24.1.u1
Goodwill and Other Intangible Assets (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Goodwill and Intangible Assets Disclosure [Abstract] |
|
Summary of Gross Carrying Amount and Accumulated Amortization of Intangible Assets by Major Class |
The following tables summarize the gross carrying amounts, accumulated amortization and net carrying amounts of intangible assets by major class (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross Carrying Amount |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
March 31, 2024 |
|
|
|
|
|
|
|
|
|
Risk contracts |
|
$ |
102,070 |
|
|
$ |
(42,734 |
) |
|
$ |
59,336 |
|
Provider network |
|
|
42,900 |
|
|
|
(8,512 |
) |
|
|
34,388 |
|
Non-compete agreements |
|
|
4,170 |
|
|
|
(2,548 |
) |
|
|
1,622 |
|
Trademarks |
|
|
1,862 |
|
|
|
(1,526 |
) |
|
|
336 |
|
Other |
|
|
693 |
|
|
|
(284 |
) |
|
|
410 |
|
Total |
|
$ |
151,695 |
|
|
$ |
(55,603 |
) |
|
$ |
96,092 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Gross Carrying Amount |
|
|
Accumulated Amortization |
|
|
Net Carrying Value |
|
December 31, 2023 |
|
|
|
|
|
|
|
|
|
Risk contracts |
|
$ |
102,070 |
|
|
$ |
(39,394 |
) |
|
$ |
62,676 |
|
Provider network |
|
|
42,900 |
|
|
|
(6,980 |
) |
|
|
35,920 |
|
Non-compete agreements |
|
|
4,170 |
|
|
|
(2,343 |
) |
|
|
1,827 |
|
Trademarks |
|
|
1,862 |
|
|
|
(1,491 |
) |
|
|
371 |
|
Other |
|
|
693 |
|
|
|
(244 |
) |
|
|
449 |
|
Total |
|
$ |
151,695 |
|
|
$ |
(50,452 |
) |
|
$ |
101,243 |
|
|
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v3.24.1.u1
Property and Equipment (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Property, Plant and Equipment [Abstract] |
|
Summary of Property and Equipment |
Property and equipment at March 31, 2024 and December 31, 2023 consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Leasehold improvements |
|
$ |
21,082 |
|
|
$ |
19,200 |
|
Vehicles |
|
|
2,779 |
|
|
|
2,892 |
|
Furniture and equipment |
|
|
12,949 |
|
|
|
12,765 |
|
Software |
|
|
3,865 |
|
|
|
3,865 |
|
Assets under finance leases (1) |
|
|
18,312 |
|
|
|
18,552 |
|
Construction in progress |
|
|
3,853 |
|
|
|
5,074 |
|
Total |
|
|
62,841 |
|
|
|
62,349 |
|
Less: Accumulated depreciation and amortization (2) |
|
|
(15,598 |
) |
|
|
(14,431 |
) |
Total Property and equipment, net |
|
$ |
47,243 |
|
|
$ |
47,918 |
|
(1) Refer to Note 12, Leases, for information. (2) Includes accumulated amortization related to finance lease right-of-use assets of $0.9 million and $0.6 million as of March 31, 2024 and December 31, 2023, respectively.
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v3.24.1.u1
Debt and Related Party Debt (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Debt Disclosure [Abstract] |
|
Summary of Debt |
As of March 31, 2024 and December 31, 2023, debt consisted of the following (in thousands):
|
|
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Indebtedness under the Credit Agreement, weighted-average interest rate of 15.2% during the three months ended March 31, 2024. |
|
$ |
383,256 |
|
|
$ |
377,340 |
|
Finance lease obligations, interest averaging 13.5% and maturing at various dates through 2043 as of March 31, 2024 and December 31, 2023. |
|
|
19,768 |
|
|
|
19,612 |
|
Other |
|
|
2,297 |
|
|
|
2,220 |
|
Less: Unamortized discounts and debt issuance costs |
|
|
(12,447 |
) |
|
|
(13,349 |
) |
|
|
|
392,874 |
|
|
|
385,823 |
|
Less: Current portion |
|
|
(390,995 |
) |
|
|
(364,380 |
) |
Long-term portion |
|
$ |
1,879 |
|
|
$ |
21,443 |
|
|
Summary of Future Maturities of Debt Outstanding |
Future maturities of the indebtedness outstanding at March 31, 2024 were as follows (in thousands):
|
|
|
|
|
Year |
|
Amount |
|
Remainder of 2024 |
|
$ |
322 |
|
2025 |
|
|
3,566 |
|
2026 |
|
|
4,172 |
|
2027 |
|
|
376,564 |
|
2028 |
|
|
769 |
|
Thereafter |
|
|
160 |
|
Total |
|
$ |
385,553 |
|
|
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v3.24.1.u1
Net Loss Per Share (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Earnings Per Share [Abstract] |
|
Summary of Calculation of Basic and Diluted Earnings Per Share |
The following table sets forth the calculation of basic and diluted net loss per share for the periods indicated based on the weighted-average number of common shares outstanding (in thousands, except share and per share data):
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
Net loss attributable to CareMax, Inc. Class A common stockholders |
|
$ |
(43,408 |
) |
|
$ |
(82,082 |
) |
|
|
|
|
|
|
|
Weighted-average basic shares outstanding |
|
|
3,778,600 |
|
|
|
3,712,027 |
|
Weighted-average diluted shares outstanding |
|
|
3,778,600 |
|
|
|
3,712,027 |
|
|
|
|
|
|
|
|
Net loss per share: |
|
|
|
|
|
|
Basic |
|
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
Diluted |
|
$ |
(11.49 |
) |
|
$ |
(22.11 |
) |
|
Potentially Dilutive Outstanding Securities Excluded from Computation of Diluted Net Loss Per Share |
The following potentially dilutive outstanding securities were excluded from the computation of diluted net loss per share because their effect would have been anti-dilutive or because issuance of shares underlying such securities is contingent upon the satisfaction of certain conditions which were not satisfied by the end of the period:
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
|
2024 |
|
|
2023 |
|
Series A and Series B warrants |
|
|
266,667 |
|
|
|
266,667 |
|
Public and private placement warrants |
|
|
193,055 |
|
|
|
193,055 |
|
Contingent consideration |
|
|
1,250,000 |
|
|
|
1,356,667 |
|
Unvested restricted stock units |
|
|
111,969 |
|
|
|
84,928 |
|
Unvested performance stock units (assumes 100% target payout) |
|
|
15,050 |
|
|
|
6,972 |
|
Unvested options |
|
|
25,012 |
|
|
|
12,452 |
|
Total |
|
|
1,861,753 |
|
|
|
1,920,740 |
|
|
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v3.24.1.u1
Fair Value Measurements (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Fair Value Disclosures [Abstract] |
|
Schedule of Assets and Liabilities Measured at Fair Value on Recurring Basis |
The following tables present information about the Company’s assets and liabilities that are measured at fair value on a recurring basis and indicate the fair value hierarchy of the valuation techniques that the Company utilized to determine such fair value (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
March 31, 2024 |
|
|
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
Description |
|
Carrying Value |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Derivative warrant liabilities - public warrants |
|
$ |
49 |
|
|
$ |
49 |
|
|
$ |
— |
|
|
$ |
— |
|
Derivative warrant liabilities - private placement warrants |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Embedded derivative liabilities - Credit Agreement |
|
|
2,354 |
|
|
|
— |
|
|
|
— |
|
|
|
2,354 |
|
Total liabilities measured at fair value |
|
$ |
2,403 |
|
|
$ |
49 |
|
|
$ |
— |
|
|
$ |
2,354 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
December 31, 2023 |
|
|
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
Description |
|
Carrying Value |
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Derivative warrant liabilities - public warrants |
|
$ |
22 |
|
|
$ |
22 |
|
|
$ |
— |
|
|
$ |
— |
|
Derivative warrant liabilities - private placement warrants |
|
|
1 |
|
|
|
— |
|
|
|
— |
|
|
|
1 |
|
Embedded derivative liabilities - Credit Agreement |
|
|
— |
|
|
|
— |
|
|
|
— |
|
|
|
— |
|
Total liabilities measured at fair value |
|
$ |
22 |
|
|
$ |
22 |
|
|
$ |
— |
|
|
$ |
1 |
|
|
Schedule of Activity of the Level 3 Liabilities Measured at Fair Value |
Activity of the Level 3 liabilities during the three months ended March 31, 2024 measured at fair value was as follows (in thousands):
|
|
|
|
Balance as of December 31, 2023 |
$ |
1 |
|
Change in fair value of Credit Agreement embedded derivative liabilities |
|
2,354 |
|
Change in fair value of derivative warrant liabilities |
|
(1 |
) |
Balance as of March 31, 2024 |
$ |
2,354 |
|
Activity of the Level 3 liabilities during the three months ended March 31, 2023 measured at fair value was as follows (in thousands):
|
|
|
|
Balance as of December 31, 2022 |
$ |
138,535 |
|
Change in fair value of derivative warrant liabilities |
|
(1,107 |
) |
Change in fair value of contingent consideration |
|
(36,136 |
) |
Balance as of March 31, 2023 |
$ |
101,293 |
|
|
Schedule of Measured at Fair Value on Nonrecurring Basis |
Financial Instruments that are not Measured at Fair Value on a Recurring Basis
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
March 31, 2024 |
|
Carrying Value |
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
(in thousands) |
|
|
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Liabilities |
|
|
|
|
|
|
|
|
|
|
|
|
Fixed rate debt (a) |
|
$ |
893 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
625 |
|
Floating rate debt (a) |
|
|
383,256 |
|
|
|
— |
|
|
|
— |
|
|
|
354,841 |
|
Total |
|
$ |
384,149 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
355,466 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fair Value |
|
December 31, 2023 |
|
Carrying Value |
|
|
Quoted Prices in Active Markets |
|
|
Significant other Observable Units |
|
|
Significant other Unobservable Units |
|
(in thousands) |
|
|
|
|
(Level 1) |
|
|
(Level 2) |
|
|
(Level 3) |
|
Liabilities |
|
|
|
|
|
|
|
|
|
|
|
|
Fixed rate debt (a) |
|
$ |
913 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
747 |
|
Floating rate debt (a) |
|
|
377,340 |
|
|
|
— |
|
|
|
— |
|
|
|
375,240 |
|
Total |
|
$ |
378,253 |
|
|
$ |
— |
|
|
$ |
— |
|
|
$ |
375,987 |
|
(a) The debt amounts above do not include the impact of debt issuance costs or discounts.
|
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v3.24.1.u1
Leases (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Leases [Abstract] |
|
Location of Finance Lease Right-of-use Assets and Lease Liabilities in Company's Condensed Consolidated Balance Sheets |
The following table presents the location of the finance lease right-of-use assets and lease liabilities in the Company’s condensed consolidated balance sheets (in thousands):
|
|
|
|
|
|
|
|
|
|
|
Condensed Consolidated Balance Sheet Location |
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Finance lease right-of-use assets, net |
Property and equipment, net |
|
$ |
18,312 |
|
|
$ |
18,552 |
|
Current finance lease liabilities |
Current portion of third-party debt, net |
|
|
19,768 |
|
|
|
— |
|
Long-term finance lease liabilities |
Long-term debt, net |
|
|
— |
|
|
|
19,612 |
|
|
Schedule of Lease Costs |
Lease costs were as follows (in thousands):
|
|
|
|
|
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
Condensed Consolidated Statements of Operations Location |
|
2024 |
|
|
2023 |
|
Operating lease cost |
Corporate, general and administrative |
|
$ |
3,904 |
|
|
$ |
4,284 |
|
Finance lease cost: |
|
|
|
|
|
|
|
Amortization of lease assets |
Depreciation and amortization |
|
|
240 |
|
|
|
— |
|
Interest on lease liabilities |
Interest expense |
|
|
656 |
|
|
|
— |
|
Variable lease cost |
Corporate, general and administrative |
|
|
1,169 |
|
|
|
669 |
|
Short-term lease cost |
Corporate, general and administrative |
|
|
278 |
|
|
|
281 |
|
Total lease cost |
|
|
$ |
6,247 |
|
|
$ |
5,234 |
|
|
Schedule of Maturities of Operating and Finance Lease Liabilities |
As of March 31, 2024, maturities of operating and finance lease liabilities were as follows (in thousands):
|
|
|
|
|
|
|
|
|
Year |
|
Operating Leases |
|
|
Finance Leases |
|
Remainder of 2024 |
|
$ |
11,030 |
|
|
$ |
1,701 |
|
2025 |
|
|
16,212 |
|
|
|
2,499 |
|
2026 |
|
|
15,708 |
|
|
|
2,549 |
|
2027 |
|
|
14,743 |
|
|
|
2,625 |
|
2028 |
|
|
13,698 |
|
|
|
2,704 |
|
Thereafter |
|
|
112,855 |
|
|
|
48,944 |
|
Total undiscounted lease obligations |
|
|
184,246 |
|
|
|
61,021 |
|
Less: Present value discount |
|
|
(73,767 |
) |
|
|
(41,253 |
) |
Present value of lease liabilities |
|
$ |
110,479 |
|
|
$ |
19,768 |
|
|
Schedule of Other Information Related to Lease Agreements |
Other information related to lease agreements was as follows (in thousands):
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Weighted-average remaining lease term (years) |
|
|
|
|
|
Operating leases |
|
11.9 |
|
|
|
11.7 |
|
Finance leases |
|
19.1 |
|
|
|
19.3 |
|
Weighted-average discount rate |
|
|
|
|
|
Operating leases |
|
8.67 |
% |
|
|
8.16 |
% |
Finance leases |
|
13.46 |
% |
|
|
13.46 |
% |
Cash paid for amounts included in measurement of liabilities |
|
|
|
|
|
Operating cash flows for operating leases |
|
810 |
|
|
|
12,605 |
|
Operating cash flows for finance leases |
|
500 |
|
|
|
1,310 |
|
|
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v3.24.1.u1
Variable Interest Entities (Tables)
|
3 Months Ended |
Mar. 31, 2024 |
Organization, Consolidation and Presentation of Financial Statements [Abstract] |
|
Summary of Financial Position and Operations of PCs and Care Optical |
The following tables summarize the financial position and operations of the PCs and Care Optical (in thousands):
|
|
|
|
|
|
|
|
|
March 31, 2024 |
|
|
December 31, 2023 |
|
Total assets |
$ |
1,077 |
|
|
$ |
1,200 |
|
Total liabilities |
$ |
10,906 |
|
|
$ |
9,896 |
|
|
|
|
|
|
|
|
Three Months Ended March 31, |
|
|
2024 |
|
|
2023 |
|
Revenues |
$ |
873 |
|
|
$ |
417 |
|
Operating expenses |
$ |
1,727 |
|
|
$ |
1,714 |
|
|
X |
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Description of Business and Going Concern - Additional Information (Details) $ / shares in Units, $ in Thousands |
3 Months Ended |
|
|
Mar. 31, 2024
USD ($)
State
Center
$ / shares
|
Dec. 31, 2023
USD ($)
$ / shares
|
Jun. 08, 2021 |
Description Of Business [Line Items] |
|
|
|
Number of centers operated and managed | Center |
55
|
|
|
Affiliated providers in number of states | State |
10
|
|
|
Cash and cash equivalents |
$ 41,479
|
$ 65,528
|
|
Accounts receivable, net |
$ 107,985
|
$ 114,754
|
|
Class A Common Stock |
|
|
|
Description Of Business [Line Items] |
|
|
|
Common stock, par value | $ / shares |
$ 0.0001
|
$ 0.0001
|
|
Reverse stock split, conversion ratio |
0.0333
|
|
|
Reverse stock split, description |
every thirty shares of the Class A Common Stock issued and outstanding as of the Effective Date automatically converted into one share of Class A Common Stock.
|
|
|
CMG | Business Combination Agreement |
|
|
|
Description Of Business [Line Items] |
|
|
|
Percentage of equity interests acquired |
|
|
100.00%
|
IMC | Business Combination Agreement |
|
|
|
Description Of Business [Line Items] |
|
|
|
Percentage of equity interests acquired |
|
|
100.00%
|
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v3.24.1.u1
Accounts Receivable - Schedule of Accounts Receivable Net, and Risk Settlement Liabilities (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Receivables [Abstract] |
|
|
Risk-based accounts receivable |
$ 161,619
|
$ 170,397
|
Incurred but not reported claims liability |
(56,471)
|
(58,027)
|
Other receivables |
2,837
|
2,384
|
Accounts receivable, net |
107,985
|
114,754
|
Risk-based accounts receivable |
21,042
|
381
|
Incurred but not reported claims liability |
(69,440)
|
(37,401)
|
Distribution liabilities |
(5,201)
|
(5,583)
|
Risk settlement liabilities |
$ (53,599)
|
$ (42,602)
|
X |
- DefinitionDistribution liabilities.
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Accounts Receivable- Summary of Changes Recognized in Prior Year Estimates (Details) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
Revenues |
$ (540)
|
$ (26,913)
|
External provider costs |
(7,363)
|
(12,413)
|
Short-term and long-term accounts receivable, net of liabilities |
(2,680)
|
$ (14,500)
|
Risk settlement liabilities |
$ (9,503)
|
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v3.24.1.u1
Accounts Receivable - Schedule of Revenues and Accounts Receivable Balances for Payors Comprising 10% or More of Revenue (Details)
|
3 Months Ended |
12 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Payor A | Customer Concentration Risk | Revenue |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
Concentration risk (as a percentage) |
19.00%
|
31.00%
|
|
Payor A | Credit Concentration Risk | Short-Term and Long-Term Accounts Receivable |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
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|
|
10.00%
|
Payor B | Customer Concentration Risk | Revenue |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
Concentration risk (as a percentage) |
13.00%
|
|
|
Payor B | Credit Concentration Risk | Short-Term and Long-Term Accounts Receivable |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
Concentration risk (as a percentage) |
|
|
10.00%
|
Payor C | Customer Concentration Risk | Revenue |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
Concentration risk (as a percentage) |
18.00%
|
22.00%
|
|
Payor D | Customer Concentration Risk | Revenue |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
Concentration risk (as a percentage) |
13.00%
|
12.00%
|
|
Payor E | Customer Concentration Risk | Revenue |
|
|
|
Accounts, Notes, Loans and Financing Receivable [Line Items] |
|
|
|
Concentration risk (as a percentage) |
11.00%
|
20.00%
|
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Acquisitions - Summary of Purchase Consideration and Fair Value of Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Business Acquisition [Line Items] |
|
|
Goodwill |
$ 156,841
|
$ 156,841
|
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v3.24.1.u1
Reinsurance - Additional Information (Details) - USD ($)
|
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Effects of Reinsurance [Line Items] |
|
|
Reinsurance recoveries recognized |
$ 7,800,000
|
$ 4,600,000
|
Reinsurance premium expense incurred |
7,900,000
|
$ 6,800,000
|
Maximum |
|
|
Effects of Reinsurance [Line Items] |
|
|
Reinsurance stop loss limit per patient per year |
300,000
|
|
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|
|
Effects of Reinsurance [Line Items] |
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Reinsurance stop loss limit per patient per year |
$ 30,000
|
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v3.24.1.u1
Goodwill and Other Intangible Assets - Summary of Gross Carrying Amount and Accumulated Amortization of Intangible Assets by Major Class (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Finite Lived Intangible Assets [Line Items] |
|
|
Gross Carrying Amount |
$ 151,695
|
$ 151,695
|
Accumulated Amortization |
(55,603)
|
(50,452)
|
Total |
96,092
|
101,243
|
Risk Contracts |
|
|
Finite Lived Intangible Assets [Line Items] |
|
|
Gross Carrying Amount |
102,070
|
102,070
|
Accumulated Amortization |
(42,734)
|
(39,394)
|
Total |
59,336
|
62,676
|
Provider Network |
|
|
Finite Lived Intangible Assets [Line Items] |
|
|
Gross Carrying Amount |
42,900
|
42,900
|
Accumulated Amortization |
(8,512)
|
(6,980)
|
Total |
34,388
|
35,920
|
Non-compete Agreements |
|
|
Finite Lived Intangible Assets [Line Items] |
|
|
Gross Carrying Amount |
4,170
|
4,170
|
Accumulated Amortization |
(2,548)
|
(2,343)
|
Total |
1,622
|
1,827
|
Trademarks |
|
|
Finite Lived Intangible Assets [Line Items] |
|
|
Gross Carrying Amount |
1,862
|
1,862
|
Accumulated Amortization |
(1,526)
|
(1,491)
|
Total |
336
|
371
|
Other |
|
|
Finite Lived Intangible Assets [Line Items] |
|
|
Gross Carrying Amount |
693
|
693
|
Accumulated Amortization |
(284)
|
(244)
|
Total |
$ 410
|
$ 449
|
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v3.24.1.u1
Property and Equipment - Summary of Property and Equipment (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
|
$ 62,841
|
$ 62,349
|
Less: Accumulated depreciation and amortization |
[1] |
(15,598)
|
(14,431)
|
Total Property and equipment, net |
|
47,243
|
47,918
|
Leasehold Improvements |
|
|
|
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
|
21,082
|
19,200
|
Vehicles |
|
|
|
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
|
2,779
|
2,892
|
Furniture and Equipment |
|
|
|
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
|
12,949
|
12,765
|
Software |
|
|
|
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
|
3,865
|
3,865
|
Assets Under Finance Lease |
|
|
|
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
[2] |
18,312
|
18,552
|
Construction in Progress |
|
|
|
Property Plant And Equipment [Line Items] |
|
|
|
Total Property and equipment, gross |
|
$ 3,853
|
$ 5,074
|
|
|
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- DefinitionAmount of accumulated amortization of right-of-use asset from finance lease.
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v3.24.1.u1
Debt and Related Party Debt - Additional Information (Details)
|
|
|
1 Months Ended |
3 Months Ended |
6 Months Ended |
Mar. 15, 2024
USD ($)
|
Mar. 08, 2023
USD ($)
|
Oct. 31, 2023
USD ($)
|
Nov. 30, 2022
USD ($)
|
Oct. 31, 2022
USD ($)
|
May 31, 2022
USD ($)
|
Sep. 30, 2026 |
Mar. 31, 2024
USD ($)
|
Mar. 31, 2023
USD ($)
|
Jun. 30, 2022
USD ($)
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Debt instrument interest capitalized percentage |
|
4.00%
|
|
|
|
|
|
|
|
|
Debt Instrument, Interest Rate Terms |
|
|
|
|
|
|
|
Based on the elections made by the Company, as of March 31, 2024, borrowings under the Credit Agreement bore interest of Term SOFR (calculated as the Secured Overnight Financing Rate published on the Federal Reserve Bank of New York’s website, plus the applicable credit spread adjustment based on the elected interest period), plus an applicable margin rate of 11.00%. As permitted under the Credit Agreement, the Company elected to capitalize 6.00% of the interest as principal amount. As a result of this election, the cash interest component of the applicable margin increased by 0.50%.
|
|
|
Scheduled payments of interest and fees |
|
|
|
$ 6,800,000
|
|
|
|
|
|
|
Maximum aggregate loan amount |
|
|
|
|
|
$ 300,000,000
|
|
|
|
|
Option to capitalize, percentage of interest as principal outstanding |
|
|
|
|
|
|
|
6.00%
|
|
|
Increase in margin rate |
2.00%
|
|
|
|
|
|
|
0.50%
|
|
|
Minimum liquidity requirement |
$ 10,000,000
|
|
|
|
|
50,000,000
|
|
|
|
|
Minimum liquidity requirement reduced amount on meeting certain adjusted EBITDA |
|
|
|
|
|
$ 25,000,000
|
|
|
|
|
De novo losses excluded from calculation of such ratio period |
|
|
|
|
|
36 months
|
|
|
|
|
Debt instrument covenants maximum leverage ratio |
|
|
|
|
|
8.5
|
|
|
|
|
Debt instrument covenant description |
|
|
|
|
|
|
|
The Credit Agreement also contains covenants that require the Company to satisfy a minimum liquidity requirement of $50.0 million, which may be decreased to $25.0 million if the Company achieves a certain adjusted EBITDA, and maintain a maximum total leverage ratio based on the Company’s consolidated EBITDA, as defined in the Credit Agreement, with de novo losses excluded from the calculation of such ratio for up to 36 months after the opening of a de novo center, which maximum total leverage ratio was initially 8.50 to 1.00, commencing with the fiscal quarter ended September 30, 2022 and is subject to a series of step-downs. For the fiscal quarters ending September 30, 2026 and thereafter the Company must maintain a maximum total leverage ratio no greater than 5.50 to 1.00.
|
|
|
Repayments of debt |
|
|
|
|
|
$ 121,000,000
|
|
$ 119,000
|
$ 25,000
|
|
Loss on debt extinguishment |
|
|
|
|
|
|
|
|
|
$ (6,200,000)
|
Related party debt, net |
|
|
|
$ 35,500,000
|
|
|
|
|
|
|
Indebtedness paid |
|
|
$ 35,500,000
|
|
|
|
|
|
|
|
Debt instrument, covenant compliance |
|
|
|
|
|
|
|
As of March 31, 2024, we were in compliance with all of the financial covenants under the Credit Agreement, as amended through the Third Amendment; however, we do not expect to be in compliance during the subsequent quarterly testing dates. A breach of any of the covenants under the Credit Agreement or the occurrence of other events specified in the Credit Agreement could result in an event of default under the same and give rise to the lenders’ right to accelerate our debt obligations thereunder and pursue other remedial actions under such agreement and/or trigger a cross default under our long-term leases. Accordingly, as of March 31, 2024, the full balance of the outstanding indebtedness related to the Credit Agreement was classified as a current liability in our condensed consolidated balance sheet.
|
|
|
Other Current Liabilities |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Derivative liabilities fair value |
|
|
|
|
|
|
|
$ 2,400,000
|
|
|
Initial Term Loans |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Aggregate principal amount |
|
|
|
|
|
190,000,000
|
|
|
|
|
Amount drawn |
|
|
|
|
|
190,000,000
|
|
|
|
|
Initial Term Loans | Term SOFR |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Debt instrument margin rate |
|
|
|
|
|
|
|
11.00%
|
|
|
Term Loan Facility |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Term loan beard fixed interest rate per annum |
|
|
|
12.00%
|
|
|
|
|
|
|
Delayed Draw Term Loan |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Aggregate principal amount |
|
$ 110,000,000
|
|
|
|
$ 110,000,000
|
|
|
|
|
Revised term loan expiration period |
|
45 days
|
|
|
|
|
|
|
|
|
Amount drawn |
|
|
|
|
|
|
|
$ 0
|
$ 30,000,000
|
|
Debt instrument, facility fee percentage |
|
|
|
3.00%
|
|
|
|
|
|
|
Promissory Note | Anthem |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Aggregate principal amount |
|
|
|
|
$ 1,000,000
|
|
|
|
|
|
Debt instrument maturity month and year |
|
|
|
|
2032-10
|
|
|
|
|
|
Term loan beard fixed interest rate per annum |
|
|
|
|
|
|
|
6.25%
|
|
|
Delayed Draw Term Loan B Facility |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Aggregate principal amount |
|
$ 60,000,000
|
|
|
|
|
|
|
|
|
Revolving Credit Facility |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Aggregate principal amount |
|
$ 45,000,000
|
|
|
|
|
|
|
|
|
Beginning on Second Anniversary |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Debt instrument interest capitalized percentage |
|
3.50%
|
|
|
|
|
|
|
|
|
Beginning on Third Anniversary |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Debt instrument interest capitalized percentage |
|
3.00%
|
|
|
|
|
|
|
|
|
Beginning on December 10, 2025 |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Debt instrument interest capitalized percentage |
|
1.50%
|
|
|
|
|
|
|
|
|
Scenario Forecast |
|
|
|
|
|
|
|
|
|
|
Debt Instrument [Line Items] |
|
|
|
|
|
|
|
|
|
|
Debt instrument covenants maximum leverage ratio |
|
|
|
|
|
|
5.5
|
|
|
|
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v3.24.1.u1
Debt and Related Party Debt - Summary of Debt (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Debt Instrument [Line Items] |
|
|
Long-term debt gross |
$ 385,553
|
|
Less: Unamortized discounts and debt issuance costs |
(12,447)
|
$ (13,349)
|
Total long-term debt |
392,874
|
385,823
|
Less: Current portion |
(390,995)
|
(364,380)
|
Long-term portion |
1,879
|
21,443
|
Credit Agreement |
|
|
Debt Instrument [Line Items] |
|
|
Long-term debt gross |
383,256
|
377,340
|
Finance Lease Obligations |
|
|
Debt Instrument [Line Items] |
|
|
Long-term debt gross |
19,768
|
19,612
|
Other |
|
|
Debt Instrument [Line Items] |
|
|
Long-term debt gross |
$ 2,297
|
$ 2,220
|
X |
- DefinitionAmount, before unamortized (discount) premium and debt issuance costs, of long-term debt. Includes, but is not limited to, notes payable, bonds payable, commercial loans, mortgage loans, convertible debt, subordinated debt and other types of debt.
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Stockholders' Equity - Additional information (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Class Of Stock [Line Items] |
|
|
Preferred stock,authorized |
1,000,000
|
1,000,000
|
Other current assets |
$ 6,650
|
$ 3,066
|
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1
|
1
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v3.24.1.u1
Stock-Based Compensation - Additional information (Details) - USD ($) $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Stock-based compensation expense |
$ 2,365
|
$ 2,298
|
2021 Plan |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Stock-based compensation expense |
$ 2,400
|
$ 2,300
|
Granted |
0
|
0
|
Previously granted awards vested |
0
|
0
|
Unrecognized stock-based compensation of unvested awards |
$ 11,800
|
$ 16,400
|
Unrecognized stock-based compensation, expected to be recognized over weighted-average period |
1 year 7 months 6 days
|
1 year 10 months 24 days
|
2021 Plan | Class A Common Stock |
|
|
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items] |
|
|
Initial shares available under plan |
233,333
|
|
Stock-based compensation incremental description |
The 2021 Plan permits the grant of an initial share pool of 233,333 shares of Class A Common Stock and will be increased automatically, without further action of the Company’s board of directors, on January 1st of each calendar year commencing after the Closing Date and ending on (and including) January 1, 2031, by a number of shares of Class A Common Stock equal to the lesser of (i) four percent of the aggregate number of shares of Class A Common Stock outstanding on December 31st of the immediately preceding calendar year, excluding for this purpose
|
|
Incremental percentage of shares available for the plan of outstanding shares |
4.00%
|
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v3.24.1.u1
Net Loss Per Share - Summary of Calculation of Basic and Diluted Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands |
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Earnings Per Share [Abstract] |
|
|
Net loss attributable to CareMax, Inc. Class A common stockholders |
$ (43,408)
|
$ (82,082)
|
Weighted average basic shares outstanding |
3,778,600
|
3,712,027
|
Weighted average diluted shares outstanding |
3,778,600
|
3,712,027
|
Net loss per share, Basic |
$ (11.49)
|
$ (22.11)
|
Net loss per share, Diluted |
$ (11.49)
|
$ (22.11)
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Net Loss Per Share - Potentially Dilutive Outstanding Securities Excluded from Computation of Diluted Net Loss Per Share (Details) - shares
|
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
1,861,753
|
1,920,740
|
Series A and Series B warrants |
|
|
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
266,667
|
266,667
|
Public and private placement warrants |
|
|
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
193,055
|
193,055
|
Contingent consideration |
|
|
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
1,250,000
|
1,356,667
|
Unvested Restricted Stock Units |
|
|
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
111,969
|
84,928
|
Unvested Performance Stock Units (Assumes 100% Target Payout) |
|
|
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
15,050
|
6,972
|
Unvested Options |
|
|
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items] |
|
|
Antidilutive shares excluded from diluted earnings per share |
25,012
|
12,452
|
X |
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Fair Value Measurements - Additional Information (Details) - USD ($)
|
3 Months Ended |
Mar. 31, 2024 |
Mar. 31, 2023 |
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] |
|
|
Recognized (loss) gain related to change in fair value of derivative warrant liabilities |
|
$ 1,100,000
|
Fair Value, Liability, Recurring Basis, Unobservable Input Reconciliation, Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration] |
|
Change in Fair Value Adjustment Of Derivative Liabilities
|
Fair value, liabilities, Level 1 to Level 2 transfers, amount |
$ 0
|
$ 0
|
Fair value, liabilities, Level 2 to Level 1 transfers, amount |
0
|
0
|
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0
|
0
|
Fair value, measurement with unobservable inputs reconciliation, liability, transfers out of Level 3 |
0
|
0
|
Maximum |
|
|
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] |
|
|
Recognized (loss) gain related to change in fair value of derivative warrant liabilities |
$ (100,000)
|
|
Fair Value, Liability, Recurring Basis, Unobservable Input Reconciliation, Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration] |
Change in Fair Value Adjustment Of Derivative Liabilities
|
|
Credit Agreement |
|
|
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] |
|
|
Embedded derivatives recognized loss related to change in fair value |
$ (2,400,000)
|
$ (0)
|
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Fair Value Measurements - Schedule of Measured at Fair Value on Nonrecurring Basis (Details) - Nonrecurring Measurement - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Carrying Value |
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
Liabilities |
$ 384,149
|
$ 378,253
|
Level 3 |
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
Liabilities |
355,466
|
375,987
|
Fixed rate debt | Carrying Value |
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
Liabilities |
893
|
913
|
Fixed rate debt | Level 3 |
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
Liabilities |
625
|
747
|
Floating rate debt | Carrying Value |
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
Liabilities |
383,256
|
377,340
|
Floating rate debt | Level 3 |
|
|
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items] |
|
|
Liabilities |
$ 354,841
|
$ 375,240
|
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Related Party Transactions - Additional Information (Details) - USD ($) $ in Thousands |
3 Months Ended |
12 Months Ended |
|
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Jul. 13, 2021 |
Related Party Transaction [Line Items] |
|
|
|
|
Other current assets |
$ 6,650
|
|
$ 3,066
|
|
Liabilities due |
$ 6,704
|
|
$ 6,275
|
|
Steward Acquisition |
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
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$ 1,200
|
|
$ 200
|
|
Steward Acquisition | Corporate General And Administrative Expenses |
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
Expenses related to transition services agreement |
200
|
$ 1,200
|
|
|
Advisory Agreement | Warrant |
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
Other current assets |
400
|
|
$ 600
|
|
Advisory Agreement | Warrant | Corporate General And Administrative Expenses |
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
Expense related to amortization |
$ 100
|
$ 100
|
|
|
Advisor | Advisory Agreement |
|
|
|
|
Related Party Transaction [Line Items] |
|
|
|
|
Additional number of warrants vest and exercisable |
5,000,000
|
|
|
|
Number of warrants remained unvested |
3,500,000
|
|
3,500,000
|
|
Minimum ownership common shares to be maintained by related party |
|
|
|
16,667
|
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v3.24.1.u1
Leases - Additional Information (Details) - USD ($) $ in Thousands |
3 Months Ended |
|
|
|
Mar. 31, 2024 |
Dec. 31, 2023 |
Mar. 31, 2023 |
Dec. 31, 2022 |
Lessee Lease Description [Line Items] |
|
|
|
|
Lease expiring term |
various times through 2043
|
|
|
|
Aggregated estimated future lease payments |
$ 43,200
|
|
|
|
Stockholders' equity |
$ 20,403
|
$ 61,444
|
$ 539,763
|
$ 619,547
|
Lease restriction or covenant |
The Company’s finance leases, two of the operating leases, and two leases that have not yet commenced, contain various covenants, that require the Company, among other things, to maintain minimum consolidated stockholder's equity of $100.0 million and a minimum cash balance of $25.0 million. In addition, these leases are subject to provisions that provide for a cross default in the event any of covenant violations under the Company’s Credit Agreement or in the event that covenant violations occur in other lease agreements with the same landlord. In March 2024, the Company failed to make rent payments due pursuant to certain of its center leases on centers that the Company generally does not intend to operate, which resulted in an event of default under the terms of the applicable lease agreements. Upon an event of default, remedies available to our landlords generally include, without limitation, terminating such lease agreement, repossessing and reletting the leased properties and requiring us to remain liable for all obligations under such lease agreement, including the difference between the rent under such lease agreement and the rent payable as a result of reletting the leased properties, or requiring us to pay the rent due for the balance of the term of such lease agreement, less proceeds from re-letting, if any. As of March 31, 2024, the Company continued to occupy each of the leased centers. The Company is currently negotiating a resolution with the landlords for certain of the leased centers, which may include the Company’s continued occupancy and use of certain of the facilities that the Company intends to continue to operate. Lease liabilities related to such leases are classified as current as of March 31, 2024, as one of the remedies available to our landlords is the acceleration of rent due during the remaining lease term.
|
|
|
|
Minimum | Credit Agreement |
|
|
|
|
Lessee Lease Description [Line Items] |
|
|
|
|
Stockholders' equity |
$ 100,000
|
|
|
|
Cash |
$ 25,000
|
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v3.24.1.u1
Leases - Location of Finance Lease Right-of-use Assets and Lease Liabilities in Company's Condensed Consolidated Balance Sheet (Details) - USD ($) $ in Thousands |
Mar. 31, 2024 |
Dec. 31, 2023 |
Finance Lease, Right-of-Use Asset, after Accumulated Amortization [Abstract] |
|
|
Finance lease right-of-use assets, net |
$ 18,312
|
$ 18,552
|
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] |
Property, Plant and Equipment, Net
|
Property, Plant and Equipment, Net
|
Current finance lease liabilities |
$ 19,768
|
|
Finance Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration] |
Third Party Debt Current
|
Third Party Debt Current
|
Long-term finance lease liabilities |
|
$ 19,612
|
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible Enumeration] |
Long-Term Debt, Excluding Current Maturities
|
Long-Term Debt, Excluding Current Maturities
|
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v3.24.1.u1
Leases - Schedule of Maturities of Operating and Finance Lease Liabilities (Details) $ in Thousands |
Mar. 31, 2024
USD ($)
|
Operating Leases |
|
Remainder of 2024 |
$ 11,030
|
2025 |
16,212
|
2026 |
15,708
|
2027 |
14,743
|
2028 |
13,698
|
Thereafter |
112,855
|
Total undiscounted lease obligations |
184,246
|
Less: Present value discount |
(73,767)
|
Lease liabilities |
110,479
|
Finance Leases |
|
Remainder of 2024 |
1,701
|
2025 |
2,499
|
2026 |
2,549
|
2027 |
2,625
|
2028 |
2,704
|
Thereafter |
48,944
|
Total undiscounted lease obligations |
61,021
|
Less: Present value discount |
(41,253)
|
Present value of lease liabilities |
$ 19,768
|
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v3.24.1.u1
v3.24.1.u1
Variable Interest Entities - Schedule of Assets and liabilities of PCs and Care Optical (Details) - USD ($) $ in Thousands |
3 Months Ended |
|
Mar. 31, 2024 |
Mar. 31, 2023 |
Dec. 31, 2023 |
Variable Interest Entity [Line Items] |
|
|
|
Assets |
$ 614,202
|
|
$ 623,301
|
Liabilities |
593,800
|
|
561,856
|
Revenues |
(540)
|
$ (26,913)
|
|
Operating expenses |
253,951
|
281,606
|
|
PCs and Care Optical |
|
|
|
Variable Interest Entity [Line Items] |
|
|
|
Assets |
1,077
|
|
1,200
|
Liabilities |
10,906
|
|
$ 9,896
|
Revenues |
873
|
417
|
|
Operating expenses |
$ 1,727
|
$ 1,714
|
|
X |
- DefinitionSum of the carrying amounts as of the balance sheet date of all assets that are recognized. Assets are probable future economic benefits obtained or controlled by an entity as a result of past transactions or events.
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