U S PHYSICAL THERAPY INC /NV (USPH)
SIC breadcrumb: Services > SIC Major Group 80 > SIC 8000 Services-Health Services
SEC company page: https://www.sec.gov/edgar/browse/?CIK=885978. Latest filing source: 0001140361-26-007170.
Informational only - descriptive public-record data, not investment advice.
Business
Read USPH's verbatim Item 1 Business section from its latest 10-K: Business.
Risk Factors
Read USPH's verbatim Item 1A Risk Factors from its latest 10-K: Risk Factors.
Selected Fundamentals
| Metric | Value | Unit | FY | Filed |
|---|---|---|---|---|
| Revenue | 780,990,000 | USD | 2025 | 2026-02-27 |
| Net income | 39,583,000 | USD | 2025 | 2026-02-27 |
| Assets | 1,204,010,000 | USD | 2025 | 2026-02-27 |
Financials
Annual standardized facts from SEC companyfacts as of latest extracted filing date 2026-02-27. Source: https://data.sec.gov/api/xbrl/companyfacts/CIK0000885978.json. Derived margins, ratios, and free cash flow are computed from the extracted annual SEC facts.
| Metric | 2009 | 2010 | 2011 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Revenue | 453,911,000 | 481,969,000 | 422,969,000 | 495,022,000 | 553,144,000 | 604,802,000 | 671,345,000 | 780,990,000 | ||||||||
| Net income | 20,551,000 | 22,256,000 | 34,873,000 | 40,039,000 | 35,194,000 | 40,831,000 | 32,158,000 | 28,239,000 | 31,424,000 | 39,583,000 | ||||||
| Operating income | 49,533,000 | 54,728,000 | 60,314,000 | 67,425,000 | 52,413,000 | 70,649,000 | 56,801,000 | 50,511,000 | 62,994,000 | 86,677,000 | ||||||
| Gross profit | 82,012,000 | 90,617,000 | 101,663,000 | 112,474,000 | 94,450,000 | 117,182,000 | 112,024,000 | 121,509,000 | 123,921,000 | 149,693,000 | ||||||
| Diluted EPS | 1.05 | 1.62 | 1.77 | 2.45 | 2.48 | 2.41 | 2.25 | 1.28 | 1.84 | 1.42 | ||||||
| Operating cash flow | 51,050,000 | 56,526,000 | 73,005,000 | 62,448,000 | 99,995,000 | 76,406,000 | 58,537,000 | 81,978,000 | 74,940,000 | 75,058,000 | ||||||
| Capital expenditures | 8,260,000 | 7,095,000 | 7,193,000 | 10,189,000 | 7,639,000 | 8,201,000 | 8,248,000 | 9,294,000 | 9,186,000 | 14,071,000 | ||||||
| Dividends paid | 8,510,000 | 10,066,000 | 11,664,000 | 14,555,000 | 4,110,000 | 18,765,000 | 21,321,000 | 24,128,000 | 26,540,000 | 27,362,000 | ||||||
| Share buybacks | 5,586,000 | 1,401,000 | 4,656,000 | 0.00 | 0.00 | 5,566,000 | ||||||||||
| Assets | 351,231,000 | 418,982,000 | 443,166,000 | 630,501,000 | 594,361,000 | 749,426,000 | 858,154,000 | 997,238,000 | 1,167,467,000 | 1,204,010,000 | ||||||
| Liabilities | 162,543,000 | 110,340,000 | 92,348,000 | 181,394,000 | 184,391,000 | 296,983,000 | 373,586,000 | 345,000,000 | 408,421,000 | 433,811,000 | ||||||
| Stockholders' equity | 187,548,000 | 204,866,000 | 215,945,000 | 240,257,000 | 276,160,000 | 295,606,000 | 315,793,000 | 476,194,000 | 488,929,000 | 476,432,000 | ||||||
| Cash and cash equivalents | 20,047,000 | 21,933,000 | 23,368,000 | 23,548,000 | 32,918,000 | 28,567,000 | 31,594,000 | 152,825,000 | 41,362,000 | 35,570,000 | ||||||
| Free cash flow | 42,790,000 | 49,431,000 | 65,812,000 | 52,259,000 | 92,356,000 | 68,205,000 | 50,289,000 | 72,684,000 | 65,754,000 | 60,987,000 |
Ratios
| Metric | 2009 | 2010 | 2011 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Net margin | 7.68% | 8.31% | 8.32% | 8.25% | 5.81% | 4.67% | 4.68% | 5.07% | ||||||||
| Operating margin | 13.29% | 13.99% | 12.39% | 14.27% | 10.27% | 8.35% | 9.38% | 11.10% | ||||||||
| Return on equity | 10.96% | 10.86% | 16.15% | 16.67% | 12.74% | 13.81% | 10.18% | 5.93% | 6.43% | 8.31% | ||||||
| Return on assets | 5.85% | 5.31% | 7.87% | 6.35% | 5.92% | 5.45% | 3.75% | 2.83% | 2.69% | 3.29% | ||||||
| Liabilities / equity | 0.87 | 0.54 | 0.43 | 0.75 | 0.67 | 1.00 | 1.18 | 0.72 | 0.84 | 0.91 | ||||||
| Current ratio | 2.68 | 1.95 | 1.89 | 1.41 | 0.94 | 1.14 | 1.30 | 2.28 | 1.18 | 1.01 |
Industry Peer Context
Net margin peer context
Operating margin peer context
ROE peer context
ROA peer context
Financial Bridges
Income statement bridge from reported figures
Figure provenance: SEC companyfacts FY 2025. Revenue: accession 0001140361-26-007170; concept Revenues; source concepts us-gaap:Revenues | Gross profit: accession 0001140361-26-007170; concept GrossProfit; source concepts us-gaap:GrossProfit | Operating income: accession 0001140361-26-007170; concept OperatingIncomeLoss; source concepts us-gaap:OperatingIncomeLoss | Net income: accession 0001140361-26-007170; concept NetIncomeLoss; source concepts us-gaap:NetIncomeLoss
Free cash flow = operating cash flow - capital expenditures
Figure provenance: SEC companyfacts FY 2025. Operating cash flow: accession 0001140361-26-007170; concept NetCashProvidedByUsedInOperatingActivities; source concepts us-gaap:NetCashProvidedByUsedInOperatingActivities | Capital expenditures: accession 0001140361-26-007170; concept PaymentsToAcquireProductiveAssets; source concepts us-gaap:PaymentsToAcquireProductiveAssets | Free cash flow: accession 0001140361-26-007170; concept NetCashProvidedByUsedInOperatingActivities - PaymentsToAcquireProductiveAssets; source concepts us-gaap:NetCashProvidedByUsedInOperatingActivities; us-gaap:PaymentsToAcquireProductiveAssets
Financial Charts
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: Revenues. Source concepts: us-gaap:Revenues.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: NetIncomeLoss. Source concepts: us-gaap:NetIncomeLoss.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: OperatingIncomeLoss. Source concepts: us-gaap:OperatingIncomeLoss.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: GrossProfit. Source concepts: us-gaap:GrossProfit.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: EarningsPerShareDiluted. Source concepts: us-gaap:EarningsPerShareDiluted.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: NetCashProvidedByUsedInOperatingActivities. Source concepts: us-gaap:NetCashProvidedByUsedInOperatingActivities.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: PaymentsToAcquireProductiveAssets. Source concepts: us-gaap:PaymentsToAcquireProductiveAssets.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: PaymentsOfDividendsCommonStock. Source concepts: us-gaap:PaymentsOfDividendsCommonStock.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: PaymentsForRepurchaseOfCommonStock. Source concepts: us-gaap:PaymentsForRepurchaseOfCommonStock.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: Assets. Source concepts: us-gaap:Assets.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: Liabilities. Source concepts: us-gaap:Liabilities.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: StockholdersEquity. Source concepts: us-gaap:StockholdersEquity.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: CashAndCashEquivalentsAtCarryingValue. Source concepts: us-gaap:CashAndCashEquivalentsAtCarryingValue.
Figure provenance: SEC companyfacts. Latest point: FY 2025 ended 2025-12-31; accession 0001140361-26-007170; filed 2026-02-27. Concept: NetCashProvidedByUsedInOperatingActivities - PaymentsToAcquireProductiveAssets. Source concepts: us-gaap:NetCashProvidedByUsedInOperatingActivities; us-gaap:PaymentsToAcquireProductiveAssets.
Quarterly
Quarterly standardized facts from SEC companyfacts as of latest extracted filing date 2026-05-08. Source: https://data.sec.gov/api/xbrl/companyfacts/CIK0000885978.json.
| Quarter | End Date | Revenue | Net Income | Diluted EPS | Method |
|---|---|---|---|---|---|
| 2022-Q2 | 2022-06-30 | 0.87 | reported discrete quarter | ||
| 2022-Q3 | 2022-09-30 | 0.72 | reported discrete quarter | ||
| 2023-Q1 | 2023-03-31 | 0.58 | reported discrete quarter | ||
| 2023-Q2 | 2023-06-30 | 151,485,000 | 10,919,000 | 0.64 | reported discrete quarter |
| 2023-Q3 | 2023-09-30 | 150,007,000 | 9,254,000 | 0.51 | reported discrete quarter |
| 2023-Q4 | 2023-12-31 | 154,801,000 | 656,000 | derived Q4 = FY annual - nine-month YTD | |
| 2024-Q1 | 2024-03-31 | 155,675,000 | 8,046,000 | 0.46 | reported discrete quarter |
| 2024-Q2 | 2024-06-30 | 167,190,000 | 7,506,000 | 0.47 | reported discrete quarter |
| 2024-Q3 | 2024-09-30 | 168,033,000 | 6,628,000 | 0.39 | reported discrete quarter |
| 2024-Q4 | 2024-12-31 | 180,447,000 | 9,244,000 | derived Q4 = FY annual - nine-month YTD | |
| 2025-Q1 | 2025-03-31 | 183,788,000 | 9,899,000 | 0.80 | reported discrete quarter |
| 2025-Q2 | 2025-06-30 | 197,344,000 | 12,393,000 | 0.58 | reported discrete quarter |
| 2025-Q3 | 2025-09-30 | 197,132,000 | 13,138,000 | 0.48 | reported discrete quarter |
| 2025-Q4 | 2025-12-31 | 202,726,000 | 4,153,000 | derived Q4 = FY annual - nine-month YTD | |
| 2026-Q1 | 2026-03-31 | 198,286,000 | 5,038,000 | -0.12 | reported discrete quarter |
Quarterly Charts
Figure provenance: SEC companyfacts. Latest point: FY 2026 ended 2026-03-31; accession 0001140361-26-020025; filed 2026-05-08. Concept: Revenues. Source concepts: us-gaap:Revenues.
Figure provenance: SEC companyfacts. Latest point: FY 2026 ended 2026-03-31; accession 0001140361-26-020025; filed 2026-05-08. Concept: NetIncomeLoss. Source concepts: us-gaap:NetIncomeLoss.
Figure provenance: SEC companyfacts. Latest point: FY 2026 ended 2026-03-31; accession 0001140361-26-020025; filed 2026-05-08. Concept: EarningsPerShareDiluted. Source concepts: us-gaap:EarningsPerShareDiluted.
Macro Cross-References
- CPIAUCSL - Consumer Price Index for All Urban Consumers: All Items in U.S. City Average
- UNRATE - Unemployment Rate
- FEDFUNDS - Federal Funds Effective Rate
- CES0500000003 - Average Hourly Earnings of All Employees, Total Private
- DFEDTARU - Federal Funds Target Range - Upper Limit
- DFEDTARL - Federal Funds Target Range - Lower Limit
- DGS3MO - Market Yield on U.S. Treasury Securities at 3-Month Constant Maturity
- DGS2 - Market Yield on U.S. Treasury Securities at 2-Year Constant Maturity
- DGS10 - Market Yield on U.S. Treasury Securities at 10-Year Constant Maturity
- DGS30 - Market Yield on U.S. Treasury Securities at 30-Year Constant Maturity
- T10Y2Y - 10-Year Treasury Constant Maturity Minus 2-Year Treasury Constant Maturity
- CPILFESL - Consumer Price Index for All Urban Consumers: All Items Less Food and Energy
- CPIUFDSL - Consumer Price Index for All Urban Consumers: Food
- CPIENGSL - Consumer Price Index for All Urban Consumers: Energy
- CUSR0000SAH1 - Consumer Price Index for All Urban Consumers: Shelter
- PCEPI - Personal Consumption Expenditures: Chain-type Price Index
- PCEPILFE - Personal Consumption Expenditures Excluding Food and Energy: Chain-type Price Index
- PPIACO - Producer Price Index by Commodity: All Commodities
- T10YIE - 10-Year Breakeven Inflation Rate
- U6RATE - Total Unemployed, Plus All Marginally Attached Workers Plus Total Employed Part Time for Economic Reasons
- PAYEMS - All Employees, Total Nonfarm
- CIVPART - Labor Force Participation Rate
- EMRATIO - Employment-Population Ratio
- UNEMPLOY - Unemployed
- CE16OV - Employment Level
- ICSA - Initial Claims
- JTSJOL - Job Openings: Total Nonfarm
- JTSQUR - Quits: Total Nonfarm
- GDPC1 - Real Gross Domestic Product
- A191RL1Q225SBEA - Real Gross Domestic Product: Percent Change from Preceding Period
- INDPRO - Industrial Production: Total Index
- TCU - Capacity Utilization: Total Index
- HOUST - New Privately-Owned Housing Units Started: Total Units
- PERMIT - New Privately-Owned Housing Units Authorized in Permit-Issuing Places: Total Units
- RSAFS - Advance Retail Sales: Retail Trade
- PCE - Personal Consumption Expenditures
- DSPIC96 - Real Disposable Personal Income
- PSAVERT - Personal Saving Rate
- M2SL - M2
- BOPGSTB - U.S. International Trade in Goods and Services: Balance
- MSPUS - Median Sales Price of Houses Sold for the United States
- HSN1F - New One Family Houses Sold: United States
- RHORUSQ156N - Homeownership Rate in the United States
- TTLCONS - Total Construction Spending: Total Construction in the United States
- RRVRUSQ156N - Rental Vacancy Rate in the United States
- TOTALSL - Total Consumer Credit Owned and Securitized
- REVOLSL - Revolving Consumer Credit Owned and Securitized
- DRCCLACBS - Delinquency Rate on Credit Card Loans, All Commercial Banks
- GDP - Gross Domestic Product
- GPDI - Gross Private Domestic Investment
- GCE - Government Consumption Expenditures and Gross Investment
- PCEC - Personal Consumption Expenditures
- NETEXP - Net Exports of Goods and Services
- GFDEBTN - Federal Debt: Total Public Debt
- GFDEGDQ188S - Federal Debt: Total Public Debt as Percent of Gross Domestic Product
- FYFSD - Federal Surplus or Deficit
- FGRECPT - Federal Government Current Receipts
- FGEXPND - Federal Government: Current Expenditures
- MANEMP - All Employees, Manufacturing
- USCONS - All Employees, Construction
- USTRADE - All Employees, Retail Trade
- USFIRE - All Employees, Financial Activities
- USGOVT - All Employees, Government
- AWHAETP - Average Weekly Hours of All Employees, Total Private
- DGORDER - Manufacturers' New Orders: Durable Goods
- NEWORDER - Manufacturers' New Orders: Nondefense Capital Goods Excluding Aircraft
- BUSINV - Total Business Inventories
- EXPGS - Exports of Goods and Services
- IMPGS - Imports of Goods and Services
- IR - Import Price Index (End Use): All Commodities
- PPIFIS - Producer Price Index by Commodity: Final Demand
Latest quarter (10-Q)
Latest 10-Q source: 0001140361-26-020025.
Item 2. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS.
The following discussion and analysis of U.S. Physical Therapy, Inc. and its subsidiaries (herein referred to as “we,” “us,” “our” or the “Company”) should be read in conjunction
with (i) our historical consolidated financial statements and accompanying notes thereto included elsewhere in this Quarterly Report on Form 10-Q; and (ii) our Annual Report on Form 10-K for the year ended December 31, 2025 filed with the
Securities and Exchange Commission (the “SEC”) on February 27, 2026 (“2025 Annual Report”).
This discussion includes forward-looking statements that are subject to risk and uncertainties. Actual results may differ substantially from the statements we make in this
section due to a number of factors that are discussed below.
FORWARD-LOOKING STATEMENTS
We make statements in this report that are considered forward-looking statements within the meaning given such term under Section 21E of the Securities Exchange Act of 1934, as
amended (the “Exchange Act”). These statements contain forward-looking information relating to the financial condition, results of operations, plans, objectives, future performance and business of our Company. These statements (often using words
such as “believes”, “expects”, “intends”, “plans”, “appear”, “should” and similar words) involve risks and uncertainties that could cause actual results to differ materially from those we project. Included among such statements, but not limited
to, are those relating to opening clinics, availability of personnel and the insurance reimbursement environment. The forward-looking statements are based on our current views and assumptions, and actual results could differ materially from those
anticipated in such forward-looking statements as a result of certain risks, uncertainties, and factors, which include, but are not limited to:
| Column 1 | Column 2 |
|---|---|
| • | changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status; |
| Column 1 | Column 2 |
|---|---|
| • | revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction; |
| Column 1 | Column 2 |
|---|---|
| • | changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients; |
| Column 1 | Column 2 |
|---|---|
| • | private third-party payors for our services may adopt payment policies that could limit our future revenue and profitability; |
| Column 1 | Column 2 |
|---|---|
| • | compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply; |
| Column 1 | Column 2 |
|---|---|
| • | compliance with state laws and regulations relating to the corporate practice of medicine and fee splitting, and associated fines and penalties for failure to comply ; |
| Column 1 | Column 2 |
|---|---|
| • | competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets; |
| Column 1 | Column 2 |
|---|---|
| • | the impact of a termination of one or more of the Company’s hospital affiliation arrangements, which could have an adverse impact on revenue and the results of operations; |
| Column 1 | Column 2 |
|---|---|
| • | the impact of future public health crises and epidemics/pandemics |
| Column 1 | Column 2 |
|---|---|
| • | certain of our acquisition agreements contain put-rights related to a future purchase of significant equity interests in our subsidiaries or in a separate company; |
| Column 1 | Column 2 |
|---|---|
| • | the impact of future vaccinations and/or testing mandates at the federal, state and/or local level, which could have an adverse impact on staffing, revenue, costs and the results of operations; |
| Column 1 | Column 2 |
|---|---|
| • | our debt and financial obligations could adversely affect our financial condition, our ability to obtain future financing and our ability to operate our business; |
| Column 1 | Column 2 |
|---|---|
| • | changes as the result of government enacted national healthcare reform; |
| Column 1 | Column 2 |
|---|---|
| • | the ability to control variable interest entities for which we do not have a direct ownership; |
| Column 1 | Column 2 |
|---|---|
| • | business and regulatory conditions, including federal and state regulations; |
| Column 1 | Column 2 |
|---|---|
| • | governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs; |
| Column 1 | Column 2 |
|---|---|
| • | revenue and earnings expectations; |
| Column 1 | Column 2 |
|---|---|
| • | contingent consideration provisions in certain of our acquisition agreements, the value of which may impact future financial results; |
35
Table of Contents
| Column 1 | Column 2 |
|---|---|
| • | legal actions, which could subject us to increased operating costs and uninsured liabilities; |
| Column 1 | Column 2 |
|---|---|
| • | general economic conditions, including but not limited to inflationary and recessionary periods; |
| Column 1 | Column 2 |
|---|---|
| • | actual or perceived events involving banking volatility or limited liability, defaults or other adverse developments that affect the U.S or the international financial systems, may result in market wide liquidity problems which could have a material and adverse impact on our available cash and results of operations; |
| Column 1 | Column 2 |
|---|---|
| • | our business depends on hiring, training, and retaining qualified employees; |
| Column 1 | Column 2 |
|---|---|
| • | availability and cost of qualified physical therapists; |
| Column 1 | Column 2 |
|---|---|
| • | competitive environment in the industrial injury prevention services business, which could result in the termination or non-renewal of contractual service arrangements and other adverse financial consequences for that service line; |
| Column 1 | Column 2 |
|---|---|
| • | our ability to identify and complete acquisitions, and the successful integration of the operations of the acquired businesses; |
| Column 1 | Column 2 |
|---|---|
| • | impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interest (minority interests); |
| Column 1 | Column 2 |
|---|---|
| • | maintaining our information technology systems with adequate safeguards to protect against cyber-attacks; |
| Column 1 | Column 2 |
|---|---|
| • | a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act; |
| Column 1 | Column 2 |
|---|---|
| • | maintaining clients for which we perform management, industrial injury prevention related services, and other services, as a breach or termination of those contractual arrangements by such clients could cause operating results to be less than expected; |
| Column 1 | Column 2 |
|---|---|
| • | maintaining adequate internal controls; |
| Column 1 | Column 2 |
|---|---|
| • | use of generative artificial intelligence; |
| Column 1 | Column 2 |
|---|---|
| • | maintaining necessary insurance coverage; |
| Column 1 | Column 2 |
|---|---|
| • | availability, terms, and use of capital; and |
| Column 1 | Column 2 |
|---|---|
| • | weather and other seasonal factors. |
Many factors are beyond our control. Given these uncertainties, you should not place undue reliance on our forward-looking statements. Please see the other sections of this
report and our other periodic reports filed with the Securities and Exchange Commission (the “SEC”) for more information on these factors. Our forward-looking statements represent our estimates and assumptions only as of the date of this report.
Except as required by law, we are under no obligation to update any forward-looking statement, regardless of the reason the statement may no longer be accurate.
EXECUTIVE SUMMARY
We operate our business through two reportable business segments. Our physical therapy operations segment consists of physical therapy, speech therapy and occupational therapy clinics
and home-care physical and speech therapy practices that provide pre- and post-operative care and treatment for a variety of orthopedic-related disorders, sports-related injuries, and rehabilitation of injured workers. Services provided by the
industrial injury prevention services (“IIP”) segment include onsite injury prevention and rehabilitation, performance optimization, post offer employment testing, functional capacity evaluations, ergonomic
assessments, occupational medicine testing services, and drug & alcohol testing. The majority of IIP is contracted with and paid for directly by employers, including a number of Fortune 500 companies. IIP is performed through Industrial
Sports Medicine Professionals with specialized training related to the musculoskeletal system.
During the three months ended March 31, 2026, and for the year ended December 31, 2025, we completed the acquisitions of clinic practices and IIP business detailed below:
36
Table of Contents
| Acquisition | Date | % Interest Acquired | Number of Clinics | |||
|---|---|---|---|---|---|---|
| January 2026 Acquisition 2 | January 31, 2026 | 70% | * | |||
| January 2026 Acquisition 1 | January 2, 2026 | 50% | 8 | |||
| July 2025 Acquisition | July 31, 2025 | 60% | 3 | |||
| April 2025 Acquisition | April 30, 2025 | 40%** | *** | |||
| February 2025 Acquisition | February 28, 2025 | 65% | 3 |
* IIP business
** On April 30, 2025, the Company acquired an outpatient home care practice that provides speech and occupational therapy through its 50% owned subsidiary Metro. After the transaction, the Company’s
ownership interest is 40%, the local partners have an ownership interest of 40% and the practice’s preacquisition owners have a 20% ownership interest.
*** Home-care business
Our strategy is to continue acquiring multi-clinic outpatient physical therapy practices and home-care physical and speech therapy practices, to develop outpatient physical therapy clinics as satellites in existing
partnerships, and to continue acquiring companies that provide industrial injury prevention services.
The following table provides a roll forward of our clinic count for the periods presented.
Clinic Count Roll Forward (1)
[[GREPCENT_TABLE]]
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[Excerpt truncated for page length; source filing is linked above.]
Latest 10-K MD&A
ITEM 7. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion and analysis of U.S. Physical Therapy, Inc. and its subsidiaries (herein referred to as “we”, “us”, “our” or the “Company”) should be read in
conjunction with the Company’s consolidated financial statements and accompanying notes included elsewhere in this Annual Report on Form 10-K. Some of the information contained in this discussion and analysis, including information with
respect to our plans and strategy for our business, includes forward-looking statements that involve risks and uncertainties. You should review the “Risk Factors” and “Forward-Looking Statements” sections of this Annual Report on Form 10-K
for a discussion of important factors that could cause actual results to differ materially from the results described in or implied by the forward-looking statements contained in the following discussion and analysis.
This section of this Annual Report on Form 10-K generally discusses 2025 and 2024 items and year-to-year comparisons between 2025 and 2024. Discussions of 2023 items
and year-to-year comparisons between 2024 and 2023 can be found in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 of the Company’s Annual Report on Form 10-K for the fiscal year
ended December 31, 2024, filed with the Securities and Exchange Commission on March 3, 2025.
EXECUTIVE SUMMARY
The Company operates its business through two reportable business segments. Our physical therapy operations consist of physical therapy, speech therapy and occupational therapy clinics
and home-care physical and speech therapy practices that provide pre- and post-operative care and treatment for a variety of orthopedic-related disorders, sports-related injuries, and rehabilitation of injured workers. Services provided by
the industrial injury prevention services (“IIP”) segment include onsite services for clients’ employees including injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional capacity
evaluations and ergonomic assessments. The majority of IIP is contracted with and paid for directly by employers, including a number of Fortune 500 companies. IIP is performed through industrial sports medicine professionals with
specialized training related to the musculoskeletal system.
During the last three years, we completed the following acquisitions of outpatient physical therapy practices, companies that manage and/or provide administrative services to outpatient
physical therapy practices, and IIP businesses detailed below:
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| Acquisition | Date | % Interest Acquired | Number of Clinics | |||
|---|---|---|---|---|---|---|
| July 2025 Acquisition | July 31, 2025 | 60% | 3 | |||
| April 2025 Acquisition | April 30, 2025 | 40%* | ** | |||
| February 2025 Acquisition | February 28, 2025 | 65% | 3 | |||
| November 2024 Acquisition | November 30, 2024 | 75% | 8 | |||
| October 2024 Acquisition | October 31, 2024 | 50% | 50 | |||
| August 2024 Acquisition | August 31, 2024 | 70% | 8 | |||
| April 2024 Acquisition | April 30, 2024 | *** | **** | |||
| March 2024 Acquisition | March 29, 2024 | 50% | 9 | |||
| October 2023 Acquisition | October 31, 2023 | ***** | **** | |||
| September 2023 Acquisition 1 | September 29, 2023 | 70% | 4 | |||
| September 2023 Acquisition 2 | September 29, 2023 | 70% | 1 | |||
| July 2023 Acquisition | July 31, 2023 | 70% | 7 | |||
| May 2023 Acquisition | May 31, 2023 | 45% | 4 | |||
| February 2023 Acquisition | February 28, 2023 | 80% | 1 |
* On April 30, 2025, the Company acquired an outpatient home care practice that provides speech and occupational therapy through its 50% owned
subsidiary MSO Metro LLC. (“Metro”). After the transaction, the Company’s ownership interest is 40%, the local partners have an ownership interest of 40% and the practice’s preacquisition owners have a 20% ownership interest.
** Home-care business.
*** On April 30, 2024, one of our primary IIP businesses, Briotix Health Limited Partnership, acquired 100% of an IIP business.
**** IIP business
***** On October 31, 2023, we concurrently acquired 100% of an IIP business and a 55% equity interest in an ergonomics software business (“October 2023 Acquisition”).
Our strategy is to continue acquiring multi-clinic outpatient physical therapy practices and home-care physical and speech therapy practices, to develop outpatient physical therapy clinics as satellites in
existing partnerships, and to continue acquiring companies that provide industrial injury prevention services.
The following table provides a roll forward of our clinic count for the periods presented.
Clinic Count Roll Forward (1)
| 2025 | 2024 | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Owned | Managed | Total | Owned | Managed | Total | |||||||||||||||||||
| Number of clinics, beginning of period | 722 | 39 | 761 | 671 | 43 | 714 | ||||||||||||||||||
| Q1 additions | 14 | - | 14 | 14 | - | 14 | ||||||||||||||||||
| Q1 closed or sold | (7 | ) | (2 | ) | (9 | ) | (6 | ) | (2 | ) | (8 | ) | ||||||||||||
| Number of clinics, end of period | 729 | 37 | 766 | 679 | 41 | 720 | ||||||||||||||||||
| Q2 additions | 6 | - | 6 | 7 | - | 7 | ||||||||||||||||||
| Q2 closed or sold | (3 | ) | (1 | ) | (4 | ) | (5 | ) | - | (5 | ) | |||||||||||||
| Number of clinics, end of period | 732 | 36 | 768 | 681 | 41 | 722 | ||||||||||||||||||
| Q3 additions | 16 | 2 | 18 | 12 | - | 12 | ||||||||||||||||||
| Q3 closed or sold | (3 | ) | (4 | ) | (7 | ) | (32 | ) | (2 | ) | (34 | ) | ||||||||||||
| Number of clinics, end of period | 745 | 34 | 779 | 661 | 39 | 700 | ||||||||||||||||||
| Q4 additions | 11 | - | 11 | 63 | - | 63 | ||||||||||||||||||
| Q4 closed or sold | (10 | ) | - | (10 | ) | (2 | ) | - | (2 | ) | ||||||||||||||
| Number of clinics, end of period | 746 | 34 | 780 | 722 | 39 | 761 |
| Year-to-date 2025 and full-year 2024 additions | 47 | 2 | 49 | 96 | - | 96 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Year-to-date 2025 and full-year 2024 closed or sold | (23 | ) | (7 | ) | (30 | ) | (45 | ) | (4 | ) | (49 | ) |
| Column 1 | Column 2 |
|---|---|
| (1) | Excludes the home care business |
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Recent Developments
On January 2, 2026, we acquired a 50% interest in a physical practice with eight-clinic locations. The prior owner retained a 50% ownership interest.
On January 31, 2026, we acquired an industrial injury prevention business. The prior owner retained a 30% ownership interest.
On February 24, 2026, our Board of Directors raised our quarterly dividend rate from $0.45 per share to $0.46 per share, effective immediately, and declared a quarterly dividend for the first quarter of 2026
at the higher rate. The dividend will be payable on April 10, 2026, to shareholders of record on March 13, 2026.
We repurchased 81,322 of our own shares for total consideration of $5.6 million from the open market during the three months ended December 31, 2025, which demonstrates our focus on enhancing shareholder
value as well as our confidence in the long-term prospects of the Company.
Strategic Hospital Alliances
On February 2, 2026, we announced a 10-year strategic alliance between our subsidiary partner, Metro, and a prominent New York hospital system, whereby 60 of Metro’s existing outpatient physical therapy
clinics in New York will become part of the hospital system’s clinical services network. The alliance is expected to begin operations with an initial group of clinics in mid-2026, with all 60 clinics anticipated to be operational by year-end
2026.
On February 25, 2026, we announced a 10-year strategic alliance between another of our subsidiary partners and a local hospital system whereby our subsidiary partner’s existing 10 outpatient physical therapy
clinics will become part of the hospital system’s clinical services network.
These arrangements will be accretive to our revenue, operating income and margins.
Medicare Reimbursement
The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (“MPFS”). Outpatient rehabilitation providers may enroll in Medicare as
institutional outpatient rehabilitation facilities (i.e., rehab agencies) or individual physical or occupational therapists in private practice. The majority of our clinicians are enrolled as individual physical or occupational therapists
in private practice while the remaining balance of providers are reimbursed through enrolled rehab agencies.
For calendar years 2021, 2022 and 2023, Centers for Medicare and Medicaid Services (“CMS”) expected decreases in Medicare reimbursement were partially offset by one-time increases in
payments as a result of other legislation passed by Congress, resulting in decreases of approximately 3.5%, 0.75% and 2.0% in each of these years, respectively. For January 1 through March 8 of 2024, CMS’s final rule resulted in an
approximate 3.5% decrease in Medicare payments for the therapy specialty. However, effective as of March 9, 2024, pursuant to the Consolidated Appropriations Act, 2024, Congress minimized the reduction in Medicare payments for therapy
services for the balance of 2024, resulting in an approximate 1.8% reduction in Medicare payments for therapy services (rather than the 3.5% decrease). The MPFS for 2025 decreased Medicare reimbursement for therapy services by approximately
2.9% as compared to the reimbursement rates in effect for most of 2024. For 2026, the proposed MPFS is expected to increase Medicare reimbursement for therapy services by approximately 1.75% as compared to the reimbursement rates for 2025.
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In the final 2020 MPFS rule, CMS clarified that when the physical therapist is involved for the entire duration of the service and the physical therapist assistant (“PTA”) provides
skilled therapy alongside the physical therapist, an identification of the PTA’s participation (as denoted by a “CQ modifier”) is not required. Also, when the same service (code) is furnished separately by the physical therapist and PTA,
CMS applies the de minimis standard to each 15-minute unit of codes, not on the total physical therapist and PTA time of the service. For dates of service on and after January 1, 2022, CMS pays for physical therapy and occupational therapy
services provided by PTAs and occupational therapist assistants (“OTAs”) at 85% of the otherwise applicable Part B payment amount. CMS allows a timed service to be billed without a CQ (for PTA’s) or CO (for OTA’s) modifier when a PTA or OTA
participates in providing care, but the physical therapist or occupational therapist meets the Medicare billing requirements without including the PTA’s or OTA’s minutes. This occurs when the physical therapist or occupational therapist
provides more minutes than the 15-minute midpoint.
RESULTS OF OPERATIONS
The defined terms with their respective description used in the following discussion are listed below:
Mature clinics are clinics (physical clinic locations and home-care business units) opened or acquired prior to January 1, 2024, and are still
operating as of the balance sheet date.
Net rate per patient visit is net patient revenue related to our physical therapy operations divided by total number of patient visits (defined
below) during the periods presented.
Patient visits is the number of unique patient visits during the periods presented for both physical clinic locations and home-care.
Average daily visits per clinic is patient visits (excluding home-care visits) divided by the number of days in which normal business operations
were conducted during the periods presented and further divided by the average number of clinics in operation during the periods presented.
Clinics are outpatient physical therapy clinics that are either owned or managed by the Company or one of its subsidiaries.
2025 Year period covering the twelve months ended December 31, 2025.
2024 Year period covering the twelve months ended December 31, 2024.
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Full Year 2025 versus Full Year 2024
| For the Year Ended | Variance | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | $ | % | |||||||||||||||||||||
| (In thousands, except percentages) | ||||||||||||||||||||||||
| Net patient revenue | $ | 650,429 | 83.3 | % | $ | 560,553 | 83.5 | % | $ | 89,876 | 16.0 | % | ||||||||||||
| Other revenue | 130,561 | 16.7 | % | 110,792 | 16.5 | % | 19,769 | 17.8 | % | |||||||||||||||
| Net revenue | 780,990 | 100.0 | % | 671,345 | 100.0 | % | 109,645 | 16.3 | % | |||||||||||||||
| Operating Cost: | ||||||||||||||||||||||||
| Salaries and related costs | 461,890 | 59.1 | % | 399,394 | 59.5 | % | 62,496 | 15.6 | % | |||||||||||||||
| Rent, supplies, contract labor and other | 140,431 | 18.0 | % | 118,910 | 17.7 | % | 21,521 | 18.1 | % | |||||||||||||||
| Depreciation and amortization | 21,059 | 2.7 | % | 17,853 | 2.7 | % | 3,206 | 18.0 | % | |||||||||||||||
| Provision for credit losses | 7,647 | 1.0 | % | 6,912 | 1.0 | % | 735 | 10.6 | % | |||||||||||||||
| Clinic closure costs - lease and other | 270 | 0.0 | % | 4,355 | 0.6 | % | (4,085 | ) | * | |||||||||||||||
| Total operating cost | 631,297 | 80.8 | % | 547,424 | 81.5 | % | 83,873 | 15.3 | % | |||||||||||||||
| Gross Profit | 149,693 | 19.2 | % | 123,921 | 18.5 | % | 25,772 | 20.8 | % | |||||||||||||||
| Corporate office costs | 69,260 | 8.9 | % | 58,290 | 8.7 | % | 10,970 | 18.8 | % | |||||||||||||||
| (Gain) loss on change in fair value of contingent earn-out consideration | (6,244 | ) | -0.8 | % | 219 | * | (6,463 | ) | * | |||||||||||||||
| Impairment of assets held for sale | - | 0.0 | % | 2,418 | * | (2,418 | ) | * | ||||||||||||||||
| Operating Income | 86,677 | 11.1 | % | 62,994 | 9.4 | % | 23,683 | 37.6 | % | |||||||||||||||
| Other (expense) income: | ||||||||||||||||||||||||
| Interest expense, debt and other | (9,459 | ) | -1.2 | % | (8,015 | ) | -1.2 | % | (1,444 | ) | 18.0 | % | ||||||||||||
| Interest income from investments | 105 | 0.0 | % | 3,941 | 0.6 | % | (3,836 | ) | -97.3 | % | ||||||||||||||
| Change in revaluation of put-right liability | (1,322 | ) | -0.2 | % | (82 | ) | 0.0 | % | (1,240 | ) | 1512.2 | % | ||||||||||||
| Equity in earnings of unconsolidated affiliate | 1,477 | 0.2 | % | 1,014 | 0.2 | % | 463 | 45.7 | % | |||||||||||||||
| Loss on sale of partnership | (123 | ) | 0.0 | % | - | 0.0 | % | (123 | ) | * | ||||||||||||||
| Other | 458 | 0.1 | % | 357 | 0.1 | % | 101 | 28.3 | % | |||||||||||||||
| Total other expense | (8,864 | ) | -1.1 | % | (2,785 | ) | -0.4 | % | (6,079 | ) | 218.3 | % | ||||||||||||
| Income before taxes | 77,813 | 10.0 | % | 60,209 | 9.0 | % | 17,604 | 29.2 | % | |||||||||||||||
| Provision for income taxes | 19,808 | 2.5 | % | 14,609 | 2.2 | % | 5,199 | 35.6 | % | |||||||||||||||
| Net income | 58,005 | 7.4 | % | 45,600 | 6.8 | % | 12,405 | 27.2 | % | |||||||||||||||
| Less: Net income attributable to non-controlling interest: | ||||||||||||||||||||||||
| Redeemable non-controlling interest - temporary equity | (13,849 | ) | -1.8 | % | (10,044 | ) | -1.5 | % | (3,805 | ) | 37.9 | % | ||||||||||||
| Non-controlling interest - permanent equity | (4,573 | ) | -0.6 | % | (4,132 | ) | -0.6 | % | (441 | ) | 10.7 | % | ||||||||||||
| (18,422 | ) | -2.4 | % | (14,176 | ) | -2.1 | % | (4,246 | ) | 30.0 | % | |||||||||||||
| Net income attributable to USPH shareholders | $ | 39,583 | 5.1 | % | $ | 31,424 | 4.7 | % | $ | 8,159 | 26.0 | % |
* Not meaningful
Total net revenue for the 2025 Year increased $109.6 million, or 16.3%, to $781.0 million from $671.3 million for the 2024 Year while operating costs increased $83.9 million, or 15.3%, to $631.3 million from
$547.4 million over the same periods, respectively. Gross profit for the 2025 Year was $149.7 million, or 19.2% of net revenue, compared to $123.9 million for the 2024 Year, or 18.5% of net revenue.
Net income attributable to our shareholders (“USPH Net Income”), a generally accepted accounting principles (“GAAP”) measure, was $39.6 million for the 2025 Year compared to $31.4 million for the 2024 Year.
Under GAAP, increases and decreases in the value of redeemable noncontrolling interests (related to ownership interests of our partners in subsidiaries that are not fully owned by USPH), net of taxes, are not included in net income, but
they are included in the calculation of earnings per share. Our improved performance in 2025 increased the value of these ownership interests, net of taxes, by $18.0 million, which reduced earnings per share. Earnings per share was $1.42
for the 2025 Year and $1.84 for the 2024 Year.
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The table below shows the calculation of earnings per share for the periods presented.
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | |||||||
| (In thousands, except per share data) | ||||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 39,583 | $ | 31,424 | ||||
| Charges to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (24,521 | ) | (4,964 | ) | ||||
| Tax effect at statutory rate (federal and state) | 6,510 | 1,268 | ||||||
| $ | 21,572 | $ | 27,728 | |||||
| Earnings per share (basic and diluted) | $ | 1.42 | $ | 1.84 | ||||
| Shares used in computation: | ||||||||
| Basic and diluted earnings per share - weighted-average shares | 15,175 | 15,064 |
We reported net earnings of $39.6 million ($1.42 per share) in 2025 and $31.4 million ($1.84 per share) in 2024.
Non-GAAP Measures
The following tables provide details of the basic and diluted earnings per share computation and reconcile net income attributable to USPH shareholders calculated in accordance with GAAP to Adjusted EBITDA,
Operating Results and other non-GAAP measures. We believe providing Adjusted EBITDA, Operating Results, and other non-GAAP measures to investors is useful information for comparing our period-to-period results as well as for comparing with
other similar businesses since most do not have redeemable instruments and therefore have different equity structures. Additionally, management believes that these non-GAAP measures provide useful supplemental information to investors,
analysts, and other stakeholders in assessing the Company’s operational performance and financial trends. We use Adjusted EBITDA, Operating Results and other non-GAAP measures, which eliminate certain items described above that can be
subject to volatility and unusual costs, as the principal measures to evaluate and monitor financial performance period over period.
Adjusted EBITDA, a non-GAAP measure, is defined as net income attributable to our shareholders before interest income, interest expense, taxes, depreciation, amortization, change in fair value of contingent
earn-out consideration, changes in revaluation of put-right liability, equity-based awards compensation expense, clinic closure costs, impairment on assets held for sale, business acquisition related costs, costs related to a one-time
financial and human resources systems upgrade, loss on sale of a partnership and other income and related portions for non-controlling interests.
Operating Results, a non-GAAP measure, equals net income attributable to our shareholders less, changes in revaluation of a put-right liability, clinic closure costs, loss on sale of a partnership, changes in
fair value of contingent earn-out consideration, business acquisition related costs, costs related to a one-time financial and human resources systems upgrade, an income tax adjustment to revalue our deferred tax assets and liabilities to
the most current statutory tax rate, and any allocations to non-controlling interests, all net of taxes. Operating Results per share also excludes the impact of the revaluation of redeemable non-controlling interest and the associated tax
impact.
Adjusted EBITDA, Operating Results and other non-GAAP measures presented are not measures of financial performance under GAAP. Adjusted EBITDA, Operating Results and other non-GAAP measures should not be
considered in isolation or as an alternative to, or substitute for, net income attributable to our shareholders presented in the consolidated financial statements.
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The tables that follow define and reconcile non-GAAP Adjusted EBITDA and non-GAAP Operating Results to the most directly comparable GAAP measure.
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | |||||||
| Adjusted EBITDA (a non-GAAP measure) | ||||||||
| Net income attributable to USPH shareholders | $ | 39,583 | $ | 31,424 | ||||
| Adjustments: | ||||||||
| Provision for income taxes | 19,808 | 14,609 | ||||||
| Depreciation and amortization | 22,391 | 18,681 | ||||||
| Interest expense, debt and other, net | 9,459 | 8,015 | ||||||
| Interest income from investments | (105 | ) | (3,941 | ) | ||||
| Impairment of assets held for sale | - | 2,418 | ||||||
| Equity-based awards compensation expense | 8,270 | 7,823 | ||||||
| Change in revaluation of put-right liability | 1,322 | 82 | ||||||
| (Gain) loss on change in fair value of contingent earn-out consideration | (6,244 | ) | 219 | |||||
| Clinic closure costs (1) | 270 | 4,355 | ||||||
| Business acquisition related costs (2) | 1,239 | 819 | ||||||
| ERP implementation costs (3) | 1,490 | - | ||||||
| Loss on sale of partnership | 123 | - | ||||||
| Other income | (235 | ) | (357 | ) | ||||
| Allocation to non-controlling interests | (2,361 | ) | (2,379 | ) | ||||
| $ | 95,010 | $ | 81,768 |
| Operating Results (a non-GAAP measure) | ||||||||
|---|---|---|---|---|---|---|---|---|
| Net income attributable to USPH shareholders | $ | 39,583 | $ | 31,424 | ||||
| Adjustments: | ||||||||
| (Gain) loss on change in fair value of contingent earn-out consideration | (6,244 | ) | 219 | |||||
| Impairment of assets held for sale | - | 2,418 | ||||||
| Change in revaluation of put-right liability | 1,322 | 82 | ||||||
| Clinic closure costs (1) | 270 | 4,355 | ||||||
| Business acquisition related costs (2) | 1,239 | 819 | ||||||
| ERP implementation costs (3) | 1,490 | - | ||||||
| Loss on sale of partnership | 123 | - | ||||||
| Income tax adjustment (4) | 1,499 | - | ||||||
| Allocation to non-controlling interest | 277 | (521 | ) | |||||
| Tax effect at statutory rate (federal and state) | 404 | (1,884 | ) | |||||
| $ | 39,963 | $ | 36,912 | |||||
| Operating Results per share (a non-GAAP measure) | $ | 2.63 | $ | 2.45 |
(1) Costs associated with the closure of 23 owned clinics during the year ended December 31, 2025 and 45 owned clinics during the year ended December 31, 2024. See Clinic Count Roll
Forward on page 34 for additional information.
(2) Primarily consists of retention bonuses, legal and consulting expenses related to the acquisitions of equity interests in certain partnerships.
(3) Consists of costs related to a one-time financial and human resources systems upgrade.
(4) Mostly consist of adjustment to revalue the Company’s deferred tax assets and liabilities to the most current statutory tax rate.
Adjusted EBITDA (1), a non-GAAP measure, was $95.0 million for the 2025 Year, an increase of $13.2 million or 16.2% million,
from $81.8 million for the 2024 Year.
Operating Results (1), a non-GAAP measure, was $40.0 million for 2025 Year, an increase of $3.1 million, from $36.9 million in
the 2024 Year. On a per share basis, Operating Results were $2.63 in 2025 Year compared to $2.45 in the 2024 Year.
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| (1) | These are non-GAAP Measures. See below for the definition and reconciliation of non-GAAP measures to the most directly comparable GAAP measure. |
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The tables below reconcile other non-GAAP measures to the most directly comparable GAAP measures.
| For the Year Ended December 31, 2025 | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reported (GAAP) | Adjustments | Adjusted (Non-GAAP) | ||||||||||||||||||||||||||
| Clinic Closure Costs | Metro Incentive Costs (1) | Business Acquisition Related Costs (2) | ERP Implementation Costs (3) | Change in Fair Value of Contingent Earn- out Consideration | ||||||||||||||||||||||||
| (in thousands, except per visit data and percentages) | ||||||||||||||||||||||||||||
| Segment information - Physical Therapy Operations | ||||||||||||||||||||||||||||
| Salaries and related costs (4) | $ | 381,556 | $ | - | $ | (670 | ) | $ | - | $ | - | $ | - | $ | 380,886 | |||||||||||||
| Operating costs (4)(5) | $ | 530,763 | $ | (270 | ) | $ | (670 | ) | $ | - | $ | - | $ | - | $ | 529,823 | ||||||||||||
| Gross profit | $ | 128,056 | $ | 270 | $ | 670 | $ | - | $ | - | $ | - | $ | 128,996 | ||||||||||||||
| Gross profit margin | 19.2 | % | * | * | 19.4 | % | ||||||||||||||||||||||
| Number of visits | 6,150,104 | 6,150,104 | ||||||||||||||||||||||||||
| Salaries and related costs per visit (4) | $ | 62.04 | $ | - | $ | (0.11 | ) | $ | - | $ | - | $ | - | $ | 61.93 | |||||||||||||
| Operating costs per visit (4)(5) | $ | 86.30 | $ | (0.04 | ) | $ | (0.11 | ) | $ | - | $ | - | $ | - | $ | 86.15 | ||||||||||||
| Operating income | $ | 86,677 | $ | 270 | $ | 670 | $ | 1,239 | $ | 1,490 | $ | (6,244 | ) | $ | 84,102 |
| For the Year Ended December 31, 2024 | ||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Reported (GAAP) | Adjustments | Adjusted (Non-GAAP) | ||||||||||||||||||||||||||
| Clinic Closure Costs | Metro Incentive Costs (1) | Business Acquisition Related Costs (2) | Impairment of Assets Held for Sale | Change in Fair Value of Contingent Earn- out Consideration | ||||||||||||||||||||||||
| (in thousands, except per visit data and percentages) | ||||||||||||||||||||||||||||
| Segment information - Physical Therapy Operations | ||||||||||||||||||||||||||||
| Salaries and related costs (4) | $ | 330,095 | $ | - | $ | (218 | ) | $ | - | $ | - | $ | - | $ | 329,877 | |||||||||||||
| Operating costs (4)(5) | $ | 460,694 | $ | (4,355 | ) | $ | (218 | ) | $ | - | $ | - | $ | - | $ | 456,121 | ||||||||||||
| Gross profit | $ | 105,914 | $ | 4,355 | $ | 218 | $ | - | $ | - | $ | - | $ | 110,487 | ||||||||||||||
| Gross profit margin | 18.4 | % | * | * | 19.2 | % | ||||||||||||||||||||||
| Number of visits | 5,353,189 | 5,353,189 | ||||||||||||||||||||||||||
| Salaries and related costs per visit (4) | $ | 61.66 | $ | - | $ | (0.04 | ) | $ | - | $ | - | $ | - | $ | 61.62 | |||||||||||||
| Operating costs per visit (4)(5) | $ | 86.06 | $ | (0.81 | ) | $ | (0.04 | ) | $ | - | $ | - | $ | - | $ | 85.21 | ||||||||||||
| Operating income | $ | 62,994 | $ | 4,355 | $ | 218 | $ | 819 | $ | 2,418 | $ | 219 | $ | 71,023 |
(1) Certain earnout bonuses and incentive costs related to the Metro acquisition.
(2) Includes expenses related to the acquisitions of equity interests in certain partnerships.
(3) Includes costs related to a one-time financial and human resources systems upgrade.
(4) Excludes costs related to management contracts.
(5) Amortization of certain intangible assets was reallocated between the physical therapy operations and IIP segments. Prior year amounts were reallocated to conform with current
presentation.
* Not meaningful
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Physical Therapy Operations
| For the Year Ended | Variance | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | $ | % | |||||||||||||
| (In thousands, except percentages) | ||||||||||||||||
| Revenue related to: | ||||||||||||||||
| Mature Clinics (1) | $ | 523,588 | $ | 523,203 | $ | 385 | 0.1 | % | ||||||||
| Clinic additions (2) | 123,074 | 25,262 | 97,812 | 387.2 | % | |||||||||||
| Clinics sold or closed (3) | 3,767 | 12,088 | (8,321 | ) | (68.8 | )% | ||||||||||
| Net Patient Revenue | 650,429 | 560,553 | 89,876 | 16.0 | % | |||||||||||
| Other (4) | 16,160 | 13,880 | 2,280 | 16.4 | % | |||||||||||
| Total | 666,589 | 574,433 | 92,156 | 16.0 | % | |||||||||||
| Operating costs (5)(7) | 538,533 | 468,519 | 70,014 | 14.9 | % | |||||||||||
| Gross profit | $ | 128,056 | $ | 105,914 | $ | 22,142 | 20.9 | % | ||||||||
| Financial and operating metrics (not in thousands): | ||||||||||||||||
| Net rate per patient visit (1) | $ | 105.76 | $ | 104.71 | $ | 1.05 | 1.0 | % | ||||||||
| Patient visits (1) | 6,150,104 | 5,353,189 | 796,915 | 14.9 | % | |||||||||||
| Average daily visits per clinic (1) | 32.2 | 30.4 | 1.8 | 5.9 | % | |||||||||||
| Gross profit margin (7) | 19.2 | % | 18.4 | % | ||||||||||||
| Adjusted gross profit margin (4)(5)(6)(7) | 19.4 | % | 19.2 | % | ||||||||||||
| Adjusted salaries and related costs per visit (6)(8) | $ | 61.93 | $ | 61.62 | $ | 0.31 | 0.5 | % | ||||||||
| Adjusted operating costs per visit (6)(7)(8) | $ | 86.15 | $ | 85.21 | $ | 0.94 | 1.1 | % |
(1) See Glossary of Terms - Revenue Metrics for definition.
(2) Includes 47 owned clinics added during the year ended December 31, 2025 and 96 owned clinics added during the year ended December 31, 2024. See Clinic Count Roll Forward on page 34 for additional
information.
(3) Includes 23 owned clinics closed during the year ended December 31, 2025 and 45 owned clinics closed during the year ended December 31, 2024. See Clinic Count Roll Forward on page 34 for additional
information.
(4) Includes revenues from management contracts.
(5) Includes costs from management contracts.
(6) Excludes $0.9 million for the 2025 Year Ended and $4.6 million for the 2024 Year Ended of certain incentive costs related to the Metro acquisition and gains or losses related to clinic closures, as
applicable. See the reconciliation of non-GAAP measures to the most directly comparable GAAP measure on page 40.
(7) Amortization of certain intangible assets was reallocated between the physical therapy operations and IIP segments. Prior year amounts were reallocated to conform with current presentation.
(8) Per visit costs exclude management contract costs.
(9) Not meaningful.
Revenues
Net revenue from physical therapy operations increased $92.2 million, or 16.0% in the 2025 Year versus the comparable prior year period. Additionally, net rate per patient visit increased to $105.76 for the
2025 Year from $104.71 for the 2024 Year. Gross profit from physical therapy operations increased $22.1 million, or 20.9%, to $128.0 million for the 2025 Year from $105.9 million for the 2024 Year. Excluding certain incentive costs related
to the Metro acquisition, which occurred on October 31, 2024, and clinic closures costs, adjusted gross profit (a non-GAAP measure), increased by $18.5 million or 16.8% over the comparable periods. See
the reconciliation of non-GAAP measures to the most directly comparable GAAP measure on page 40.
For the 2025 Year, we had 6,150,104 total patient visits compared to 5,353,189 for the 2024 Year.
Other revenue was $16.2 million for the 2025 Year and $13.9 million for the 2024 Year, of which revenue from, management contracts was $9.6 million for the 2025 Year as compared to $9.8
million for the 2024 Year.
Operating costs
Operating costs increased by $70.0 million or 15.0% to $538.5 million for the 2025 Year from $468.5 million in the 2024 Year. Operating costs were 80.8% of net revenue for
the 2025 Year compared to 81.5% of net revenue for the 2024 Year. Excluding certain incentive costs related to the Metro acquisition and losses related to clinic closures for both periods, total adjusted operating costs per visit
(excluding management contracts) was $86.15 in the 2025 Year compared to $85.21 in the comparable prior year period. See the reconciliation of non-GAAP measures to the most directly comparable GAAP
measure on page 40.
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Salaries and related costs, clinics (excluding management contracts) increased to $381.6 million in the 2025 Year from $330.1 million in the 2024 Year, an increase of $51.5
million, or 15.6% mostly due to the clinics added since the comparable prior year period. Excluding certain incentive costs related to the Metro acquisition and losses related to clinic closures, adjusted salaries and related costs per visit was $61.93 in the 2025 Year compared to $61.62 in the comparable prior period. See the reconciliation of non-GAAP measures to the most directly comparable GAAP measure on page 40.
Rent, supplies, contract labor and other costs, related to clinics (excluding management contracts) increased to $123.5 million in the 2025 Year from $104.6 million in the 2024 Year, an
increase of $19.0 million, or 18.1% mostly due to clinic additions.
Depreciation and amortization increased to $17.8 million in 2025 Year from $14.8 million in the 2024 Year, an increase of $3.1 million, or 20.7%, primarily due to clinic additions in the
2025 Year compared to the 2024 Year. Amortization of certain intangible assets was reallocated between the physical therapy operations and IIP segments. Prior year amounts were reallocated to conform with current presentation.
Clinic closure costs for the 2025 Year were $0.3 million compared to $4.4 million in the 2024 Year. We closed 45 underperforming clinics in the 2024 Year compared to
23 clinics in the 2025 Year.
The provision for credit losses was $7.6 million for the 2025 Year and $6.9 million for the 2024 Year. As a percentage of net patient revenues, the provision for credit losses was 1.2%
for both the 2025 Year and the 2024 Year.
Gross Profit
Gross profit from physical therapy operations increased $22.1 million or 20.9% to $128.1 million, or 19.2% as a percent of net revenues, for the 2025 Year as compared to $105.9 million, or 18.4% as a percent
of net revenues, for the 2024 Year. Excluding certain incentive costs related to the Metro acquisition and clinic closure costs for both periods of $0.9 million, the adjusted gross profit margin ( a non-GAAP measure) increased $18.5 million, or 16.8%, to $129.0 million, or 19.4% as a percent of net revenues for the 2025 Year compared to $110.5 million, or 19.2% as a percent
of net revenues, for the 2024 Year. See the reconciliation of non-GAAP measures to the more directly comparable GAAP measure provided on page 40 for more information.
Industrial Injury Prevention Services
| For the Year Ended | Variance | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | $ | % | |||||||||||||
| (In thousands, except percentages) | ||||||||||||||||
| Net revenue | $ | 114,401 | $ | 96,912 | $ | 17,489 | 18.0 | % | ||||||||
| Operating costs (1) | 92,764 | 78,905 | 13,859 | 17.6 | % | |||||||||||
| Gross profit | $ | 21,637 | $ | 18,007 | $ | 3,630 | 20.2 | % | ||||||||
| Gross profit margin | 18.9 | % | 18.6 | % |
(1) Amortization of certain intangible assets was reallocated between the physical therapy operations and IIP segments. Prior year amounts were reallocated to conform with current presentation.
Revenues from IIP increased $17.5 million, or 18.0%, $114.4 million for the 2025 Year from $96.9 million for the 2024 Year. Gross profit from IIP operations increased $3.6 million, or 20.2%, to $21.6 million
for the 2025 Year from $18.0 million in the 2024 Year. The gross profit margin from IIP operations was 18.9% for the 2025 Year compared to 18.6% for the 2024 Year. Excluding the IIP acquisition made in April 2024, IIP revenue increased by
$10.7 million in the 2025 Year and gross profit margin increased $1.5 million or 9.1% in the 2025 Year over the comparable prior year period.
Corporate Office Costs
We are in the process of implementing a new enterprise resource planning (“ERP”) system designed to support certain human resources and accounting functions. The
implementation is intended to enhance system integration, standardize processes, and improve operational efficiency and reporting capabilities. We expect to continue the phased implementation of the ERP system over time while maintaining
existing systems and controls during the transition. Corporate office costs were $69.3 million for the 2025 Year compared to $58.3 million for the 2024 Year. As a percentage of net revenue, corporate office costs were 8.9% and
8.7% over the same periods, respectively. Excluding acquisition integration costs and the costs associated with the implementation of the new financial and human resources system of $2.4 million and $0.8 million in the comparative years,
corporate office costs was 8.6% of net revenue for the 2025 Year and the 2024 Year.
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Impairment of Goodwill and Other Intangible Assets, and Assets Held for Sale
During the 2024 Year, we recorded a non-cash impairment charge of $2.4 million related to the impairment of assets held for sale. There were no non-cash impairment charges for the 2025 Year.
Operating Income
Operating income was $86.7 million for the Year 2025 compared to $63.0 million for the 2024 Year. Excluding certain costs described above, adjusted operating income (a non-GAAP measure) increased to $84.1
million for the Year 2025 from $71.0 million for the 2024 Year, an increase of 18.4%. See the reconciliation of non-GAAP measures to the most directly comparable GAAP measure on page 40.
Other (Expenses) Income
Interest Expense, Debt and Other
Interest expense, debt and other was $9.5 million compared to $8.0 million in the 2024 Year as a result of increased borrowings for the 2025 Year. The interest rate on the Company’s credit facilities was 5.0%
for the 2025 Year and 4.7% for the 2024 Year, with an all-in effective interest rate on the credit facilities (including all associated costs), of 5.6% and 5.5% over the same periods, respectively.
Interest income from investment
Interest income from investment amounted to $0.1 million for the 2025 Year and $3.9 million for the 2024 Year.
Change in fair value of contingent earn-out consideration and put-right liabilities
We revalued contingent earn-out consideration related to certain acquisitions and recognized a net gain (a decrease in the related liabilities) of $6.2 million for
the 2025 Year compared to a net loss of $0.2 million for the 2024 Year (an increase in the related liabilities).
For the 2025 Year, we revalued a put-right liability related to the future purchase of an IIP business and recognized a net non-cash expense (an increase in the
related liability) of $1.3 million compared to a net non-cash expense of $0.1 million for the 2024 Year.
Equity in earnings of unconsolidated affiliate
We recognized income of $1.5 million for the 2025 Year and $1.0 million for the 2024 Year from a joint venture which provides physical therapy services for patients at hospitals. Since we
are deemed to not have a controlling interest in the joint venture, our investment is accounted for using the equity method of accounting.
Provision for Income Taxes
The provision for income tax was $19.8 million, or an effective tax rate of 33.4%, for the 2025 Year and $14.6 million, or an effective tax rate of 31.7%, for the 2024 Year. Income tax expense for the 2025
Year included an adjustment of $1.2 million to revalue the Company’s deferred tax assets and liabilities using the most current statutory income tax rate. The following table shows the calculation of our effective tax rate for the periods
presented.
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| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | |||||||
| (In thousands, except percentages) | ||||||||
| Income before taxes | $ | 77,813 | $ | 60,209 | ||||
| Less: Net income attributable to non-controlling interest: | ||||||||
| Redeemable non-controlling interest - temporary equity | (13,849 | ) | (10,044 | ) | ||||
| Non-controlling interest - permanent equity | (4,573 | ) | (4,132 | ) | ||||
| $ | (18,422 | ) | $ | (14,176 | ) | |||
| Income before taxes less net income attributable to non-controlling interest | $ | 59,391 | $ | 46,033 | ||||
| Provision for income taxes | $ | 19,808 | $ | 14,609 | ||||
| Effective income tax rate | 33.4 | % | 31.7 | % |
Net Income Attributable to Non-controlling Interest
Net income attributable to redeemable non-controlling interest (temporary equity) was $13.8 million for the 2025 Year and $10.0 million for the 2024 Year. Net income attributable to
non-controlling interest (permanent equity) was $4.6 million for the 2025 Year and $4.1 million for the 2024 Year.
Other Comprehensive Income
We entered into an interest rate swap agreement in May 2022, which became effective on June 30, 2022. The maturity date of the swap agreement is June 30, 2027. It has a $150 million
notional value adjusted concurrently with scheduled principal payments made on the term loan. Beginning in July 2022, we pay a fixed one-month Secured Overnight Financing Rate (“SOFR”) of interest of 2.815%. The total interest rate in any
period also includes an applicable margin based on the Company’s consolidated leverage ratio. Unrealized gains and losses related to the fair value of the interest rate swap are recorded to accumulated other comprehensive income (loss), net
of tax.
The fair value of the interest rate swap was $0.9 million, and $3.8 million at December 31, 2025 and December 31, 2024 respectively, which has been included within other assets (current
and long term) in the Consolidated Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statements of Comprehensive Income was an unrealized loss of less than $2.1 million, net of tax, for the 2025 Year and
an unrealized gain of less than $0.1 million, net of tax, for the 2024 Year.
LIQUIDITY AND CAPITAL RESOURCES
We believe that our business has sufficient cash to allow us to meet our short-term cash requirements. Total cash and cash equivalents were $35.6 million as of December 31, 2025, compared
to $41.4 million as of December 31, 2024.
Additionally, we had $161.8 million of outstanding borrowings and $144.5 million in available credit under our Senior Credit Facilities as of December 31, 2025, compared to $151.6 million
of outstanding borrowings and $164.0 million in available credit under our Senior Credit Facilities as of December 31, 2024.
We believe that our cash and cash equivalents and availability under our Senior Credit Facilities are sufficient to fund the working capital needs of our operating subsidiaries through at
least February 27, 2027.
As of December 31, 2025, we had $35.6 million of cash on hand. We plan to continue developing new clinics and making additional acquisitions. We have, from time to time, purchased from
or sold to our limited partners non-controlling interests in our existing partnerships. We may purchase or sell additional non-controlling interests in the future. Generally, any acquisition or purchase of non-controlling interests is
expected to be accomplished using our cash, financing, or a combination of the two.
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We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts. Claims are submitted to payors daily, weekly or monthly
in accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time-consuming and typically involves the submission of claims to multiple payors whose payment of claims
may be dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting CMS approval initially may not be
submitted for six months or more. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor
type receivables, the write-off generally occurs after the balance has been outstanding for 120 days or longer. As of December 31, 2025, we have accrued $6.5 million related to credit balances (including in accrued expenses), a portion of
which is due to patients and payors. The credit balances are expected to be resolved or paid in the next twelve months.
The average accounts receivable days outstanding was 31 days on December 31, 2025, and December 31, 2024. Net patient receivables in the amounts of $7.3 million and $6.1 million were
written off in 2025 and 2024, respectively.
We continue to return cash to stockholders through dividends and share repurchases. In November 2025, the Board of Directors authorized a fourth quarter dividend payment of
$0.45 per share. The Board of Directors approved a share repurchase program effective August 5, 2025. The program authorizes the repurchase by the Company of up to $25.0 million of its
outstanding shares of common stock over the period ending on December 31, 2026. Under the share repurchase program, shares may be repurchased from time to time in the open market or negotiated transactions at prevailing market rates, or
by other means in accordance with federal securities laws. The timing and amount of share repurchases under the share repurchase program, if any, will depend on several factors, including the Company’s stock price performance, ongoing
capital allocation priorities and general market conditions. We repurchased 81,322 of our own shares for total consideration of $5.6 million on the open market during the three and twelve months ended December 31, 2025.
Cash Flow
A summary of our operating, investing, and financing activities is discussed below.
| Year Ended | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2025 | December 31, 2024 | December 31, 2023 | ||||||||||
| Net cash provided by operating activities | $ | 75,058 | $ | 74,940 | $ | 81,978 | ||||||
| Net cash used in investing activities | (36,713 | ) | (149,450 | ) | (45,015 | ) | ||||||
| Net cash (used in) provided by financing activities | (44,137 | ) | (36,953 | ) | 84,268 |
Operating Activities
Cash provided by operating activities increased $0.2 million to $75.1 million for the year ended December 31, 2025, as compared to $74.9 million for the year ended December 31, 2024.
Investing Activities
Cash used in investing activities during the year ended December 31, 2025, totaled $36.7 million and consisted of $25.9 million used in the purchase of majority interests in businesses
and non-controlling interest, temporary and permanent equity, and $14.1 million of fixed assets purchases. These uses were partially offset by $1.4 million received in distributions from an unconsolidated affiliate.
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Financing Activities
Cash used in financing activities during the year ended December 31, 2025, totaled $44.1 million and primarily consisted of $27.4 million of dividends paid to our shareholders, $19.3
million of distributions to non-controlling interests, $9.4 million of payments on the term loan, and $5.6 million paid for the repurchase of common stock. These uses were partially offset by new borrowings of approximately $19.5 million on
our Senior Credit Facilities.
Senior Credit Facilities
On December 5, 2013, we entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended and/or restated
in August 2015, January 2016, March 2017, November 2017, and January 2021.On June 17, 2022, we entered into the Third Amended and Restated Credit Agreement (the “Credit Agreement”) among Bank of America, N.A., as administrative agent
(“Administrative Agent”) and the lenders from time-to-time party thereto.
The Credit Agreement, which matures on June 17, 2027, provides for loans in an aggregate principal amount of $325 million. Such loans will be available through the following facilities
(collectively, the “Senior Credit Facilities”):
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| 1) | Revolving Facility: $175 million, five-year, revolving credit facility (“Revolving Facility”), which includes a $12 million sublimit for the issuance of standby letters of credit and a $15 million sublimit for swingline loans (each, a “Swingline Loan”). |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| 2) | Term Facility: $150 million term loan facility (the “Term Facility”). The Term Facility amortizes in quarterly installments of: (a) 0.625% in each of the first two years, (b) 1.250% in the third and fourth year, and (c) 1.875% in the fifth year of the Credit Agreement. The remaining outstanding principal balance of all term loans is due on the maturity date. |
The proceeds of the Revolving Facility have been and shall continue to be used by us for working capital and other general corporate purposes of our Company and its subsidiaries,
including to fund future acquisitions and invest in growth opportunities. The proceeds of the Term Facility were used by us to refinance the indebtedness outstanding under the Second Amended and Restated Credit Agreement, to pay fees and
expenses incurred in connection with the loan facilities transactions, for working capital and other general corporate purposes.
We are permitted to increase the Revolving Facility and/or add one or more tranches of term loans in an aggregate amount not to exceed the sum of (i) $100 million plus (ii) an unlimited
additional amount, provided that (in the case of clause (ii)), after giving effect to such increases, the pro forma Consolidated Leverage Ratio (as defined in the Credit Agreement) would not exceed 2.0:1.0, and the aggregate amount of all
incremental increases under the Revolving Facility does not exceed $50,000,000.
The interest rates per annum applicable to the Senior Credit Facilities (other than in respect of Swingline Loans) will be Term SOFR as defined in the agreement plus an applicable margin
or, at our option, an alternate base rate plus an applicable margin.
We also pay to the Administrative Agent, for the account of each lender under the Revolving Facility, a commitment fee equal to the actual daily excess of each lender’s commitment over
its outstanding credit exposure under the Revolving Facility (“unused fee”). We may prepay and/or repay the revolving loans and the term loans, and/or terminate the revolving loan commitments, in whole or in part, at any time without
premium or penalty, subject to certain conditions.
The Credit Agreement contains customary covenants limiting, among other things, the incurrence of additional indebtedness, the creation of liens, mergers, consolidations, liquidations and
dissolutions, sales of assets, dividends, and other payments in respect of equity interests, acquisitions, investments, loans and guarantees, subject, in each case, to customary exceptions, thresholds and baskets. The Credit Agreement
includes certain financial covenants which include the Consolidated Fixed Charge Coverage Ratio and the Consolidated Leverage Ratio, as defined in the Credit Agreement. The Credit Agreement also contains customary events of default.
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Our obligations under the Credit Agreement are guaranteed by our wholly owned material domestic subsidiaries (each, a “Guarantor”), and our obligations and any Guarantors are secured by a
perfected first priority security interest in substantially all of our existing and future personal property and each Guarantor, subject to certain exceptions.
As of December 31, 2025, $131.3 million was outstanding on the Term Facility while $30.5 million was outstanding under the Revolving Facility, resulting in $144.5 million of credit
availability. As of December 31, 2025, we were in compliance with all of the covenants contained in the Credit Agreement. The interest rate for the 2025 Year on our Senior Credit Facilities, net of savings from the interest rate swap
described below, was 5.0%, with an all-in interest rate, including all associated costs, of 5.6%. Interest is payable at the end of the selected interest period but no less frequently than quarterly and on the date of maturity.
Interest Rate Swap
In May 2022, we entered into an interest rate swap agreement, effective on June 30, 2022, with Bank of America, N.A, which became effective on June 30, 2022. It has a $150 million
notional value adjusted concurrently with scheduled principal payments made on the term loan and has a maturity date of June 30, 2027. Beginning in July 2022, we receive 1-month SOFR, and pay a fixed rate of interest of 2.815% on 1-month
SOFR on a quarterly basis. The total interest rate in any period also includes an applicable margin based on our consolidated leverage ratio. In connection with the swap, no cash was exchanged between us and the counterparty.
We designated our interest rate swap as a cash flow hedge and structured it to be highly effective. Consequently, unrealized gains and losses related to the fair value of the interest
rate swap are recorded to accumulate other comprehensive income (loss), net of tax.
As of December 31, 2025, the fair value of the interest rate swap was $0.9 million, a decrease of $2.1 million, net of any income tax effect, as compared to December 31, 2024. The fair
value of the interest rate swap is included in other assets (current and long term) in our consolidated balance sheet while the increase in fair value is presented as unrealized loss in our consolidated statements of comprehensive income.
The interest rate swap arrangement generated $2.0 million in interest savings for the 2025 Year.
Notes Payable and Deferred Payments Related to Acquisitions
We generally enter into various notes payable as a means of financing our acquisitions. Our present outstanding notes payable primarily relate to the acquisitions of a business or
acquisitions of majority interests in such businesses. At December 31, 2025, our remaining outstanding balance on these notes aggregated $1.3 million, of which $0.8 million is payable in 2026, $0.4 million is payable in 2027 and less than
$0.1 million is payable in 2028. Notes are generally payable in equal annual installments of principal over two years plus any accrued and unpaid interest. Interest accrues at various interest rates ranging from 4.5% to 8.5% per annum.
On September 30, 2025, together with a local partner, we acquired a two-clinic practice for a purchase price of $0.4 million, which was paid in cash. As part of this transaction, we
agreed to additional consideration if future objectives are met. The contingent consideration was valued at less than $0.1 million as of December 31, 2025.
On July 31, 2025, we acquired a 60% equity interest in a three-clinic practice with the practice owners retaining a 40% equity interest. The purchase price for the 60% equity interest was approximately $7.9
million, of which $7.6 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and interest is payable on July 31, 2027. As
part of this transaction, we agreed to additional consideration if future operational objectives are met. The contingent consideration was valued at $2.8 million as of December 31, 2025.
On April 30, 2025, we acquired an outpatient home-care physical and speech therapy practice through our 50%-owned subsidiary, Metro. After the transaction, our ownership interest is 40%, our local partners
have a partnership interest of 40% and the practice’s pre-acquisition owners have a 20% ownership interest. The purchase price for the 80% equity interest was approximately $2.3 million which was paid in cash. As part of this transaction, we agreed to additional consideration if future operational objectives are met. The maximum amount of additional contingent consideration due under this agreement is $1.8 million. The contingent
consideration was valued at $1.0 million as of December 31, 2025.
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On February 28, 2025, we acquired a 65% interest in a physical therapy practice with three clinic locations. The prior owners retained a 35% ownership interest. The purchase price for the
65% interest was approximately $3.8 million which was paid in cash. As part of this transaction, we agreed to additional consideration if future operational objectives are met. The maximum amount of additional contingent consideration due
under this agreement is $1.3 million. The contingent consideration was valued at $0.5 million as of December 31, 2025.
On November 30, 2024, we acquired a 75% equity interest in an eight-clinic physical therapy practice. The owner of the practice retained 25% of the equity interests. The purchase price
for the 75% equity interest was approximately $15.9 million, of which $15.7 million was paid in cash, and $0.2 million was in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and interest is due and
payable on December 1, 2026.
On October 31, 2024, we acquired a 50% interest in Metro pursuant to a Equity Interest Purchase Agreement (the “Purchase Agreement”) dated October 7, 2024 among U.S. Physical Therapy,
Ltd. (a subsidiary of the Company), Metro, the members of Metro, and Michael G. Mayrsohn, as Sellers’ Representative. We also became the managing member of Metro. We paid a purchase price of approximately $76.5 million, $75.0 million of
which was funded by our cash on hand and the remaining $1.5 million through the issuance of 18,358 shares of the Company’s common stock based on a trailing five-day average as of the day immediately prior to closing. The shares of the
Company’s common stock were issued in reliance upon exemptions from registration pursuant to Section 4(2) under the Securities Act. The Purchase Agreement also included an earnout where the sellers can earn up to another $20.0 million of
additional consideration if certain performance criteria relating to the Metro business are achieved. The value of the contingent consideration at December 31, 2025 was $7.4 million.
On August 31, 2024, we acquired a 70% equity interest in an eight-clinic practice physical therapy and the original practice owners retained a 30% equity interest. The purchase price for
the 70% equity interest was approximately $2.0 million. As part of the transaction, we agreed to additional contingent consideration if future operational and financial objectives are met. The maximum amount of additional contingent
consideration due under this agreement is $3.6 million. The contingent consideration was valued at $0.5 million on December 31, 2025.
On April 30, 2024, we acquired 100% of an IIP business through one of its primary IIP businesses, Briotix Health Limited Partnership, for a purchase price of approximately $24.0 million,
of which $0.5 million was in the form of a note payable. The principal and the interest has been paid as of December 31, 2025. As part of the transaction, we agreed to additional contingent consideration if future operational objectives are
met by the business. In August 2025, we paid $1.9 million in full settlement of the contingent consideration.
On March 29, 2024, we acquired a 50% equity interest in a nine-clinic physical therapy and hand therapy practice. The original owners of the practice retained the remaining 50%. The
purchase price for the 50% equity interest was approximately $16.4 million, of which $0.5 million was in the form of a note payable. The note accrues interest at 4.5% per annum and the principal and the interest are payable on March 29,
2026. As part of the transaction, we agreed to additional contingent consideration if future operational and financial objectives are met. There is no maximum payout. In November 2025, we paid $2.5 million in full settlement of the
contingent consideration.
On September 29, 2023, we acquired a 70% equity interest in a four-clinic physical therapy practice. The owner of the practice retained 30% of the equity interests. The purchase price for
the 70% equity interest was approximately $6.0 million, of which $5.4 million was paid in cash, and $0.6 million was in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and interest are payable in
two installments. The first payment of principal and interest of $0.3 million was paid in January 2024, and the second installment of $0.3 million was due on September 30, 2025. The final payment of principal and interest of $0.3 million
was paid in August 2025.
In a separate transaction, on September 29, 2023, we acquired a 70% equity interest in a single clinic physical therapy practice. The owner of the practice retained 30% of the equity
interests. The purchase price for the 70% equity interest was approximately $7.8 million, of which $7.4 million was paid in cash and $0.4 million was a deferred payment. The $0.4 million deferred payment was paid in full in September 2025.
On July 31, 2023, we acquired a 70% equity interest in a five-clinic practice. The practice’s owners retained a 30% equity interest. The purchase price for the 70% equity interest was
approximately $2.1 million, of which $1.8 million was paid in cash and $0.3 million is a deferred payment that was due on June 30, 2025. The deferred payment was paid in full in August 2025.
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On May 31, 2023, we and a local partner together acquired a 75% interest in a four-clinic physical therapy practice. After the transaction, our ownership interest is 45%, our local
partner’s ownership interest is 30%, and the practice’s pre-acquisition owners have a 25% ownership interest. The purchase price for the 75% equity interest was approximately $3.1 million, of which $1.7 million was paid in cash by us, $1.1
million was paid in cash by the local partner, and $0.3 million was in the form of a note payable (of which $0.2 million was to be paid by us and $0.1 million was to be paid by the local partner). The note was paid in full on July 1, 2024.
On February 28, 2023, we acquired 80% interest in a one-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for 80% equity
interest was approximately $6.2 million, of which $5.8 million was paid in cash and $0.4 million in the form of a note payable. The note accrued interest at 4.5% per annum. The note was paid in full on February 28, 2025.
Redeemable Non-Controlling Interest
Certain of our limited partnership agreements and operating agreements provide that, upon the triggering events, we have a call right and the selling entity or individual has a put right
for the purchase and sale of the limited partnership interest held by the partner. Once triggered, the put right and the call right do not expire, even upon an individual partner’s death,` and contain no mandatory redemption feature. In
addition, in certain of these limited partnership agreements and operating agreements, the selling entity or individual also has a put right that can be exercised after the passage of a designated period of time or upon a termination of
employment. The purchase price of the underlying equity interest upon the exercise of either the put right or the call right is calculated per the terms of the respective agreements and classified as redeemable non-controlling interest
(temporary equity) in our consolidated balance sheets. The fair value of the redeemable non-controlling interest at December 31, 2025 was $293.3 million.
Contractual Obligations
We have future obligations for debt repayments and associated interest payments as well as future minimum lease payments under our non-cancellable operating leases. The obligations as of
December 31, 2025, are summarized as follows:
| Total | 2026 | 2027 | 2028 | 2029 | 2030 | Thereafter | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (In thousands) | |||||||||||||||||||||||||||
| Company credit facility (1) | $ | 161,750 | $ | 9,375 | $ | 152,375 | $ | - | $ | - | $ | - | $ | - | |||||||||||||
| Notes payable (2) | 1,329 | 841 | 459 | 29 | - | - | - | ||||||||||||||||||||
| Interest expense on Term Facility and notes payable (3) | 7,401 | 5,953 | 1,448 | - | - | - | - | ||||||||||||||||||||
| Operating leases (4) | 205,452 | 58,482 | 46,622 | 34,327 | 23,752 | 15,008 | 27,261 | ||||||||||||||||||||
| $ | 375,932 | $ | 74,651 | $ | 200,904 | $ | 34,356 | $ | 23,752 | $ | 15,008 | $ | 27,261 |
(1) Amounts due under our Company’s Senior Credit Facilities discussed above.
(2) Amounts due related to certain acquisitions discussed above.
(3) Interest on our Senior Credit Facility was estimated using the average outstanding balance for the respective periods and our effective interest rate on our Term Facility for the 2025 Year of 4.7%.
Interest on our other debt was estimated using the stated rate in the debt agreement.
(4) Includes variable non-lease components, including but not limited to common area maintenance.
CRITICAL ACCOUNTING POLICIES
Management’s discussion and analysis of financial condition and results of operations is based upon our consolidated financial statements which have been prepared in accordance with
accounting principles generally accepted in the United States. The preparation of these financial statements requires estimates and judgments that affect the reported amounts of our assets, liabilities, net sales and expenses, and
disclosure of contingent assets and liabilities. Management bases estimates on historical experience and other assumptions it believes to be reasonable given the circumstances and evaluates these estimates on an ongoing basis. Actual
results may differ from these estimates under different assumptions or conditions.
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We believe that the following critical accounting policies involve a higher degree of judgment and complexity. See Item 8, Note 2, Significant Accounting Policies, to our audited
consolidated financial statements which are included elsewhere in this Annual Report on Form 10-K for a complete discussion of our significant accounting policies. The following reflect the significant estimates and judgments used in the
preparation of our consolidated financial statements.
Revenue Recognition
The Company recognizes revenue in accordance with Accounting Standards Codification (“ASC”) 606. For ASC 606, there is an implied contract between the Company and the patient upon each
patient visit. Separate contractual arrangements exist between the Company and third-party payors (e.g. insurers, managed care programs, government programs, workers’ compensation) which establish the amounts the third parties pay on behalf
of the patients for covered services rendered. While these agreements are not considered contracts with the customer, they are used for determining the transaction price for services provided to the patients covered by the third-party
payors. The payor contracts do not indicate performance obligations for the Company but indicate reimbursement rates for patients who are covered by those payors when the services are provided. At that time, the Company is obligated to
provide services for the reimbursement rates stipulated in the payor contracts. The execution of the contract alone does not indicate a performance obligation. For self-paying customers, the performance obligation exists when the Company
provides the services at established rates. The difference between the Company’s established rate and the anticipated reimbursement rate is accounted for as an offset to revenue—contractual allowance. Payments for services rendered are
typically due 30 to 120 days after receipt of the invoice.
Patient revenue
Revenues are recognized in the period in which services are rendered. Net patient revenue consists of revenues from physical therapy and occupational therapy clinics that provide pre-and
post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenue (patient revenues less estimated
contractual allowances – described below) is recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied.
There is an implied contract between us and the patient upon each patient visit. Separate contractual arrangements exist between us and third-party payors (e.g. insurers, managed care programs, government programs, and workers’ compensation
programs) which establish the amounts the third parties pay on behalf of the patients for covered services rendered. While these agreements are not considered contracts with the customer, they are used for determining the transaction price
for services provided to the patients covered by the third-party payors. The payor contracts do not indicate performance obligations for us but indicate reimbursement rates for patients who are covered by those payors when the services are
provided. At that time, we are obligated to provide services for the reimbursement rates stipulated in the payor contracts. The execution of the contract alone does not indicate a performance obligation. For self-paying customers, the
performance obligation exists when we provide the services at established rates. The difference between our established rate and the anticipated reimbursement rate is accounted for as an offset to revenue—contractual allowance.
Other Revenues
Revenue derived from management agreements with physicians and hospitals is included in other revenue in the consolidated statements of net income. We do not have any ownership interest
in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for our employees, are recorded when
incurred.
Revenues from the IIP business, which are included in other revenues in the consolidated statements of net income, are derived from onsite services we provide to clients’ employees
including injury prevention, rehabilitation, ergonomic assessments, and performance optimization. Revenue from the IIP business is recognized when obligations under the terms of the contract are satisfied. Revenues are recognized at an
amount equal to the consideration we expect to receive in exchange for providing injury prevention services to our clients. The revenue is determined and recognized based on the number of hours and respective rate for services provided in a
given period.
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Additionally, other revenue includes services we provide on-site at locations such as schools and industrial worksites for physical or occupational therapy services, athletic trainers and
gym membership fees. Contract terms and rates are agreed to in advance between us and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in
advance, revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time when the services are performed.
Management contract revenue, which is also included in other revenue, is derived from contractual arrangements whereby the Company manages a clinic for unrelated physician groups and
hospitals. Typically, revenue is determined based on the number of visits conducted at the clinic and recognized at a point in time when services are performed. Costs, typically consisting of salaries, are recorded when incurred. Management
contract revenue was $9.6 million for the year ended December 31, 2025 and $9.8 million for the year ended December 31, 2024.
Contractual Allowances
The allowance for estimated contractual adjustments is based on terms of payor contracts and historical collection and write-off experience. Contractual allowances result from the
differences between the rates charged for services performed and expected reimbursements by both insurance companies and government-sponsored healthcare programs for such services. Medicare regulations and the various third-party payors and
managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in Company clinics. The Company estimates contractual allowances based on its interpretation of the applicable
regulations, payor contracts and historical calculations. Each month the Company estimates its contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate
contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on the Company’s historical experience, calculating the contractual allowance reserve percentage at the payor level is
sufficient to allow the Company to provide the necessary detail and accuracy with its collectability estimates. However, the services authorized, provided and related reimbursement are subject to interpretation that could result in payments
that differ from the Company’s estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. The Company’s billing system does not capture the exact change in its
contractual allowance reserve estimate from period to period. In order to assess the accuracy of its revenues, management regularly compares its cash collections to corresponding net revenues measured both in the aggregate and on a
clinic-by-clinic basis. In the aggregate, historically the difference between net revenues and corresponding cash collections for any fiscal year has generally reflected a difference not exceeding 1.5% of net revenues. As a result, the
Company believes that a change in the contractual allowance reserve estimate would not likely be more than 1.0% to 1.5% on any balance sheet date.
Provision for Credit Losses
We determine allowances for credit losses based on the specific agings of receivables and payor classifications at each clinic. The provision for credit losses is included in clinic
operating costs in the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and provision for credit losses, includes only those amounts we
estimate to be collectible. Our provision for credit losses was 1.0% of total net revenue for each years ended December 31, 2025 and 2024, respectively. Management believes that this is reasonable because the majority of our payors
consist of highly solvent, highly regulated, commercial insurance companies as well as government programs, including Medicare.
Goodwill and Other Indefinite-Lived Intangible Assets
Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable
intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the
purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.
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Goodwill and other indefinite-lived intangible assets are not amortized but are instead subject to periodic impairment evaluations. The fair value of goodwill and other identifiable
intangible assets with indefinite lives are evaluated for impairment at least annually and upon the occurrence of certain events or conditions and are written down to fair value if considered impaired. These events or conditions include but
are not limited to a significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating, or cash flow loss combined with a history of such losses or a projection of continuing
losses; or a sale or disposition of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. We evaluate
indefinite-lived tradenames in conjunction with our annual goodwill impairment test.
Impairment of Goodwill, Other Indefinite-Lived Intangible Assets and Long-Lived Assets
We operate our business through two segments consisting of our physical therapy clinics and our IIP business. For purposes of goodwill impairment analysis, each of our segments is further
broken down into reporting units. Reporting units within our physical therapy business comprise of regions primarily based on each clinic’s location. In addition to the seven regions, in 2025 and 2024, the IIP business consisted of two
reporting units.
As part of the impairment analysis, we are first required to assess qualitatively if we can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not
impaired, we are then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less
than its carrying amount, we consider relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. We consider both the income and market approach in determining the fair value of its reporting units
when performing a quantitative analysis.
An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds
the estimated fair value of the reporting unit.
Additionally, we review property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances that indicate the related
amounts may be impaired.
During the year-ended December 31, 2024, we recorded a non-cash impairment charge of $2.4 million related to assets held for sale. There was no non-cash impairment charge in 2025.
We will continue to monitor for any triggering events or other indicators of impairment.
Redeemable Non-Controlling Interest
The non-controlling interests that are reflected as redeemable non-controlling interest in our consolidated financial statements consist of those owners, including us, that have certain
redemption rights, whether currently exercisable or not, and which currently, or in the future, require that we purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met and the owners request
the purchase (“Put Right”). We also have a call right (“Call Right”). Most of the Put Rights or Call Rights may be triggered by the owner or us, respectively, at such time as both of the following events have occurred: 1) termination of the
owner’s employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement. Other
Put Rights may be triggered at the discretion of the owner after a set period of time has passed. The Put Rights and Call Rights are not automatic (even upon death) and require either the owner or us to exercise our rights when the
conditions triggering the Put or Call Rights have been satisfied. The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership
agreements.
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On the date we acquire a controlling interest in a Subsidiary and the limited partnership agreement or operating agreement, as applicable, for such Subsidiary contains redemption rights
not under our control, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption—Redeemable non-controlling interest. Then, in each reporting
period thereafter until it is purchased by us, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial value, based on the predetermined formula defined in the respective limited
partnership agreement. As a result, the value of the non-controlling interest is not adjusted below its initial value. We record any adjustment in the redemption value, net of tax, directly to retained earnings and not in the consolidated
statements of net income. Although the adjustments are not reflected in the consolidated statements of net income, current accounting rules require that we reflect the adjustments, net of tax, in the earnings per share calculation. The
amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statement of income. We believe the redemption value (i.e. the carrying amount) and fair
value are the same.
Non-Controlling Interest
We recognize non-controlling interests, in which we have no obligation but the right to purchase the non-controlling interests, as equity in the consolidated financial statements separate
from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the consolidated statements of net income. Operating losses are allocated to
non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner. When we purchase a non-controlling interest and the purchase differs from the book value at the time of purchase, any
excess or shortfall is recognized as an adjustment to additional paid-in capital.
MD&A history
Prior-year 10-K MD&A spans are extracted from SEC filings with the same bounded parser used for the latest filing. The latest 10-K appears above; prior years are below.
FY 2024 10-K MD&A
SEC filing source: 0001140361-25-006750.
ITEM 7. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion and analysis of U.S. Physical Therapy, Incl and its subsidiaries (herein referred to as “we”, “us”, “our” or the “Company”) should be read in
conjunction with the Company’s consolidated financial statements and accompanying notes included elsewhere in this Annual Report on Form 10-K. Some of the information contained in this discussion and analysis, including information with respect
to our plans and strategy for our business, includes forward-looking statements that involve risks and uncertainties. You should review the “Risk Factors” and “Forward-Looking Statements” sections of this Annual Report on Form 10-K for a
discussion of important factors that could cause actual results to differ materially from the results described in or implied by the forward-looking statements contained in the following discussion and analysis.
This section of this Annual Report on Form 10-K generally discusses 2024 and 2023 items and year-to-year comparisons between 2024 and 2023. Discussions of 2022 items and
year-to-year comparisons between 2023 and 2022 can be found in “Management’s Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 of the Company’s Annual Report on Form 10-K for the fiscal year ended
December 31, 2023, filed with the Securities and Exchange Commission on February 29, 2024.
EXECUTIVE SUMMARY
U.S. Physical Therapy, Inc. and our subsidiaries (collectively, “we”, “us”, “our” or the “Company”), operate our business through two reportable business segments. Our reportable segments consist
of the physical therapy operations segment and the industrial injury prevention services (“IIP”) segment. Through our subsidiaries, we operate and/or manage outpatient physical therapy clinics that provide pre-and post-operative care for a
variety of orthopedic-related disorders and sports-related injuries, treatment for neurological-related injuries and rehabilitation of injured workers. We also have a majority interest in businesses which are leading providers of industrial
injury prevention services. Services provided in this business include onsite injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional capacity evaluations and ergonomic assessments. The majority
of the IIP services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. These services are performed through Industrial Sports Medicine
Professionals, consisting primarily of specialized certified athletic trainers.
During the last three years, we completed the following acquisitions of outpatient physical therapy practices, companies that manage and/or provide administrative services to outpatient physical
therapy practices, and IIP businesses detailed below:
| Acquisition | Date | % Interest Acquired | Number of Clinics | |||
|---|---|---|---|---|---|---|
| November 2024 Acquisition | November 30, 2024 | 75% | 8 | |||
| October 2024 Acquisition | October 31, 2024 | 50% | 50 | |||
| August 2024 Acquisition | August 31, 2024 | 70% | 8 | |||
| April 2024 Acquisition | April 30, 2024 | ** | * | |||
| March 2024 Acquisition | March 29, 2024 | 50% | 9 | |||
| October 2023 Acquisition | October 31, 2023 | *** | * | |||
| September 2023 Acquisition 1 | September 29, 2023 | 70% | 4 | |||
| September 2023 Acquisition 2 | September 29, 2023 | 70% | 1 | |||
| July 2023 Acquisition | July 31, 2023 | 70% | 7 | |||
| May 2023 Acquisition | May 31, 2023 | 45% | 4 | |||
| February 2023 Acquisition | February 28, 2023 | 80% | 1 | |||
| November 2022 Acquisition | November 30, 2022 | 80% | 13 | |||
| October 2022 Acquisition | October 31, 2022 | 60% | 14 | |||
| September 2022 Acquisition | September 30, 2022 | 80% | 2 | |||
| August 2022 Acquisition | August 31, 2022 | 70% | 6 | |||
| March 2022 Acquisition | March 31, 2022 | 70% | 6 |
| Column 1 | Column 2 |
|---|---|
| * | IIP business |
| Column 1 | Column 2 |
|---|---|
| ** | On April 30, 2024, one of our primary IIP businesses, Briotix Health Limited Partnership, acquired 100% of an IIP business. |
| Column 1 | Column 2 |
|---|---|
| *** | On October 31, 2023, we concurrently acquired 100% of an IIP business and a 55% equity interest in an ergonomics software business (“October 2023 Acquisition”). |
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The following table provides a roll forward of our clinic count for the periods presented.
Clinic Count Roll Forward (1)
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | |||||||
| Number of clinics owned or managed, beginning of period | 671 | 640 | ||||||
| Additions (2) | 103 | 46 | ||||||
| Closed or sold | (45 | ) | (15 | ) | ||||
| Number of clinics owned or managed, end of period | 729 | 671 | ||||||
| (1) The Company also manages clinics owned by third parties through management contracts. In addition to the clinic count shown above, as of December 31, 2024, the Company managed 39 clinics bringing the total owned/managed clinics to 768. As of December 31, 2023, the Company managed 43 clinics bringing the total owned/managed clinics to 714. | ||||||||
| (2) Includes clinics added through acquisitions. |
Our strategy is to continue acquiring outpatient physical therapy practices, develop outpatient physical therapy clinics as satellites in existing partnerships, and continue acquiring
companies that manage outpatient physical therapy clinics or provide or serve our IIP sector.
In May 2023, we completed a secondary offering of 1,916,667 shares of its common stock at an offering price of $90.00 per share. Upon completion of the offering, we received net proceeds of
approximately $163.6 million, after deducting an underwriting discount of $8.6 million and recognizing related fees and expenses of $0.2 million. A portion of the net proceeds was used to repay the $35.0 million then outstanding under our
credit agreement while the remainder was used primarily for additional acquisitions.
On February 3, 2025, we completed the sales process that began in 2024 for a business unit within the physical therapy operations segment. In connection with the sales process, the assets and
liabilities of the clinics sold were revalued as of December 31, 2024, and an impairment of approximately $2.4 million was included in the accompanying Consolidated Statements of Net Income in Item 8. The sale closed at a price of $0.7 million.
On February 25, 2025, our Board of Directors raised our quarterly dividend rate from $0.44 per share to $0.45 per share and declared a quarterly dividend for the first quarter of 2025 at the higher rate. The
dividend will be payable on April 11, 2025, to shareholders of record on March 14, 2025.
On February 28, 2025, we acquired a 65% interest in a physical therapy practice with three clinic locations. The prior owners retained a 35% ownership
interest.
Medicare Reimbursement
The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (“MPFS”). Outpatient rehabilitation providers may enroll in Medicare as
institutional outpatient rehabilitation facilities (i.e., rehab agencies) or individual physical or occupational therapists in private practice. The majority of our clinicians are enrolled as individual physical or occupational therapists in
private practice while the remaining balance of providers are reimbursed through enrolled rehab agencies.
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For calendar years 2021, 2022 and 2023, Centers for Medicare and Medicaid Services (“CMS”) expected decreases in Medicare reimbursement were partially offset by one-time increases in payments
as a result of other legislation passed by Congress, resulting in decreases of approximately 3.5%, 0.75% and 2.0% in each of these years, respectively. For January 1 through March 8 of 2024, CMS’s final rule resulted in an approximate 3.5%
decrease in Medicare payments for the therapy specialty. However, effective as of March 9, 2024, pursuant to the Consolidated Appropriations Act, 2024, Congress minimized the reduction in Medicare payments for therapy services for the balance
of 2024, resulting in an approximate 1.8% reduction in Medicare payments for therapy services (rather than the 3.5% decrease). The MPFS proposed by CMS for 2025 will decrease Medicare reimbursement for therapy services by approximately 2.9% as
compared to the reimbursement rates in effect for most of 2024.
In the final 2020 MPFS rule, CMS clarified that when the physical therapist is involved for the entire duration of the service and the physical therapist assistant (“PTA”) provides skilled
therapy alongside the physical therapist, an identification of the PTA’s participation (as denoted by a “CQ modifier”) is not required. Also, when the same service (code) is furnished separately by the physical therapist and PTA, CMS applies
the de minimis standard to each 15-minute unit of codes, not on the total physical therapist and PTA time of the service. For dates of service on and after January 1, 2022, CMS pays for physical therapy and occupational therapy services
provided by PTAs and occupational therapist assistants (“OTAs”) at 85% of the otherwise applicable Part B payment amount. CMS allows a timed service to be billed without a CQ (for PTA’s) or CO (for OTA’s) modifier when a PTA or OTA participates
in providing care, but the physical therapist or occupational therapist meets the Medicare billing requirements without including the PTA’s or OTA’s minutes. This occurs when the physical therapist or occupational therapist provides more
minutes than the 15-minute midpoint. The proposed 2025 MPFS final rule does not contain any policy changes concerning the modifiers for services provided by physical therapy and occupational therapist assistants.
RESULTS OF OPERATIONS
The defined terms with their respective description used in the following discussion are listed below:
Mature clinics are clinics opened or acquired prior to January 1, 2023, and are still operating as of the balance sheet date.
Net rate per patient visit is net patient revenue related to our physical therapy operations divided by total number of patient visits (defined
below) during the periods presented.
Patient visits is the number of unique patient visits during the periods presented.
Average daily visits per clinic is patient visits divided by the number of days in which normal business operations were conducted during the
periods presented and further divided by the average number of clinics in operation during the periods presented.
Clinics are outpatient physical therapy clinics that are either owned or managed by the Company or one of its subsidiaries.
2024 Year period covering the twelve months ended December 31, 2024.
2023 Year period covering the twelve months ended December 31, 2023.
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Full Year 2024 versus Full Year 2023
| For the Year Ended | Variance | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | $ | % | |||||||||||||||||||||
| (In thousands, except percentages) | ||||||||||||||||||||||||
| Net patient revenue | $ | 560,553 | 83.5 | % | $ | 514,556 | 85.1 | % | $ | 45,997 | 8.9 | % | ||||||||||||
| Other revenue | 110,792 | 16.5 | % | 90,246 | 14.9 | % | 20,546 | 22.8 | % | |||||||||||||||
| Net revenue | 671,345 | 100.0 | % | 604,802 | 100.0 | % | 66,543 | 11.0 | % | |||||||||||||||
| Operating Cost: | ||||||||||||||||||||||||
| Salaries and related costs | 399,394 | 59.5 | % | 353,390 | 58.4 | % | 46,004 | 13.0 | % | |||||||||||||||
| Rent, supplies, contract labor and other | 118,910 | 17.7 | % | 108,596 | 18.0 | % | 10,314 | 9.5 | % | |||||||||||||||
| Depreciation and amortization | 17,853 | 2.7 | % | 14,960 | 2.5 | % | 2,893 | 19.3 | % | |||||||||||||||
| Provision for credit losses | 6,912 | 1.0 | % | 6,172 | 1.0 | % | 740 | 12.0 | % | |||||||||||||||
| Clinic closure costs - lease and other | 4,355 | 0.6 | % | 175 | 0.0 | % | 4,180 | * | ||||||||||||||||
| Total operating cost | 547,424 | 81.5 | % | 483,293 | 79.9 | % | 64,131 | 13.3 | % | |||||||||||||||
| Gross Profit | 123,921 | 18.5 | % | 121,509 | 20.1 | % | 2,412 | 2.0 | % | |||||||||||||||
| Corporate office costs | 58,290 | 8.7 | % | 51,953 | 8.6 | % | 6,337 | 12.2 | % | |||||||||||||||
| Impairment of goodwill and other intangible assets | - | 0.0 | % | 17,495 | 2.9 | % | (17,495 | ) | * | |||||||||||||||
| Impairment of assets held for sale | 2,418 | 0.4 | % | - | * | 2,418 | * | |||||||||||||||||
| Operating Income | 63,213 | 9.4 | % | 52,061 | 8.6 | % | 11,152 | 21.4 | % | |||||||||||||||
| Other (expense) income: | ||||||||||||||||||||||||
| Interest expense, debt and other | (8,015 | ) | -1.2 | % | (9,303 | ) | -1.5 | % | 1,288 | -13.8 | % | |||||||||||||
| Interest income from investments | 3,941 | 0.6 | % | 3,774 | 0.6 | % | 167 | 4.4 | % | |||||||||||||||
| Change in fair value of contingent earn-out consideration | (219 | ) | 0.0 | % | (1,550 | ) | -0.3 | % | 1,331 | -86 | % | |||||||||||||
| Change in revaluation of put-right liability | (82 | ) | 0.0 | % | 2,582 | 0.4 | % | (2,664 | ) | -103.2 | % | |||||||||||||
| Equity in earnings of unconsolidated affiliate | 1,014 | 0.2 | % | 955 | 0.2 | % | 59 | 6.2 | % | |||||||||||||||
| Relief Funds | - | 0.0 | % | 467 | 0.1 | % | (467 | ) | * | |||||||||||||||
| Other | 357 | 0.1 | % | 390 | 0.1 | % | (33 | ) | -8.5 | % | ||||||||||||||
| Total other expense | (3,004 | ) | -0.4 | % | (2,685 | ) | -0.4 | % | (319 | ) | 11.9 | % | ||||||||||||
| Income before taxes | 60,209 | 9.0 | % | 49,376 | 8.2 | % | 10,833 | 21.9 | % | |||||||||||||||
| Provision for income taxes | 14,609 | 2.2 | % | 12,156 | 2.0 | % | 2,453 | 20.2 | % | |||||||||||||||
| Net income | 45,600 | 6.8 | % | 37,220 | 6.2 | % | 8,380 | 22.5 | % | |||||||||||||||
| Less: Net income attributable to non-controlling interest: | ||||||||||||||||||||||||
| Redeemable non-controlling interest - temporary equity | (10,044 | ) | -1.5 | % | (4,426 | ) | -0.7 | % | (5,618 | ) | 126.9 | % | ||||||||||||
| Non-controlling interest - permanent equity | (4,132 | ) | -0.6 | % | (4,555 | ) | -0.8 | % | 423 | -9.3 | % | |||||||||||||
| (14,176 | ) | -2.1 | % | (8,981 | ) | -1.5 | % | (5,195 | ) | 57.8 | % | |||||||||||||
| Net income attributable to USPH shareholders | $ | 31,424 | 4.7 | % | $ | 28,239 | 4.7 | % | $ | 3,185 | 11.3 | % |
| Column 1 | Column 2 |
|---|---|
| * | Not meaningful |
Total net revenue 2024 Year increased $66.5 million, or 11.0%, to $671.3 million from $604.8 million for the 2023 Year while operating costs increased $64.1 million, or 13.3%, to $547.4 million from $483.3
million over the same periods, respectively. These increases were primarily due to the increase in visits from the 58 net new clinic additions during 2024 Year.
Gross profit, which included $4.4 million of costs associated with the 45 clinic closures, was $123.9 million, or 18.5% of net revenue, during the 2024 Year compared to $121.5 million, or 20.1% of net revenue,
for the 2023 Year. Excluding the clinic closure costs, Adjusted gross profit (1), for the 2024 Year was $128.3 million, or 19.1% of net revenue, compared to
$121.7 million, or 20.1% of net revenue, for the 2023 Year.
USPH Net Income was $31.4 million for the 2024 Year compared to $28.2 million for the 2023 Year. For the 2024 Year, USPH Net Income included a charge of $4.4 million (prior to allocation of the related minority interest and income taxes) related
to the closure of 45 underperforming clinics, a non-cash charge of $2.4 million (prior to allocation of income taxes) related to the impairment of assets held for sale and a $1.0 million true-up of income tax expense. For the 2023 Year, USPH Net
Income included a charge of $17.5 million (prior to the allocation of minority interest and income taxes) related to the impairment of goodwill and other intangible assets.
In accordance with GAAP, the revaluation of noncontrolling interest, net of taxes, is not included in net income but is charged directly to retained earnings; however, this change is included in the computation
of earnings per share. Earnings per share, was $1.84 for the 2024 Year compared to $1.28 in the 2023 Year.
| Column 1 | Column 2 |
|---|---|
| (1) | These are non-GAAP Measures. See below for the definition and reconciliation of non-GAAP measures to the most directly comparable GAAP measure. |
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The table below shows the calculation of earnings per share for the periods presented.
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | |||||||
| (In thousands, except per share data) | ||||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 31,424 | $ | 28,239 | ||||
| Charges to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (4,964 | ) | (13,565 | ) | ||||
| Tax effect at statutory rate (federal and state) | 1,268 | 3,466 | ||||||
| $ | 27,728 | $ | 18,140 | |||||
| Earnings per share (basic and diluted) | $ | 1.84 | $ | 1.28 | ||||
| Shares used in computation: | ||||||||
| Basic and diluted earnings per share - weighted-average shares | 15,064 | 14,188 |
Non-GAAP Measures
The following tables provide details of the basic and diluted earnings per share computation and reconcile net income attributable to USPH shareholders calculated in accordance with GAAP to Adjusted EBITDA,
Operating Results and other non-GAAP measures. Management believes providing Adjusted EBITDA, Operating Results, and other non-GAAP measures to investors is useful information for comparing the Company’s period-to-period results as well as for
comparing with other similar businesses since most do not have redeemable instruments and therefore have different equity structures. Additionally, management believes that these non-GAAP measures provide useful supplemental information to
investors, analysts, and other stakeholders in assessing the Company’s operational performance and financial trends. Management uses Adjusted EBITDA, Operating Results and other non-GAAP measures, which eliminate certain items described above
that can be subject to volatility and unusual costs, as the principal measures to evaluate and monitor financial performance period over period.
Adjusted EBITDA, a non-GAAP measure, is defined as net income attributable to our shareholders before interest income, interest expense, taxes, depreciation, amortization, change in fair value of contingent
earn-out consideration, payments received from the federal government under the Corona virus Aid, Relief and Economic Security Act (“Relief Funds”), non-cash impairment charges, changes in revaluation of put-right liability, equity-based awards
compensation expense, clinic closure costs, business acquisition related costs and other income and related portions for non-controlling interests.
Operating Results, a non-GAAP measure, equals net income attributable to our shareholders less, changes in revaluation of a put-right liability, Relief Funds, non-cash impairment charges, clinic closure costs,
changes in fair value of contingent earn-out consideration, business acquisition related costs and any allocations to non-controlling interests, all net of taxes. Operating Results per share also excludes the impact of the revaluation of
redeemable non-controlling interest and the associated tax impact.
Adjusted EBITDA, Operating Results and other non-GAAP measures presented are not measures of financial performance under GAAP. Adjusted EBITDA, Operating Results and other non-GAAP measures should not be
considered in isolation or as an alternative to, or substitute for, net income attributable to our shareholders presented in the consolidated financial statements.
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The tables below define and reconcile non-GAAP Adjusted EBITDA and non-GAAP Operating Results to the most directly comparable GAAP measure.
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | |||||||
| (In thousands, except per share data) | ||||||||
| Adjusted EBITDA (a non-GAAP measure) | ||||||||
| Net income attributable to USPH shareholders | $ | 31,424 | $ | 28,239 | ||||
| Adjustments: | ||||||||
| Provision for income taxes | 14,609 | 12,156 | ||||||
| Depreciation and amortization | 18,681 | 15,695 | ||||||
| Interest expense, debt and other, net | 8,015 | 9,303 | ||||||
| Interest income from investments | (3,941 | ) | (3,774 | ) | ||||
| Impairment of goodwill and other intangible assets | - | 17,495 | ||||||
| Impairment of assets held for sale | 2,418 | - | ||||||
| Equity-based awards compensation expense | 7,823 | 7,236 | ||||||
| Change in revaluation of put-right liability | 82 | (2,582 | ) | |||||
| Change in fair value of contingent earn-out consideration | 219 | 1,550 | ||||||
| Clinic closure costs (1) | 4,355 | 175 | ||||||
| Business acquisition related costs (2) | 819 | - | ||||||
| Relief Funds | - | (467 | ) | |||||
| Other income | (357 | ) | (390 | ) | ||||
| Allocation to non-controlling interests | (2,379 | ) | (6,724 | ) | ||||
| $ | 81,768 | $ | 77,912 | |||||
| Operating Results (a non-GAAP measure) | ||||||||
| Net income attributable to USPH shareholders | $ | 31,424 | $ | 28,239 | ||||
| Adjustments: | ||||||||
| Impairment of goodwill and other intangible assets | - | 17,495 | ||||||
| Impairment of assets held for sale | 2,418 | - | ||||||
| Change in fair value of contingent earn-out consideration | 219 | 1,550 | ||||||
| Change in revaluation of put-right liability | 82 | (2,582 | ) | |||||
| Clinic closure costs (1) | 4,355 | 175 | ||||||
| Business acquisition related costs (2) | 819 | - | ||||||
| Relief Funds | - | (467 | ) | |||||
| Allocation to non-controlling interest | (521 | ) | (5,196 | ) | ||||
| Tax effect at statutory rate (federal and state) | (1,884 | ) | (2,804 | ) | ||||
| $ | 36,912 | $ | 36,410 | |||||
| Operating Results per share (a non-GAAP measure) | $ | 2.45 | $ | 2.57 |
(1) Costs associated with the closure of 45 clinics during the 2024 Year. Closure costs in the 2023 Year were not material.
(2) Primarily consists of legal and consulting expenses related to the acquisition of 50% equity interest in a management services organization that provides management and administrative services to 50
physical therapy clinics.
Adjusted EBITDA (1), a non-GAAP measure, was $81.8 million for the 2024 Year, an increase of $3.9 million, from $77.9 million for
the 2023 Year.
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Operating Results (1), a non-GAAP measure, was $36.9 million for 2024 Year, an increase of $0.5 million, from $36.4 million in the
2023 Year. On a per share basis, Operating Results were $2.45 in the 2024 Year compared to $2.57 in the 2023 Year due to the increase in the number of shares outstanding associated with the Company’s secondary offering completed in May 2023. In
addition, the 2024 Year includes a $1.0 million true-up of income tax expense recorded during the three months ended December 31, 2024.
The tables below reconcile other non-GAAP measures to the most directly comparable GAAP measures.
| For the Year Ended | ||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | |||||||||||||||||||||||||||||||
| As Reported (GAAP) | Closure Costs (1) | Non-Cash Impairment (2) | As Adjusted (Non-GAAP) | As Reported (GAAP) | Closure Costs (1) | Non-Cash Impairment (2) | As Adjusted (Non-GAAP) | |||||||||||||||||||||||||
| (in thousands, except per share data, and percentages) | ||||||||||||||||||||||||||||||||
| Operating costs | $ | 547,424 | $ | (4,355 | ) | $ | - | $ | 543,069 | $ | 483,293 | $ | (175 | ) | $ | - | $ | 483,118 | ||||||||||||||
| Gross profit | 123,921 | 4,355 | - | 128,276 | 121,509 | 175 | - | 121,684 | ||||||||||||||||||||||||
| Gross margin | 18.5 | % | * | * | 19.1 | % | 20.1 | % | * | * | 20.1 | % | ||||||||||||||||||||
| Operating income | 63,213 | 4,355 | 2,418 | 69,986 | 52,061 | 175 | 17,495 | 69,731 | ||||||||||||||||||||||||
| Provision for taxes | 14,609 | (1,113 | ) | (618 | ) | 12,878 | 12,156 | (45 | ) | (3,129 | ) | 8,982 | ||||||||||||||||||||
| Minority interest | (14,176 | ) | 492 | - | (13,684 | ) | (8,981 | ) | 20 | (5,249 | ) | (14,210 | ) | |||||||||||||||||||
| USPH Net Income | 31,424 | 3,734 | 1,800 | 36,958 | 28,239 | 150 | 9,117 | 37,506 | ||||||||||||||||||||||||
| Earnings per share | $ | 1.84 | 0.25 | 0.12 | $ | 2.21 | $ | 1.28 | 0.01 | $ | 0.64 | $ | 1.93 | |||||||||||||||||||
| Segment information - Physical Therapy Operations | ||||||||||||||||||||||||||||||||
| Operating costs | $ | 470,485 | $ | (4,355 | ) | $ | - | $ | 466,130 | $ | 421,484 | $ | (175 | ) | $ | - | $ | 421,309 | ||||||||||||||
| Gross profit | 103,948 | 4,355 | - | 108,303 | 105,064 | 175 | - | 105,239 | ||||||||||||||||||||||||
| Gross margin | 18.1 | % | * | * | 18.9 | % | 20.0 | % | * | * | 20.0 | % |
| Column 1 | Column 2 |
|---|---|
| (1) | Costs associated with the closure of 45 clinics during the 2024 Year. Closure costs for the comparable prior year periods were not material. We believe that presenting this information will allow investors to evaluate the performance of the Company's business more objectively. |
| Column 1 | Column 2 |
|---|---|
| (2) | A non-cash impairment charge of $2.4 million was recognized during the three months ended December 31, 2024, related to the impairment of assets held for sale, while $17.5 million of a non-cash impairment charge was recognized during the three months ended December 31, 2023, related to a reporting unit in the Company’s IIP segment. |
| Column 1 | Column 2 |
|---|---|
| * | Not meaningful |
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Physical Therapy Operations
| For the Year Ended | Variance | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | $ | % | |||||||||||||
| (In thousands, except percentages) | ||||||||||||||||
| Revenue related to: | ||||||||||||||||
| Mature Clinics (1) | $ | 501,304 | $ | 489,233 | $ | 12,071 | 2.5 | % | ||||||||
| Clinic additions (2) | 52,943 | 12,406 | 40,537 | 326.8 | % | |||||||||||
| Clinics sold or closed (3) | 6,306 | 12,917 | (6,611 | ) | (51.2 | )% | ||||||||||
| Net Patient Revenue | 560,553 | 514,556 | 45,997 | 8.9 | % | |||||||||||
| Other (4) | 13,880 | 11,992 | 1,888 | 15.7 | % | |||||||||||
| Total | 574,433 | 526,548 | 47,885 | 9.1 | % | |||||||||||
| Operating costs (4) | 470,485 | 421,484 | 49,001 | 11.6 | % | |||||||||||
| Gross profit | $ | 103,948 | $ | 105,064 | $ | (1,116 | ) | (1.1 | )% | |||||||
| Financial and operating metrics (not in thousands): | ||||||||||||||||
| Net rate per patient visit (1) | $ | 104.71 | $ | 102.80 | $ | 1.91 | 1.9 | % | ||||||||
| Patient visits (1) | 5,353,189 | 5,005,426 | 347,763 | 6.9 | % | |||||||||||
| Average daily visits per clinic (1) | 30.4 | 30.0 | 0.4 | 1.3 | % | |||||||||||
| Gross margin | 18.1 | % | 20.0 | % | ||||||||||||
| Gross margin excluding closure costs, non-GAAP (6) | 18.9 | % | 20.0 | % | ||||||||||||
| Salaries and related costs per visit, clinics (5) | $ | 61.66 | $ | 59.19 | $ | 2.47 | 4.2 | % | ||||||||
| Operating costs per visit, clinics (5) | $ | 86.43 | $ | 82.79 | $ | 3.64 | 4.4 | % | ||||||||
| Operating costs per visit, clinics, excluding closure costs, non-GAAP (6) | $ | 85.61 | $ | 82.75 | $ | 2.86 | 3.5 | % | ||||||||
| Number of clinics at the end of the period | 729 | 671 | 58.0 | 8.6 | % |
| Column 1 | Column 2 |
|---|---|
| (1) | See defined terms above for definitions. |
| Column 1 | Column 2 |
|---|---|
| (2) | Clinic additions during the years ended 2024 and 2023. |
| Column 1 | Column 2 |
|---|---|
| (3) | Revenue from closed clinics includes revenue from the 45 and 15 clinics closed during the full year December 31, 2024 and 2023, respectively. |
| Column 1 | Column 2 |
|---|---|
| (4) | Includes revenues and costs from management contracts. |
| Column 1 | Column 2 |
|---|---|
| (5) | Per visit costs excludes management contract costs. |
| Column 1 | Column 2 |
|---|---|
| (6) | Excludes closure costs during the twelve months ended; refer to reconciliation of non-GAAP measured to most comparable GAAP measures for more information. |
Revenues
Revenues from physical therapy operations increased $47.9 million, or 9.1%, to $574.4 million in the 2024 Year compared to $526.5 million in the 2023 Year. This increase was primarily due to the increase in
volume from the 58 net clinics added since the comparable prior year period, a 1.5% increase in volume at mature clinics and an increase in net rate per patient visit to $104.71 for the 2024 Year from $102.80 for the 2023 Year. The increase in
net rate per patient visit was mainly driven by higher reimbursement rates from commercial and other payors as a result of contract negotiations as well as an increase in workers compensation as a percent of our total net patient revenues.
Other revenue was $13.9 million for the 2024 Year and $12.0 million for the 2023 Year, of which management contracts was $9.8 million for the 2024 Year as compared to $8.6 million for the 2023
Year.
Operating costs
Operating costs increased by $49.0 million or 11.6% to $470.4 million for the 2024 Year from $421.4 million in the 2023 Year. The increase was primarily due to the higher volume from the new
clinics added since the comparable year period as well as increased patient visits in Mature Clinics. On a per visit basis (excluding management contracts), operating costs increased to $86.43 for the 2024 Year compared to $82.79 for the 2023
Year.
Salaries and related costs, clinics (excluding management contracts) increased to $330.1 million in the 2024 Year from $296.3 million in the 2023 Year, an increase of $33.8 million, or 11.4%
mostly due to the new clinics added year over year as well as increased volume from Mature Clinics. Salaries and related costs per visit (excluding management contracts), related to clinics increased to $61.66 for the 2024 Year from 59.19 for
the 2023 Year.
Rent, supplies, contract labor and other costs, related to clinics (excluding management contracts) increased to $104.6 million in the 2024 Year from $97.2 million in the 2023 Year, an
increase of $7.4 million, or 7.6% mostly due to clinic additions. Rent, supplies, contract labor and other per visit (excluding management contracts), related to clinics increased slightly to $19.53 for the 2024 Year from 19.43 for the 2023
Year.
Depreciation and amortization increased to $16.7 million in 2024 Year from $14.5 million in the 2023 Year, an increase of $2.2 million, or 15.1% primarily due to additional clinics in the
2024 Year compared to the 2023 Year.
Clinic closure costs increased to $4.4 million in the 2024 Year from $0.2 million in the 2023 Year, due to the closure of 45 underperforming clinics in the 2024 Year.
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The provision for credit losses was $6.9 million for the 2024 Year and $6.2 million for the 2023 Year. As a percentage of net revenues, the provision for credit losses were 1.0% for both 2024 and
2023.
Gross Profit
Gross profit from physical therapy operations, which included $4.4 million of costs associated with the 45 clinic closures, was $103.9 million, or 18.1% of net revenue, for the 2024 Year compared to $105.1
million, or 20.0% of net revenue, for the 2023 Year. Excluding the clinic closure costs, adjusted physical therapy gross profit(1) was $108.3 million, or 18.9% of net revenue, in the 2024 Year compared to $105.2 million, or 20.0% of
net revenue, in the 2023 Year.
Industrial Injury Prevention Services
| For the Year Ended | Variance | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | $ | % | |||||||||||||
| (In thousands, except percentages) | ||||||||||||||||
| Net revenue | $ | 96,912 | $ | 78,254 | $ | 18,658 | 23.8 | % | ||||||||
| Operating costs | 76,939 | 61,809 | 15,130 | 24.5 | % | |||||||||||
| Gross profit | $ | 19,973 | $ | 16,445 | $ | 3,528 | 21.5 | % | ||||||||
| Gross margin | 20.6% | 21.0% |
Revenues from IIP increased $18.7 million, or 23.8%, to $96.9 million for the 2024 Year from $78.3 million for the 2023 Year. Gross profit from IIP operations increased $3.5 million, or 21.5%, to $20.0 million
for the 2024 Year from $16.4 million for the 2023 Year while the gross profit margin from IIP operations was 20.6% for the 2024 Year compared to 21.0% for the 2023 Year.
Corporate Office Costs
Corporate office costs were $58.3 million, or 8.7% of net revenue, in the 2024 Year, compared to $52.0 million, or 8.6% of net revenue, in the 2023 Year. The increase in corporate
office costs was primarily due to higher salaries and related costs to support the larger number of clinics.
Impairment of Goodwill and Other Intangible Assets, and Assets Held for Sale
A non-cash impairment charge of $2.4 million was recognized during the 2024 Year related to the impairment of assets held for sale while a non-cash impairment charge of $17.5 million was recognized during the
2023 Year related to the reporting unit in the Company’s IIP segment.
Operating Income
Operating income was $63.2 million for the 2024 Year compared to $52.1 million for the 2023 Year. Excluding the clinic closure costs and non-cash impairment charges, adjusted operating income (1) was $70.0 million during the 2024 Year compared to $69.7 million during the 2023 Year.
Other (Expenses) Income
Interest Expense, Debt and Other
Interest expense, debt and other was $8.0 million compared to $9.3 million in the 2023 Year, with the decrease primarily due to lower outstanding borrowings with proceeds from the Company’s secondary offering
completed in May 2023. The interest rate on the Company’s term loan was 4.7% for the 2024 Year and 4.9% for the 2023 Year, with an all-in effective interest rate on the credit facility including all associated costs, of 5.5% and 5.3% over the
same periods, respectively.
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Interest income from investment
Interest income from investment amounted to $3.9 million for the 2024 Year and $3.8 million for 2023 Year. This interest income is a result of investing excess cash associated with proceeds from
our secondary offering completed in May 2023.
Change in fair value of contingent earn-out consideration and put-right liabilities
We revalued contingent earn-out consideration related to certain acquisitions resulting in an expense of $0.2 million for the 2024 Year compared to $1.6 million for the 2023 Year.
For the 2024 Year, we recorded a loss of $0.1 million on the valuation of the put-right liability compared to a $2.6 million gain for the 2023 Year. The put-right relates to the potential future
purchase of a company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area.
Equity in earnings of unconsolidated affiliate
We recognized income of $1.0 million for both the 2024 Year and the 2023 Year from a joint venture which provides physical therapy services for patients
at hospitals. Since we are deemed to not have a controlling interest in the joint venture, our investment is accounted for using the equity method of accounting.
Provision for Income Taxes
The provision for income tax was $14.6 million for the 2024 Year and $12.2 million for the 2023 Year while the effective tax rate was 31.7% and 30.1% over the same periods, respectively. The 2024 Year includes a
$1.0 million true-up of income tax expense. The following table shows the calculation of our effective tax rate for the periods presented.
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | |||||||
| (In thousands, except percentages) | ||||||||
| Income before taxes | $ | 60,209 | $ | 49,376 | ||||
| Less: Net income attributable to non-controlling interest: | ||||||||
| Redeemable non-controlling interest - temporary equity | (10,044 | ) | (4,426 | ) | ||||
| Non-controlling interest - permanent equity | (4,132 | ) | (4,555 | ) | ||||
| $ | (14,176 | ) | $ | (8,981 | ) | |||
| Income before taxes less net income attributable to non-controlling interest | $ | 46,033 | $ | 40,395 | ||||
| Provision for income taxes | $ | 14,609 | $ | 12,156 | ||||
| Effective income tax rate | 31.7 | % | 30.1 | % |
Net Income Attributable to Non-controlling Interest
Net income attributable to redeemable non-controlling interest (temporary equity) was $10.0 million for the 2024 Year and $4.4 million for the 2023 Year. Net income attributable to
non-controlling interest (permanent equity) was $4.1 million for the 2024 Year and $4.6 million for the 2023 Year.
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Other Comprehensive Income
We entered into an interest rate swap agreement in May 2022, which became effective on June 30, 2022. The maturity date of the swap agreement is June 30, 2027. It has a $150 million notional
value adjusted concurrently with scheduled principal payments made on the term loan. Beginning in July 2022, we pay a fixed one-month Secured Overnight Financing Rate (“SOFR”) of interest of 2.815%. The total interest rate in any period also
includes an applicable margin based on the Company’s consolidated leverage ratio. In the 2024 Year, our interest rate including the applicable margin was 4.7%. Unrealized gains and losses related to the fair value of the interest rate swap are
recorded to accumulated other comprehensive income (loss), net of tax.
The fair value of the interest rate swap was $3.8 million, and $3.7 million at December 31, 2024 and December 31, 2023 respectively, which has been included within other assets (current and long
term) in the Consolidated Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statements of Comprehensive Income was an unrealized gain of less than $0.1 million, net of tax, for the 2024 Year and an unrealized
loss of $1.2 million, net of tax, for the 2023 Year.
| Column 1 | Column 2 |
|---|---|
| (1) | These are Non-GAAP Measures. Please see above in the “Non-GAAP Measures” section for the definition and reconciliation of Non-GAAP measures to the most directly comparable GAAP measure. |
LIQUIDITY AND CAPITAL RESOURCES
We believe that our business has sufficient cash to allow us to meet our short-term cash requirements. Total cash and cash equivalents were $41.4 million as of December 31, 2024, compared to
$152.8 million as of December 31, 2023.
Additionally, we had $151.6 million of outstanding borrowings and $164.0 million in available credit under our credit facilities as of December 31, 2024, compared to $144.4 million of outstanding
borrowings and $175.0 million in available credit under our credit facilities as of December 31, 2023.
On May 30, 2023, we completed a secondary offering of our common stock resulting in net proceeds of $163.6 million after deducting fees associated with the transaction. A portion of the net
proceeds was used to repay the $35.0 million then outstanding under our Credit Agreement while the remainder was used primarily for acquisitions from May 2023 through December 2024. Prior to using the cash, our cash was invested in a high-yield
savings account which generated interest income of approximately 3.9 million and $3.8 million in the Year 2024 and Year 2023, respectively.
We believe that our cash and cash equivalents and availability under our Credit Facilities are sufficient to fund the working capital needs of our operating subsidiaries through at least March 3,
2026.
As of December 31, 2024, we had $41.4 million of cash on hand, a significant portion of which is available for deployment into development and other growth initiatives. We plan to continue
developing new clinics and making additional acquisitions. We have, from time to time, purchased from or sold to non-controlling interests of limited partners in our existing partnerships. We may purchase or sell additional non-controlling
interests in the future. Generally, any acquisition or purchase of non-controlling interests is expected to be accomplished using our cash, financing, or a combination of the two.
We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts. Claims are submitted to payors daily, weekly or monthly in
accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time-consuming and typically involves the submission of claims to multiple payors whose payment of claims may be
dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting CMS approval initially may not be submitted for
six months or more. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor type receivables,
the write-off generally occurs after the balance has been outstanding for 120 days or longer. As of December 31, 2024, we have accrued $6.4 million related to credit balances (including in accrued expenses), a portion of which is due to
patients and payors. The credit balances are expected to be resolved or paid in the next twelve months.
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The average accounts receivable days outstanding was 31 days on December 31, 2024, and 29 days on December 31, 2023. Net patient receivables in the amounts of $6.1 million and $6.3 million were
written off in 2024 and 2023, respectively.
Cash Flow
A summary of our operating, investing, and financing activities is discussed below.
| Year Ended | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2024 | December 31, 2023 | December 31, 2022 | ||||||||||
| Net cash provided by operating activities | $ | 74,940 | $ | 81,978 | $ | 58,537 | ||||||
| Net cash used in financing activities | (149,450 | ) | (45,015 | ) | (81,269 | ) | ||||||
| Net cash (used in) provided by financing activities | (36,953 | ) | 84,268 | 25,759 |
Operating Activities
Cash provided by operating activities decreased $7.0 million to $74.9 million for the year ended December 31, 2024, as compared to $82.0 million for the year ended December 31, 2023.
Investing Activities
Cash used in investing activities during the year ended December 31, 2024, totaled $149.5 million and consisted of $142.1 million used in the purchase of majority interests in businesses and
non-controlling interest, temporary and permanent equity, and $9.2 million of fixed assets purchases. These were partially offset by $1.0 million in distributions from an unconsolidated affiliate.
Financing Activities
Cash used in financing activities during the year ended December 31, 2024, totaled $37.0 million and primarily consisted of $26.5 million of dividends paid to our shareholders, $11.8 million of
net payments under our revolving credit facility, and $14.7 million of distributions to non-controlling interests. These uses were partially offset by new borrowings of $19.0 million on our Senior Credit Facilities.
Senior Credit Facilities
On December 5, 2013, we entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended and/or restated in August
2015, January 2016, March 2017, November 2017, and January 2021.On June 17, 2022, we entered into the Third Amended and Restated Credit Agreement (the “Credit Agreement”) among Bank of America, N.A., as administrative agent (“Administrative
Agent”) and the lenders from time-to-time party thereto.
The Credit Agreement, which matures on June 17, 2027, provides for loans in an aggregate principal amount of $325 million. Such loans will be available through the following facilities
(collectively, the “Senior Credit Facilities”):
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| 1) | Revolving Facility: $175 million, five-year, revolving credit facility (“Revolving Facility”), which includes a $12 million sublimit for the issuance of standby letters of credit and a $15 million sublimit for swingline loans (each, a “Swingline Loan”). |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| 2) | Term Facility: $150 million term loan facility (the “Term Facility”). The Term Facility amortizes in quarterly installments of: (a) 0.625% in each of the first two years, (b) 1.250% in the third and fourth year, and (c) 1.875% in the fifth year of the Credit Agreement. The remaining outstanding principal balance of all term loans is due on the maturity date. |
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The proceeds of the Revolving Facility have been and shall continue to be used by us for working capital and other general corporate purposes of our Company and its subsidiaries, including to fund
future acquisitions and invest in growth opportunities. The proceeds of the Term Facility were used by us to refinance the indebtedness outstanding under the Second Amended and Restated Credit Agreement, to pay fees and expenses incurred in
connection with the loan facilities transactions, for working capital and other general corporate purposes.
We are permitted to increase the Revolving Facility and/or add one or more tranches of term loans in an aggregate amount not to exceed the sum of (i) $100 million plus (ii) an unlimited additional
amount, provided that (in the case of clause (ii)), after giving effect to such increases, the pro forma Consolidated Leverage Ratio (as defined in the Credit Agreement) would not exceed 2.0:1.0, and the aggregate amount of all incremental
increases under the Revolving Facility does not exceed $50,000,000.
The interest rates per annum applicable to the Senior Credit Facilities (other than in respect of Swingline Loans) will be Term SOFR as defined in the agreement plus an applicable margin or, at
our option, an alternate base rate plus an applicable margin.
We also pay to the Administrative Agent, for the account of each lender under the Revolving Facility, a commitment fee equal to the actual daily excess of each lender’s commitment over its
outstanding credit exposure under the Revolving Facility (“unused fee”). We may prepay and/or repay the revolving loans and the term loans, and/or terminate the revolving loan commitments, in whole or in part, at any time without premium or
penalty, subject to certain conditions.
The Credit Agreement contains customary covenants limiting, among other things, the incurrence of additional indebtedness, the creation of liens, mergers, consolidations, liquidations and
dissolutions, sales of assets, dividends, and other payments in respect of equity interests, acquisitions, investments, loans and guarantees, subject, in each case, to customary exceptions, thresholds and baskets. The Credit Agreement includes
certain financial covenants which include the Consolidated Fixed Charge Coverage Ratio and the Consolidated Leverage Ratio, as defined in the Credit Agreement. The Credit Agreement also contains customary events of default.
Our obligations under the Credit Agreement are guaranteed by our wholly owned material domestic subsidiaries (each, a “Guarantor”), and our obligations and any Guarantors are secured by a
perfected first priority security interest in substantially all of our existing and future personal property and each Guarantor, subject to certain exceptions.
As of December 31, 2024, $140.6 million was outstanding on the Term Facility while $11.0 million was outstanding under the Revolving Facility, resulting in $164.0 million of credit availability.
As of December 31, 2024, we were in compliance with all of the covenants contained in the Credit Agreement. The interest rate for the 2024 Year on our Senior Credit Facilities, net of savings from the interest rate swap described below, was
4.7%, with an all-in interest rate, including all associated costs, of 5.5%. Interest is payable at the end of the selected interest period but no less frequently than quarterly and on the date of maturity.
Interest Rate Swap
In May 2022, we entered into an interest rate swap agreement, effective on June 30, 2022, with Bank of America, N.A, which became effective on June 30, 2022. It has a $150 million notional value
adjusted concurrently with scheduled principal payments made on the term loan and has a maturity date of June 30, 2027. Beginning in July 2022, we receive 1-month SOFR, and pay a fixed rate of interest of 2.815% on 1-month SOFR on a quarterly
basis. The total interest rate in any period also includes an applicable margin based on our consolidated leverage ratio. In connection with the swap, no cash was exchanged between us and the counterparty.
We designated our interest rate swap as a cash flow hedge and structured it to be highly effective. Consequently, unrealized gains and losses related to the fair value of the interest rate swap
are recorded to accumulate other comprehensive income (loss), net of tax.
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As of December 31, 2024, the fair value of the interest rate swap was $3.8 million, an increase of $0.1 million, net of any income tax effect, as compared to December 31, 2023. The fair value of
the interest rate swap is included in other assets (current and long term) in our consolidated balance sheet while the increase in fair value is presented as unrealized loss in our consolidated statements of comprehensive income. The interest
rate swap arrangement generated $3.4 million in interest savings for the 2024 Year. The average interest rate for the term facility, net of the savings from the swap in the 2024 Year was 4.7%.
Notes Payable and Deferred Payments Related to Acquisitions
We generally enter into various notes payable as a means of financing our acquisitions. Our present outstanding notes payable primarily relate to the acquisitions of a business or acquisitions of
majority interests in such businesses. At December 31, 2024, our remaining outstanding balance on these notes aggregated $3.0 million, of which $2.0 million are payable in 2025, $0.9 million are payable in 2026, and $0.1 million are payable in
2027. Notes are generally payable in equal annual installments of principal over two years plus any accrued and unpaid interest. Interest accrues at various interest rates ranging from 4.0% to 8.5% per annum.
On November 30, 2024, we acquired a 75% equity interest in an eight-clinic physical therapy practice. The owner of the practice retained 25% of the equity interests. The purchase price for the 75%
equity interest was approximately $15.9 million, of which $15.7 million was paid in cash, and $0.2 million was in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and interest is payable in one
installment which is due on December 1, 2026.
On October 31, 2024, we acquired a 50% interest in MSO Metro, LLC (“Metro”) pursuant to a Equity Interest Purchase Agreement (the “Purchase Agreement”) dated October 7, 2024 among U.S. Physical
Therapy, Ltd. (a subsidiary of the Company), Metro, the members of Metro, and Michael G. Mayrsohn, as Sellers’ Representative. We also became the managing member of Metro. We paid a purchase price of approximately $76.5 million, $75.0 million
of which was funded by our cash on hand and the remaining $1.5 million through the issuance of 18,358 shares of the Company’s common stock based on a trailing five-day average as of the day immediately prior to closing. The shares of the
Company’s common stock were issued in reliance upon exemptions from registration pursuant to Section 4(2) under the Securities Act. The Purchase Agreement also included an earnout where the sellers can earn up to another $20.0 million of
additional consideration if certain performance criteria relating to the Metro business are achieved. The value of the contingent consideration at December 31, 2024 was $11.3 million.
On August 31, 2024, we acquired a 70% equity interest in an eight-clinic practice physical therapy and the original practice owners retained a 30% equity interest. The purchase price for the 70%
equity interest was approximately $2.0 million. As part of the transaction, we agreed to additional contingent consideration if future operational and financial objectives are met. The maximum amount of additional contingent consideration due
under this agreement is $3.6 million. The contingent consideration was valued at $3.2 million on December 31, 2024.
On April 30, 2024, we acquired 100% of an IIP business through one of its primary IIP businesses, Briotix Health Limited Partnership, for a purchase price of approximately $24.0 million, of which
$0.5 million was in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and the interest are payable on May 1, 2025. As part of the transaction, we agreed to additional contingent consideration if future
operational objectives are met by the business. The maximum amount of additional contingent consideration due under this agreement is $10.0 million. The contingent consideration was valued at $2.5 million as of December 31, 2024.
On March 29, 2024, we acquired a 50% equity interest in a nine-clinic physical therapy and hand therapy practice. The original owners of the practice retained the remaining 50%. The purchase price
for the 50% equity interest was approximately $16.4 million, of which $0.5 million was in the form of a note payable. The note accrues interest at 4.5% per annum and the principal and the interest are payable on March 29, 2026. As part of the
transaction, we agreed to additional contingent consideration if future operational and financial objectives are met. There is no maximum payout. The contingent consideration was valued at $0.2 million on December 31, 2024.
On September 29, 2023, we acquired a 70% equity interest in a four-clinic physical therapy practice. The owner of the practice retained 30% of the equity interests. The purchase price for the 70%
equity interest was approximately $6.0 million, of which $5.4 million was paid in cash, and $0.6 million was in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and interest are payable in two
installments. The first payment of principal and interest of $0.3 million was paid in January 2024, and the second installment of $0.3 million is due on September 30, 2025.
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In a separate transaction, on September 29, 2023, we acquired a 70% equity interest in a single clinic physical therapy practice. The owner of the practice retained 30% of the equity interests.
The purchase price for the 70% equity interest was approximately $7.8 million, of which $7.4 million was paid in cash and $0.4 million is a deferred payment due on June 30, 2025.
On July 31, 2023, we acquired a 70% equity interest in a five-clinic practice. The practice’s owners retained a 30% equity interest. The purchase price for the 70% equity interest was
approximately $2.1 million, of which $1.8 million was paid in cash and $0.3 million is a deferred payment due on June 30, 2025.
On May 31, 2023, we and a local partner together acquired a 75% interest in a four-clinic physical therapy practice. After the transaction, our ownership interest is 45%, our local partner’s
ownership interest is 30%, and the practice’s pre-acquisition owners have a 25% ownership interest. The purchase price for the 75% equity interest was approximately $3.1 million, of which $1.7 million was paid in cash by us, $1.1 million was
paid in cash by the local partner, and $0.3 million was in the form of a note payable (of which $0.2 million was to be paid by us and $0.1 million was to be paid by the local partner). The note was paid in full on July 1, 2024.
On February 28, 2023, we acquired 80% interest in a one-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for 80% equity interest was
approximately $6.2 million, of which $5.8 million was paid in cash and $0.4 million in the form of a note payable. The note accrues interest at 4.5% per annum and the principal and interest were paid on February 28, 2025.
Redeemable Non-Controlling Interest
Certain of our limited partnership agreements and operating agreements provide that, upon the triggering events, we have a call right and the selling entity or individual has a put right for the
purchase and sale of the limited partnership interest held by the partner. Once triggered, the put right and the call right do not expire, even upon an individual partner’s death, and contain no mandatory redemption feature. In addition, in
certain of these limited partnership agreements and operating agreements, the selling entity or individual also has a put right that can be exercised after the passage of a designated period of time or upon a termination of employment. The
purchase price of the underlying equity interest upon the exercise of either the put right or the call right is calculated per the terms of the respective agreements and classified as redeemable non-controlling interest (temporary equity) in
our consolidated balance sheets. The fair value of the redeemable non-controlling interest at December 31, 2024 was $269.0 million.
Contractual Obligations
We have future obligations for debt repayments and associated interest payments as well as future minimum lease payments under our non-cancellable operating leases. The obligations as of December
31, 2024, are summarized as follows:
| Total | 2025 | 2026 | 2027 | 2028 | 2029 | Thereafter | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (In thousands) | |||||||||||||||||||||||||||
| Company's Senior Credit Facilities (1) | $ | 151,625 | $ | 9,375 | $ | 9,375 | $ | 132,875 | $ | - | $ | - | $ | - | |||||||||||||
| Notes payable (2) | 2,952 | 2,047 | 894 | 11 | - | - | - | ||||||||||||||||||||
| Interest expense on Senior Credit Facilities and notes payable (3) | 18,739 | 6,456 | 6,182 | 6,101 | - | - | - | ||||||||||||||||||||
| Operating leases (4) | 188,799 | 55,557 | 45,020 | 33,718 | 22,556 | 13,389 | 18,559 | ||||||||||||||||||||
| $ | 362,115 | $ | 73,435 | $ | 61,471 | $ | 172,705 | $ | 22,556 | $ | 13,389 | $ | 18,559 |
| Column 1 | Column 2 |
|---|---|
| (1) | Amounts due under our Senior Credit Facilities discussed above. |
| Column 1 | Column 2 |
|---|---|
| (2) | Amounts due related to certain acquisitions discussed above. |
| Column 1 | Column 2 |
|---|---|
| (3) | Interest on our Senior Credit Facilities was estimated using the average outstanding balance for the respective periods and our effective interest rate on our Term Facility and Revolving Facility at December 31, 2024. Interest on our other debt was estimated using the stated rate in the debt agreement. |
| Column 1 | Column 2 |
|---|---|
| (4) | Includes variable non-lease components, including but not limited to common area maintenance. |
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CRITICAL ACCOUNTING POLICIES
Management’s discussion and analysis of financial condition and results of operations is based upon our consolidated financial statements which have been prepared in accordance with accounting
principles generally accepted in the United States. The preparation of these financial statements requires estimates and judgments that affect the reported amounts of our assets, liabilities, net sales and expenses, and disclosure of contingent
assets and liabilities. Management bases estimates on historical experience and other assumptions it believes to be reasonable given the circumstances and evaluates these estimates on an ongoing basis. Actual results may differ from these
estimates under different assumptions or conditions.
We believe that the following critical accounting policies involve a higher degree of judgment and complexity. See Note 2, Significant Accounting Policies, to our audited consolidated financial
statements which are included elsewhere in this Annual Report on Form 10-K for a complete discussion of our significant accounting policies. The following reflect the significant estimates and judgments used in the preparation of our
consolidated financial statements.
Revenue Recognition
Patient revenue
Revenues are recognized in the period in which services are rendered. Net patient revenue consists of revenues from physical therapy and occupational therapy clinics that provide pre-and
post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenue (patient revenues less estimated
contractual adjustments – described below) is recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied.
There is an implied contract between us and the patient upon each patient visit. Separate contractual arrangements exist between us and third-party payors (e.g. insurers, managed care programs, government programs, and workers’ compensation
programs) which establish the amounts the third parties pay on behalf of the patients for covered services rendered. While these agreements are not considered contracts with the customer, they are used for determining the transaction price for
services provided to the patients covered by the third-party payors. The payor contracts do not indicate performance obligations for us but indicate reimbursement rates for patients who are covered by those payors when the services are
provided. At that time, we are obligated to provide services for the reimbursement rates stipulated in the payor contracts. The execution of the contract alone does not indicate a performance obligation. For self-paying customers, the
performance obligation exists when we provide the services at established rates. The difference between our established rate and the anticipated reimbursement rate is accounted for as an offset to revenue—contractual allowance.
Other Revenues
Revenue derived from management agreements with physicians and hospitals is included in other revenue in the consolidated statements of net income. We do not have any ownership interest in these
clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for our employees, are recorded when incurred.
Revenues from the IIP business, which are included in other revenues in the consolidated statements of net income, are derived from onsite services we provide to clients’ employees including
injury prevention, rehabilitation, ergonomic assessments, and performance optimization. Revenue from the IIP business is recognized when obligations under the terms of the contract are satisfied. Revenues are recognized at an amount equal to
the consideration we expect to receive in exchange for providing injury prevention services to our clients. The revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period.
Additionally, other revenue includes services we provide on-site at locations such as schools and industrial worksites for physical or occupational therapy services, athletic trainers and gym
membership fees. Contract terms and rates are agreed to in advance between us and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in advance,
revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time when the services are performed.
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We determine allowances for credit losses based on the specific agings of receivables and payor classifications at each clinic. The provision for credit losses is included in clinic operating
costs in the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and provision for credit losses, includes only those amounts we estimate to be
collectible. Our provision for credit losses was 1.0% of total net revenue for each years ended December 31, 2024, 2023 and 2022, respectively. Management believes that this is reasonable because the majority of our payors consist of highly
solvent, highly regulated, commercial insurance companies as well as government programs, including Medicare.
Contractual Allowances
Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare
programs for such services. Medicare regulations and the various third-party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in our clinics. We estimate
contractual allowances based on our interpretation of the applicable regulations, payor contracts and historical calculations. Each month we estimate our contractual allowance for each clinic based on payor contracts and the historical
collection experience of the clinic and apply an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on our historical experience, calculating the contractual
allowance reserve percentage at the payor level is sufficient to allow us to provide the necessary detail and accuracy with our collectability estimates. However, the services authorized and provided and related reimbursement are subject to
interpretation that could result in payments that differ from our estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. Our billing systems may not capture the exact
change in our contractual allowance reserve estimate from period to period. Therefore, in order to assess the accuracy of our revenues and hence our contractual allowance reserves, our management regularly compares our cash collections to
corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, the historical difference between net revenues and corresponding cash collections in any given fiscal year has generally reflected a
difference within approximately 1.0% to 1.5% of net revenues. Additionally, analysis of subsequent period’s contractual write-offs on a payor basis reflects a difference within approximately 1.0% to 1.5% between the actual aggregate contractual
reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, we believe that a reasonable likely change in the contractual allowance reserve estimate would
not be more than 1.0% to 1.5% of gross billings in accounts receivable at December 31, 2024. For purposes of demonstrating the sensitivity of this estimate on our Company’s financial condition, a 1.0% to 1.5% increase or decrease in our
aggregate contractual allowance reserve percentage would decrease or increase, respectively, net patient revenue by approximately $1.0 million to $1.5 million for the year ended December 31, 2024. Management believes the changes in the estimate
of the contractual allowance reserve for the periods ended December 31, 2024, and 2023 have not been material to the statements of income.
Goodwill and Other Indefinite-Lived Intangible Assets
Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible
assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of
a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.
Goodwill and other indefinite-lived intangible assets are not amortized but are instead subject to periodic impairment evaluations. The fair value of goodwill and other identifiable intangible
assets with indefinite lives are evaluated for impairment at least annually and upon the occurrence of certain events or conditions and are written down to fair value if considered impaired. These events or conditions include but are not
limited to a significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating, or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale
or disposition of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. We evaluate indefinite-lived tradenames in
conjunction with our annual goodwill impairment test.
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Impairment of Goodwill, Other Indefinite-Lived Intangible Assets and Long-Lived Assets
We operate our business through two segments consisting of our physical therapy clinics and our IIP business. For purposes of goodwill impairment analysis, each of our segments is further broken
down into reporting units. Reporting units within our physical therapy business comprise of regions primarily based on each clinic’s location. In addition to the six regions, in 2024 and 2023, the IIP business consisted of two reporting units.
As part of the impairment analysis, we are first required to assess qualitatively if we can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not
impaired, we are then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than
its carrying amount, we consider relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. We consider both the income and market approach in determining the fair value of its reporting units when
performing a quantitative analysis.
An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the
estimated fair value of the reporting unit.
Additionally, we review property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances that indicate the related amounts may
be impaired.
We recorded a non-cash impairment charge of $2.4 million related to assets held for sale during the year-ended December 31, 2024 and $17.5 million related to a reporting unit in our IIP
business during the year ended December 31, 2023.
We will continue to monitor for any triggering events or other indicators of impairment.
Redeemable Non-Controlling Interest
The non-controlling interests that are reflected as redeemable non-controlling interest in our consolidated financial statements consist of those owners, including us, that have certain redemption
rights, whether currently exercisable or not, and which currently, or in the future, require that we purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met and the owners request the purchase
(“Put Right”). We also have a call right (“Call Right”). Most of the Put Rights or Call Rights may be triggered by the owner or us, respectively, at such time as both of the following events have occurred: 1) termination of the owner’s
employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement. Other Put Rights
may be triggered at the discretion of the owner after a set period of time has passed. The Put Rights and Call Rights are not automatic (even upon death) and require either the owner or us to exercise our rights when the conditions triggering
the Put or Call Rights have been satisfied. The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership agreements.
On the date we acquire a controlling interest in a Subsidiary and the limited partnership agreement or operating agreement, as applicable, for such Subsidiary contains redemption rights not under
our control, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption—Redeemable non-controlling interest. Then, in each reporting period thereafter
until it is purchased by us, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial value, based on the predetermined formula defined in the respective limited partnership agreement.
As a result, the value of the non-controlling interest is not adjusted below its initial value. We record any adjustment in the redemption value, net of tax, directly to retained earnings and not in the consolidated statements of net income.
Although the adjustments are not reflected in the consolidated statements of net income, current accounting rules require that we reflect the adjustments, net of tax, in the earnings per share calculation. The amount of net income attributable
to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statement of income. We believe the redemption value (i.e. the carrying amount) and fair value are the same.
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Non-Controlling Interest
We recognize non-controlling interests, in which we have no obligation but the right to purchase the non-controlling interests, as equity in the consolidated financial statements separate from the
parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the consolidated statements of net income. Operating losses are allocated to non-controlling
interests even when such allocation creates a deficit balance for the non-controlling interest partner. When we purchase a non-controlling interest and the purchase differs from the book value at the time of purchase, any excess or shortfall is
recognized as an adjustment to additional paid-in capital.
FY 2023 10-K MD&A
SEC filing source: 0001140361-24-010454.
ITEM 7. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS
The following discussion and analysis of U.S. Physical Therapy, Incl and its subsidiaries (herein referred to as “we”, “us”, “our” or the “Company”) should be read in
conjunction with the Company’s consolidated financial statements and accompanying notes included elsewhere in this Annual Report on Form 10-K. Some of the information contained in this discussion and analysis, including information with respect
to our plans and strategy for our business, includes forward-looking statements that involve risks and uncertainties. You should review the “Risk Factors” and “Forward-Looking Statements” sections of this Annual Report on Form 10-K for a
discussion of important factors that could cause actual results to differ materially from the results described in or implied by the forward-looking statements contained in the following discussion and analysis.
This section of this Annual Report on Form 10-K generally discusses 2023 and 2022 items and year-to-year comparisons between 2023 and 2022. Discussions of 2021 items and
year-to-year comparisons between 2022 and 2021 can be found in “Management's Discussion and Analysis of Financial Condition and Results of Operations” in Part II, Item 7 of the Company's Annual Report on Form 10-K for the fiscal year ended
December 31, 2022, filed with the Securities and Exchange Commission on February 28, 2023.
EXECUTIVE SUMMARY
We operate our business through our reportable segments which include the (1) physical therapy operations segment and (2) the industrial injury prevention services (“IIP”) segment. Our physical
therapy operations consist of physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic-related disorders, sports-related injuries, preventive care, rehabilitation of injured workers
and neurological injuries. Services provided by the IIP segment include onsite injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional evaluations and ergonomic assessments. The majority of these
services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. These services are performed through Industrial Sports Medicine
Professionals, consisting of both physical therapists and specialized certified athletic trainers (“ATCs”).
During the last three years, we completed the following acquisitions of clinic practices and IIP businesses detailed below:
| % Interest | Number of | |||||
|---|---|---|---|---|---|---|
| Acquisition | Date | Acquired | Clinics | |||
| October 2023 Acquisition | October 31, 2023 | ** | * | |||
| September 2023 Acquisition 1 | September 29, 2023 | 70% | 4 | |||
| September 2023 Acquisition 2 | September 29, 2023 | 70% | 1 | |||
| July 2023 Acquisition | July 31, 2023 | 70% | 7 | |||
| May 2023 Acquisition | May 31, 2023 | 45% | 4 | |||
| February 2023 Acquisition | February 28, 2023 | 80% | 1 | |||
| November 2022 Acquisition | November 30, 2022 | 80% | 13 | |||
| October 2022 Acquisition | October 31, 2022 | 60% | 14 | |||
| September 2022 Acquisition | September 30, 2022 | 80% | 2 | |||
| August 2022 Acquisition | August 31, 2022 | 70% | 6 | |||
| March 2022 Acquisition | March 31, 2022 | 70% | 6 | |||
| December 2021 Acquisition | December 31, 2021 | 75% | 3 | |||
| November 2021 Acquisition | November 30, 2021 | 70% | * | |||
| September 2021 Acquisition | September 30, 2021 | 100% | * | |||
| June 2021 Acquisition | June 30, 2021 | 65% | 8 | |||
| March 2021 Acquisition | March 31, 2021 | 70% | 6 |
| Column 1 | Column 2 |
|---|---|
| * | IIP business |
| Column 1 | Column 2 |
|---|---|
| ** | On October 31, 2023, we concurrently acquired 100% of an IIP business and a 55% equity interest in an ergonomics software business (“October 2023 Acquisition”). |
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The following table provides a roll forward of our clinic count for the periods presented.
| For the Year Ended | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2023 | December 31, 2022 | December 31, 2021 | ||||||||||
| Number of clinics, beginning of period | 640 | 591 | 554 | |||||||||
| Additions | 46 | 65 | 42 | |||||||||
| Closed or sold | (15 | ) | (16 | ) | (5 | ) | ||||||
| Number of clinics, end of period | 671 | 640 | 591 |
Our strategy is to continue acquiring outpatient physical therapy practices, develop outpatient physical therapy clinics as satellites in existing partnerships, and continue acquiring companies that provide or serve our
IIP sector.
In May 2023, we completed a secondary offering of 1,916,667 shares of its common stock at an offering price of $90.00 per share. Upon completion of the offering, we received net proceeds of
approximately $163.6 million, after deducting an underwriting discount of $8.6 million and recognizing related fees and expenses of $0.2 million. A portion of the net proceeds was used to repay the $35.0 million then outstanding under our credit
agreement while the remainder is expected to be used primarily for additional acquisitions.
Our Board of Directors raised our quarterly dividend to $0.44 per share, on February 27, 2024, and declared a quarterly dividend for the first quarter of 2024 at the higher rate.
Medicare Reimbursement
The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (“MPFS”). Outpatient
rehabilitation providers may enroll in Medicare as institutional outpatient rehabilitation facilities (i.e., rehab agencies) or individual physical or occupational therapists in private practice. The majority of our clinicians are enrolled as
individual physical or occupational therapists in private practice while the remaining balance of providers are reimbursed through enrolled rehab agencies. The following is a summary of significant regulatory changes which have affected our
results of operations as well as the policies and payment rates that may affect our future results of operations.
For calendar years 2021 and 2022, CMS’s expected decreases in Medicare reimbursement were mostly offset by one-time increases in payments as a result of other
legislation passed by Congress. Payments under the 2023 MPFS physician fee schedule decreased by 2%, and for calendar year 2024, CMS’s final policies for 2024 will result in an approximately 3.5% decrease in Medicare payments for the therapy
specialty.
In the final 2020 MPFS rule, CMS clarified that when the physical therapist is involved for the entire duration of the service and the physical
therapist assistant (“PTA”) provides skilled therapy alongside the physical therapist, the CQ modifier is not required. Also, when the same service (code) is furnished separately by the physical therapist and PTA, CMS applies the de minimis
standard to each 15-minute unit of codes, not on the total physical therapist and PTA time of the service. For dates of service on and after January 1, 2022, CMS pays for physical therapy and occupational therapy services provided by PTAs and
occupational therapist assistants (“OTAs”) at 85% of the otherwise applicable Part B payment amount. CMS allows a timed service to be billed without the CQ or CO modifier when a PTA or OTA participates in providing care, but the physical
therapist or occupational therapist meets the Medicare billing requirements without including the PTA’s or OTA’s minutes. This occurs when the physical therapist or occupational therapist provides more minutes than the 15-minute midpoint. The
calendar year 2024 MPFS final rule did not contain any policy changes concerning the modifiers for services provided by physical therapy and occupational therapy assistants.
RESULTS OF OPERATIONS
The defined terms with their respective description used in the following discussion are listed below:
| Mature Clinics are clinics opened or acquired prior to January 1, 2022, and are still operating as of December 31, 2023. |
|---|
| Net rate per patient visit is net patient revenue related to our physical therapy operations divided by total number of patient visits (defined below) during the periods presented. |
| Patient visits is the number of unique patient visits during the periods presented. |
| Average daily visits per clinic is patient visits divided by the number of days in which normal business operations were conducted during the periods presented and further divided by the average number clinics in operation during the periods presented. |
| Full Year 2023 refers to the year ended December 31, 2023. |
| Full Year 2022 refers to the year ended December 31, 2022. |
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Full Year 2023 versus Full Year 2022
Total net revenue for the Full Year 2023 increased $51.7 million, or 9.3%, to $604.8 million from $553.1 million for the Full Year 2022 while operating costs increased $42.2 million, or 9.6%, to
$483.3 million from $441.1 million over the same periods, respectively. Total operating cost was $483.3 million for the 2023 Year, or 79.9% of total revenue, as compared to $441.1million or 79.7% of total revenue for the 2022 Year. Gross profit
for the Full Year 2023 was $121.5 million, or 20.1% of net revenue, compared to $112.0 million for the Full Year 2022, or 20.3% of net revenue.
Net income attributable to our shareholders (“USPH net income”) was $28.2 million for Full Year 2023 compared to $32.2 million for Full Year 2022. USPH net income included a non-cash impairment
charge, prior to allocation to non-controlling interest and income taxes, of $17.5 million in the year ended December 31, 2023 ($9.1 million net of $5.2 million allocated to non-controlling interest and $3.1 million income tax) and $9.1 million
in the year ended December 31, 2022 ($4.7 million net of $2.7 million allocated to non-controlling interest and $1.6 million income tax). In accordance with Generally Accepted Accounting Principles (“GAAP”), the revaluation of non-controlling
interest, net of taxes, is not included in net income but is charged directly to retained earnings; however, this change is included in the computation of earnings per share. Earnings per share for Full Year 2023 were $1.28 compared to $2.25 for
Full Year 2022.
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2023 | December 31, 2022 | |||||||
| (In thousands, except per share data) | ||||||||
| Earnings per share | ||||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 28,239 | $ | 32,158 | ||||
| Charges to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (13,565 | ) | (3,890 | ) | ||||
| Tax effect at statutory rate (federal and state) | 3,466 | 994 | ||||||
| $ | 18,140 | $ | 29,262 | |||||
| Earnings per share (basic and diluted) | $ | 1.28 | $ | 2.25 | ||||
| Shares used in computation - basic and diluted | 14,188 | 12,985 |
Non-GAAP Measures
We use Adjusted EBITDA and Operating Results, non-GAAP measures, which eliminate certain items described below that can be subject to volatility and unusual costs, as the principal measures to
evaluate and monitor financial performance period over period. We believe that Adjusted EBITDA and Operating Results are useful measures for investors to use in comparing the Company's period-to-period results as well as for comparing with other
similar businesses since most do not have redeemable instruments and therefore have different equity structures.
Adjusted EBITDA is defined as net income attributable to our shareholders before interest income, interest expense, taxes, depreciation, amortization, non-cash asset impairment charge, change in
fair value of contingent earn-out consideration, Relief Funds, changes in revaluation of put-right liability, equity-based awards compensation expense, and related portions for non-controlling interests.
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Operating Results equals net income attributable to our shareholders less non-cash asset impairment charge, changes in revaluation of put-right liability, Relief Funds, changes in fair value of
contingent earn-out consideration, and any allocations to non-controlling interests, all net of taxes. Operating Results per share also exclude the impact of the revaluation of redeemable non-controlling interest and the associated tax impact.
The tables below reconcile net income attributable to our shareholders calculated in accordance with GAAP to Operating Results and Adjusted EBITDA.
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ADJUSTED EBITDA AND OPERATING RESULTS
(IN THOUSANDS, EXCEPT PER SHARE DATA)
(unaudited)
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2023 | December 31, 2022 | |||||||
| (In thousands, except per share data) | ||||||||
| Adjusted EBITDA (a non-GAAP measure) | ||||||||
| Net income attributable to USPH shareholders | $ | 28,239 | $ | 32,158 | ||||
| Adjustments: | ||||||||
| Provision for income taxes | 12,156 | 12,164 | ||||||
| Depreciation and amortization | 15,695 | 14,743 | ||||||
| Interest expense, debt and other, net | 9,303 | 5,779 | ||||||
| Interest income from investments | (3,774 | ) | - | |||||
| Impairment of goodwill and other intangible assets | 17,495 | 9,112 | ||||||
| Equity-based awards compensation expense | 7,236 | 7,264 | ||||||
| Change in revaluation of put-right liability | (2,582 | ) | 5 | |||||
| Change in fair value of contingent earn-out consideration | 1,550 | (2,520 | ) | |||||
| Relief Funds* | (467 | ) | - | |||||
| Other income | (390 | ) | (859 | ) | ||||
| Allocation to non-controlling interests | (6,744 | ) | (4,185 | ) | ||||
| 77,717 | 73,661 | |||||||
| Operating Results (a non-GAAP measure) | ||||||||
| Net income attributable to USPH shareholders | $ | 28,239 | $ | 32,158 | ||||
| Adjustments: | ||||||||
| Impairment of goodwill and other intangible assets | 17,495 | 9,112 | ||||||
| Change in fair value of contingent earn-out consideration | 1,550 | (2,520 | ) | |||||
| Change in revaluation of put-right liability | (2,582 | ) | 5 | |||||
| Relief Funds* | (467 | ) | - | |||||
| Allocation to non-controlling interest | (5,215 | ) | (2,734 | ) | ||||
| Tax effect at statutory rate (federal and state) | (2,755 | ) | (987 | ) | ||||
| $ | 36,265 | $ | 35,034 | |||||
| Operating Results per share (a non-GAAP measure) | $ | 2.56 | $ | 2.70 |
*In March 2020 in response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The
CARES Act provided waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, to be used
for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. The Company recorded income under the CARES
Act ("Relief Funds").
Adjusted EBITDA increased $4.1 million to $77.7 million for Full Year 2023 from $73.7 million in Full Year 2022 while Operating Results increased $1.2 million to $36.3 million, or $2.56 per share,
in Full Year 2023 from $35.0 million, or $2.70 per share, in the Full Year 2022. The increase in both Adjusted EBITDA and Operating Results was primarily associated with clinic additions since the comparable prior year period and increased
volume at mature clinics.
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Physical Therapy Operations
| For the Year Ended December 31, | Variance | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2023 | 2022 | $ | % | ||||||||||||||
| (In thousands, except percentages) | |||||||||||||||||
| Revenue related to: | |||||||||||||||||
| Mature Clinics (1) | $ | 452,459 | $ | 421,806 | $ | 30,653 | 7.3 | % | |||||||||
| Clinic additions (2) | 60,495 | 39,990 | 20,505 | * | (6) | ||||||||||||
| Clinics sold or closed (3) | 1,602 | 2,794 | (1,192 | ) | * | (6) | |||||||||||
| Net Patient Revenue | 514,556 | 464,590 | 49,966 | 10.8 | % | ||||||||||||
| Other (4) | 11,992 | 11,502 | 490 | 4.3 | % | ||||||||||||
| Total | 526,548 | 476,092 | 50,456 | 10.6 | % | ||||||||||||
| Operating costs (4) | 421,484 | 380,035 | 41,449 | 10.9 | % | ||||||||||||
| Gross profit | $ | 105,064 | $ | 96,057 | $ | 9,007 | 9.4 | % | |||||||||
| Financial and operating metrics (not in thousands): | |||||||||||||||||
| Net rate per patient visit (1) | $ | 102.80 | $ | 103.63 | $ | (0.83 | ) | (0.8 | )% | ||||||||
| Patient visits (1) | 5,005,426 | 4,483,282 | 522,144.0 | 11.6 | % | ||||||||||||
| Average daily visits per clinic (1) | 30.0 | 28.7 | 1.3 | 4.5 | % | ||||||||||||
| Gross margin | 20.0 | % | 20.2 | % | |||||||||||||
| Salaries and related costs per visit, clinics (5) | $ | 59.19 | $ | 59.52 | $ | (0.33 | ) | (0.6 | )% | ||||||||
| Operating costs per visit, clinics (5) | $ | 82.79 | $ | 83.34 | $ | (0.55 | ) | (0.7 | )% | ||||||||
| Working days | 254 | 255 | (1 | ) | (0.4 | )% | |||||||||||
| Number of clinics at the end of the period | 671 | 640 | 31 | 4.8 | % |
| Column 1 | Column 2 |
|---|---|
| (1) | See defined terms above for definitions. |
| Column 1 | Column 2 |
|---|---|
| (2) | Clinic additions during the years ended 2023 and 2022. |
| Column 1 | Column 2 |
|---|---|
| (3) | Revenue from closed clinics includes revenues from the 15 and 16 clinics closed during the full year December 31, 2023 and 2022, respectively. |
| Column 1 | Column 2 |
|---|---|
| (4) | Includes revenues and costs from management contracts. |
| Column 1 | Column 2 |
|---|---|
| (5) | Excludes management contract costs. |
| Column 1 | Column 2 |
|---|---|
| (6) | Not meaningful. |
Revenues
Revenues increased $50.5 million, or 10.6%, to $526.5 million in Full Year 2023 compared to $476.1 million in Full Year 2022. This increase was primarily due to a record-high average daily visits
per clinic for a full year in the Company’s history of 30.0 visits, and an increase in volume from the 31 net new clinics added since the comparable prior year period, partially offset by a decrease in net rate per patient visit to $102.80 for
Full Year 2023 compared to $103.63 for Full Year 2022. Total patient visits were 5,005,426 for the 2023 Year and 4,483,282 for the 2022 Year, an increase of 11.6%, with visits at mature clinics up 3.1%. The decrease in net rate in the Full Year
2023 from the Full Year 2022 was primarily due to the combined Medicare rate reductions in 2022 and 2023. All other payor categories, including commercial and workers’ compensation, increased as compared to the prior year.
Other revenue was $12.0 million for the Full Year 2023 Year and $11.5 million for the Full Year 2022, of which management contracts was $8.6 million for the Full Year 2023 as compared to $8.1
million for the Full Year 2022.
Operating costs
Operating costs increased by $41.4 million or 10.9% to $421.5 million in the Full Year 2023 from $380.0 million in the Full Year 2022. The
increase was primarily due to the higher volume from the new clinics added since the comparable year period as well as increased patient visits in Mature Clinics. Operating costs for Mature Clinics increased $10.1 million year over year to
$363.2 million for the Full Year 2023 from $353.2 million for the Full Year 2022 due to increased visits in the comparable periods. On a per visit basis (excluding management contracts), operating costs decreased to $82.79 for the Full Year
2023 compared to $83.34 for the Full Year 2022.
Salaries and related costs related to clinics increased to $296.3 million in the Full Year 2023 from $266.8 million in the 2022 Year, an
increase of $29.5 million, or 11.1%. Salaries and related costs per visit (excluding management contracts), related to clinics decreased to $59.19 for the Full Year 2023 from 59.52 for the Full Year 2022 mostly due to the 31 new clinics added
year over year as well as increased visits from Mature Clinics.
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Rent, supplies, contract labor and other costs related to clinics increased to $97.2 million in the Full Year 2023 from $87.6 million in the 2022 Year, an increase of $9.6 million, or 11.1% mostly
due to the 31 new clinics added year over year as well as increased visits from Mature Clinics. Rent, supplies, contract labor and other costs, clinics decreased slightly on a per visit basis to $19.42 per visit for the Full Year 2023 compared to
$19.53 for the Full Year 2022. Operating costs related to management contracts increased 10.7% from $6.4 million for the Full Year 2022 to $7.1 million in the Full Year 2023.
The provision for credit losses was $6.2 million for the Full Year 2023 and $5.5 million for the Full Year 2022. As a percentage of net revenues, the provision for credit losses were 1.0% for both
2023 and 2022. Our provision for credit losses as a percentage of total patient accounts receivable was 5.0% on December 31, 2023, and 5.2% on December 31, 2022.
Gross Profit
Gross profit from physical therapy operations increased $9.0 million, or 9.4%, to $105.1 million for Full Year 2023 from $96.1 million for Full Year 2022 while the gross profit margin from physical
therapy operations decreased slightly to 20.0% for Full Year 2023 from 20.2% and Full Year 2022.
Industrial Injury Prevention Services
| For the Year Ended December 31, | ||||||||
|---|---|---|---|---|---|---|---|---|
| 202 | 2022 | |||||||
| (In thousands, except percentages) | ||||||||
| Net revene | $ | 78,254 | $ | 77,052 | ||||
| Operating costs | 61,809 | 61,085 | ||||||
| Gross profit | $ | 16,445 | $ | 15,967 | ||||
| Gross margin | 21.0 | % | 20.7 | % |
IIP business revenue increased $1.2 million to $78.3 million for the Full Year 2023 as compared to $77.1 million for the Full Year 2022. Operating costs related to the IIP business increased 1.2% in
the Full Year 2023 to $61.8 million from $61.1 million for the Full Year 2022. Gross profit increased $0.5 million, or 3.0%, to $16.4 million for Full Year 2023 from $16.0 million for the Full Year 2022 while gross profit margin percentage from
IIP operations increased slightly to 21.0% for Full Year 2023 from 20.7% for the Full Year 2022.
Corporate Office Costs
Corporate office costs were $52.0 million, or 8.6% of net revenue, for the Full Year 2023 compared to $46.1 million, or 8.3% of net revenue, for the Full Year 2022. The increase in corporate office
costs was primarily due to higher salaries and related costs to support the larger number of clinics.
Impairment of Goodwill and Other Intangible Assets
A non-cash impairment charge of $17.5 million was recognized during the Full Year 2023 related to a reporting unit in our IIP segment. This compares to a $9.1 million non-cash impairment charge to
goodwill in the comparable prior year period related to the same reporting unit.
Operating Income
Operating income was $52.1 million for the Full Year 2023 compared to $56.8 million for the Full Year 2022. Excluding the non-cash impairment charge of $17.5 million in the Full Year 2023 and $9.1
million in the Full Year 2022, operating income was $69.6 million for the twelve months ended 2023 compared to $65.9 million for the twelve months ended 2022.
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Other (Expenses) Income
Interest Expense, Debt and Other
Interest expense, net of $3.3 million savings from an interest rate swap arrangement discussed below in the “Liquidity and Capital Resources - Interest Rate Swap”, increased $3.5 million to $9.3 million for the Full Year 2023 compared to $5.8 million in the Full Year 2022 due to increased borrowings. The interest rate on the Company’s term loan, was
4.9% for the Full Year 2023, with an all-in effective interest rate, including all associated costs, of 5.3%.
Interest income from investment
Interest income from investment amounted to $3.8 million for the Full Year 2023. This interest income is a result of investing excess cash associated with proceeds from our secondary offering
completed in May 2023.
Change in fair value of contingent earn-out consideration
We revalued contingent earn-out consideration related to certain acquisitions resulting in an expense of $1.6 million for the Full Year 2023 compared to a gain of $2.5 million for the Full Year
2022.
Change in Revaluation of Put-Right Liability
For the Full Year 2023, we recorded a gain of $2.6 million on the valuation of the put-right liability compared to a loss of less than $0.1 million for the Full Year 2022. The put-right relates to
the potential future purchase of a company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area.
Equity in earnings of unconsolidated affiliate
For the Full Year 2023, we recognized income of $1.0 million compared to $1.2 million for the Full Year 2022 from a joint venture which provides physical
therapy services for patients at hospitals. Since we are deemed to not have a controlling interest in the joint venture, our investment is accounted for using the equity method of accounting.
Provision for Income Taxes
The provision for income tax was $12.2 million for each of the years ended 2023 and 2022. The provision for income tax as a percentage of income before taxes less net income attributable to
non-controlling interest (effective tax rate) was 30.1% for 2023 and 27.4% for 2022 as calculated below. The increase in the effective tax rate was primarily due to return-to-provision adjustments mostly related to true up of differences between
tax and book basis of certain intangibles.
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| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2023 | December 31, 2022 | |||||||
| (In thousands, except percentages) | ||||||||
| Income before taxes | $ | 49,376 | $ | 55,571 | ||||
| Less: Net income attributable to non-controlling interest: | ||||||||
| Redeemable non-controlling interest - temporary equity | (4,426 | ) | (6,902 | ) | ||||
| Non-controlling interest - permanent equity | (4,555 | ) | (4,347 | ) | ||||
| $ | (8,981 | ) | $ | (11,249 | ) | |||
| Income before taxes less net income attributable to non-controlling interest | $ | 40,395 | $ | 44,322 | ||||
| Provision for income taxes | $ | 12,156 | $ | 12,164 | ||||
| Effective income tax rate | 30.1 | % | 27.4 | % |
Net Income Attributable to Non-controlling Interest
Net income attributable to redeemable non-controlling interest (temporary equity) was $4.4 million for the Full Year 2023 and $6.9 million for the Full Year 2022. Net income attributable to
non-controlling interest (permanent equity) was $4.6 million for the Full Year 2023 and $4.3 million for the Full Year 2022.
Other Comprehensive Income
We entered into an interest rate swap agreement in May 2022, which became effective on June 30, 2022. The maturity date of the swap agreement is June 30, 2027. It has a $150 million notional value
adjusted concurrently with scheduled principal payments made on the term loan. Beginning in July 2022, we pay a fixed one-month Secured Overnight Financing Rate (“SOFR”) of interest of 2.815%. The total interest rate in any period also includes
an applicable margin based on the Company’s consolidated leverage ratio. In the Full Year 2023, our interest rate including the applicable margin was 4.9%. Unrealized gains and losses related to the fair value of the interest rate swap are
recorded to accumulated other comprehensive income (loss), net of tax. The fair value of the interest rate swap at December 31, 2023, was $3.7 million, and $5.4 million at December 31, 2022, which has been included within Other assets (current
and long term) in the accompanying Consolidated Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statements of Comprehensive Income was an unrealized loss of $1.2 million, net of tax, for the 2023 Year.
LIQUIDITY AND CAPITAL RESOURCES
We believe that our business has sufficient cash to allow us to meet our short-term cash requirements. Total cash and cash equivalents were $152.8 million as of December 31, 2023, compared to $31.6
million as of December 31, 2022. Additionally, we had $144.4 million of outstanding borrowings and $175.0 million in available credit under our credit facilities as of December 31, 2023, compared to $179.1 million of outstanding borrowings and
$145.9 million in available credit under our credit facilities as of December 31, 2022.
On May 30, 2023, we completed a secondary offering of our common stock resulting in net proceeds of $163.6 million after deducting fees associated with the transaction. A portion of the net proceeds
was used to repay the $35.0 million then outstanding under our Credit Agreement while the remainder is expected to be used primarily for acquisitions. Our cash is currently invested in a high-yield savings account which generated interest income
of approximately $2.1 million in 2023.
We believe that our cash and cash equivalents and availability under our Credit Facilities are sufficient to fund the working capital needs of our operating subsidiaries through at least February
29, 2025.
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Historically, we have generated sufficient cash from operations to fund our development activities and to cover operational needs. We plan to continue developing new clinics and making additional
acquisitions. We have, from time to time, purchased the non-controlling interests of limited partners in our existing partnerships. We may purchase additional non-controlling interests in the future. Generally, any acquisition or purchase of
non-controlling interests is expected to be accomplished using our cash, financing, or a combination of the two.
We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts. Claims are submitted to payors daily, weekly or monthly in
accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time consuming and typically involves the submission of claims to multiple payors whose payment of claims may be
dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting CMS approval initially may not be submitted for
six months or more. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor type receivables,
the write-off generally occurs after the balance has been outstanding for 120 days or longer. As of December 31, 2023, we have accrued $8.8 million related to credit balances (included in accrued expenses), a portion of which is due to
patients and payors. The credit balances are expected to be resolved or paid in the next twelve months.
The average accounts receivable days outstanding was 29 days on December 31, 2023, and 31 days on December 31, 2022. Net patient receivables in the amounts of $6.3 million and $5.5 million were
written-off in 2023 and 2022, respectively.
Cash Flow
A summary of our operating, investing, and financing activities is discussed below.
| Year Ended | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2023 | December 31, 2022 | December 31, 2021 | |||||||||
| Net cash provided by operating activities | $ | 81,978 | $ | 58,537 | $ | 76,406 | |||||
| Net cash used in investing activities | 45,015 | 81,269 | 124,136 | ||||||||
| Net cash provided by financing activities | 84,268 | 25,759 | 43,379 |
Operating Activities
Cash provided by operating activities increased $23.4 million to $82.0 million for the year ended December 31, 2023 as compared to $58.5 million for the year ended December 31, 2022. This increase
was mostly due to higher Adjusted EBITDA as well as increased collections from patient receivables.
Investing Activities
Cash used in investing activities during the year ended December 31, 2023 totaled $45.0 million and consisted of $9.3 million of fixed assets purchases and $37.8 million used in the purchase of
majority interests in businesses and non-controlling interest, temporary and permanent equity. These were partially offset by $1.0 million proceeds from sale of non-controlling interest, temporary and permanent and $0.8 million distribution from
an unconsolidated affiliate.
Financing Activities
Cash provided by financing activities during the year ended December 31, 2023, totaled $84.3 million and consisted of $163.6 million proceeds from a secondary
offering completed in May 2023, partially offset by $31.0 million of net payments under our revolving credit facility, $24.1 million of dividends paid to our shareholders, $16.1 million distribution to non-controlling interest and payments of
$8.2 million on our debt.
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Senior Credit Facilities
On December 5, 2013, we entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended and/or restated in August
2015, January 2016, March 2017, November 2017, and January 2021.On June 17, 2022, we entered into the Third Amended and Restated Credit Agreement (the “Credit Agreement”) among Bank of America, N.A., as administrative agent (“Administrative
Agent”) and the lenders from time-to-time party thereto.
The Credit Agreement, which matures on June 17, 2027, provides for loans in an aggregate principal amount of $325 million. Such loans will be available through the following facilities
(collectively, the “Senior Credit Facilities”):
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| 1) | Revolving Facility: $175 million, five-year, revolving credit facility (“Revolving Facility”), which includes a $12 million sublimit for the issuance of standby letters of credit and a $15 million sublimit for swingline loans (each, a “Swingline Loan”). |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| 2) | Term Facility: $150 million term loan facility (the “Term Facility”). The Term Facility amortizes in quarterly installments of: (a) 0.625% in each of the first two years, (b) 1.250% in the third and fourth year, and (c) 1.875% in the fifth year of the Credit Agreement. The remaining outstanding principal balance of all term loans is due on the maturity date. |
The proceeds of the Revolving Facility have been and shall continue to be used by us for working capital and other general corporate purposes of our Company and its subsidiaries, including to fund
future acquisitions and invest in growth opportunities. The proceeds of the Term Facility were used by us to refinance the indebtedness outstanding under the Second Amended and Restated Credit Agreement, to pay fees and expenses incurred in
connection with the loan facilities transactions, for working capital and other general corporate purposes.
We are permitted to increase the Revolving Facility and/or add one or more tranches of term loans in an aggregate amount not to exceed the sum of (i) $100 million plus (ii) an unlimited additional
amount, provided that (in the case of clause (ii)), after giving effect to such increases, the pro forma Consolidated Leverage Ratio (as defined in the Credit Agreement) would not exceed 2.0:1.0, and the aggregate amount of all incremental
increases under the Revolving Facility does not exceed $50,000,000.
The interest rates per annum applicable to the Senior Credit Facilities (other than in respect of Swingline Loans) will be Term SOFR as defined in the agreement plus an applicable margin or, at our
option, an alternate base rate plus an applicable margin. The interest rate for the 2023 Year on our Senior Credit Facilities, net of savings from the interest rate swap described below, was 5.1%, with an all-interest rate, including all
associated costs, of 5.7%. Interest is payable at the end of the selected interest period but no less frequently than quarterly and on the date of maturity.
We will also pay to the Administrative Agent, for the account of each lender under the Revolving Facility, a commitment fee equal to the actual daily excess of each lender’s commitment over its
outstanding credit exposure under the Revolving Facility (“unused fee”). We may prepay and/or repay the revolving loans and the term loans, and/or terminate the revolving loan commitments, in whole or in part, at any time without premium or
penalty, subject to certain conditions.
The Credit Agreement contains customary covenants limiting, among other things, the incurrence of additional indebtedness, the creation of liens, mergers, consolidations, liquidations and
dissolutions, sales of assets, dividends, and other payments in respect of equity interests, acquisitions, investments, loans and guarantees, subject, in each case, to customary exceptions, thresholds and baskets. The Credit Agreement includes
certain financial covenants which include the Consolidated Fixed Charge Coverage Ratio and the Consolidated Leverage Ratio, as defined in the Credit Agreement. The Credit Agreement also contains customary events of default.
Our obligations under the Credit Agreement are guaranteed by our wholly owned material domestic subsidiaries (each, a “Guarantor”), and our obligations and any Guarantors are secured by a perfected
first priority security interest in substantially all of our existing and future personal property and each Guarantor, subject to certain exceptions.
As of December 31, 2023, $144.4 million was outstanding on the Term Facility while none was outstanding under the Revolving Facility, resulting in $175.0 million of credit availability. As of
December 31, 2023, we were in compliance with all of the covenants contained in the Credit Agreement. The average effective interest rate, net of the savings from interest rate swap discussed below, for borrowings under the Senior Credit
Facility, inclusive of all associated costs, was 5.3% for the Full Year 2023.
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Interest Rate Swap
In May 2022, we entered into an interest rate swap agreement, effective on June 30, 2022, with Bank of America, N.A, which became effective on June 30, 2022. It has a $150 million notional value
adjusted concurrently with scheduled principal payments made on the term loan and has a maturity date of June 30, 2027. Beginning in July 2022, we receive 1-month SOFR, and pay a fixed rate of interest of 2.815% on 1-month SOFR on a quarterly
basis. The total interest rate in any period also includes an applicable margin based on our consolidated leverage ratio. In connection with the swap, no cash was exchanged between us and the counterparty.
We designated our interest rate swap as a cash flow hedge and structured it to be highly effective. Consequently, unrealized gains and losses related to the fair value of the interest rate swap are
recorded to accumulate other comprehensive income (loss), net of tax.
As of December 31, 2023, the fair value of the interest rate swap was $3.7 million, a decrease of $1.2 million, net of a $0.4 million, income tax effect, as compared to December 31, 2022. The fair
value of the interest rate swap is included in other assets (current and long term) in our consolidated balance sheet while the increase in fair value is presented as unrealized loss in our unaudited consolidated statements of comprehensive
income. The interest rate swap arrangement generated $3.3 million in interest savings for the Full Year 2023. The average interest rate for the term facility, net of the savings from the swap in the Full Year 2023 was 4.9%.
Notes Payable and Deferred Payments Related to Acquisitions
We generally enter into various notes payable as a means of financing our acquisitions. Our present outstanding notes payable primarily relate to the acquisitions of a business or acquisitions of
majority interests in such businesses. At December 31, 2023, our remaining outstanding balance on these notes aggregated $5.3 million. $1.6 million of the outstanding notes payable are payable in 2023, $2.4 million is payable in 2024, and $1.3
million is payable in 2025. Notes are generally payable in equal annual installments of principal over two years plus any accrued and unpaid interest. Interest accrues at various interest rates ranging from 3.25% to 8.0% per annum.
On September 29, 2023, we acquired a 70% equity interest in a four-clinic physical therapy practice. The owner of the practice retained 30% of the equity interests. The purchase price for the 70%
equity interest was approximately $6.0 million, of which $5.4 million was paid in cash, and $0.6 million was in the form of a note payable. The note accrues interest at 5.0% per annum and the principal and interest are payable in two
installments. The first payment of principal and interest of $0.3 million was paid January 2024, and the second installment of $0.3 million is due on September 30, 2025.
In a separate transaction, on September 29, 2023, we acquired a 70% equity interest in a single clinic physical therapy practice. The owner of the practice retained 30% of the equity interests.
The purchase price for the 70% equity interest was approximately $7.8 million, of which $7.4 million was paid in cash and $0.4 million is a deferred payment due on June 30, 2025.
On July 31, 2023, we acquired a 70% equity interest in a five-clinic practice. The practice’s owners retained a 30% equity interest. The purchase price for the 70% equity interest was
approximately $2.1 million, of which $1.8 million was paid in cash and $0.3 million is a deferred payment due on June 30, 2025.
On May 31, 2023, we and a local partner together acquired a 75% interest in a four-clinic physical therapy practice. After the transaction, our ownership interest is 45%, our local partner’s
ownership interest is 30%, and the practice’s pre-acquisition owners have a 25% ownership interest. The purchase price for the 75% equity interest was approximately $3.1 million, of which $1.7 million was paid in cash by us, $1.1 million was
paid in cash by the local partner, and $0.3 million was in the form of a note payable (of which $0.2 million will be paid by us and $0.1 million will be paid by the local partner). The note will be paid on July 1, 2024. We guaranteed the full
payment of $0.3 million on its due date.
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On February 28, 2023, we acquired an 80% interest in a one-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for the 80% equity
interest was approximately $6.2 million, of which $5.8 million was paid in cash and $0.4 million in the form of a note payable. The note accrues interest at 4.5% per annum and the principal and interest are payable on February 28, 2025.
On November 30, 2022, we acquired an 80% interest in a thirteen-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for the 80% equity
interest was approximately $25.0 million, of which $24.2 million was paid in cash and $0.8 million in the form of a note payable. The note accrues interest at 7.0% per annum and the principal and interest are payable on November 30, 2024.
On October 31, 2022, we acquired a 60% interest in a fourteen-clinic physical therapy practice. The practice’s owners retained 40% of the equity interests. The purchase price for the 60% equity
interest was approximately $19.5 million, with a potential additional amount to be paid at a later date based on the performance of the business. This contingent consideration had a fair value of $9.8 million on December 31, 2023. The fair value
of this contingent consideration will be adjusted quarterly based on certain criteria and market inputs. There is no maximum payout for this contingency.
On September 30, 2022, we acquired an 80% interest in a two-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for the 80% equity
interest was approximately $4.2 million, of which $3.9 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 5.5% per annum and the principal and interest are payable on September 30, 2024.
On August 31, 2022, we acquired a 70% interest in a six-clinic physical therapy practice. The practice’s owners retained 30% of the equity interests. The purchase price for the 70% equity interest
was approximately $3.5 million, of which $3.3 million was paid in cash and $0.2 million in the form of a note payable. The note accrues interest at 5.5% per annum and the principal and interest are payable on August 31, 2024.
On March 31, 2022, we acquired a 70% interest in a six-clinic physical therapy practice. The practice’s owners retained 30% of the equity interests. The purchase price for the 70% equity interest
was approximately $11.5 million, of which $11.2 million was paid in cash and $0.3 million is in the form of a note payable. The note accrues interest at 3.5% per annum and the principal and interest are payable on March 31, 2024.
Historically, we have generated sufficient cash from operations to fund our development activities and to cover operational needs. We currently have $152.8 million of cash on hand, a significant
portion of which is available for deployment into development and other growth initiatives. We plan to continue developing new clinics and making additional acquisitions. We have from time to time purchased the non-controlling interests of
limited partners in our Clinic Partnerships. We may purchase additional non-controlling interests in the future. Generally, any acquisition or purchase of non-controlling interests is expected to be accomplished using a combination of cash and
financing. A large acquisition may require financing.
We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts. Claims are submitted to payors daily, weekly or monthly in
accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time consuming and typically involves the submission of claims to multiple payors whose payment of claims may be
dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting CMS approval initially may not be submitted for
six months or more. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor type receivables,
the write-off generally occurs after the account receivable has been outstanding for 120 days or longer.
Redeemable Non-Controlling Interest
Certain of our limited partnership agreements, as amended, provide that, upon the triggering events, we have a call right and the selling entity or individual has a put right for the purchase and
sale of the limited partnership interest held by the partner. Once triggered, the put right and the call right do not expire, even upon an individual partner’s death, and contain no mandatory redemption feature. The purchase price of the
partner’s limited partnership interest upon the exercise of either the put right or the call right is calculated per the terms of the respective agreements and classified as redeemable non-controlling interest (temporary equity) in our
consolidated balance sheets. The fair value of the redeemable non-controlling interest at December 31, 2023 was $174.8 million.
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In the event that a limited non-controlling interest partner’s employment ceases at any time after a specified date that is typically between three and five years from the acquisition date, we
have agreed to certain contractual provisions which enable such non-controlling interest partners to exercise their right to trigger our repurchase of that partner’s non-controlling interest at a predetermined multiple of earnings before
interest and taxes.
Share Repurchase Program
In March 2009, the Board authorized the repurchase of up to 10% of our common stock (“March 2009 Authorization”). Under the March 2009 Authorization, the Company has purchased a total of 859,499
shares. In November 2023, the Board terminated the March 2009 Authorization such that any such repurchase of our common stock would be considered and determined by the Board at the time of repurchase. We did not purchase any shares of our
common stock during the year ended December 31, 2023, or December 31, 2022.
Contractual Obligations
We have future obligations for debt repayments and associated interest payments as well as future minimum rentals under our non-cancellable operating leases. The obligations as of December 31, 2023,
are summarized as follows:
| Total | 2024 | 2025 | 2026 | 2027 | 2028 | Thereafter | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (In thousands) | |||||||||||||||||||||||||||
| Term facility (1) | $ | 144,375 | 5,625 | 7,500 | 9,375 | $ | 121,875 | $ | - | $ | - | ||||||||||||||||
| Notes payable (2) | 3,775 | 2,486 | 1,289 | - | - | - | - | ||||||||||||||||||||
| Interest expense on Term Facility and notes payable (3) | 20,958 | 6,725 | 6,508 | 6,210 | 1,515 | - | - | ||||||||||||||||||||
| Operating leases (4) | 144,666 | 46,845 | 36,447 | 27,406 | 18,495 | 10,025 | 5,448 | ||||||||||||||||||||
| $ | 313,774 | $ | 61,681 | $ | 51,744 | $ | 42,991 | $ | 141,885 | $ | 10,025 | $ | 5,448 |
(1) Amounts due under our Term Facility discussed above.
(2) Amounts due related to certain acquisitions discussed above.
(3) Interest on our Senior Credit Facility was estimated using the average outstanding balance for the respective periods and our effective interest rate on our Term Facility at December 31, 2023, of 4.7%. Interest on our other debt was
estimated using the stated rate in the debt agreement.
(4) Includes variable non-lease components, including but not limited to common area maintenance.
CRITICAL ACCOUNTING POLICIES
Management’s discussion and analysis of financial condition and results of operations is based upon our consolidated financial statements which have been prepared in accordance with accounting
principles generally accepted in the United States. The preparation of these financial statements requires estimates and judgments that affect the reported amounts of our assets, liabilities, net sales and expenses, and disclosure of contingent
assets and liabilities. Management bases estimates on historical experience and other assumptions it believes to be reasonable given the circumstances and evaluates these estimates on an ongoing basis. Actual results may differ from these
estimates under different assumptions or conditions.
We believe that the following critical accounting policies involve a higher degree of judgment and complexity. See Note 2, Significant Accounting Policies, to our audited consolidated financial
statements which are included elsewhere in this Annual Report on Form 10-K for a complete discussion of our significant accounting policies. The following reflect the significant estimates and judgments used in the preparation of our consolidated
financial statements.
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Revenue Recognition
Revenues are recognized in the period in which services are rendered. Net patient revenue consists of revenues from physical therapy and occupational therapy clinics that provide pre-and
post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenue (patient revenues less estimated contractual
adjustments – described below) is recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied. There is an
implied contract between us and the patient upon each patient visit. Separate contractual arrangements exist between us and third-party payors (e.g. insurers, managed care programs, government programs, and workers' compensation programs) which
establish the amounts the third parties pay on behalf of the patients for covered services rendered. While these agreements are not considered contracts with the customer, they are used for determining the transaction price for services provided
to the patients covered by the third-party payors. The payor contracts do not indicate performance obligations for us but indicate reimbursement rates for patients who are covered by those payors when the services are provided. At that time, we
are obligated to provide services for the reimbursement rates stipulated in the payor contracts. The execution of the contract alone does not indicate a performance obligation. For self-paying customers, the performance obligation exists when we
provide the services at established rates. The difference between our established rate and the anticipated reimbursement rate is accounted for as an offset to revenue—contractual allowance.
Management contract revenue, which is included in other revenue in the consolidated statements of net income, is derived from contractual arrangements whereby we manage a clinic owned by a third
party. We do not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for
our employees, are recorded when incurred.
Revenues from the IIP business, which are also included in other revenues in the consolidated statements of net income, are derived from onsite services we provide to clients’ employees including
injury prevention, rehabilitation, ergonomic assessments, and performance optimization. Revenue from the IIP business is recognized when obligations under the terms of the contract are satisfied. Revenues are recognized at an amount equal to the
consideration we expect to receive in exchange for providing injury prevention services to our clients. The revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period.
Additionally, other revenue includes services we provide on-site at locations such as schools and industrial worksites for physical or occupational therapy services, athletic trainers and gym
membership fees. Contract terms and rates are agreed to in advance between us and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in advance,
revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time when the services are performed.
We determine
allowances for credit losses based on the specific agings of receivables and payor classifications at each clinic. The provision for credit losses is included in clinic operating costs in the statements of net income. Patient accounts receivable,
which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for credit losses, includes only those amounts we estimate to be collectible. Our provision for credit losses was 1.0% of total net revenue
for each years ended December 31, 2023, 2022 and 2021, respectively. Management believes that this is reasonable because the majority of our payors consist of highly solvent, highly regulated, commercial insurance companies as well as government
programs, including Medicare.
Contractual Allowances
Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare
programs for such services. Medicare regulations and the various third-party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in our clinics. We estimate
contractual allowances based on our interpretation of the applicable regulations, payor contracts and historical calculations. Each month we estimate our contractual allowance for each clinic based on payor contracts and the historical collection
experience of the clinic and apply an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on our historical experience, calculating the contractual allowance reserve
percentage at the payor level is sufficient to allow us to provide the necessary detail and accuracy with our collectability estimates. However, the services authorized and provided and related reimbursement are subject to interpretation that
could result in payments that differ from our estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. Our billing systems may not capture the exact change in our
contractual allowance reserve estimate from period to period. Therefore, in order to assess the accuracy of our revenues and hence our contractual allowance reserves, our management regularly compares our cash collections to corresponding net
revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, the historical difference between net revenues and corresponding cash collections in any given fiscal year has generally reflected a difference within
approximately 1.0% to 1.5% of net revenues. Additionally, analysis of subsequent period’s contractual write-offs on a payor basis reflects a difference within approximately 1.0% to 1.5% between the actual aggregate contractual reserve percentage
as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, we believe that a reasonable likely change in the contractual allowance reserve estimate would not be more than 1.0%
to 1.5% of gross billings in accounts receivable at December 31, 2023. For purposes of demonstrating the sensitivity of this estimate on our Company’s financial condition, a 1.0% to 1.5% increase or decrease in our aggregate contractual allowance
reserve percentage would decrease or increase, respectively, net patient revenue by approximately $1.4 million to $1.5 million for the year ended December 31, 2023. Management believes the changes in the estimate of the contractual allowance
reserve for the periods ended December 31, 2023, 2022 and 2021 have not been material to the statement of income.
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Goodwill
Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible
assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a
non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.
Goodwill and other indefinite-lived intangible assets are not amortized but are instead subject to periodic impairment evaluations. The fair value of goodwill and other identifiable intangible
assets with indefinite lives are evaluated for impairment at least annually and upon the occurrence of certain events or conditions and are written down to fair value if considered impaired. These events or conditions include but are not limited
to a significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating, or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale or
disposition of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. We evaluate indefinite-lived tradenames in
conjunction with our annual goodwill impairment test.
We operate our business through two segments consisting of our physical therapy clinics and our IIP business. For purposes of goodwill impairment analysis, each of our segments is further broken
down into reporting units. Reporting units within our physical therapy business comprise of regions primarily based on each clinic’s location. In addition to the six regions, in 2023 and 2022, the IIP business consisted of two reporting units.
As part of the impairment analysis, we are first required to assess qualitatively if we can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not impaired,
we are then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than its carrying
amount, we consider relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. We consider both the income and market approach in determining the fair value of its reporting units when performing a
quantitative analysis.
An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the estimated
fair value of the reporting unit. The evaluation of goodwill in 2021 did not result in any goodwill amounts that were deemed impaired.
We recorded a charge for goodwill impairment of $15.8 million and $9.1 million in the years ended December 31, 2023, and December 31, 2022, respectively. We also recorded a charge of $1.7 million
for the impairment of a tradename during the year ended December 31, 2023. The charges for impairment related to one reporting unit in the IIP business. The impairments are a result of a change in the reporting unit’s current and projected
operating income as well as various market inputs based on current market conditions.
During the year ended December 31, 2023, we did not recognize any additional impairment as a result of the Company’s annual assessment of goodwill and tradenames for the other seven reporting units.
We also noted no impairment to long-lived assets for all reporting units.
We will continue to monitor for any triggering events or other indicators of impairment.
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No impairment was recognized as part of our annual assessment of goodwill for the other seven reporting units.
Redeemable Non-Controlling Interest
The non-controlling interests that are reflected as redeemable non-controlling interest in our consolidated financial statements consist of those owners, including us, that have certain redemption
rights, whether currently exercisable or not, and which currently, or in the future, require that we purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met and the owners request the purchase
(“Put Right”). We also have a call right (“Call Right”). The Put Right or Call Right may be triggered by the owner or us, respectively, at such time as both of the following events have occurred: 1) termination of the owner’s employment,
regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement. The Put Rights and Call Rights
are not automatic (even upon death) and require either the owner or us to exercise our rights when the conditions triggering the Put or Call Rights have been satisfied. The purchase price is derived at a predetermined formula based on a multiple
of trailing twelve months earnings performance as defined in the respective limited partnership agreements.
On the date we acquire a controlling interest in a partnership and the limited partnership agreement for such partnerships contains redemption rights not under our control, the fair value of the
non-controlling interest is recorded in the consolidated balance sheet under the caption—Redeemable non-controlling interest. Then, in each reporting period thereafter until it is purchased by us, the
redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial value, based on the predetermined formula defined in the respective limited partnership agreement. As a result, the value of the
non-controlling interest is not adjusted below its initial value. We record any adjustment in the redemption value, net of tax, directly to retained earnings and not in the consolidated statements of net income. Although the adjustments are not
reflected in the consolidated statements of net income, current accounting rules require that we reflect the adjustments, net of tax, in the earnings per share calculation. The amount of net income attributable to redeemable non-controlling
interest owners is included in consolidated net income on the face of the consolidated statement of income. We believe the redemption value (i.e. the carrying amount) and fair value are the same.
Non-Controlling Interest
We recognize non-controlling interests, in which we have no obligation but the right to purchase the non-controlling interests, as equity in the consolidated financial statements separate from the
parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the consolidated statements of net income. Operating losses are allocated to non-controlling
interests even when such allocation creates a deficit balance for the non-controlling interest partner. When we purchase a non-controlling interest and the purchase differs from the book value at the time of purchase, any excess or shortfall is
recognized as an adjustment to additional paid-in capital.
FY 2022 10-K MD&A
SEC filing source: 0001140361-23-009198.
ITEM 7. MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS.
EXECUTIVE SUMMARY
Our reportable segments consist of the physical therapy operations segment and the industrial injury prevention services segment. Through our subsidiaries, we operate outpatient physical therapy
clinics that provide pre-and post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurological-related injuries and rehabilitation of injured workers. We also have majority interests in
companies which are leading providers of industrial injury prevention services (“IIP”). Services provided in these businesses include onsite injury prevention and rehabilitation, performance optimization, post-offer employment testing, functional
capacity evaluations and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. These
services are performed through Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs).
During the last three years, we completed the acquisitions of eleven multi-clinic practices and two industrial injury prevention services businesses as detailed below:
| % Interest | Number of | ||||||
|---|---|---|---|---|---|---|---|
| Acquisition | Date | Acquired | Clinics | ||||
| November 2022 Acquisition | November 30, 2022 | 80% | 13 | ||||
| October 2022 Acquisition | October 31, 2022 | 60% | 14 | ||||
| September 2022 Acquisition | September 30, 2022 | 80% | 2 | ||||
| August 2022 Acquisition | August 31, 2022 | 70% | 6 | ||||
| March 2022 Acquisition | March 31, 2022 | 70% | 6 | ||||
| December 2021 Acquisition | December 31, 2021 | 75% | 3 | ||||
| November 2021 Acquisition | November 30, 2021 | 70% | * | ||||
| September 2021 Acquisition | September 30, 2021 | 100% | * | ||||
| June 2021 Acquisition | June 30, 2021 | 65% | 8 | ||||
| March 2021 Acquisition | March 31, 2021 | 70% | 6 | ||||
| November 2020 Acquisition | November 30, 2020 | 75% | 3 | ||||
| September 2020 Acquisition | September 30, 2020 | 70% | ** | ||||
| February 2020 Acquisition | February 27, 2020 | 65% *** | 4 |
| Column 1 | Column 2 |
|---|---|
| * | Industrial injury prevention services business |
| Column 1 | Column 2 |
|---|---|
| ** | The business includes six management contracts which have been in place for a number of years. As of the date acquired, the contracts had a remaining term of five years. |
| Column 1 | Column 2 |
|---|---|
| *** | The four clinics are in four separate partnerships. The Company's interest in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. |
Besides the multi-clinic acquisitions referenced in the table above, during 2022 and 2021, we purchased the assets and business of three individual physical therapy clinics in separate transactions.
The clinics operate as satellite clinics of three of our existing clinic partnerships.
During the year ended December 31, 2022, we sold five clinics and closed eleven clinics. The aggregate sales price was $0.3 million. During the year ended December 31, 2021, we sold two clinics for an
aggregate sales price of $0.1 million, and we closed three clinics. During the year ended December 31, 2020, we closed 34 clinics, and we sold 14 previously closed clinics for an aggregate sales price was $1.1 million. Of the total sales price,
$0.7 million was paid in cash and $0.4 million in a note receivable which was fully received in June 2022.
We intend to continue to pursue additional acquisition opportunities as well as open new clinics and satellite clinics.
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Impact of COVID-19
As previously disclosed in various filings with the Securities and Exchange Commission (the “SEC”), our results were negatively impacted by the effects of the COVID-19 pandemic especially in the years
ended December 31, 2021 and 2020. The COVID-19 pandemic continues to evolve, and we cannot predict any future impact on our business, operating results, cash flows and financial condition.
Relief Funds
In March 2020 in response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The CARES Act provided additional waivers, reimbursement,
grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for
preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. For the years ended December 31, 2021 and 2020, we
recorded income of approximately $4.6 million and $13.5 million of payments under the CARES Act (“Relief Funds”) respectively. Under our accounting policy, these payments were recorded as Other income – Relief Funds. These funds are not required
to be repaid upon attestation and compliance with certain terms and conditions, which could change materially based on evolving grant compliance provisions and guidance provided by the U.S. Department of Health and Human Services. Currently, we
can attest and comply with the terms and conditions. We will continue to monitor the evolving guidelines and may record adjustments as additional information is released.
Medicare Accelerated and Advance Payment Program (“MAAPP Funds”)
The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing MAAPP funds during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive
advanced payments for future Medicare services provided. We applied for and received approval to receive MAAPP Funds from Centers for Medicare & Medicaid Services in April 2020. We recorded the $14.1 million in advance payments received as a
liability. During the quarter ended March 31, 2021, we repaid the MAAPP funds of $14.1 million rather than applying them to future services performed.
CRITICAL ACCOUNTING POLICIES
Critical accounting policies are those that have a significant impact on our results of operations and financial position involving significant estimates requiring our judgment. Our critical
accounting policies are:
Revenue Recognition.
Revenues are recognized in the period in which services are rendered. Net patient revenue consists of revenues for physical therapy and occupational therapy clinics that provide pre-and post-operative
care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenue (patient revenues less estimated contractual adjustments –
described below) is recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied. There is an implied contract
between us and the patient upon each patient visit. Separate contractual arrangements exist between us and third-party payors (e.g. insurers, managed care programs, government programs, and workers' compensation programs) which establish the
amounts the third parties pay on behalf of the patients for covered services rendered. While these agreements are not considered contracts with the customer, they are used for determining the transaction price for services provided to the
patients covered by the third-party payors. The payor contracts do not indicate performance obligations for us but indicate reimbursement rates for patients who are covered by those payors when the services are provided. At that time, we are
obligated to provide services for the reimbursement rates stipulated in the payor contracts. The execution of the contract alone does not indicate a performance obligation. For self-paying customers, the performance obligation exists when we
provide the services at established rates. The difference between our established rate and the anticipated reimbursement rate is accounted for as an offset to revenue—contractual allowance.
Management contract revenue, which is included in other revenue in the consolidated statements of net income, is derived from contractual arrangements whereby we manage a clinic owned by a third
party. We do not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for
our employees, are recorded when incurred.
Revenues from the industrial injury prevention services business, which are also included in other revenues in the consolidated statements of net income, are derived from onsite services we provide to
clients’ employees including injury prevention, rehabilitation, ergonomic assessments and performance optimization. Revenue from the industrial injury prevention services business is recognized when obligations under the terms of the contract are
satisfied. Revenues are recognized at an amount equal to the consideration we expect to receive in exchange for providing injury prevention services to our clients. The revenue is determined and recognized based on the number of hours and
respective rate for services provided in a given period.
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Additionally, other revenue includes services we provide on-site at locations such as schools and industrial worksites for physical or occupational therapy services, athletic trainers and gym
membership fees. Contract terms and rates are agreed to in advance between us and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in advance,
revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time when the services are performed.
We determine allowances for credit losses based on the specific agings of receivables and payor classifications at each clinic. The provision for credit losses is included in clinic operating costs in
the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for credit losses, includes only those amounts we estimate to be collectible.
The following table details the revenue related to the various categories (in thousands):
| Year Ended | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | December 31, 2020 | |||||||||
| Net patient revenue | $ | 464,590 | $ | 438,330 | $ | 373,340 | |||||
| Other revenue | 3,407 | 2,939 | 2,020 | ||||||||
| Net patient revenue from physical therapy operations | $ | 467,997 | $ | 441,269 | $ | 375,360 | |||||
| Revenue from management contracts | 8,095 | 9,853 | 8,410 | ||||||||
| Revenue from industrial injury prevention services | 77,052 | 43,900 | 39,199 | ||||||||
| Total revenue | $ | 553,144 | $ | 495,022 | $ | 422,969 |
Contractual Allowances. Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by
both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third-party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms
payable for the services provided in our clinics. We estimate contractual allowances based on our interpretation of the applicable regulations, payor contracts and historical calculations. Each month we estimate our contractual allowance for each
clinic based on payor contracts and the historical collection experience of the clinic and apply an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on our
historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow us to provide the necessary detail and accuracy with our collectability estimates. However, the services authorized and
provided and related reimbursement are subject to interpretation that could result in payments that differ from our estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management.
Our billing systems may not capture the exact change in our contractual allowance reserve estimate from period to period. Therefore, in order to assess the accuracy of our revenues and hence our contractual allowance reserves, our management
regularly compares our cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, the historical difference between net revenues and corresponding cash collections in any given
fiscal year has generally reflected a difference within approximately 1.0% to 1.5% of net revenues. Additionally, analysis of subsequent period’s contractual write-offs on a payor basis reflects a difference within approximately 1.0% to 1.5%
between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, we believe that a reasonable likely change in the
contractual allowance reserve estimate would not be more than 1% to 1.5% of gross billings in accounts receivable at December 31, 2022. For purposes of demonstrating the sensitivity of this estimate on our Company’s financial condition, a 1% to
1.5% increase or decrease in our aggregate contractual allowance reserve percentage would decrease or increase, respectively, net patient revenue by approximately $1.4 million to $1.3 million for the year ended December 31, 2022. Management
believes the changes in the estimate of the contractual allowance reserve for the periods ended December 31, 2022, 2021 and 2020 have not been material to the statement of income.
The following table sets forth information regarding our patient accounts receivable as of the dates indicated (in thousands):
| December 31, | |||||||
|---|---|---|---|---|---|---|---|
| 2022 | 2021 | ||||||
| Gross patient accounts receivable | $ | 144,758 | $ | 129,524 | |||
| Less contractual allowances | 89,995 | 80,484 | |||||
| Subtotal - accounts receivable | 54,763 | 49,040 | |||||
| Less allowance for credit losses | 2,829 | 2,768 | |||||
| Net patient accounts receivable | $ | 51,934 | $ | 46,272 |
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The following table presents our patient accounts receivable aging by payor class as of the dates indicated (in thousands):
| December 31, 2022 | December 31, 2021 | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Current to | Current to | ||||||||||||||||||||||
| Payor | 120 Days | 120+ Days | Total | 120 Days | 120+ Days | Total | |||||||||||||||||
| Managed Care/ Commercial Plans | $ | 16,439 | $ | 2,168 | $ | 18,607 | $ | 13,985 | $ | 2,381 | $ | 16,366 | |||||||||||
| Medicare/Medicaid | 15,987 | 1,657 | 17,644 | 13,442 | 1,636 | 15,078 | |||||||||||||||||
| Workers Compensation* | 5,996 | 1,341 | 7,337 | 5,600 | 1,312 | 6,912 | |||||||||||||||||
| Self-pay | 4,048 | 3,338 | 7,386 | 4,371 | 3,316 | 7,687 | |||||||||||||||||
| Other** | 1,463 | 2,326 | 3,789 | 1,168 | 1,829 | 2,997 | |||||||||||||||||
| Totals | $ | 43,933 | $ | 10,830 | $ | 54,763 | $ | 38,566 | $ | 10,474 | $ | 49,040 |
| Column 1 | Column 2 |
|---|---|
| * | Workers compensation is paid by state administrators or their designated agents. |
| Column 1 | Column 2 |
|---|---|
| ** | Other includes primarily litigation claims and, to a lesser extent, vehicular insurance claims. |
Goodwill
Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible
assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a
non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.
Goodwill and other indefinite-lived intangible assets are not amortized but are instead subject to periodic impairment evaluations. The fair value of goodwill and other identifiable intangible assets
with indefinite lives are evaluated for impairment at least annually and upon the occurrence of certain events or conditions and are written down to fair value if considered impaired. These events or conditions include but are not limited to a
significant adverse change in the business environment, regulatory environment, or legal factors; a current period operating, or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale or disposition
of a significant portion of a reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. We evaluate indefinite-lived tradenames in conjunction with
our annual goodwill impairment test.
We operate our business through two segments consisting of our physical therapy clinics and our industrial injury prevention services business. For purposes of goodwill impairment analysis, each of
our segments is further broken down into reporting units. Reporting units within our physical therapy business comprise of regions primarily based on each clinic’s location. In addition to the six regions, in 2022 and 2021, the industrial injury
prevention services businesses consisted of two reporting units.
As part of the impairment analysis, we are first required to assess qualitatively if we can conclude whether goodwill is more likely than not impaired. If goodwill is more likely than not impaired, we
are then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a reporting unit is less than its carrying
amount, we consider relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. We consider both the income and market approach in determining the fair value of its reporting units when performing a
quantitative analysis.
An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the estimated
fair value of the reporting unit. The evaluation of goodwill in 2021 and 2020 did not result in any goodwill amounts that were deemed impaired.
In 2022, we recorded a charge for goodwill impairment of $9.1 million related to one reporting unit in the industrial injury prevention services business. The impairment is related to a change in the
reporting unit’s current and projected operating income as well as various inputs based on current market conditions, including the higher interest rate environment.
No impairment was recognized as part of our annual assessment of goodwill for the other seven reporting units.
Redeemable Non-Controlling Interest
The non-controlling interests that are reflected as redeemable non-controlling interest in our consolidated financial statements consist of those owners, including us, that have certain redemption
rights, whether currently exercisable or not, and which currently, or in the future, require that we purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met and the owners request the purchase
(“Put Right”). We also have a call right (“Call Right”). The Put Right or Call Right may be triggered by the owner or us, respectively, at such time as both of the following events have occurred: 1) termination of the owner’s employment,
regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement. The Put Rights and Call Rights
are not automatic (even upon death) and require either the owner or us to exercise our rights when the conditions triggering the Put or Call Rights have been satisfied. The purchase price is derived at a predetermined formula based on a multiple
of trailing twelve months earnings performance as defined in the respective limited partnership agreements.
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On the date we acquire a controlling interest in a partnership and the limited partnership agreement for such partnerships contains redemption rights not under our control, the fair
value of the non-controlling interest is recorded in the consolidated balance sheet under the caption—Redeemable non-controlling interest. Then, in
each reporting period thereafter until it is purchased by us, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial value, based on the predetermined formula defined in the respective
limited partnership agreement. As a result, the value of the non-controlling interest is not adjusted below its initial value. We record any adjustment in the redemption value, net of tax, directly to retained earnings and not in the
consolidated statements of income. Although the adjustments are not reflected in the consolidated statements of income, current accounting rules require that we reflect the adjustments, net of tax, in the earnings per share calculation. The
amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statement of income. We believe the redemption
value (i.e. the carrying amount) and fair value are the same.
Non-Controlling Interest
We recognize non-controlling interests, in which we have no obligation but the right to purchase the non-controlling interests, as equity in the consolidated financial statements separate from the
parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the consolidated statements of income. Operating losses are allocated to non-controlling interests
even when such allocation creates a deficit balance for the non-controlling interest partner. When we purchase a non-controlling interest and the purchase differs from the book value at the time of purchase, any excess or shortfall is recognized
as an adjustment to additional paid-in capital.
RESULTS OF OPERATIONS
The defined terms with their respective description used in the following discussion are listed below:
| 2022 Year | Year ended December 31, 2022 |
|---|---|
| 2021 Year | Year ended December 31, 2021 |
| Clinic Additions | Clinics opened or acquired during the year ended December 31, 2022 and 2021 |
| 2022 Clinic Additions | Clinics opened or acquired during the year ended December 31, 2022 |
| 2021 Clinic Additions | Clinics opened or acquired during the year ended December 31, 2021 |
| Clinics Additions | Clinics opened or acquired during the year ended December 31, 2022 and 2021 |
| Mature Clinics | Clinics opened or acquired prior to January 1, 2021 and are still operating |
Selected Operating and Financial Data
The following table presents selected operating and financial data, used by management as key indicators of our operating performance:
| For the Years Ended December 31, | |||||||
|---|---|---|---|---|---|---|---|
| 2022 | 2021 | ||||||
| Number of clinics at the end of period | 640 | 591 | |||||
| Working Days | 255 | 254 | |||||
| Average visits per day per clinic | 28.7 | 29.1 | |||||
| Total patient visits | 4,483,282 | 4,219,576 | |||||
| Net patient revenue per visit | $ | 103.63 | $ | 103.88 |
2022 Compared to 2021
For the 2022 Year, our net income attributable to our shareholders was $32.2 million as compared to $40.8 million for the 2021 Year. In accordance with current accounting guidance, the revaluation of redeemable
non-controlling interest, net of taxes, is not included in net income but charged directly to retained earnings; however, the charge for this change is included in the earnings per basic and diluted share calculation. Including the charge for
revaluation of redeemable non-controlling interest, net of taxes, the amount is $29.3 million, or earnings per diluted share of $2.25, for the 2022 Year, and $31.1 million, or earnings per diluted share of $2.41 for the 2021 Year. See table below (in thousands, except per share data):
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| Year Ended December 31, | ||||||||
|---|---|---|---|---|---|---|---|---|
| 2022 | 2021 | |||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 32,158 | $ | 40,831 | ||||
| Charges to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (3,890 | ) | (13,011 | ) | ||||
| Tax effect at statutory rate (federal and state) of 25.55% | 994 | 3,324 | ||||||
| $ | 29,262 | $ | 31,144 | |||||
| Earnings per share (basic and diluted) | $ | 2.25 | $ | 2.41 |
Non-GAAP Measures
Operating Results and Adjusted EBITDA are not measures of financial performance under GAAP. Adjusted EBITDA and Operating Results should not be considered in isolation or as
an alternative to, or substitute for, net income attributable to USPH shareholders presented in the consolidated financial statements.
Adjusted EBITDA is defined as net income attributable to our shareholders before interest income, interest expense, taxes, depreciation, amortization, goodwill impairment
charges, change in fair value of contingent earn-out consideration, Relief Funds, changes in revaluation of put-right liability, equity-based awards compensation expense, settlement of a legal matter, and related portion for non-controlling
interests.
Operating Results, a non-GAAP measure, equals net income attributable to our diluted shareholders per the consolidated statements of income, less a goodwill impairment charge
related to the industrial injury prevention services acquisition in November 2021 (“IIP Acquisition”), changes in fair value of contingent consideration, expenses related to executive officer transitions, settlement of a legal matter, and any
allocations to non-controlling interests, all net of taxes. Operating Results per diluted share also exclude the impact of the revaluation of redeemable non-controlling interest and the associated tax impact.
The tables (in thousands, except per share data) below reconcile net income attributable to our shareholders calculated in accordance with GAAP to Operating Results and Adjusted EBITDA, non-GAAP measures defined
above. We use Operating Results and Adjusted EBITDA, which eliminate certain items described above that can be subject to volatility and unusual costs, as one the principal measures to evaluate and monitor financial performance period over
period. We believe that Operating Results and Adjusted EBITDA are useful information for investors to use in comparing the Company's period-to-period results as well as for comparing with other similar businesses since most do not have
redeemable instruments and therefore have different equity structures.
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See table below for a detailed computation (in thousands, except per share data):
| Year Ended December 31, | ||||||||
|---|---|---|---|---|---|---|---|---|
| 2022 | 2021* | |||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 32,158 | $ | 40,831 | ||||
| Charges to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (3,890 | ) | (13,011 | ) | ||||
| Tax effect at statutory rate (federal and state) of 25.55% | 994 | 3,324 | ||||||
| $ | 29,262 | $ | 31,144 | |||||
| Earnings per share (basic and diluted) | $ | 2.25 | $ | 2.41 | ||||
| Adjustments: | ||||||||
| Goodwill impairment charge | 9,112 | - | ||||||
| Change in fair value of contingent earn-out consideration | (2,520 | ) | - | |||||
| Change in revaluation of put-right liability | 5 | - | ||||||
| Expenses related to executive officer transitions | - | 1,301 | ||||||
| Relief Funds | - | (4,597 | ) | |||||
| Settlement of a legal matter | - | 2,635 | ||||||
| Allocation to non-controlling interests | (2,734 | ) | 676 | |||||
| Revaluation of redeemable non-controlling interest | 3,890 | 13,011 | ||||||
| Tax effect at statutory rate (federal and state) | (1,981 | ) | (3,328 | ) | ||||
| Operating Results (a non-GAAP measure) | $ | 35,034 | $ | 40,842 | ||||
| Relief Funds | - | 4,597 | ||||||
| Allocation to non-controlling interests | - | (715 | ) | |||||
| Tax effect at statutory rate (federal and state) of 25.55% | - | (992 | ) | |||||
| Operating Results (including Relief Funds) (a non-GAAP measure) | $ | 35,034 | $ | 43,732 | ||||
| Basic and diluted Operating Results per share (a non-GAAP measure) | ||||||||
| Including Relief Funds | $ | 2.70 | $ | 3.39 | ||||
| Excluding Relief Funds | $ | 2.70 | $ | 3.17 | ||||
| Shares used in computation - basic and diluted | 12,985 | 12,898 |
| Year Ended December 31, | ||||||||
|---|---|---|---|---|---|---|---|---|
| 2022 | 2021 | * | ||||||
| Net income attributable to USPH shareholders | $ | 32,158 | $ | 40,831 | ||||
| Adjustments: | ||||||||
| Depreciation and amortization | 14,743 | 11,591 | ||||||
| Goodwill impairment | 9,112 | - | ||||||
| Change in fair value of contingent earn-out consideration | (2,520 | ) | - | |||||
| Settlement of a legal matter | - | 2,635 | ||||||
| Other and interest income | (859 | ) | (199 | ) | ||||
| Change in revaluation of put-right liability | 5 | - | ||||||
| Interest expense - debt and other, net | 5,779 | 942 | ||||||
| Provision for income taxes | 12,164 | 15,272 | ||||||
| Equity-based awards compensation expense | 7,264 | 7,867 | ||||||
| Allocation to non-controlling interests | (4,185 | ) | (1,277 | ) | ||||
| Adjusted EBITDA (a non-GAAP measure) | 73,661 | 77,662 | ||||||
| Relief Funds | $ | - | $ | (4,597 | ) | |||
| Allocation to non-controlling interests | - | 715 | ||||||
| Adjusted EBITDA (excluding Relief Funds) (a non-GAAP measure) | $ | 73,661 | $ | 73,780 |
| Column 1 | Column 2 |
|---|---|
| * | Revised to conform to current year presentation. |
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For the 2022 Year, our Adjusted EBITDA, a non-GAAP measure, was $73.7 million, as compared to $73.8 million, excluding Relief Funds for the 2021 Year. Adjusted EBITDA including Relief Funds for the
2022 Year and 2021 Year was $73.7 million and $77.7 million, respectively.
For the 2022 Year, the Company’s Operating Results, a non-GAAP measure, was $35.0 million, or $2.70 per diluted share, as compared to $40.8 million (excluding Relief Funds), or $3.17 per diluted share, for the 2021
Year. For the 2021 Year, the Company’s Operating Results including Relief Funds was $43.7 million, or $3.39 per diluted share.
Reported total revenue
Reported total revenue for the 2022 Year was $553.1 million, an increase of 11.7% as compared to $495.0 million for the 2021 Year. See
table below for a detail of reported total revenue (in thousands):
| For the Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | ||||||
| Revenue related to Mature Clinics | $ | 421,806 | $ | 420,093 | |||
| Revenue related to 2022 Clinic Additions | 14,779 | - | |||||
| Revenue related to 2021 Clinic Additions | 25,211 | 12,638 | |||||
| Revenue from clinics sold or closed in 2022 | 2,794 | 5,143 | |||||
| Revenue from clinics sold or closed in 2021 | - | 456 | |||||
| Net patient revenue from physical therapy operations | 464,590 | 438,330 | |||||
| Other revenue | 3,407 | 2,939 | |||||
| Revenue from physical therapy operations | 467,997 | 441,269 | |||||
| Revenue from management contracts | 8,095 | 9,853 | |||||
| Revenue from industrial injury prevention services | 77,052 | 43,900 | |||||
| Total revenue | $ | 553,144 | $ | 495,022 |
Net patient revenue from physical therapy operations
Net patient revenue from physical therapy operations and other revenue from physical therapy operations increased $26.7 million, or 6.1%, to $468.0 million for the 2022 Year from $441.3 million in the
2021 Year. Included in net patient revenue from physical therapy operations are revenues related to clinics sold or closed of $2.8 million for the 2022 Year and $5.6 million for the 2021 Year. During the 2022 Year, we sold our interest in five
clinics and closed eleven clinics. Excluding revenue from the clinics sold or closed, net patient revenue from physical therapy operations was approximately $461.8 million for the 2022 Year and $432.7 million for the 2021 Year, an increase of
5.0%. Revenue related to Mature Clinics increased $1.7 million, or 0.4%, for the 2022 Year compared to the 2021 Year.
The average net patient revenue per visit was $103.63 for the 2022 Year as compared to $103.88 for the 2021 Year, including all clinics operational during such periods. Total patient visits were
4,483,282 for the 2022 Year and 4,219,576 for the 2021 Year, an increase of 6.2%.
Other revenue from physical therapy operations, management contracts and industrial injury prevention services
Other revenue was $3.4 million in the 2022 Year and $2.9 million in the 2021 Year. Revenues from management contracts were $8.0 million in the 2022 Year as compared to $9.9 million in the 2021 Year. IIP services
revenue increased 75.5% to $77.1 million for the 2022 Year as compared to $43.9 million for the 2021 Year. The 2022 Year includes revenue of $26.7 million related to the IIP Acquisition, compared to $2.2 million in the 2021 Year.
Operating cost
Total operating cost was $441.1 million for the 2022 Year, or 79.7% of total revenue, as compared to $377.8 million or 76.3% of total revenue for the 2021 Year. Included in operating cost
for the 2022 Year was $33.2 million related to Clinic Additions, of which $20.8 million was associated with the 2021 Clinic Additions. Included in operating cost for 2021 was $10.3 million related to 2021 Clinic Additions. Operating cost related
to Mature Clinics increased by $16.7 million for the 2022 Year compared to the 2021 Year. Operating cost related to management contracts decreased by $1.9 million in the 2022 Year compared to the 2021 Year. In addition, operating cost related to
the industrial injury prevention services business increased by $27.9 million for the comparable period of which $22.4 million related to the industrial injury prevention services acquisition in November 2021. We experienced pressure on labor
rates and other costs in the 2022 Year due to the inflationary economic environment.
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See table below for a detail of operating cost (in thousands):
| For the Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | ||||||
| Operating cost related to Mature Clinics | $ | 337,606 | $ | 320,882 | |||
| Operating cost related to 2022 Clinic Additions | 12,425 | 74 | |||||
| Operating cost related to 2021 Clinic Additions | 20,792 | 10,299 | |||||
| Operating cost related to clinics sold or closed in 2022 | 2,810 | 4,561 | |||||
| Operating cost related to clinics sold or closed in 2021 | - | 512 | |||||
| Operating cost related to physical therapy operations | 373,633 | 336,328 | |||||
| Operating cost related to management contracts | 6,402 | 8,306 | |||||
| Operating cost related to industrial injury prevention services | 61,085 | 33,206 | |||||
| Total operating cost | $ | 441,120 | $ | 377,840 |
Operating Cost—Salaries and Related Costs
Salaries and related costs increased to $319.2 million for the 2022 Year from $278.5 million in 2021, an increase of $40.7 million, or 14.6%. Included in salaries and related costs related to 2022
Clinic Additions for the 2022 Year was $8.0 million. Salaries and related costs for clinics sold or closed in the 2022 Year and the 2021 Year were $1.8 million and $3.3 million in 2022 and 2021, respectively. Salaries and related costs for Mature
Clinics increased $9.2 million in the 2022 Year compared to the 2021 Year. Salaries and related costs for management contracts decreased $1.7 million in the 2022 Year compared to the 2021 Year. Salaries and related costs for the industrial injury
prevention services business increased $19.6 million for the comparable periods. Salaries and related costs as a percentage of net revenues were 57.7% for the 2022 Year and 56.3% for the 2021 Year. Salaries and related costs for physical therapy
operations were $59.52 per visit in the 2022 Year as compared to $57.20 per visit in the 2021 Year, an increase of $2.32. See table below for a detail of salaries and related costs (in thousands):
| For the Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | ||||||
| Physical therapy operations | |||||||
| Salaries and related costs related to Mature Clinics | $ | 243,131 | $ | 233,951 | |||
| Salaries and related costs related to 2022 Clinic Additions | 8,059 | - | |||||
| Salaries and related costs related to 2021 Clinic Additions | 13,688 | 6,668 | |||||
| Salaries and related costs related to clinics sold or closed in 2022 | 1,848 | 3,073 | |||||
| Salaries and related costs related to clinics sold or closed in 2021 | - | 248 | |||||
| Salaries and related costs related to physical therapy operations | 266,726 | 243,940 | |||||
| Salaries and related costs related to management contracts | 5,634 | 7,316 | |||||
| Salaries and related costs related to industrial injury prevention services | 46,831 | 27,213 | |||||
| Total salaries and related costs | $ | 319,191 | $ | 278,469 |
Operating Cost—Rent, Supplies, Contract Labor and Other
Rent, supplies, contract labor and other costs increased to $116.4 million in the 2022 Year from $94.1 million in the 2021 Year, an increase of $22.3 million, or 23.7%. Included in rent, supplies,
contract labor and other costs for 2022 and 2021 related to Clinic Additions was $10.9 million in 2022 and $3.6 million in 2021. Rent, supplies, contract labor and other costs for clinics related to partnership interests closed or sold in 2022
and 2021 were $0.9 million and $1.7 million, respectively. Rent, supplies, contract labor and other costs related to Mature Clinics increased by $7.8 million in the 2022 Year compared to the 2021 Year. Rent, supplies, contract labor and other
costs as a percent of net revenues was 21.0% for 2022 and 19.0% for 2021. Rent, supplies, contract labor and other costs for physical therapy operations were $19.53 per visit in 2022 as compared to $18.77 per visit in 2021, an increase of $0.78
per visit. See table below for a detail of rent, supplies, contract labor and other costs (in thousands):
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| For the Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | ||||||
| Physical therapy operations | |||||||
| Rent, supplies, contract labor and other costs related to Mature Clinics | $ | 89,534 | $ | 81,750 | |||
| Rent, supplies, contract labor and other costs related to 2022 Clinic Additions | 4,167 | 71 | |||||
| Rent, supplies, contract labor and other costs related to 2021 Clinic Additions | 6,777 | 3,539 | |||||
| Rent, supplies, contract labor and other costs related to clinics sold or closed in 2022 | 868 | 1,422 | |||||
| Rent, supplies, contract labor and other costs related to clinics sold or closed in 2021 | - | 301 | |||||
| Total Physical therapy operations | 101,346 | 87,083 | |||||
| Rent, supplies, contract labor and other costs related to physical therapy management contracts | 768 | 990 | |||||
| Rent, supplies, contract labor and other costs related to industrial injury prevention services | 14,267 | 5,993 | |||||
| Total rent, supplies, contract labor and other costs | $ | 116,381 | $ | 94,066 |
Operating Cost—Provision for Credit Losses
The provision for credit losses for net patient receivables was $5.5 million for 2022 and $5.3 million for 2021. As a percentage of net patient revenues, the provision for credit
losses was 1.0% for 2022 and 1.1% for 2021. The provision for credit losses at the end of each period is based on a detailed, clinic-by-clinic review of overdue accounts and is regularly reviewed in the aggregate in light of historical
experience.
Our provision for credit losses as a percentage of total patient accounts receivable was 5.17% on December 31, 2022, and 5.64% at December 31, 2021.
The average accounts receivable days outstanding was 31 days on December 31, 2022 and 32 days on December 31, 2021. Net patient receivables in the amounts of $5.5 million and $4.6
million were written-off in 2022 and 2021, respectively.
Gross Profit
Gross profit was $112.0 million for 2022, a decrease of $5.2 million, or 4.4% as compared to $117.2 million for 2021. The gross profit percentage was 20.3% of total revenue for 2022 as
compared to 23.7% for 2021. The gross profit percentage for our physical therapy operations was 20.2% for 2022 as compared to 23.8% for 2021. The gross profit percentage on management contracts was 20.9% for 2022 as compared to 15.7% for 2021.
The gross profit percentage for industrial injury prevention services was 20.7% for 2022 as compared to 24.4% for 2021. Gross profit in the 2022 Year was affected by pressure on labor rates and other costs due to the inflationary
economic environment. The IIP margin in 2022 was impacted by the lower margin profile of the IIP Acquisition. The table below details the gross profit (in thousands):
| For the Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | ||||||
| Physical therapy operations | $ | 94,364 | $ | 104,941 | |||
| Management contracts | 1,693 | 1,547 | |||||
| Industrial injury prevention services | 15,967 | 10,694 | |||||
| Gross profit | $ | 112,024 | $ | 117,182 |
Goodwill Impairment
In 2022, we recorded a charge for goodwill impairment of $9.1 million related to the IIP Acquisition. The impairment is related to a change in the IIP Acquisition’s current and projected operating income as well as
various inputs based on current market conditions, including the higher interest rate environment.
Corporate Office Costs
Corporate office costs were $46.1 million for 2022 compared to $46.5 million for 2021. Corporate office costs were 8.3% of total revenue for 2022 as compared to 9.4% for 2021. The decrease was
primarily due to lower estimated bonus expense in 2022 as compared to 2021.
Operating Income
Operating income for 2022 was $56.8 million, and $70.6 million for 2021. Operating income as a percentage of total revenue was 10.3% for 2022 as compared to 14.3% for 2021.
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Change in fair value of contingent earn-out consideration
We revalued contingent earn-out consideration related to some of our acquisitions resulting in the elimination of $2.5 million of liabilities previously booked in 2022.
Equity in earnings of unconsolidated affiliate
Through a subsidiary, we have a 49% joint venture interest in a company which provides physical therapy services for patients at hospitals. Since we are deemed to not have a controlling interest in
the joint venture, our investment is accounted for using the equity method of accounting. The investment balance of this joint venture as of December 31, 2022, is $12.1 million. For 2022, we recognized income of $1.2 million on this joint
venture.
Change in Revaluation of Put-Right Liability
For the 2022 Year, the valuation of the put-right liability remained relatively the same. The put right relates to the potential future purchase of a company that provides
physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to us in approximately five years from November 2021 with such right having a $3.5 million value as of both December 31, 2022 and 2021, as reflected on our consolidated balance sheet in Other long-term liabilities. The value of this right will continue to be adjusted in future periods, as
appropriate.
Other and interest income
Other and interest income amounted to $0.9 million primarily derived from a gain of $0.6 million from the sales of various clinics during the 2022 Year. Other and interest income was $0.2
million in the 2021 Year.
Interest Expense—Debt and Other, net
Interest expense—debt, net and other primarily from the $150 million term loan and revolving credit facility entered into in June 2022, details of which are disclosed in Note 10 to our financial
statements included in Item 8, amounted to $5.8 million mostly due to higher borrowings. See discussion of Other Comprehensive Income below. Interest expense, primarily from our revolving line of credit, was $0.9 million for the 2021 Year.
Provision for Income Taxes
The provision for income tax was $12.2 million for 2022 and $15.3 million for 2021. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling
interest (effective tax rate) was 27.4% for 2022 and 27.2% for 2021. See table below ($ in thousands):
| For the Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2022 | December 31, 2021 | |||||||
| Income before taxes | $ | 55,571 | $ | 73,196 | ||||
| Less: net income attributable to non-controlling interest: | ||||||||
| Redeemable non-controlling interest - temporary equity | (6,902 | ) | (11,358 | ) | ||||
| Non-controlling interest - permanent equity | (4,347 | ) | (5,735 | ) | ||||
| $ | (11,249 | ) | $ | (17,093 | ) | |||
| Income before taxes less net income attributable to non-controlling interest | $ | 44,322 | $ | 56,103 | ||||
| Provision for income taxes | $ | 12,164 | $ | 15,272 | ||||
| Percentage | 27.4 | % | 27.2 | % |
Net Income Attributable to Non-controlling Interest
Net income attributable to redeemable non-controlling interest (temporary equity) was $6.9 million for 2022 and $11.4 million for 2021. Net income attributable to non-controlling interest (permanent
equity) was $4.3 million for 2022 and $5.7 million for 2021. During 2022, $2.7 million of the goodwill impairment charge related to redeemable non-controlling interest (temporary equity).
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Other Comprehensive Income
We entered into an interest rate swap agreement in May 2022, which became effective on June 30, 2022. The maturity date of the swap agreement is June 30, 2027. It has a $150 million notional value adjusted
concurrently with scheduled principal payments made on the term loan. Beginning in July 2022, we pay a fixed one-month Secured Overnight Financing Rate (“SOFR”) of interest of 2.815%. The total interest rate in any period also includes an
applicable margin based on the Company’s consolidated leverage ratio. In the 2022 Year, our interest rate including the applicable margin was 4.665%. Unrealized gains and losses related to the fair value of the interest rate swap are recorded to
accumulated other comprehensive income (loss), net of tax. The fair value of the interest rate swap at December 31, 2022, was $5.4 million, which has been included within Other assets (current and long term) in the accompanying Consolidated
Balance Sheet. The impact of the interest rate swap on the accompanying Consolidated Statements of Comprehensive Income was an unrealized gain of $4.0 million, net of tax, for the 2022 Year.
LIQUIDITY AND CAPITAL RESOURCES
We believe that our business has sufficient cash to allow us to meet our short-term cash requirements. On December 31, 2022, and December 31, 2021, we had $31.6 million and $28.6 million,
respectively, in cash and cash equivalents. We believe that our cash and cash equivalents and availability under our Credit Facilities are sufficient to fund the working capital needs of our operating subsidiaries through at least December 31,
2023.
Cash and cash equivalents increased by $3.0 million from December 31, 2021, to December 31, 2022. During the 2022 Year, $58.5 million was provided by operations and $65.1 million, net of payments,
was provided by proceeds on our Credit Agreement (described below). The major uses of cash for investing and financing activities included: distributions to non-controlling interests inclusive of those classified as redeemable non-controlling
interest ($15.3 million), dividends paid to our shareholders ($21.3 million), purchase of non-controlling interest ($74.8 million), and purchase of fixed assets ($8.2 million).
On June 17, 2022, we entered into the Third Amended and Restated Credit Agreement (the “Credit Agreement”) among Bank of America, N.A., as administrative agent (“Administrative Agent”) and the lenders
from time-to-time party thereto.
The Credit Agreement, which matures on June 17, 2027, provides for loans in an aggregate principal amount of $325 million. Such loans will be available through the following facilities (collectively,
the “Senior Credit Facilities”):
1) Revolving Facility: $175 million, five-year, revolving credit facility (“Revolving Facility”), which includes a $12 million sublimit
for the issuance of standby letters of credit and a $15 million sublimit for swingline loans (each, a “Swingline Loan”).
2) Term Facility: $150 million term loan facility (the “Term Facility”). The Term Facility amortizes in quarterly installments of: (a)
0.625% in each of the first two years, (b) 1.250% in the third and fourth year, and (c) 1.875% in the fifth year of the Credit Agreement. The remaining outstanding principal balance of all term loans is due on the maturity date.
The proceeds of the Revolving Facility have been and shall continue to be used by us for working capital and other general corporate purposes of our Company and its subsidiaries, including to fund
future acquisitions and invest in growth opportunities. The proceeds of the Term Facility were used by us to refinance the indebtedness outstanding under the Second Amended and Restated Credit Agreement, to pay fees and expenses incurred in
connection with the loan facilities transactions, for working capital and other general corporate purposes.
We will be permitted to increase the Revolving Facility and/or add one or more tranches of term loans in an aggregate amount not to exceed the sum of (i) $100 million plus (ii) an unlimited additional
amount, provided that (in the case of clause (ii)), after giving effect to such increases, the pro forma Consolidated Leverage Ratio (as defined in the Credit Agreement) would not exceed 2.0:1.0, and the aggregate amount of all incremental
increases under the Revolving Facility does not exceed $50,000,000.
The interest rates per annum applicable to the Senior Credit Facilities (other than in respect of Swingline Loans) will be Term SOFR as defined in the agreement plus an applicable margin or, at our
option, an alternate base rate plus an applicable margin. Currently, our interest rate including the applicable margin is 4.665%. Interest is payable at the end of the selected interest period but no less frequently than quarterly and on the date
of maturity.
We will also pay to the Administrative Agent, for the account of each lender under the Revolving Facility, a commitment fee equal to the actual daily excess of each lender’s commitment over its
outstanding credit exposure under the Revolving Facility (“unused fee”). We may prepay and/or repay the revolving loans and the term loans, and/or terminate the revolving loan commitments, in whole or in part, at any time without premium or
penalty, subject to certain conditions.
The Credit Agreement contains customary covenants limiting, among other things, the incurrence of additional indebtedness, the creation of liens, mergers, consolidations, liquidations and
dissolutions, sales of assets, dividends, and other payments in respect of equity interests, acquisitions, investments, loans and guarantees, subject, in each case, to customary exceptions, thresholds and baskets. The Credit Agreement includes
certain financial covenants which include the Consolidated Fixed Charge Coverage Ratio and the Consolidated Leverage Ratio, as defined in the Credit Agreement. The Credit Agreement also contains customary events of default.
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Our obligations under the Credit Agreement are guaranteed by our wholly owned material domestic subsidiaries (each, a “Guarantor”), and our obligations and any Guarantors are secured by a perfected
first priority security interest in substantially all of our existing and future personal property and each Guarantor, subject to certain exceptions.
In May 2022, we entered into an interest rate swap agreement, effective on June 30, 2022, with Bank of America, N.A, which became effective on June 30, 2022. It has a $150 million notional value
adjusted concurrently with schedule principal payments made on the term loan, and has a maturity date of June 30, 2027. Beginning in July 2022, we receive 1-month SOFR, and pay a fixed rate of interest of 2.815% on 1-month SOFR on a quarterly
basis. The total interest rate in any period also includes an applicable margin based on our consolidated leverage ratio. In connection with the swap, no cash was exchanged between us and the counterparty.
We designated its interest rate swap as a cash flow hedge and structured it to be highly effective. Consequently, unrealized gains and losses related to the fair value of the interest rate swap are
recorded to accumulated other comprehensive income (loss), net of tax.
On December 31, 2022, $150.0 million was outstanding on the Term Loan and the Revolving Facility remains available resulting in $175.0 million of availability. As of December 31, 2022, we were in
compliance with all of the covenants thereunder. Through the date of this report, we have drawn $31.0 million on the Revolving Facility.
On November 30, 2022, we acquired an 80% interest in a thirteen-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for the 80% equity
interest was approximately $25.0 million, of which $24.2 million was paid in cash and $0.8 million in the form of a note payable. The note accrues interest at 7.0% per annum and the principal and interest are payable on November 30, 2024.
On October 31, 2022, we acquired an 60% interest in a fourteen-clinic physical therapy practice. The practice’s owners retained 40% of the equity interests. The purchase price for the 60% equity
interest was approximately $19.5 million, with a potential additional amount to be paid at a later date based on the performance of the business. This contingent consideration had a fair value of $8.3 million on December 31, 2022. The fair value
of this contingent consideration will be adjusted quarterly based on certain criteria and market inputs.
On September 30, 2022, we acquired an 80% interest in a two-clinic physical therapy practice. The practice’s owners retained 20% of the equity interests. The purchase price for the 80% equity interest
was approximately $4.2 million, of which $3.9 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 5.5% per annum and the principal and interest are payable on September 30, 2024.
On August 31, 2022, we acquired a 70% interest in a six-clinic physical therapy practice. The practice’s owners retained 30% of the equity interests. The purchase price for the 70% equity interest was
approximately $3.5 million, of which $3.3 million was paid in cash and $0.2 million in the form of a note payable. The note accrues interest at 5.5% per annum and the principal and interest are payable on August 31, 2024.
On March 31, 2022, we acquired a 70% interest in a six-clinic physical therapy practice. The practice’s owners retained 30% of the equity interests. The purchase price for the 70% equity interest was
approximately $11.5 million, of which $11.2 million was paid in cash and $0.3 million is in the form of a note payable. The note accrues interest at 3.5% per annum and the principal and interest are payable on March 31, 2024.
On December 31, 2021, we acquired a 75% interest in a three-clinic physical therapy practice with the practice founder retaining 25%. The purchase price for the 75% interest was approximately $3.7
million, of which $3.5 million was paid in cash and $0.2 million in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest are payable on December 31, 2023.
On November 30, 2021, we acquired approximately 70% interest in a leading provider of industrial injury prevention services. The previous owners retained the
remaining interest. The initial purchase price for the 70% equity interest was $63.2 million not inclusive of additional contingent consideration of $2.0 million if certain operational objectives were met, of which $62.2 million was paid in
cash, and $1.0 million is in the form of a note payable. The note accrues interest at 3.25% and the principal and interest is payable on November 30, 2023. The Company revalued the contingent earn-out consideration related to the acquisition
during the year ended December 31, 2022, resulting in the elimination of the $2.0 million liability previously booked. As part of this transaction, the previous owners have a put right which relates to the potential future purchase of a
company that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a distinct market area. The owners have the right to put this transaction to us in approximately five years from November 2021, with such put right having a fair value of $3.5 million on November 30, 2021. The fair value of this put right remained $3.5 million on December 31, 2022 , as reflected on our consolidated balance sheet in Other
long-term liabilities. The value of this right will be adjusted in future periods, as appropriate, with any change in fair value reflected in our consolidated statement of income.
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On September 30, 2021, we acquired a company that specializes in return-to-work and ergonomic services, among other offerings. The business generates more than $2.0 million in annual revenue. We
acquired the company’s assets at a purchase price of approximately $3.3 million (which includes the obligation to pay an amount up to $0.6 million in contingent payment consideration in conjunction with the acquisition if specified future
operational objectives are met) and contributed those assets to our IIP subsidiary. The initial purchase price, not inclusive of the $0.6 million contingent payment, was approximately $2.7 million, of which $2.4 million was paid in cash, and $0.3
million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest are payable on September 30, 2023.
On June 30, 2021, we acquired a 65% interest in an eight-clinic physical therapy practice with the practice founders retaining 35%. The purchase price was approximately $10.3 million, of which $9.0
million was paid in cash, $1.0 million was payable based on the achievement of certain business criteria and $0.3 million is in the form of a note payable. The business criteria were met and accordingly $1.0 million was paid in July 2022. The
note accrues interest at 3.25% per annum and the principal and interest are payable on June 30, 2023. Additionally, we have an obligation to pay an additional amount up to $0.8 million in contingent payment consideration in conjunction with the
acquisition if specified future operational objectives are met. We recorded acquisition-date fair value of this contingent liability based on the likelihood of the contingent earn-out payment. The earn-out payment will subsequently be remeasured
to fair value each reporting date.
On March 31, 2021, we acquired a 70% interest in a five-clinic physical therapy practice with the practice founders retaining 30%. When acquired, the practice was developing a sixth clinic which has
been completed. The purchase price for the 70% interest was approximately $12.0 million, of which $11.7 million was paid in cash and $0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal
and interest are payable on March 31, 2023.
Historically, we have generated sufficient cash from operations to fund our development activities and to cover operational needs. We plan to continue developing new clinics and making additional
acquisitions. We have from time to time purchased the non-controlling interests of limited partners in our Clinic Partnerships. We may purchase additional non-controlling interests in the future. Generally, any acquisition or purchase of
non-controlling interests is expected to be accomplished using a combination of cash and financing. Any large acquisition would likely require financing.
We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts. Claims are submitted to payors daily, weekly or monthly in accordance
with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time consuming and typically involves the submission of claims to multiple payors whose payment of claims may be dependent upon
the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting CMS approval initially may not be submitted for six months or
more. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor type receivables, the write-off
generally occurs after the account receivable has been outstanding for 120 days or longer.
We have future obligations for debt repayments, employment agreements and future minimum rentals under operating leases. The obligations as of December 31, 2022 are summarized as follows (in
thousands):
| Total | 2023 | 2024 | 2025 | 2026 | 2027 | Thereafter | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Credit Agreement | $ | 179,126 | 3,751 | 4,687 | 7,500 | 9,375 | $ | 153,813 | $ | - | |||||||||||||||||
| Notes Payable | 6,430 | 4,516 | 1,914 | - | - | - | - | ||||||||||||||||||||
| Interest Payable | 292 | 221 | 71 | - | - | - | - | ||||||||||||||||||||
| Employee Agreements | 64,311 | 58,624 | 5,687 | - | - | - | - | ||||||||||||||||||||
| Operating Leases | 143,740 | 45,074 | 35,572 | 26,440 | 18,081 | 10,613 | 7,960 | ||||||||||||||||||||
| $ | 393,899 | $ | 112,186 | $ | 47,931 | $ | 33,940 | $ | 27,456 | $ | 164,426 | $ | 7,960 |
We generally enter into various notes payable as a means of financing our acquisitions. Our present outstanding notes payable primarily relate to the acquisitions of a business or acquisitions of
majority interests in businesses. At December 31, 2022, our remaining outstanding balance on these notes aggregated $6.4 million.
The notes payable for the acquisition of businesses of $6.4 million are payable in 2023 and 2024. Notes are generally payable in equal annual installments of principal over two years plus any accrued
and unpaid interest. See above table for a detail of future principal payments. Interest accrues at various interest rates ranging from 3.25% to 7.0% per annum.
The limited partnership agreements, as amended, provide that, upon the triggering events, we have a Call Right and the selling entity or individual has a Put Right for the purchase and sale of the
limited partnership interest held by the partner. Once triggered, the Put Right and the Call Right do not expire, even upon an individual partner’s death, and contain no mandatory redemption feature. The purchase price of the partner’s limited
partnership interest upon the exercise of either the Put Right or the Call Right is calculated per the terms of the respective agreements and classified as redeemable non-controlling interest (temporary equity) in our consolidated balance sheets.
The fair value of the redeemable non-controlling interest at December 31, 2022 was $167.5 million.
As of December 31, 2022, we have accrued $8.1 million related to credit balances and overpayments due to patients and payors. This amount is expected to be paid in 2023.
From September 2001 through December 31, 2008, our Board of Directors (“Board”) authorized us to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of our
common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of our common stock (“March 2009 Authorization”). Our Amended Credit Agreement permits share repurchases of up to $15,000,000 in the
aggregate, subject to compliance with covenants. We are required to retire shares purchased under the March 2009 Authorization.
There is no expiration date for the share repurchase program. As of December 31, 2022, there are currently an additional estimated 185,117 shares (based on the closing price of $81.03 on December 31,
2022) that may be purchased from time to time in the open market or private transactions depending on price, availability and our cash position. We did not purchase any shares of our common stock during the years ended December 31, 2022, and
2021.
We have an investment in a joint venture that is accounted for using the equity method of accounting.
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FACTORS AFFECTING FUTURE RESULTS
The risks related to our business and operations include:
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | the multiple effects of the impact of public health crises and epidemics/pandemics, such as the novel strain of COVID-19 and its variants, for which the total financial magnitude cannot be currently estimated; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | one of our acquisition agreements contains a Put Right related to a future purchase of a majority interest in a separate company; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | the impact of COVID-19 related vaccination and/or testing mandates at the federal, state and/or local level, which could have an adverse impact on staffing, revenue, costs and the results of operations: |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | our debt and financial obligations could adversely affect our financial condition, our ability to obtain future financing and our ability to operate our business; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | changes as the result of government enacted national healthcare reform; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | business and regulatory conditions including federal and state regulations; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | revenue and earnings expectations; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | legal actions, which could subject us to increased operating costs and uninsured liabilities; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | general economic conditions, including but not limited to inflationary and recessionary periods; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | our business depends on hiring, training, and retaining qualified employees |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | availability and cost of qualified physical therapists; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | competitive environment in the industrial injury prevention services business, which could result in the termination or non-renewal of contractual service arrangements and other adverse financial consequences for that service line; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | acquisitions, and the successful integration of the operations of the acquired businesses; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interest (minority interests); |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | maintaining our information technology systems with adequate safeguards to protect against cyber-attacks; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | maintaining clients for which we perform management, industrial injury prevention related services, and other services, as a breach or termination of those contractual arrangements by such clients could cause operating results to be less than expected; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | maintaining adequate internal controls; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | maintaining necessary insurance coverage; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | availability, terms, and use of capital; and |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | weather and other seasonal factors. |
See also Risk Factors in Item 1A of this Annual Report on Form 10-K.
FY 2021 10-K MD&A
SEC filing source: 0001140361-22-007247.
EXECUTIVE SUMMARY
Our Business.
Our reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. Through our subsidiaries, we operate
outpatient physical therapy clinics that provide pre-and post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurological-related injuries and rehabilitation of injured workers. We also
have majority interests in companies which are leading providers of industrial injury prevention services. Services provided in these businesses include onsite injury prevention and rehabilitation, performance optimization, post-offer employment
testing, functional capacity evaluations and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their
contractors. These services are performed through Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs).
During the last three years we completed the acquisitions of seven multi-clinic practices and three industrial injury prevention services businesses as detailed
below:
| Acquisition | Date | % Interest Acquired | Number of Clinics | |||
|---|---|---|---|---|---|---|
| December 2021 Acquisition | December 31, 2021 | 75% | 3 | |||
| November 2021 Acquisition | November 30, 2021 | 70% | * | |||
| September 2021 Acquisition | September 30, 2021 | 100% | * | |||
| June 2021 Acquisition | June 30, 2021 | 65% | 8 | |||
| March 2021 Acquisition | March 31, 2021 | 70% | 6 | |||
| November 2020 Acquisition | November 30, 2020 | 75% | 3 | |||
| September 2020 Acquisition | September 30, 2020 | 70% | ** | |||
| February 2020 Acquisition | February 27, 2020 | 65% *** | 4 | |||
| September 2019 Acquisition | September 30, 2019 | 67% | 11 | |||
| April 2019 Acquisition | April 11, 2019 | 100% | * |
| Column 1 | Column 2 |
|---|---|
| * | Industrial injury prevention business |
| Column 1 | Column 2 |
|---|---|
| ** | The business includes six management and services contracts which have been in place for a number of years. As of the date acquired, the contracts had a remaining term of five years. |
| Column 1 | Column 2 |
|---|---|
| *** | The four clinics are in four separate partnerships. The Company's interest in the four partnershipsrange from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. |
Besides the multi-clinic acquisitions referenced in the table above, during 2021 and 2020, we purchased the assets and business of three physical therapy clinics
in separate transactions. The clinics operate as satellite clinics of three of our existing clinic partnerships.
During the year ended December 31, 2021, we sold two clinics. The aggregate sales price was $0.1 million. During the year ended December 31, 2020, we sold 14
previously closed clinics. The aggregate sales price was $1.1 million, of which $0.7 million was paid in cash and $0.4 million in a note receivable, payable in two equal installments of principal and any accrued interest. The first payment was
received in June 2021 and the next payment is due on June 15, 2022.
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We intend to continue to pursue additional acquisition opportunities, develop new clinics and open satellite clinics.
Impact of COVID-19
As previously disclosed in a series of filings with the SEC and further described in detail in our Quarterly Reports on Form 10-Q for the first three quarters of
2020 and our Annual Report on Form 10-K for the year ended December 31, 2020, our results were negatively impacted by the effects of the COVID-19 pandemic in 2020. For the 2021 period as compared to the 2020 period, the increase in revenues and
expenses are primarily due to our business returning to and now exceeding pre-pandemic results.
We have put preparedness plans in place at our facilities to maintain continuity of operations, while also taking steps to keep employees and patients safe. In
line with recommendations to reduce large gatherings and increase social distancing, we continue to allow a large number of office-based employees to work remotely. We are monitoring the situation and will adjust work environments accordingly.
In March 2020 in response to the COVID-19 pandemic, the federal government approved the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”). The CARES
Act provides numerous tax provisions and other stimulus measures, including temporary changes regarding the prior and future utilization of net operating losses, temporary changes to the prior and future limitations on interest deductions,
temporary suspension of certain payment requirements for the employer portion of Social Security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property, and the creation of certain
payroll tax credits associated with the retention of employees.
We have received a number of benefits under the CARES Act including, but not limited to:
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. We applied for and received approval to receive MAAP funds from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. We recorded the $14.1 million in advance payments received as a liability. During the quarter ended March 31, 2021, we repaid the MAAPP funds of $14.1 million rather than applying them to future services performed. |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | We elected to defer depositing the employer’s share of Social Security taxes for payments due from March 27, 2020, through December 31, 2020, interest-free and penalty-free. In December 2021, we paid $4.1 million related to these deferred payments. As of December 31, 2021, $4.2 million related to these deferred payments is included in accrued liabilities. |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | The CARES Act provided additional waivers, reimbursement, grants and other funds to assist health care providers during the COVID-19 pandemic, including $100.0 billion in appropriations for the Public Health and Social Services Emergency Fund, also referred to as the Provider Relief Fund, to be used for preventing, preparing, and responding to the coronavirus, and for reimbursing eligible health care providers for lost revenues and health care related expenses that are attributable to COVID-19. For the years ended December 31, 2021, and December 31, 2020, the Company’s consolidated subsidiaries recorded income of approximately $4.6 million and $13.5 million, respectively, of payments under the CARES Act (“Relief Funds”). Under the Company’s accounting policy, these payments were recorded as Other income – Relief Funds. These funds are not required to be repaid upon attestation and compliance with certain terms and conditions, which could change materially based on evolving grant compliance provisions and guidance provided by the U.S. Department of Health and Human Services. Currently, the Company can attest and comply with the terms and conditions. We will continue to monitor the evolving guidelines and may record adjustments as additional information is released. |
CRITICAL ACCOUNTING POLICIES
Critical accounting policies are those that have a significant impact on our results of operations and financial position involving significant estimates requiring
our judgment. Our critical accounting policies are:
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Revenue Recognition.
Revenues are recognized in the period in which services are rendered. Net patient revenue consists of revenues for physical therapy and occupational therapy
clinics that provide pre-and post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenue (patient
revenues less estimated contractual adjustments) is recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied.
There is an implied contract between us and the patient upon each patient visit. Generally, this occurs as we provide physical and occupational therapy services, as each service provided is distinct and future services rendered are not dependent
on previously rendered services. We have agreements with third-party payors that provide for payments to us at amounts different from our established rates. The allowance for estimated contractual adjustments is based on terms of payor contracts
and historical collection and write-off experience.
Management contract revenue, which is included in other revenue in the consolidated statements of net income, is derived from contractual arrangements whereby we
manage a clinic owned by a third party. We do not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are
performed. Costs, typically salaries for our employees, are recorded when incurred.
Revenues from the industrial injury prevention services business, which are also included in other revenues in the consolidated statements of net income, are
derived from onsite services we provide to clients’ employees including injury prevention, rehabilitation, ergonomic assessments and performance optimization. Revenue from the industrial injury prevention services business is recognized when
obligations under the terms of the contract are satisfied. Revenues are recognized at an amount equal to the consideration we expect to receive in exchange for providing injury prevention services to our clients. The revenue is determined and
recognized based on the number of hours and respective rate for services provided in a given period.
Additionally, other revenue includes services we provide on-site at locations such as schools and industrial worksites for physical or occupational therapy
services, athletic trainers and gym membership fees. Contract terms and rates are agreed to in advance between us and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If
the services are paid in advance, revenue is recorded as a contract liability over the period of the agreement and recognized at the point in time when the services are performed.
We implemented ASC 606 beginning January 1, 2018, using a modified retrospective transition method. The principal change relates to how the new standard requires
healthcare providers to estimate the amount of variable consideration to be included in the transaction price up to an amount which is probable that a significant reversal will not occur. The most common forms of variable consideration we
experience are amounts for services provided that are ultimately not realizable from a customer. There were no changes to revenues or other revenues upon implementation. Under the new standards, our estimate for unrealizable amounts will continue
to be recognized as a reduction to revenue. The bad debt expense historically reported will not materially change.
For ASC 606, there is an implied contract between us and the patient upon each patient visit. Separate contractual arrangements exist between us and third-party
payors (e.g. insurers, managed care programs, government programs, and workers' compensation programs which establish the amounts the third parties pay on behalf of the patients for covered services rendered. While these agreements are not
considered contracts with the customer, they are used for determining the transaction price for services provided to the patients covered by the third-party payors. The payor contracts do not indicate performance obligations for us but indicate
reimbursement rates for patients who are covered by those payors when the services are provided. At that time, we are obligated to provide services for the reimbursement rates stipulated in the payor contracts. The execution of the contract alone
does not indicate a performance obligation. For self-paying customers, the performance obligation exists when we provide the services at established rates. The difference between our established rate and the anticipated reimbursement rate is
accounted for as an offset to revenue—contractual allowance.
We determine allowances for credit losses based on the specific agings of receivables and payor classifications at each clinic. The provision for credit losses is
included in clinic operating costs in the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for credit losses, includes only those
amounts we estimate to be collectible.
The following table details the revenue related to the various categories (in thousands):
| Year Ended | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | December 31, 2019 | |||||||||
| Net patient revenue | $ | 438,330 | $ | 373,340 | $ | 433,345 | |||||
| Other revenue | 2,939 | 2,020 | 2,486 | ||||||||
| Physical therapy operations | 441,269 | 375,360 | 435,831 | ||||||||
| Management contract revenue | 9,853 | 8,410 | 8,676 | ||||||||
| Industrial injury prevention services revenue | 43,900 | 39,199 | 37,462 | ||||||||
| $ | 495,022 | $ | 422,969 | $ | 481,969 |
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Contractual Allowances. Contractual allowances result from the differences between the rates charged for services
performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third party payors and managed care contracts are often complex and may include
multiple reimbursement mechanisms payable for the services provided in our clinics. We estimate contractual allowances based on our interpretation of the applicable regulations, payor contracts and historical calculations. Each month we estimate
our contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and apply an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor
of the clinic. Based on our historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow us to provide the necessary detail and accuracy with our collectability estimates. However, the
services authorized and provided and related reimbursement are subject to interpretation that could result in payments that differ from our estimates. Payor terms are periodically revised necessitating continual review and assessment of the
estimates made by management. Our billing systems may not capture the exact change in our contractual allowance reserve estimate from period to period. Therefore, in order to assess the accuracy of our revenues and hence our contractual allowance
reserves, our management regularly compares our cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, the historical difference between net revenues and corresponding cash
collections in any given fiscal year has generally reflected a difference within approximately 1.0% to 1.5% of net revenues. Additionally, analysis of subsequent period’s contractual write-offs on a payor basis reflects a difference within
approximately 1.0% to 1.5% between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, we believe that a reasonable
likely change in the contractual allowance reserve estimate would not be more than 1% to 1.5% of gross billings in accounts receivable at December 31, 2021. For purposes of demonstrating the sensitivity of this estimate on our Company’s financial
condition, a 1% to 1.5% increase or decrease in our aggregate contractual allowance reserve percentage would decrease or increase, respectively, net patient revenue by approximately $1.3 million to $1.9 million for the year ended December 31,
2021. Management believes the changes in the estimate of the contractual allowance reserve for the periods ended December 31, 2021, 2020 and 2019 have not been material to the statement of income.
The following table sets forth information regarding our patient accounts receivable as of the dates indicated (in thousands):
| December 31, | |||||||
|---|---|---|---|---|---|---|---|
| 2021 | 2020 | ||||||
| Gross patient accounts receivable | $ | 129,524 | $ | 119,180 | |||
| Less contractual allowances | 80,484 | 75,266 | |||||
| Subtotal - accounts receivable | 49,040 | 43,914 | |||||
| Less allowance for credit losses | 2,768 | 2,008 | |||||
| Net patient accounts receivable | $ | 46,272 | $ | 41,906 |
The following table presents our patient accounts receivable aging by payor class as of the dates indicated (in thousands):
| December 31, 2021 | December 31, 2020 | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Payor | Current to 120 Days | 120+ Days | Total | Current to 120 Days | 120+ Days | Total | |||||||||||||||||
| Managed Care/ Commercial Plans | $ | 13,985 | $ | 2,381 | $ | 16,366 | $ | 13,053 | $ | 1,774 | $ | 14,827 | |||||||||||
| Medicare/Medicaid | 13,442 | 1,636 | 15,078 | 10,707 | 1,196 | 11,903 | |||||||||||||||||
| Workers Compensation* | 5,600 | 1,312 | 6,912 | 6,576 | 926 | 7,502 | |||||||||||||||||
| Self-pay | 4,371 | 3,316 | 7,687 | 4,086 | 3,146 | 7,232 | |||||||||||||||||
| Other** | 1,168 | 1,829 | 2,997 | 1,108 | 1,342 | 2,450 | |||||||||||||||||
| Totals | $ | 38,566 | $ | 10,474 | $ | 49,040 | $ | 35,530 | $ | 8,384 | $ | 43,914 |
| Column 1 | Column 2 |
|---|---|
| * | Workers compensation is paid by state administrators or their designated agents. |
| Column 1 | Column 2 |
|---|---|
| ** | Other includes primarily litigation claims and, to a lesser extent, vehicular insurance claims. |
Reimbursement for Medicare beneficiaries is based upon a fee schedule published by HHS. For a more complete description of our third-party revenue sources, see “Business—Sources of Revenue” in Item 1.
Goodwill. The fair value of goodwill and other identifiable intangible assets with indefinite lives are evaluated for
impairment at least annually and upon the occurrence of certain events or conditions and are written down to fair value if considered impaired. These events or conditions include but are not limited to: a significant adverse change in the
business environment, regulatory environment, or legal factors; a current period operating or cash flow loss combined with a history of such losses or a projection of continuing losses; or a sale or disposition of a significant portion of a
reporting unit. The occurrence of one of these events or conditions could significantly impact an impairment assessment, necessitating an impairment charge. We evaluate indefinite-lived tradenames in conjunction with our annual goodwill
impairment test.
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We operate a two segment business which is made up of various clinics within partnerships, and the other is an industrial injury prevention services business. The
partnerships are components of regions and are aggregated to the operating segment level for the purpose of determining our reporting units when performing our annual goodwill impairment test. In 2021, 2020 and 2019, there were six regions. In
addition to the six regions, in 2021 and 2020, the impairment analysis included a separate analysis for the industrial injury prevention services business, as a separate reporting unit.
As part of the impairment analysis, we are first required to assess qualitatively if we can conclude whether goodwill is more likely than not impaired. If goodwill
is more likely than not impaired, we are then required to complete a quantitative analysis of whether a reporting unit’s fair value is less than its carrying amount. In evaluating whether it is more likely than not that the fair value of a
reporting unit is less than its carrying amount, we consider relevant events or circumstances that affect the fair value or carrying amount of a reporting unit. We consider both the income and market approach in determining the fair value of its
reporting units when performing a quantitative analysis.
An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable
intangible assets, exceeds the estimated fair value of the reporting unit. The evaluation of goodwill in 2021, 2020 and 2019 did not result in any goodwill amounts that were deemed impaired.
For our annual assessment of goodwill, we evaluated whether events or circumstances indicated that it was more likely than not that the fair value of the reporting
units were reduced below their carrying value as of December 31, 2021. As a result of the assessment, we determined that it was not more likely than not that goodwill and tradenames of the reporting units were impaired as of December 31, 2021.
Redeemable Non-Controlling Interest—The non-controlling interests that are reflected as redeemable non-controlling
interest in our consolidated financial statements consist of those owners, including us, that have certain redemption rights, whether currently exercisable or not, and which currently, or in the future, require that we purchase or the owner sell
the non-controlling interest held by the owner, if certain conditions are met and the owners request the purchase (“Put Right”). We also have a call right (“Call Right”). The Put Right or Call Right may be triggered by the owner or us,
respectively, at such time as both of the following events have occurred: 1) termination of the owner’s employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the
transaction, typically three to five years, as defined in the limited partnership agreement. The Put Rights and Call Rights are not automatic (even upon death) and require either the owner or us to exercise our rights when the conditions
triggering the Put or Call Rights have been satisfied. The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership agreements.
On the date we acquire a controlling interest in a partnership and the limited partnership agreement for such partnerships contains redemption rights not
under our control, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption—Redeemable non-controlling interest. Then, in each reporting period thereafter until it is purchased by us, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial value, based on the
predetermined formula defined in the respective limited partnership agreement. As a result, the value of the non-controlling interest is not adjusted below its initial value. We record any adjustment in the redemption value, net of tax,
directly to retained earnings and not in the consolidated statements of income. Although the adjustments are not reflected in the consolidated statements of income, current accounting rules require that we reflect the adjustments, net of tax,
in the earnings per share calculation. The amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statement of income. We believe the redemption value (i.e. the carrying amount) and fair value are the same.
Effective December 31, 2017, we entered into amendments to our limited partnership agreements for our acquired partnerships replacing the mandatory redemption
feature. No monetary consideration was paid to the partners to amend the agreements. The amended limited partnership agreements provide that, upon the triggering events, we have a Call Right and the selling entity or individual has a Put Right
for the purchase and sale of the limited partnership interest held by the partner. Once triggered, the Put Right and the Call Right do not expire, even upon an individual partner’s death, and contain no mandatory redemption feature. The purchase
price of the partner’s limited partnership interest upon the exercise of either the Put Right or the Call Right is calculated per the terms of the respective agreements. We accounted for the amendment of the limited partnership agreements as an
extinguishment of the outstanding mandatorily redeemable non-controlling interests, which were classified as liabilities, through the issuance of new redeemable non-controlling interests classified in temporary equity. Pursuant to Accounting
Standards Codification (“ASC”) 470-50-40-2, we removed the outstanding liabilities at their carrying amounts, recognized the new temporary equities at their fair value, and recorded no gain or loss on extinguishment as management believes the
redemption value (i.e. the carrying amount) and fair value are the same. In summary, the redemption values of the mandatorily redeemable non-controlling interest (previously classified as liabilities) were reclassified as redeemable
non-controlling interest (temporary equity) at fair value on the December 31, 2017, consolidated balance sheet.
Non-Controlling Interest—We recognize non-controlling interests, in which we have no obligation but the right to purchase
the non-controlling interests, as equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of
the consolidated statements of income. Operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner. When we purchase a non-controlling interest and the
purchase differs from the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.
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SELECTED OPERATING AND FINANCIAL DATA
The following table and discussion relate to continuing operations unless otherwise noted. The defined terms with their respective description used in the
following discussion are listed below:
| 2021 | Year ended December 31, 2021 |
|---|---|
| 2020 | Year ended December 31, 2020 |
| 2021 Additions | Clinics opened or acquired during the year ended December 31, 2021 |
| 2020 Additions | Clinics opened or acquired during the year ended December 31, 2020 |
| Clinics Additions | Clinics opened or acquired during the year ended December 31, 2021 and 2020 |
| Mature Clinics | Clinics opened or acquired prior to January 1, 2020 and are still operating |
The following table presents selected operating and financial data, used by management as key indicators of our operating performance:
| For the Years Ended December 31, | |||||||
|---|---|---|---|---|---|---|---|
| 2021 | 2020 | ||||||
| Number of clinics, at the end of period | 591 | 554 | |||||
| Working Days | 254 | 256 | |||||
| Average visits per day per clinic | 29.1 | 24.6 | |||||
| Total patient visits | 4,219,576 | 3,533,371 | |||||
| Net patient revenue per visit | $ | 103.88 | $ | 105.66 |
RESULTS OF OPERATIONS
2021 COMPARED TO 2020
For 2021, the net income attributable to our shareholders was $40.8 million compared to $35.2 million for 2020 and $40.0 million for the year ended December 31,
2019 (“2019”). Inclusive of the charge or credit for revaluation of non-controlling interest, net of taxes, used to compute earnings per diluted share in accordance with GAAP, the amount was $31.1 million, or $2.41 per diluted share, for 2021 as
compared to $31.8 million, or $2.48 per diluted share, for 2020, and $31.3 million, or $2.45 per diluted share, for 2019. For both 2021 and 2020, in accordance with current accounting guidance, the revaluation of
redeemable non-controlling interest, net of tax, is not included in net income but rather charged directly to retained earnings; however, the charge for this change is included in the earnings per basic and diluted share calculation. See table
below (in thousands, except per share data):
| For the Year Ended December 31, | ||||||||
|---|---|---|---|---|---|---|---|---|
| 2021 | 2020 | |||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 40,831 | $ | 35,194 | ||||
| (Charges) credit to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (13,011 | ) | (4,632 | ) | ||||
| Tax effect at statutory rate (federal and state) of 25.55% and 26.25%, respectively | 3,324 | 1,216 | ||||||
| $ | 31,144 | $ | 31,778 | |||||
| Earnings per share (basic and diluted) | $ | 2.41 | $ | 2.48 |
For 2021, our Operating Results, inclusive of Relief Funds, were $43.8 million, or $3.39 per diluted share, an increase of 13.8%, as compared to $38.4 million, or
$2.99 per diluted share, for 2020. For 2021, our Operating Results, excluding Relief Funds (as defined below), were $40.9 million, or $3.17 per diluted share, an increase of 33.5%, as compared to $30.6 million, or $2.39 per diluted share, for
2020. Operating Results, a non-Generally Accepted Accounting Principles (“non-GAAP”) measure, equals net income attributable to diluted shareholders per the consolidated statements of income less gain on sale of partnership interests and clinics
plus charges incurred for clinic closure costs and expenses related to executive officer transitions and settlement of a legal matter, all net of taxes. Operating Results per diluted share also excludes the impact of the revaluation of redeemable
non-controlling interest and the associated tax impact. See table below for a detailed computation (in thousands, except per share data):
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| For the Year Ended December 31, | ||||||||
|---|---|---|---|---|---|---|---|---|
| 2021 | 2020 | |||||||
| Computation of earnings per share - USPH shareholders: | ||||||||
| Net income attributable to USPH shareholders | $ | 40,831 | $ | 35,194 | ||||
| Credit (charges) to retained earnings: | ||||||||
| Revaluation of redeemable non-controlling interest | (13,011 | ) | (4,632 | ) | ||||
| Tax effect at statutory rate (federal and state) of 25.55% and 26.25%, respectively | 3,324 | 1,216 | ||||||
| $ | 31,144 | $ | 31,778 | |||||
| Earnings per share (basic and diluted) | $ | 2.41 | $ | 2.48 | ||||
| Adjustments: | ||||||||
| Closure costs | 30 | 3,931 | ||||||
| Expenses related to executive officers transition | 1,301 | 1,331 | ||||||
| Gain on sale of partnership interest and clinics | - | (1,091 | ) | |||||
| Relief Funds | (4,597 | ) | (13,500 | ) | ||||
| Settlement of a liability | 2,635 | - | ||||||
| Allocation to non-controlling interest | 676 | 3,116 | ||||||
| Revaluation of redeemable non-controlling interest | 13,011 | 4,632 | ||||||
| Tax effect at statutory rate (federal and state) of 25.55% and 26.25%, respectively | (3,336 | ) | 415 | |||||
| Operating Results (excluding Relief Funds) (a non-GAAP measure) | $ | 40,864 | $ | 30,612 | ||||
| Relief Funds | $ | 4,597 | $ | 13,500 | ||||
| Allocation to non-controlling interest | (715 | ) | (2,893 | ) | ||||
| Tax effect at statutory rate (federal and state) of 25.55% and 26.25%, respectively | (992 | ) | (2,784 | ) | ||||
| Operating Results (including Relief Funds) (a non-GAAP measure) | $ | 43,754 | $ | 38,435 | ||||
| Basic and diluted Operating Results per share (excluding Relief Funds) (a non-GAAP measure) | $ | 3.17 | $ | 2.39 | ||||
| Basic and diluted Operating Results per share (including Relief Funds) (a non-GAAP measure) | $ | 3.39 | $ | 2.99 | ||||
| Shares used in computation - basic and diluted | 12,898 | 12,835 |
The above table reconciles net income attributable to our shareholders calculated in accordance with GAAP to Operating Results, a non-GAAP measure defined above.
We believe that Operating Results, which eliminates certain items described above that can be subject to volatility and unusual costs, is one of the principal measures to evaluate and monitor financial performance period over period. We also
believe that Operating Results is useful information for investors to use in comparing the Company's period-to-period results as well as for comparing with other similar businesses.
Operating Results is not a measure of financial performance under GAAP and, therefore, should not be considered in isolation or as an alternative to, or substitute
for, net income attributable to our shareholders presented in the consolidated financial statements.
Reported total revenue
Reported total revenue for 2021 increased $72.1 million, or 17.0% to $495.0 million as compared to $423.0 million for 2020. See table below
for a detail of reported total revenue (in thousands):
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| Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | ||||||
| Revenue related to Mature Clinics | $ | 402,744 | $ | 358,103 | |||
| Revenue related to 2021 Clinic Additions | 13,802 | - | |||||
| Revenue related to 2020 Clinic Additions | 21,283 | 9,664 | |||||
| Revenue from clinics sold or closed in 2021 | 455 | 1,242 | |||||
| Revenue from clinics sold or closed in 2020 | 46 | 4,331 | |||||
| Net patient revenue from physical therapy operations | 438,330 | 373,340 | |||||
| Other revenue | 2,939 | 2,020 | |||||
| Revenue from physical therapy operations | 441,269 | 375,360 | |||||
| Management contract revenue | 9,853 | 8,410 | |||||
| Industrial injury prevention services | 43,900 | 39,199 | |||||
| Net Revenue | $ | 495,022 | $ | 422,969 |
Net patient revenue from physical therapy operations
Net patient revenue from physical therapy operations increased $65.0 million, or 17.4%, to $438.3 million for 2021 from $373.3 million in 2020. Included in net
patient revenue from physical therapy operations are revenues related to clinics sold or closed of $0.5 million for 2021 and $5.5 million for 2020. During 2021, the Company sold its interest in two clinics and closed three clinics. During 2020,
the Company sold its interest in 14 clinics and closed 34 clinics. For comparison purposes, excluding revenue from the clinics sold or closed, net patient revenue from physical therapy operations was approximately $437.8 million for 2021 and
$367.8 million for 2020, an increase of 19.1%. Revenue related to Mature Clinics increased $44.6 million, or 12.5%, for 2021 compared to 2020.
The average net patient revenue per visit was $103.88 for 2021 as compared to $105.66 for 2020, including all clinics operational during such periods. Total
patient visits were 4,219,576 for 2021 and 3,533,371 for 2020, an increase of 19.4%.
Net patient revenues are based on established billing rates less allowances and discounts for patients covered by contractual programs and workers’ compensation. Net patient revenues
reflect contractual and other adjustments, which we evaluate monthly, relating to patient discounts from certain payors. Payments received under these contractual programs and workers’ compensation are based on predetermined rates and are
generally less than the established billing rates of the clinics.
Other revenue from physical therapy operations, management contracts and industrial injury prevention services
Other revenue was $2.9 million in 2021 and $2.0 million in 2020. Revenues from management contracts were $9.9 million in 2021
as compared to $8.4 million in 2020. Revenue from our industrial injury prevention services business increased 12.0% to $43.9 million in 2021 compared to $39.2 million in 2020, with $2.2 million of the increase related to the acquisition of an
industrial injury prevention services business on November 30, 2021.
Operating cost
Total operating cost, excluding closure costs, a non-GAAP measure, was $377.8 million in 2021, as compared to $324.6 million in 2020. Total operating cost,
excluding closure costs, was 76.3% as a percentage of net revenue in 2021 and 76.7% in 2020. On a cost per visit basis, total operating cost, excluding closure costs, was $79.70 per visit in 2021 as compared to $81.74 per visit in 2020, a
decrease of 2.5%. Included in operating cost for 2021 was $30.6 million related to Clinic Additions, of which $19.6 million was associated with the 2020 Clinic Additions. Included in operating cost for 2020 was $8.4 million related to 2020
Clinic Additions. Operating cost related to Mature Clinics increased by $31.7 million for 2021 compared to 2020. Operating cost related to management contracts increased by $1.7 million in 2021 compared to 2020. In addition, operating cost
related to the industrial injury prevention services business increased by $4.1 million for the comparable periods. See table below for a detail of operating cost, excluding closure costs (a non-GAAP measure) (in thousands):
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| Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | |||||||
| Operating cost related to Mature Clinics | $ | 305,148 | $ | 273,476 | ||||
| Operating cost related to 2021 Clinic Additions | 11,080 | - | ||||||
| Operating cost related to 2020 Clinic Additions | 19,561 | 8,416 | ||||||
| Operating cost related to clinics sold or closed in 2021 | 484 | 1,345 | ||||||
| Operating cost related to clinics sold or closed in 2020 | 25 | 5,583 | ||||||
| Closure costs | 30 | 3,931 | ||||||
| Physical therapy operations | 336,328 | 292,751 | ||||||
| Physical therapy management contracts | 8,306 | 6,655 | ||||||
| Industrial injury prevention services | 33,206 | 29,113 | ||||||
| Total operating cost | $ | 377,840 | $ | 328,519 | ||||
| Less: Physical therapy operations - closure costs | (30 | ) | (3,931 | ) | ||||
| Total operating cost excluding closure costs (a non-GAAP measure) | $ | 377,810 | $ | 324,588 |
Closure costs in 2020 were $3.9 million, which includes estimates of remaining lease obligations, derecognition of goodwill and other costs related to closed and
sold clinics. Each component of clinic operating costs is discussed below:
Operating Cost—Salaries and Related Costs
Salaries and related costs increased to $278.5 million for 2021 from $235.6 million in 2020, an increase of $42.8 million, or 18.2%. Included in salaries and
related costs for 2021 was $7.3 million related to 2021 Clinic Additions. Salaries and related costs for clinics sold or closed in 2021 and 2020 were $0.3 million and $3.8 million in 2021 and 2020, respectively. Salaries and related costs for
Mature Clinics increased $26.5 million in 2021 compared to 2020. Salaries and related costs for management contracts increased $1.4 million for 2021 compared to 2020. Salaries and related costs for the industrial injury prevention services
business increased $2.8 million for the comparable periods. Salaries and related costs as a percentage of net revenues were 56.3% for 2021 and 55.7% for 2020. Salaries and related costs for physical therapy operations were $57.81 per visit in
2021 as compared to $58.10 per visit in 2020, a decrease of 0.5%. See table below for a detail of salaries and related costs (in thousands):
| Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | ||||||
| Physical therapy operations | |||||||
| Salaries and related costs related to Mature Clinics | $ | 222,431 | $ | 195,962 | |||
| Salaries and related costs related to 2021 Clinic Additions | 7,258 | - | |||||
| Salaries and related costs related to 2020 Clinic Additions | 13,940 | 5,495 | |||||
| Salaries and related costs related to clinics sold or closed in 2021 | 293 | 805 | |||||
| Salaries and related costs related to clinics sold or closed in 2020 | 18 | 3,009 | |||||
| Total Physical therapy operations | 243,940 | 205,271 | |||||
| Physical therapy management contracts | 7,316 | 5,921 | |||||
| Industrial injury prevention services | 27,213 | 24,437 | |||||
| Total salaries and related costs | $ | 278,469 | $ | 235,629 |
Operating Cost—Rent, Supplies, Contract Labor and Other
Rent, supplies, contract labor and other costs increased to $94.0 million for 2021 from $84.3 million for 2020, an increase of $9.7 million, or 11.5%. Included in
rent, supplies, contract labor and other costs for 2021 and 2020 related to Clinic Additions was $9.0 million. Rent, supplies, contract labor and other costs for clinics related to partnership interests closed or sold in 2021 and 2020 were $0.2
million and $2.8 million in 2020, respectively. Rent, supplies, contract labor and other costs related to Mature Clinics increased $4.4 million. Rent, supplies, contract labor and other costs as a percent of net revenues was 19.0% for 2021 and
19.9% for 2020. Rent, supplies, contract labor and other costs for physical therapy operations were $20.63 per visit in 2021 as compared to $22.37 per visit in 2020, a decrease of 7.8%. See table below for a detail of rent, supplies, contract
labor and other costs (in thousands):
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| Year Ended | |||||||
|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | ||||||
| Physical therapy operations | |||||||
| Rent, supplies, contract labor and other costs related to Mature Clinics | $ | 77,770 | $ | 73,348 | |||
| Rent, supplies, contract labor and other costs related to 2021 Clinic Additions | 3,653 | - | |||||
| Rent, supplies, contract labor and other costs related to 2020 Clinic Additions | 5,436 | 2,846 | |||||
| Rent, supplies, contract labor and other costs related to clinics sold or closed in 2021 | 187 | 528 | |||||
| Rent, supplies, contract labor and other costs related to clinics sold or closed in 2020 | 8 | 2,328 | |||||
| Total Physical therapy operations | 87,054 | 79,050 | |||||
| Physical therapy management contracts | 989 | 734 | |||||
| Industrial injury prevention services | 5,993 | 4,552 | |||||
| Total rent, supplies, contract labor and other costs | $ | 94,036 | $ | 84,336 |
Operating Cost—Provision for Credit Losses
The provision for credit losses for net patient receivables was $5.3 million for 2021 and $4.6 million for 2020. As a percentage of net patient revenues, the
provision for credit losses was 1.1% for both 2021 and 2020. The provision for credit losses at the end of each period is based on a detailed, clinic-by-clinic review of overdue accounts and is regularly reviewed in the aggregate in light of
historical experience.
Our provision for credit losses as a percentage of total patient accounts receivable was 5.64% at December 31, 2021 and 4.57% at December 31, 2020.
The average accounts receivable days outstanding were 32 days at December 31, 2021 and December 31, 2020. Net patient receivables in the amounts of $4.6 million
and $4.5 million were written-off in 2021 and 2020, respectively.
Gross Profit
Gross profit, excluding closure costs, a non-GAAP measure, was $117.2 million for 2021, an increase of $18.8 million, or 19.1% as compared to $98.4 million for
2020. The gross profit percentage, less closure costs, was 23.7% of total revenue for 2021, an increase of 40 basis points, as compared to 23.3% for 2020. The gross profit percentage for the Company’s physical therapy operations, excluding
closure costs, was 23.8% for 2021, an increase of 70 basis points as compared to 23.1% for 2020. The gross profit percentage on management contracts revenue was 15.7% for 2021 as compared to 20.9% for 2020. The gross profit percentage for the
industrial injury prevention services business was 24.4% for 2021 as compared to 25.7% for 2020. See table below for details on gross profit, excluding closure costs (a non-GAAP measure) (in thousands) and a reconciliation against Gross Profit
(in thousands):
| Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | |||||||
| Physical therapy operations | $ | 104,971 | $ | 86,540 | ||||
| Management contracts | 1,547 | 1,755 | ||||||
| Industrial injury prevention services | 10,694 | 10,086 | ||||||
| Physical therapy operations - closure costs | (30 | ) | (3,931 | ) | ||||
| Gross profit | $ | 117,182 | $ | 94,450 | ||||
| Physical therapy operations - closure costs | 30 | 3,931 | ||||||
| Gross profit, excluding closure costs (a non-GAAP measure) | $ | 117,212 | $ | 98,381 |
Corporate Office Costs
Corporate office costs were $46.5 million for 2021 compared to $42.0 million for 2020. Corporate office costs were 9.4% of total revenue for 2021 as compared to
9.9% for 2020. For 2020, corporate offices costs included temporary salary reductions and furloughs related to the pandemic. Also, in both 2021 and 2020, corporate office costs included $1.3 million in equity compensation expense related to the
accelerated vesting of restricted stock previously granted to two executive officers upon their retirement in July 2021 and November 2020. Excluding the equity compensation related to the accelerated vesting of restricted stock, corporate office
costs was 9.1% of total revenue for 2021 and 9.6% for 2020.
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Operating Income
Operating income for 2021 was $70.6 million, an increase of $18.2 million, or 34.8%, as compared to $52.4 million for 2020. Operating income as a percentage of
total revenue increased 190 basis points from 12.4% for 2020 to 14.3% for 2021.
Other Income—Relief Funds
Relief Funds recognized in other income were $4.6 million for 2021 and $13.5 million for 2020. See discussion related to Relief Funds for more information.
Other Income - Resolution of a Payor Matter and Other Expense – Settlement of a Legal Matter
Other income for the 2021 Year includes $1.2 million of income related to the positive resolution of a payor matter and other expense includes a $2.6 million
increase in a reserve related to a settlement of a legal matter. In January 2022, the Company paid $2.75 million related to this matter.
Interest Expense—Debt and Other
Interest expense—debt and other was $0.9 million for 2021 and $1.6 million for 2020. At December 31, 2021, $114.0 million was outstanding under our Amended Credit
Agreement (as defined below under “—Liquidity and Capital Resources”). See “—Liquidity and Capital Resources” below for a discussion of the terms of our Amended Credit Agreement.
Provision for Income Taxes
The provision for income tax was $15.3 million for 2021 and $13.0 million for 2020. The provision for income tax as a percentage of income before taxes less net
income attributable to non-controlling interest (effective tax rate) was 27.2% for 2021 and 27.0% for 2020. See table below ($ in thousands):
| Year Ended | ||||||||
|---|---|---|---|---|---|---|---|---|
| December 31, 2021 | December 31, 2020 | |||||||
| Income before taxes | $ | 73,196 | $ | 65,513 | ||||
| Less: net income attributable to non-controlling interest: | ||||||||
| Redeemable non-controlling interest - temporary equity | (11,358 | ) | (11,175 | ) | ||||
| Non-controlling interest - permanent equity | (5,735 | ) | (6,122 | ) | ||||
| $ | (17,093 | ) | $ | (17,297 | ) | |||
| Income before taxes less net income attributable to non-controlling interest | $ | 56,103 | $ | 48,216 | ||||
| Provision for income taxes | $ | 15,272 | $ | 13,022 | ||||
| Effective tax rate | 27.2 | % | 27.0 | % |
Net Income Attributable to Non-controlling Interest
Net income attributable to redeemable non-controlling interest (temporary equity) was $11.4 million for 2021 and $11.2 million for 2020. Net income attributable
to non-controlling interest (permanent equity) was $5.7 million for 2021 and $6.1 million for 2020.
LIQUIDITY AND CAPITAL RESOURCES
We believe that our business is generating sufficient cash flow from operating activities to allow us to meet our short-term and long-term cash requirements, other
than those with respect to future significant acquisitions. At December 31, 2021, we had $28.5 million in cash and cash equivalents compared to $32.9 million at December 31, 2020. Although the start-up costs associated with opening new clinics
and our planned capital expenditures are significant, we believe that our cash and cash equivalents and the availability under our Amended Credit Agreement are sufficient to fund the working capital needs of our operating subsidiaries, future
clinic development and acquisitions and investments through at least December 2022. Significant acquisitions would likely require financing under our Amended Credit Agreement.
Effective December 5, 2013, we entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit
facility. This agreement was amended in August 2015, January 2016, March 2017, November 2017, January 2021, and November 2021 (hereafter is referred to as “Amended Credit Agreement”). In November 2021, we exercised the accordion feature in the
Amended Credit Agreement to increase to limit on our facility from $125.0 million to $150.0 million, with an updated accordion feature providing for an additional capacity of $25.0 million, therefore increasing the availability up to $175.0
million.
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The 2021 amendment to the Amended Credit Agreement allows for cash and noncash consideration for acquisitions permitted under the Amended Credit Agreement of up to
$50,000,000 for any fiscal year, and allows for payments in cash dividends to shareholders in an aggregate amount not to exceed $50,000,000 in any fiscal year. The Amended Credit Agreement is unsecured and includes certain financial covenants
which include a consolidated fixed charge coverage ratio and a consolidated leverage ratio, as defined in the agreement. The Amended Credit Agreement is unsecured and has loan covenants, including requirements that we comply with a consolidated
fixed charge coverage ratio and consolidated leverage ratio. Proceeds from the Amended Credit Agreement may be used for working capital, acquisitions, purchases of our common stock, dividend payments to our common stockholders, capital
expenditures and other corporate purposes. The pricing grid is based on our consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.25% to 2.0% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Fees
under the Amended Credit Agreement include an unused commitment fee ranging from 0.25% to 0.3% depending on our consolidated leverage ratio and the amount of funds outstanding under the Amended Credit Agreement.
On December 31, 2021, $114.0 million was outstanding on the Amended Credit Agreement resulting in $61.0 million of availability. As of the date of this report, we
were in compliance with all of the covenants thereunder.
Cash provided by operations was $76.4 million and net proceeds from our Amended Credit Agreement amounted to $98.0 million. The major uses of cash for investing
and financing activities included: purchase of interests in businesses ($86.8 million), purchases of redeemable non-controlling interest, temporary equity ($28.5 million), purchases of fixed assets ($8.2 million), proceeds on sale of partnership
interest ($0.3 million), distributions to non-controlling interests ($16.9 million), payments of cash dividends to our shareholders ($18.8 million), and payments on notes payable ($4.9 million).
On December 31, 2021, we acquired a 75% interest in a three-clinic physical therapy practice with the practice founder retaining 25%. The purchase price for the
75% interest was approximately $3.7 million, of which $3.5 million was paid in cash and $0.2 million in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on December 31, 2023.
On November 30, 2021, we acquired an approximate 70% interest in a leading provider of industrial injury prevention services.
The previous owners retained the remaining interest. The initial purchase price for the 70% equity interest, not inclusive of the $2.0 million contingent payment in
conjunction with the acquisition if specified future operational objectives are met, was approximately $63.2 million, of which $62.2 million was paid in cash, and $1.0 million is in the form of a note payable. The note accrues interest at 3.25%
and the principal and interest is payable on November 30, 2023. The business generates approximately $27.0 million in annual revenue at a margin of approximately
20%. As part of the transaction, we also agreed to the potential future purchase of a separate company under the same ownership that provides physical therapy and rehabilitation services to hospitals and other ancillary providers in a
distinct market area. The current owners have the right to put this transaction to us in approximately five years, with such right having a $3.5 million fair value at
December 31, 2021, as reflected on the Company’s consolidated balance sheet in Other long-term liabilities. The value of this right will be adjusted in future periods, as appropriate, with any change in fair value reflected in the Company’s consolidated statement of income.
On September 30, 2021, we acquired a company that specializes in return-to-work and ergonomic services, among other offerings.
The business generates more than $2.0 million in annual revenue. We acquired the company’s assets at a purchase price of approximately $3.3 million (which includes the obligation to pay an amount up to $0.6 million in contingent payment
consideration in conjunction with the acquisition if specified future operational objectives are met) and contributed those assets to our industrial injury prevention services
subsidiary. The initial purchase price, not inclusive of the $0.6 million contingent payment, was approximately $2.7 million, of which $2.4 million was paid in cash, and $0.3 million is in the form of a note payable. The note accrues interest at
3.25% per annum and the principal and interest is payable on September 30, 2023.
On June 30, 2021, we acquired a 65% interest in an eight-clinic physical therapy practice with the previous owners retaining 35%. The purchase price was approximately $10.3 million, of which $9.0 million was paid in cash, $1.0 million is payable based on the achievement of certain business criteria
and $0.3 million is in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on June 30, 2023. Additionally, we have an obligation to pay an additional amount up to $0.8 million in
contingent payment consideration in conjunction with the acquisition if specified future operational objectives are met. We recorded acquisition-date fair value of this contingent liability based on the likelihood of the contingent earn-out
payment. The earn-out payment will subsequently be remeasured to fair value each reporting date.
On March 31, 2021, we acquired a 70% interest in a five-clinic physical therapy practice with the previous owners retaining 30%. When acquired, the practice was developing a sixth clinic which has been completed. The purchase price for the 70% interest was approximately $12.0 million, of which
$11.7 million was paid in cash and $0.3 million in the form of a note payable. The note accrues interest at 3.25% per annum and the principal and interest is payable on March 31, 2023.
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On November 30, 2020, we acquired a 75% interest in a three-clinic physical therapy practice with the previous owners retaining 25%. The purchase price for the 75% interest was $8.9 million (net of cash acquired), of which $8.6 million was paid in cash and $0.3 million in the form of a note payable
that is payable in two principal installments totaling $162,500 each. The first principal payment plus accrued interest was paid in November 2021 with the second installment to be paid in November 2022. The note accrues interest at 3.25% per
annum.
On September 30, 2020, we acquired a 70% interest in an entity which holds six management contracts that have been in place for
a number of years and had five years remaining on their term as of the acquisition date. The previous owners retained the remaining 30%. The purchase price for the 70%
interest was approximately $4.2 million, with $3.7 million payable in cash and $0.5 million in notes payable. One of the notes payable of $0.2 million was paid in September 2021 and the note of $0.3 million was paid in November 2020.
On February 27, 2020, we acquired interests in a four-clinic physical therapy practice. The four clinics are operated in four
separate partnerships. The Company’s interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in
cash and $0.3 million in the form of a seller note. The note accrues interest at 4.75% per annum and the principal and interest was paid in February 2022.
On September 30, 2019, we acquired a 67% interest in an eleven-clinic physical therapy practice with the previous owners retaining 33%. The purchase price for the 67% interest was $12.4 million, of which $12.1 million was paid in cash and $0.3 million in the form of a seller note that is payable in
two principal installments totaling $150,000 each. The first principal payment plus accrued interest was paid in September 2020 and the second installment was paid in September 2021. The note accrues interest at 5.0% per annum.
On April 11, 2019, we acquired a company that is a provider of industrial injury prevention services. The acquired company
specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network of 45 states including onsite at eleven client
locations. The business was then combined with Briotix Health, the Company’s industrial injury prevention services operation, increasing the Company’s ownership position in the Briotix Health partnership to approximately 76.0%. The purchase price
for the acquired company was $22.9 million ($23.6 million less cash acquired of $0.7 million), which consisted of $18.9 million in cash, (of which $0.5 million will be paid to certain shareholders), and a $4.0 million seller note. The note was
paid in April 2021.
Historically, we have generated sufficient cash from operations to fund our development activities and to cover operational needs. We plan to continue developing
new clinics and making additional acquisitions. We have from time to time purchased the non-controlling interests of limited partners in our Clinic Partnerships. We may purchase additional non-controlling interests in the future. Generally, any
acquisition or purchase of non-controlling interests is expected to be accomplished using a combination of cash and financing. Any large acquisition would likely require financing.
We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts. Claims are submitted to payors
daily, weekly or monthly in accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time consuming and typically involves the submission of claims to multiple payors whose
payment of claims may be dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting CMS approval initially
may not be submitted for six months or more. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay
payor type receivables, the write-off generally occurs after the account receivable has been outstanding for 120 days or longer.
We have future obligations for debt repayments, employment agreements and future minimum rentals under operating leases. The obligations as of December 31, 2021
are summarized as follows (in thousands):
| Total | 2022 | 2023 | 2024 | 2025 | 2026 | Thereafter | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Credit Agreement | $ | 114,000 | $ | - | $ | - | $ | - | $ | 114,000 | $ | - | $ | - | |||||||||||||
| Notes Payable | 4,417 | 830 | 3,587 | - | - | - | - | ||||||||||||||||||||
| Interest Payable | 292 | 74 | 218 | - | - | - | - | ||||||||||||||||||||
| Employee Agreements | 61,278 | 52,837 | 8,321 | 120 | - | - | - | ||||||||||||||||||||
| Operating Leases | 136,992 | 41,270 | 33,637 | 25,527 | 17,111 | 10,575 | 8,872 | ||||||||||||||||||||
| $ | 316,979 | $ | 95,011 | $ | 45,763 | $ | 25,647 | $ | 131,111 | $ | 10,575 | $ | 8,872 |
We generally enter into various notes payable as a means of financing our acquisitions. Our present outstanding notes payable primarily relate to the acquisitions
of a business or acquisitions of majority interests in businesses. At December 31, 2021, our remaining outstanding balance on these notes aggregated $4.4 million.
The notes payable for the acquisition of businesses of $4.4 million are payable in 2022 and 2023. Notes are generally payable
in equal annual installments of principal over two years plus any accrued and unpaid interest. See above table for a detail of future principal payments. Interest accrues at various interest rates ranging from 3.25% to 4.75% per annum.
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The limited partnership agreements, as amended, provide that, upon the triggering events, we have a Call Right and the selling
entity or individual has a Put Right for the purchase and sale of the limited partnership interest held by the partner. Once triggered, the Put Right and the Call Right do not expire, even upon an individual partner’s death, and contain no
mandatory redemption feature. The purchase price of the partner’s limited partnership interest upon the exercise of either the Put Right or the Call Right is calculated per the terms of the respective agreements and classified as redeemable
non-controlling interest (temporary equity) in our consolidated balance sheets. The fair value of the redeemable non-controlling interest at December 31, 2021 was $154.4 million.
As of December 31, 2021, we have accrued $6.6 million related to credit balances and overpayments due to patients and payors.
This amount is expected to be paid in 2022.
From September 2001 through December 31, 2008, our Board of Directors (“Board”) authorized us to purchase, in the open market or
in privately negotiated transactions, up to 2,250,000 shares of our common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of our common stock (“March 2009 Authorization”). Our Amended
Credit Agreement permits share repurchases of up to $15,000,000 in the aggregate, subject to compliance with covenants. We are required to retire shares purchased under the March 2009 Authorization.
There is no expiration date for the share repurchase program. As of December 31, 2021, there are currently an additional
estimated 156,986 shares (based on the closing price of $95.55 on December 31, 2021) that may be purchased from time to time in the open market or private transactions depending on price, availability and our cash position. We did not purchase
any shares of our common stock during the years ended December 31, 2021 and 2020.
We have an investment in a joint venture that is accounted
for using the equity method of accounting.
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FACTORS AFFECTING FUTURE RESULTS
The risks related to our business and operations include:
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | the multiple effects of the impact of public health crises and epidemics/pandemics, such as the novel strain of COVID-19 and its variants, for which the total financial magnitude cannot be currently estimated; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | the impact of COVID-19 related vaccination and/or testing mandates at the federal, state and/or local level, which could have an adverse impact on staffing, revenue, costs and the results of operations: |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | changes as the result of government enacted national healthcare reform; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | business and regulatory conditions including federal and state regulations; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | revenue and earnings expectations; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | legal actions, which could subject us to increased operating costs and uninsured liabilities; |
| Column 1 | Column 2 | Column 3 |
|---|---|---|
| • | general economic conditions; |
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| • | availability and cost of qualified physical therapists; |
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| • | personnel productivity and retaining key personnel; |
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| • | competitive environment in the industrial injury prevention services business, which could result in the termination or non-renewal of contractual service arrangements and other adverse financial consequences for that service line; |
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| • | acquisitions, and the successful integration of the operations of the acquired businesses; |
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| • | impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interest (minority interests); |
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| • | maintaining our information technology systems with adequate safeguards to protect against cyber-attacks; |
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| • | a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act; |
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| • | maintaining clients for which we perform management and other services, as a breach or termination of those contractual arrangements by such clients could cause operating results to be less than expected; |
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| • | maintaining adequate internal controls; |
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| • | maintaining necessary insurance coverage; |
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| • | availability, terms, and use of capital; and |
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| • | weather and other seasonal factors. |
See also Risk Factors in Item 1A of this Annual Report on Form 10-K.