| ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 | |||||
| TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 | |||||
| (State or other jurisdiction of incorporation or organization) | (I.R.S. Employer Identification No.) | |||||||
| Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||||||
| ☒ | Accelerated filer | ☐ | Non-accelerated filer | ☐ | Smaller reporting company | |||||||||||||||||||||||||||
| Emerging growth company | ||||||||||||||||||||||||||||||||
| PART I. | ||||||||
| Cautionary Statement Regarding Forward-Looking Statements | ||||||||
| Item 1. | Business | |||||||
| Item 1A. | Risk Factors | |||||||
| Item 1B. | Unresolved Staff Comments | |||||||
| Item 2. | Properties | |||||||
| Item 3. | Legal Proceedings | |||||||
| Item 4. | Mine Safety Disclosures | |||||||
| PART II. | ||||||||
| Item 5. | Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities | |||||||
| Item 6. | Reserved | |||||||
| Item 7. | Management’s Discussion and Analysis of Financial Condition and Results of Operations | |||||||
| Item 7A. | Quantitative and Qualitative Disclosures About Market Risk | |||||||
| Item 8. | Financial Statements and Supplementary Data | |||||||
| Item 9. | Changes In and Disagreements with Accountants on Accounting and Financial Disclosure | |||||||
| Item 9A. | Controls and Procedures | |||||||
| Item 9B. | Other Information | |||||||
| PART III. | ||||||||
| Item 10. | Directors, Executive Officers and Corporate Governance | |||||||
| Item 11. | Executive Compensation | |||||||
| Item 12. | Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters | |||||||
| Item 13. | Certain Relationships and Related Transactions, and Director Independence | |||||||
| Item 14. | Principal Accountant Fees and Services | |||||||
| PART IV. | ||||||||
| Item 15. | Exhibits, and Financial Statement Schedules | |||||||
| Exhibit Index | ||||||||
| Signatures | ||||||||
| PART I | ||||||||||||||
| Item 1. | Business. | ||||
| Year Ended December 31, | ||||||||||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Home Health | $ | 1,531,491 | $ | 1,551,542 | $ | 1,463,779 | ||||||||||||||
| Hospice | 407,489 | 311,218 | 243,806 | |||||||||||||||||
| Home and Community-Based | 180,587 | 189,561 | 194,584 | |||||||||||||||||
| Facility-Based | 127,916 | 132,098 | 128,578 | |||||||||||||||||
| HCI | 35,288 | 35,203 | 32,457 | |||||||||||||||||
| Consolidated Net Service Revenue | $ | 2,282,771 | $ | 2,219,622 | $ | 2,063,204 | ||||||||||||||
| Item 1A. | Risk Factors. | ||||
| Item 1B. | Unresolved Staff Comments. | ||||
| Item 2. | Properties. | ||||
| Item 3. | Legal Proceedings. | ||||
| Item 4. | Mine Safety Disclosures. | ||||
| PART II | ||||||||||||||
| Item 5. | Market for Registrant's Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities | ||||

| December 31, | ||||||||||||||||||||||||||||||||||||||
| 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | |||||||||||||||||||||||||||||||||
| LHC Group, Inc. | $ | 100.00 | $ | 153.27 | $ | 224.91 | $ | 348.28 | $ | 224.05 | $ | 263.98 | ||||||||||||||||||||||||||
| NASDAQ Composite | 100.00 | 97.16 | 132.81 | 192.47 | 235.15 | 158.65 | ||||||||||||||||||||||||||||||||
| S&P Health Care | 100.00 | 106.47 | 128.64 | 145.93 | 184.07 | 180.47 | ||||||||||||||||||||||||||||||||
| Peer Group | 100.00 | 159.91 | 205.29 | 298.16 | 199.42 | 173.24 | ||||||||||||||||||||||||||||||||
| Item 6. | Reserved | ||||
| Item 7. | Management’s Discussion and Analysis of Financial Condition and Results of Operations. | ||||
| Home Health Agencies | Hospice Agencies | Home and Community -Based Agencies | Long-Term Acute Care Hospitals | HCI | ||||||||||||||||||||||||||||
| Total at January 1, 2021 | 537 | 120 | 124 | 12 | 12 | |||||||||||||||||||||||||||
| Developed | — | 1 | 13 | — | 2 | |||||||||||||||||||||||||||
| Acquired | 27 | 49 | 1 | — | — | |||||||||||||||||||||||||||
| Divested/Merged | (7) | — | (2) | — | — | |||||||||||||||||||||||||||
| Total at December 31, 2021 | 557 | 170 | 136 | 12 | 14 | |||||||||||||||||||||||||||
| Developed | — | — | — | — | 0 | |||||||||||||||||||||||||||
| Acquired | 12 | — | 1 | — | — | |||||||||||||||||||||||||||
| Divested/Merged | (42) | (11) | (9) | — | (7) | |||||||||||||||||||||||||||
| Total at December 31, 2022 | 527 | 159 | 128 | 12 | 7 | |||||||||||||||||||||||||||
| Description | Fiscal Year 2023 Rate per patient day | Fiscal Year 2022 Rate per patient day | ||||||
| Routine Home Care days 1-60 | $ | 211.34 | $ | 203.4 | ||||
| Routine Home Care days 61+ | $ | 167.00 | $ | 160.74 | ||||
| Continuous Home Care | $ | 1,522.04 | $ | 1,462.52 | ||||
| Full Rate = 24 hours of care | ||||||||
$60.94 = hourly rate for 2022 $63.42 = hourly rate for 2023 | ||||||||
| Inpatient Respite Care | $ | 492.10 | $ | 473.75 | ||||
| General Inpatient Care | $ | 1,110.76 | $ | 1,068.28 | ||||
| Year Ended December 31, | ||||||||||||||
| 2022 | 2021 | |||||||||||||
| Consolidated Services Data: | ||||||||||||||
| Net service revenue | $ | 2,282,771 | $ | 2,219,622 | ||||||||||
| Cost of service revenue (excluding depreciation and amortization) | 1,399,158 | 1,336,609 | ||||||||||||
| Gross margin | 883,613 | 883,013 | ||||||||||||
| General and administrative expenses | 764,239 | 696,435 | ||||||||||||
| Impairment of intangibles and other | 10,854 | 937 | ||||||||||||
| Operating income | 108,520 | 185,641 | ||||||||||||
| Interest expense | (31,311) | (4,338) | ||||||||||||
| Income tax expense | 16,961 | 37,687 | ||||||||||||
| Income attributable to noncontrolling interests | 20,377 | 27,888 | ||||||||||||
| Net income available to LHC Group, Inc.’s common stockholders | $ | 39,871 | $ | 115,728 | ||||||||||
| Year Ended December 31, | ||||||||||||||
| 2022 | 2021 | |||||||||||||
| Consolidated Services Data: | ||||||||||||||
| Cost of service revenue (excluding depreciation and amortization) | 61.3 | % | 60.2 | % | ||||||||||
| Gross margin | 38.7 | 39.8 | ||||||||||||
| General and administrative expenses | 33.5 | 31.4 | ||||||||||||
| Impairment of intangibles and other | 0.5 | — | ||||||||||||
| Operating income | 4.8 | 8.4 | ||||||||||||
| Interest expense | (1.4) | (0.2) | ||||||||||||
| Income tax expense | 29.9 | 24.6 | ||||||||||||
| Income attributable to noncontrolling interests | 0.9 | 1.3 | ||||||||||||
| Net income attributable to LHC Group, Inc.’s common stockholders | 1.7 | 5.2 | ||||||||||||
| Segment | 2022 | 2021 | ||||||||||||
| Home Health | 67.1 | % | 69.9 | % | ||||||||||
| Hospice | 17.9 | 14.0 | ||||||||||||
| Home and Community-Based | 7.9 | 8.5 | ||||||||||||
| Facility-Based | 5.6 | 6.0 | ||||||||||||
| Healthcare Innovations | 1.5 | 1.6 | ||||||||||||
| 100.0 | % | 100.0 | % | |||||||||||
| 2022 | 2021 | ||||||||||||||||
| Home Health | |||||||||||||||||
| Salaries, wages, and benefits | $ | 813,516 | 53.1 | % | $ | 819,041 | 52.8 | % | |||||||||
| Transportation | 39,507 | 2.6 | 37,416 | 2.4 | |||||||||||||
| Supplies and services | 40,979 | 2.7 | 45,228 | 2.9 | |||||||||||||
| Total | $ | 894,002 | 58.4 | % | $ | 901,685 | 58.1 | % | |||||||||
| Hospice | |||||||||||||||||
| Salaries, wages, and benefits | $ | 198,656 | 48.8 | % | $ | 142,070 | 45.6 | % | |||||||||
| Transportation | 12,730 | 3.1 | 9,204 | 3.0 | |||||||||||||
| Supplies and services | 58,791 | 14.4 | 43,621 | 14.0 | |||||||||||||
| Total | $ | 270,177 | 66.3 | % | $ | 194,895 | 62.6 | % | |||||||||
| Home and Community-Based | |||||||||||||||||
| Salaries, wages, and benefits | $ | 127,572 | 70.6 | % | $ | 134,852 | 71.1 | % | |||||||||
| Transportation | 1,718 | 1.0 | 1,681 | 0.9 | |||||||||||||
| Supplies and services | 852 | 0.5 | 1,319 | 0.7 | |||||||||||||
| Total | $ | 130,142 | 72.1 | % | $ | 137,852 | 72.7 | % | |||||||||
| Facility-Based | |||||||||||||||||
| Salaries, wages, and benefits | $ | 73,133 | 57.2 | % | $ | 66,067 | 50.0 | % | |||||||||
| Transportation | 250 | 0.2 | 68 | 0.1 | |||||||||||||
| Supplies and services | 19,953 | 15.6 | 23,135 | 17.5 | |||||||||||||
| Total | $ | 93,336 | 73.0 | % | $ | 89,270 | 67.6 | % | |||||||||
| Healthcare Innovations | |||||||||||||||||
| Salaries, wages, and benefits | $ | 11,270 | 31.9 | % | $ | 12,620 | 35.8 | % | |||||||||
| Transportation | 193 | 0.5 | 220 | 0.6 | |||||||||||||
| Supplies and services | 38 | 0.1 | 67 | 0.2 | |||||||||||||
| Total | $ | 11,501 | 32.5 | % | $ | 12,907 | 36.6 | % | |||||||||
| Consolidated | |||||||||||||||||
| Salaries, wages, and benefits | $ | 1,224,147 | 53.6 | % | $ | 1,174,650 | 52.9 | % | |||||||||
| Transportation | 54,398 | 2.4 | 48,589 | 2.2 | |||||||||||||
| Supplies and services | 120,613 | 5.3 | 113,370 | 5.1 | |||||||||||||
| Total | $ | 1,399,158 | 61.3 | % | $ | 1,336,609 | 60.2 | % | |||||||||
| 2022 | 2021 | ||||||||||||||||
| Home Health | |||||||||||||||||
| General and administrative | $ | 508,554 | 33.2 | % | $ | 489,092 | 31.5 | % | |||||||||
| Depreciation and amortization | 12,630 | 0.8 | 12,040 | 0.8 | |||||||||||||
| Total | $ | 521,184 | 34.0 | % | $ | 501,132 | 32.3 | % | |||||||||
| Hospice | |||||||||||||||||
| General and administrative | $ | 124,391 | 30.5 | % | $ | 86,781 | 27.9 | % | |||||||||
| Depreciation and amortization | 4,846 | 1.2 | 2,912 | 0.9 | |||||||||||||
| Total | $ | 129,237 | 31.7 | % | $ | 89,693 | 28.8 | % | |||||||||
| Home and Community-Based | |||||||||||||||||
| General and administrative | $ | 46,959 | 26.0 | % | $ | 45,062 | 23.8 | % | |||||||||
| Depreciation | 1,271 | 0.7 | 1,662 | 0.9 | |||||||||||||
| Total | $ | 48,230 | 26.7 | % | $ | 46,724 | 24.7 | % | |||||||||
| Facility-Based | |||||||||||||||||
| General and administrative | $ | 44,630 | 34.9 | % | $ | 41,975 | 31.8 | % | |||||||||
| Depreciation and amortization | 3,443 | 2.7 | 3,329 | 2.5 | |||||||||||||
| Total | $ | 48,073 | 37.6 | % | $ | 45,304 | 34.3 | % | |||||||||
| Healthcare Innovations | |||||||||||||||||
| General and administrative | $ | 16,562 | 46.9 | % | $ | 12,608 | 35.8 | % | |||||||||
| Depreciation | 953 | 2.7 | 974 | 2.8 | |||||||||||||
| Total | $ | 17,515 | 49.6 | % | $ | 13,582 | 38.6 | % | |||||||||
| Consolidated | |||||||||||||||||
| General and administrative | $ | 741,096 | 32.5 | % | $ | 675,518 | 30.4 | % | |||||||||
| Depreciation | 23,143 | 1.0 | 20,917 | 0.9 | |||||||||||||
| Total | $ | 764,239 | 33.5 | % | $ | 696,435 | 31.4 | % | |||||||||
| Year Ended December 31, | ||||||||||||||
| 2022 | 2021 | |||||||||||||
| Net cash provided by (used in): | ||||||||||||||
| Operating activities | $ | 49,974 | $ | (100,332) | ||||||||||
| Investing activities | (58,360) | (607,778) | ||||||||||||
| Financing activities | 16,488 | 431,350 | ||||||||||||
| Change in cash | $ | 8,102 | $ | (276,760) | ||||||||||
| Cash at beginning of period | 9,809 | 286,569 | ||||||||||||
| Cash at end of period | $ | 17,911 | $ | 9,809 | ||||||||||
| Leverage Ratio | Eurodollar Margin | Base Rate Margin | Commitment Fee Rate | |||||||||||||||||
| ≤ 1.00:1.00 | 1.25 | % | 0.25 | % | 0.15 | % | ||||||||||||||
| >1.00:1.00 ≤ 2.00:1.00 | 1.50 | % | 0.50 | % | 0.20 | % | ||||||||||||||
| >2.00:1.00 ≤ 3.00:1.00 | 1.75 | % | 0.75 | % | 0.25 | % | ||||||||||||||
| >3.00:1.00 | 2.00 | % | 1.00 | % | 0.30 | % | ||||||||||||||
| Payor | 2022 | 2021 | 2020 | |||||||||||||||||
| Medicare | 59.6 | % | 59.8 | % | 62.1 | % | ||||||||||||||
| Medicaid | 3.2 | 3.1 | 2.5 | |||||||||||||||||
| Other | 37.2 | 37.1 | 35.4 | |||||||||||||||||
| 100.0 | % | 100.0 | % | 100.0 | % | |||||||||||||||
| Item 7A. | Quantitative and Qualitative Disclosures About Market Risk. | ||||
| Item 8. | Financial Statements and Supplementary Data. | ||||
| Item 9. | Changes In and Disagreements with Accountants on Accounting and Financial Disclosure. | ||||
| Item 9A. | Disclosure Controls and Procedures. | ||||
| Item 9B. | Other Information. | ||||
| PART III | ||||||||||||||
| Item 10. | Directors, Executive Officers and Corporate Governance. | ||||
| Name | Position (s) | Age | Director Since | Class | ||||||||||||||||||||||
| Monica F. Azare | Director | 56 | 2007 | Class II | ||||||||||||||||||||||
| Teri G. Fontenot | Director | 69 | 2019 | Class II | ||||||||||||||||||||||
| Jonathan Goldberg | Director | 71 | 2018 | Class III | ||||||||||||||||||||||
| Clifford S. Holtz | Lead Independent Director | 64 | 2018 | Class III | ||||||||||||||||||||||
| John L. Indest | Director | 71 | 2000 | Class II | ||||||||||||||||||||||
| Keith G. Myers | Director, Chairman, Chief Executive Officer | 64 | 1994 | Class I | ||||||||||||||||||||||
| Ronald T. Nixon | Director | 67 | 2001 | Class I | ||||||||||||||||||||||
| W. Earl Reed, III | Director | 71 | 2018 | Class I | ||||||||||||||||||||||
| Brent Turner | Director | 57 | 2014 | Class III | ||||||||||||||||||||||
| Name | Position(s) | Age | Executive Officer Since | |||||||||||||||||
| Keith G. Myers | Director, Chairman, Chief Executive Officer | 64 | 1994 | |||||||||||||||||
| Joshua L. Proffitt | President, Chief Operating Officer | 45 | 2012 | |||||||||||||||||
| Dale G. Mackel | Executive Vice President, Chief Financial Officer and Treasurer | 59 | 2020 | |||||||||||||||||
| Bruce Greenstein | Executive Vice President, Chief Strategy and Innovation Officer | 55 | 2018 | |||||||||||||||||
| Nicholas Gachassin, III | Executive Vice President, General Counsel | 56 | 2019 | |||||||||||||||||
Name | Audit | Compensation | Nominating and Corporate Governance | Clinical Quality | Corporate Development | ||||||||||||
Monica F. Azare | X | X* | |||||||||||||||
Teri G. Fontenot | X* | X | X | ||||||||||||||
Jonathan Goldberg | X* | X | X | ||||||||||||||
Clifford S. Holtz | X | X | X | ||||||||||||||
John L. Indest | X* | X | |||||||||||||||
Keith G. Myers | |||||||||||||||||
Ronald T. Nixon | X | X | |||||||||||||||
W. Earl Reed, III | X | X | X | ||||||||||||||
Brent Turner | X | X* | |||||||||||||||
| Item 11. | Executive Compensation. | ||||
Compensation Principle | Element of Compensation Program that Reflects Principle | |||||||
• Our executives should be provided with total compensation opportunities at levels that are competitive for comparable positions at companies with whom we compete for talent. | • Based on review of peer group market data, our executive compensation program is competitive relative to our peer group, with opportunities for our executives to earn compensation that is at or above median levels based on meeting or exceeding key company and individual performance measures. | |||||||
• A significant portion of executive compensation should be linked to the company’s achievement of performance goals and increased stock value in a way that proportionally rewards higher performance levels. | • Annual bonus awards and long-term equity awards are earned based on company performance, and the value of restricted stock awards is based on our stock value. | |||||||
• Each of our executive’s interests should be closely aligned with those of our stockholders by making stock-based incentives a core element of our compensation program. | • We grant annual equity awards to our executives in the form of restricted stock based on company and individual executive performance. | |||||||
FIXED | AT RISK/PERFORMANCE BASED | |||||||||||||||||||||||||
Name | 2022 Total Compensation (as Reported in the Summary Compensation Table) | % Attributable to Salary and All Other Compensation | % Attributable to Annual Cash Incentive Award | % Attributable to Restricted Stock Grants | ||||||||||||||||||||||
Keith G. Myers | $ | 5,453,394 | 18% | —% | 82% | |||||||||||||||||||||
Joshua L. Proffitt | 4,273,517 | 16 | — | 84 | ||||||||||||||||||||||
Dale G. Mackel | 3,083,484 | 26 | — | 74 | ||||||||||||||||||||||
Bruce Greenstein | 1,830,979 | 30 | — | 70 | ||||||||||||||||||||||
Nicholas Gachassin, III | 999,280 | 42 | — | 58 | ||||||||||||||||||||||
| Annual EPS Goals for 2022 | Amount of STI Earned | ||||
| $5.55 | 50% of STI Target | ||||
| $5.66 | 80% of STI Target | ||||
| $5.77 | 100% of STI Target | ||||
| $5.88 | 100% of STI Target, plus 10% of base salary | ||||
| $6.00 | 100% of STI Target, plus 20% of base salary | ||||
| Chief Executive Officer | 5x annual base salary | ||||
| President and Chief Operating Officer | 3x annual base salary | ||||
| Chief Financial Officer | 2x annual base salary | ||||
Name and Principal Position | Year | Salary ($)(1) | Bonus ($)(2) | Stock Awards ($)(3) | Non-Equity Incentive Plan Compensation ($)(4) | All Other Compensation ($)(5) | Total ($) | |||||||||||||||||||||||||||||||||||||
| Keith G. Myers | 2022 | 996,000 | — | 4,451,294 | — | 6,100 | 5,453,394 | |||||||||||||||||||||||||||||||||||||
| Chief Executive Officer | 2021 | 996,000 | — | 3,305,950 | — | 5,539 | 4,307,489 | |||||||||||||||||||||||||||||||||||||
| 2020 | 996,000 | — | 2,334,461 | — | 5,539 | 3,336,000 | ||||||||||||||||||||||||||||||||||||||
| Joshua L. Proffitt | 2022 | 663,000 | — | 3,610,517 | — | — | 4,273,517 | |||||||||||||||||||||||||||||||||||||
| President and Chief Operating Officer | 2021 | 663,000 | — | 2,415,175 | — | — | 3,078,175 | |||||||||||||||||||||||||||||||||||||
| 2020 | 663,000 | — | 1,767,243 | — | 50,000 | 2,480,243 | ||||||||||||||||||||||||||||||||||||||
| Dale G. Mackel | 2022 | 500,000 | 300,000 | 2,277,715 | — | 5,769 | 3,083,484 | |||||||||||||||||||||||||||||||||||||
Executive Vice President, Chief Financial Officer and Treasurer | 2021 | 500,000 | — | 122,100 | — | 5,240 | 627,340 | |||||||||||||||||||||||||||||||||||||
| 2020 | 83,333 | — | 250,115 | 31,250 | 30,000 | 394,698 | ||||||||||||||||||||||||||||||||||||||
| Bruce Greenstein | 2022 | 541,000 | — | 1,283,879 | — | 6,100 | 1,830,979 | |||||||||||||||||||||||||||||||||||||
| Executive Vice President, Chief Strategy and Innovation Officer | 2021 | 541,000 | — | 1,577,381 | — | 5,800 | 2,124,181 | |||||||||||||||||||||||||||||||||||||
| 2020 | 540,750 | — | 934,027 | 210,000 | 5,700 | 1,690,477 | ||||||||||||||||||||||||||||||||||||||
| Nicholas Gachassin, III | 2022 | 415,000 | — | 584,280 | — | — | 999,280 | |||||||||||||||||||||||||||||||||||||
| Executive Vice President, Chief General Counsel | 2021 | 415,000 | 3,461 | 468,975 | — | — | 887,436 | |||||||||||||||||||||||||||||||||||||
| 2020 | 400,000 | — | 359,522 | 120,000 | — | 879,522 | ||||||||||||||||||||||||||||||||||||||
Estimated Future Payouts Under Non-Equity Incentive Plan Awards (1) | All Other Stock Awards: Number of Shares of Stock or Units (#)(2) | Grant Date Fair Value of Stock Awards ($)(3) | ||||||||||||||||||||||||||||||
Name | Grant Date | Threshold ($) | Target ($) | Maximum ($) | ||||||||||||||||||||||||||||
Keith G. Myers | ||||||||||||||||||||||||||||||||
EPS Target Bonus | 498,000 | 996,000 | 1,195,200 | |||||||||||||||||||||||||||||
Stretch Target Bonus | 99,600 | |||||||||||||||||||||||||||||||
Restricted Stock | 3/1/2022 | 31,845 | 4,451,294 | |||||||||||||||||||||||||||||
Joshua L. Proffitt | ||||||||||||||||||||||||||||||||
EPS Target Bonus | 331,500 | 663,000 | 795,600 | |||||||||||||||||||||||||||||
Stretch Target Bonus | 66,300 | |||||||||||||||||||||||||||||||
Restricted Stock | 3/1/2022 | 25,830 | 3,610,517 | |||||||||||||||||||||||||||||
Dale G. Mackel | ||||||||||||||||||||||||||||||||
EPS Target Bonus | 187,500 | 375,000 | 475,000 | |||||||||||||||||||||||||||||
Stretch Target Bonus | 37,500 | |||||||||||||||||||||||||||||||
Restricted Stock | 3/1/2022 | 16,295 | 2,277,715 | |||||||||||||||||||||||||||||
Bruce Greenstein | ||||||||||||||||||||||||||||||||
EPS Target Bonus | 210,000 | 420,000 | 528,200 | |||||||||||||||||||||||||||||
Stretch Target Bonus | 42,000 | |||||||||||||||||||||||||||||||
Restricted Stock | 3/1/2022 | 9,185 | 1,283,879 | |||||||||||||||||||||||||||||
Nicholas Gachassin, III | ||||||||||||||||||||||||||||||||
EPS Target Bonus | 125,000 | 250,000 | 333,000 | |||||||||||||||||||||||||||||
Stretch Target Bonus | 25,000 | |||||||||||||||||||||||||||||||
Restricted Stock | 3/1/2022 | 4,180 | 584,280 | |||||||||||||||||||||||||||||
Stock Awards | ||||||||||||||
Name | Number of Shares or Units of Stock That Have Not Vested (#)(1) | Market Value of Shares or Units of Stock That Have Not Vested ($)(2) | ||||||||||||
Keith G. Myers | 83,641 | 13,523,913 | ||||||||||||
Joshua L. Proffitt | 60,301 | 9,750,069 | ||||||||||||
Dale G. Mackel | 14,257 | 2,305,214 | ||||||||||||
Bruce Greenstein | 23,677 | 3,828,334 | ||||||||||||
Nicholas Gachassin, III | 9,378 | 1,516,329 | ||||||||||||
Name | Shares of Restricted Stock | Vesting Schedule | |||||||||||||||
Mr. Myers | 12,244 | 100% on March 1, 2023 | |||||||||||||||
| 13,724 | 50% on March 1, 2023 and on the next anniversary thereof | ||||||||||||||||
| 11,532 | 33% on March 1, 2023 and on each of the two subsequent anniversaries thereof | ||||||||||||||||
| 14,296 | 25% on March 1, 2023 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
| 31,845 | 20% on March 1, 2023 and on each of the four subsequent anniversaries thereof | ||||||||||||||||
Mr. Proffitt | 3,480 | 100% on March 1, 2023 | |||||||||||||||
| 2,275 | 100% on May 1, 2023 | ||||||||||||||||
| 4,110 | 50% on March 1, 2023 and on the next anniversary thereof | ||||||||||||||||
| 5,432 | 50% on October 1, 2023 and on the next anniversary thereof | ||||||||||||||||
| 8,730 | 33% on March 1, 2023 and on each of the two subsequent anniversaries thereof | ||||||||||||||||
| 10,444 | 25% on March 1, 2023 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
| 25,830 | 20% on March 1, 2023 and on each of the four subsequent anniversaries thereof | ||||||||||||||||
Mr. Mackel | 693 | 33% on November 1, 2023 and on each of the two subsequent anniversaries thereof | |||||||||||||||
| 528 | 25% on March 1, 2023 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
| 13,036 | 25% on March 1, 2024 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
Mr. Greenstein | 1,394 | 100% on August 1, 2023 | |||||||||||||||
| 1,828 | 50% on March 1, 2023 and on the next anniversary thereof | ||||||||||||||||
| 4,614 | 33% on March 1, 2023 and on each of the two subsequent anniversaries thereof | ||||||||||||||||
| 5,088 | 25% on March 1, 2023 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
| 1,568 | 25% on July 1, 2023 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
| 9,185 | 20% on March 1, 2023 and on each of the four subsequent anniversaries thereof | ||||||||||||||||
| Mr. Gachassin | 1,394 | 50% on January 1, 2023 and on the subsequent anniversary thereof | |||||||||||||||
| 1,776 | 33% on March 1, 2023 and on each of the two subsequent anniversaries thereof | ||||||||||||||||
| 2,028 | 25% on March 1, 2023 and on each of the three subsequent anniversaries thereof | ||||||||||||||||
| 4,180 | 20% on March 1, 2023 and on each of the four subsequent anniversaries thereof | ||||||||||||||||
Stock Awards | ||||||||||||||
Name | Number of Shares Acquired on Vesting (#) | Value Realized on Vesting ($)(1) | ||||||||||||
Keith G. Myers | 34,789 | 4,862,806 | ||||||||||||
Joshua L. Proffitt | 18,630 | 2,725,335 | ||||||||||||
Dale G. Mackel | 3,622 | 583,389 | ||||||||||||
Bruce Greenstein | 5,510 | 807,957 | ||||||||||||
Nicholas Gachassin, III | 1,796 | 249,268 | ||||||||||||
Name | Effective Date of Current Employment Agreement | Expiration Date of Current Employment Agreement | ||||||||||||
Keith G. Myers | April 1, 2017 | March 31, 2023 | ||||||||||||
Joshua L. Proffitt | October 7, 2019 | September 30, 2023 | ||||||||||||
Dale G. Mackel | November 2, 2020 | October 31, 2023 | ||||||||||||
Bruce Greenstein | July 1, 2021 | June 30, 2024 | ||||||||||||
Nicholas Gachassin, III | January 2, 2020 | January 2, 2024 | ||||||||||||
Myers | Proffitt | Mackel | Greenstein | Gachassin | |||||||||||||||||||||||||
Reason for Termination: | |||||||||||||||||||||||||||||
By Company Without Cause; by Executive for Good Reason | |||||||||||||||||||||||||||||
Cash Severance(1) | $ | 2,988,000 | $ | 1,989,000 | $ | 1,612,475 | $ | 1,460,721 | $ | 996,004 | |||||||||||||||||||
Health and Welfare Continuation(2) | 19,932 | 25,304 | 12,769 | 15,265 | — | ||||||||||||||||||||||||
Total Estimated Value of Payments and Benefits | 3,007,932 | 2,014,304 | 1,625,244 | 1,475,986 | 996,004 | ||||||||||||||||||||||||
Termination Without Cause or by Executive for Good Reason Within 24 Months Following a Change of Control | |||||||||||||||||||||||||||||
Cash Severance(1) | 4,980,000 | 3,315,000 | 2,487,458 | 2,434,535 | 1,660,006 | ||||||||||||||||||||||||
Health and Welfare Continuation(2) | 19,932 | 25,304 | 12,769 | 15,265 | — | ||||||||||||||||||||||||
Value of Accelerated Equity Awards(3) | 13,523,913 | 9,750,069 | 2,305,214 | 3,828,334 | 1,516,329 | ||||||||||||||||||||||||
Total Estimated Value of Payments and Benefits | 18,523,845 | 13,090,373 | 4,805,441 | 6,278,134 | 3,176,335 | ||||||||||||||||||||||||
Death or Disability | |||||||||||||||||||||||||||||
Value of Accelerated Equity Awards(3) | 13,523,913 | 9,750,069 | 2,305,214 | 3,828,334 | 1,516,329 | ||||||||||||||||||||||||
Total Estimated Value of Payments and Benefits | $ | 13,523,913 | $ | 9,750,069 | $ | 2,305,214 | $ | 3,828,334 | $ | 1,516,329 | |||||||||||||||||||
Name | Fees Earned or Paid in Cash($)(1) | Stock Awards ($)(2) | Total ($) | |||||||||||||||||
Monica F. Azare | 104,500 | 177,859 | 282,359 | |||||||||||||||||
Teri G. Fontenot | 121,000 | 177,859 | 298,859 | |||||||||||||||||
Jonathan Goldberg | 112,000 | 177,859 | 289,859 | |||||||||||||||||
Clifford S. Holtz (3) | 134,000 | 366,551 | 500,551 | |||||||||||||||||
John L. Indest (4) | 101,527 | 177,859 | 279,386 | |||||||||||||||||
Ronald T. Nixon | 97,000 | 177,859 | 274,859 | |||||||||||||||||
W. Earl Reed, III | 109,000 | 177,859 | 286,859 | |||||||||||||||||
Brent Turner | 106,000 | 177,859 | 283,859 | |||||||||||||||||
| Director | Shares of Restricted Stock | |||||||
| Monica F. Azare | 1,100 | |||||||
| Teri G. Fontenot | 1,100 | |||||||
| Jonathan Goldberg | 1,100 | |||||||
| Clifford S. Holtz | 2,267 | |||||||
| John L. Indest | 1,100 | |||||||
| Ronald T. Nixon | 1,100 | |||||||
| W. Earl Reed, III | 1,100 | |||||||
| Brent Turner | 1,100 | |||||||
| Item 12. | Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters. | ||||
Beneficial Ownership | ||||||||||||||
Name (1) | Number | Percent | ||||||||||||
Director Nominees, Continuing Directors and Named Executive Officers | ||||||||||||||
Keith G. Myers (2) | 948,933 | 3.1% | ||||||||||||
Monica F. Azare (3) | 30,521 | * | ||||||||||||
Teri G. Fontenot (3) | 7,700 | * | ||||||||||||
Jonathan Goldberg (4) | 57,472 | * | ||||||||||||
Clifford S. Holtz (5) | 12,023 | * | ||||||||||||
John L. Indest (6) | 34,948 | * | ||||||||||||
Ronald T. Nixon (3) | 27,100 | * | ||||||||||||
W. Earl Reed, III (7) | 138,797 | * | ||||||||||||
Brent Turner (3) | 14,200 | * | ||||||||||||
Joshua L. Proffitt (8) | 106,238 | * | ||||||||||||
Dale G. Mackel (9) | 18,039 | |||||||||||||
Bruce Greenstein (10) | 34,126 | * | ||||||||||||
Nicholas Gachassin, III (11) | 13,040 | * | ||||||||||||
All continuing directors, director nominees, and executive officers of the company as a group (13 persons) | 1,443,137 | 4.7% | ||||||||||||
Certain Beneficial Owners | ||||||||||||||
BlackRock, Inc. (12) 55 East 52nd Street New York, NY 10055 | 4,625,583 | 14.9% | ||||||||||||
| The Vanguard Group (13) 100 Vanguard Blvd. Malvern, PA 19355 | 2,919,047 | 9.4% | ||||||||||||
| (a) | (b) | (c) | ||||||||||||||||||
| Plan Category | Number of Shares to be Issued Upon Exercise of Outstanding Options, Warrants, and Rights | Weighted-Average Exercise Price of Outstanding Price of Outstanding Rights | Number of Shares Remaining Available for Future Issuance Under Equity Compensation Plans (Excluding Securities Reflected in Column (a) (1) | |||||||||||||||||
| Equity compensation plans approved by Stockholders: | — | $ | — | 1,632,806 | ||||||||||||||||
| Equity compensation plans not approved by Stockholders: | — | — | — | |||||||||||||||||
| Total | — | $ | — | 1,632,806 | ||||||||||||||||
| Item 13. | Certain Relationships and Related Transactions, and Director Independence. | ||||
| Item 14. | Principal Accountant Fees and Services. | ||||
Fee Category | 2022 | 2021 | ||||||||||||
Audit Fees (1) | $ | 2,986,129 | $ | 2,310,000 | ||||||||||
Audit-Related Fees (2) | — | — | ||||||||||||
Tax Fees (3) | — | — | ||||||||||||
All Other Fees (4) | 105,000 | 204,150 | ||||||||||||
Total | $ | 3,091,129 | $ | 2,514,150 | ||||||||||
| PART IV | ||||||||||||||
| Item 15. | Exhibits, Financial Statement Schedules. | ||||
| Report of Independent Registered Public Accounting Firm | F-1 | ||||
| Consolidated Balance Sheets as of December 31, 2022 and 2021 | F-3 | ||||
| For each of the years in the three-year period ended December 31, 2022 | |||||
| Consolidated Statements of Income | F-4 | ||||
| Consolidated Statements of Stockholders' Equity | F-5 | ||||
| Consolidated Statements of Cash Flows | F-7 | ||||
| Notes to the Consolidated Financial Statements | F-9 | ||||
| As of December 31, | ||||||||||||||
| 2022 | 2021 | |||||||||||||
| ASSETS | ||||||||||||||
| Current assets: | ||||||||||||||
| Cash | $ | $ | ||||||||||||
| Receivables: | ||||||||||||||
| Patient accounts receivable | ||||||||||||||
| Other receivables | ||||||||||||||
| Total receivables | ||||||||||||||
| Prepaid income taxes | ||||||||||||||
| Prepaid expenses | ||||||||||||||
| Other current assets | ||||||||||||||
| Total current assets | ||||||||||||||
Property, building and equipment, net of accumulated depreciation of $ | ||||||||||||||
| Goodwill | ||||||||||||||
Intangible assets, net of accumulated amortization of $ | ||||||||||||||
| Operating lease right of use asset | ||||||||||||||
| Other assets | ||||||||||||||
| Total assets | $ | $ | ||||||||||||
| LIABILITIES AND STOCKHOLDERS’ EQUITY | ||||||||||||||
| Current liabilities: | ||||||||||||||
| Accounts payable and other accrued liabilities | $ | $ | ||||||||||||
| Salaries, wages and benefits payable | ||||||||||||||
| Self insurance reserves | ||||||||||||||
| Contract liabilities - deferred revenue | ||||||||||||||
| Current operating lease payable | ||||||||||||||
| Amounts due to governmental entities | ||||||||||||||
| Current liabilities - deferred employer payroll tax | ||||||||||||||
| Total current liabilities | ||||||||||||||
| Deferred income taxes | ||||||||||||||
| Income taxes payable | ||||||||||||||
| Revolving credit facility | ||||||||||||||
| Operating lease payable | ||||||||||||||
| Total liabilities | ||||||||||||||
| Noncontrolling interest-redeemable | ||||||||||||||
| Commitments and contingencies | ||||||||||||||
| Stockholders’ equity: | ||||||||||||||
| LHC Group, Inc. stockholders’ equity: | ||||||||||||||
Preferred stock – $ | ||||||||||||||
Common stock – $ | ||||||||||||||
Treasury stock – | ( | ( | ||||||||||||
| Additional paid-in capital | ||||||||||||||
| Retained earnings | ||||||||||||||
| Total LHC Group, Inc. stockholders’ equity | ||||||||||||||
| Noncontrolling interest – non-redeemable | ||||||||||||||
| Total stockholders’ equity | ||||||||||||||
| Total liabilities and stockholders’ equity | $ | $ | ||||||||||||
| For the year ended December 31, | ||||||||||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| $ | $ | $ | ||||||||||||||||||
| Gross margin | ||||||||||||||||||||
| General and administrative expenses | ||||||||||||||||||||
| Impairment of intangibles and other | ||||||||||||||||||||
| Operating income | ||||||||||||||||||||
| Interest expense | ( | ( | ( | |||||||||||||||||
| Income before income taxes and noncontrolling interests | ||||||||||||||||||||
| Income tax expense | ||||||||||||||||||||
| Net income | ||||||||||||||||||||
| Less net income attributable to noncontrolling interests | ||||||||||||||||||||
| Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | |||||||||||||||||
| Earnings per share - basic: | ||||||||||||||||||||
| Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | |||||||||||||||||
| Earnings per share - diluted: | ||||||||||||||||||||
| Net income attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | |||||||||||||||||
| Weighted average shares outstanding: | ||||||||||||||||||||
| Basic | ||||||||||||||||||||
| Diluted | ||||||||||||||||||||
| LHC Group, Inc. | Noncontrolling interest non- redeemable | Total equity | Non controlling interest redeemable | Net income | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Common Stock | Additional paid-in capital | Retained earnings | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Issued | Treasury | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Amount | Shares | Amount | Shares | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Balances at December 31, 2019 | $ | $ | ( | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acquired noncontrolling interest | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Purchase of additional controlling interest | — | — | — | — | ( | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Sale of noncontrolling interest | — | — | — | — | ( | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Noncontrolling interest distributions | — | — | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Nonvested stock compensation | — | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Issuance of vested stock | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treasury shares redeemed to pay income tax | — | — | ( | — | — | — | ( | — | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Exercise of stock options | — | ( | — | — | ( | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Issuance of common stock under Employee Stock Purchase Plan | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Balances at December 31, 2020 | $ | $ | ( | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acquired noncontrolling interest | — | — | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Purchase of additional controlling interest | — | — | — | — | ( | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Sale of noncontrolling interest | — | — | — | — | ( | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Noncontrolling interest distributions | — | — | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Nonvested stock compensation | — | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Issuance of vested stock | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treasury shares redeemed to pay income tax | — | — | ( | — | — | ( | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repurchase of common stock | — | — | ( | — | — | — | ( | — | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Issuance of common stock under Employee Stock Purchase Plan | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Balances at December 31, 2021 | $ | $ | ( | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Net income | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acquired noncontrolling interest | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Purchase of additional controlling interest | — | — | — | — | ( | — | ( | ( | — | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Sale of noncontrolling interest | — | — | — | — | ( | — | — | ( | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Noncontrolling interest distributions | — | — | — | — | — | — | ( | ( | ( | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Nonvested stock compensation | — | — | — | — | — | — | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Issuance of vested stock | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treasury shares redeemed to pay income tax | — | — | ( | — | — | ( | — | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Exercise of stock options | — | ( | ( | — | — | ( | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Repurchase of common stock | — | — | ( | — | — | — | ( | — | |||||||||||||||||||||||||||||||||||||||||||||||||||
| Issuance of common stock under Employee Stock Purchase Plan | — | — | — | — | — | — | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Balances at December 31, 2022 | $ | $ | ( | $ | $ | $ | $ | $ | |||||||||||||||||||||||||||||||||||||||||||||||||||
| For the year ended December 31, | ||||||||||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Operating activities: | ||||||||||||||||||||
Net income | $ | $ | $ | |||||||||||||||||
Adjustments to reconcile net income to net cash provided by operating activities: | ||||||||||||||||||||
| Depreciation and amortization expense | ||||||||||||||||||||
| Amortization and impairment of operating lease right of use asset | ||||||||||||||||||||
| Stock-based compensation expense | ||||||||||||||||||||
| Deferred income taxes | ( | |||||||||||||||||||
| Loss (gain) on disposal of assets | ( | |||||||||||||||||||
| Impairment of intangibles and other | ||||||||||||||||||||
| Changes in operating assets and liabilities, net of acquisitions: | ||||||||||||||||||||
| Receivables | ( | ( | ||||||||||||||||||
| Prepaid expenses | ( | ( | ||||||||||||||||||
| Other assets | ( | ( | ||||||||||||||||||
| Prepaid income taxes | ( | ( | ||||||||||||||||||
| Accounts payable and accrued expenses | ( | |||||||||||||||||||
| Salaries, wages, and benefits payable and self-insurance reserves | ||||||||||||||||||||
| Other liabilities | ( | ( | ||||||||||||||||||
| Contract liabilities - deferred revenue | ( | ( | ||||||||||||||||||
| Operating lease payable | ( | ( | ( | |||||||||||||||||
| Income tax payable | ( | ( | ||||||||||||||||||
| Net amounts due to/from governmental entities | ( | ( | ||||||||||||||||||
| Net cash provided by (used in) operating activities | ( | |||||||||||||||||||
| Investing activities: | ||||||||||||||||||||
Cash paid for acquisitions, net of cash acquired | ( | ( | ( | |||||||||||||||||
| Minority interest investments | ( | ( | ||||||||||||||||||
| Proceeds from sale of assets | ||||||||||||||||||||
| Proceeds from sale of an entity | ||||||||||||||||||||
Purchases of property, building and equipment | ( | ( | ( | |||||||||||||||||
| Purchase of intangible assets | ( | |||||||||||||||||||
| Net cash used in investing activities | ( | ( | ( | |||||||||||||||||
| Financing activities: | ||||||||||||||||||||
| Proceeds from line of credit | ||||||||||||||||||||
| Payments on line of credit | ( | ( | ( | |||||||||||||||||
| Government stimulus advance | ( | |||||||||||||||||||
| Proceeds from employee stock purchase plan | ||||||||||||||||||||
| Payments on deferred financing fees | ( | |||||||||||||||||||
| Payments on repurchasing common stock | ( | ( | ||||||||||||||||||
| Noncontrolling interest distributions | ( | ( | ( | |||||||||||||||||
| Purchase of additional controlling interest | ( | ( | ( | |||||||||||||||||
| Sale of noncontrolling interest | ||||||||||||||||||||
| Withholding taxes paid on stock-based compensation | ( | ( | ( | |||||||||||||||||
| Net cash provided by (used in) financing activities | ( | |||||||||||||||||||
| Change in cash | ( | |||||||||||||||||||
| Cash at beginning of period | ||||||||||||||||||||
| Cash at end of period | $ | $ | $ | |||||||||||||||||
| Supplemental disclosures of cash flow information | ||||||||||||||||||||
| Interest paid | $ | $ | $ | |||||||||||||||||
| Income taxes paid | $ | $ | $ | |||||||||||||||||
| Non-Cash Operating activity: | ||||||||||||||||||||
| Operating right of use assets in exchange for lease obligations | ||||||||||||||||||||
| Non-Cash Investing activity: | ||||||||||||||||||||
| Accrued capital expenditures | ||||||||||||||||||||
| Net working capital adjustment | ||||||||||||||||||||
| Non-Cash Financing activity: | ||||||||||||||||||||
| Contribution of noncontrolling interest | ||||||||||||||||||||
| Year Ended December 31, | ||||||||||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Suspension of 2% sequestration payment adjustment | $ | $ | $ | |||||||||||||||||
| Suspension of LTACH site-neutral payment | ||||||||||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Home Health: | ||||||||||||||||||||
| Medicare | % | % | % | |||||||||||||||||
| Managed Care, Commercial, and Other | ||||||||||||||||||||
| % | % | % | ||||||||||||||||||
| Hospice: | ||||||||||||||||||||
| Medicare | % | % | % | |||||||||||||||||
| Managed Care, Commercial, and Other | ||||||||||||||||||||
| % | % | % | ||||||||||||||||||
| Home and Community-Based: | ||||||||||||||||||||
| Medicaid | % | % | % | |||||||||||||||||
| Managed Care, Commercial, and Other | ||||||||||||||||||||
| % | % | % | ||||||||||||||||||
| Facility-Based: | ||||||||||||||||||||
| Medicare | % | % | % | |||||||||||||||||
| Managed Care, Commercial, and Other | ||||||||||||||||||||
| % | % | % | ||||||||||||||||||
| Healthcare Innovations: | ||||||||||||||||||||
| Medicare | % | % | % | |||||||||||||||||
| Managed Care, Commercial, and Other | ||||||||||||||||||||
| % | % | % | ||||||||||||||||||
| 2022 | 2021 | ||||||||||
| Medicare | % | % | |||||||||
| Medicaid | |||||||||||
| Managed Care, Commercial, and Other | |||||||||||
| Total patient accounts receivable | % | % | |||||||||
| 2022 | 2021 | |||||||||||||
| Land | $ | $ | ||||||||||||
| Building and leasehold improvements | ||||||||||||||
| Transportation equipment | ||||||||||||||
| Office furniture and medical equipment | ||||||||||||||
| Construction in progress | ||||||||||||||
| Less accumulated depreciation | ||||||||||||||
| Property, building and equipment, net | $ | $ | ||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Weighted average number of shares outstanding for basic per share calculation | ||||||||||||||||||||
| Effect of dilutive potential shares: | ||||||||||||||||||||
| Nonvested restricted stock | ||||||||||||||||||||
| Adjusted weighted average shares for diluted per share calculation | ||||||||||||||||||||
| Antidilutive shares | ||||||||||||||||||||
| Consideration | ||||||||
| Cash | $ | |||||||
| Fair value of total consideration transferred | ||||||||
| Recognized amounts of identifiable assets acquired and liabilities assumed | ||||||||
| Trade names | $ | |||||||
| Certificates of need/licenses | ||||||||
| Non-compete agreements | ||||||||
| Operating lease right of use asset | ||||||||
| Accounts payable and other accrued liabilities | ( | |||||||
| Salaries, wages, and benefits payable | ( | |||||||
| Current operating lease payable | ( | |||||||
| Total identifiable assets and liabilities | $ | |||||||
| Noncontrolling interest | ||||||||
Goodwill, including noncontrolling interest of $ | $ | |||||||
Home Health | Hospice | Home and community- based | Facility-based | HCI | Total | |||||||||||||||||||||||||||||||||
| Goodwill | ||||||||||||||||||||||||||||||||||||||
| Balance as of December 31, 2020 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Acquisitions | — | |||||||||||||||||||||||||||||||||||||
| Noncontrolling interest | — | — | ||||||||||||||||||||||||||||||||||||
| Adjustments and disposals | ( | — | — | ( | ||||||||||||||||||||||||||||||||||
| Balance as of December 31, 2021 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Acquisitions | ||||||||||||||||||||||||||||||||||||||
| Noncontrolling interest | — | |||||||||||||||||||||||||||||||||||||
| Adjustments and disposals | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||||
| Balance as of December 31, 2022 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Intangibles Assets | ||||||||||||||||||||||||||||||||||||||
| Balance as of December 31, 2020 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Acquisitions | ||||||||||||||||||||||||||||||||||||||
| Amortization | ( | ( | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||
| Adjustments and disposals | ( | ( | ||||||||||||||||||||||||||||||||||||
| Balance as of December 31, 2021 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Acquisitions | ||||||||||||||||||||||||||||||||||||||
| Amortization | ( | ( | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||
| Adjustments and disposals | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||||
| Balance as of December 31, 2022 | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| 2022 | 2021 | |||||||||||||
| Indefinite-lived intangible assets: | ||||||||||||||
| Trade names | $ | $ | ||||||||||||
| Certificates of need/licenses | ||||||||||||||
| Net total | $ | $ | ||||||||||||
| Definite-lived intangible assets: | ||||||||||||||
| Trade names | ||||||||||||||
| Gross carrying amount | $ | $ | ||||||||||||
| Accumulated amortization | ( | ( | ||||||||||||
| Net total | $ | $ | ||||||||||||
| Non-compete agreements | ||||||||||||||
| Gross carrying amount | $ | $ | ||||||||||||
| Accumulated amortization | ( | ( | ||||||||||||
| Net total | $ | $ | ||||||||||||
| Customer relationships | ||||||||||||||
| Gross carrying amount | $ | $ | ||||||||||||
| Accumulated amortization | ( | ( | ||||||||||||
| Net total | $ | $ | ||||||||||||
| Total definite-lived intangible assets | ||||||||||||||
| Gross carrying amount | $ | $ | ||||||||||||
| Accumulated amortization | ( | ( | ||||||||||||
| Net total | $ | $ | ||||||||||||
| Total intangible assets: | ||||||||||||||
| Gross carrying amount | $ | $ | ||||||||||||
| Accumulated amortization | ( | ( | ||||||||||||
| Net total | $ | $ | ||||||||||||
| Year | Amortization amount | |||||||
| 2023 | $ | |||||||
| 2024 | ||||||||
| 2025 | ||||||||
| 2026 | ||||||||
| 2027 | ||||||||
| Total | $ | |||||||
| 2022 | 2021 | |||||||||||||
| Deferred tax assets: | ||||||||||||||
| Allowance for uncollectible accounts | $ | $ | ||||||||||||
| Accrued employee benefits | ||||||||||||||
| Stock compensation | ||||||||||||||
| Accrued self-insurance | ||||||||||||||
| Acquisition costs | ||||||||||||||
| Net operating loss carry forward | ||||||||||||||
| Intangible asset impairment | ||||||||||||||
| Interest Expense | ||||||||||||||
| Lease payable | ||||||||||||||
| Government stimulus advance | ||||||||||||||
| Payroll tax | ||||||||||||||
| Other | ||||||||||||||
| Gross deferred tax assets | ||||||||||||||
| Less: valuation allowance | ( | ( | ||||||||||||
| Net deferred tax assets | $ | $ | ||||||||||||
| Deferred tax liabilities: | ||||||||||||||
| Amortization of intangible assets | ( | ( | ||||||||||||
| Tax depreciation in excess of book depreciation | ( | ( | ||||||||||||
| Prepaid expenses | ( | ( | ||||||||||||
| Non-accrual experience accounting method | ( | ( | ||||||||||||
| Right of use asset | ( | ( | ||||||||||||
| Other | ( | ( | ||||||||||||
| Deferred tax liabilities | ( | ( | ||||||||||||
| Net deferred tax liability | $ | ( | $ | ( | ||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Current: | ||||||||||||||||||||
| Federal | $ | ( | $ | $ | ||||||||||||||||
| State | ||||||||||||||||||||
| Deferred: | ||||||||||||||||||||
| Federal | ( | |||||||||||||||||||
| State | ( | |||||||||||||||||||
| ( | ||||||||||||||||||||
| Total income tax expense | $ | $ | $ | |||||||||||||||||
| 2022 | 2021 | 2020 | ||||||||||||||||||
| Federal statutory tax rate | % | % | % | |||||||||||||||||
| State income taxes, net of federal benefit | ||||||||||||||||||||
| Nondeductible expenses | ||||||||||||||||||||
| Uncertain tax position | ( | |||||||||||||||||||
| Cares Act Enactment | ( | |||||||||||||||||||
| Excess tax benefit | ( | ( | ( | |||||||||||||||||
| Credits and other | ( | ( | ( | |||||||||||||||||
| Effective tax rate | % | % | % | |||||||||||||||||
| Unrecognized tax benefits | ||||||||
| As of January 1, 2021 | $ | |||||||
| Acquired unrecognized tax position | ||||||||
| Increased (decreased) in unrecognized tax benefits as a result of: | ||||||||
| Tax positions taken in the current year | ||||||||
| Lapse of statute of limitations | ( | |||||||
| As of December 31, 2021 | $ | |||||||
| Increased (decreased) in unrecognized tax benefits as a result of: | ||||||||
| Tax positions taken in the current year | ||||||||
| Lapse of statute of limitations | ( | |||||||
| As of December 31, 2022 | $ | |||||||
| Year | Principal payment amount | |||||||
| 2023 | $ | |||||||
| 2024 | ||||||||
| 2025 | ||||||||
| 2026 | ||||||||
| 2027 | ||||||||
| Total | $ | |||||||
| Nonvested stock | Options | |||||||||||||||||||||||||
| Number of Shares | Weighted average grant date fair value | Number of Shares | Weighted average grant date fair value | |||||||||||||||||||||||
| Share grants outstanding at December 31, 2021 | $ | $ | ||||||||||||||||||||||||
| Granted | ||||||||||||||||||||||||||
| Vested or exercised | ( | ( | ||||||||||||||||||||||||
| Share grants outstanding at December 31, 2022 | $ | $ | ||||||||||||||||||||||||
| Range of Exercise Price | Shares | Wtd. Avg. Remaining Contractual Life | Wtd. Avg. Exercise Price | ||||||||
$ | $ | ||||||||||
$ | $ | ||||||||||
Over $ | $ | ||||||||||
| $ | |||||||||||
| Number of Shares | Weighted Average Per Share Price | |||||||||||||
| Shares issued in 2020 | $ | |||||||||||||
| Shares issued in 2021 | $ | |||||||||||||
| Shares issued in 2022 | $ | |||||||||||||
| December 31, 2022 | December 31, 2021 | |||||||||||||
| Operating lease right of use asset | $ | $ | ||||||||||||
| Current operating lease payable | $ | $ | ||||||||||||
| Long-term operating lease payable | $ | $ | ||||||||||||
| 2022 | 2021 | 2020 | |||||||||||||||
| Operating lease cost | $ | $ | $ | ||||||||||||||
| Short-term lease cost | |||||||||||||||||
| Variable lease cost | |||||||||||||||||
| Total lease costs | $ | $ | $ | ||||||||||||||
| Year | Total | |||||||
| 2023 | $ | |||||||
| 2024 | ||||||||
| 2025 | ||||||||
| 2026 | ||||||||
| Thereafter | ||||||||
| Total future minimum lease payments | ||||||||
| Less: Imputed interest | ( | |||||||
| Total | $ | |||||||
| Year Ended December 31, 2022 | ||||||||||||||||||||||||||||||||||||||
| Home Health | Hospice | Home and Community-Based | Facility-Based | HCI | Total | |||||||||||||||||||||||||||||||||
| Net service revenue | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Cost of service revenue (excluding depreciation and amortization) | ||||||||||||||||||||||||||||||||||||||
| General and administrative expenses | ||||||||||||||||||||||||||||||||||||||
| Impairment of intangibles and other | ||||||||||||||||||||||||||||||||||||||
| Operating income (loss) | ( | |||||||||||||||||||||||||||||||||||||
| Interest expense | ( | ( | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||
| Income (loss) before income taxes and noncontrolling interests | ( | ( | ||||||||||||||||||||||||||||||||||||
| Income tax expense (benefit) | ( | ( | ( | |||||||||||||||||||||||||||||||||||
| Net income (loss) | ( | ( | ||||||||||||||||||||||||||||||||||||
| Less net income (loss) attributable to noncontrolling interests | ( | ( | ||||||||||||||||||||||||||||||||||||
| Net income (loss) attributable to LHC Group, Inc.’s common stockholders | $ | $ | ( | $ | ( | $ | ( | $ | $ | |||||||||||||||||||||||||||||
| Total assets | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Year Ended December 31, 2021 | ||||||||||||||||||||||||||||||||||||||
| Home Health | Hospice | Home and Community-Based | Facility-Based | HCI | Total | |||||||||||||||||||||||||||||||||
| Net service revenue | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Cost of service revenue (excluding depreciation and amortization) | ||||||||||||||||||||||||||||||||||||||
| General and administrative expenses | ||||||||||||||||||||||||||||||||||||||
| Impairment of intangibles and other | — | |||||||||||||||||||||||||||||||||||||
| Operating income (loss) | ( | |||||||||||||||||||||||||||||||||||||
| Interest expense | ( | ( | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||
| Income (loss) before income taxes and noncontrolling interests | ( | |||||||||||||||||||||||||||||||||||||
| Income tax expense (benefit) | ( | |||||||||||||||||||||||||||||||||||||
| Net income (loss) | ( | |||||||||||||||||||||||||||||||||||||
| Less net income (loss) attributable to noncontrolling interests | ( | |||||||||||||||||||||||||||||||||||||
| Net income (loss) attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | $ | ( | $ | $ | |||||||||||||||||||||||||||||||
| Total assets | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Year Ended December 31, 2020 | ||||||||||||||||||||||||||||||||||||||
| Home Health | Hospice | Home and Community-Based | Facility-Based | HCI | Total | |||||||||||||||||||||||||||||||||
| Net service revenue | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Cost of service revenue (excluding depreciation and amortization) | ||||||||||||||||||||||||||||||||||||||
| General and administrative expenses | ||||||||||||||||||||||||||||||||||||||
| Impairment of intangibles and other | ||||||||||||||||||||||||||||||||||||||
| Operating income (loss) | ( | ( | ||||||||||||||||||||||||||||||||||||
| Interest expense | ( | ( | ( | ( | ( | ( | ||||||||||||||||||||||||||||||||
| Income (loss) before income taxes and noncontrolling interests | ( | ( | ||||||||||||||||||||||||||||||||||||
| Income tax expense (benefit) | ( | ( | ||||||||||||||||||||||||||||||||||||
| Net income (loss) | ( | ( | ||||||||||||||||||||||||||||||||||||
| Less net income (loss) attributable to noncontrolling interests | ( | ( | ||||||||||||||||||||||||||||||||||||
| Net income (loss) attributable to LHC Group, Inc.’s common stockholders | $ | $ | $ | ( | $ | ( | $ | $ | ||||||||||||||||||||||||||||||
| Total assets | $ | $ | $ | $ | $ | $ | ||||||||||||||||||||||||||||||||
| Exhibit Number | Description of Exhibits | |||||||
| 2.1 | ||||||||
| 3.1 | ||||||||
| 3.2 | ||||||||
| 4.1 | ||||||||
| 4.2 | ||||||||
| 10.1+ | ||||||||
| 10.2+ | ||||||||
| 10.3+ | ||||||||
| 10.4+ | ||||||||
| 10.5+ | ||||||||
| 10.6+ | ||||||||
| 10.7+ | ||||||||
| 10.8+ | ||||||||
| 10.9+ | ||||||||
| 10.10+ | ||||||||
| 10.11+ | ||||||||
| 10.12+ | ||||||||
| 10.13+ | ||||||||
| 10.14+ | ||||||||
| 21.1 | ||||||||
| 23.1 | ||||||||
| 24.1 | ||||||||
| 31.1 | ||||||||
| 31.2 | ||||||||
| 32.1* | ||||||||
| 101.INS | XBRL Instance Document | |||||||
| 101.SCH | XBRL Schema Document | |||||||
| 101.CAL | XBRL Calculation Linkbase Document | |||||||
| 101.DEF | XBRL Definition Linkbase Document | |||||||
| 101.LAB | XBRL Label Linkbase Document | |||||||
| 101.PRE | XBRL Presentation Linkbase Document | |||||||
| 104 | Cover Page Interactive Data File | |||||||
| + | Indicates a management contract or compensatory plan. | ||||
| * | This exhibit is furnished to the SEC as an accompanying document and is not deemed to be "filed" for purposes of Section 18 of the Securities Exchange Act of 1934 or otherwise subject to the liabilities of that Section, and the document will not be deemed incorporated by reference into any filing under the Securities Act of 1933. | ||||
| LHC GROUP, INC. | ||||||||
| February 22, 2023 | /s/ KEITH G. MYERS | |||||||
| Keith G. Myers | ||||||||
| Chief Executive Officer | ||||||||
| Signature | Title | Date | ||||||||||||
/s/ KEITH G. MYERS Keith G. Myers | Chief Executive Officer and Chairman of the Board of Directors | February 22, 2023 | ||||||||||||
/s/ DALE G. MACKEL Dale G. Mackel | Chief Financial Officer, Principal Accounting Officer | February 22, 2023 | ||||||||||||
/s/ KIMBERLY S. SEYMOUR Kimberly S. Seymour | Senior Vice President of Accounting, Chief Accounting Officer | February 22, 2023 | ||||||||||||
/s/ MONICA F. AZARE Monica F. Azare | Director | February 22, 2023 | ||||||||||||
/s/ TERI G. FONTENOT Teri G. Fontenot | Director | February 22, 2023 | ||||||||||||
/s/ JONATHAN D. GOLDBERG Jonathan D. Goldberg | Director | February 22, 2023 | ||||||||||||
/s/ CLIFFORD S. HOLTZ Clifford S. Holtz | Director | February 22, 2023 | ||||||||||||
/s/ JOHN L. INDEST John L. Indest | Director | February 22, 2023 | ||||||||||||
/s/ RONALD T. NIXON Ronald T. Nixon | Director | February 22, 2023 | ||||||||||||
/s/ W. EARL REED, III W. Earl Reed, III | Director | February 22, 2023 | ||||||||||||
/s/ BRENT TURNER Brent Turner | Director | February 22, 2023 | ||||||||||||
Company | Domestic State | |||||||
| Able Home Health, Inc. | Alabama | |||||||
Advanced Care House Calls of Alabama, LLC | Alabama | |||||||
Alabama Health Care Group, LLC | Alabama | |||||||
| Alabama Physical Therapy Services of Birmingham, LLC | Alabama | |||||||
Athens-Limestone HomeCare, LLC | Alabama | |||||||
Baptist Home Health, LLC | Alabama | |||||||
Camden HomeCare, LLC | Alabama | |||||||
Centre Home Care, LLC | Alabama | |||||||
Clay County Hospital Home Care, LLC | Alabama | |||||||
Coosa Valley HomeCare, LLC | Alabama | |||||||
East Alabama Medical Center HomeCare, LLC | Alabama | |||||||
Fayette Medical Center HomeCare, LLC | Alabama | |||||||
Fort Payne Home Care, LLC | Alabama | |||||||
HGA HomeCare, LLC | Alabama | |||||||
| Gulf Homecare, Inc. | Alabama | |||||||
Infirmary Home Health Agency, Inc. | Alabama | |||||||
LHCG CXXVIII, LLC | Alabama | |||||||
LHCG LI, LLC | Alabama | |||||||
LHCG LXIV, LLC | Alabama | |||||||
LHCG LXXIX, LLC | Alabama | |||||||
LHCG LXXXIV, LLC | Alabama | |||||||
LHCG XXII, LLC | Alabama | |||||||
LHCG XXIX, LLC | Alabama | |||||||
LHCG XXXIV, LLC | Alabama | |||||||
| LHCG CCVI, LLC | Alabama | |||||||
Marion Regional HomeCare, LLC | Alabama | |||||||
Medical Centers HomeCare, LLC | Alabama | |||||||
Mizell Memorial Hospital HomeCare, LLC | Alabama | |||||||
Princeton Home Health, LLC | Alabama | |||||||
Southeast Alabama HomeCare, LLC | Alabama | |||||||
SunCrest Home Health of AL, Inc. | Alabama | |||||||
Thomas Home Health, LLC | Alabama | |||||||
| Alaska Health Care Group, LLC | Alaska | |||||||
Advanced Care House Calls of Arizona, LLC | Arizona | |||||||
Arizona Health Care Group, LLC | Arizona | |||||||
Arizona In-Home Healthcare Partnership-I, LLC | Arizona | |||||||
Arizona In-Home Healthcare Partnership-II, LLC | Arizona | |||||||
Arizona In-Home Healthcare Partnership-III, LLC | Arizona | |||||||
Arizona In-Home Partner-I, LLC | Arizona | |||||||
Arizona In-Home Partner-II, LLC | Arizona | |||||||
Arizona In-Home Partner-III, LLC | Arizona | |||||||
| Arizona Physical Therapy Services of Cottonwood, LLC | Arizona | |||||||
| Arizona Physical Therapy Services of Mesa, LLC | Arizona | |||||||
| Arizona Physical Therapy Services of Phoenix, LLC | Arizona | |||||||
| Arizona Physical Therapy Services of Scottsdale, LLC | Arizona | |||||||
LHCG LVI, LLC | Arizona | |||||||
LHCG LXXVII, LLC | Arizona | |||||||
| LHCG CCII, LLC | Arizona | |||||||
| LHCG CCXX, LLC | Arizona | |||||||
| LHCG CLXXI, LLC | Arizona | |||||||
| LHCG CLXXII, LLC | Arizona | |||||||
| LHCG CXCVI, LLC | Arizona | |||||||
| Western Arizona Regional Home Health and Hospice, LLC | Arizona | |||||||
AHCG Management, LLC | Arkansas | |||||||
Arkansas Extended Care, LLC | Arkansas | |||||||
Arkansas Health Care Group, LLC | Arkansas | |||||||
Arkansas Healthcare Partners, LLC | Arkansas | |||||||
Arkansas Home Health Providers-III, LLC | Arkansas | |||||||
Arkansas Home Health Providers-IV, LLC | Arkansas | |||||||
Arkansas Home Hospice, LLC | Arkansas | |||||||
Arkansas HomeCare of Forrest City, LLC | Arkansas | |||||||
Arkansas HomeCare of Fulton, LLC | Arkansas | |||||||
Arkansas HomeCare of Hot Springs, LLC | Arkansas | |||||||
Arkansas In-Home Healthcare Partnership-I, LLC | Arkansas | |||||||
Arkansas In-Home Healthcare Partnership-II, LLC | Arkansas | |||||||
Arkansas In-Home Partner-I, LLC | Arkansas | |||||||
Arkansas In-Home Partner-II, LLC | Arkansas | |||||||
Arkansas Nursing Providers, LLC | Arkansas | |||||||
| Arkansas Physical Therapy Services of Conway, LLC | Arkansas | |||||||
| Arkansas Physical Therapy Services of Rogers, LLC | Arkansas | |||||||
CMC Home Health and Hospice, LLC | Arkansas | |||||||
Dallas County Medical Center HomeCare, LLC | Arkansas | |||||||
East Arkansas Health Holdings, LLC | Arkansas | |||||||
Elite Physical Therapy Services, LLC | Arkansas | |||||||
Eureka Springs Hospital HomeCare, LLC | Arkansas | |||||||
Eureka Springs Hospital Hospice, LLC | Arkansas | |||||||
Fort Smith HMA Home Health, LLC | Arkansas | |||||||
Hospice of Central Arkansas, LLC | Arkansas | |||||||
Jefferson Regional HomeCare, LLC | Arkansas | |||||||
| LHCG CC, LLC | Arkansas | |||||||
LHCG CII, LLC | Arkansas | |||||||
LHCG CIV, LLC | Arkansas | |||||||
| LHCG CLXVII, LLC | Arkansas | |||||||
| LHCG CLXVIII, LLC | Arkansas | |||||||
LHCG CV, LLC | Arkansas | |||||||
LHCG CXIX, LLC | Arkansas | |||||||
LHCG CXVIII, LLC | Arkansas | |||||||
LHCG CXXV, LLC | Arkansas | |||||||
| LHCG CXXXX, LLC | Arkansas | |||||||
LHCG CXXXXI, LLC | Arkansas | |||||||
LHCG CXXXXII, LLC | Arkansas | |||||||
| LHCG LXVIII, LLC | Arkansas | |||||||
LHCG LXXXIII, LLC | Arkansas | |||||||
LHCG LXXXV, LLC | Arkansas | |||||||
| LHCG LXXXVI, LLC | Arkansas | |||||||
LHCG XLII, LLC | Arkansas | |||||||
Mena Medical Center Home Health, LLC | Arkansas | |||||||
Mena Medical Center Hospice, LLC | Arkansas | |||||||
| Midwest Hospice, LLC | Arkansas | |||||||
Northeast Arkansas Partnership, LLC | Arkansas | |||||||
Patient’s Choice Hospice, LLC | Arkansas | |||||||
Southwest Arkansas HomeCare, LLC | Arkansas | |||||||
| Alaska Health Care Group, LLC | Alaska | |||||||
Advanced Care House Calls of California, LLC | California | |||||||
California Health Care Group, LLC | California | |||||||
LHCG XXXVIII, LLC | California | |||||||
Advanced Care House Calls of Colorado, LLC | Colorado | |||||||
Colorado Health Care Group, LLC | Colorado | |||||||
Colorado In-Home Healthcare Partnership-I, LLC | Colorado | |||||||
Colorado In-Home Partner-I, LLC | Colorado | |||||||
LHCG LVII, LLC | Colorado | |||||||
| LHCG CLXIII, LLC | Colorado | |||||||
Advanced Care House Calls of Connecticut, LLC | Connecticut | |||||||
| Connecticut Health Care Group Holdings, LLC | Connecticut | |||||||
Connecticut Home Health Care, Inc. | Connecticut | |||||||
Patient Care Connecticut, LLC | Connecticut | |||||||
Patient Care HHA, LLC | Connecticut | |||||||
Patient's Choice Homecare, LLC | Connecticut | |||||||
Priority Care, Inc. | Connecticut | |||||||
Adult Day Care of America, Inc. | Delaware | |||||||
AF-CH-HH, LLC | Delaware | |||||||
AFAM Holding Co, LLC | Delaware | |||||||
| AFAM Holding Co II, LLC | Delaware | |||||||
| AFAM Holding Co III, LLC | Delaware | |||||||
AFAM Sub I, LLC | Delaware | |||||||
Almost Family, Inc. | Delaware | |||||||
Altus Hospice of Georgia, LLC | Delaware | |||||||
Augusta Home Care Services, LLC | Delaware | |||||||
Berwick Home Care Services, LLC | Delaware | |||||||
Birmingham Home Care Services, LLC | Delaware | |||||||
Blue Island Home Care Services, LLC | Delaware | |||||||
| Brookdale Hospice of Philadelphia, LLC | Delaware | |||||||
Cambridge Home Health Care Holdings, Inc. | Delaware | |||||||
Clarksville Home Care Services, LLC | Delaware | |||||||
Cleveland Home Care Services, LLC | Delaware | |||||||
Compassionate Hospice of Georgia, Inc. | Delaware | |||||||
Crossroads Home Care Services, LLC | Delaware | |||||||
Deming Home Care Services, LLC | Delaware | |||||||
El Dorado Home Care Services, LLC | Delaware | |||||||
Emporia Home Care Services, LLC | Delaware | |||||||
Florence Home Care Services, LLC | Delaware | |||||||
Franklin Home Care Services, LLC | Delaware | |||||||
Fulton Home Care Services, LLC | Delaware | |||||||
Gadsden Home Care Services, LLC | Delaware | |||||||
Galesburg Home Care, LLC | Delaware | |||||||
Granite City Home Care Services, LLC | Delaware | |||||||
Halcyon Healthcare, LLC | Delaware | |||||||
Hattiesburg Home Care Services, LLC | Delaware | |||||||
Helena Home Care Services, LLC | Delaware | |||||||
| Health at Home - Seattle Metro, LLC | Delaware | |||||||
| Health at Home - Sonoma, LLC | Delaware | |||||||
| Health at Home Holdings, LLC | Delaware | |||||||
| Health at Home Holdings - Alabama, LLC | Delaware | |||||||
| Health at Home Holdings - Albuquerque, LLC | Delaware | |||||||
| Health at Home Holdings - Arizona, LLC | Delaware | |||||||
| Health at Home Holdings - Boston, LLC | Delaware | |||||||
| Health at Home Holdings - Charlotte, LLC | Delaware | |||||||
| Health at Home Holdings - Chicago, LLC | Delaware | |||||||
| Health at Home Holdings - Detroit, LLC | Delaware | |||||||
| Health at Home Holdings - Durham, LLC | Delaware | |||||||
| Health at Home Holdings - Edmond, LLC | Delaware | |||||||
| Health at Home Holdings - High Point LLC | Delaware | |||||||
| Health at Home Holdings - Indianapolis, LLC | Delaware | |||||||
| Health at Home Holdings - Ohio, LLC | Delaware | |||||||
| Health at Home Holdings - Philadelphia, LLC | Delaware | |||||||
| Health at Home Holdings - Portland, LLC | Delaware | |||||||
| Health at Home Holdings - Seattle Metro, LLC | Delaware | |||||||
| Health at Home Holdings - Sonoma, LLC | Delaware | |||||||
| Health at Home Holdings - St. Louis, LLC | Delaware | |||||||
| Health at Home Holdings - Tulsa, LLC | Delaware | |||||||
| Health at Home Hospice - Chicago, LLC | Delaware | |||||||
| Health at Home Hospice - Cleveland, LLC | Delaware | |||||||
| Health at Home Hospice - Columbus, LLC | Delaware | |||||||
| Health at Home Hospice - Davton, LLC | Delaware | |||||||
| Health at Home Hospice - Detroit, LLC | Delaware | |||||||
| Health at Home Hospice - Indianapolis, LLC | Delaware | |||||||
| Health at Home Hospice - Minnestoa, LLC | Delaware | |||||||
| Health at Home Hospice - Phoenix, LLC | Delaware | |||||||
| Health at Home Hospice - Portland, LLC | Delaware | |||||||
| Health at Home Hospice - Sacromento, LLC | Delaware | |||||||
| Health at Home Therapy - Atlanta, LLC | Delaware | |||||||
| Health of Home Therapy - Greenville, LLC | Delaware | |||||||
| Health of Home Therapy - Knoxville, LLC | Delaware | |||||||
| Health of Home Therapy - New Jersey, LLC | Delaware | |||||||
| Illinois Home Care Holdings, LLC | Delaware | |||||||
Ingenios Health Co | Delaware | |||||||
Ingenios Health Holdings, Inc. | Delaware | |||||||
In-Home Healthcare Partnership, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Alabama, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Albuquerque, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Boston, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Charlotte, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Chicago, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Detroit, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Durham, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Edmond, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Hartford, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of High Point, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Indianapolis, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Minneapolis, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Ohio, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Philadelphia, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Portland, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Rhode Island, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of St. Louis, LLC | Delaware | |||||||
| Innovative Senior Care Home Health of Tulsa, LLC | Delaware | |||||||
| ISCHH of Minneapolis Holdings, LLC | Delaware | |||||||
Jackson Home Care Services, LLC | Delaware | |||||||
Jourdanton Home Care Services, LLC | Delaware | |||||||
Knoxville Home Care Services, LLC | Delaware | |||||||
La Porte Home Care Services, LLC | Delaware | |||||||
Lakeland Home Care Services, LLC | Delaware | |||||||
Lancaster Home Care Services, LLC | Delaware | |||||||
LHC Group, Inc. | Delaware | |||||||
| LHC Group Recruiting & Training Center, LLC | Delaware | |||||||
LHCG Partner, LLC | Delaware | |||||||
LHCG New York Holding, LLC | Delaware | |||||||
Louisa Home Care Holdings, LLC | Delaware | |||||||
Louisa Home Care Services, LLC | Delaware | |||||||
| LTS At Home, LLC | Delaware | |||||||
Mooresville Home Care Services, LLC | Delaware | |||||||
Northampton Home Care, LLC | Delaware | |||||||
| Nurse on Call of Arizona, LLC | Delaware | |||||||
Oklahoma City Home Care Services, LLC | Delaware | |||||||
OMNI Home Health Holdings, Inc. | Delaware | |||||||
OMNI Home Health Services, LLC | Delaware | |||||||
| Palmetto Express Company, LLC | Delaware | |||||||
Patient Care New Jersey, Inc. | Delaware | |||||||
Patient Care Pennsylvania, Inc. | Delaware | |||||||
Patient Care, Inc. | Delaware | |||||||
Petersburg Home Care Services, LLC | Delaware | |||||||
Pottstown Home Care Services, LLC | Delaware | |||||||
Red Bud Home Care Services, LLC | Delaware | |||||||
River West Home Care, LLC | Delaware | |||||||
Scranton Quincy Home Care Services, LLC | Delaware | |||||||
Sharon Home Care Services, LLC | Delaware | |||||||
Shelbyville Home Care Services, LLC | Delaware | |||||||
SJ Home Care, LLC | Delaware | |||||||
Spokane Home Care Services, LLC | Delaware | |||||||
Springdale Home Care Services, LLC | Delaware | |||||||
Tomball Texas Home Care Services, LLC | Delaware | |||||||
Tucson Home Care Services, LLC | Delaware | |||||||
Valparaiso Home Care Services, LLC | Delaware | |||||||
Venice Home Care Services, LLC | Delaware | |||||||
Victoria Texas Home Care Services, LLC | Delaware | |||||||
Waukegan Hospice, LLC | Delaware | |||||||
Weatherford Home Care Services, LLC | Delaware | |||||||
West Grove Home Care, LLC | Delaware | |||||||
Wilkes-Barre Home Care Services, LLC | Delaware | |||||||
Woodward Home Care Services, LLC | Delaware | |||||||
York Home Care Services, LLC | Delaware | |||||||
Youngstown Home Care Services, LLC | Delaware | |||||||
LHCG CXXXXV, LLC | District of Columbia | |||||||
Washington D.C. Health Care Group, LLC | District of Columbia | |||||||
Advanced Care House Calls of Florida, LLC | Florida | |||||||
Almost Family ACO Services of South Florida, LLC | Florida | |||||||
Almost Family PC of Ft. Lauderdale, LLC | Florida | |||||||
Almost Family PC of SW Florida, LLC | Florida | |||||||
Almost Family PC of West Palm, LLC | Florida | |||||||
Bayfront HMA Home Health, LLC | Florida | |||||||
BGR Acquisition, LLC | Florida | |||||||
Brevard HMA Home Health, LLC | Florida | |||||||
Brevard HMA Hospice, LLC | Florida | |||||||
Caretenders of Jacksonville, LLC | Florida | |||||||
Caretenders Visiting Services of District 6, LLC | Florida | |||||||
Caretenders Visiting Services of District 7, LLC | Florida | |||||||
Caretenders Visiting Services of Gainesville, LLC | Florida | |||||||
Caretenders Visiting Services of Hernando County, LLC | Florida | |||||||
Caretenders Visiting Services of Ocala, LLC | Florida | |||||||
Caretenders Visiting Services of Pinellas County, LLC | Florida | |||||||
Caretenders Visiting Services of St. Augustine, LLC | Florida | |||||||
| Central Florida Partnership, LLC | Florida | |||||||
| Florida Physical Therapy Services of Fort Myers, LLC | Florida | |||||||
| Florida Physical Therapy Services of Gainesville, LLC | Florida | |||||||
Florida Physical Therapy Services of Miramar, LLC | Florida | |||||||
| Florida Physical Therapy Services of Ocala, LLC | Florida | |||||||
Florida Physical Therapy Services of Panama City, LLC | Florida | |||||||
Florida Physical Therapy Services of Pensacola, LLC | Florida | |||||||
| Florida Physical Therapy Services of Sarasota, LLC | Florida | |||||||
| Florida Physical Therapy Services of Sarasota II, LLC | Florida | |||||||
| Florida Physical Therapy Services of Sun City, LLC | Florida | |||||||
Home Health Agency - Central Pennsylvania, LLC | Florida | |||||||
Home Health Agency - Collier, LLC | Florida | |||||||
Home Health Agency - Hillsborough, LLC | Florida | |||||||
Home Health Agency - Indiana, LLC | Florida | |||||||
Home Health Agency - Pennsylvania, LLC | Florida | |||||||
Home Health Agency - Philadelphia, LLC | Florida | |||||||
Home Health Agency - Pinellas, LLC | Florida | |||||||
Key West HHA, LLC | Florida | |||||||
Key West PD, LLC | Florida | |||||||
LHC Health Care Group of Florida, LLC | Florida | |||||||
LHCG LXXXII, LLC | Florida | |||||||
LHCG XIX, LLC | Florida | |||||||
| LHCG CLIII, LLC | Florida | |||||||
| LHCG CLIV, LLC | Florida | |||||||
| LHCG CLV, LLC | Florida | |||||||
| LHCG CLVI, LLC | Florida | |||||||
| LHCG CLVII, LLC | Florida | |||||||
| LHCG CLX, LLC | Florida | |||||||
| LHCG CCX, LLC | Florida | |||||||
Lifeline Home Health Care of Lady Lake, LLC | Florida | |||||||
Lifeline Home Health Care of Lakeland, LLC | Florida | |||||||
Lifeline Home Health Care of Marathon, LLC | Florida | |||||||
Lifeline Home Health Care of Port Charlotte, LLC | Florida | |||||||
Mederi Caretenders VS of Broward, LLC | Florida | |||||||
Mederi Caretenders VS of SE FL, LLC | Florida | |||||||
Mederi Caretenders VS of SW FL, LLC | Florida | |||||||
Mederi Caretenders VS of Tampa, LLC | Florida | |||||||
Merderi Private Care, LLC | Florida | |||||||
Munroe Regional HomeCare, LLC | Florida | |||||||
North Okaloosa Home Health, LLC | Florida | |||||||
OMNI Health Management, LLC | Florida | |||||||
OMNI Home Health - District 1, LLC | Florida | |||||||
OMNI Home Health - District 2, LLC | Florida | |||||||
OMNI Home Health – District 4, LLC | Florida | |||||||
OMNI Home Health - Hernando, LLC | Florida | |||||||
OMNI Home Health - Jacksonville, LLC | Florida | |||||||
SunCrest Home Health of Tampa, LLC | Florida | |||||||
SWF Home Care Services, LLC | Florida | |||||||
Advanced Care House Calls of Georgia, LLC | Georgia | |||||||
Compassionate Healthcare Management Group, Inc. | Georgia | |||||||
| Eastern Georgia Partnership, LLC | Georgia | |||||||
Floyd HomeCare, LLC | Georgia | |||||||
Georgia Health Care Group, LLC | Georgia | |||||||
Georgia HomeCare of Harris, LLC | Georgia | |||||||
Grace Hospice, LLC | Georgia | |||||||
| LHCG CCXXII, LLC | Georgia | |||||||
| LHCG CCXXVI, LLC | Georgia | |||||||
| LHCG CCXXVII, LLC | Georgia | |||||||
| LHCG CCXXVIII, LLC | Georgia | |||||||
| LHCG CLXI, LLC | Georgia | |||||||
| LHCG CLXIV, LLC | Georgia | |||||||
| LHCG CLXV, LLC | Georgia | |||||||
LHCG CXXIII, LLC | Georgia | |||||||
LHCG LXXIV, LLC | Georgia | |||||||
LHCG LXXV, LLC | Georgia | |||||||
LHCG XL, LLC | Georgia | |||||||
Northwest Georgia Home Health, LLC | Georgia | |||||||
| Southern Georgia Partnership, LLC | Georgia | |||||||
SunCrest Healthcare, Inc. | Georgia | |||||||
Suncrest Home Health-Southside, LLC | Georgia | |||||||
SunCrest Home Health of Georgia, Inc. | Georgia | |||||||
SunCrest Home Health of South GA, Inc. | Georgia | |||||||
Advanced Care House Calls of Idaho, LLC | Idaho | |||||||
| Heart /n Home Hospice and Palliative Care, LLC | Idaho | |||||||
| HNH Birdie One, LLC | Idaho | |||||||
Idaho Health Care Group, LLC | Idaho | |||||||
Idaho In-Home Healthcare Partnership-I, LLC | Idaho | |||||||
Idaho In-Home Partner-I, LLC | Idaho | |||||||
| Kambros, LLC | Idaho | |||||||
LHCG XVII, LLC | Idaho | |||||||
LHCG XXI, LLC | Idaho | |||||||
Advanced Care House Calls of Illinois, LLC | Illinois | |||||||
Caretenders Visiting Services of Southern Illinois, LLC | Illinois | |||||||
Illinois Health Care Group, LLC | Illinois | |||||||
Illinois Home Care Holdings, LLC | Illinois | |||||||
Illinois Home Health Care, LLC | Illinois | |||||||
Illinois LIV, LLC | Illinois | |||||||
LHCG XXXVII, LLC | Illinois | |||||||
IN HomeCare Network Central, LLC | Indiana | |||||||
IN HomeCare Network North, LLC | Indiana | |||||||
| Indiana Health Care Group, LLC | Indiana | |||||||
| LHCG CXCVII, LLC | Indiana | |||||||
NP Services of IN, LLC | Indiana | |||||||
ACHC ACO, LLC | Kentucky | |||||||
ACO Clinical Partners, LLC | Kentucky | |||||||
Advanced Care House Calls of Kentucky, LLC | Kentucky | |||||||
| Advanced Clinical Partners, LLC | Kentucky | |||||||
AFAM Acquisition, LLC | Kentucky | |||||||
Almost Family ACO Services of Kentucky, LLC | Kentucky | |||||||
Almost Family PC of Kentucky, LLC | Kentucky | |||||||
| Apex Clinical Partners, LLC | Kentucky | |||||||
Bluegrass Accountable Care, LLC | Kentucky | |||||||
Caretenders of Cleveland, Inc. | Kentucky | |||||||
Caretenders of Columbus, Inc. | Kentucky | |||||||
Caretenders Visiting Services Employment Company, Inc. | Kentucky | |||||||
| Caretenders Visiting Services of District 6, LLC | Kentucky | |||||||
| Caretenders Visiting Services of District 7, LLC | Kentucky | |||||||
Caretenders Visiting Services of Kentuckiana, LLC | Kentucky | |||||||
Caretenders Visiting Services of Orlando, LLC | Kentucky | |||||||
Caretenders VS of Central KY, LLC | Kentucky | |||||||
Caretenders VS of Lincoln Trail, LLC | Kentucky | |||||||
Caretenders VS of Louisville, LLC | Kentucky | |||||||
Caretenders VS of Western KY, LLC | Kentucky | |||||||
Home Health of Jefferson Co, LLC | Kentucky | |||||||
| Imperium Clinical Partners II, LLC | Kentucky | |||||||
| Imperium Clinical Partners III, LLC | Kentucky | |||||||
Imperium Health Management, LLC | Kentucky | |||||||
Kentuckiana Clinical Partners, LLC | Kentucky | |||||||
Kentucky Accountable Care, LLC | Kentucky | |||||||
Kentucky Clinical Partners, LLC | Kentucky | |||||||
Kentucky Health Care Group, LLC | Kentucky | |||||||
Kentucky Home Health Care, LLC | Kentucky | |||||||
Kentucky HomeCare of Henderson, LLC | Kentucky | |||||||
Kentucky In-Home Healthcare Partnership-I, LLC | Kentucky | |||||||
Kentucky In-Home Healthcare Partnership-II, LLC | Kentucky | |||||||
Kentucky In-Home Partner-I, LLC | Kentucky | |||||||
Kentucky In-Home Partner-II, LLC | Kentucky | |||||||
Kentucky LV, LLC | Kentucky | |||||||
LHC HomeCare-Lifeline, LLC | Kentucky | |||||||
LHCG LXX, LLC | Kentucky | |||||||
LHCG LXXI, LLC | Kentucky | |||||||
LHCG XLVI, LLC | Kentucky | |||||||
LHCG XXIII, LLC | Kentucky | |||||||
Lifeline Home Health Care of Bowling Green, LLC | Kentucky | |||||||
Lifeline Home Health Care of Fulton, LLC | Kentucky | |||||||
Lifeline Home Health Care of Hopkinsville, LLC | Kentucky | |||||||
Lifeline Home Health Care of Lexington, LLC | Kentucky | |||||||
Lifeline Home Health Care of Russellville, LLC | Kentucky | |||||||
Lifeline Home Health Care of Somerset, LLC | Kentucky | |||||||
Lifeline HomeCare of Salem, LLC | Kentucky | |||||||
Lifeline Private Duty Services of Kentucky, LLC | Kentucky | |||||||
Lifeline Rockcastle Home Health, LLC | Kentucky | |||||||
NP Services of KY, LLC | Kentucky | |||||||
Physicians Accountable Care, LLC | Kentucky | |||||||
Physicians Accountable Care of Kentucky, LLC | Kentucky | |||||||
Trigg County Home Health, LLC | Kentucky | |||||||
Twin Lakes Home Health Agency, LLC | Kentucky | |||||||
AAA Home Health, Inc. | Louisiana | |||||||
Acadian Home Health Care Services, LLC | Louisiana | |||||||
Acadian HomeCare of New Iberia, LLC | Louisiana | |||||||
Acadian HomeCare, LLC | Louisiana | |||||||
Acadian Physical Therapy Services, LLC | Louisiana | |||||||
Baton Rouge HomeCare, LLC | Louisiana | |||||||
Beauregard Memorial Hospital HomeCare, LLC | Louisiana | |||||||
Egan Health Care Corporation | Louisiana | |||||||
Egan Healthcare of Northshore, Inc | Louisiana | |||||||
Egan Healthcare of Plaquemines, Inc | Louisiana | |||||||
Egan Hospice Services of Northshore, LLC | Louisiana | |||||||
Feliciana Physical Therapy Services, LLC | Louisiana | |||||||
Hood Home Health Service, LLC | Louisiana | |||||||
LHC Group Employee Hardship Relief Fund | Louisiana | |||||||
| LHC Group Health Clinic, LLC | Louisiana | |||||||
LHC Group Pharmaceutical Services II, LLC | Louisiana | |||||||
LHC Group Pharmaceutical Services III, LLC | Louisiana | |||||||
LHC Group Pharmaceutical Services, LLC | Louisiana | |||||||
LHC Physician Services, LLC | Louisiana | |||||||
LHC Real Estate I, LLC | Louisiana | |||||||
LHC Real Estate II, LLC | Louisiana | |||||||
LHCG CIX, LLC. | Louisiana | |||||||
LHCG CVI, LLC | Louisiana | |||||||
LHCG CVII, LLC | Louisiana | |||||||
LHCG CVIII, LLC | Louisiana | |||||||
LHCG CX, LLC | Louisiana | |||||||
LHCG CXX, LLC | Louisiana | |||||||
LHCG CXXVI, LLC | Louisiana | |||||||
LHCG LXVII, LLC | Louisiana | |||||||
LHCG LXXII, LLC | Louisiana | |||||||
LHCG LXXVI, LLC | Louisiana | |||||||
LHCG LXXVIII, LLC | Louisiana | |||||||
LHCG V, LLC | Louisiana | |||||||
LHCG VI, LLC | Louisiana | |||||||
LHCG VIII, LLC | Louisiana | |||||||
LHCG X, LLC | Louisiana | |||||||
LHCG XII, LLC | Louisiana | |||||||
LHCG XIII, LLC | Louisiana | |||||||
LHCG XIV, LLC | Louisiana | |||||||
LHCG XLIII, LLC | Louisiana | |||||||
LHCG XLIV, LLC | Louisiana | |||||||
LHCG XV, LLC | Louisiana | |||||||
LHCG XVI, LLC | Louisiana | |||||||
LLC-I, LLC | Louisiana | |||||||
LLC-II, LLC | Louisiana | |||||||
| LHCG CLXIX, LLC | Louisiana | |||||||
| LHCG CCV, LLC | Louisiana | |||||||
| LHCG CCXIII, LLC | Louisiana | |||||||
| LHCG CCIII, LLC | Louisiana | |||||||
Louisiana Extended Care Hospital of Kenner, LLC | Louisiana | |||||||
Louisiana Health Care Group, LLC | Louisiana | |||||||
Louisiana Home Health of Feliciana, LLC | Louisiana | |||||||
Louisiana Home Health of Hammond, LLC | Louisiana | |||||||
Louisiana Home Health of Houma, LLC | Louisiana | |||||||
Louisiana HomeCare of Delhi, LLC | Louisiana | |||||||
Louisiana HomeCare of Kenner, LLC | Louisiana | |||||||
Louisiana HomeCare of Lutcher, LLC | Louisiana | |||||||
Louisiana HomeCare of Minden, LLC | Louisiana | |||||||
Louisiana HomeCare of Miss-Lou, LLC | Louisiana | |||||||
Louisiana HomeCare of Monroe, LLC | Louisiana | |||||||
Louisiana HomeCare of North Louisiana, LLC | Louisiana | |||||||
Louisiana HomeCare of Northwest Louisiana, LLC | Louisiana | |||||||
Louisiana HomeCare of Plaquemine, LLC | Louisiana | |||||||
Louisiana HomeCare of Raceland, LLC | Louisiana | |||||||
Louisiana HomeCare of Slidell, LLC | Louisiana | |||||||
Louisiana Hospice and Palliative Care, LLC | Louisiana | |||||||
Louisiana Hospice Group, LLC | Louisiana | |||||||
Louisiana In-Home Healthcare Partnership - I, LLC | Louisiana | |||||||
Louisiana In-Home Partner - I, LLC | Louisiana | |||||||
Louisiana Physical Therapy Services of Bossier City, LLC | Louisiana | |||||||
| Louisiana Physical Therapy Services of Harahan, LLC | Louisiana | |||||||
| Louisiana Physical Therapy Services of Lafayette, LLC | Louisiana | |||||||
Louisiana Physical Therapy, LLC | Louisiana | |||||||
Northshore Extended Care Hospital, LLC | Louisiana | |||||||
Oak Shadows of Jennings, LLC | Louisiana | |||||||
Palmetto Express, LLC | Louisiana | |||||||
Patient’s Choice Hospice and Palliative Care of Louisiana, LLC | Louisiana | |||||||
Primary Care at Home of Louisiana II, LLC | Louisiana | |||||||
Primary Care at Home of Louisiana III, LLC | Louisiana | |||||||
Primary Care at Home of Louisiana IV, LLC | Louisiana | |||||||
Primary Care at Home of Louisiana, LLC | Louisiana | |||||||
Richardson Medical Center HomeCare, LLC | Louisiana | |||||||
Southeast Louisiana HomeCare, LLC | Louisiana | |||||||
Specialty Extended Care Hospital of Monroe, LLC | Louisiana | |||||||
St. James HomeCare, LLC | Louisiana | |||||||
St. Landry Family Healthcare, LLC | Louisiana | |||||||
Texas Health Care Group Holdings, LLC | Louisiana | |||||||
The Hospice Promise Foundation | Louisiana | |||||||
Tri-Parish Community HomeCare, LLC | Louisiana | |||||||
Vital Hospice, Inc. | Louisiana | |||||||
Advanced Care House Calls of Maryland, LLC | Maryland | |||||||
| Chester River Home Care & Hospice, LLC | Maryland | |||||||
FirstCall Health Services, Inc. | Maryland | |||||||
HomeCall, Inc. | Maryland | |||||||
| LHCG CCXXIV, LLC | Maryland | |||||||
| LHCG CCXXV, LLC | Maryland | |||||||
LHCG CL, LLC | Maryland | |||||||
LHCG CXLIX, LLC | Maryland | |||||||
LHCG LXXXI, LLC | Maryland | |||||||
Maryland Health Care Group, LLC | Maryland | |||||||
| Maryland Healthcare Partnership, LLC | Maryland | |||||||
| Maryland Intermediary-I, LLC | Maryland | |||||||
| Maryland Intermediary-II, LLC | Maryland | |||||||
| Maryland Intermediary-III, LLC | Maryland | |||||||
| Maryland Intermediary-IV, LLC | Maryland | |||||||
| Maryland Physical Therapy Services of Frederick, LLC | Maryland | |||||||
Primary Care at Home of Maryland, LLC | Maryland | |||||||
Advanced Care House Calls of Massachusetts, LLC | Massachusetts | |||||||
Caretenders VS of Boston, LLC | Massachusetts | |||||||
| LHCG CXCII, LLC | Massachusetts | |||||||
LHCG LVIII, LLC | Massachusetts | |||||||
Long Term Solutions, Inc. | Massachusetts | |||||||
Massachusetts Health Care Group, LLC | Massachusetts | |||||||
| Massachusetts Physical Therapy Services of Framingham, LLC | Massachusetts | |||||||
| Massachusetts Physical Therapy Services of Quincy Bay, LLC | Massachusetts | |||||||
| New Mexico Physical Therapy Services of Albuquerque, LLC | Massachusetts | |||||||
Advanced Care House Calls of Michigan, LLC | Michigan | |||||||
| LHC Home Health Care Group of Michigan, LLC | Michigan | |||||||
Michigan In-Home Healthcare Partnership-I, LLC | Michigan | |||||||
Michigan In-Home Healthcare Partnership-II, LLC | Michigan | |||||||
Michigan In-Home Healthcare Partnership-III, LLC | Michigan | |||||||
Michigan In-Home Healthcare Partnership-IV, LLC | Michigan | |||||||
Michigan In-Home Partner-I, LLC | Michigan | |||||||
Michigan In-Home Partner-II, LLC | Michigan | |||||||
Michigan In-Home Partner-III, LLC | Michigan | |||||||
Michigan In-Home Partner-IV, LLC | Michigan | |||||||
LHCG XLVIII, LLC | Minnesota | |||||||
Minnesota Health Care Group, LLC | Minnesota | |||||||
Able Home Health, Inc. | Mississippi | |||||||
Advanced Care House Calls of Mississippi, LLC | Mississippi | |||||||
Community Hospice, LLC | Mississippi | |||||||
Cornerstone Palliative and Hospice, LLC | Mississippi | |||||||
Covenant Palliative and Hospice, LLC | Mississippi | |||||||
Leaf River Health Care, LLC | Mississippi | |||||||
LHCG C, LLC | Mississippi | |||||||
| LHCG CXCV, LLC | Mississippi | |||||||
LHCG XCIX, LLC | Mississippi | |||||||
LHCG XCVIII, LLC | Mississippi | |||||||
LHCG XXVI, LLC | Mississippi | |||||||
Mississippi Health Care Group, LLC | Mississippi | |||||||
Mississippi HomeCare of Jackson II, LLC | Mississippi | |||||||
Mississippi HomeCare, LLC | Mississippi | |||||||
| Mississippi Physical Therapy Services of Biloxi, LLC | Mississippi | |||||||
Picayune HomeCare, LLC | Mississippi | |||||||
South Mississippi Home Health, Inc. | Mississippi | |||||||
South Mississippi Home Health, Inc. - Region I | Mississippi | |||||||
South Mississippi Home Health, Inc. - Region II | Mississippi | |||||||
South Mississippi Home Health, Inc. - Region III | Mississippi | |||||||
Access Hospice, LLC | Missouri | |||||||
Caretenders Visiting Services of St. Louis, LLC | Missouri | |||||||
Kirksville Home Care Services, LLC | Missouri | |||||||
| LHCG CXCI, LLC | Missouri | |||||||
LHCG CXLVI, LLC | Missouri | |||||||
LHCG CXLVII, LLC | Missouri | |||||||
LHCG CXLVIII, LLC | Missouri | |||||||
LHCG CXXXXIII, LLC | Missouri | |||||||
LHCG LXIX, LLC | Missouri | |||||||
LHCG LXV, LLC | Missouri | |||||||
LHCG XXV, LLC | Missouri | |||||||
Missouri Health Care Group, LLC | Missouri | |||||||
Southwest Missouri HomeCare, LLC | Missouri | |||||||
SunCrest Home Health of MO, Inc. | Missouri | |||||||
| Montana Health Care Group, LLC | Montana | |||||||
Nebraska Health Care Group, LLC | Nebraska | |||||||
Advanced Care House Calls of Nevada, LLC | Nevada | |||||||
Assured Capital Partners, Inc. | Nevada | |||||||
LHCG CXXXIX, LLC | Nevada | |||||||
LHCG CXXXVIII, LLC | Nevada | |||||||
LHCG CXXXXIV, LLC | Nevada | |||||||
LHCG XXXIX, LLC | Nevada | |||||||
| LHCG CLII, LLC | Nevada | |||||||
Nevada Health Care Group, LLC | Nevada | |||||||
Advanced Care House Calls of New Hampshire, LLC | New Hampshire | |||||||
New Hampshire Health Care Group, LLC | New Hampshire | |||||||
| New Hampshire Physical Therapy Services of Hanover, LLC | New Hampshire | |||||||
| LHCG CCIX, LLC | New Jersey | |||||||
| LHCG CCXI, LLC | New Jersey | |||||||
| LHCG CCXII, LLC | New Jersey | |||||||
| LHCG CCXV, LLC | New Jersey | |||||||
| LHCG CCXVII, LLC | New Jersey | |||||||
LHCG CXLIV, LLC | New Jersey | |||||||
LHCG CXLV, LLC | New Jersey | |||||||
| New Jersey Health Care Group, LLC | New Jersey | |||||||
Patient Care Medical Services, Inc. | New Jersey | |||||||
Patient Care of Hudson County, LLC | New Jersey | |||||||
Advanced Care House Calls of New Mexico, LLC | New Mexico | |||||||
| New Mexico Health Care Group, LLC | New Mexico | |||||||
Advanced Care House Calls of New York, LLC | New York | |||||||
BHC Services, Inc. | New York | |||||||
BRACOR, Inc. | New York | |||||||
| LHCG New York Holdings, LLC | New York | |||||||
Litson Certified Care, Inc. | New York | |||||||
Litson Health Care, Inc. | New York | |||||||
National Health Industries, Inc. | New York | |||||||
Western Region Health Corporation | New York | |||||||
Willcare, Inc. | New York | |||||||
Cape Fear Valley HomeCare and Hospice, LLC | North Carolina | |||||||
LHCG CXXXXVI, LLC | North Carolina | |||||||
LHCG L, LLC | North Carolina | |||||||
| LHCG CLXXIX, LLC | North Carolina | |||||||
North Carolina Health Care Group, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-I, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-II, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-III, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-IV, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-IX, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-V, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-VI, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-VII, LLC | North Carolina | |||||||
North Carolina In-Home Healthcare Partnership-VIII, LLC | North Carolina | |||||||
North Carolina In-Home Partner-I, LLC | North Carolina | |||||||
North Carolina In-Home Partner-II, LLC | North Carolina | |||||||
North Carolina In-Home Partner-III, LLC | North Carolina | |||||||
North Carolina In-Home Partner-IV, LLC | North Carolina | |||||||
North Carolina In-Home Partner-IX, LLC | North Carolina | |||||||
North Carolina In-Home Partner-V, LLC | North Carolina | |||||||
North Carolina In-Home Partner-VI, LLC | North Carolina | |||||||
North Carolina In-Home Partner-VII, LLC | North Carolina | |||||||
North Carolina In-Home Partner-VIII, LLC | North Carolina | |||||||
NP Services of NC, LLC | North Carolina | |||||||
Advance Geriatric Education and Consulting, LLC | Ohio | |||||||
Assisted Care by Black Stone of Central Ohio, LLC | Ohio | |||||||
Assisted Care by Black Stone of Cincinnati, LLC | Ohio | |||||||
Assisted Care by Black Stone of Dayton, LLC | Ohio | |||||||
Assisted Care by Black Stone of Northwest Ohio, LLC | Ohio | |||||||
Assisted Care by Black Stone of Toledo, LLC | Ohio | |||||||
Black Stone of Central Ohio, LLC | Ohio | |||||||
Black Stone of Cincinnati, LLC | Ohio | |||||||
Black Stone of Dayton, LLC | Ohio | |||||||
Black Stone of Northeast Ohio, LLC | Ohio | |||||||
Black Stone of Northwest Ohio, LLC | Ohio | |||||||
Black Stone Operations, LLC | Ohio | |||||||
Blackstone Group, LLC | Ohio | |||||||
Blackstone Health Care, LLC | Ohio | |||||||
Cambridge Home Health Care, Inc. | Ohio | |||||||
Cambridge Home Health Care, Inc. / Private | Ohio | |||||||
Cambridge Personal Care, LLC | Ohio | |||||||
Care Advisors by Black Stone, LLC | Ohio | |||||||
Caretenders VNA of Ohio, LLC | Ohio | |||||||
Caretenders VS of Ohio, LLC | Ohio | |||||||
Caretenders VS of SE Ohio, LLC | Ohio | |||||||
Home Health Care by Black Stone of Central Ohio, LLC | Ohio | |||||||
Home Health Care by Black Stone of Cincinnati, LLC | Ohio | |||||||
Home Health Care by Black Stone of Dayton, LLC | Ohio | |||||||
Home Health Care by Black Stone of Northwest Ohio, LLC | Ohio | |||||||
LHCG XCI, LLC | Ohio | |||||||
LHCG XCII, LLC | Ohio | |||||||
| LHCG CCVII, LLC | Ohio | |||||||
| LHCG CCVIII, LLC | Ohio | |||||||
MJ Nursing at Blackstone, LLC | Ohio | |||||||
NP Services of OH, LLC | Ohio | |||||||
Ohio Health Care Group, LLC | Ohio | |||||||
Ohio HomeCare, LLC | Ohio | |||||||
Ohio In-Home Healthcare Partnership-I, LLC | Ohio | |||||||
Ohio In-Home Partner-I, LLC | Ohio | |||||||
| Ohio Physical Therapy Services of Xenia, LLC | Ohio | |||||||
| Ohio Physical Therapy Services of Mayfield Heights, LLC | Ohio | |||||||
| Ohio Physical Therapy Services of Richmond Heights, LLC | Ohio | |||||||
S&B Health Care, LLC | Ohio | |||||||
Clinton Home Health & Hospice, LLC | Oklahoma | |||||||
| LHCG CLXX, LLC | Oklahoma | |||||||
Mayes County HMA Home Health, LLC | Oklahoma | |||||||
OHHP, LLC | Oklahoma | |||||||
Oklahoma Health Care Group, LLC | Oklahoma | |||||||
Ponca City Home Care Services, LLC | Oklahoma | |||||||
Summit Properties - Muskogee, LLC | Oklahoma | |||||||
| Advanced Care House Calls of Oregon, LLC | Oregon | |||||||
LHCG LXXIII, LLC | Oregon | |||||||
Oregon Health Care Group, LLC | Oregon | |||||||
Salem HomeCare, LLC | Oregon | |||||||
Three Rivers HomeCare, LLC | Oregon | |||||||
| Advanced Care House Calls of Pennsylvania, LLC | Pennsylvania | |||||||
Keystone Healthcare Partnership, LLC | Pennsylvania | |||||||
LHCG CXL, LLC | Pennsylvania | |||||||
LHCG CXLI, LLC | Pennsylvania | |||||||
LHCG CXLII, LLC | Pennsylvania | |||||||
LHCG CXLIII, LLC | Pennsylvania | |||||||
LHCG XXVII, LLC | Pennsylvania | |||||||
| Patient Care Pennsylvania II, LLC | Pennsylvania | |||||||
Pennsylvania Health Care Group Holdings, LLC | Pennsylvania | |||||||
Pennsylvania In-Home Healthcare Partnership-I, LLC | Pennsylvania | |||||||
Pennsylvania In-Home Healthcare Partnership-II, LLC | Pennsylvania | |||||||
Pennsylvania In-Home Healthcare Partnership-III, LLC | Pennsylvania | |||||||
Pennsylvania In-Home Partner-I, LLC | Pennsylvania | |||||||
Pennsylvania In-Home Partner-II, LLC | Pennsylvania | |||||||
Pennsylvania In-Home Partner-III, LLC | Pennsylvania | |||||||
Advanced Care House Calls of Rhode Island, LLC | Rhode Island | |||||||
| LHCG CCXIV, LLC | Rhode Island | |||||||
| LHCG CLXXXIX, LLC | Rhode Island | |||||||
LHCG LIX, LLC | Rhode Island | |||||||
Rhode Island Health Care Group, LLC | Rhode Island | |||||||
Advanced Care House Calls of South Carolina, LLC | South Carolina | |||||||
Halcyon Hospice of Aiken, LLC | South Carolina | |||||||
| Heart of Hospice, LLC | South Carolina | |||||||
LHCG XLI, LLC | South Carolina | |||||||
| LHCG CLXVI, LLC | South Carolina | |||||||
| Palliative Care at Heart, LLC | South Carolina | |||||||
South Carolina Health Care Group, LLC | South Carolina | |||||||
South Carolina In-Home Healthcare Partnership-I, LLC | South Carolina | |||||||
South Caroline In-Home Partner-I, LLC | South Carolina | |||||||
Advanced Care House Calls of Tennessee, LLC | Tennessee | |||||||
Almost Family ACO Services of Tennessee, LLC | Tennessee | |||||||
Cedar Creek Home Health Care Agency, LLC | Tennessee | |||||||
Elk Valley Health Services, LLC | Tennessee | |||||||
Elk Valley Home Health Care Agency, LLC | Tennessee | |||||||
Elk Valley Professional Affiliates, Inc. | Tennessee | |||||||
Gericare, LLC | Tennessee | |||||||
HMC Home Health, LLC | Tennessee | |||||||
LHC HomeCare of Tennessee, LLC | Tennessee | |||||||
| LHCG CCXX, LLC | Tennessee | |||||||
| LHCG CXC, LLC | Tennessee | |||||||
LHCG CXXXII, LLC | Tennessee | |||||||
LHCG CXXXIII, LLC | Tennessee | |||||||
LHCG CXXXIV, LLC | Tennessee | |||||||
LHCG CXXXV, LLC | Tennessee | |||||||
| LHCG CXXXVI, LLC | Tennessee | |||||||
LHCG CXXXVI, LLC | Tennessee | |||||||
LHCG LXII, LLC | Tennessee | |||||||
LHCG LXXXVIII, LLC | Tennessee | |||||||
LHCG XCIII, LLC | Tennessee | |||||||
LHCG XCIV, LLC | Tennessee | |||||||
LHCG XCV, LLC | Tennessee | |||||||
LHCG XCVI, LLC | Tennessee | |||||||
LHCG XCVII, LLC | Tennessee | |||||||
| LHCG CLXII, LLC | Tennessee | |||||||
Lifeline Home Health Care of Springfield, LLC | Tennessee | |||||||
Lifeline Home Health Care of Union City, LLC | Tennessee | |||||||
Lifeline of West Tennessee, LLC | Tennessee | |||||||
Medical Center Home Health, LLC | Tennessee | |||||||
Morristown-Hamblen HomeCare & Hospice, LLC | Tennessee | |||||||
Primary Care at Home of Tennessee, LLC | Tennessee | |||||||
SunCrest Companion Services, LLC | Tennessee | |||||||
SunCrest Healthcare of East Tennessee, LLC | Tennessee | |||||||
SunCrest Healthcare of Middle TN, LLC | Tennessee | |||||||
SunCrest Healthcare of West Tennessee, LLC | Tennessee | |||||||
SunCrest Home Health of Claiborne County, Inc. | Tennessee | |||||||
SunCrest Home Health of Manchester, Inc. | Tennessee | |||||||
SunCrest Home Health of Nashville, Inc. | Tennessee | |||||||
SunCrest LBL Holdings, Inc. | Tennessee | |||||||
SunCrest Outpatient Rehab Services of TN, LLC | Tennessee | |||||||
SunCrest Outpatient Rehab Services, LLC | Tennessee | |||||||
SunCrest Telehealth Services, Inc. | Tennessee | |||||||
Tennessee Health Care Group, LLC | Tennessee | |||||||
Tennessee In-Home Healthcare Partnership-I, LLC | Tennessee | |||||||
Tennessee In-Home Healthcare Partnership-II, LLC | Tennessee | |||||||
Tennessee In-Home Healthcare Partnership-III, LLC | Tennessee | |||||||
Tennessee In-Home Healthcare Partnership-IV, LLC | Tennessee | |||||||
Tennessee In-Home Partner-I, LLC | Tennessee | |||||||
Tennessee In-Home Partner-II, LLC | Tennessee | |||||||
Tennessee In-Home Partner-III, LLC | Tennessee | |||||||
Tennessee In-Home Partner-IV, LLC | Tennessee | |||||||
Tennessee Nursing Services of Morristown, Inc. | Tennessee | |||||||
Tennessee Physical Therapy Services of Kingsport, LLC | Tennessee | |||||||
Tennessee Physical Therapy Services of Knoxville, LLC | Tennessee | |||||||
| Tennessee Physical Therapy Services of Mt. Juliet, LLC | Tennessee | |||||||
| Tennessee Physical Therapy Services of Memphis, LLC | Tennessee | |||||||
University of TN Medical Center Home Care Services, LLC | Tennessee | |||||||
West Tennessee HomeCare, LLC | Tennessee | |||||||
Woods Home Health, LLC | Tennessee | |||||||
| Advanced Care House Calls of Texas, LLC | Texas | |||||||
GSHS Home Health, LP. | Texas | |||||||
Home Care Connections, Inc. | Texas | |||||||
In-Home Healthcare Partnership of Texas-I, LLC | Texas | |||||||
In-Home Partner of Texas-I, LLC | Texas | |||||||
LHCG CXI, LLC | Texas | |||||||
LHCG CXII, LLC | Texas | |||||||
LHCG CXIII, LLC | Texas | |||||||
LHCG CXIV, LLC | Texas | |||||||
| LHCG CXCIII, LLC | Texas | |||||||
LHCG CXV, LLC | Texas | |||||||
LHCG CXVI, LLC | Texas | |||||||
LHCG CXVII, LLC | Texas | |||||||
LHCG CXXI, LLC | Texas | |||||||
LHCG CXXII, LLC | Texas | |||||||
LHCG CXXIV, LLC | Texas | |||||||
LHCG CXXX, LLC | Texas | |||||||
LHCG CXXXI, LLC | Texas | |||||||
LHCG CXXXVII, LLC | Texas | |||||||
LHCG Partner II, LLC | Texas | |||||||
LHCG XXXIII, LLC | Texas | |||||||
LHCG CLI, LLC | Texas | |||||||
| LHCG CXCIV, LLC | Texas | |||||||
Marshall HomeCare, LLC | Texas | |||||||
Red River HomeCare, LLC | Texas | |||||||
Rivercrest Home Health Care, Inc. | Texas | |||||||
Southwet Post-Acute Care Partnership, LLC | Texas | |||||||
Texas Health Care Group of Texarkana, LLC | Texas | |||||||
Texas Health Care Group of The Golden Triangle, LLC | Texas | |||||||
Texas Health Care Group, LLC | Texas | |||||||
| Texas Physical Therapy Services of Baytown, LLC | Texas | |||||||
| Texas Physical Therapy Services of Burleson, LLC | Texas | |||||||
Wichita Falls Texas Home Care, LLC | Texas | |||||||
LHCG LX, LLC | Utah | |||||||
Utah Health Care Group, LLC | Utah | |||||||
Advanced Care House Calls Virginia, LLC | Virginia | |||||||
LHCG CXXVII, LLC | Virginia | |||||||
LHCG LXXX, LLC | Virginia | |||||||
| LHCG CXCVIII, LLC | Virginia | |||||||
| LHCG CXCIX, LLC | Virginia | |||||||
| LHCG CCI, LLC | Virginia | |||||||
| LHCG CCIV, LLC | Virginia | |||||||
Virginia Health Care Group, LLC | Virginia | |||||||
Virginia HomeCare, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-I, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-II, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-III, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-IV, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-IX, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-V, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-VI, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-VII, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-VIII, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-X, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-XI, LLC | Virginia | |||||||
Virginia In-Home Healthcare Partnership-XII, LLC | Virginia | |||||||
Virginia In-Home Partner-I, LLC | Virginia | |||||||
Virginia In-Home Partner-II, LLC | Virginia | |||||||
Virginia In-Home Partner-III, LLC | Virginia | |||||||
Virginia In-Home Partner-IV, LLC | Virginia | |||||||
Virginia In-Home Partner-IX, LLC | Virginia | |||||||
Virginia In-Home Partner-V, LLC | Virginia | |||||||
Virginia In-Home Partner-VI, LLC | Virginia | |||||||
Virginia In-Home Partner-VII, LLC | Virginia | |||||||
Virginia In-Home Partner-VIII, LLC | Virginia | |||||||
Virginia In-Home Partner-X, LLC | Virginia | |||||||
Virginia In-Home Partner-XI, LLC | Virginia | |||||||
Virginia In-Home Partner-XII, LLC | Virginia | |||||||
Advanced Care House Calls of Washington, LLC | Washington | |||||||
LHCG LXIII, LLC | Washington | |||||||
Northeast Washington Home Health, Inc. | Washington | |||||||
Northwest Healthcare Alliance, Inc. | Washington | |||||||
Washington Health Care Group, LLC | Washington | |||||||
Washington HomeCare and Hospice of Central Basin, LLC | Washington | |||||||
Boone Memorial HomeCare, LLC | West Virginia | |||||||
Grant Memorial HomeCare and Hospice, LLC | West Virginia | |||||||
Home Care Plus, Inc. | West Virginia | |||||||
Housecalls Home Health & Hospice, LLC | West Virginia | |||||||
Jackson County Home Health, LLC | West Virginia | |||||||
LHC HomeCare of West Virginia, LLC | West Virginia | |||||||
LHC Physician Services of West Virginia, LLC | West Virginia | |||||||
LHCG LII, LLC | West Virginia | |||||||
LHCG LXXXIX, LLC | West Virginia | |||||||
LHCG LXXXVII, LLC | West Virginia | |||||||
LHCG XC, LLC | West Virginia | |||||||
Mountaineer HomeCare, LLC | West Virginia | |||||||
Preston Memorial HomeCare, LLC | West Virginia | |||||||
Primary Care at Home of West Virginia, LLC | West Virginia | |||||||
Princeton Community HomeCare, LLC | West Virginia | |||||||
Roane HomeCare, LLC | West Virginia | |||||||
St. Mary’s Medical Center Home Health Services, LLC | West Virginia | |||||||
West Virginia Health Care Group, LLC | West Virginia | |||||||
West Virginia HomeCare, LLC | West Virginia | |||||||
West Virginia Physical Therapy Services of Charleston, LLC | West Virginia | |||||||
Wetzel County HomeCare, LLC | West Virginia | |||||||
Advanced Care House Calls of Wisconsin, LLC | Wisconsin | |||||||
| Almost Family Personal Care, LLC | Wisconsin | |||||||
HHA of Wisconsin, LLC | Wisconsin | |||||||
LHCG XLVII, LLC | Wisconsin | |||||||
Wisconsin Health Care Group, LLC | Wisconsin | |||||||
| Wyoming Health Care Group, LLC | Wyoming | |||||||
| /s/ Keith G. Myers | |||||
| Keith G. Myers | |||||
| Chief Executive Officer (Principal executive officer) | |||||
| /s/ Dale G. Mackel | |||||
| Dale G. Mackel | |||||
| Chief Financial Officer | |||||
| (Principal financial officer) | |||||
| /s/ Keith G. Myers | |||||
| Keith G. Myers | |||||
| Chief Executive Officer | |||||
| (Principal executive officer) | |||||
| /s/ Dale G. Mackel | |||||
| Dale G. Mackel | |||||
| Chief Financial Officer | |||||
| (Principal financial officer) | |||||
Audit Information |
12 Months Ended |
|---|---|
Dec. 31, 2022 | |
| Audit Information [Abstract] | |
| Auditor Name | KPMG LLP |
| Auditor Location | Baton Rouge, Louisiana |
| Auditor Firm ID | 185 |
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands |
Dec. 31, 2022 |
Dec. 31, 2021 |
|---|---|---|
| Statement of Financial Position [Abstract] | ||
| Property, building and equipment, accumulated depreciation | $ 114,427 | $ 98,394 |
| Intangible assets, accumulated amortization | $ 23,726 | $ 19,152 |
| Preferred stock, par value (in dollars per share) | $ 0.01 | |
| Preferred stock, shares authorized (in shares) | 5,000,000 | |
| Preferred stock, shares issued (in shares) | 0 | |
| Preferred stock, shares outstanding (in shares) | 0 | |
| Common stock, par value (in dollars per share) | $ 0.01 | $ 0.01 |
| Common stock, shares authorized (in shares) | 60,000,000 | 60,000,000 |
| Common stock, shares, issued (in shares) | 36,744,210 | 36,549,524 |
| Common stock, shares outstanding (in shares) | 30,595,381 | 30,634,414 |
| Treasury shares (in shares) | 6,148,829 | 5,915,110 |
Organization |
12 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Dec. 31, 2022 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Organization, Consolidation and Presentation of Financial Statements [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Organization | Organization LHC Group, Inc. (the “Company”) is a health care provider specializing in the post-acute continuum of care. The Company provides services through five segments: home health, hospice, home and community-based services, facility-based services, the latter primarily through long-term acute care hospitals ("LTACHs"), and healthcare innovations ("HCI"). As of December 31, 2022, the Company, through its wholly and majority-owned subsidiaries, equity joint ventures, controlled affiliates, and management agreements, operated 920 service providers in 37 states within the continental United States and the District of Columbia. LHC Group, Inc. and UnitedHealth Group Incorporated Merger On March 28, 2022, the Company entered into an Agreement and Plan of Merger (the "Merger Agreement") with UnitedHealth Group Incorporated ("Parent") and Lightning Merger Sub Inc., a wholly owned subsidiary of Parent ("Merger Sub"), pursuant to which Merger Sub will be merged with and into the Company (the "Merger"), with the Company surviving the Merger as a wholly owned subsidiary of Parent. At a Special Meeting of Stockholders held on June 21, 2022, the stockholders of the Company approved the Merger. On December 6, 2022, the Company delivered written notice to UnitedHealth Group extending the Outside Date, as defined in the Merger Agreement, to March 28, 2023. The parties to the Merger continue to work toward the expected consummation of the Merger prior to the end of the first quarter of 2023. COVID-19 Update SARS-CoV-2 ("COVID-19") continues to cause disruption in the economy, in terms of increased costs and disruptions in the labor market. The impact of COVID-19 is lessened as vaccines have become available in the United States; however, we continue to see periodic increases in the number of cases due to the spread of COVID-19 variants. The effects of COVID-19 continue to materially impact our business. As a result, operating results for the twelve months ended December 31, 2022 may not be directly comparable to operating results for the twelve months ended December 31, 2021. CARES Act In response to COVID-19, the U.S. Government enacted the Coronavirus Aid, Relief, and Economic Security Act ("CARES Act") on March 27, 2020. The CARES Act also provided financial hardship relief to Medicare providers impacted by the COVID-19 pandemic in order to provide necessary funds when there is a disruption in Medicare claims submission and/or Medicare claims processing by distributing funds through the Accelerated and Advanced Payments Program ("CAAP"). In addition, the CARES Act suspended the 2% sequestration payment adjustments on Medicare patient claims with dates of service from May 1 through December 31, 2020, suspended the application of site-neutral payment for LTACH admissions that were admitted during the Public Health Emergency ("PHE"), and delayed payment of the employer portion of social security tax. On April 14, 2021, Congress passed legislation to continue the suspension of the 2% sequestration payment adjustments on Medicare patient claims with dates of service through December 31, 2021. On December 10, 2021, the Protecting Medicare and American Farmers from Sequester Cuts Act legislation passed, which continued the suspension of the sequestration payment adjustments for Medicare patient claims with dates of service through March 31, 2022. Medicare patient claims with dates of service between April 1 through June 30, 2022 had a 1% sequestration adjustment and Medicare patient claims with dates of service beginning July 1, 2022 had a 2% sequestration adjustment. On February 9, 2023, the U.S. Department of Health and Human Services extended the PHE until May 11, 2023. CAAP During the twelve months ended December 31, 2021, the Company had $106.5 million of accelerated payments under the CAAP, which was recorded in contract liabilities - deferred revenue in our consolidated balance sheets in accordance with Accounting Standards Update ("ASU") 2014-09, Revenue from Contracts with Customers ("Topic 606"). On October 1, 2020, the repayment and recoupment terms for CAAP funds were amended by the Continuing Appropriations Act, 2021 and Other Extensions Act, which provides that recoupment will begin one year from the date the CAAP funds were received. The repayment terms began one year starting from the date the CAAP funds were issued and continued for 11 months, as CMS recouped the initial 25% of Medicare payments otherwise owed to the Company. If any amount of CAAP funds that we received from CMS remained unpaid after the initial 11 month period, CMS recouped 50% of Medicare payments otherwise owed to the Company during the following six months. Interest began accruing on any amount of the CAAP funds that we received from CMS that remained unpaid following those recoupment periods. CMS issued a repayment letter to the Company for any such outstanding amounts, which must be paid in full within 30 days from the date of the letter. As of December 31, 2022, the Company repaid $106.5 million before any interest was accrued. Other The Company recognized the following amounts of net service revenue due to the suspension of the 2% sequestration payment adjustment and the suspension of LTACH site-neutral payments (amounts in thousands):
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Summary of Significant Accounting Policies |
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| Accounting Policies [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Summary of Significant Accounting Policies | Summary of Significant Accounting Policies Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles ("US GAAP") requires management to make estimates and assumptions that affect the reported amounts of the Company's accompanying consolidated financial statements and notes to the consolidated financial statements. Actual results could differ from those estimates. A description of the significant accounting policies and a discussion of the significant estimates and judgments associated with such policies are described below. Principles of Consolidation The consolidated financial statements include all subsidiaries and entities controlled by the Company through direct ownership of majority interest or controlling member ownership of such entities. Third party equity interests in the consolidated joint ventures are reflected as noncontrolling interests in the Company’s consolidated financial statements. All significant intercompany accounts and transactions have been eliminated in consolidation. All business combinations accounted for under the acquisition method have been included in the consolidated financial statements from the respective dates of acquisition. The Company consolidates equity joint venture entities as the Company has controlling interests, has voting control over these entities, or has ability to exercise significant influence in these entities. The members of the Company's equity joint ventures participate in profits and losses in proportion to their equity interests. The Company, through wholly owned subsidiaries, leases home health licenses necessary to operate certain of its home nursing and hospice agencies. As with wholly owned subsidiaries, the Company owns 100% of the equity of these entities and consolidates them based on such ownership. Revenue Recognition Basis of Presentation Net service revenue from contracts with customers is recognized in the period the performance obligations are satisfied under the Company's contracts by transferring the requested services to patients in amounts that reflect the consideration to which is expected to be received in exchange for providing patient care, which is the transaction price allocated to the services provided in accordance with Topic 606 and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"). Net service revenue is recognized as performance obligations are satisfied, which can vary depending on the type of services provided. The performance obligation is the delivery of patient care in accordance with the requested services outlined in physicians' orders, which are based on specific goals for each patient. The performance obligations are associated with contracts in duration of less than one year; therefore, the optional exemption provided by ASC 606 was elected resulting in the Company not being required to disclose the aggregate amount of the transaction price allocated to the performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The Company's unsatisfied or partially unsatisfied performance obligations are primarily completed when the patients are discharged and typically occur within days or weeks of the end of the period. The Company determines the transaction price based on gross charges for services provided, reduced by explicit price concessions and estimates for implicit price concessions. Explicit price concessions include contractual adjustments provided to patients and third-party payors. Implicit price concessions include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from regulatory reviews, audits, billing reviews and other matters. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (i.e. change in credit risk) are recorded as a provision for doubtful accounts within general and administrative expenses. Explicit price concessions are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Implicit price concessions are recorded for self-pay, uninsured patients and other payors by major payor class based on historical collection experience, and current business and economic conditions, representing the difference between amounts billed and amounts expected to be collected. The Company assesses the ability to collect for the healthcare services provided at the time of patient admission based on the verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and reviews. The Company has determined estimates for price concessions related to regulatory reviews based on historical experience and success rates in the claim appeals and adjudication process. Revenue is recorded at amounts estimated to be realizable for services provided. The following table sets forth the percentage of net service revenue earned by category of payor for each segment for the years ending December 31:
Medicare The following describes the payment models in effect during the twelve months ended December 31, 2022. Such payment models have been subject to temporary adjustments made by CMS in response to COVID-19 pandemic as described elsewhere in this Annual Report on Form 10-K. The 2% sequestration reduction adjustment was suspended for patient claims with dates of service that began May 1, 2020 through March 31, 2022. Medicare patient claims with dates of services between April 1 through June 30, 2022 had a 1% sequestration payment adjustment. Medicare patient claims with dates of service beginning July 1, 2022 had the full 2% sequestration payment adjustment. Home Health Services The Company records revenue as services are provided under the Patient Driven Groupings Model ("PDGM"). For each 30-day period, the patient is classified into one of 432 home health resource groups prior to receiving services. Each 30-day period is placed into a subgroup falling under the following categories: (i) timing being early or late, (ii) admission source being community or institutional, (iii) one of 12 clinical groupings based on the patient's principal diagnosis, (iv) functional impairment level of low, medium, or high, and (v) a co-morbidity adjustment of none, low, or high based on the patient's secondary diagnoses. Each 30-day period payment from Medicare reflects base payment adjustments for case-mix and geographic wage differences. In addition, payments may reflect one of three retroactive adjustments to the total reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment whereby the number of visits is dependent on the clinical grouping; and/or (c) a partial payment if the patient transferred to another provider or from another provider before completing the episode. The retroactive adjustments outlined above are recognized in net service revenue when the event causing the adjustment occurs and during the period in which the services are provided to the patient. The Company reviews these adjustments to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustments is subsequently resolved. Net service revenue and related patient accounts receivable are recorded at amounts estimated to be realized from Medicare for services rendered. Hospice Services The Company records revenue based upon the date of service at amounts equal to the estimated payment rates. The Company receives one of four predetermined daily rates based upon the level of care provided by the Company, which can be routine care, general inpatient care, continuous home care, and respite care. There are two separate payment rates for routine care: payment for the first 60-days of care and care beyond 60-days. In addition to the two routine rates, the Company may also receive a service intensity add-on ("SIA"). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. Adjustments to Medicare revenue are made from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of these adjustments based on our historical experience. Hospice payments are subject to variable consideration through an inpatient cap and an overall Medicare payment cap. The inpatient cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from inpatient care services and the overall Medicare payment cap relates to individual programs receiving reimbursements in excess of a “cap amount,” determined by Medicare to be payment equal to 12 months of hospice care for the aggregate base of hospice patients, indexed for inflation. The determination for each cap is made annually based on the 12-month period ending on September 30 of each year. The Company monitors its limits on a provider-by-provider basis and records an estimate of its liability for reimbursements received in excess of the cap amount, if any, in the reporting period. Facility-Based Services Gross revenue is recorded as services are provided under the LTACH prospective payment system. Each patient is assigned a long-term care diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare LTACH patient classified in that particular long-term care diagnosis-related group. For selected LTACH patients, the amount may be further adjusted based on length-of-stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for LTACH claims paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Net service revenue adjustments resulting from reviews and audits of Medicare cost report settlements are considered implicit price concessions for LTACHs and are measured at expected value. Non-Medicare Revenue Other sources of net service revenue for all segments fall into Medicaid, managed care or other payors of the Company's services. Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized for Medicaid services as services are provided based on this fee schedule. The Company's managed care and other payors reimburse the Company based upon a predetermined fee schedule or an episodic basis, depending on the terms of the applicable contract. Accordingly, the Company recognizes revenue from managed care and other payors as services are provided, such costs are incurred, and estimates of expected payments are known for each different payer, thus the Company's revenue is recorded at the estimated transaction price. Contingent Service Revenues The HCI segment provides strategic health management services to Affordable Care Organizations ("ACOs") that have been approved to participate in the Medicare Shared Savings Program ("MSSP"). The HCI segment has service agreements with ACOs that provide for sharing of MSSP payments received by the ACO, if any. ACOs are legal entities that contract with CMS to provide services to the Medicare fee-for-service population for a specified annual period with the goal of providing better care for the individual, improving health for populations and lowering costs. ACOs share savings with CMS to the extent that the actual costs of serving assigned beneficiaries are below certain trended benchmarks of such beneficiaries and certain quality performance measures are achieved. The generation of shared savings is the performance obligation of each ACO, which only become certain upon the final issuance of unembargoed calculations by CMS, generally in the third quarter of each year. During the years ended December 31, 2022, 2021, and 2020, the HCI segment recorded net service revenue of $15.6 million, $12.1 million, and $9.6 million, respectively, related to the 2021, 2020 and 2019 ACO respective service periods, as certain ACOs served by the HCI segment received a MSSP payment from CMS confirming the performance obligation has been met. Patient Accounts Receivable The Company reports patient accounts receivable from services rendered at their estimated transaction price, which includes price concessions based on the amounts expected to be due from payors. The Company's patient accounts receivable is uncollateralized and primarily consist of amounts due from Medicare, Medicaid, other third-party payors, and to a lesser degree patients. The credit risk from other payors is limited due to the significance of Medicare as the primary payor. The Company believes the credit risk associated with its Medicare accounts is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The Company does not believe that there are any other significant concentrations from any particular payor that would subject it to any significant credit risk in the collection of patient accounts receivable. The following table sets forth the percentage of patient accounts receivable by payor for the years ended December 31:
Business Combinations The Company accounts for its acquisitions in accordance with ASC 805, "Business Combinations" ("ASC 805") using the acquisition method of accounting. Assets typically acquired consist primarily of Medicare licenses, trade names, certificates of need, and/or non-compete agreements. The assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is also measured and recorded at fair value as of the acquisition date. Goodwill represents the excess of the cost of an acquired entity over the net amounts assigned to assets acquired and liabilities assumed. The operations of the acquisitions are included in the consolidated financial statements from their respective dates of acquisition. Acquisition transactions that occurred in 2022 and 2021 are further described in Note 3 and Note 4 to the Consolidated Financial Statements included in this Annual Report on Form 10-K. Insurance Programs The Company bears significant risk under its large-deductible workers’ compensation insurance program and its self-insured employee health program. Under the workers’ compensation insurance program, the Company bears risk up to $1.0 million per incident, after which stop-loss coverage is maintained. The Company purchases stop-loss insurance for the employee health plan and bear risk up to $0.5 million per incident. Malpractice and general patient liability claims for incidents which may give rise to litigation have been asserted against the Company by various claimants. The claims are in various stages of processing and some may ultimately be brought to trial. The Company currently carries professional liability insurance coverage on a claims made basis and general liability insurance coverage on an occurrence basis for this exposure with a $0.3 million deductible. The Company also carries Directors and Officers coverage (also on a claims made basis) for potential claims against the Company’s directors and officers, including securities actions, with a deductible of $2.5 million. The Company records estimated liabilities for its insurance programs based on information provided by the third-party plan administrators, historical claims experience, the life cycle of claims, expected costs of claims incurred but not paid, and expected costs to settle unpaid claims. The Company monitors its estimated insurance-related liabilities and recoveries, if any, on a monthly basis and records amounts due under insurance policies in other current assets, while recording the estimated carrier liability in self-insurance reserves. As facts change, it may become necessary to make adjustments that could be material to the Company’s results of operations and financial condition. Goodwill and Intangible Assets Goodwill Goodwill represents the excess of amounts paid for acquisitions over the fair value of net identifiable assets acquired less liabilities assumed. The Company assigns assets acquired, including goodwill, and liabilities assumed to one or more reporting units as of the date of the acquisition. The Company's reporting units are home health, hospice, home and community-based, LTACH, and HCI. The LTACHs are incorporated in the Company's facility-based operating segment. The other locations within the facility-based segment do not share in the economic benefits of the LTACH reporting unit, and as such, are excluded from the annual impairment testing. Goodwill and purchased intangible assets with indefinite useful lives are not amortized. ASC 350, "Intangibles - Goodwill and Other" ("ASC 350") requires that all indefinite-lived intangible assets, such as goodwill, be tested for impairment at least annually or sooner whenever events or changes in circumstances indicate that the asset is impaired. An entity may perform a qualitative assessment to determine whether it is necessary to perform the quantitative impairment test. In assessing whether the asset is impaired, the Company assess all relevant events and circumstances for each of the Company's reporting units. The Company performs its goodwill impairment testing on an annual basis as of November 30, and whenever events or changes in circumstances indicate that the carrying value of a reporting unit likely exceeds its fair value. This involves estimating the fair value of the reporting units using discounted cash flow models. For 2022, the Company performed its annual impairment review of goodwill at November 30. The Company assessed and reviewed factors such as: labor cost; financial performance, such as cash flows and planned revenue; regulatory factors; market considerations, such as market-dependent multiples; and access of capital. For 2022, the Company performed a qualitative assessment of goodwill for each of its reporting units. When performing its quantitative assessment, the Company determined the existence of events and circumstances that would lead to a determination that is more likely than not that the fair value of the reporting units for hospice, home and community-based, and LTACHs could be less than its carrying value. The Company was required to perform a quantitative assessment on these reporting units. The Company's quantitative assessment for the determination of impairment was made by comparing the carrying amount of the hospice, home and community-based, and LTACH reporting units with its fair value, calculated by a combination of market and discounted cash flow approaches. Minor changes to assumptions used in these approaches could have had a significant effect on the assessment of the fair value of these reporting units. The Company's home and community-based and LTACH reporting units fair value exceeded its respective carrying value by 5% and 1%, respectively. Both reporting units are at risk of failing step one of the impairment test in future quarters if financial performance continues to decrease and the cost of debt continues to increase. The Company has not recognized any goodwill impairment charges in 2022, 2021 or 2020 related to the annual impairment testing. Components of the Company's reporting units are collections of markets of similar service offerings that operate collaboratively under a house of brands, i.e. multiple brands are used across markets, states, and segments. The Company recognized an impairment of $5.3 million, $0.02 million and $0.5 million, respectively, for the twelve months ended December 31, 2022, 2021, and 2020 related to goodwill associated with the closure of underperforming locations. The impairments were determined using prices of comparable businesses in respective markets. Intangible assets: Indefinite-lived assets The Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need, and Medicare licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need, and licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the useful lives of these intangible assets and the Company intends to renew and operate the certificates of need and licenses and use the trade names indefinitely. In some cases, the value of licenses and certificates of need is increased by moratoriums in effect. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. The Company performed a qualitative assessment and determined that it is not more likely than not that the fair values of these assets are less than the carrying amounts. During the twelve months ended December 31, 2022, 2021, and 2020, the Company did not record an impairment charge related to indefinite-lived intangible assets in the annual impairment testing. During the twelve months ended December 31, 2022, 2021, and 2020, the Company closed underperforming locations and impaired certificates of need or Medicare licenses for these providers. The Company recognized an of $5.6 million, $0.9 million, $0.7 million, respectively. The amounts of impairment of the certificate of needs or Medicare licenses was its carrying value at the time of closure. Intangible assets: Definite-lived assets Included in intangible assets are definite-lived assets subject to amortization such as non-compete agreements, customer relationships, and defensive assets, which are defined as trade names that are not actively used. Amortization of definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets, ranging from to 16 years. Amortization expense for the Company's definite-lived intangible assets for the years ended December 31, 2022, 2021, and 2020, was $4.6 million, $1.5 million, and $1.2 million, respectively. Amortization expense was recorded in general and administrative expenses. Due to/from Governmental Entities The Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. Additionally, reimbursements received in excess of hospice cap amounts are recorded in this account, if any. Property, Building and Equipment Property, building and equipment are recorded at cost. Property, building and equipment acquired in connection with business combinations are recorded at estimated fair value in accordance with the acquisition method of accounting in accordance with ASC 805. Expenditures that increase capacities or extend useful lives are capitalized to the appropriate property, building and equipment accounts. Costs and related accumulated depreciation associated with assets that are sold or retired are written off and any gain or loss are recorded in operating income. Routine repairs and maintenance costs are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful life of the individual assets. The estimated useful life of buildings is 39 years, while the estimated useful life of transportation equipment, fixed equipment, office furniture, and computer equipment range from to 15 years. The useful life for leasehold improvements is the shorter of the lease term or the expected life of the leasehold improvement. In accordance with ASC 360, "Property, Plant, and Equipment", the Company evaluates its long-lived assets for possible impairment whenever events or changes in circumstances occur that indicate that the carrying amount of the asset may not be recoverable. There were no impairment charges recognized during the periods ended December 31, 2022, 2021, and 2020. The following table describes the Company’s components of property, building and equipment for the years ended December 31, 2022 and 2021 (amounts in thousands):
Building and leasehold improvements and office furniture and medical equipment were reclassified as of December 31, 2021 due to the reclassification of fixed equipment associated with the Company's implementation of a new enterprise resource planning software. Depreciation expense for the years ended December 31, 2022, 2021 and 2020 was $18.6 million, $19.4 million, and $20.0 million, respectively, which was recorded in general and administrative expenses. In addition, during the years ended December 31, 2021 and 2020, the Company capitalized $1.0 million and $1.1 million, respectively, in interest costs related to the construction of its home office expansion project. Construction of its home office expansion projection was completed during the twelve months ended December 31, 2021. Noncontrolling Interest The Company classifies noncontrolling interests of its joint ventures based upon a review of the legal provisions governing the redemption of such interests. In each of the Company’s joint ventures, those provisions are embodied within the joint venture’s operating agreement. For joint ventures with operating agreement provisions that establish an obligation for the Company to purchase the third party partners’ noncontrolling interests other than as a result of events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as redeemable noncontrolling interests in temporary equity. For joint ventures with operating agreement provisions that establish an obligation that the Company purchase the third party partners’ noncontrolling interests, but which obligation is triggered by events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. Additionally, for joint ventures with operating agreement provisions that do not establish an obligation for the Company to purchase the third party partners’ noncontrolling interests (e.g., where the Company has the option, but not the obligation, to purchase the third party partners’ noncontrolling interests), such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. The Company’s equity joint ventures that are classified as redeemable noncontrolling interests are subject to operating agreement provisions that require the Company to purchase the noncontrolling partner’s interest upon the occurrence of certain triggering events, which are defined as the bankruptcy of the partner or the partner’s exclusion from the Medicare or Medicaid programs. These triggering events and the related repurchase provisions are specific to each redeemable equity joint venture, since the triggering of a repurchase obligation for any one redeemable noncontrolling interest in an equity joint venture does not necessarily impact any of the other redeemable noncontrolling interests in other equity joint ventures. Upon the occurrence of a triggering event requiring the purchase of a redeemable noncontrolling interest, the Company would be required to purchase the noncontrolling partner’s interest based upon a valuation methodology set forth in the applicable joint venture agreement. Redeemable noncontrolling interests and nonredeemable noncontrolling interests are initially recorded at their fair value as of the closing date of the transaction establishing the joint venture. Such fair values are determined using various accepted valuation methods, including the income approach, the market approach, the cost approach, and a combination of one or more of these approaches. A number of facts and circumstances concerning the operation of the joint venture are evaluated for each transaction, including (but not limited to) the ability to choose management, control over acquiring or liquidating assets, and control over the joint venture’s strategy and direction, in order to determine the fair value of the noncontrolling interest. Subsequent to the closing date of the transaction establishing the joint venture, recorded values for both redeemable and nonredeemable noncontrolling interests are adjusted at the end of each reporting period for (a) comprehensive income (loss) that is attributed to the noncontrolling interest, which is calculated by multiplying the noncontrolling interest percentage by the comprehensive income (loss) of the joint venture’s operations during the reporting period, (b) dividends paid to the noncontrolling interest partner during the reporting period, and (c) any other transactions that increase or decrease the Company’s ownership interest in the joint venture, as a result of which the Company retains its controlling interest. If the Company determines based upon its analysis as of the end of each reporting period in accordance with authoritative accounting guidance, that it is not probable that an event would occur to otherwise require the redemption of a redeemable noncontrolling interest (i.e., the date for such event is not set or such event is not certain to occur), then the Company does not adjust the recorded amount of such redeemable noncontrolling interest. The carrying amount of each redeemable equity instrument presented in temporary equity as of December 31, 2022 is not less than the initial amount reported for each instrument. The activity of noncontrolling interest-redeemable for the twelve months ended December 31, 2022, 2021, and 2020 is summarized in the Company’s statements of stockholders' equity. Based upon the Company’s evaluation of the redemption provisions concerning redeemable noncontrolling interests as of December 31, 2022, the Company determined in accordance with authoritative accounting guidance that it was not probable that an event otherwise requiring redemption of any redeemable noncontrolling interest would occur (i.e., the date for such event was not set or such event is not certain to occur). Therefore, none of the redeemable noncontrolling interests were identified as mandatorily redeemable interests at such times, and the Company did not record any values in respect of any mandatorily redeemable interests. Stock-Based Compensation The Company accounts for its stock-based awards in accordance with provisions of ASC 718, "Compensation - Stock Compensation" ("ASC 718"). The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of compensation. In accordance with ASC 718, the expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis over the requisite service period. See Note 7 to the Consolidated Financial Statements included in this Annual Report on Form 10-K for additional information. Earnings Per Share The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31, 2022, 2021, and 2020:
Investments During the twelve months ended December 31, 2022, the Company invested $15.0 million and became a minority owner in a post-acute management services company, invested $0.1 million in Jumpstart Nova Fund, LP, and invested $0.2 million in LHCC Aging Innovations Fund I, LP. During the twelve months ended December 31, 2021, the Company invested $10.0 million and became a minority owner in a healthcare analytics company and invested $0.1 million in an investment fund focused on minority-owned businesses. These investments are recorded in other assets in our consolidated balance sheets. These investments were accounted for under the cost method of accounting as the Company does not have the ability to exercise significant influence in connection with its minority ownership positions.
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| Business Combinations [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Acquisitions, Divestitures, and Joint Venture Activities | Acquisitions, Divestitures, and Joint Venture Activities 2022 Acquisitions On September 1, 2021, the Company purchased Heart of Hospice. During the twelve months ended December 31, 2022, the Company recorded a decrease in patient accounts receivable of $1.5 million due to information obtained that relates to facts and circumstances that existed at the time of acquisition; therefore, it was an adjustment to the provisional amounts previously recognized. On November 1, 2021, the Company purchased Brookdale Health Care Services' agencies from the recently formed home health, hospice, and outpatient therapy venture between HCA Healthcare and Brookdale Senior Living. The Company's net working capital adjustment was finalized during the twelve months ended December 31, 2022 for $3.1 million and recorded in accordance with ASC Topic 805, Business Combinations, as an increase to the consideration transferred. In addition, amounts due to government entities was reduced by $3.2 million to reflect payments made for prior years' hospice cap liability. On May 1, 2022, the Company purchased the majority ownership of a home health agency from Archbold Medical Center, which included two locations in Georgia for a total consideration for the acquisition of $3.7 million. On October 1, 2022, the Company purchased eight home health providers located in Georgia from Three Rivers Home Health Services, Inc. for a total consideration for the acquisition of $18.5 million. On November 1, 2022, the Company purchased the majority ownership of two home health agencies and one home and community-based agency located in Maryland from the University of Maryland Shore Regional Health, Inc. for a total consideration for the acquisition of $4.8 million. The purchase prices were determined based on the Company's analysis of comparable acquisitions and the target market's potential future cash flows. Goodwill generated from the acquisitions was recognized based on the expected contributions of each acquisition to the overall corporate strategy. The Company expects its portion of goodwill to be fully tax deductible. The acquisitions were accounted for under the acquisition method of accounting. Accordingly, the accompanying financial information includes the results of operations of the acquired entities from the date of acquisition. Transaction costs associated with acquisitions are expensed as incurred. During the twelve months ended December 31, 2022, the Company incurred $0.2 million in acquisition-related transaction costs, which was recorded in the consolidated statements of income as general and administrative expenses. The following table summarizes the amounts of the assets acquired and liabilities assumed at the acquisition dates, as well as their fair value at the acquisition dates and the noncontrolling interest acquired during the twelve months ended December 31, 2022 (amounts in thousands):
Trade names, certificates of need and licenses are indefinite-lived assets and, therefore, not subject to amortization. Acquired trade names that are not being used actively are amortized over the estimated useful life on the straight line basis. Trade names are valued using the relief from royalty method, a form of the income approach. Certificates of need are valued using the replacement cost approach based on registration fees and opportunity costs. Licenses are valued based on the estimated direct costs associated with recreating the asset, including opportunity costs based on an income approach. In the case of states with a moratorium in place, the licenses are valued using the multi-period excess earnings method. Noncontrolling interest is recorded at fair value. 2022 Joint Venture Activities During the twelve months ended December 31, 2022, the Company purchased additional controlling membership interests in four of our equity joint venture partnerships, whereby the agencies became wholly-owned subsidiaries of the Company. The total consideration for these additional controlling interest purchases was $1.9 million. The transactions were accounted for as equity transactions. During the twelve months ended December 31, 2022, the Company sold noncontrolling membership interests in five home health agencies. The total consideration of the sales of noncontrolling membership interest was $5.2 million. The transactions were accounted for as equity transactions. 2021 Acquisitions On July 1, 2021, the Company purchased Heart n' Home Hospice for $50.1 million, which included seven wholly-owned hospice locations in Idaho and two wholly-owned hospice locations in Oregon. In addition, the Company purchased Casa de la Luz on July 1, 2021 for $48.0 million, which included two wholly-owned hospice and palliative care locations in Arizona. On September 1, 2021, the Company purchased Heart of Hospice for $278.0 million, which included 24 wholly-owned hospice locations in Arkansas, Louisiana, Mississippi, Oklahoma, and South Carolina. On November 1, 2021, the Company purchased Brookdale Health Care Services' agencies from the recently formed home health, hospice, and outpatient therapy venture between HCA Healthcare and Brookdale Senior Living, Inc. The wholly-owned purchased agencies included 23 home health locations, 11 hospice locations, and 13 main therapy agencies across 22 states. Total consideration for this acquisition was $197.0 million, of which $178.8 million was paid in cash, net of working capital adjustments. In separate acquisitions, the Company acquired the majority-ownership of four home health agencies, three hospice agencies, and one home and community-based agency during the twelve months ended December 31, 2021 for an aggregate purchase price $17.8 million. The purchase prices were determined based on the Company's analysis of comparable acquisitions and the target market's potential future cash flows. Transaction costs associated with acquisitions are expensed as incurred. During the twelve months ended December 31, 2021, the Company incurred $9.1 million in acquisition-related transaction costs, which was recorded in the consolidated statements of income as general and administrative expenses. 2021 Divestitures During the twelve months ended December 31, 2021, the Company sold its controlling membership interests in a home health agency previously operated as an equity joint venture and sold its pharmacy location, which was wholly-owned. The total consideration for these controlling interest sales was $1.5 million and resulted in a loss of $0.1 million, which was accounted for as a loss on the sale of entities and recorded in general and administrative expenses. 2021 Joint Venture Activities During the twelve months ended December 31, 2021, the Company purchased additional controlling membership interests in four of our equity joint venture partnerships, whereby the agencies became wholly-owned subsidiaries of the Company. The total consideration for these additional controlling interest purchases was $2.1 million. The transactions were accounted for as equity transactions. During the twelve months ended December 31, 2021, the Company sold noncontrolling membership interests in two home health agencies. The total consideration of the sales of noncontrolling membership interest was $1.9 million. The transactions were accounted for as equity transactions.
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| Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Goodwill and Other Intangibles, Net | Goodwill and Other Intangibles, Net The following table summarizes changes in goodwill and other intangibles assets by segment during the twelve months ended December 31, 2022 and 2021 (amounts in thousands):
The Company determined that there was no impairment for the goodwill of any reporting unit as of December 31, 2022, 2021, and 2020 based on the Company's annual impairment testing. During 2022, 2021, and 2020, the Company closed underperforming locations. Due to these closures, the Company recorded $5.3 million, $0.02 million, and $0.5 million of impairment of goodwill during the years ended December 31, 2022, 2021, and 2020. The amount of disposal of goodwill was determined using prices of comparable businesses in the market. This was recorded in impairment of intangibles and other on the Company's consolidated statements of income and disclosed in the changes in goodwill table in adjustments and disposals. The Company performed an impairment analysis on its indefinite-lived intangible assets related to the Company's trade names, certificates of needs, and licenses and determined that it is not more likely than not that the fair values of the indefinite-lived intangible assets are less than its carrying amount as of November 30, 2022; however, the Company did record $5.6 million, $0.9 million, and $0.7 million, during the years ended December 31, 2022, 2021, and 2020. These impairments related to closures of underperforming locations. The amounts of disposal of the indefinite-lived intangible assets were the carrying values at the time of closure. This was recorded in impairment of intangibles and other on the Company's consolidated statements of income and disclosed in the changes in intangible assets table in adjustments and disposals. During the twelve months ended December 31, 2021, the Company divested a certificate of need of $0.4 million, which was accounted for as a loss on the sale of an entity and recorded on the Company's consolidated statements of income in general and administrative expenses. The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2022 and 2021 (amounts in thousands):
Remaining useful lives of trade names, customer relationships, and non-compete agreements were 6.7, 15.3 and 3.8 years, respectively at December 31, 2022. Similar amounts at December 31, 2021 were 7.8, 16.3 and 4.9 years, respectively. Amortization expense for the Company's intangible assets was $4.6 million, $1.5 million, and $1.2 million for the years ended December 31, 2022, 2021 and 2020, which was recorded on the Company's consolidated statements of income in general and administrative expenses. The estimated intangible asset amortization expense for each of the five years subsequent to December 31, 2022 is as follows (amounts in thousands):
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| Income Tax Disclosure [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Income Taxes | Income Taxes The Company accounts for income taxes using the asset and liability method. Under the asset and liability method, deferred taxes are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax laws that will be in effect when the differences are expected to reverse. Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2022 and 2021 were as follows (amounts in thousands):
Based on the Company’s historical pattern of taxable income, the Company believes it will produce sufficient income in the future to realize its deferred income tax assets. Management provides a valuation allowance for any net deferred tax assets when it is more likely than not that a portion of such net deferred tax assets will not be recovered. The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, for the twelve months ended December 31, were as follows (amounts in thousands):
A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each of the twelve months ended December 31, were as follows:
The Company is subject to both federal tax and state income tax for jurisdictions within which it operates. Within these jurisdictions, the Company is open to examination for tax years ended after December 31, 2012. As of December 31, 2022, the Company has gross U.S. operating loss carry forwards of $102.5 million that are available to reduce future taxable income. If not used to offset taxable income, a portion of these losses will expire between 2032 and 2034. Losses generated in years ending after December 31, 2017 have an unlimited carryforward under the Tax Cut and Jobs Act ("2017 Tax Act"). Due to U.S. limitations on acquired operating losses, a valuation allowance has been established on $1.6 million of these losses. Gross state operating loss carryforwards totaling $189.4 million at December 31, 2022 are being carried forward in jurisdictions where the Company is permitted to use tax losses from prior periods to reduce future taxable income. If not used to offset future taxable income, these losses will expire between 2023 and 2042. Due to uncertainty regarding the Company's ability to use some of the carryforwards, a valuation allowance has been established on $56.2 million of state net operating loss carryforwards. Based on the Company's historical record of producing taxable income and expectations for the future, the Company has concluded that future operating income will be sufficient to give rise to taxable income sufficient to utilize the remaining state net operating loss carryforwards. The effective tax rate for the twelve months ended December 31, 2022 benefited from $1.0 million of excess tax benefits associated with stock-based compensation arrangements. For the twelve months ended December 31, 2021, the effective tax rate benefited from $2.4 million of excess tax benefits associated with stock-based compensation arrangements. In response to the COVID-19 pandemic, the CARES Act was signed into law in March 2020. The CARES Act lifts certain deduction limitations originally imposed by the 2017 Tax Act. Corporate taxpayers may carryback net operating losses ("NOLs") originating during 2018 through 2020 for up to five years, which was not previously allowed under the 2017 Tax Act. The CARES Act also eliminates the 80% of taxable income limitations by allowing corporate entities to fully utilize NOL carryforwards to offset taxable income in 2018, 2019, or 2020. Taxpayers may generally deduct interest up to the sum of 50% of adjusted taxable income plus business interest income (30% limit under the 2017 Tax Act) for tax years beginning January 1, 2019 and 2020. The CARES Act allows taxpayers with alternative minimum tax credits to claim a refund in 2020 for the entire amount of the credits instead of recovering the credits through refunds over a period of years, as originally enacted by the 2017 Tax Act. In addition, the CARES Act raises the corporate charitable deduction limit to 25% of taxable income and makes qualified improvement property generally eligible for 15-year cost-recovery and 100% bonus depreciation. The effective tax rate for the twelve months ended December 31, 2020 benefited from a $4.3 million impact from the enactment of the CARES Act. The benefit was primarily driven by NOL carryback provisions and rate differential between the affected years. There was no material impact to our net deferred tax assets as of December 31, 2020. US GAAP prescribes a recognition threshold and measurement attribute for the accounting and financial statement disclosure of tax positions taken or expected to be taken in a tax return. The evaluation of a tax position is a two-step process. The first step requires the Company to determine whether it is more likely than not that a tax position will be sustained upon examination based on the technical merits of the position. The second step requires the Company to recognize in the financial statements each tax position that meets the more likely than not criteria, measured at the amount of benefit that has a greater than 50% likelihood of being realized. The Company's unrecognized tax benefits would affect the tax rate, if recognized. The Company includes the full amount of unrecognized tax benefits in noncurrent income taxes payable in the consolidated balance sheets. The Company anticipates it is reasonably possible an increase or decrease in the amount of unrecognized tax benefits could be made in the next twelve months; however, the Company does not presently anticipate that any increase or decrease in unrecognized tax benefits will be material to the consolidated financial statements. The impact of the CARES Act increased unrecognized tax benefits by $2.1 million, which also had an impact on the Company's effective tax rate for the twelve months ended December 31, 2020. The impact was primarily driven by the NOL carryback mentioned above to previously closed years. As of December 31, 2022 and 2021, the Company recognized $7.2 million and $7.3 million, respectively, in unrecognized tax benefits. A reconciliation of the total amounts of unrecognized tax benefits follows:
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Debt |
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| Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Debt | Debt Credit Facility On August 3, 2021, the Company entered into an Amended and Restated Senior Credit Facility (the "2021 Amended Credit Agreement"), which provided a senior, secured revolving line of credit commitment with a maximum principal borrowing limit of $800.0 million, which included an additional $500.0 million accordion expansion, and a letter of credit sub-limit equal to $75.0 million. On December 31, 2021, the aggregate commitment was increased to a maximum borrowing limit of $1.0 billion, with an additional $300.0 million accordion expansion. The expiration date of the 2021 Amended Credit Agreement is August 3, 2026. The Company's obligations under the 2021 Amended Credit Agreement are secured by substantially all of the assets of the Company and its wholly-owned subsidiaries (subject to customary exclusions), which assets include the Company's equity ownership of its wholly-owned subsidiaries and its equity ownership in joint venture entities. The Company's wholly-owned subsidiaries also guarantee the obligations of the Company under the 2021 Amended Credit Agreement. Revolving loans under the 2021 Amended Credit Agreement bear interest at, as selected by the Company, either a (i) the prevailing London Interbank Offered Rate ("LIBOR") (with interest periods of one, three, or six months at the Company's option) plus a spread of 1.25% to 2.00% based on the Company's quarterly consolidated Leverage Ratio or (ii) the prevailing prime or base rate plus a spread of 0.25% to 1.00% based on the Company's quarterly consolidated Leverage Ratio. Swing line loans bear interest at the Base Rate. The Company is limited to 15 Eurodollar borrowings outstanding at any time. The Company is required to pay a commitment fee for the unused commitments at rates ranging from 0.15% to 0.30% per annum depending upon the Company's quarterly consolidated Leverage Ratio. The Base Rate at December 31, 2022 was 8.50% and the Eurodollar Rate was 6.44%. As of December 31, 2022, the effective interest rate on outstanding borrowings under the 2021 Amended Credit Agreement was 6.39%. On March 5, 2021, the ICE Benchmark Administration, the administrator of LIBOR, announced its intention to cease the publication of LIBOR settings for 1-month, 3-month, 6-month, and 12-month LIBOR borrowings immediately on June 30, 2023. JPMorgan Chase Bank, N.A will transition our 2021 Amended Credit Agreement to an alternate rate to CME Term SOFR Reference Rate ("SOFR"), which is administered by CME Group Benchmark Administration Ltd ("CME"). Due to the differences observed between LIBOR rates and SOFR published rates, JPMorgan Chase Bank, N.A. will use a credit spread adjustment ("CSA") in order to minimize value transfer and leave the existing margin applicable to our 2021 Amended Credit Agreement. The CSA used by JPMorgan Chase Bank, N.A. is based on the average of the differences between LIBOR and SOFR over a 12-month period and will be added to SOFR. As of December 31, 2022 the Company had $733.0 million drawn and letters of credit in the amount of $24.1 million outstanding under the credit facility. At December 31, 2021, the Company had $661.2 million drawn and letters of credit in the amount of $24.3 million outstanding under the credit facility. Under the terms of the 2021 Amended Credit Agreement, the Company is required to maintain certain financial ratios and comply with certain financial covenants. The 2021 Amended Credit Agreement permits the Company to make certain restricted payments, such as purchasing shares of its stock, within certain parameters, provided the Company maintains compliance with those financial ratios and covenants after giving effect to such restricted payments. The Company was in compliance with its debt covenants under the 2021 Amended Credit Agreement at December 31, 2022. The scheduled principal payments on long-term debt for each of the five years subsequent to December 31, 2022 is as follows (amounts in thousands):
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| Equity [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Stockholders' Equity | Stockholders’ Equity Equity Based Awards The 2018 Incentive Plan is administered by the Compensation Committee of the Company’s Board of Directors. The total number of shares of the Company's common stock originally reserved were 2,210,544 shares of our common stock and a total of 1,544,734 shares are currently available for issuance. A variety of discretionary awards for employees, officers, directors, and consultants are authorized under the 2018 Incentive Plan, including incentive or non-qualified stock options and restricted stock, restricted stock units and performance-based awards. All awards must be evidenced by a written award certificate which will include the provisions specified by the Compensation Committee of the Board of Directors. The Compensation Committee determines the exercise price for stock options, which cannot be less than the fair market value of the Company’s common stock as of the date of grant. Share Based Compensation Nonvested Stock The Company issues stock-based compensation to employees in the form of nonvested stock, which is an award of common stock subject to certain restrictions. The awards, which the Company calls nonvested shares, generally vest over five years, conditioned on continued employment for the full incentive period. Compensation expense for the nonvested stock is recognized for the awards that are expected to vest. The expense is based on the fair value of the awards on the grant date recognized on a straight-line basis over the requisite service period, which generally relates to the vesting period. The Company estimates forfeitures at the time of grant and revises the estimate in subsequent periods if actual forfeitures differ to ensure that total compensation expense recognized is at least equal to the value of vested awards. The Company applies the same guidance to nonemployee share-based awards. During 2022, 2021, and 2020, respectively, the Company granted 182,310, 109,985, and 114,680 nonvested shares of stock to employees. During 2022, 2021, and 2020, respectively, the Company granted 10,935, 5,735, and 10,890 nonvested shares of stock to a consultant. All shares granted were granted pursuant to the 2018 Incentive Plan. The shares will vest over a period of five years, conditioned on continued employment and in accordance with the consulting agreement. During 2022, 2021, and 2020, respectively, the Company granted 8,800, 7,200 and 9,900 nonvested shares of stock to the independent directors. The shares vest 100% on the one year anniversary date. During 2021, the Company granted 3,500 nonvested shares of common stock to the Company's Lead Director, which shares vest one-third at the date of grant and one-third on each of the first two anniversaries of the grant date. During 2020, one retired director was granted 775 nonvested shares of common stock, which vest 100% at the grant date. Shares granted to directors were pursuant to the Second Amended and Restated 2005 Non-Employee Directors Compensation Plan. The fair value of nonvested shares is determined based on the closing trading price of the Company’s shares on the grant date. The weighted average grant date fair values of nonvested shares granted during the years ended December 31, 2022, 2021 and 2020 were $139.64, $186.08 and $123.89, respectively. The following table represents the share grants stock activity for the year ended December 31, 2022:
As of December 31 2022, there was $44.9 million of total unrecognized compensation cost related to nonvested shares granted. That cost is expected to be recognized over the weighted average period of 3.11 years. The total fair value of shares vested in the year ended 2022, 2021, and 2020 were $17.9 million, $14.1 million, and $12.2 million, respectively. The Company recorded $20.0 million, $15.9 million and $14.3 million in compensation expense related to non-vested stock grants in the years ended December 31, 2022, 2021 and 2020, respectively. Aggregate intrinsic value for options represents the estimated value of the Company's common stock at the end of the period in excess of the weighted average exercise price multiplied by the number of options exercisable. The aggregate intrinsic value of options outstanding at December 31, 2022 was $7.1 million. The following table summarizes information about stock options outstanding and exercisable at December 31, 2022:
Employee Stock Purchase Plan In 2006, the Company adopted the Employee Stock Purchase Plan allowing eligible employees to purchase the Company’s common stock at 95% of the market price on the last day of each calendar quarter. There were 250,000 shares reserved for the plan. On June 20, 2013, the Amended and Restated Employee Stock Purchase Plan was approved by the Company’s stockholders. As a result of the amendment, the Employee Stock Purchase Plan was modified as follows: •An additional 250,000 shares of common stock were authorized for issuance over the term of the Employee Stock Purchase Plan. •The term of the Employee Stock Purchase Plan was extended from January 1, 2016 to January 1, 2023. The Board of Directors approved the cessation of any new offering periods granted to employees in 2023 and approved for the termination of the participation of all employees in the Employee Stock Purchase Plan. Any payroll withholdings with respect to unpurchased shares were refunded to the participants. The following table represents the shares issued during 2022, 2021, and 2020, under the Employee Stock Purchase Plan:
Treasury Stock In conjunction with the vesting of the nonvested shares of stock or exercise of options, recipients incur personal income tax obligations. The Company allows the recipients to turn in shares of common stock to satisfy those personal tax obligations. The Company redeemed 43,097, 64,584 and 78,767 shares of common stock related to these tax obligations during the years ended December 31, 2022, 2021, and 2020, respectively. Such shares are held in treasury stock and are available for reissuance by the Company. Stock Repurchase On December 6, 2021, the Company's Board of Directors approved a share repurchase program authorizing repurchases up to $250.0 million of the Company's common stock. The Company may purchase common stock in open market transactions, block or privately negotiated transactions, and may from time to time purchase shares pursuant to a trading plan in accordance with Rule 10b5-1 and Rule 10b-18 under the Exchange Act or by any combination of such methods, in each case subject to compliance with all SEC rules and other legal requirements. The number of shares to be purchased and the timing of the purchases are based on a variety of factors, including, but not limited to, the level of cash balances, credit availability, debt covenant restrictions, general business conditions, the market price of our stock and the availability of alternative investment opportunities. No time limit was set for completion of repurchases under the new authorization, and the program may be suspended or discontinued at any time. The Company uses the cost method to account for the repurchase of common stock. During the twelve months ended December 31, 2022, the Company repurchased 190,622 shares from the open market under its Stock Repurchase plan at an aggregate cost of $25.5 million. During the twelve months ended December 31, 2021, the Company repurchased 634,869 shares from the open market at an aggregate cost of $83.7 million. The remaining dollar value of shares authorized to be purchased under the Stock Repurchase plan was $140.8 million at December 31, 2022.
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Leases |
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| Leases [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Leases | Leases The Company determines if a contract contains a lease at inception date. The Company's leases are operating leases, primarily for office and office equipment, that expire at various dates over the next five years. The facility based leases have renewal options for periods ranging from to nine years. As it is not reasonably certain these renewal options will be exercised, the options were not considered in the lease term, and payments associated with the option years are excluded from lease payments. Payments due under operating leases include fixed and variable payments. These variable payments for the Company's office leases can include operating expenses, utilities, property taxes, insurance, common area maintenance, and other facility-related expense. Additionally, any leases with terms less than one year were not recognized as operating lease right of use assets or payables for short term leases in accordance with the election of ‘package of practical expedient’ under ASU 2016-02. The Company recognizes operating lease right of use assets and operating lease payable based on the present value of the future minimum lease payments at the lease commencement date. The Company's leases do not provide implicit rates. Therefore, the Company used an incremental borrowing rate based on the information available at the lease commencement date in determining the present value of future payments. As of December 31, 2022, the weighted-average remaining lease term was 3.60 years and weighted-average discount rate was 4.36%. As of December 31, 2021, the weighted-average remaining lease term was 3.85 years and weighted-average discount rate was 4.22%. The following table summarizes the operating lease right of use assets and related lease payables in the consolidated balance sheets at December 31, 2022 and 2021 (amounts in thousands):
The components of lease costs for operating leases for the years ended December 31, 2022, 2021, and 2020 were as follows: (amounts in thousands):
Maturities of operating lease payables as of December 31, 2022 were as follows (amounts in thousands):
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Employee Benefit Plan |
12 Months Ended |
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Dec. 31, 2022 | |
| Share-Based Payment Arrangement [Abstract] | |
| Employee Benefit Plan | Employee Benefit Plan Defined Contribution Plan The Company sponsors a 401(k) plan for all eligible employees. The plan allows participants to contribute up to the IRS 402(g) limits each year, both on a pretax and after tax basis, which was $20,500 in 2022. The plan also allows discretionary Company contributions as determined by the Company’s Board of Directors. Effective January 1, 2006, the Company implemented a discretionary match of up to two percent of participating employee contributions. The employer contribution will vest 25% in an employee's account for each year of service with the Company and 25% each additional year until it is fully vested in year . Contribution expense to the Company was $12.0 million, $12.6 million and $11.9 million in the years ended December 31, 2022, 2021, and 2020, respectively.
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Commitments and Contingencies |
12 Months Ended |
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Dec. 31, 2022 | |
| Commitments and Contingencies Disclosure [Abstract] | |
| Commitments and Contingencies | Commitments and Contingencies Contingencies The Company provides services in a highly regulated industry and is a party to various proceedings and regulatory and other governmental and internal audits and investigations in the ordinary course of business (including audits by Zone Program Integrity Contractors ("ZPICs") and Recovery Audit Contractors ("RACs") and investigations resulting from the Company's obligation to self-report suspected violations of law). Management cannot predict the ultimate outcome of any regulatory, other governmental, and internal audits and investigations. While such audits and investigations are the subject of administrative appeals, the appeals process, even if successful, may take several years to resolve. The Department of Justice, CMS, or other federal and state enforcement and regulatory agencies may conduct additional investigations related to the Company's businesses. These audits and investigations have caused and could potentially continue to cause delays in collections and, recoupments from governmental payors. As of December 31, 2022 and 2021, respectively, the Company recorded $12.0 million and $16.9 million in other assets, which are from government payors related to the disputed finding of pending ZPIC audits. Additionally, these audits may subject the Company to sanctions, damages, extrapolation of damage findings, additional recoupments, fines, and other penalties (some of which may not be covered by insurance), which may, either individually or in the aggregate, have a material adverse effect on the Company's business and financial condition. We are involved in various legal proceedings arising in the ordinary course of business. Although the results of litigation cannot be predicted with certainty, we believe the outcome of pending litigation will not have a material adverse effect, after considering the effect of our insurance coverage, on our consolidated financial information. Legal fees related to all legal matters are expensed as incurred. Joint Venture Buy/Sell Provisions Most of the Company’s joint ventures include a buy/sell option that grants to the Company and its joint venture partners the right to require the other joint venture party to either purchase all of the exercising member’s membership interests or sell to the exercising member all of the non-exercising member’s membership interest, at the non-exercising member’s option, within 30 days of the receipt of notice of the exercise of the buy/sell option. In some instances, the purchase price is based on a multiple of the historical or future earnings before income taxes and depreciation and amortization of the equity joint venture at the time the buy/sell option is exercised. In other instances, the buy/sell purchase price will be negotiated by the partners and subject to a fair market valuation process. The Company has not received notice from any joint venture partners of their intent to exercise the terms of the buy/sell agreement nor has the Company notified any joint venture partners of its intent to exercise the terms of the buy/sell agreement. Compliance The laws and regulations governing the Company’s operations, along with the terms of participation in various government programs, regulate how the Company does business, the services offered and its interactions with patients and the public. These laws and regulations, and their interpretations, are subject to frequent change. Changes in existing laws or regulations, or their interpretations, or the enactment of new laws or regulations could materially and adversely affect the Company’s operations and financial condition. The Company is subject to various routine and non-routine governmental reviews, audits and investigations. In recent years, federal and state civil and criminal enforcement agencies have heightened and coordinated their oversight efforts related to the health care industry, including referral practices, cost reporting, billing practices, joint ventures and other financial relationships among health care providers. Violation of the laws governing the Company’s operations, or changes in the interpretation of those laws, could result in the imposition of fines, civil or criminal penalties, and/or termination of the Company’s rights to participate in federal and state-sponsored programs and suspension or revocation of the Company’s licenses. The Company believes that it is in material compliance with all applicable laws and regulations.
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Segment Information |
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| Segment Reporting [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Segment Information | Segment Information The Company's reporting segments include (1) home health services, (2) hospice services, (3) home and community-based services, (4) facility-based services and (5) healthcare innovations (“HCI”). The accounting policies of the segments are the same as those described in the summary of significant accounting policies, as described in Note 2 to the Consolidated Financial Statements included in this Annual Report on Form 10-K. Reportable segments have been identified based upon how management has organized the business by services provided to customers and how the chief operating decision maker manages the business and allocates resources, consistent with the criteria in ASC 280, Segment Reporting. The following tables summarize the Company’s segment information for the twelve months ended December 31, 2022, 2021 and 2020 (amounts in thousands):
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Fair Value of Financial Instruments |
12 Months Ended |
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Dec. 31, 2022 | |
| Fair Value Disclosures [Abstract] | |
| Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying amounts of the Company’s cash, receivables, accounts payable, accrued liabilities, and operating lease right of use assets and liabilities approximate their fair values because of their short maturity. The estimated fair value of intangible assets acquired was calculated using level 3 inputs based on the present value of anticipated future benefits. For the year ended December 31, 2022, the carrying value of the Company’s long-term debt approximates fair value as the interest rates approximates current rates. |
Summary of Significant Accounting Policies (Policies) |
12 Months Ended |
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Dec. 31, 2022 | |
| Accounting Policies [Abstract] | |
| Use of Estimates | Use of Estimates The preparation of financial statements in conformity with U.S. generally accepted accounting principles ("US GAAP") requires management to make estimates and assumptions that affect the reported amounts of the Company's accompanying consolidated financial statements and notes to the consolidated financial statements. Actual results could differ from those estimates.
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| Principles of Consolidation | Principles of Consolidation The consolidated financial statements include all subsidiaries and entities controlled by the Company through direct ownership of majority interest or controlling member ownership of such entities. Third party equity interests in the consolidated joint ventures are reflected as noncontrolling interests in the Company’s consolidated financial statements. All significant intercompany accounts and transactions have been eliminated in consolidation. All business combinations accounted for under the acquisition method have been included in the consolidated financial statements from the respective dates of acquisition. The Company consolidates equity joint venture entities as the Company has controlling interests, has voting control over these entities, or has ability to exercise significant influence in these entities. The members of the Company's equity joint ventures participate in profits and losses in proportion to their equity interests. The Company, through wholly owned subsidiaries, leases home health licenses necessary to operate certain of its home nursing and hospice agencies. As with wholly owned subsidiaries, the Company owns 100% of the equity of these entities and consolidates them based on such ownership.
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| Revenue Recognition | Revenue Recognition Basis of Presentation Net service revenue from contracts with customers is recognized in the period the performance obligations are satisfied under the Company's contracts by transferring the requested services to patients in amounts that reflect the consideration to which is expected to be received in exchange for providing patient care, which is the transaction price allocated to the services provided in accordance with Topic 606 and ASU 2015-14, Revenue from Contracts with Customers (Topic 606): Deferral of the Effective Date (collectively, "ASC 606"). Net service revenue is recognized as performance obligations are satisfied, which can vary depending on the type of services provided. The performance obligation is the delivery of patient care in accordance with the requested services outlined in physicians' orders, which are based on specific goals for each patient. The performance obligations are associated with contracts in duration of less than one year; therefore, the optional exemption provided by ASC 606 was elected resulting in the Company not being required to disclose the aggregate amount of the transaction price allocated to the performance obligations that are unsatisfied or partially unsatisfied as of the end of the reporting period. The Company's unsatisfied or partially unsatisfied performance obligations are primarily completed when the patients are discharged and typically occur within days or weeks of the end of the period. The Company determines the transaction price based on gross charges for services provided, reduced by explicit price concessions and estimates for implicit price concessions. Explicit price concessions include contractual adjustments provided to patients and third-party payors. Implicit price concessions include discounts provided to self-pay, uninsured patients or other payors, adjustments resulting from regulatory reviews, audits, billing reviews and other matters. Subsequent changes to the estimate of the transaction price are recorded as adjustments to net service revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in the patient's ability to pay (i.e. change in credit risk) are recorded as a provision for doubtful accounts within general and administrative expenses. Explicit price concessions are recorded for the difference between our standard rates and the contracted rates to be realized from patients, third party payors and others for services provided. Implicit price concessions are recorded for self-pay, uninsured patients and other payors by major payor class based on historical collection experience, and current business and economic conditions, representing the difference between amounts billed and amounts expected to be collected. The Company assesses the ability to collect for the healthcare services provided at the time of patient admission based on the verification of the patient's insurance coverage under Medicare, Medicaid, and other commercial or managed care insurance programs. Amounts due from third-party payors, primarily commercial health insurers and government programs (Medicare and Medicaid), include variable consideration for retroactive revenue adjustments due to settlements of audits and reviews. The Company has determined estimates for price concessions related to regulatory reviews based on historical experience and success rates in the claim appeals and adjudication process. Revenue is recorded at amounts estimated to be realizable for services provided. MedicareThe following describes the payment models in effect during the twelve months ended December 31, 2022. Such payment models have been subject to temporary adjustments made by CMS in response to COVID-19 pandemic as described elsewhere in this Annual Report on Form 10-K. The 2% sequestration reduction adjustment was suspended for patient claims with dates of service that began May 1, 2020 through March 31, 2022. Medicare patient claims with dates of services between April 1 through June 30, 2022 had a 1% sequestration payment adjustment. Medicare patient claims with dates of service beginning July 1, 2022 had the full 2% sequestration payment adjustment. Home Health Services The Company records revenue as services are provided under the Patient Driven Groupings Model ("PDGM"). For each 30-day period, the patient is classified into one of 432 home health resource groups prior to receiving services. Each 30-day period is placed into a subgroup falling under the following categories: (i) timing being early or late, (ii) admission source being community or institutional, (iii) one of 12 clinical groupings based on the patient's principal diagnosis, (iv) functional impairment level of low, medium, or high, and (v) a co-morbidity adjustment of none, low, or high based on the patient's secondary diagnoses. Each 30-day period payment from Medicare reflects base payment adjustments for case-mix and geographic wage differences. In addition, payments may reflect one of three retroactive adjustments to the total reimbursement: (a) an outlier payment if the patient’s care was unusually costly; (b) a low utilization adjustment whereby the number of visits is dependent on the clinical grouping; and/or (c) a partial payment if the patient transferred to another provider or from another provider before completing the episode. The retroactive adjustments outlined above are recognized in net service revenue when the event causing the adjustment occurs and during the period in which the services are provided to the patient. The Company reviews these adjustments to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustments is subsequently resolved. Net service revenue and related patient accounts receivable are recorded at amounts estimated to be realized from Medicare for services rendered. Hospice Services The Company records revenue based upon the date of service at amounts equal to the estimated payment rates. The Company receives one of four predetermined daily rates based upon the level of care provided by the Company, which can be routine care, general inpatient care, continuous home care, and respite care. There are two separate payment rates for routine care: payment for the first 60-days of care and care beyond 60-days. In addition to the two routine rates, the Company may also receive a service intensity add-on ("SIA"). The SIA is based on visits made in the last seven days of life by a registered nurse or medical social worker for patients in a routine level of care. The performance obligation is the delivery of hospice services to the patient, as determined by a physician, each day the patient is on hospice care. Adjustments to Medicare revenue are made from regulatory reviews, audits, billing reviews and other matters. The Company estimates the impact of these adjustments based on our historical experience. Hospice payments are subject to variable consideration through an inpatient cap and an overall Medicare payment cap. The inpatient cap relates to individual programs receiving more than 20% of its total Medicare reimbursement from inpatient care services and the overall Medicare payment cap relates to individual programs receiving reimbursements in excess of a “cap amount,” determined by Medicare to be payment equal to 12 months of hospice care for the aggregate base of hospice patients, indexed for inflation. The determination for each cap is made annually based on the 12-month period ending on September 30 of each year. The Company monitors its limits on a provider-by-provider basis and records an estimate of its liability for reimbursements received in excess of the cap amount, if any, in the reporting period. Facility-Based Services Gross revenue is recorded as services are provided under the LTACH prospective payment system. Each patient is assigned a long-term care diagnosis-related group. The Company is paid a predetermined fixed amount intended to reflect the average cost of treating a Medicare LTACH patient classified in that particular long-term care diagnosis-related group. For selected LTACH patients, the amount may be further adjusted based on length-of-stay and facility-specific costs, as well as in instances where a patient is discharged and subsequently re-admitted, among other factors. The Company calculates the adjustment based on a historical average of these types of adjustments for LTACH claims paid. Similar to other Medicare prospective payment systems, the rate is also adjusted for geographic wage differences. Net service revenue adjustments resulting from reviews and audits of Medicare cost report settlements are considered implicit price concessions for LTACHs and are measured at expected value. Non-Medicare Revenue Other sources of net service revenue for all segments fall into Medicaid, managed care or other payors of the Company's services. Medicaid reimbursement is based on a predetermined fee schedule applied to each service provided. Therefore, revenue is recognized for Medicaid services as services are provided based on this fee schedule. The Company's managed care and other payors reimburse the Company based upon a predetermined fee schedule or an episodic basis, depending on the terms of the applicable contract. Accordingly, the Company recognizes revenue from managed care and other payors as services are provided, such costs are incurred, and estimates of expected payments are known for each different payer, thus the Company's revenue is recorded at the estimated transaction price. Contingent Service Revenues The HCI segment provides strategic health management services to Affordable Care Organizations ("ACOs") that have been approved to participate in the Medicare Shared Savings Program ("MSSP"). The HCI segment has service agreements with ACOs that provide for sharing of MSSP payments received by the ACO, if any. ACOs are legal entities that contract with CMS to provide services to the Medicare fee-for-service population for a specified annual period with the goal of providing better care for the individual, improving health for populations and lowering costs. ACOs share savings with CMS to the extent that the actual costs of serving assigned beneficiaries are below certain trended benchmarks of such beneficiaries and certain quality performance measures are achieved. The generation of shared savings is the performance obligation of each ACO, which only become certain upon the final issuance of unembargoed calculations by CMS, generally in the third quarter of each year. During the years ended December 31, 2022, 2021, and 2020, the HCI segment recorded net service revenue of $15.6 million, $12.1 million, and $9.6 million, respectively, related to the 2021, 2020 and 2019 ACO respective service periods, as certain ACOs served by the HCI segment received a MSSP payment from CMS confirming the performance obligation has been met.
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| Patient Accounts Receivable | Patient Accounts Receivable The Company reports patient accounts receivable from services rendered at their estimated transaction price, which includes price concessions based on the amounts expected to be due from payors. The Company's patient accounts receivable is uncollateralized and primarily consist of amounts due from Medicare, Medicaid, other third-party payors, and to a lesser degree patients. The credit risk from other payors is limited due to the significance of Medicare as the primary payor. The Company believes the credit risk associated with its Medicare accounts is limited due to (i) the historical collection rate from Medicare and (ii) the fact that Medicare is a U.S. government payor. The Company does not believe that there are any other significant concentrations from any particular payor that would subject it to any significant credit risk in the collection of patient accounts receivable.
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| Business Combinations | Business CombinationsThe Company accounts for its acquisitions in accordance with ASC 805, "Business Combinations" ("ASC 805") using the acquisition method of accounting. Assets typically acquired consist primarily of Medicare licenses, trade names, certificates of need, and/or non-compete agreements. The assets acquired and liabilities assumed, if any, are measured at fair value on the acquisition date using the appropriate valuation method. The noncontrolling interest associated with joint venture acquisitions is also measured and recorded at fair value as of the acquisition date. Goodwill represents the excess of the cost of an acquired entity over the net amounts assigned to assets acquired and liabilities assumed. The operations of the acquisitions are included in the consolidated financial statements from their respective dates of acquisition. |
| Insurance Programs | Insurance Programs The Company bears significant risk under its large-deductible workers’ compensation insurance program and its self-insured employee health program. Under the workers’ compensation insurance program, the Company bears risk up to $1.0 million per incident, after which stop-loss coverage is maintained. The Company purchases stop-loss insurance for the employee health plan and bear risk up to $0.5 million per incident. Malpractice and general patient liability claims for incidents which may give rise to litigation have been asserted against the Company by various claimants. The claims are in various stages of processing and some may ultimately be brought to trial. The Company currently carries professional liability insurance coverage on a claims made basis and general liability insurance coverage on an occurrence basis for this exposure with a $0.3 million deductible. The Company also carries Directors and Officers coverage (also on a claims made basis) for potential claims against the Company’s directors and officers, including securities actions, with a deductible of $2.5 million. The Company records estimated liabilities for its insurance programs based on information provided by the third-party plan administrators, historical claims experience, the life cycle of claims, expected costs of claims incurred but not paid, and expected costs to settle unpaid claims. The Company monitors its estimated insurance-related liabilities and recoveries, if any, on a monthly basis and records amounts due under insurance policies in other current assets, while recording the estimated carrier liability in self-insurance reserves. As facts change, it may become necessary to make adjustments that could be material to the Company’s results of operations and financial condition.
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| Goodwill | Goodwill Goodwill represents the excess of amounts paid for acquisitions over the fair value of net identifiable assets acquired less liabilities assumed. The Company assigns assets acquired, including goodwill, and liabilities assumed to one or more reporting units as of the date of the acquisition. The Company's reporting units are home health, hospice, home and community-based, LTACH, and HCI. The LTACHs are incorporated in the Company's facility-based operating segment. The other locations within the facility-based segment do not share in the economic benefits of the LTACH reporting unit, and as such, are excluded from the annual impairment testing. Goodwill and purchased intangible assets with indefinite useful lives are not amortized. ASC 350, "Intangibles - Goodwill and Other" ("ASC 350") requires that all indefinite-lived intangible assets, such as goodwill, be tested for impairment at least annually or sooner whenever events or changes in circumstances indicate that the asset is impaired. An entity may perform a qualitative assessment to determine whether it is necessary to perform the quantitative impairment test. In assessing whether the asset is impaired, the Company assess all relevant events and circumstances for each of the Company's reporting units. The Company performs its goodwill impairment testing on an annual basis as of November 30, and whenever events or changes in circumstances indicate that the carrying value of a reporting unit likely exceeds its fair value. This involves estimating the fair value of the reporting units using discounted cash flow models. For 2022, the Company performed its annual impairment review of goodwill at November 30. The Company assessed and reviewed factors such as: labor cost; financial performance, such as cash flows and planned revenue; regulatory factors; market considerations, such as market-dependent multiples; and access of capital. For 2022, the Company performed a qualitative assessment of goodwill for each of its reporting units. When performing its quantitative assessment, the Company determined the existence of events and circumstances that would lead to a determination that is more likely than not that the fair value of the reporting units for hospice, home and community-based, and LTACHs could be less than its carrying value. The Company was required to perform a quantitative assessment on these reporting units. The Company's quantitative assessment for the determination of impairment was made by comparing the carrying amount of the hospice, home and community-based, and LTACH reporting units with its fair value, calculated by a combination of market and discounted cash flow approaches. Minor changes to assumptions used in these approaches could have had a significant effect on the assessment of the fair value of these reporting units. The Company's home and community-based and LTACH reporting units fair value exceeded its respective carrying value by 5% and 1%, respectively. Both reporting units are at risk of failing step one of the impairment test in future quarters if financial performance continues to decrease and the cost of debt continues to increase.
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| Intangible assets: Indefinite-lived assets | Intangible assets: Indefinite-lived assets The Company also has indefinite-lived assets that are not subject to amortization expense such as trade names, certificates of need, and Medicare licenses to conduct specific operations within geographic markets. The Company has concluded that trade names, certificates of need, and licenses have indefinite lives, because there are no legal, regulatory, contractual, economic or other factors that would limit the useful lives of these intangible assets and the Company intends to renew and operate the certificates of need and licenses and use the trade names indefinitely. In some cases, the value of licenses and certificates of need is increased by moratoriums in effect. These indefinite-lived intangible assets are reviewed annually for impairment or more frequently if circumstances indicate impairment may have occurred. The Company performed a qualitative assessment and determined that it is not more likely than not that the fair values of these assets are less than the carrying amounts.
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| Intangible assets: Definite-lived assets | Intangible assets: Definite-lived assetsIncluded in intangible assets are definite-lived assets subject to amortization such as non-compete agreements, customer relationships, and defensive assets, which are defined as trade names that are not actively used. Amortization of definite-lived intangible assets is calculated on a straight-line basis over the estimated useful lives of the related assets, ranging from to 16 years. |
| Due to/from Governmental Entities | Due to/from Governmental EntitiesThe Company’s LTACHs are reimbursed for certain activities based on tentative rates. The amounts recorded in due to/from governmental entities on the Company’s consolidated balance sheets relate to settled and open cost reports that are subject to the completion of audits and the issuance of final assessments. Final reimbursement is determined based on submission of annual cost reports and audits by the fiscal intermediary. Adjustments are accrued on an estimated basis in the period the related services were rendered and further adjusted as final settlements are determined. These adjustments are accounted for as changes in estimates. Additionally, reimbursements received in excess of hospice cap amounts are recorded in this account, if any. |
| Property, Plant and Equipment | Property, Building and Equipment Property, building and equipment are recorded at cost. Property, building and equipment acquired in connection with business combinations are recorded at estimated fair value in accordance with the acquisition method of accounting in accordance with ASC 805. Expenditures that increase capacities or extend useful lives are capitalized to the appropriate property, building and equipment accounts. Costs and related accumulated depreciation associated with assets that are sold or retired are written off and any gain or loss are recorded in operating income. Routine repairs and maintenance costs are expensed as incurred. Depreciation is computed using the straight-line method over the estimated useful life of the individual assets. The estimated useful life of buildings is 39 years, while the estimated useful life of transportation equipment, fixed equipment, office furniture, and computer equipment range from to 15 years. The useful life for leasehold improvements is the shorter of the lease term or the expected life of the leasehold improvement. In accordance with ASC 360, "Property, Plant, and Equipment", the Company evaluates its long-lived assets for possible impairment whenever events or changes in circumstances occur that indicate that the carrying amount of the asset may not be recoverable.
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| Noncontrolling Interest | Noncontrolling Interest The Company classifies noncontrolling interests of its joint ventures based upon a review of the legal provisions governing the redemption of such interests. In each of the Company’s joint ventures, those provisions are embodied within the joint venture’s operating agreement. For joint ventures with operating agreement provisions that establish an obligation for the Company to purchase the third party partners’ noncontrolling interests other than as a result of events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as redeemable noncontrolling interests in temporary equity. For joint ventures with operating agreement provisions that establish an obligation that the Company purchase the third party partners’ noncontrolling interests, but which obligation is triggered by events that lead to a liquidation of the joint venture, such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. Additionally, for joint ventures with operating agreement provisions that do not establish an obligation for the Company to purchase the third party partners’ noncontrolling interests (e.g., where the Company has the option, but not the obligation, to purchase the third party partners’ noncontrolling interests), such noncontrolling interests are classified as nonredeemable noncontrolling interests in permanent equity. The Company’s equity joint ventures that are classified as redeemable noncontrolling interests are subject to operating agreement provisions that require the Company to purchase the noncontrolling partner’s interest upon the occurrence of certain triggering events, which are defined as the bankruptcy of the partner or the partner’s exclusion from the Medicare or Medicaid programs. These triggering events and the related repurchase provisions are specific to each redeemable equity joint venture, since the triggering of a repurchase obligation for any one redeemable noncontrolling interest in an equity joint venture does not necessarily impact any of the other redeemable noncontrolling interests in other equity joint ventures. Upon the occurrence of a triggering event requiring the purchase of a redeemable noncontrolling interest, the Company would be required to purchase the noncontrolling partner’s interest based upon a valuation methodology set forth in the applicable joint venture agreement. Redeemable noncontrolling interests and nonredeemable noncontrolling interests are initially recorded at their fair value as of the closing date of the transaction establishing the joint venture. Such fair values are determined using various accepted valuation methods, including the income approach, the market approach, the cost approach, and a combination of one or more of these approaches. A number of facts and circumstances concerning the operation of the joint venture are evaluated for each transaction, including (but not limited to) the ability to choose management, control over acquiring or liquidating assets, and control over the joint venture’s strategy and direction, in order to determine the fair value of the noncontrolling interest. Subsequent to the closing date of the transaction establishing the joint venture, recorded values for both redeemable and nonredeemable noncontrolling interests are adjusted at the end of each reporting period for (a) comprehensive income (loss) that is attributed to the noncontrolling interest, which is calculated by multiplying the noncontrolling interest percentage by the comprehensive income (loss) of the joint venture’s operations during the reporting period, (b) dividends paid to the noncontrolling interest partner during the reporting period, and (c) any other transactions that increase or decrease the Company’s ownership interest in the joint venture, as a result of which the Company retains its controlling interest. If the Company determines based upon its analysis as of the end of each reporting period in accordance with authoritative accounting guidance, that it is not probable that an event would occur to otherwise require the redemption of a redeemable noncontrolling interest (i.e., the date for such event is not set or such event is not certain to occur), then the Company does not adjust the recorded amount of such redeemable noncontrolling interest. The carrying amount of each redeemable equity instrument presented in temporary equity as of December 31, 2022 is not less than the initial amount reported for each instrument. The activity of noncontrolling interest-redeemable for the twelve months ended December 31, 2022, 2021, and 2020 is summarized in the Company’s statements of stockholders' equity. Based upon the Company’s evaluation of the redemption provisions concerning redeemable noncontrolling interests as of December 31, 2022, the Company determined in accordance with authoritative accounting guidance that it was not probable that an event otherwise requiring redemption of any redeemable noncontrolling interest would occur (i.e., the date for such event was not set or such event is not certain to occur). Therefore, none of the redeemable noncontrolling interests were identified as mandatorily redeemable interests at such times, and the Company did not record any values in respect of any mandatorily redeemable interests.
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| Share-Based Compensation | Stock-Based CompensationThe Company accounts for its stock-based awards in accordance with provisions of ASC 718, "Compensation - Stock Compensation" ("ASC 718"). The Company grants restricted stock or restricted stock units to employees and members of its Board of Directors as a form of compensation. In accordance with ASC 718, the expense for such awards is based on the grant date fair value of the award and is recognized on a straight-line basis over the requisite service period. |
| Fair Value of Financial Instruments | The carrying amounts of the Company’s cash, receivables, accounts payable, accrued liabilities, and operating lease right of use assets and liabilities approximate their fair values because of their short maturity. The estimated fair value of intangible assets acquired was calculated using level 3 inputs based on the present value of anticipated future benefits. |
Organization (Tables) |
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| Organization, Consolidation and Presentation of Financial Statements [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Net Service Revenues | The Company recognized the following amounts of net service revenue due to the suspension of the 2% sequestration payment adjustment and the suspension of LTACH site-neutral payments (amounts in thousands):
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Summary of Significant Accounting Policies (Tables) |
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| Accounting Policies [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Percentage of Net Service Revenue Earned by Category of Payor | The following table sets forth the percentage of net service revenue earned by category of payor for each segment for the years ending December 31:
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| Schedules of Percentage of Patient Accounts Receivable by Payor | The following table sets forth the percentage of patient accounts receivable by payor for the years ended December 31:
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| Schedule of Property, Plant and Equipment | The following table describes the Company’s components of property, building and equipment for the years ended December 31, 2022 and 2021 (amounts in thousands):
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| Schedule of Shares Used in Computation of Basic and Diluted Per Share Information | The following table sets forth shares used in the computation of basic and diluted per share information for the years ended December 31, 2022, 2021, and 2020:
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Acquisitions, Divestitures, and Joint Venture Activities (Tables) |
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| Business Combinations [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Recognized Identified Assets Acquired and Liabilities Assumed | The following table summarizes the amounts of the assets acquired and liabilities assumed at the acquisition dates, as well as their fair value at the acquisition dates and the noncontrolling interest acquired during the twelve months ended December 31, 2022 (amounts in thousands):
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Goodwill and Other Intangibles, Net (Tables) |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Dec. 31, 2022 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Changes in Goodwill by Segment | The following table summarizes changes in goodwill and other intangibles assets by segment during the twelve months ended December 31, 2022 and 2021 (amounts in thousands):
|
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| Schedule of Changes in Intangible Assets, Indefinite | The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2022 and 2021 (amounts in thousands):
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| Schedule of Changes in Intangible Assets, Finite | The following tables summarize the changes in intangible assets during the twelve months ended December 31, 2022 and 2021 (amounts in thousands):
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| Schedule of Estimated Intangible Asset Amortization Expense | The estimated intangible asset amortization expense for each of the five years subsequent to December 31, 2022 is as follows (amounts in thousands):
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Income Taxes (Tables) |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2022 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Income Tax Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Significant Components of Deferred Tax Assets and Liabilities | Significant components of the Company’s deferred tax assets and liabilities as of December 31, 2022 and 2021 were as follows (amounts in thousands):
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| Components of the Company’s Income Tax Expense | The components of the Company’s income tax expense from continuing operations, less noncontrolling interest, for the twelve months ended December 31, were as follows (amounts in thousands):
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| Statutory Rate and Provisions for Income Taxes | A reconciliation of the difference between the federal statutory tax rate and the Company's effective tax rate for income taxes for each of the twelve months ended December 31, were as follows:
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| Schedule of Unrecognized Tax Benefits | A reconciliation of the total amounts of unrecognized tax benefits follows:
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Debt (Tables) |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2022 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Principal Payments on Long-Term Debt | The scheduled principal payments on long-term debt for each of the five years subsequent to December 31, 2022 is as follows (amounts in thousands):
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Stockholders' Equity (Tables) |
12 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2022 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Equity [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Schedule of Share Grants Activity | The following table represents the share grants stock activity for the year ended December 31, 2022:
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| Schedule of Stock Options | The following table represents the share grants stock activity for the year ended December 31, 2022:
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| Schedule of Stock Option Outstanding, by Exercise Price Range | The following table summarizes information about stock options outstanding and exercisable at December 31, 2022:
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| Summary of Shares Issued Under Employee Stock Purchase Plan | The following table represents the shares issued during 2022, 2021, and 2020, under the Employee Stock Purchase Plan:
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Leases (Tables) |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2022 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Leases [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Assets and Liabilities, Lessee | The following table summarizes the operating lease right of use assets and related lease payables in the consolidated balance sheets at December 31, 2022 and 2021 (amounts in thousands):
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lease, Cost | The components of lease costs for operating leases for the years ended December 31, 2022, 2021, and 2020 were as follows: (amounts in thousands):
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Lessee, Operating Lease, Liability, Maturity | Maturities of operating lease payables as of December 31, 2022 were as follows (amounts in thousands):
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Information (Tables) |
12 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dec. 31, 2022 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Schedule of Segment Information | The following tables summarize the Company’s segment information for the twelve months ended December 31, 2022, 2021 and 2020 (amounts in thousands):
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization - Narrative (Details) |
12 Months Ended |
|---|---|
|
Dec. 31, 2022
state
serviceProvider
segment
| |
| Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
| Number of segments | segment | 5 |
| Number of service providers | serviceProvider | 920 |
| Number of states in which entity operates | state | 37 |
Organization - CARES Act (Details) - USD ($) $ in Thousands |
12 Months Ended | |
|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
|
| Organization, Consolidation and Presentation of Financial Statements [Abstract] | ||
| Contract liabilities - deferred revenue | $ 0 | $ 106,489 |
| Provider relief funds returned | 106,500 | |
| Employee-related liabilities | $ 26,800 | |
| Tax payments for employee related liabilities | $ 26,800 |
Organization - Schedule of Net Service Revenue (Details) - USD ($) $ in Thousands |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||
| Suspension of 2% sequestration payment adjustment | $ 9,952 | $ 26,768 | $ 18,137 |
| Suspension of LTACH site-neutral payment | $ 20,311 | $ 25,744 | $ 19,205 |
Summary of Significant Accounting Policies - Percentage of Patient Accounts Receivable by Payor (Details) - Customer concentration risk - Accounts Receivable |
12 Months Ended | |
|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
|
| Concentration Risk [Line Items] | ||
| Concentration risk percentage | 100.00% | 100.00% |
| Medicare | ||
| Concentration Risk [Line Items] | ||
| Concentration risk percentage | 65.60% | 60.30% |
| Medicaid | ||
| Concentration Risk [Line Items] | ||
| Concentration risk percentage | 5.20% | 7.50% |
| Managed Care, Commercial, and Other | ||
| Concentration Risk [Line Items] | ||
| Concentration risk percentage | 29.20% | 32.20% |
Summary of Significant Accounting Policies - Components of Property, Building and Equipment (Detail) - USD ($) $ in Thousands |
Dec. 31, 2022 |
Dec. 31, 2021 |
|---|---|---|
| Property, Plant and Equipment [Line Items] | ||
| Property, building and equipment, gross | $ 268,710 | $ 252,353 |
| Less accumulated depreciation | 114,427 | 98,394 |
| Property, building and equipment, net | 154,283 | 153,959 |
| Land | ||
| Property, Plant and Equipment [Line Items] | ||
| Property, building and equipment, gross | 7,339 | 7,339 |
| Building and leasehold improvements | ||
| Property, Plant and Equipment [Line Items] | ||
| Property, building and equipment, gross | 111,858 | 105,444 |
| Transportation equipment | ||
| Property, Plant and Equipment [Line Items] | ||
| Property, building and equipment, gross | 20,442 | 19,898 |
| Office furniture and medical equipment | ||
| Property, Plant and Equipment [Line Items] | ||
| Property, building and equipment, gross | 129,071 | 117,084 |
| Construction in progress | ||
| Property, Plant and Equipment [Line Items] | ||
| Property, building and equipment, gross | $ 0 | $ 2,588 |
Summary of Significant Accounting Policies - Shares Used in Computation of Basic and Diluted Per Share Information (Detail) - shares |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Accounting Policies [Abstract] | |||
| Weighted average number of shares outstanding for basic per share calculation (in shares) | 30,539,343 | 31,195,305 | 31,092,417 |
| Effect of dilutive potential shares: | |||
| Nonvested restricted stock (in shares) | 120,384 | 201,353 | 273,348 |
| Adjusted weighted average shares for diluted per share calculation (in shares) | 30,659,727 | 31,396,658 | 31,365,765 |
| Antidilutive shares (in shares) | 87,333 | 117,238 | 1,155 |
Summary of Significant Accounting Policies - Investments (Details) - USD ($) $ in Millions |
12 Months Ended | |
|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
|
| Post Acute Management Services Company | ||
| Summary Of Significant Accounting Policies [Line Items] | ||
| Investment, cost method | $ 15.0 | |
| LHCC Aging Innovations Fund I, LP | ||
| Summary Of Significant Accounting Policies [Line Items] | ||
| Investment, cost method | 0.2 | |
| Healthcare Analytics Company | ||
| Summary Of Significant Accounting Policies [Line Items] | ||
| Investment, cost method | $ 10.0 | |
| Jumpstart Nova Fund, LP | ||
| Summary Of Significant Accounting Policies [Line Items] | ||
| Investment, cost method | $ 0.1 | $ 0.1 |
Goodwill and Other Intangibles, Net - Schedule of Intangible Asset Future Amortization Expense (Detail) $ in Thousands |
Dec. 31, 2022
USD ($)
|
|---|---|
| Amortization amount | |
| 2023 | $ 2,708 |
| 2024 | 2,224 |
| 2025 | 1,860 |
| 2026 | 1,579 |
| 2027 | 656 |
| Total | $ 9,027 |
Income Taxes - Components of the Company’s Income Tax Expense (Detail) - USD ($) $ in Thousands |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Current: | |||
| Federal | $ (883) | $ 10,746 | $ 37,253 |
| State | 1,931 | 4,220 | 12,232 |
| Total Current | 1,048 | 14,966 | 49,485 |
| Deferred: | |||
| Federal | 14,677 | 17,699 | (10,800) |
| State | 1,236 | 5,022 | (2,642) |
| Total Deferred | 15,913 | 22,721 | (13,442) |
| Total income tax expense | $ 16,961 | $ 37,687 | $ 36,043 |
Income Taxes - Statutory Rate and Provisions for Income Taxes Percent (Detail) |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Income Tax Disclosure [Abstract] | |||
| Federal statutory tax rate | 21.00% | 21.00% | 21.00% |
| State income taxes, net of federal benefit | 8.10% | 4.80% | 5.20% |
| Nondeductible expenses | 5.40% | 1.40% | 1.90% |
| Uncertain tax position | (0.10%) | 0.10% | 1.50% |
| Cares Act Enactment | 0.00% | 0.00% | (2.90%) |
| Excess tax benefit | (1.80%) | (1.50%) | (1.70%) |
| Credits and other | (2.70%) | (1.20%) | (0.60%) |
| Effective tax rate | 29.90% | 24.60% | 24.40% |
Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Operating Loss Carryforwards [Line Items] | |||
| Excess tax benefits associated with stock-based compensation arrangements | $ 1,000 | $ 2,400 | |
| CARES Act Impact, tax benefit | 4,300 | ||
| Unrecognized tax benefits, period change | 2,100 | ||
| Unrecognized tax benefits | 7,219 | $ 7,320 | $ 6,203 |
| Domestic Tax Authority | |||
| Operating Loss Carryforwards [Line Items] | |||
| Operating loss carryforwards | 102,500 | ||
| Valuation allowance | 1,600 | ||
| State and Local Jurisdiction | |||
| Operating Loss Carryforwards [Line Items] | |||
| Operating loss carryforwards | 189,400 | ||
| Valuation allowance | $ 56,200 | ||
Income Taxes - Total Amounts of Unrecognized Tax (Detail) - USD ($) $ in Thousands |
12 Months Ended | |
|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
|
| Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward] | ||
| Beginning balance | $ 7,320 | $ 6,203 |
| Acquired unrecognized tax position | 0 | |
| Increased (decreased) in unrecognized tax benefits as a result of: | ||
| Tax positions taken in the current year | 304 | 1,244 |
| Lapse of statute of limitations | (405) | (127) |
| Ending balance | $ 7,219 | $ 7,320 |
Debt - Schedule of Principal Payments on Long-Term Debt (Detail) $ in Thousands |
Dec. 31, 2022
USD ($)
|
|---|---|
| Principal payment amount | |
| 2023 | $ 0 |
| 2024 | 0 |
| 2025 | 0 |
| 2026 | 733,000 |
| 2027 | 0 |
| Total | $ 733,000 |
Stockholders' Equity - Shares of Common Stock Issued Under Employee Stock Purchase Plan (Details) - $ / shares |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Equity [Abstract] | |||
| Shares issued during period (in shares) | 16,272 | 13,792 | 14,313 |
| Weighted average per share price of shares issued (in dollars per share) | $ 146.28 | $ 186.20 | $ 152.10 |
Leases - Additional information (Detail) |
Dec. 31, 2022 |
Dec. 31, 2021 |
|---|---|---|
| Lessee, Lease, Description [Line Items] | ||
| Operating lease term | 5 years | |
| Long-term operating lease payable | 3 years 7 months 6 days | 3 years 10 months 6 days |
| Weighted average discount rate | 4.36% | 4.22% |
| Minimum | ||
| Lessee, Lease, Description [Line Items] | ||
| Renewal term | 1 year | |
| Maximum | ||
| Lessee, Lease, Description [Line Items] | ||
| Renewal term | 9 years |
Leases - Information Related to Leases (Details) (Details) - USD ($) $ in Thousands |
Dec. 31, 2022 |
Dec. 31, 2021 |
|---|---|---|
| Leases [Abstract] | ||
| Operating lease right of use asset | $ 107,993 | $ 113,399 |
| Current operating lease payable | 36,445 | 37,630 |
| Long-term operating lease payable | $ 74,520 | $ 78,688 |
Leases - Lease Cost (Details) - USD ($) $ in Thousands |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Leases [Abstract] | |||
| Operating lease cost | $ 58,182 | $ 51,080 | $ 47,288 |
| Short-term lease cost | 3,128 | 3,480 | 4,273 |
| Variable lease cost | 4,569 | 4,013 | 4,187 |
| Total lease costs | $ 65,879 | $ 58,573 | $ 55,748 |
Leases - Future Minimum Rental Commitments Under Non-cancelable Operating Leases (Detail) $ in Thousands |
Dec. 31, 2022
USD ($)
|
|---|---|
| Leases [Abstract] | |
| 2023 | $ 40,077 |
| 2024 | 31,845 |
| 2025 | 23,424 |
| 2026 | 14,510 |
| Thereafter | 9,275 |
| Total future minimum lease payments | 119,131 |
| Less: Imputed interest | (8,166) |
| Total | $ 110,965 |
Employee Benefit Plan - Additional Information (Detail) - USD ($) $ in Millions |
12 Months Ended | ||
|---|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
Dec. 31, 2020 |
|
| Share-Based Payment Arrangement [Abstract] | |||
| Employer contribution as a percentage of employee contributions | 2.00% | ||
| Employer contribution | 25.00% | ||
| Full vesting period of employer contribution | 4 years | ||
| Contribution expenses | $ 12.0 | $ 12.6 | $ 11.9 |
Commitments and Contingencies - Additional Information (Detail) - USD ($) $ in Millions |
12 Months Ended | |
|---|---|---|
Dec. 31, 2022 |
Dec. 31, 2021 |
|
| Commitments and Contingencies Disclosure [Abstract] | ||
| Other assets, amount from government payors | $ 12.0 | $ 16.9 |
| Period of joint venture buy/sell option | 30 days | |
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