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American Renal Associates Holdings, Inc. – ‘10-K’ for 12/31/17 – ‘R36’

On:  Tuesday, 3/6/18, at 4:29pm ET   ·   For:  12/31/17   ·   Accession #:  1498068-18-12   ·   File #:  1-37751

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  As Of               Filer                 Filing    For·On·As Docs:Size

 3/06/18  American Renal Assocs Holdin… Inc 10-K       12/31/17  109:11M

Annual Report   —   Form 10-K   —   Sect. 13 / 15(d) – SEA’34
Filing Table of Contents

Document/Exhibit                   Description                      Pages   Size 

 1: 10-K        Annual Report                                       HTML   1.63M 
 2: EX-10.11    Material Contract                                   HTML     43K 
 3: EX-21.1     Subsidiaries List                                   HTML     90K 
 4: EX-23.1     Consent of Experts or Counsel                       HTML     27K 
 5: EX-31.1     Certification -- §302 - SOA'02                      HTML     35K 
 6: EX-31.2     Certification -- §302 - SOA'02                      HTML     35K 
 7: EX-32.1     Certification -- §906 - SOA'02                      HTML     30K 
 8: EX-32.2     Certification -- §906 - SOA'02                      HTML     30K 
15: R1          Document and Entity Information                     HTML     55K 
16: R2          Consolidated Balance Sheets                         HTML    121K 
17: R3          Consolidated Balance Sheets (Parenthetical)         HTML     46K 
18: R4          Consolidated Statements of Operations               HTML     98K 
19: R5          Consolidated Statements of Comprehensive Income     HTML     42K 
20: R6          Consolidated Statements of Changes in Equity        HTML    126K 
21: R7          Consolidated Statements of Changes in Equity        HTML     31K 
                (Parenthetical)                                                  
22: R8          Consolidated Statements of Cash Flows               HTML    166K 
23: R9          Basis of Presentation and Organization              HTML     34K 
24: R10         Summary of Significant Accounting Policies          HTML     93K 
25: R11         Initial Public Offering                             HTML     50K 
26: R12         Cash                                                HTML     34K 
27: R13         Prepaid Expenses and Other Current Assets           HTML     36K 
28: R14         Acquisitions                                        HTML     45K 
29: R15         Fair Value Measurements                             HTML    102K 
30: R16         Property and Equipment                              HTML     44K 
31: R17         Intangible Assets and Goodwill                      HTML     57K 
32: R18         Accrued Expenses and Other Current Liabilities      HTML     43K 
33: R19         Variable Interest Entities                          HTML     36K 
34: R20         Noncontrolling Interests Subject to Put Provisions  HTML     59K 
35: R21         Changes in Ownership Interest in Consolidated       HTML     45K 
                Subsidiaries                                                     
36: R22         Debt                                                HTML     76K 
37: R23         Leases                                              HTML     53K 
38: R24         Income Taxes                                        HTML    101K 
39: R25         Earnings (Loss) Per Share                           HTML     69K 
40: R26         Equity                                              HTML     34K 
41: R27         Stock-Based Compensation                            HTML    113K 
42: R28         Related Party Transactions                          HTML     47K 
43: R29         Commitments and Contingencies                       HTML     36K 
44: R30         Certain Legal Matters                               HTML     47K 
45: R31         Employee Benefit Plan                               HTML     30K 
46: R32         Concentrations                                      HTML     32K 
47: R33         Selected Quarterly Financial Data (Unaudited)       HTML     76K 
48: R34         Subsequent Event                                    HTML     30K 
49: R35         Schedule Ii - Valuation and Qualifying Accounts     HTML     45K 
50: R36         Summary of Significant Accounting Policies          HTML    138K 
                (Policies)                                                       
51: R37         Summary of Significant Accounting Policies          HTML     31K 
                (Tables)                                                         
52: R38         Cash (Tables)                                       HTML     33K 
53: R39         Prepaid Expenses and Other Current Assets (Tables)  HTML     36K 
54: R40         Acquisitions (Tables)                               HTML     37K 
55: R41         Fair Value Measurements (Tables)                    HTML     98K 
56: R42         Property and Equipment (Tables)                     HTML     43K 
57: R43         Intangible Assets and Goodwill (Tables)             HTML     59K 
58: R44         Accrued Expenses and Other Current Liabilities      HTML     44K 
                (Tables)                                                         
59: R45         Noncontrolling Interests Subject to Put Provisions  HTML     53K 
                (Tables)                                                         
60: R46         Changes in Ownership Interest in Consolidated       HTML     46K 
                Subsidiaries (Tables)                                            
61: R47         Debt (Tables)                                       HTML     57K 
62: R48         Leases (Tables)                                     HTML     47K 
63: R49         Income Taxes (Tables)                               HTML     99K 
64: R50         Earnings (Loss) Per Share (Tables)                  HTML     67K 
65: R51         Stock-Based Compensation (Tables)                   HTML    100K 
66: R52         Selected Quarterly Financial Data (Unaudited)       HTML     75K 
                (Tables)                                                         
67: R53         Basis of Presentation and Organization (Details)    HTML     42K 
68: R54         Summary of Significant Accounting Policies          HTML     96K 
                (Details)                                                        
69: R55         Initial Public Offering (Details)                   HTML    124K 
70: R56         Cash (Details)                                      HTML     37K 
71: R57         Prepaid Expenses and Other Current Assets           HTML     34K 
                (Details)                                                        
72: R58         Acquisitions (Details)                              HTML     53K 
73: R59         Fair Value Measurements - Narrative (Details)       HTML     40K 
74: R60         Fair Value Measurements - Schedule of fair value    HTML     85K 
                (Details)                                                        
75: R61         Fair Value Measurements - Fair value rollforward    HTML     37K 
                of tax receivable agreement liability (Details)                  
76: R62         Property and Equipment (Details)                    HTML     50K 
77: R63         Intangible Assets and Goodwill - Schedule of        HTML     52K 
                intangible assets (Details)                                      
78: R64         Intangible Assets and Goodwill - Estimated annual   HTML     44K 
                amortization expense (Details)                                   
79: R65         Intangible Assets and Goodwill - Changes in the     HTML     38K 
                value of goodwilll (Details)                                     
80: R66         Accrued Expenses and Other Current Liabilities      HTML     45K 
                (Details)                                                        
81: R67         Variable Interest Entities (Details)                HTML     32K 
82: R68         Noncontrolling Interests Subject to Put Provisions  HTML     61K 
                (Details)                                                        
83: R69         Changes in Ownership Interest in Consolidated       HTML     45K 
                Subsidiaries (Details)                                           
84: R70         Debt - Schedule of long term-term debt (Details)    HTML     56K 
85: R71         Debt - Narrative (Detail)                           HTML    126K 
86: R72         Debt Debt - Scheduled maturities of long-term debt  HTML     47K 
                (Details)                                                        
87: R73         Leases (Details)                                    HTML     47K 
88: R74         Leases - Schedule of Future Minimum Lease Payments  HTML     82K 
                (Details)                                                        
89: R75         Income Taxes - Provision (Benefit) for Income       HTML     48K 
                Taxes (Details)                                                  
90: R76         Income Taxes - Significant components of deferred   HTML     67K 
                tax assets and liabilities (Details)                             
91: R77         Income Taxes Income Taxes - Narrative (Details)     HTML     37K 
92: R78         Income Taxes - Reconciliation of the federal        HTML     51K 
                statutory rate (Details)                                         
93: R79         Earnings (Loss) Per Share (Details)                 HTML     68K 
94: R80         Equity (Details)                                    HTML     50K 
95: R81         Stock-Based Compensation - Narrative (Details)      HTML     61K 
96: R82         Stock-Based Compensation - Equity Grants,           HTML     35K 
                Assumptions and Activity (Details)                               
97: R83         Stock-Based Compensation - Assumptions used for     HTML     50K 
                options granted (Details)                                        
98: R84         Stock-Based Compensation - Stock option activity    HTML     94K 
                (Details)                                                        
99: R85         Stock-Based Compensation - Restricted stock         HTML     62K 
                activity (Details)                                               
100: R86         Related Party Transactions (Details)                HTML     87K  
101: R87         Commitments and Contingencies (Details)             HTML     35K  
102: R88         Certain Legal Matters (Details)                     HTML     52K  
103: R89         Employee Benefit Plan (Details)                     HTML     29K  
104: R90         Concentrations (Details)                            HTML     28K  
105: R91         Selected Quarterly Financial Data (Unaudited)       HTML     51K  
                (Details)                                                        
106: R92         Schedule Ii - Valuation and Qualifying Accounts     HTML     37K  
                (Details)                                                        
108: XML         IDEA XML File -- Filing Summary                      XML    189K  
107: EXCEL       IDEA Workbook of Financial Reports                  XLSX    126K  
 9: EX-101.INS  XBRL Instance -- ara-20171231                        XML   2.46M 
11: EX-101.CAL  XBRL Calculations -- ara-20171231_cal                XML    342K 
12: EX-101.DEF  XBRL Definitions -- ara-20171231_def                 XML    725K 
13: EX-101.LAB  XBRL Labels -- ara-20171231_lab                      XML   2.22M 
14: EX-101.PRE  XBRL Presentations -- ara-20171231_pre               XML   1.28M 
10: EX-101.SCH  XBRL Schema -- ara-20171231                          XSD    218K 
109: ZIP         XBRL Zipped Folder -- 0001498068-18-000012-xbrl      Zip    306K  


‘R36’   —   Summary of Significant Accounting Policies (Policies)


This is an IDEA Financial Report.  [ Alternative Formats ]



 
v3.8.0.1
Summary of Significant Accounting Policies (Policies)
12 Months Ended
Accounting Policies [Abstract]  
Basis of Presentation and Consolidation
Basis of Presentation and Consolidation
 
The accompanying consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”). Our consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries and variable interest entities that operate its clinics (“joint ventures”). For its joint ventures, the Company has determined that a majority voting interest and/or contractual rights granted to it provides the Company with the ability to direct the activities of these entities, and therefore the Company has determined that it is the primary beneficiary of these entities. Accordingly, the financial results of these joint ventures are fully consolidated into the Company’s operating results. The equity interests of the outside investors in the equity and results of operations of these consolidated entities are accounted for and presented as noncontrolling interests. All significant intercompany balances and transactions of our wholly owned subsidiaries and joint ventures, including management fees from subsidiaries, are eliminated in consolidation.

For the year ended December 31, 2017, certain amounts within the Financing Activities section of the Statements of Cash Flows are shown gross to reflect the debt refinancing that was completed during the year. This presentation differs from previously filed quarterly reports for the interim periods ended June 30, 2017 and September 30, 2017, which were shown on a net cash basis.  We concluded that the change in the presentation is immaterial to these interim financial statements as there is no impact on net cash used in financing activities.
Use of Estimates
Use of Estimates
 
The preparation of financial statements in conformity with U.S GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, and contingencies. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time made. All significant assumptions and estimates underlying the reported amounts in the consolidated financial statements and accompanying notes are regularly reviewed and updated. Changes in estimates are reflected in the financial statements based upon ongoing actual experience, trends, or subsequent settlements and realizations, depending on the nature and predictability of the estimates and contingencies.
 
The most significant assumptions and estimates underlying these financial statements and accompanying notes involve revenue recognition and provisions for uncollectible accounts, impairments and valuation adjustments, the useful lives of property and equipment, fair value measurements, accounting for income taxes, acquisition accounting valuation estimates, commitments and contingencies and stock‑based compensation. Specific risks and contingencies related to these estimates are further addressed within the notes to the consolidated financial statements.
Segment Information
Segment Information
 
Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision‑maker, or decision‑making group, in making decisions how to allocate resources and assess performance. The Company views its operations and manages its business as one reportable business segment, the ownership and operation of dialysis clinics, all of which are located in the United States.
Contingencies
Contingencies
 
The Company and its subsidiaries are defendants in various legal actions in the normal course of business. We record a liability when we believe that it is probable that a loss has been incurred, and the amount can be reasonably estimated. If we determine that a loss is reasonably possible and the loss or range of loss can be estimated, we disclose the possible loss in the Notes to the Consolidated Financial Statements.
 
We evaluate, on a quarterly basis, developments in our legal matters that could affect the amount of liability that has been previously accrued, and the matters and related reasonably possible losses disclosed, and make adjustments and changes to our disclosures as appropriate. Significant judgment is required to determine both likelihood of there being and the estimated amount of a loss related to such matters. Until the final resolution of such matters, there may be an exposure to loss in excess of the amount recorded, and such amounts could be material. Should any of our estimates and assumptions change or prove to have been incorrect, it could have a material impact on our business, consolidated financial position, results of operations, or cash flows.
Fair Value Measurements
Fair Value Measurements
 
The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities and noncontrolling interests. The Company also has classified certain assets, liabilities and noncontrolling interests subject to put provisions that are measured at fair value into the appropriate fair value hierarchy levels. The determination of the fair value of these assets and liabilities is a critical accounting estimate that involves significant judgements and assumptions and may not be indicative of the actual values at which these assets could be sold to a third party or at which these obligations could be settled.
Accounts Receivable
Accounts Receivable
 
Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability and net realizable value of the Company’s accounts receivable, the Company analyzes its historical cash collection experience and trends for each of its government payors and commercial payors to estimate the adequacy of the allowance for doubtful accounts and the amount of the provision for bad debts. Management regularly updates its analysis based upon the most recent information available to determine its current provision for bad debts and the adequacy of its allowance for doubtful accounts. For receivables associated with services provided to patients covered by government payors, like Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for bad debts on the remaining balance due depending upon the Company’s estimate of the amounts ultimately collectible from other secondary coverage sources or from the patients. For receivables associated with services to patients covered by commercial payors that are either based upon contractual terms or for non‑contracted health plan coverage, the Company provides an allowance for doubtful accounts and a provision for bad debts based upon its historical collection experience and potential inefficiencies in its billing processes and for which collectability is determined to be unlikely. Receivables where the patient is the primary payor make up less than 2% of the Company’s accounts receivable. It is the Company’s policy to reserve for a portion of these outstanding accounts receivable balances based on historical collection experience and for which collectability is determined to be unlikely.
 
Patient accounts receivable from the Medicare and Medicaid programs were $97,594 and $91,967 at December 31, 2017 and 2016, respectively, which does not include reductions due to contractual allowances and bad debts. No other single payor accounted for more than 10% of total patient accounts receivable.
Inventories
Inventories
 
Inventories are stated at the lower of cost (first‑in, first‑out method) or market, and consist principally of pharmaceuticals and dialysis‑related consumable supplies.
Property and Equipment
Property and Equipment
 
We account for property and equipment at cost less accumulated depreciation and amortization. Depreciation is being recorded over the remaining useful lives. Property and equipment acquired as part of an acquisition are recorded at fair value and other purchases are stated at cost with depreciation calculated using the straight‑line method over their estimated useful lives as follows:
 
Buildings
39 years
Leasehold improvements
Shorter of lease term or useful lives
Equipment and information systems
3 to 10 years

 
Upon retirement or sale, the cost and related accumulated depreciation are removed from the accounts, and any resulting gain or loss is credited or charged to income. Maintenance and repairs are charged to expense as incurred.
Amortizable Intangible Assets
Amortizable Intangible Assets
 
Amortizable intangible assets include noncompete agreements, certificates of need and right of first refusal waivers. Each of these assets is amortized on a straight‑line basis over the term of the agreement, which is generally 5 to 10 years.
Identified Non Amortizable Intangible Assets and Goodwill
Identified Non‑Amortizable Intangible Assets and Goodwill
 
Goodwill represents the excess cost of a business acquisition over the fair value of the net assets acquired. Indefinite‑life identifiable intangible assets and goodwill are not amortized but are tested for impairment at least annually. The Company performs its annual review in the fourth quarter of each year, or more frequently if indicators of potential impairment exist, to determine if the carrying value of the recorded goodwill or indefinite lived intangible assets is impaired. If an asset is impaired, the difference between the value of the asset reflected on the financial statements and its current fair value is recognized as an expense in the period in which the impairment occurs.
 
Each reporting period, the Company can elect to initially perform a qualitative assessment to determine whether it is necessary to perform the quantitative goodwill impairment test. If the Company believes, as a result of its qualitative assessment, that it is not more likely than not that the fair value of a reporting unit containing goodwill is less than its carrying amount, then the quantitative goodwill impairment test is unnecessary. If the Company elects to bypass the qualitative assessment option, or if the qualitative assessment was performed and resulted in the Company being unable to conclude that it is not more likely than not that the fair value of a reporting unit containing goodwill is less than its carrying amount, the Company will perform the quantitative goodwill impairment test. The Company performs the quantitative goodwill impairment test by calculating the fair value of the reporting unit using a discounted cash flow method, and then comparing the fair value with the carrying amount of the reporting unit. If the carrying amount of the reporting unit exceeds its fair value, the Company records the difference as an impairment loss, if any.  Such analysis is based on macro-economic factors and research, current financial information such as current results of operations and balance sheets, and projected financial results,which include only anticipated growth from current operations.  The weighted average cost of capital method is used to determine the discount rate and the Gordon Growth Model is used to determine the residual value necessary for the discounted cash flow method.  Changes in the estimates or assumptions used in these models could impact the results of the valuations.  Based on these assessments and tests, we have concluded there was no impairment for the years ended December 31, 2017 and 2016.

The Company has elected to early adopt Accounting Standards Update (“ASU”) 2017-04, Intangibles - Goodwill and Other (Topic 350) - Simplifying the Test for Goodwill Impairment, effective with the annual review performed in the fourth quarter of 2017.  These amendments eliminate Step 2 from the goodwill impairment test in order to simplify the subsequent measurement of goodwill and are adopted on a prospective basis.
Impairment of Long-Lived Assets
Impairment of Long‑Lived Assets
 
Long‑lived assets include property and equipment and finite‑lived intangibles. In the event that facts and circumstances indicate that these assets may be impaired, an evaluation of recoverability at the lowest asset group level would be performed. If an evaluation is required, the estimated future undiscounted cash flows associated with the asset would be compared to the asset’s carrying amount to determine if a write‑down to fair value is required. The lowest level for which identifiable cash flows exist is the operating clinic level. A triggering event was not identified, and as such there was no impairment charge recorded for the years ended 2017 and 2016.
Net Patient Service Operating Revenues
Net Patient Service Operating Revenues
 
Patient service operating revenues are recognized as services are provided to patients and consist primarily of reimbursement for dialysis. A fee schedule is maintained for dialysis treatment and other patient services; however, actual collectible revenue is normally at a discount to the fee schedule. Medicare and Medicaid programs are billed at predetermined net realizable rates per treatment that are established by statute or regulation. Revenue for contracted payors is recorded at contracted rates and other payors are billed at usual and customary rates, and a contractual allowance is recorded to reflect the expected net realizable revenue for services provided. Contractual allowances, along with provisions for uncollectible amounts, are estimated based upon contractual terms, regulatory compliance, and historical collection experience. Net revenue recognition and allowances for uncollectible billings require the use of estimates of the amounts that will actually be realized.
 
Patient service operating revenues may be subject to adjustment as a result of (i) examinations of the Company or Medicare or Medicaid Managed Care programs that the Company serves, by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different fiscal intermediaries or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of service provided; (iv) retroactive applications or interpretations of governmental requirements; and (v) claims for refund from private payors, including as the result of government actions.
 
Patient service operating revenues associated with patients whose primary coverage is under governmental programs, including Medicare and Medicaid, and Medicare or Medicaid Managed Care programs, accounted for approximately 63%, 56% and 58% of total patient service operating revenues for the years ended December 31, 2017, 2016 and 2015, respectively.
 
Patient service operating revenues are reduced by the provision for uncollectible accounts to arrive at net patient service operating revenues.
Income Taxes
Income Taxes
 
The Company accounts for income taxes under the liability approach. Under this approach, deferred tax assets and liabilities are recognized based upon temporary differences between the financial statement and tax bases of assets and liabilities, as measured by the enacted tax rates, which will be in effect when these differences reverse. Deferred tax expense or benefit is the result of changes in deferred tax assets and liabilities between reporting periods. A valuation allowance is established when, based on an evaluation of objectively verifiable evidence, there is a likelihood that some portion or all of the deferred tax assets will not be realized.
 
The Company’s income tax provision (benefit) relates to its share of pre‑tax income (losses) from its ownership interest in its subsidiaries as these entities are pass‑through entities for tax purposes. Accordingly, the Company is not taxed on the share of pre‑tax income attributable to noncontrolling interests, and net income attributable to noncontrolling interests in our consolidated financial statements has not been presented net of income taxes attributable to these noncontrolling interests.
 
The Company recognizes a tax position in its financial statements when that tax position, based solely upon its technical merits, is more likely than not to be sustained upon examination by the relevant taxing authority. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. In addition, the recognition threshold of more‑likely‑than‑not must continue to be met in each reporting period to support continued recognition of the tax benefit. Tax positions that previously failed to meet the more‑likely‑than‑not recognition threshold are recognized in the first financial reporting period in which that threshold is met. Previously recognized tax positions that no longer meet the more‑likely‑than‑not recognition threshold are derecognized in the financial reporting period in which that threshold is no longer met. The Company recognizes interest and penalties related to unrecorded tax positions in its income tax expense.
Noncontrolling Interests
Noncontrolling Interests
 
Noncontrolling interests represent the proportionate equity interests of other partners in the Company’s consolidated subsidiaries, which are not wholly owned. The Company classifies noncontrolling interests not subject to put provisions as a separate component of equity, but apart from the Company’s equity. The Company presents consolidated net income (loss) and comprehensive income attributable to the Company and to noncontrolling interests on the face of the consolidated statements of operations and statements of comprehensive income, respectively. In addition, changes in the Company’s ownership interest while the Company retains a controlling financial interest are accounted for as equity transactions.

Member interests with redemption features that are not solely within the Company’s control, such as the Company’s noncontrolling interests that are subject to put provisions, are presented outside of permanent equity and are measured at the greater of the noncontrolling interest balance determined pursuant to ASC 810-10, Consolidation, or the redemption value. Changes in the fair value of noncontrolling interests subject to put provisions are accounted for as equity transactions. Subsequent measurements are accounted for under the guidance set forth in ASC 480, Distinguishing Liabilities from Equity. Equity instruments that are currently redeemable are adjusted to the maximum redemption amount at the balance sheet date and are presented in temporary equity based on the conditions that exist as of the balance sheet date. In instances where the equity instrument is not currently redeemable and the Company has determined that it is probable that the equity instrument may become redeemable, the Company recognizes the change in the redemption value immediately as it occurs and adjusts the carrying amount of the instrument to equal the redemption value as of the balance sheet date. Changes in the redemption value over fair value are recognized as reductions of earnings available to shareholders of the Company. The Company does not have any instruments that are not currently redeemable in which it is probable that the instrument may become redeemable. At the balance sheet date, the amount presented in temporary equity is no less than the initial amount reported in temporary equity for the instrument. We estimate the fair value of the noncontrolling interests subject to these put provisions using an average multiple of earnings, based on historical earnings and other factors. The estimate of the fair values of the interests subject to these put provisions is a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which these obligations may ultimately be settled in the future. The estimated fair values of the interests subject to these put provisions can also fluctuate and the implicit multiple of earnings at which these obligations may be settled will vary depending upon market conditions and access to the credit and capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses and the economic performance of these businesses.
Stock-Based Compensation
Stock‑Based Compensation
 
The Company measures and recognizes compensation expense for all share‑based payment awards based on estimated fair values at the date of grant. Determining the fair value of share‑based awards requires judgment in developing assumptions, which involve a number of variables. We calculate fair value by using a Monte Carlo simulation‑based approach for the portion of the option that contain both a market and performance condition and the Black‑Scholes valuation model for the portion of the option that contains a performance or a service‑based condition. The fair value of restricted stock awards is equal to the closing sale price of the Company’s common stock on the date of grant.

Key inputs used to estimate the fair value of stock options include the exercise price of the award, the expected term of the option, the expected volatility of the common stock over the option’s expected terms, the risk‑free interest rate over the option’s expected term and the Company’s expected annual dividend yield. Since we have limited history as a public company and do not yet have sufficient trading history for our common stock, the expected volatility was estimated based on the historical equity volatility of common stock of comparable publicly traded entities over a period equal to the expected term of the stock option grants. For each of the comparable publicly traded entities, the historical equity volatility and the capital structure of the entity were used to calculate the implied stock volatility. The average implied stock volatility of the comparable publicly traded entities was then used to calculate a relevered equity volatility for the Company based on the Company’s own capital structure. The comparable entities from the healthcare sector were chosen based on area of specialty. We will continue to apply this process until a sufficient amount of historical information regarding the volatility of our own stock price becomes available. Stock‑based compensation expense for performance or service‑based stock awards is recognized over the requisite service period using the straight‑line method, which is generally the vesting period of the equity award, and is adjusted each period for actual forfeitures. The Company adopted the provision of ASU 2016-9, Compensation – Stock Compensation (Topic 718) – Improvements to Employee Share-Based Payment Accounting as of July 1, 2016.  Upon early adoption, the Company elected to change its accounting policy to recognize forfeitures as they occur.  The change was applied on a modified retrospective basis.  See “Note 19 - Stock-Based Compensation” for additional discussion. For market and performance awards whose vesting is contingent upon a specified event, we recognize stock compensation expense over the derived service period.
Interest Rate Swap and Cap Agreements
Interest Rate Swap and Cap Agreements
 
The Company carries a combination of interest rate caps and forward interest rate swap as a means of hedging its exposure to and volatility from variable‑based interest rate changes as part of its overall interest rate risk management strategy. The agreements are not held for trading or speculative purposes and have the economic effect of converting the LIBOR variable component of the Company’s interest rate to a fixed rate. These agreements are designated as cash flow hedges, and as a result, hedge‑effective gains or losses resulting from changes in fair values of these instruments are reported in other comprehensive income until such time as each swap or cap is realized, at which time the amounts are reclassified to other income (expense). The instruments are perfectly effective. In the event the critical terms of the agreements no longer match the Company's exposure, we will measure the ineffectiveness, and record those cumulative measurements in the noncash component of interest expense. Net amounts paid or received for each swap or cap that has settled has been reflected as adjustments to interest expense. These instruments do not contain credit risk contingent features.
Recent Accounting Pronouncements
Recent Accounting Pronouncements
 
In February 2018, the Financial Accounting Standards Board (“FASB”) issued ASU 2018-02 Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income.” This amendment provides for the reclassification of the effect of remeasuring deferred tax balances related to items within accumulated other comprehensive income (“AOCI”) to retained earnings resulting from the Tax Cuts and Jobs Act of 2017. For public business entities, the ASU is effective for fiscal years beginning after December 15, 2018, and interim periods within those years, with early adoption permitted. Adoption of this ASU is to be applied either in the period of adoption or retrospectively to each period in which the effect of the change in the tax laws or rates were recognized. The Company is currently assessing the impact of the new standard on its financial statements.

In August 2017, the FASB issued ASU 2017-12,  Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities, which amends and simplifies existing guidance in order to allow companies to more accurately present the economic effects of risk management activities in the financial statements. For public business entities, the ASU is effective for fiscal years beginning after December 15, 2018, and interim periods therein; however, early adoption by all entities is permitted upon its issuance. The Company does not believe this ASU will have a material impact on its financial statements.
In January 2017, the FASB issued ASU 2017-04 Intangibles - Goodwill and Other (Topic 350) - Simplifying the Test for Goodwill Impairment.” These amendments eliminate Step 2 from the goodwill impairment test. The amendments also eliminate the requirements for any reporting unit with a zero or negative carrying amount to perform a qualitative assessment and, if it fails that qualitative test, to perform Step 2 of the goodwill impairment test. An entity still has the option to perform the qualitative assessment for a reporting unit to determine if the quantitative impairment test is necessary. The guidance is effective for annual or any interim goodwill impairment tests in fiscal years beginning after December 15, 2019. Early adoption is permitted for interim or annual goodwill impairment tests performed on testing dates after January 1, 2017. ASU 2017-04 should be adopted on a prospective basis. The Company adopted the guidance as of October 1, 2017, which did not have a material impact on the Company's financial statements.

In August 2016, the FASB issued ASU 2016-15, Statement of Cash Flows (Topic 230). The objective of this update is to provide additional guidance and reduce diversity in practice when classifying certain transactions within the statement of cash flows. In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash. The new standard requires that the statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. These standards are effective for financial statements issued for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years. Early application is permitted for all organizations. The Company adopted the provisions of ASU 2016-18 as of January 1, 2017 and applied it retrospectively for all periods presented, which did not have a material impact on the Company's financial statements.
 
In March 2016, the FASB issued ASU 2016-09, Compensation – Stock Compensation (Topic 718) – Improvements to Employee Share-Based Payment Accounting. The ASU identifies areas for simplification involving several aspects of share-based payment transactions, including the income tax consequences, classification of awards as equity or liabilities, an option to recognize gross stock compensation expense with actual forfeitures recognized as they occur, as well as certain classifications on the statement of cash flows. ASU 2016-09 is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. Early application is permitted for all organizations, and the Company adopted the provisions of ASU 2016-09 as of July 1, 2016. Upon early adoption, the Company elected to change its accounting policy to account for forfeitures as they occur. The change was applied on a modified retrospective basis resulting in an increase to stock compensation expense for the year ended December 31, 2016 of $354.  Amendments related to accounting for excess tax benefits have been adopted prospectively, resulting in recognition of excess tax benefits against income tax expenses rather than additional paid-in capital of $225 for the year ended December 31, 2016.  Excess tax benefits for share-based payments are now included in net operating cash rather than net financing cash. The changes have been applied prospectively in accordance with the ASU and prior periods have not been adjusted.
 
In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) – Leases: Amendments to the FASB Accounting Standards Codification. The amendments are expected to increase transparency and comparability by recognizing lease assets and liabilities from lessees on the balance sheet and disclosing key information about leasing arrangements in the financial statements. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. Early application is permitted for all organizations. The Company has engaged a professional services firm to assist in the implementation of ASU 2016-02. The Company expects a balance sheet extension due to the “on balance sheet” recognition of right of use assets and liabilities for agreed lease payment obligations related to certain leased clinics and buildings which are currently classified as operating leases. The impact on the Company will depend on the contract portfolio at the effective date, as well as the transition method. The Company does not expect any impact on the current debt covenants, as
described in Note 14 - Debt.  The Company expects to apply the modified retrospective method after review of the analysis is performed. The Company is currently assessing the impact the adoption of ASU 2016-02 will have on the consolidated financial statements, and has implemented significant lease accounting systems which will ultimately assist in the application of the new standard.
 
In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606), which requires companies to recognize revenue when a customer obtains control rather than when companies have transferred substantially all risks and rewards of a good or service. The FASB has issued additional updates to serve as clarification to the original standard update. The new standard also requires entities to enhance disclosures about the nature, amount, timing and uncertainty of revenue and cash flows arising from contracts with customers. The new standard allows for either a full retrospective or a modified retrospective transition method and is effective for fiscal years beginning after December 15, 2017.

The Company engaged a professional services firm and formed a revenue steering committee to assess the impact from the implementation of ASU 2014-09. The Company analyzed the impact of the standard by gaining an understanding of our service offerings, and reviewed contracts to identify potential differences that may result from applying the requirements of the new standard. Based on the procedures performed, there will not be a material change in the timing of revenue recognition; however, the Company notes that a majority of its provision for uncollectible accounts will be recognized as a direct reduction to patient service operating revenues, instead of separately as a deduction to arrive at net patient service operating revenue. The Company has adopted the standard as of January 1, 2018 using the modified retrospective method and will apply this guidance to any new contracts as well as contracts that are not completed contracts as of that date with no cumulative effect adjustment. The Company has also made progress on evaluating new disclosure requirements.

Dates Referenced Herein   and   Documents Incorporated by Reference

This ‘10-K’ Filing    Date    Other Filings
12/15/19
12/15/18
Filed on:3/6/188-K
1/1/18
For Period end:12/31/17
12/15/174,  8-K
10/1/17
9/30/1710-Q
6/30/1710-Q
1/1/17
12/31/1610-K
12/15/16
7/1/168-K
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