Nutex Health Inc.
For the period ended Mar 31, 2025. Filed May 13, 2025.
View on SEC.govAbout this filing
A company's report for each of its first three quarters. The financial statements are not audited. It shows how the business has moved since the last annual report, and what management says changed.
Mar 31, 2025 · Filed May 13, 2025
Extracted filing text, with the paragraph anchors used by the comparison.
See the whole filing, with its images and exhibitsContents
Item 1. Financial Statements
NUTEX HEALTH INC.
CONDENSED CONSOLIDATED BALANCE SHEETS
| | | | | | | |
|---|---|---|---|---|---|---|
| (In thousands, except share and per share amounts) · · March 31, 2025 · · December 31, 2024 | ||||||
| Assets | | | | | | |
| Current assets: | | | | | | |
| Cash and cash equivalents | | $87,670 | | $43,581 | ||
| Accounts receivable | | 295,082 | | 232,449 | ||
| Accounts receivable - related parties | | 4,258 | | 3,602 | ||
| Inventories | | 3,118 | | 2,850 | ||
| Prepaid expenses and other current assets | | | 11,389 | | | 9,998 |
| Total current assets | | | 401,517 | | | 292,480 |
| Property and equipment, net | | | 76,431 | | | 77,933 |
| Operating right-of-use assets | | | 27,466 | | | 27,872 |
| Finance right-of-use assets | | 216,193 | | 218,889 | ||
| Intangible assets, net | | | 15,205 | | | 15,530 |
| Goodwill, net | | 13,919 | | 13,919 | ||
| Deferred tax assets | | | 10,487 | | | 7,987 |
| Other assets | | | 698 | | | 711 |
| Total assets | | $761,916 | | $655,321 | ||
| | | | | | | |
| Liabilities and Equity | | | ||||
| Current liabilities: | | | ||||
| Accounts payable | | $19,836 | | $9,614 | ||
| Accounts payable - related parties | | 5,679 | | 4,345 | ||
| Lines of credit | | 7,126 | | 3,554 | ||
| Current portion of long-term debt | | 13,635 | | 14,395 | ||
| Operating lease liabilities, current portion | | | 2,103 | | | 2,080 |
| Finance lease liabilities, current portion | | | 8,027 | | | 7,705 |
| Accrued arbitration expenses | | | 51,803 | | | 47,742 |
| Accrued income tax expense | | | 43,718 | | | 25,989 |
| Accrued expenses and other current liabilities | | | 24,639 | | 25,442 | |
| Total current liabilities | | 176,566 | | 140,866 | ||
| Long-term debt, net | | | 21,733 | | | 22,466 |
| Operating lease liabilities, net | | | 30,350 | | | 30,617 |
| Finance lease liabilities, net | | | 258,387 | | | 259,479 |
| Total liabilities | | 487,036 | | 453,428 | ||
| | | | | | | |
| Commitments and contingencies (Note 9) | | | | | | |
| | | | | | | |
| Equity: | | | | | | |
| Common stock, $0.001 par value; 950,000,000 shares authorized; 5,528,448 and 5,511,452 shares issued and outstanding as of March 31, 2025 and December 31, 2024, respectively | | | 6 | | | 6 |
| Additional paid-in capital | | | 539,361 | | | 503,233 |
| Accumulated deficit | | | (342,259) | | | (356,893) |
| Nutex Health Inc. equity | | | 197,108 | | | 146,346 |
| Noncontrolling interests | | 77,772 | | | 55,547 | |
| Total equity | | | 274,880 | | | 201,893 |
| Total liabilities and equity | | $761,916 | | $655,321 | ||
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| (In thousands, except share and per share amounts) | 2025 | 2024 | ||||
| Revenue: | | | | | | |
| Hospital division | | $203,947 | | $60,029 | ||
| Population health management division | | | 7,842 | | | 7,424 |
| Total revenue | | | 211,789 | | | 67,453 |
| | | | | | | |
| Operating costs and expenses: | | | | | | |
| Payroll | | | 34,860 | | | 27,003 |
| Contract services | | | 38,655 | | | 11,319 |
| Medical supplies | | | 3,801 | | | 5,322 |
| Depreciation and amortization | | 5,092 | | 4,186 | ||
| Other | | | 11,043 | | | 9,466 |
| Total operating costs and expenses | | | 93,451 | | | 57,296 |
| | | | | | | |
| Gross profit | | | 118,338 | | | 10,157 |
| | | | | | | |
| Corporate and other costs: | | | | | | |
| Stock-based compensation | | | 36,094 | | | 49 |
| General and administrative expenses | | | 10,035 | | | 8,658 |
| Total corporate and other costs | | | 46,129 | | | 8,707 |
| | | | | | | |
| Operating income | | 72,209 | | | 1,450 | |
| | | | | | | |
| Interest expense, net | | | 6,120 | | | 4,444 |
| Gain on warrant liability | | | - | | | (2,601) |
| Other (income) expense | | 3,325 | | (241) | ||
| Income (loss) before taxes | | | 62,764 | | | (152) |
| | | | | | | |
| Income tax expense | | | 18,541 | | | 390 |
| | | | | | | |
| Net income (loss) | | | 44,223 | | | (542) |
| | | | | | | |
| Less: net income (loss) attributable to noncontrolling interests | | | 29,589 | | | (178) |
| | | | | | | |
| Net income (loss) attributable to Nutex Health Inc. | | $14,634 | | $(364) | ||
| | | | | | | |
| Income (loss) per common share: | | | | | | |
| Basic | | $2.65 | | $(0.08) | ||
| Diluted | | $2.56 | | $(0.08) | ||
CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY
| | | | | | | | | | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| · · Common Stock · · Additional Paid-in · · Accumulated · · Noncontrolling · · Total | |||||||||||||||||
| (In thousands, except share data) · Shares · Amount · Capital · Deficit · Interests · Equity | |||||||||||||||||
| | | | | | | | | | | | | | | | | | |
| Balance at December 31, 2023 | | 4,511,199 | | $5 | | $470,521 | | $(409,073) | | $17,652 | | $79,105 | |||||
| Common stock issued for Employee Stock Purchase Plan | | 746 | | | - | | | 19 | | | - | | | - | | | 19 |
| Common stock issuance for Securities Purchase Agreement | | 444,444 | | | - | | | 1,541 | | | - | | | - | | | 1,541 |
| Debt conversion to common stock | | 11,824 | | | - | | | 321 | | | - | | | - | | | 321 |
| Stock-based compensation | | - | | | - | | | 49 | | | - | | | - | | | 49 |
| Vesting of Restricted Stock Units | | 1,298 | | | - | | | - | | | - | | | - | | | - |
| Reverse stock split adjustment | | 2,426 | | | - | | | - | | | - | | | - | | | - |
| Distributions | | - | | | - | | | - | | | - | | | (481) | | | (481) |
| Net loss | | - | | | - | | | - | | | (364) | | | (178) | | | (542) |
| Balance at March 31, 2024 | | 4,971,937 | | $5 | | $472,451 | | $(409,437) | | $16,993 | | $80,012 | |||||
| | | | | | | | | | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Balance at December 31, 2024 | | 5,511,452 | | $6 | | $503,233 | | $(356,893) | | $55,547 | | $201,893 | |||||
| Common stock issued for Employee Stock Purchase Plan | | 1,161 | | | - | | | 40 | | | - | | | - | | | 40 |
| Stock-based compensation | | - | | | - | | | 36,088 | | | - | | | - | | | 36,088 |
| Vesting of Restricted Stock Units | | 15,835 | | | - | | | - | | | - | | | - | | | - |
| Distributions | | - | | | - | | | - | | | - | | | (7,364) | | | (7,364) |
| Net income | | - | | | - | | | - | | | 14,634 | | | 29,589 | | | 44,223 |
| Balance at March 31, 2025 | | 5,528,448 | | $6 | | $539,361 | | $(342,259) | | $77,772 | | $274,880 | |||||
| | | | | | | | | | | | | | | | | | |
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| (In thousands) | 2025 | 2024 | ||||
| Cash flows from operating activities: | | | | | | |
| Net income (loss) | | $44,223 | | $(542) | ||
| Adjustments to reconcile net income (loss) to net cash from operating activities: | | | | | | |
| Depreciation and amortization | | 5,092 | | | 4,186 | |
| Gain on warrant liability | | | - | | | (2,601) |
| Stock-based compensation expense | | | 36,094 | | | 49 |
| Deferred tax (benefit) expense | | (2,500) | | | (95) | |
| Debt accretion expense | | 253 | | | 365 | |
| Changes in operating assets and liabilities, net of the effects of acquisitions: | | | | | | |
| Accounts receivable | | | (62,633) | | | (2,909) |
| Accounts receivable - related party | | (656) | | | (62) | |
| Inventories | | | (268) | | | 415 |
| Prepaid expenses and other current assets | | (1,378) | | | 796 | |
| Operating right-of-use assets | | | 406 | | | 273 |
| Accounts payable | | 10,222 | | | (1,681) | |
| Accounts payable - related party | | | 1,334 | | | 475 |
| Operating lease liabilities | | | (245) | | | (376) |
| Accrued arbitration expenses | | | 4,061 | | | - |
| Accrued income tax expense | | | 17,729 | | | - |
| Accrued expenses and other current liabilities | | | (769) | | | 4,758 |
| Net cash from operating activities | | | 50,965 | | | 3,051 |
| | | | | | | |
| Cash flows from investing activities: | | | | | | |
| Acquisitions of property and equipment | | (64) | | | (733) | |
| Net cash from investing activities | | | (64) | | | (733) |
| | | | | | | |
| Cash flows from financing activities: | | | | | | |
| Proceeds from lines of credit | | | 3,864 | | | - |
| Proceeds from long-term debt | | | 157 | | | 2,915 |
| Repayments of lines of credit | | | (292) | | | (595) |
| Repayments of long-term debt | | | (1,810) | | | (4,388) |
| Repayments of finance leases | | (1,367) | | | (968) | |
| Proceeds from common stock issuance, net issuance costs | | | - | | | 9,203 |
| Members' distributions | | | (7,364) | | | (481) |
| Net cash from financing activities | | | (6,812) | | | 5,686 |
| Net change in cash, cash equivalents and restricted cash | | | 44,089 | | | 8,004 |
| Cash, cash equivalents and restricted cash - beginning of the period | | | 43,581 | | | 22,002 |
| Cash, cash equivalents and restricted cash - end of the period | | $87,670 | | $30,006 | ||
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
Note 1– Organization and Operations
Nutex Health Inc. (“Nutex Health” or the “Company”), is a physician-led, healthcare services and operations company with 24 hospital facilities in 11 states (hospital division), and a primary care-centric, risk-bearing population health management division. Our hospital division implements and operates different innovative health care models, including micro-hospitals, specialty hospitals and hospital outpatient departments. The population health management division owns and operates provider networks such as independent physician associations (“IPAs”).
We employ approximately 830 full-time employees, contract 255 doctors at our facilities and partner with over 2,100 physicians within our networks as of March 31, 2025. Our corporate headquarters is based in Houston, Texas. We were incorporated on April 13, 2000 in the state of Delaware.
Merger of Nutex Health Holdco LLC and Clinigence Holdings, Inc. On April 1, 2022, the merger (the “Merger”) of Nutex Health Holdco LLC and Clinigence Holdings, Inc. (“Clinigence”) was completed pursuant to the Agreement and Plan of Merger (the “Merger Agreement”) entered into on November 23, 2021 between Clinigence, Nutex Acquisition LLC (a Delaware limited liability company and wholly-owned subsidiary of Clinigence), Nutex, Micro Hospital Holding LLC (solely for the purposes of certain sections of the Merger Agreement), Nutex Health Holdco LLC and Thomas Vo, M.D., solely in his capacity as the representative of the equity holders of Nutex Health Holdco LLC.
In connection with the Merger Agreement, Nutex Health Holdco LLC entered into certain Contribution Agreements with holders of equity interests (“Nutex Owners”) of subsidiaries and affiliates (the “Nutex Subsidiaries”) pursuant to which such Nutex Owners agreed to contribute certain equity interests in the Nutex Subsidiaries to Nutex Health Holdco LLC in exchange for specified equity interests in Nutex Health Holdco LLC (collectively, the “Contribution Transaction”). Nutex Owners, having ownership interests representing approximately 84% of the agreed upon aggregate equity value of the Nutex Subsidiaries, agreed to contribute all or a portion of their equity interests, as applicable.
Pursuant to the Merger Agreement, each unit representing an equity interest in Nutex Health Holdco LLC that was issued and outstanding immediately prior to the effective time of the Merger (but following the Contribution Transaction) was converted into the right to receive 3.571428575 shares of Clinigence common stock, resulting in an aggregate issuance of 592,791,712 shares (3,951,944 after the 2024 Reverse Stock Splits) of Clinigence common stock.
After completing the merger, Clinigence was renamed Nutex Health Inc.
2024 Reverse Stock Splits.
1:10 Reverse stock split. In addition, the Company’s Board of Directors (the “Board”) determined to effect a reverse stock split of the common stock at a 1-for-10 ratio (the “1:10 Reverse Stock Split”) effective as of 11:59 pm Eastern time on July 2, 2024. The Company’s stockholders, at the annual meeting on June 17, 2024, had approved a reverse stock split within a range of 1:2 and 1:16 to be effected within one year of approval at the discretion of the Board. This 1:10 Reverse Stock Split is in addition to the Company’s previous 1:15 reverse stock split effective as of 11:59 pm Eastern time on April 9, 2024 (together, the “2024 Reverse Stock Splits”). The Company’s common stock began trading on The Nasdaq Stock Market (the “NASDAQ”) on a post-1:10 Reverse Stock Split basis under the Company’s existing trading symbol “NUTX” at the open of the market on July 3, 2024. The 1:10 Reverse Stock Split was also implemented for the purpose of regaining compliance with the minimum bid price requirement for continued listing of the Company’s common stock on the NASDAQ.
As a result of the 2024 Reverse Stock Splits, the Company had 5,511,452 shares of common stock outstanding as of December 31, 2024, inclusive of whole shares issued for fractional shares, and the number of authorized shares of common stock remains at 950,000,000. The Company had 5,528,448 shares of common stock outstanding as of March 31, 2025.
Unless otherwise indicated, all authorized, issued and outstanding stock and per share amounts contained in the accompanying unaudited condensed consolidated financial statements have been adjusted to reflect the 2024 Reverse Stock Splits for all prior periods presented. Proportionate adjustments for the 2024 Reverse Stock Splits were made to the exercise prices and number of shares issuable under the Company’s equity incentive plans, and the number of shares underlying outstanding equity awards, as applicable.
The impacts of the 2024 Reverse Stock Splits were applied retroactively for all periods presented in accordance with applicable guidance. Therefore, prior period amounts are different than those previously reported. Certain amounts within the following tables may not foot due to rounding.
The following table illustrates changes in equity, as previously reported prior to, and as adjusted subsequent to, the impact of the 2024 Reverse Stock Splits retroactively adjusted for the periods presented (dollars in thousands):
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · · March 31, 2024 | |||||||||
| | | | As Previously | | | Impact of 2024 Reverse | | | As |
| | | | Reported | | | Stock Splits | | | Revised |
| Common Stock - Shares | | | 49,719,375 | | | (44,747,438) | | | 4,971,937 |
| Common Stock - Amount | | $50 | | $(45) | | $5 | |||
| Additional Paid-in Capital | | $472,406 | | $45 | | $472,451 | |||
The following table illustrates changes in loss per share and weighted average shares outstanding, as previously reported prior to, and as adjusted subsequent to, the impact of the 2024 Reverse Stock Splits retroactively adjusted for the periods presented (dollars in thousands):
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · · Three months ended March 31, 2024 | |||||||||
| | | | As Previously | | | Impact of 2024 Reverse | | | As |
| | | | Reported | | | Stock Splits | | | Revised |
| Loss attributable to common stockholders | | $(364) | | $ | - | | $(364) | ||
| Weighted average shares used to compute basic and diluted EPS | | | 48,492,347 | | | (43,643,112) | | | 4,849,235 |
| Loss per share - basic and diluted | | $(0.01) | | $(0.07) | | $(0.08) | |||
The following outstanding stock options and warrants exercisable or issuable into shares of common stock were not included in the computation of diluted shares outstanding because the effect would be anti-dilutive:
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · · Three months ended March 31, 2024 | |||||||||
| | | | As Previously | | | Impact of 2024 Reverse | | | As |
| | | | Reported | | | Stock Splits | | | Revised |
| Common stock options | | | 275,810 | | | (248,220) | | | 27,590 |
| Common stock warrants | | | 6,518,681 | | | (5,866,900) | | | 651,781 |
Stock options were adjusted retroactively to give effect to the 2024 Reverse Stock Splits for the three months ended March 31, 2024:
| | | | | | | | | | | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| · · As Previously Reported · · Impact of the 2024 Reverse Stock Splits · · Revised | ||||||||||||||||||
| · · Options · · Weighted Average · · Options · · Weighted Average · · Options · · Weighted Average | ||||||||||||||||||
| · · Outstanding · · Exercise Price · · Outstanding · · Exercise Price · · Outstanding · · Exercise Price | ||||||||||||||||||
| Options outstanding at December 31, 2023 | | | 275,810 | | $33.58 | | | (248,220) | | $302.20 | | | 27,590 | | $335.78 | |||
| Options exercised | | | — | | | — | | | — | | | — | | | — | | | — |
| Options cancelled | | | — | | | — | | | — | | | — | | | — | | | — |
| Options outstanding at March 31, 2024 | | | 275,810 | | $33.58 | | | (248,220) | | $ | - | | | 27,590 | | $335.78 | ||
Warrants were adjusted retroactively to give effect to the 2024 Reverse Stock Splits for the three months ended March 31, 2024:
| | | | | | | | | | | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| · · As Previously Reported · · Impact of the 2024 Reverse Stock Splits · · Revised | ||||||||||||||||||
| · · Warrants · · Weighted Average · · Warrants · · Weighted Average · · Warrants · · Weighted Average | ||||||||||||||||||
| · · Outstanding · · Exercise Price · · Outstanding · · Exercise Price · · Outstanding · · Exercise Price | ||||||||||||||||||
| Warrants outstanding at December 31, 2023 | | | 1,356,237 | | $17.41 | | | (1,220,701) | | $140.75 | | | 135,537 | | $158.16 | |||
| Warrants issued | | | 4,444,444 | | | 2.25 | | | (4,000,000) | | | 20.25 | | | 444,444 | | | 22.50 |
| Warrants amended | | | 718,000 | | | 3.00 | | | (646,200) | | | 27.00 | | | 71,800 | | | 30.00 |
| Warrants exercised | | | - | | | - | | | - | | | - | | | - | | | - |
| Warrants expired | | | - | | | - | | | - | | | - | | | - | | | - |
| Warrants outstanding at March 31, 2024 | | | 6,518,681 | | $5.16 | | | (5,866,901) | | $ | - | | | 651,781 | | $51.56 | ||
Note 2 - Summary of Significant Accounting Policies
Basis of presentation. These unaudited condensed financial statements present the Company’s consolidated financial condition and results of operations including those of majority-owned subsidiaries and variable interest entities (“VIEs”) for which the Company is the primary beneficiary.
The hospital division includes the Company’s healthcare billing and collections organization and hospital entities. In addition, the Company has financial and operating relationships with multiple professional entities (the “Physician LLCs”) and real estate entities (the “Real Estate Entities”). The Physician LLCs employ the physicians who provide services at the Company’s hospitals. These Physician LLCs are consolidated by the Company as VIEs because they do not have sufficient equity at risk to finance their activities independently. The Company is considered the primary beneficiary of these entities because (i) it has the power to direct the activities that most significantly affect their economic performance through its contractuals and operational oversight, and (ii) it has the obligation to absorb losses and the right to receive benefits that could be significant, as evidenced by the Company’s historical practice of providing financial support during periods of cash shortfall and receiving the benefit of services.
The Real Estate Entities own the land and buildings used by the Company’s hospital entities and lease these facilities to the Company. These entities have mortgage loans payable to third parties which are collateralized by the land and buildings. The Company consolidates certain Real Estate Entities as VIEs when the Company’s hospital entities are guarantors or co-borrowers under the related mortgage loans. In such cases, the Company is considered the primary beneficiary because it has the power to direct the entities’ most significant activities and has the obligation to absorb losses and the right to receive benefits that could be significant to the Real Estate Entities.
While the Company does not hold any direct equity ownership in the consolidated Physician LLCs or Real Estate Entities, it is deemed to have an indirect economic interest through its contractual relationships with intermediary entities such as ER LLCs, which provide operational and functional support to the VIEs. As a result, 100% of the equity in these VIEs is reflected as noncontrolling interest in the Company’s unaudited condensed consolidated balance sheets and statements of operations. Certain of the Physician LLCs and Real Estate Entities are owned in part and, in some cases, controlled by related parties, including members of the Company’s executive management team.
The population health management division includes our management services organization. Additionally, Associated Hispanic Physicians of So. California (“AHISP”), an independent physician association (“IPA”) entity not owned by the Company, is consolidated as a VIE of the Company’s wholly-owned subsidiary AHP Health Management Services (“AHP”). AHP is deemed the primary beneficiary of AHISP because it has the power to direct the significant activities of AHISP through a comprehensive management services agreement and has the right to receive substantially all of the economic benefits from its operations.
All significant intercompany balances and transactions have been eliminated in consolidation.
Interim financial statements. These unaudited condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) regarding interim financial reporting. Accordingly, they do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”). The unaudited condensed consolidated financial statements include all material adjustments of a normal recurring nature that, in the opinion of management, are necessary for a fair presentation of the results of operations for the interim periods presented. These interim financial statements should be read together with the consolidated financial statements and notes thereto included in our audited financial statements for the year ended December 31, 2024.
Use of estimates. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amount of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include (i) estimates of net revenue and accounts receivable, (ii) fair value of acquired assets and liabilities in business combinations and (iii) impairment of long-lived assets and goodwill. Actual results could differ from those estimates. During the year ended December 31, 2024, we effected a change in estimate for estimates of net revenue and accounts receivable.
*Cash and cash equivalents.*The Company considers all highly liquid investments with an original maturity of three months or less to be cash and cash equivalents. The Company has cash amounts, that were at times material, held in covered banking institutions in excess of the insured amounts, but does not deem the risk of loss to be likely. The following is a summary of cash, cash equivalents and restricted cash as of March 31, 2025 and December 31, 2024 (in thousands):
| | | | | | | |
|---|---|---|---|---|---|---|
| · · March 31, · · December 31, | ||||||
| · · 2025 · · 2024 | ||||||
| Cash and cash equivalents | | $84,729 | | $40,640 | ||
| Restricted cash - short term | | | 2,941 | | | 2,941 |
| Cash, cash equivalents and restricted cash | | $87,670 | | $43,581 | ||
Segment reporting. A public company is required to report descriptive information about its reportable operating segments. Operating segments, as defined, are components of an enterprise about which separate financial information is available that is evaluated regularly by the chief operating decision maker in deciding how to allocate resources and in assessing performance. Aggregation of similar operating segments into a single reportable operating segment is permitted if the businesses have similar economic characteristics and meet established criteria. The Company operates three reportable segments – the hospital division, the population health management division and the real estate division. The real estate division is comprised of the Real Estate Entities. Refer toNote 15 – Segment Informationfor information on the Company’s segments.
Reclassifications. Financial statements presented for prior periods include reclassifications between common stock and additional paid-in capital that were made to conform to the current year presentation. The reclassifications have no effect on prior period results.
Recent accounting pronouncements – issued, not yet adopted
In December 2023, the FASB issued Accounting Standards Update (“ASU”) 2023-09 –Income Taxes (Topic 740): Improvements to Income Tax Disclosures, which requires public entities, on an annual basis, to provide disclosure of specific categories in the rate reconciliation, as well as disclosure of income taxes paid disaggregated by jurisdiction. The update is effective for annual periods beginning after December 15, 2024. We are assessing the potential impact of this update.
In November 2024, the FASB issued ASU 2024-03 –Income Statement – Reporting Comprehensive Income-Expense Disaggregation Disclosures (Subtopic 220-40): Disaggregation of Income Statement Expenses, requiring public entities to disclose additional information about specific expense categories in the notes to the financial statements on an interim
and annual basis. ASU 2024-03 is effective for fiscal years beginning after December 15, 2026, and for interim periods beginning after December 15, 2027. The Company is currently evaluating the impact of this update.
Note 3 – Revenue
We disaggregate revenue from contracts with customers into types of services or products, consistent with our reportable segments, as follows (in thousands):
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| · 2025 · 2024 | ||||||
| Hospital division revenue | | | 203,947 | | | 60,029 |
| Population health management division revenue | | | 7,842 | | | 7,424 |
| Total revenue | | $211,789 | | $67,453 | ||
Hospital division revenue. We receive payment for facility services rendered by us from federal agencies, private insurance carriers, and patients. The Physician LLCs receive payment for doctor services from these same sources. On average, greater than 96% of our net patient service revenue is paid by insurers and other non-patient third parties. The remaining revenue is paid by our patients in the form of copays, deductibles and self-payment. We generally operate as an out-of-network provider and, as such, do not have negotiated reimbursement rates with insurance companies.
The following tables present the allocation of the estimated transaction price with the patient among the primary patient classification of insurance coverage:
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| | | 2025 | 2024 | |||
| | | | | | | |
| Insurance | | | 96% | | | 91% |
| Self pay | | | 2% | | | 6% |
| Workers compensation | | 1% | | | 2% | |
| Medicare/Medicaid | | | 1% | | | 1% |
| Total | | | 100% | | | 100% |
The No Surprises Act (“NSA”) is a federal law that took effect January 1, 2022, to protect consumers from most instances of “surprise” balance billing. With respect to the Company, the NSA limits the amount an insured patient will pay for emergency services furnished by an out-of-network provider. The NSA addresses the payment of these out-of-network providers by group health plans or health insurance issuers (collectively, “insurers”). In particular, the NSA requires insurers to reimburse out-of-network providers at a statutorily calculated “out-of-network rate.” In states without an all-payor model agreement or specified state law, the out-of-network rate is either the amount agreed to by the insurer and the out-of-network provider or an amount determined through an independent dispute resolution (“IDR”) process.
Under the NSA, insurers must issue an initial payment or notice of denial of payment to a provider within thirty days after the provider submits a bill for an out-of-network service. If the provider disagrees with the insurer’s determination, the provider may initiate a thirty-business day period of open negotiation with the insurer over the claim. If the parties cannot resolve the dispute through negotiation, the parties may then proceed to the IDR process.
On July 1, 2024, we engaged with a third-party IDR vendor to further support all our out of network claims and determine which claims would be beneficial to arbitrate. The IDR process can take up tothree tofive months to receive payments. To facilitate the dispute arbitration process, the Company incurred fees to the Centers for Medicare and Medicaid Services (“CMS”), the organizations that arbitrate the payment amount between the plan and providers known as independent dispute resolution entities (“IDRE”), and commission and fees to the third-party IDR vendor. IDRE fee payments represent refundable payments if arbitrations are successful. Therefore, these payments are reported as prepaid and other current assets in the consolidated balance sheets. The unsuccessful portion of the IDRE fee payments is written off to contract services expense in the consolidated statements of operations. Prepaid expenses related to IDRE fees was
$9.6 million as of March 31, 2025. Accounts payable to the third-party IDR vendor was $12.2 million as of March 31, 2025. Total accrued arbitration expenses were $51.8 million as of March 31, 2025.
Population health management division revenue. We recognize revenue for capitation and management fees for services to IPAs and physician groups. Capitation revenue consists primarily of capitated fees for medical services provided by physician-owned entities we consolidate as VIEs. Capitated arrangements are made directly with various managed care providers including HMOs. Capitation revenues are typically prepaid monthly to us based on the number of enrollees selecting us as their healthcare provider. Capitation is a fixed payment amount per patient per unit of time paid in advance for the delivery of health care services, whereby the service providers are generally liable for excess medical costs. We receive management fees that are based on gross capitation revenues of the IPAs or physician groups we manage. Revenue is recognized and received monthly for our services.
Note 4 - Property and Equipment
The principal categories of property and equipment, net are summarized as follows (in thousands):
| | | | | | | | | |
|---|---|---|---|---|---|---|---|---|
| · Useful · · March 31, · · December 31, | ||||||||
| | Life (years) | | 2025 | 2024 | ||||
| | | | | | | | | |
| Buildings and improvements | | 39 | | $19,650 | | $19,650 | ||
| Land | | - | | 4,410 | | 4,410 | ||
| Leasehold improvements | | 10-39 | | 28,173 | | 28,126 | ||
| Construction in progress | | - | | 1,680 | | 1,892 | ||
| Medical equipment | | 10 | | 35,495 | | 35,395 | ||
| Office furniture and equipment | | 7 | | 3,985 | | 3,985 | ||
| Computer hardware and software | | 5 | | | 7,779 | | | 7,579 |
| Vehicles | | 5 | | 95 | | 95 | ||
| Signage | | 10 | | 2,086 | | 2,072 | ||
| Total cost | | | | 103,353 | | 103,204 | ||
| Less: accumulated depreciation | | | | (26,922) | | | (25,271) | |
| Total property and equipment, net | | | | $76,431 | | $77,933 | ||
We consolidatetwo Real Estate Entities in the Company. Refer toNote 17 – Variable Interest Entities.
Depreciation and amortization of property and equipment for the three months ended March 31, 2025 and 2024 totaled $1.7 million and $1.6 million, respectively.
Note 5 – Intangible Assets and Goodwill
Intangible Assets. The following tables provide detail of the Company’s intangible assets (in thousands):
| | | | | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| · · Gross · · Accumulated · · Net Carrying · · Weighted Average | ||||||||||||
| March 31, 2025 · · Carrying Amount · · Amortization · · Amount · · Useful Life (in years) | ||||||||||||
| Amortizing intangible assets: | | | | | | | | | | | | |
| Member relationships | | $18,491 | | $3,557 | | $14,934 | | | 15 | |||
| Trademarks | | | 474 | | | 203 | | | 271 | | | 7 |
| Total | | $18,965 | | $3,760 | | $15,205 | | | | |||
| | | | | | | | | | | | | |
| December 31, 2024 | | | | | | | | | | | | |
| Amortizing intangible assets: | | | | | | | | | | | | |
| Member relationships | | $18,491 | | $3,248 | | $15,243 | | | 15 | |||
| Trademarks | | | 474 | | | 187 | | | 287 | | | 7 |
| Total | | $18,965 | | $3,435 | | $15,530 | | | | |||
Member relationships and trademarks are associated with existing entities in the population health management division.
Amortization of intangible assets for the three months ended March 31, 2025 and 2024 totaled $0.3 million and $0.4 million, respectively.
Goodwill. The carrying amount of goodwill by operating segment is as follows (in thousands):
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · · Hospital Division · · Population Health Management Division · · Total | |||||||||
| Balance as of March 31, 2025 | | | | | | | | | |
| Goodwill | | | 1,139 | | | 415,251 | | | 416,390 |
| Accumulated impairment losses | | | (1,139) | | | (401,332) | | | (402,471) |
| | | $ | - | | $13,919 | | $13,919 | ||
Note 6 – Accrued Expenses and Other Current Liabilities
Accrued expenses and other current liabilities consisted of the following (in thousands):
| | | | | | | |
|---|---|---|---|---|---|---|
| · March 31, · · December 31, | ||||||
| | | 2025 | 2024 | |||
| | | | | | | |
| Accrued wages and benefits | | $13,256 | | $14,123 | ||
| Accrued supplier expenses | | | 3,047 | | | 4,205 |
| Accrued medical claims | | | 3,788 | | | 3,564 |
| Accrued taxes | | | 1,589 | | | 1,130 |
| Accrued other | | 2,959 | | | 2,420 | |
| Total accrued expenses and other current liabilities | | $24,639 | | $25,442 | ||
Note 7 – Debt
The Company’s outstanding debt is shown in the following table (dollars in thousands):
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · Maturity · · Interest · · March 31, · · December 31, | |||||||||
| · Dates · · Rates · · 2025 · · 2024 | |||||||||
| | | | | | | | | | |
| Term loans secured by all assets | 04/2025 - 10/2029 | | 4.00 - 15.50% | | $8,937 | | $9,665 | ||
| Term loans secured by property and equipment | 5/2025 - 01/2030 | | 3.41 - 7.82% | | | 8,645 | | | 9,028 |
| Term loan secured by deposits | 04/2025 | | 7.36% | | | 1,630 | | | 1,989 |
| Line of credit secured by all assets | 05/2025 - 01/2026 | | 6.00 - 9.50% | | | 7,126 | | | 3,521 |
| Term loans of consolidated Real Estate Entities | 05/2028 - 03/2037 | | 3.50 - 3.59% | | | 11,501 | | | 11,811 |
| Unsecured convertible term notes | 10/2025 | | 8.00 - 10.00% | | | 5,385 | | | 5,385 |
| Total | | | | | | 43,224 | | | 41,399 |
| Less: unamortized issuance costs and discount | | | | | | 730 | | | 984 |
| Less: short-term lines of credit | | | | | | 7,126 | | | 3,554 |
| Less: current portion of long-term debt | | | | | | 13,635 | | | 14,395 |
| Total long-term debt | | | | | $21,733 | | $22,466 | ||
Term loans and lines of credit. We have entered into private debt arrangements with banking institutions for the purchase of equipment and to provide working capital and liquidity through cash and lines of credit. Unless otherwise delineated above, these debt arrangements are obligations of Nutex and/or its wholly-owned subsidiaries. Consolidated Real Estate Entities have entered into private debt arrangements with banking institutions for purposes of purchasing land, constructing new emergency room facilities and building out leasehold improvements which are leased to our hospital entities. Nutex is a guarantor or, in limited cases, a co-borrower on the debt arrangements of the Real Estate Entities for the periods shown.
At March 31, 2025, the Company was not subject to any financial covenants under its outstanding debt arrangements.
At March 31, 2025, we had remaining availability of $4.9 million under outstanding lines of credit.
September 2023 Convertible Debt Issuance.
From September 2023 to December 2023, the Company conducted a private offering of convertible notes (“Unsecured Convertible Term Notes”) andsix-year warrants (“Warrants”) to accredited investors (the “Holders”) as defined in Rule 501 under the 1933 Act and issued Unsecured Convertible Term Notes convertible into an aggregate of 89,751 shares (13,462,500 prior to the 2024 Reverse Stock Splits) of common stock at a conversion price of $60.00 per share ($0.40 prior to the 2024 Reverse Stock Splits) and Warrants to purchase an aggregate of 44,875 shares of common stock (6,731,250 prior to the 2024 Reverse Stock Splits) at an exercise price of $60.00 per share ($0.40 prior to the 2024 Reverse Stock Splits). We also issued Warrants for the purchase of 26,925 shares (4,038,750 prior to the 2024 Reverse Stock Splits) to the placement agent. The Unsecured Convertible Term Notes mature on October 31, 2025 and the Warrants expire on December 31, 2029.
On March 26, 2024, the Company and the Holders agreed to amend the conversion price of the Unsecured Convertible Term Notes and exercise price of the Warrants to $30.00 each ($0.20 prior to the 2024 Reverse Stock Splits), resulting in the Unsecured Convertible Term Notes being convertible into 179,500 shares of common stock (26,925,000 prior to the 2024 Reverse Stock Splits), the Warrants exercisable for 89,750 shares of common stock (13,462,500 prior to the 2024
Reverse Stock Splits) and the placement agent Warrants exercisable for 53,850 shares of common stock (8,077,500 prior to the 2024 Reverse Stock Splits).
The Unsecured Convertible Term Notes bear an annual interest rate of 8% if paid in cash or an annual interest rate of 10% if paid in the form of common stock. The payment of interest in the form of common stock is at the discretion of the Company. When paid in common stock, the number of shares is equal to the quotient of the total accrued interest due divided by the last reported sale price of the Company’s common stock on the last complete trading day of such quarter. The Holders have the option, at any time, to convert all or any portion of the unpaid principal and interest outstanding in common stock at the conversion price of $30.00 per share. If the Company fails to pay the outstanding principal amount and all accrued interest within 30 days of the maturity date, the interest rate payable is adjusted to 12%.
The Company appointed Emerson Equity LLC as placement agent for the September 2023 Private Offering. Per the Placement Agent Agreement, the Company agrees to pay (i) a cash commission equal to 10% of the gross proceeds and (ii) warrants to purchase a number of common stock equal to 20% of the total number of shares issuable upon conversion or exercise of the Unsecured Convertible Term Notes and Warrants, as applicable. For the three months ended March 31, 2025, no warrants were exercised. On April 9, 2025, $0.4 million of the Unsecured Convertible Term Notes converted to 13,333 shares based on the terms noted above.
The net carrying amount of the Unsecured Convertible Term Notes was $4.7 million and $4.5 million as of March 31, 2025 and December 31, 2024, respectively, and the weighted average effective interest rate on the convertible debt was 21.5% for both periods.
The Unsecured Convertible Term Notes interest expense was $0.4 million for the three months ending March 31, 2025, comprising $0.3 million in amortization expense and $0.1 million in accrued interest expense. For the three months ended March 31, 2024 interest expense was $0.3 million, comprising $0.2 million in amortization expense and $0.1 million in accrued interest expense.
| | | | |
|---|
Note 8 – Leases
We have entered into hospital property, office and equipment rental agreements with various lessors including related parties. The following tables disclose information about our leases of property and equipment (in thousands):
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| | | 2025 | 2024 | |||
| | | | | | | |
| Operating lease cost | | $1,093 | | $645 | ||
| | | | | | | |
| Finance lease cost: | | | | | | |
| Amortization of right-of-use assets | | $3,293 | | $2,226 | ||
| Interest on lease liabilities | | | 5,005 | | | 3,400 |
| Total finance lease cost | | $8,298 | | $5,626 | ||
Note 9 – Commitments and Contingencies
Litigation. The Company, its consolidated subsidiaries or VIEs may be named in various claims and legal actions in the normal course of business. Based upon counsel and management’s opinion, the outcome of such matters is not expected to have a material adverse effect on the unaudited condensed consolidated financial statements.
Note 10 – Stock-based Compensation
In 2023, the stockholders of the Company approved the Amended and Restated Nutex Health Inc. 2023 Equity Incentive Plan (the “2023 Plan”), providing a total of 73,426 shares of Common Stock (11,013,943 prior to the 2024 Reverse Stock Splits) for issuance. Awards granted under the 2023 Plan may be incentive stock options, non-statutory stock
options, restricted stock, restricted stock units, stock appreciation rights, performance units or performance shares. The awards are granted at an exercise price equal to the fair market value on the date of grant. The 2023 Plan is subject to annual increases on January 1st of each calendar year through January 1, 2033 of up to 1% of the issued and outstanding shares of the Company’s common stock on the final day of the preceding calendar year, at the discretion of the Compensation Committee of the Board. During the second quarter of 2024, the number of shares to be issued under the 2023 Plan increased to 118,563 shares, most of which were issued as restricted stock units in June 2024, as discussed below. During the first quarter of 2025, the number of shares to be issued under the 2023 Plan increased to 55,115 shares, most of which were issued as restricted stock units in March 2025, as discussed below.
Total stock-based compensation expense for the three months ended March 31, 2025 and 2024 was $36.1 million and less than $0.1 million, respectively. Stock-based compensation expense includes amounts recognized for awards granted to employees for services rendered and non-employee arrangments, specifically the obligations for under-construction and ramping hospitals.
For the three months ended March 31, 2025, approximately 99% of total stock-based compensation expense of $36.1 million is due to the obligations for under-construction and ramping hospitals, noted below.
*Obligations for under-construction and ramping hospitals.*Under the terms of the Contribution Agreements, contributing owners of the under-construction hospitals and ramping hospitals (as determined on April 1, 2022) are eligible to receive a one-time additional issuance of Company common stock.
| ● | With respect to ramping hospitals that were acquired before the Merger, 24 months after the opening date (the “Determination Date”) of the applicable ramping hospital, such owner is eligible to receive such owner’s pro rata share of a number of shares of Company common stock equal to (i) the trailing twelve months earnings before interest, taxes, depreciation and amortization on the respective Determination Date, multiplied by (ii) 10, (iii) minus the initial equity value received at the closing of the Merger, and (iv) minus such owner’s pro rata share of the aggregate debt of the applicable ramping hospital outstanding as of the closing of the Merger. The number of additional shares to be issued will be determined based on the greater of (a) the price of the Company’s common stock at the time of determination or (b) $2.80 ($420.00 after the 2024 Reverse Stock Splits), as adjusted for any stock dividends, combinations, splits, recapitalizations and the like with respect to the Company’s common stock. |
| ● | With respect to under construction hospitals that were acquired before the Merger, contributing owners of under construction hospitals will be eligible to receive, on the Determination Date, such owner’s pro rata share of a number of shares of Company common stock equal to (a)(i) the trailing twelve months earnings before interest, taxes, depreciation and amortization as of the Determination Date multiplied by (ii) 10, minus (iii) the aggregate amount of such owner’s capital contribution to the under construction hospital, minus (iv) such owner’s pro rata share of the aggregate debt of the applicable under construction hospital outstanding as of the closing of the Merger, divided by (b) the greater of (i) the price of the Company common stock at the time of determination or (ii) $2.80 ($420.00 after the 2024 Reverse Stock Splits), as adjusted for any stock dividends, combinations, splits, recapitalizations and the like with respect to the Company’s common stock. |
The vesting period for these obligations is the 24 month period starting from the opening date of the applicable facility. The Company accrues the compensation cost of these obligations based on the probable outcome of the performance conditions noted above. We recognized stock-based compensation expense related to obligations for under-construction and ramping hospitals for three months ended March 31, 2025 and 2024 of $36.0 million andzero, respectively, based on our current estimates of future obligations to the contributing owners.
Options. The following table summarizes stock-based awards activity:
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · · · · · · · · Weighted Average | |||||||||
| · · Options · · Weighted Average · · Remaining Contractual | |||||||||
| · · Outstanding · · Exercise Price · · Life (Years) | |||||||||
| | | | | | | | | | |
| Options outstanding at December 31, 2023 | | | 27,590 | | $335.78 | | | 6.94 | |
| Options exercised | | | — | | | — | | | |
| Options cancelled | | | — | | | — | | | |
| Options outstanding at March 31, 2024 | | | 27,590 | | $335.78 | | | 6.69 | |
| | | | | | | | | | |
| Options outstanding at December 31, 2024 | | | 21,965 | | $331.34 | | | 5.45 | |
| Options exercised | | | — | | | — | | | |
| Options cancelled | | | (2,200) | | | 330.72 | | | |
| Options outstanding at March 31, 2025 | | | 19,765 | | $331.40 | | | 5.72 | |
Options outstanding as of March 31, 2025 consisted of:
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| Expiration · · Number · · Number · · Exercise | |||||||||
| Date · · Outstanding · · Exercisable · · Price | |||||||||
| | | | | | | | | | |
| January 27, 2027 | | | 300 | | | 300 | | | 225.00 |
| May 11, 2027 | | | 1,201 | | | 1,201 | | | 225.00 |
| June 9, 2027 | | | 167 | | | 167 | | | 376.50 |
| January 28, 2028 | | | 300 | | | 300 | | | 241.50 |
| August 4, 2029 | | | 68 | | | 68 | | | 834.00 |
| January 27, 2030 | | | 1,115 | | | 1,115 | | | 225.00 |
| January 28, 2031 | | | 6,667 | | | 6,667 | | | 241.50 |
| September 9, 2031 | | | 9,446 | | | 9,446 | | | 412.50 |
| December 17, 2031 | | | 501 | | | 501 | | | 525.00 |
| Total | | | 19,765 | | | 19,765 | | | |
Restricted Stock Units. On June 16, 2024, the Company issued 118,538 RSUs (1,184,946 prior to the 1:10 Reverse Stock Split) valued at $0.6 million to certain employees participating in the Company’s long-term incentive program.39,514 RSUs vested on March 1, 2025,39,514 RSUs will vest on March 1, 2026, and 39,510 will vest on March 1, 2027.
On March 10, 2025, the Company issued 60,365 RSUs valued at $2.5 million to certain employees participating in the Company’s long-term incentive program.20,122 RSUs will vest on March 1, 2026,20,122 RSUs will vest on March 1, 2027, and 20,123 will vest on March 1, 2028.
For grants of restricted stock units, we recognize compensation expense over the applicable vesting period equal to the fair value of our common stock at grant date. Grants of restricted stock units generally vestone third per year on each of the first three anniversaries of the grant date. The following table summarizes the changes in restricted stock units during the three months ended March 31, 2025 and 2024:
| | | | | | | |
|---|---|---|---|---|---|---|
| | | Shares(in thousands) | Weighted Average Grant-Date Fair Value Per Share | |||
| | | | | | | |
| Non-vested awards, December 31, 2023 | | | 3 | | $151.50 | |
| Granted | | | — | | | — |
| Vested | | (2) | | | 151.50 | |
| Non-vested awards, March 31, 2024 | | | 1 | | $151.50 | |
| | | | | | | |
| Non-vested awards, December 31, 2024 | | | 117 | | $37.23 | |
| Granted | | | 61 | | | 41.15 |
| Forfeitures | | | (5) | | | 5.40 |
| Vested | | | (16) | | | 105.80 |
| Non-vested awards, March 31, 2025 | | | 157 | | $34.96 | |
As of March 31, 2025 and 2024, we estimate $2.9 million and $0.2 million, respectively, of unrecognized compensation cost related to restricted stock units issued to our employees to be recognized over the weighted-average vesting period of 1.9 years and 0.9 years, respectively.
Employee Stock Purchase Plan. In May 2023, the Board adopted the 2023 Employee Stock Purchase Plan (“2023 ESPP”), which was subsequently approved by the Company’s stockholders and became effective in June 2023. The 2023 ESPP authorizes the initial issuance of up to 33,333 shares (5,000,000 prior to the 2024 Reverse Stock Splits) of the Company’s common stock to eligible employees, who are entitled to purchase shares of common stock equal to 85% of the closing price on the purchase date with accumulated payroll deductions. During the three months ended March 31, 2025 and 2024, the Company issued 1,161 shares and 746 shares, respectively, under the ESPP.
Note 11 – Equity
We are authorized to issue up to a total of 950,000,000 shares of common stock having a par value of $0.001 per share. Holders of our common stock are entitled toone vote for each share held of record on all matters submitted to a vote of stockholders and to receive ratably in proportion to the shares of common stock held by them any dividends declared from time to time by the Board. Our common stock has no preferences or rights of conversion, exchange, pre-exemption or other subscription rights.
Common Stock Warrants. Warrant activity is as follows:
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| · · · · · · · Weighted Average | |||||||||
| · · Warrants · · Weighted Average · · Remaining Contractual | |||||||||
| · · Outstanding · · Exercise Price · · Life (years) | |||||||||
| | | | | | | | | | |
| Warrants outstanding at December 31, 2023 | | | 135,537 | | $158.16 | | | 4.42 | |
| Warrants issued | | | 444,445 | | | 22.50 | | | |
| Warrants exercised | | | 71,801 | | | 30.00 | | | |
| Warrants expired | | | - | | | - | | | |
| Warrants outstanding at March 31, 2024 | | | 651,783 | | $51.56 | | | 4.78 | |
| | | | | | | | | | |
| Warrants outstanding at December 31, 2024 | | | 207,338 | | $113.78 | | | 3.68 | |
| Warrants issued | | | - | | | - | | | |
| Warrants exercised | | | - | | | - | | | |
| Warrants expired | | | (3,701) | | | 1,000.50 | | | |
| Warrants outstanding at March 31, 2025 | | | 203,637 | | $97.68 | | | 3.76 | |
Warrants outstanding as of March 31, 2025 consisted of:
| | | | | | | | | | |
|---|---|---|---|---|---|---|---|---|---|
| Expiration · · Number · · Number · · Exercise | |||||||||
| Date · · Outstanding · · Exercisable · · Price | |||||||||
| | | | | | | | | | |
| October 31, 2025 | | | 10,444 | | | 10,444 | | | 232.50 |
| October 31, 2025 | | | 108 | | | 108 | | | 187.50 |
| February 26, 2026 | | | 1,922 | | | 1,922 | | | 600.00 |
| July 31, 2026 | | | 16,888 | | | 16,888 | | | 232.50 |
| May 31, 2027 | | | 30,674 | | | 30,764 | | | 262.50 |
| September 30, 2029 | | | 16,501 | | | 16,501 | | | 30.00 |
| October 31, 2029 | | | 57,250 | | | 57,250 | | | 30.00 |
| November 30, 2029 | | | 5,167 | | | 5,167 | | | 30.00 |
| December 31, 2029 | | | 64,683 | | | 64,863 | | | 30.00 |
| Total | | | 203,637 | | | 203,907 | | | |
Note 12 – Income Taxes
Income tax provisions for interim quarterly periods are generally based on an estimated annual effective income tax rate calculated separately from the effect of significant, infrequent or unusual items related specifically to interim periods. The income tax impact of discrete items is recognized in the period these occur.
Our effective tax rate was 29.5% and 14.2% for the three months ended March 31, 2025 and 2024, respectively. The primary difference from the federal statutory rate of 21% is related to state taxes, income of noncontrolling interests in flow-through entities and permanent differences for non-deductible expenses.
Note 13 – Earnings (Loss) per Share
The following is the computation of earnings (loss) per basic and diluted share (dollars in thousands):
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| | | 2025 | 2024 | |||
| Basic earnings (loss) per share: | | | | | | |
| Numerator: | | | | | | |
| Net income (loss) attributable to common stockholders | | $14,634 | | $(364) | ||
| Denominator: | | | | | | |
| Weighted average shares used to compute basic EPS | | | 5,516,999 | | | 4,849,235 |
| Basic earnings (loss) per share: | | $2.65 | | $(0.08) | ||
| | | | | | | |
| Diluted earnings (loss) per share: | | | | | | |
| Numerator: | | | | | | |
| Net income (loss) attributable to common stockholders | | $14,634 | | $(364) | ||
| Dilutive net income attributable to common stockholders | | | 14,963 | | | |
| Denominator: | | | | | | |
| Weighted average shares used to compute basic EPS | | | 5,516,999 | | | 4,849,235 |
| Dilutive effect of convertible note | | | 179,500 | | | - |
| Dilutive effect of common stock warrants | | | 55,303 | | | - |
| Dilutive effect of unvested restricted stock | | | 101,534 | | | - |
| Weighted average shares used to compute diluted EPS | | | 5,853,336 | | | 4,849,235 |
| Diluted earnings (loss) per share: | | $2.56 | | $(0.08) | ||
Due to antidilution, the computation of diluted earnings for the three months ended March 31, 2024 excludes the 27,590 common stock options (4,137,149 prior to the 2024 Reverse Stock Splits),651,781 warrants (97,780,228 prior to the
2024 Reverse Stock Splits),1,298 restricted stock units (194,720 prior to the 2024 Reverse Stock Splits) and 179,500 common stock (26,925,000 prior to the 2024 Reverse Stock Splits) issuable upon conversion of outstanding convertible debt.
The dilutive effect of convertible debt was calculated using the if-converted method, whereas the dilutive effect of the assumed exercise of outstanding options, warrants and unvested restricted stock was calculated using the treasury stock method.
Note 14 - Supplemental Cash Flows Information
The below supplemental cash flows information is presented in thousands:
| | | | | | | |
|---|---|---|---|---|---|---|
| · · Three Months Ended March 31, | ||||||
| · · 2025 · 2024 | ||||||
| Cash paid for interest on long-term debt | | $608 | | $548 | ||
| Cash paid for interest on finance leases | | | 5,005 | | | 4,038 |
| Cash paid for operating leases | | | 932 | | | 582 |
| Cash paid for income taxes | | | 3,300 | | | - |
| Non-cash investing and financing activities: | | | | | | |
| Financed capital expenditures | | | 92 | | | - |
| Acquisition of finance leases | | | 597 | | | - |
| Warrant liability related to common stock issuance | | | - | | | 7,662 |
| Common stock issued for Employee Stock Purchase Plan | | | 40 | | | 19 |
| Convertible debt converted to common stock | | | - | | | 321 |
Note 15 – Segment Information
We report the results of our operations asthree segments in our unaudited condensed consolidated financial statements: (i) the hospital division, (ii) the population health management division and (iii) the real estate division.
The Company’s chief operating decision maker (“CODM”) is our Chief Executive Officer (“CEO”). The determination of our reporting segments was made based on our strategic priorities, which corresponds to the way our CODM reviews and evaluates operating performance to make decisions about resources to be allocated. For our operating segments, the CODM uses segment gross profit and segment income before tax to allocate resources (including financial and capital resources) in the annual and forecasting processes. On a monthly basis, the CODM considers month-to-month and budget-to-actual variances for both measures when allocating resources to segments.
Other hospital division expenses include expenses such as facility-specific utilities, marketing and advertising, repairs and maintenance, and other tax expenses. Corporate costs primarily include expenses for support functions and salaries and benefits for corporate employees and are excluded from segment operating results.
Reportable segment information, including intercompany transactions, is presented below (in thousands):
| | | | | | | | |
|---|---|---|---|---|---|---|---|
| · · · March 31, · · December 31, | |||||||
| · · · 2025 · · 2024 | |||||||
| Assets: | | | | | | | |
| Hospital division | | | $715,447 | | $607,591 | ||
| Population health management division | | | | 27,271 | | | 28,338 |
| Real estate division | | | | 19,198 | | | 19,392 |
| Total Assets | | | $761,916 | | $655,321 | ||
| | | | | | | | |
|---|---|---|---|---|---|---|---|
| · · · Three Months Ended March 31, | |||||||
| · · · 2025 · 2024 | |||||||
| Revenue from external customers: | | | | | | | |
| Hospital division | | | $203,947 | | $60,029 | ||
| Population health management division | | | | 7,842 | | | 7,424 |
| Total revenue | | | $211,789 | | $67,453 | ||
| | | | | | | | |
| Segment expenses: | | | | | | | |
| Hospital division | | | | | | | |
| Payroll | | | $34,579 | | $25,875 | ||
| Contract services | | | | 31,760 | | | 5,574 |
| Medical supplies | | | | 3,801 | | | 5,322 |
| Other hospital division expenses | | | | 11,269 | | | 8,052 |
| Hospital division expenses | | | | 81,409 | | | 44,823 |
| Population health management division expenses | | | | 6,950 | | | 8,288 |
| Total segment expenses | | | $88,359 | | $53,111 | ||
| | | | | | | | |
| Depreciation and amortization: | | | | | | | |
| Hospital division | | | $4,643 | | $3,764 | ||
| Population health management division | | | | 340 | | | 421 |
| Real estate division | | | | 109 | | | 1 |
| Total depreciation and amortization | | | $5,092 | | $4,186 | ||
| | | | | | | | |
| Segment gross profit (loss): | | | | | | | |
| Hospital division | | | $117,895 | | $10,471 | ||
| Population health management division | | | | 552 | | | (314) |
| Real estate division | | | | (109) | | | - |
| Total segment gross profit | | | $118,338 | | $10,157 | ||
| | | | | | | | |
| Consolidated operating income: | | | | | | | |
| Total segment gross profit | | | $118,338 | | $10,157 | ||
| Corporate and other costs | | | | (46,129) | | | (8,707) |
| Consolidated operating income | | | $72,209 | | $1,450 | ||
| | | | | | | | |
| Segment income: | | | | | | | |
| Hospital division | | | | | | | |
| Hospital division gross profit | | | $117,895 | | $10,471 | ||
| Interest expense, net | | | | 5,575 | | | 4,402 |
| Other expense (income) | | | | 3,354 | | | (229) |
| Hospital division income before income taxes | | | $108,966 | | $6,298 | ||
| Population health management division income (loss) before income taxes | | | | 554 | | | (330) |
| Real estate division loss before income taxes | | | | (109) | | | (527) |
| Non-segment loss before income taxes | | | | (46,647) | | | (5,593) |
| Income (loss) before income taxes | | | $62,764 | | $(152) | ||
| | | | | | | | |
| Capital expenditures: | | | | | | | |
| Hospital division | | | $64 | | $733 | ||
| Total capital expenditures | | | $64 | | $733 | ||
Note 16 – Related Party Transactions ** **
Related party transactions included the following:
| ● | The Physician LLCs employ the doctors who work in our hospitals. We have no direct ownership interest in these entities, but they are owned and, in some instances, controlled by related parties including our CEO, Dr. Thomas Vo. The Physician LLCs are consolidated by the Company as VIEs because they do not have significant equity at risk, and we have historically provided support to them in the event of cash shortages and been the primary beneficiary of their services. |
|---|
The Physician LLCs had outstanding obligations to their member owners, who are also Company stockholders, totaling less than $0.1 million at March 31, 2025 and $0.8 million at December 31, 2024 reported within accounts payable – related party in our unaudited condensed consolidated balance sheets.
Most of our hospital division facilities are leased from real estate entities which are owned by related parties. These leases are typically on a triple net basis where our hospital division is responsible for all operating costs, repairs and taxes on the facilities. Our obligations under these leases are presented inNote 8 – Leases. During the three months ended March 31, 2025 and 2024, we made cash payments for these lease obligations totaling $6.1 million and $4.7 million, respectively.
| ● | We consolidate Real Estate Entities as VIEs when they do not have sufficient equity at risk and our hospital entities are guarantors or co-borrowers under their outstanding mortgage loans. The consolidated Real Estate Entities have mortgage loans payable to third parties which are collateralized by the land and buildings. We have no direct ownership interest in these entities, but they are owned and, in some instances, controlled by related parties including our CEO. As of March 31, 2025, two Real Estate Entities continue to be consolidated in our financial statements. |
|---|
| ● | Accounts receivable – related party included $4.3 million at both March 31, 2025 and December 31, 2024 due from noncontrolling interest owners of consolidated ER Entities. |
|---|
| ● | Micro Hospital Holding LLC, an affiliate controlled by our CEO, and 2GT PLLC, an affiliate controlled by a physician partner, made advances to one of our hospital facilities, SE Texas ER. For Micro Hospital Holding LLC, these advances totaled $1.4 million at both March 31, 2025 and December 31, 2024. For 2GT PLLC, these advances totaled $1.2 million and zero at March 31, 2025 and December 31, 2024, respectively. These amounts are reported as accounts payable – related party in our unaudited condensed consolidated balance sheets. The advances have no stated maturity and bear no interest. |
|---|
| ● | Accounts payable – related party in our unaudited condensed consolidated balance sheets included $0.3 million at March 31, 2025 and zero at December 31, 2024 for reimbursement of expenses incurred on our behalf. |
|---|
In addition, we have outstanding obligations of contributions for facilities currently under construction totaling $1.9 million and $1.6 million at March 31, 2025 and December 31, 2024, respectively, reported within accounts payable-related party in our unaudited condensed consolidated balance sheets.
| ● | We provided managerial services to emergency centers owned and, in some instances, controlled by related parties including an entity controlled by our CEO. In the three months ended March 31, 2025 and 2024, we did not recognize any revenue for these services. |
|---|
Note 17 – Variable Interest Entities
The following tables provide the balance sheet amounts for consolidated VIEs (in thousands):
| | | | | | | | | |
|---|---|---|---|---|---|---|---|---|
| | March 31, 2025 | |||||||
| · Real Estate · · Physician · · | ||||||||
| · Entities · · LLCs · · IPAs | ||||||||
| | | | | | | | | |
| Current assets | $38 | | $34,785 | | $9,294 | |||
| Property and equipment, net | | - | | | 4 | | | 112 |
| Long-term assets | | 33,211 | | | - | | | - |
| | | | | | | | | |
| Total assets | $33,249 | | $34,789 | | $9,406 | |||
| | | | | | | | | |
| Current liabilities | | - | | | 10,466 | | | 9,406 |
| Long-term liabilities | | 11,460 | | | - | | | - |
| | | | | | | | | |
| Total liabilities | | 11,460 | | | 10,466 | | | 9,406 |
| | | | | | | | | |
| Equity | | 21,789 | | | 24,323 | | | - |
| | | | | | | | | |
| Total liabilities and equity | $33,249 | | $34,789 | | $9,406 | |||
| | | | | | | | | |
|---|---|---|---|---|---|---|---|---|
| | December 31, 2024 | |||||||
| · Real Estate · · Physician · · | ||||||||
| · Entities · · LLCs · · IPAs | ||||||||
| | | | | | | | | |
| Current assets | $122 | | $23,041 | | $10,109 | |||
| Property and equipment, net | | - | | | 4 | | | 116 |
| Long-term assets | | 33,185 | | | - | | | - |
| | | | | | | | | |
| Total assets | $33,307 | | $23,045 | | $10,225 | |||
| | | | | | | | | |
| Current liabilities | | - | | | - | | | 10,226 |
| Long-term liabilities | | 11,768 | | | - | | | - |
| | | | | | | | | |
| Total liabilities | | 11,768 | | | - | | | 10,226 |
| | | | | | | | | |
| Equity | | 21,539 | | | 23,045 | | | - |
| | | | | | | | | |
| Total liabilities and equity | $33,307 | | $23,045 | | $10,226 | |||
The assets of each of the hospital facilities may only be used to settle the liabilities of that entity or its consolidated VIEs and may not be required to be used to settle the liabilities of any of the other hospital facilities, other VIEs, or corporate entities. Additionally, the assets of corporate entities cannot be used to settle the liabilities of VIEs. The Company has aggregated all of the Physician LLCs and Real Estate Entities into two categories above, because they have similar risk characteristics, and presenting distinct financial information for each VIE would not add more useful information.
Real Estate Entities are consolidated by the Company as VIEs because they do not have sufficient equity at risk and our hospital entities are guarantors of their outstanding mortgage loans. We have been working with the third-party lenders to remove our guarantees of their outstanding mortgage loans. As these guarantees are released, the associated Real
Estate Entity no longer qualifies as a VIE and is deconsolidated. As of March 31, 2025, two Real Estate Entities continue to be consolidated in our financial statements.
Note 18 - Subsequent Events
The Company has evaluated subsequent events through the filing of this report and determined that there have been no events that have occurred that would require adjustments to our disclosures in the unaudited condensed consolidated financial statements other than the conversion of certain Unsecured Convertible Term Notes disclosed inNote 7 - Debt.
The text of this filing, as the company filed it with the SEC, without its images or exhibits. This is not investment advice.