P3 Health Partners Inc
For the period ended Jun 30, 2024. Filed Aug 7, 2024.
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Jun 30, 2024 · Filed Aug 7, 2024
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Notes to Condensed Consolidated Financial Statements (Unaudited)
NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
| Note 1: Organization | 10 |
|---|---|
| Note 2: Going Concern and Liquidity | 10 |
| Note 3: Significant Accounting Policies | 10 |
| Note 4: Recent Accounting Pronouncements | 12 |
| Note 5: Fair Value Measurements and Hierarchy | 14 |
| Note 6: Property and Equipment | 15 |
| Note 7: Intangible Assets | 15 |
| Note 8: Debt | 15 |
| Note 9: Net Loss per Share | 17 |
| Note 10: Redeemable Non-controlling Interest | 18 |
| Note 11: Segment Reporting | 18 |
| Note 12: Capitalization | 19 |
| Note 13: Variable Interest Entities | 20 |
Note 1: Organization
P3 Health Partners Inc. (“P3”) is a patient-centered and physician-led population health management company and, for accounting purposes, the successor to P3 Health Group Holdings, LLC and its subsidiaries (collectively, “P3 LLC,” and together with P3, the “Company”) after the consummation of a series of business combinations in December 2021 with Foresight Acquisition Corp. (the “Business Combinations”). As the sole manager of P3 LLC, P3 operates and controls all of the business and affairs of P3 LLC and P3’s only assets are equity interests in P3 LLC.
P3 LLC was founded on April 12, 2017 and began commercial operations on April 20, 2017 to provide population health management services on an at-risk basis to insurance plans offering medical coverage to Medicare beneficiaries under Medicare Advantage programs. Medicare Advantage programs are insurance products created solely for Medicare beneficiaries. Insurance plans contract directly with the Centers for Medicare and Medicaid Services (“CMS”) to offer Medicare beneficiaries benefits that replace traditional Medicare fee-for-service (“FFS”) coverage.
The Company’s contracts with health plans are based on an at-risk shared savings model. Under this model, the Company is financially responsible for the cost of all contractually-covered services provided to members assigned to the Company by health plans in exchange for a fixed monthly “capitation” payment, which is generally a percentage of the payment health plans receive from CMS. Under this arrangement, Medicare beneficiaries generally receive all their healthcare coverage through the Company’s network of employed and affiliated physicians and specialists.
The services provided to health plans’ members vary by contract. These may include utilization management, care management, disease education, and maintenance of a quality improvement and quality management program for members assigned to the Company. The Company is also responsible for the credentialing of its providers, processing and payment of claims, and the establishment of a provider network for certain health plans.
In addition to the Company’s contracts with health plans, the Company provides primary healthcare services through its employed physician clinic locations. These primary care clinics are reimbursed for services provided under FFS contracts with various payers and through capitated – per member, per month (“PMPM”) arrangements.
Note 2: Going Concern and Liquidity
The accompanying unaudited condensed consolidated financial statements have been prepared assuming the Company will continue as a going concern. The Company has experienced losses since its inception and had net losses of $28.8 million and $27.6 million for the three months ended June 30, 2024 and 2023, respectively, and $78.4 million and $80.0 million for the six months ended June 30, 2024 and 2023, respectively. Such losses were primarily the result of costs incurred in adding new members, building relationships with physician partners and payors, and developing new services. The Company anticipates operating losses and negative cash flows to continue for the foreseeable future as it continues to grow membership.
As of June 30, 2024 and December 31, 2023, the Company had $73.1 million and $36.3 million, respectively, in unrestricted cash and cash equivalents available to fund future operations. The Company’s capital requirements will depend on many factors, including the pace of the Company’s growth, ability to manage medical costs, the maturity of its members, and its ability to raise capital. The Company continues to explore raising additional capital through a combination of debt financing and equity issuances. When the Company pursues additional debt and/or equity financing, there can be no assurance that such financing will be available on terms commercially acceptable to the Company. If the Company is unable to obtain additional funding when needed, it will need to curtail planned activities in order to reduce costs, which will likely have an unfavorable effect on the Company’s ability to execute on its business plan, and have an adverse effect on its business, results of operations, and future prospects. As a result of these matters, substantial doubt exists about the Company’s ability to continue as a going concern within one year after the date the financial statements are issued. The accompanying unaudited condensed consolidated financial statements do not include any adjustments that might result from the outcome of these uncertainties.
Note 3: Significant Accounting Policies
Basis of Presentation
The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States (“GAAP”) for interim financial information and with the instructions to Form 10-Q and Article 10 of the U.S. Securities and Exchange Commission (“SEC”) Regulation S-X. The unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements included in its Annual Report on Form 10-K for the year ended December 31, 2023. Certain information and footnote disclosures normally included in financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to SEC rules and regulations dealing with interim financial statements.
Management believes the accompanying unaudited condensed consolidated financial statements reflect all adjustments of a normal recurring nature necessary for a fair presentation of periods presented. The consolidated operating results for the three and six months ended June 30, 2024 are not necessarily indicative of the results that may be expected for the year ending December 31, 2024, or for any other future annual or interim period.
Principles of Consolidation
The accompanying unaudited condensed consolidated financial statements include the accounts of the Company and all significant intercompany transactions and balances have been eliminated.
The Company periodically evaluates entities for consolidation either through ownership of a majority voting interest, or through means other than voting interest, in accordance with the Variable Interest Entity (“VIE”) accounting model. This evaluation includes a qualitative review of the design of the entity, its organizational structure, including decision making ability and financial agreements, as well as a quantitative review. The Company consolidates a VIE when it has a variable interest that provides it with a controlling financial interest in the VIE, referred to as the primary beneficiary of the VIE.
As the sole managing member of P3 LLC, P3 has the right to direct the most significant activities of P3 LLC and the obligation to absorb losses and receive benefits. The rights of the non-managing members of P3 LLC are limited and protective in nature and do not give substantive participation rights over the sole managing member. Accordingly, P3 identifies itself as the primary beneficiary of P3 LLC and began consolidating P3 LLC as of December 3, 2021, the closing date of the Business Combinations (the “Closing Date”), resulting in a non-controlling interest related to the common units of P3 LLC (“Common Units”) held by members other than P3. Additionally, as more fully described in Note 13 “Variable Interest Entities,” P3 LLC is the primary beneficiary of the following physician practices (collectively, the “Network VIEs”):
Kahan, Wakefield, Abdou, PLLC
Bacchus, Wakefield, Kahan, PC
P3 Health Partners Professional Services, P.C.
P3 Medical Group, P.C.
P3 Health Partners California, P.C. (f/k/a Omni IPA Medical Group, Inc.)
Comprehensive Loss
Comprehensive loss includes net loss to common stockholders as well as other changes in equity that result from transactions and economic events other than those with stockholders. There was no difference between comprehensive loss and net loss to common stockholders for the periods presented.
Use of Estimates
The preparation of these unaudited condensed consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that could affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the reporting period. On an ongoing basis, the Company evaluates its estimates, including, but not limited to, those related to allowance for credit losses, revenue recognition, the liability for unpaid claims, equity-based compensation, premium deficiency reserves (“PDR”), fair value and impairment recognition of long-lived assets (including intangibles), fair value of liability classified instruments, and judgments related to deferred income taxes. The Company bases its estimates on the best information available at the time, its experiences, and various other assumptions believed to be reasonable under the circumstances. Actual results could differ from those estimates.
Significant Accounting Policies
A description of the Company’s significant accounting policies is included in the audited consolidated financial statements within Annual Report on Form 10-K for the year ended December 31, 2023. No changes to significant accounting policies have occurred since December 31, 2023.
Revenue Recognition
In the first quarter of 2024, the Company released a portion of the constraint applied in previous periods with respect to risk adjustment revenue for dates of service in 2023, which resulted in increases to capitation revenue of $7.5 million and $15.2 million for the three and six months ended June 30, 2024, respectively.
The Company categorizes revenue based on various factors such as the nature of contracts as follows:
| Revenue Type | Three Months Ended June 30, 2024 | % of Total | Three Months Ended June 30, 2023 | % of Total |
|---|---|---|---|---|
| (dollars in thousands) | ||||
| Capitated revenue | $374,306 | 98.7% | $325,616 | 98.9% |
| Other patient service revenue: | ||||
| Clinical fees & insurance revenue | 1,107 | 0.3 | 1,164 | 0.4 |
| Care coordination / management fees | 3,603 | 1.0 | 2,065 | 0.6 |
| Incentive fees | 141 | 0.0 | 241 | 0.1 |
| Total other patient service revenue | 4,851 | 1.3 | 3,470 | 1.1 |
| Total revenue | $379,157 | 100.0% | $329,086 | 100.0% |
| Revenue Type | Six Months Ended June 30, 2024 | % of Total | Six Months Ended June 30, 2023 | % of Total |
|---|---|---|---|---|
| (dollars in thousands) | ||||
| Capitated revenue | $758,440 | 98.8% | $624,320 | 98.9% |
| Other patient service revenue: | ||||
| Clinical fees & insurance revenue | 3,052 | 0.4 | 2,644 | 0.4 |
| Care coordination / management fees | 5,993 | 0.8 | 3,915 | 0.6 |
| Incentive fees | 160 | 0.0 | 284 | 0.1 |
| Total other patient service revenue | 9,205 | 1.2 | 6,843 | 1.1 |
| Total revenue | $767,645 | 100.0% | $631,163 | 100.0% |
During each of the three months ended June 30, 2024 and 2023, four health plan customers each accounted for 10% or more of total revenue and collectively comprised 59% and 62% of the Company’s total revenue, respectively. During each of the six months ended June 30, 2024 and 2023, four health plan customers each accounted for 10% or more of total revenue and collectively comprised 60% and 62% of the Company’s total revenue, respectively. Three health plan customers accounted for 10% or more of total health plan receivable each as of June 30, 2024 and December 31, 2023.
Note 4: Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
ASU 2024-02, Codification Improvements—Amendments to Remove References to the Concepts Statements (“ASU 2024-02”)
Accounting Standards Update (“ASU”) 2024-02 removes references to various Financial Accounting Standards Board (“FASB”) Concepts Statements from the FASB accounting standards codification (the “Codification”) to simplify and clarify the accounting guidance. The ASU aims to distinguish between authoritative and nonauthoritative literature and to address unintended applications of guidance. The Company adopted ASU 2024-02 effective January 1, 2024. The guidance will be applied prospectively to all new transactions recognized on or after January 1, 2024.
ASU 2020-06, Debt – Debt with Conversion and Other Options (Subtopic 470-20) and Derivatives and Hedging — Contracts in Entity’s Own Equity (Subtopic 815-40), Accounting for Convertible Instruments and Contracts in an Entity’s Own Equity (“ASU 2020-06”)
ASU 2020-06 eliminates two of the three models in ASC 470-20 that require issuers to separately account for embedded conversion features and eliminates some of the requirements for equity classification in ASC 815-40-25 for contracts in an entity’s own equity. The guidance also requires entities to use the if-converted method for all convertible instruments in the diluted earnings per share calculation and generally requires them to include the effect of potential share settlement for instruments that may be settled in cash or shares. The Company adopted ASU 2020-06 effective January 1, 2024 using the modified retrospective method. The Company’s liability-classified stock warrants remained classified as liabilities under the amended guidance. The adoption of this standard did not have a material impact on the Company’s consolidated financial statements and related disclosures.
Recent Accounting Pronouncements Not Yet Adopted
ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures (“ASU 2023-09”)
ASU 2023-09 enhances the transparency and decision usefulness of income tax disclosures, in response to investors’ feedback, indicating the need for improved information to assess an entity’s operations, tax risks, and planning opportunities, particularly in understanding exposure to jurisdictional tax changes and their impact on cash flows. The amendments address these concerns by improving income tax disclosures, primarily related to the rate reconciliation and income taxes paid information. The amendments in this update are effective for annual periods beginning after December 15, 2024 and should be applied prospectively. Early adoption and retrospective application is permitted. The Company is evaluating the effect ASU 2023-09 will have on its consolidated financial statements and related disclosures.
ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures (“ASU 2023-07”)
ASU 2023-07 improves the disclosures about a public entity’s reportable segments and addresses requests from investors for additional, more detailed information about a reportable segment’s expenses. The amendments in this update are effective for fiscal years beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. The amendments require retrospective application to all prior periods presented in the financial statements. Upon transition, the segment expense categories and amounts disclosed in the prior periods should be based on the significant segment expense categories identified and disclosed in the period of adoption. The Company is evaluating the effect ASU 2023-07 will have on its consolidated financial statements and related disclosures.
ASU 2023-06, Disclosure Improvements: Codification Amendments In Response to the SEC’s Disclosure Update and Simplification Initiative (“ASU 2023-06”)
ASU 2023-06 clarifies or improves disclosure and presentation requirements on a variety of topics and aligns the requirements in the Codification with the SEC’s regulations. The effective date for each amendment will be the date on which the SEC’s removal of that related disclosure from Regulation S-X or Regulation S-K becomes effective, with early adoption prohibited. The amendments in this update should be applied prospectively. If by June 30, 2027, the SEC has not removed the applicable requirement from Regulation S-X or Regulation S-K, the pending content of the related amendment will be removed from the Codification and will not become effective for any entity. The Company is evaluating the effect ASU 2023-06 will have on its consolidated financial statements and related disclosures.
Note 5: Fair Value Measurements and Hierarchy
Information about the Company’s financial liabilities measured at fair value on a recurring basis is presented below:
| Level 1 | Level 2 | Level 3 | Total | |
|---|---|---|---|---|
| (in thousands) | ||||
| Warrant liability as of June 30, 2024 | $950 | $— | $24,505 | $25,455 |
| Warrant liability as of December 31, 2023 | $1,056 | $— | $29 | $1,085 |
The key Level 3 weighted average inputs into the option pricing model related to the private placement warrants to purchase Class A common stock were as follows:
| June 30, 2024 | December 31, 2023 | |
|---|---|---|
| Volatility | 95% | 75% |
| Risk-free interest rate | 4.33% | 4.01% |
| Exercise price | $0.51 | $11.50 |
| Expected term | 6.9 Years | 2.9 Years |
Generally, an increase in the market price of the Company’s shares of common stock, an increase in the volatility of the Company’s shares of common stock, and an increase in the remaining term of the warrants would each result in a directionally similar change in the estimated fair value of the Company’s warrant liabilities. Such changes would increase the associated liability while decreases in these assumptions would decrease the associated liability. An increase in the risk-free interest rate would result in a decrease in the estimated fair value measurement and thus a decrease in the associated liability. The Company has not, and does not plan to, declare dividends on its common stock and, as such, there is no change in the estimated fair value of the warrant liabilities due to the dividend assumption.
The following table sets forth a summary of changes in the fair value of the Company’s private placement warrants to purchase Class A common stock, which are considered to be Level 3 fair value measurements:
| Six Months Ended June 30, | ||
|---|---|---|
| 2024 | 2023 | |
| (in thousands) | ||
| Beginning balance | $29 | $40 |
| Issuance of Common Warrants (see Note 12) | 33,259 | — |
| Mark-to-market adjustment of stock warrants | (8,783) | 27 |
| Ending balance | $24,505 | $67 |
The Company recorded a gain of $8.7 million and loss of $1.7 million from changes in the fair value of stock warrants for the three months ended June 30, 2024 and 2023, respectively, and a gain of $8.9 million and loss of $1.1 million from changes in the fair value of stock warrants for the six months ended June 30, 2024 and 2023, respectively.
The book value of cash; clinic fees, insurance receivables, and other receivables; accounts payable; and accrued expenses and other current liabilities approximate fair value because of the short maturity and high liquidity of these instruments.
Note 6: Property and Equipment
The Company’s property and equipment balances consisted of the following as of:
| June 30, 2024 | December 31, 2023 | |
|---|---|---|
| (in thousands) | ||
| Leasehold improvements | $3,001 | $2,933 |
| Furniture & fixtures | 1,175 | 1,165 |
| Computer equipment & software | 7,079 | 3,699 |
| Medical equipment | 1,106 | 1,106 |
| Software (development in process) | 343 | 3,877 |
| Vehicles | 660 | 654 |
| Other | 7 | 33 |
| 13,371 | 13,467 | |
| Less: accumulated depreciation | (5,834) | (4,781) |
| Property and equipment, net | $7,537 | $8,686 |
Total depreciation of property and equipment recognized on the condensed consolidated statements of operations was $0.6 million for each of the three months ended June 30, 2024 and 2023, and $1.1 million and $1.2 million for the six months ended June 30, 2024 and 2023, respectively.
Note 7: Intangible Assets
Intangible assets, net consisted of the following as of:
| June 30, 2024 | December 31, 2023 | |||||
|---|---|---|---|---|---|---|
| Gross CarryingAmount | AccumulatedAmortization | Net CarryingAmount | Gross CarryingAmount | AccumulatedAmortization | Net CarryingAmount | |
| (in thousands) | ||||||
| Indefinite lived intangible assets: | ||||||
| Medical licenses | $700 | $— | $700 | $700 | $— | $700 |
| Definite lived intangible assets: | ||||||
| Customer relationships | 684,000 | (176,700) | 507,300 | 684,000 | (142,500) | 541,500 |
| Trademarks | 148,635 | (39,056) | 109,579 | 148,635 | (31,671) | 116,964 |
| Payor contracts | 4,700 | (1,175) | 3,525 | 4,700 | (940) | 3,760 |
| Provider network | 4,800 | (1,231) | 3,569 | 4,800 | (991) | 3,809 |
| Total | $842,835 | $(218,162) | $624,673 | $842,835 | $(176,102) | $666,733 |
Amortization of intangible assets was $21.0 million and $21.1 million during the three months ended June 30, 2024 and 2023, respectively, and $42.1 million and $42.0 million during the six months ended June 30, 2024 and 2023, respectively.
Note 8: Debt
Short-term Debt
In January 2024, the Company entered into a short-term financing agreement totaling $1.9 million for the funding of certain insurance policies. The term of the agreement isnine months and the annual interest rate is 8.25%. Remaining scheduled principal payments as of June 30, 2024 are $0.6 million to be paid in the third quarter of 2024 and $0.2 million to be paid in the fourth quarter of 2024.
Long-term Debt
Long-term debt consisted of the following:
| June 30, 2024 | December 31, 2023 | |
|---|---|---|
| (in thousands) | ||
| Repurchase promissory note, interest paid at 11.0%, due June 2026 | $15,000 | $15,000 |
| Term loan facility, interest paid at 12.0%, due December 2025 | 65,000 | 65,000 |
| Unsecured promissory note, interest paid at 14.0%, due May 2026 | 29,102 | 29,102 |
| VGS 2 Promissory Note | 25,375 | — |
| Long-term debt, gross | 134,477 | 109,102 |
| Less: unamortized debt issuance costs and original issue discount | (1,353) | (783) |
| Long-term debt, net | $133,124 | $108,319 |
VGS 2 Promissory Note
On March 22, 2024, P3 LLC entered into a related party financing transaction with VBC Growth SPV 2, LLC (“VGS 2”), consisting of the issuance by P3 LLC of an unsecured promissory note (the “VGS 2 Promissory Note”) to VGS 2. The VGS 2 Promissory Note provided for funding of up to $25.0 million. The VGS 2 Promissory Note matures on September 30, 2027. P3 LLC paid VGS 2 an up-front fee of 1.5% of the aggregate principal amount of the loan in-kind. Interest is payable at 17.5% per annum on a quarterly cycle (in arrears) beginning June 30, 2024. P3 LLC may elect to pay either (1)8.0% cash interest and 9.5% interest paid in-kind (“PIK”), or (2)17.5% PIK interest, provided that payment of cash interest will be permitted only to the extent permitted by the Term Loan Agreement and the 2024 Subordination Agreement (defined below), and if not so permitted, such interest shall accrue as PIK interest. The VGS 2 Promissory Note provides for mandatory prepayments with the proceeds of certain asset sales, and VGS 2 has the right to demand payment in full upon (i) a change of control of the Company and (ii) certain qualified financings (as defined in the VGS 2 Promissory Note).
The VGS 2 Promissory Note restricts P3 LLC’s ability and the ability of its subsidiaries to, among other things, incur indebtedness and liens, and make investments and restricted payments. The maturity date may be accelerated as a remedy under the certain default provisions in the agreement, or in the event a mandatory prepayment event occurs.
In addition, P3 LLC will pay VGS 2 a back-end fee at the time the VGS 2 Promissory Note is redeemed as follows: (i) if paid after June 30, 2024 and on or before September 30, 2024,4.5%; (ii) if paid after September 30, 2024 and on or before December 31, 2024,6.75% and (iii) if paid after December 31, 2024,9.0%. As of June 30, 2024, the Company had recorded debt issuance costs and original issue discount of $0.5 million related to this financing.
2024 Subordination Agreement
In connection with the transactions described above, P3 LLC entered into a subordination agreement, dated as of March 22, 2024 (the “2024 Subordination Agreement”), by and among the Company, CRG Servicing LLC (“CRG”), as administrative agent under the Term Loan Facility and VGS 2. Pursuant to the 2024 Subordination Agreement, VGS 2 agreed to subordinate its right of payment under the VGS 2 Promissory Note to the right of payment and security interests of the lenders under the Term Loan Facility. The terms of the 2024 Subordination Agreement will effectively require P3 LLC to pay all interest under the VGS 2 Promissory Note in-kind.
Amendment to Term Loan Agreement and Consent
In connection with the transactions described above, P3 LLC entered into that certain (i) Fourth Amendment to Term Loan Agreement (the “Term Loan Amendment”), dated as of the March 22, 2024, by and among P3 LLC, as borrower, the subsidiary guarantors party thereto, the lenders from time to time party thereto and CRG, as administrative agent and collateral agent and (ii) Consent (the “Consent”), dated as of the March 22, 2024, by and between P3 LLC, as borrower, and VBC Growth SPV, LLC, as holder. The Term Loan Amendment and Consent collectively permit the issuance of the VGS 2 Promissory Note and the entry into the 2024 Subordination Agreement.
The Company was in compliance with its covenants under the term loan facility and the unsecured promissory notes as of June 30, 2024; however, there can be no assurance that the Company will be able to maintain compliance with these covenants in the future or that the lenders under the term loan facility and the unsecured promissory notes or the lenders of any future indebtedness the Company may incur will grant any waiver or forbearance with respect to such covenants that we may request in the future.
Note 9: Net Loss per Share
The following table provides the computation of basic and diluted net loss per share:
| Three Months Ended June 30, | Six Months Ended June 30, | |||
|---|---|---|---|---|
| 2024 | 2023 | 2024 | 2023 | |
| (in thousands, except per share data) | ||||
| Numerator–basic: | ||||
| Net loss attributable to Class A common stockholders–basic | $(12,020) | $(9,816) | $(30,720) | $(19,015) |
| Numerator–diluted: | ||||
| Net loss attributable to Class A common stockholders–basic | $(12,020) | $(9,816) | $(30,720) | $(19,015) |
| Effective of dilutive securities: | ||||
| Shares of Class V common stock | — | — | — | (61,015) |
| Liability-classified warrants | (8,779) | — | (8,779) | — |
| Net loss attributable to Class A common stockholders–diluted | $(20,799) | $(9,816) | $(39,499) | $(80,030) |
| Denominator–basic: | ||||
| Weighted average Class A common shares outstanding–basic | 136,601 | 107,454 | 127,806 | 74,699 |
| Net loss per share attributable to Class A common stockholders–basic | $(0.09) | $(0.09) | $(0.24) | $(0.25) |
| Denominator–diluted: | ||||
| Weighted average Class A common shares outstanding–basic | 136,601 | 107,454 | 127,806 | 74,699 |
| Weighted average effect of dilutive securities: | ||||
| Shares of Class V common stock | — | — | — | 201,329 |
| Liability-classified warrants | 4,482 | — | 2,241 | — |
| Weighted average shares outstanding–diluted | 141,083 | 107,454 | 130,047 | 276,028 |
| Net loss per share attributable to Class A common stockholders–diluted | $(0.15) | $(0.09) | $(0.30) | $(0.29) |
Shares of Class V common stock do not share in the earnings or losses of P3 and are therefore not participating securities. As such, separate presentation of basic and diluted net income per share for Class V common stock under the two-class method is not required. The following table presents potentially dilutive securities excluded from the computation of diluted net loss per share for the periods presented because their effect would have been anti-dilutive.
| Three Months Ended June 30, | Six Months Ended June 30, | |||
|---|---|---|---|---|
| 2024 | 2023 | 2024 | 2023 | |
| (in thousands) | ||||
| Stock warrants (1) | 107,718 | 81,938 | 107,718 | 81,938 |
| Stock options (1) | 21,530 | 5,924 | 21,530 | 5,924 |
| Restricted stock units (1) | 8,932 | 1,250 | 8,932 | 1,250 |
| Restricted stock awards (1) | — | 250 | — | 250 |
| Shares of Class V common stock (2) | 195,957 | 198,610 | 195,957 | — |
| Total | 334,137 | 287,972 | 334,137 | 89,362 |
(1)Represents the number of instruments outstanding at the end of the period. Application of the treasury stock method would reduce this amount if they had a dilutive effect and were included in the computation of diluted net loss per share
(2)Shares of Class V common stock at the end of the period, including shares tied to unvested Common Units, are considered potentially dilutive shares of Class A common stock under application of the if-converted method.
Note 10: Redeemable Non-controlling Interest
Non-controlling interest represents the portion of P3 LLC that the Company controls and consolidates but does not own (i.e., the Common Units held directly by equity holders other than the Company).
The ownership of the Common Units is summarized as follows:
| June 30, 2024 | December 31, 2023 | |||
|---|---|---|---|---|
| Units (in thousands) | Ownership % | Units (in thousands) | Ownership % | |
| P3 Health Partners Inc.’s ownership of Common Units | 161,762 | 45.2% | 116,588 | 37.2% |
| Non-controlling interest holders’ ownership of Common Units | 195,957 | 54.8 | 196,569 | 62.8 |
| Total Common Units | 357,719 | 100.0% | 313,157 | 100.0% |
During the six months ended June 30, 2024 and 2023, there were an aggregate of 0.6 million shares and 3.4 million shares, respectively, of Class A common stock issued to P3 LLC members in connection with such members’ redemptions of an equivalent number of Common Units and corresponding cancellation and retirement of an equivalent number of Class V common stock. Such retired shares of Class V common stock may not be reissued. The redemptions occurred pursuant to the terms of the P3 LLC Amended and Restated Limited Liability Agreement (the “P3 LLC A&R LLC Agreement”).
As of June 30, 2024, there wasno remeasurement adjustment recorded as the fair value of redeemable non-controlling interest (i.e., based on the five-day volume-weighted average price of a share of Class A common stock) was less than the carrying value. As of June 30, 2023, there was a $330.6 million remeasurement adjustment recorded as the fair value of redeemable non-controlling interest was greater than the carrying value. The offset of the fair value adjustment was recorded to additional paid in capital.
Note 11: Segment Reporting
The Company’s operations are organized underone reportable segment. The Chief Executive Officer, who is the Company’s chief operating decision maker, manages the Company’s operations and reviews financial information on a consolidated basis. Decisions regarding resource allocation and assessment of profitability are based on the Company’s responsibility to deliver high quality primary medical care services to its patient population. For the periods presented, all the Company’s revenue was earned in the United States. Likewise, all the Company’s long-lived assets were located in the United States.
Note 12: Capitalization
May 2024 Private Placement
On May 24, 2024, pursuant to a Securities Purchase Agreement (the “Purchase Agreement”), dated May 22, 2024 with the purchasers named therein (the “Purchasers”), which included certain affiliated entities of Chicago Pacific Founders GP, L.P., a Delaware limited partnership (“CPF GP”), and institutional investors, the Company issued approximately 67.4 million units at a price of approximately $0.6270 per unit. Each unit consists ofone share of Class A common stock and a warrant (the “Common Warrants”) to purchaseone share of Class A common stock at an exercise price of $0.5020. Certain institutional investors elected to receive pre-funded warrants (the “Pre-Funded Warrants,” and together with the Common Warrants, the “Warrants”) to purchase Class A common stock in lieu of a portion of their Class A common stock. In total, the Company sold (i) an aggregate of 41.6 million shares of its Class A common stock (the “Shares”), (ii) Common Warrants to purchase an aggregate of 67.4 million shares of Class A common stock, and (iii) Pre-Funded Warrants to purchase an aggregate of 25.8 million shares of Class A common stock for aggregate proceeds of $39.8 million, net of $2.4 million in offering costs (collectively, the “May 2024 Private Placement”). The Common Warrants were recorded as liability-classified financial instruments and the Pre-Funded Warrants were recorded as equity-classified financial instruments.
The key Level 3 inputs into the option pricing model related to the Common Warrants were as follows:
| Volatility | 95% |
|---|---|
| Risk-free interest rate | 4.50% |
| Exercise price | $0.50 |
| Expected term | 7.0 Years |
Registration Rights Agreement
On May 24, 2024, in connection with the May 2024 Private Placement, the Company entered into a Registration Rights Agreement (the “Registration Rights Agreement”) with the Purchasers. Pursuant to the Registration Rights Agreement, the Company agreed to prepare and file a registration statement with the SEC for purposes of registering the resale of the Shares and shares of common stock issuable upon exercise of the Warrants, which was filed with the SEC on June 18, 2024 and declared effective by the SEC on June 27, 2024. The Registration Rights Agreement also contains certain shelf takedown and piggyback rights.
The Company has also agreed, among other things, to indemnify the Purchasers, their officers, directors, members, employees and agents, successors and assigns under the registration statement from certain liabilities and to pay all fees and expenses incident to the Company’s obligations under the Registration Rights Agreement.
Amended and Restated Letter Agreement with CPF
On May 24, 2024, in connection with entry into the Purchase Agreement, the Company entered into an amended and restated letter agreement (the “Amended and Restated Letter Agreement”) with CPF GP, and Chicago Pacific Founders GP III, L.P., a Delaware limited partnership (“CPF GP III,” and together with CPF GP, “CPF”) (on behalf of the funds of which CPF GP is the general partner, certain funds of which CPF GP III is the general partner and/or certain of their affiliated entities and funds (collectively, the “CPF Parties”)). The Amended and Restated Letter Agreement provides that for as long as the CPF Parties own 40% of the Company’s outstanding common stock, (i) CPF will be entitled to designate one additional independent member of the Company’s board of directors, and (ii) CPF will be entitled to certain information rights and protective provisions. As of the date of the issuance of these financial statements, CPF has not exercised its right to designate a director under the terms of the Amended and Restated Letter Agreement. The CPF Parties also agreed to extend a standstill restriction that limits the ownership of the CPF Parties to 49.99% of the Company’s Class A common stock and Class V common stock from the date of the closing of the May 2024 Private Placement to July 31, 2025.
Restricted Stock Unit Settlement
On December 31, 2023,1.5 million restricted stock units (“RSU”), each RSU representing the right to receive one share of Class A common stock of the Company, previously granted to Sherif Abdou, M.D., the Company’s former Chief
Executive Officer, vested pursuant to the terms of a Restricted Stock Unit Agreement between the Company and Dr. Abdou. The Company timely paid $0.7 million in withholding taxes attributable to the vesting of the RSUs to the Internal Revenue Service on behalf of Dr. Abdou on January 10, 2024. Dr. Abdou repaid such sum to the Company on May 2, 2024.
Note 13: Variable Interest Entities
P3 LLC has Management Services Agreements (“MSAs”) and deficit funding agreements with the Network VIEs. The MSAs provide that the P3 LLC will furnish administrative personnel, office supplies and equipment, general business services, contract negotiation, and billing and collection services to the Network VIEs. Fees for these services are the excess of the Network VIEs’ revenue over expenses. Per the deficit funding agreements, P3 LLC is obligated to advance funds, as needed, to support the Network VIE’s working capital needs to the extent operating expenses exceed gross revenue. These advances accrue interest at a rate of prime plus 2%. Net advances made to the Network VIEs and accrued interest on those advances are presented within due to consolidated entities of P3 in the table below. Additionally, P3 LLC entered into stock transfer restriction agreements with the practice shareholders of the Network VIEs, which, by way of a call option, unequivocally permit P3 LLC to appoint successor physicians if a practice shareholder vacates their ownership position. Accordingly, P3 LLC identifies itself as the primary beneficiary of the Network VIEs. Practice shareholders, who are employees of P3 LLC, retain equity ownership in the Network VIEs, which represents nominal non-controlling interests; however, the non-controlling interests do not participate in the profit or loss of the Network VIEs.
P3 LLC, directly or indirectly via its wholly owned subsidiaries, may not use or access any net assets of the Network VIEs to settle its obligations or the obligations of its wholly owned subsidiaries. Additionally, the creditors of the Network VIEs do not have recourse to the net assets of P3 LLC.
Since P3 LLC represents substantially all the assets and liabilities of the Company, the following tables provide a summary of the assets, liabilities, and operating performance of only VIEs held at the P3 LLC level.
| June 30, 2024 | December 31, 2023 | |
|---|---|---|
| (in thousands) | ||
| ASSETS | ||
| Cash | $7,865 | $6,491 |
| Clinic fees, insurance and other receivable | 1,557 | 138 |
| Health plan receivable | 576 | 571 |
| Prepaid expenses and other current assets | 931 | 1,261 |
| Property and equipment, net | 46 | 23 |
| Other long-term assets | 129 | 153 |
| TOTAL ASSETS | $11,104 | $8,637 |
| LIABILITIES AND MEMBERS’ DEFICIT | ||
| Accounts payable | $4,393 | $5,073 |
| Accrued expenses and other current liabilities | 955 | 515 |
| Accrued payroll | 3,433 | 3,141 |
| Claims payable | 4,600 | 3,973 |
| Other long-term liabilities | 934 | 946 |
| Due to consolidated entities of P3 | 47,018 | 44,200 |
| TOTAL LIABILITIES | 61,333 | 57,848 |
| MEMBERS’ DEFICIT | (50,229) | (49,211) |
| TOTAL LIABILITIES AND MEMBERS’ DEFICIT | $11,104 | $8,637 |
| Three Months Ended June 30, | Six Months Ended June 30, | |||
|---|---|---|---|---|
| 2024 | 2023 | 2024 | 2023 | |
| (in thousands) | ||||
| Revenue | $9,354 | $9,511 | $19,118 | $20,350 |
| Expense | 9,803 | 11,847 | 19,700 | 25,522 |
| Net loss | $(449) | $(2,336) | $(582) | $(5,172) |
The text of this filing, as the company filed it with the SEC, without its images or exhibits. This is not investment advice.