LifeStance Reports Fourth Quarter and Full Year 2024 Results
LifeStance Health Group (NASDAQ: LFST) reported strong financial results for Q4 and full year 2024. Full-year revenue grew 19% to $1.251 billion, while Q4 revenue increased 16% to $325.5 million.
Key highlights include:
- Clinician base grew 12% to 7,424, adding 779 clinicians in 2024
- Visit volumes rose 15% to 7.9 million for the full year
- Generated $107.3 million in operating cash flow
- Adjusted EBITDA doubled to $119.7 million
- Free Cash Flow reached $85.7 million
For 2025, LifeStance projects revenue between $1.40-1.44 billion and Adjusted EBITDA of $130-150 million. Q1 2025 guidance expects revenue of $320-340 million.
LifeStance Health Group (NASDAQ: LFST) ha riportato risultati finanziari solidi per il quarto trimestre e l'intero anno 2024. Il fatturato annuale è cresciuto del 19% raggiungendo 1,251 miliardi di dollari, mentre il fatturato del quarto trimestre è aumentato del 16% a 325,5 milioni di dollari.
I principali punti salienti includono:
- La base di clinici è cresciuta del 12% a 7.424, con l'aggiunta di 779 clinici nel 2024
- Il volume delle visite è aumentato del 15% a 7,9 milioni per l'intero anno
- Generato 107,3 milioni di dollari in flusso di cassa operativo
- EBITDA rettificato raddoppiato a 119,7 milioni di dollari
- Il flusso di cassa libero ha raggiunto 85,7 milioni di dollari
Per il 2025, LifeStance prevede un fatturato compreso tra 1,40 e 1,44 miliardi di dollari e un EBITDA rettificato di 130-150 milioni di dollari. Le previsioni per il primo trimestre del 2025 prevedono un fatturato di 320-340 milioni di dollari.
LifeStance Health Group (NASDAQ: LFST) reportó resultados financieros sólidos para el cuarto trimestre y el año completo 2024. Los ingresos anuales crecieron un 19% alcanzando 1.251 millones de dólares, mientras que los ingresos del cuarto trimestre aumentaron un 16% a 325,5 millones de dólares.
Los puntos destacados incluyen:
- La base de clínicos creció un 12% a 7.424, añadiendo 779 clínicos en 2024
- Los volúmenes de visitas aumentaron un 15% a 7,9 millones para el año completo
- Generó 107,3 millones de dólares en flujo de caja operativo
- El EBITDA ajustado se duplicó a 119,7 millones de dólares
- El flujo de caja libre alcanzó 85,7 millones de dólares
Para 2025, LifeStance proyecta ingresos entre 1,40 y 1,44 mil millones de dólares y un EBITDA ajustado de 130-150 millones de dólares. La guía para el primer trimestre de 2025 espera ingresos de 320-340 millones de dólares.
라이프스탠스 헬스 그룹 (NASDAQ: LFST)는 2024년 4분기 및 연간 재무 결과를 발표했습니다. 연간 수익은 19% 증가하여 12억 5,100만 달러에 달했으며, 4분기 수익은 16% 증가하여 3억 2,550만 달러에 이르렀습니다.
주요 하이라이트는 다음과 같습니다:
- 임상 의사 수가 12% 증가하여 7,424명에 도달했으며, 2024년에는 779명의 임상 의사가 추가되었습니다.
- 방문 수는 연간 15% 증가하여 790만 건에 달했습니다.
- 운영 현금 흐름에서 1억 730만 달러를 생성했습니다.
- 조정된 EBITDA가 1억 1,970만 달러로 두 배 증가했습니다.
- 자유 현금 흐름이 8,570만 달러에 도달했습니다.
2025년을 위해 라이프스탠스는 수익을 14억에서 14억 4천만 달러로, 조정된 EBITDA를 1억 3천만에서 1억 5천만 달러로 예상하고 있습니다. 2025년 1분기 가이드는 3억 2천만에서 3억 4천만 달러의 수익을 예상합니다.
LifeStance Health Group (NASDAQ: LFST) a annoncé des résultats financiers solides pour le quatrième trimestre et l'année entière 2024. Le chiffre d'affaires annuel a augmenté de 19% pour atteindre 1,251 milliard de dollars, tandis que le chiffre d'affaires du quatrième trimestre a augmenté de 16% pour atteindre 325,5 millions de dollars.
Les points saillants comprennent:
- La base de cliniciens a augmenté de 12% pour atteindre 7 424, ajoutant 779 cliniciens en 2024
- Le volume des visites a augmenté de 15% pour atteindre 7,9 millions pour l'année entière
- A généré 107,3 millions de dollars de flux de trésorerie opérationnel
- L'EBITDA ajusté a doublé pour atteindre 119,7 millions de dollars
- Le flux de trésorerie libre a atteint 85,7 millions de dollars
Pour 2025, LifeStance prévoit un chiffre d'affaires compris entre 1,40 et 1,44 milliard de dollars et un EBITDA ajusté de 130 à 150 millions de dollars. Les prévisions pour le premier trimestre 2025 s'attendent à un chiffre d'affaires de 320 à 340 millions de dollars.
LifeStance Health Group (NASDAQ: LFST) hat starke finanzielle Ergebnisse für das vierte Quartal und das gesamte Jahr 2024 gemeldet. Der Jahresumsatz stieg um 19% auf 1,251 Milliarden Dollar, während der Umsatz im vierten Quartal um 16% auf 325,5 Millionen Dollar zunahm.
Wichtige Highlights sind:
- Die Zahl der Kliniker wuchs um 12% auf 7.424, mit 779 neuen Klinikern im Jahr 2024
- Die Besuchszahlen stiegen um 15% auf 7,9 Millionen für das gesamte Jahr
- Generierte 107,3 Millionen Dollar an operativem Cashflow
- Das bereinigte EBITDA verdoppelte sich auf 119,7 Millionen Dollar
- Der freie Cashflow erreichte 85,7 Millionen Dollar
Für 2025 prognostiziert LifeStance einen Umsatz zwischen 1,40 und 1,44 Milliarden Dollar und ein bereinigtes EBITDA von 130 bis 150 Millionen Dollar. Die Prognose für das erste Quartal 2025 erwartet einen Umsatz von 320 bis 340 Millionen Dollar.
- Revenue grew 19% YoY to $1.251B
- Adjusted EBITDA doubled to $119.7M
- Strong free cash flow of $85.7M
- 12% growth in clinician base
- 15% increase in visit volumes
- Operating cash flow of $107.3M
- Full year net loss of $57.4M
- Operating loss of $31.6M
- Net long-term debt of $279.8M
Insights
LifeStance Health's Q4 and full-year 2024 results demonstrate strong execution in the rapidly growing mental healthcare market. The company reported Q4 revenue of $325.5 million (up 16%) and full-year revenue of $1.25 billion (up 19%), driven by both clinician growth and increased revenue per visit.
The company's operational metrics show impressive scaling: clinician count increased 12% year-over-year to 7,424, while visit volumes grew 14% in Q4 and 15% annually to 7.9 million visits. The faster revenue growth compared to visit growth indicates improving revenue per visit, suggesting either favorable reimbursement trends or an optimized service mix.
Most notably, LifeStance is showing accelerating financial efficiency. Center Margin expanded significantly to 33.6% of revenue in Q4, up from 29.7% in the prior-year period. Adjusted EBITDA more than doubled year-over-year to $119.7 million, representing 9.6% of revenue compared to 5.6% in 2023. This margin expansion demonstrates the inherent operating leverage in LifeStance's business model as it scales.
The company's cash generation capabilities have strengthened considerably, with $107.3 million in operating cash flow and $85.7 million in free cash flow for the year. With $154.6 million in cash against $279.8 million in net long-term debt, LifeStance maintains a manageable 1.8x net debt to Adjusted EBITDA ratio.
The 2025 guidance projects continued growth, though at a more moderate pace of 12-15%. While this represents a deceleration from 2024's 19% growth, the projected Adjusted EBITDA growth of 9-25% suggests management remains focused on balancing growth with profitability improvements. The company appears well-positioned to benefit from ongoing mental healthcare demand while progressing toward sustainable profitability.
SCOTTSDALE, Ariz., Feb. 27, 2025 (GLOBE NEWSWIRE) -- LifeStance Health Group, Inc. (Nasdaq: LFST), one of the nation’s largest providers of outpatient mental healthcare, today announced financial results for the fourth quarter and full year ended December 31, 2024.
(All results compared to prior-year comparative period, unless otherwise noted)
2024 Highlights and 2025 Outlook
- Fourth quarter revenue of
$325.5 million increased16% and full year revenue of$1,251.0 million increased19% compared to revenue of$1,055.7 million - Clinician base increased
12% to 7,424 clinicians, a sequential net increase of 155 in the fourth quarter and 779 for the full year - Fourth quarter visit volumes increased
14% to 2.0 million and full year visit volumes increased15% to 7.9 million - Net loss of
$7.1 million in the fourth quarter and$57.4 million for the full year - Net cash from operations of
$62.3 million in the fourth quarter and$107.3 million for the full year - Adjusted EBITDA of
$32.8 million in the fourth quarter and$119.7 million for the full year - Free Cash Flow of
$56.0 million in the fourth quarter and$85.7 million for the full year - Expecting full year 2025 revenue of
$1.40 billion to$1.44 billion , Center Margin of$440 million to$464 million , and Adjusted EBITDA of$130 million to$150 million
“The team delivered exceptional performance in 2024,” said Ken Burdick, Chairman and CEO of LifeStance. “We grew revenue
| Financial Highlights | |||||||||||||||||||||||||
| Q4 2024 | Q4 2023 | Y/Y | FY 2024 | FY 2023 | Y/Y | ||||||||||||||||||||
| (in millions) | |||||||||||||||||||||||||
| Total revenue | $ | 325.5 | $ | 280.6 | 16 | % | $ | 1,251.0 | $ | 1,055.7 | 19 | % | |||||||||||||
| Income (loss) from operations | 1.1 | (32.3 | ) | (103 | %) | (31.6 | ) | (189.1 | ) | (83 | %) | ||||||||||||||
| Center Margin | 109.4 | 83.3 | 31 | % | 402.4 | 302.1 | 33 | % | |||||||||||||||||
| Net loss | (7.1 | ) | (45.0 | ) | (84 | %) | (57.4 | ) | (186.3 | ) | (69 | %) | |||||||||||||
| Adjusted EBITDA | 32.8 | 20.3 | 62 | % | 119.7 | 59.0 | 103 | % | |||||||||||||||||
| As % of Total revenue: | |||||||||||||||||||||||||
| Income (loss) from operations | 0.3 | % | (11.5 | %) | (2.5 | %) | (17.9 | %) | |||||||||||||||||
| Center Margin | 33.6 | % | 29.7 | % | 32.2 | % | 28.6 | % | |||||||||||||||||
| Net loss | (2.2 | %) | (16.0 | %) | (4.6 | %) | (17.6 | %) | |||||||||||||||||
| Adjusted EBITDA | 10.1 | % | 7.2 | % | 9.6 | % | 5.6 | % | |||||||||||||||||
(All results compared to prior-year period, unless otherwise noted)
- In the fourth quarter, revenue grew
16% to$325.5 million , and for the full year, revenue grew$195.3 million or19% to$1,251.0 million compared to revenue of$1,055.7 million . Strong revenue growth in the fourth quarter was driven primarily by improvements in total revenue per visit and higher visit volumes from net clinician growth. - In the fourth quarter, income from operations was
$1.1 million , and for the full year, loss from operations was$31.6 million . In the fourth quarter, net loss was$7.1 million and for the full year, net loss was$57.4 million . - In the fourth quarter, Center Margin grew
31% to$109.4 million , or33.6% of total revenue. For the full year, Center Margin grew33% to$402.4 million , or32.2% of total revenue. - In the fourth quarter, Adjusted EBITDA increased
62% to$32.8 million , or10.1% of total revenue. Adjusted EBITDA as a percentage of revenue increased in the fourth quarter as a result of higher total revenue per visit and lower center costs as a percentage of revenue. For the full year, Adjusted EBITDA grew103% to$119.7 million , or9.6% of total revenue.
Balance Sheet, Cash Flow and Capital Allocation
For the year ended December 31, 2024, LifeStance provided
2025 Guidance
LifeStance is providing the following outlook for 2025:
- The Company expects full year revenue of
$1.40 billion to$1.44 billion , Center Margin of$440 million to$464 million , and Adjusted EBITDA of$130 million to$150 million . - For the first quarter of 2025, the Company expects total revenue of
$320 million to$340 million , Center Margin of$100 million to$114 million , and Adjusted EBITDA of$27 million to$33 million .
Conference Call, Webcast Information, and Presentations
LifeStance will hold a conference call today, February 27, 2025 at 8:30 a.m. Eastern Time to discuss the fourth quarter and full year 2024 results. Investors who wish to participate in the call should dial 1-800-715-9871, domestically, or 1-646-307-1963, internationally, approximately 10 minutes before the call begins and provide conference ID number 4372752 or ask to be joined into the LifeStance call. A real-time audio webcast can be accessed via the Events and Presentations section of the LifeStance Investor Relations website (https://investor.lifestance.com), where related materials will be posted prior to the conference call.
About LifeStance Health Group, Inc.
Founded in 2017, LifeStance (Nasdaq: LFST) is reimagining mental health. We are one of the nation’s largest providers of virtual and in-person outpatient mental healthcare for children, adolescents and adults experiencing a variety of mental health conditions. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. LifeStance and its supported practices employ approximately 7,400 psychiatrists, advanced practice nurses, psychologists and therapists and operates across 33 states and more than 550 centers. To learn more, please visit www.LifeStance.com.
We routinely post information that may be important to investors on the “Investor Relations” section of our website at investor.lifestance.com. We encourage investors and potential investors to consult our website regularly for important information about us.
Forward-Looking Statements
Statements in this press release and on the related teleconference that express a belief, expectation or intention, as well as those that are not historical fact, are forward-looking statements. These statements include, but are not limited to, statements with respect to: full year and first quarter guidance and management's related assumptions; business plans and objectives; and other statements contained in this press release that are not historical facts. When used in this press release and on the related teleconference, words such as “may,” “will,” “should,” “could,” “intend,” “potential,” “continue,” “anticipate,” “believe,” “estimate,” “expect,” “plan,” “target,” “predict,” “project,” “seek” and similar expressions as they relate to us are intended to identify forward-looking statements. They involve a number of risks and uncertainties that may cause actual events and results to differ materially from such forward-looking statements. These risks and uncertainties include, but are not limited to: if reimbursement rates paid by third-party payors are reduced or if third-party payors otherwise restrain our ability to obtain or deliver care to patients, our business could be harmed; we may not grow at the rates we historically have achieved or at all, even if our key metrics may imply future growth, including if we are unable to successfully execute on our growth initiatives and business strategies; if we fail to manage our growth effectively, our expenses could increase more than expected, our revenue may not increase proportionally or at all, and we may be unable to execute on our business strategy; our ability to recruit new clinicians and retain existing clinicians; we conduct business in a heavily regulated industry and if we fail to comply with these laws and government regulations, we could incur penalties or be required to make significant changes to our operations or experience adverse publicity, which could have a material adverse effect on our business, results of operations and financial condition; we are dependent on our relationships with supported practices, which we do not own, to provide healthcare services, and our business would be harmed if those relationships were disrupted or if our arrangements with these entities became subject to legal challenges; we operate in a competitive industry, and if we are not able to compete effectively, our business and financial condition would be harmed; the impact of health care reform legislation and other changes in the healthcare industry and in health care spending on us is currently unknown, but may harm our business; if our or our vendors’ security measures fail or are breached and unauthorized access to our employees’, patients’ or partners’ data is obtained, our systems may be perceived as insecure, we may incur significant liabilities, including through private litigation or regulatory action, our reputation may be harmed, and we could lose patients and partners; our business depends on our ability to effectively invest in, implement improvements to and properly maintain the uninterrupted operation and data integrity of our information technology and other business systems; our existing indebtedness could adversely affect our business and growth prospects; and other risks and uncertainties set forth under “Risk Factors” included in the reports we have filed or will file with the Securities and Exchange Commission, including our Annual Report on Form 10-K for the year ended December 31, 2023 and subsequent filings made with the Securities and Exchange Commission. LifeStance does not undertake to update any forward-looking statements made in this press release to reflect any change in management's expectations or any change in the assumptions or circumstances on which such statements are based, except as otherwise required by law.
Non-GAAP Financial Information
This press release contains certain non-GAAP financial measures, including Center Margin, Adjusted EBITDA, and Adjusted EBITDA margin. Tables showing the reconciliation of these non-GAAP financial measures to the comparable GAAP measures are included at the end of this release. Management believes these non-GAAP financial measures are useful in evaluating the Company’s operating performance, and may be helpful to securities analysts, institutional investors and other interested parties in understanding the Company’s operating performance and prospects. This press release also refers to Free Cash Flow, which is calculated as net cash provided by (used in) operating activities less purchases of property and equipment. Management believes Free Cash Flow is a useful indicator of liquidity that provides information to management and investors about the amount of cash generated from our operations that, after investments in property and equipment, can be used for future growth. These non-GAAP financial measures, as calculated, may not be comparable to companies in other industries or within the same industry with similarly titled measures of performance. Therefore, the Company’s non-GAAP financial measures should be considered in addition to, not as a substitute for, or in isolation from, measures prepared in accordance with GAAP, such as net loss or loss from operations.
Center Margin and Adjusted EBITDA anticipated for the first quarter of 2025 and full year 2025 are calculated in a manner consistent with the historical presentation of these measures at the end of this release. Reconciliation for the forward-looking first quarter of 2025 and full year 2025 Center Margin, Adjusted EBITDA guidance and Free Cash Flow is not being provided, as LifeStance does not currently have sufficient data to accurately estimate the variables and individual adjustments for such reconciliation. As such, LifeStance management cannot estimate on a forward-looking basis without unreasonable effort the impact these variables and individual adjustments will have on its reported results.
Management acknowledges that there are many items that impact a company’s reported results and the adjustments reflected in these non-GAAP measures are not intended to present all items that may have impacted these results.
| Consolidated Financial Information and Reconciliations | ||||||||
| CONSOLIDATED BALANCE SHEETS | ||||||||
| (unaudited) | ||||||||
| (In thousands, except for par value) | ||||||||
| December 31, | ||||||||
| 2024 | 2023 | |||||||
| CURRENT ASSETS | ||||||||
| Cash and cash equivalents | $ | 154,571 | $ | 78,824 | ||||
| Patient accounts receivable, net | 131,802 | 125,405 | ||||||
| Prepaid expenses and other current assets | 26,137 | 21,502 | ||||||
| Total current assets | 312,510 | 225,731 | ||||||
| NONCURRENT ASSETS | ||||||||
| Property and equipment, net | 166,041 | 188,222 | ||||||
| Right-of-use assets | 147,878 | 170,703 | ||||||
| Intangible assets, net | 190,799 | 221,072 | ||||||
| Goodwill | 1,293,346 | 1,293,346 | ||||||
| Other noncurrent assets | 7,724 | 10,895 | ||||||
| Total noncurrent assets | 1,805,788 | 1,884,238 | ||||||
| Total assets | $ | 2,118,298 | $ | 2,109,969 | ||||
| LIABILITIES AND STOCKHOLDERS' EQUITY | ||||||||
| CURRENT LIABILITIES | ||||||||
| Accounts payable | $ | 7,242 | $ | 7,051 | ||||
| Accrued payroll expenses | 117,461 | 102,478 | ||||||
| Other accrued expenses | 46,942 | 35,012 | ||||||
| Contingent consideration | — | 8,169 | ||||||
| Operating lease liabilities, current | 49,449 | 46,475 | ||||||
| Other current liabilities | 7,792 | 3,688 | ||||||
| Total current liabilities | 228,886 | 202,873 | ||||||
| NONCURRENT LIABILITIES | ||||||||
| Long-term debt, net | 279,790 | 280,285 | ||||||
| Operating lease liabilities, noncurrent | 148,699 | 181,357 | ||||||
| Deferred tax liability, net | 14,329 | 15,572 | ||||||
| Other noncurrent liabilities | 309 | 952 | ||||||
| Total noncurrent liabilities | 443,127 | 478,166 | ||||||
| Total liabilities | $ | 672,013 | $ | 681,039 | ||||
| COMMITMENTS AND CONTINGENCIES | ||||||||
| STOCKHOLDERS’ EQUITY | ||||||||
| Preferred stock – par value | — | — | ||||||
| Common stock – par value | 3,827 | 3,789 | ||||||
| Additional paid-in capital | 2,259,818 | 2,183,684 | ||||||
| Accumulated other comprehensive income | 929 | 2,303 | ||||||
| Accumulated deficit | (818,289 | ) | (760,846 | ) | ||||
| Total stockholders' equity | 1,446,285 | 1,428,930 | ||||||
| Total liabilities and stockholders’ equity | $ | 2,118,298 | $ | 2,109,969 | ||||
| CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS | ||||||||||||
| (unaudited) | ||||||||||||
| (In thousands, except for Net Loss per Share) | ||||||||||||
| Year Ended December 31, | ||||||||||||
| 2024 | 2023 | 2022 | ||||||||||
| TOTAL REVENUE | $ | 1,250,970 | $ | 1,055,665 | $ | 859,542 | ||||||
| OPERATING EXPENSES | ||||||||||||
| Center costs, excluding depreciation and amortization shown separately below | 848,571 | 753,569 | 622,525 | |||||||||
| General and administrative expenses | 363,062 | 410,793 | 377,993 | |||||||||
| Depreciation and amortization | 70,950 | 80,437 | 69,198 | |||||||||
| Total operating expenses | $ | 1,282,583 | $ | 1,244,799 | $ | 1,069,716 | ||||||
| LOSS FROM OPERATIONS | $ | (31,613 | ) | $ | (189,134 | ) | $ | (210,174 | ) | |||
| OTHER EXPENSE | ||||||||||||
| Gain (loss) on remeasurement of contingent consideration | 1,725 | 3,972 | (1,688 | ) | ||||||||
| Transaction costs | (827 | ) | (89 | ) | (722 | ) | ||||||
| Interest expense, net | (26,535 | ) | (21,220 | ) | (19,928 | ) | ||||||
| Other expense | (363 | ) | (112 | ) | (218 | ) | ||||||
| Total other expense | $ | (26,000 | ) | $ | (17,449 | ) | $ | (22,556 | ) | |||
| LOSS BEFORE INCOME TAXES | (57,613 | ) | (206,583 | ) | (232,730 | ) | ||||||
| INCOME TAX BENEFIT | 170 | 20,321 | 17,166 | |||||||||
| NET LOSS | $ | (57,443 | ) | $ | (186,262 | ) | $ | (215,564 | ) | |||
| NET LOSS PER SHARE, BASIC AND DILUTED | (0.15 | ) | (0.51 | ) | (0.61 | ) | ||||||
| Weighted-average shares used to compute basic and diluted net loss per share | 379,147 | 367,457 | 355,278 | |||||||||
| NET LOSS | $ | (57,443 | ) | $ | (186,262 | ) | $ | (215,564 | ) | |||
| OTHER COMPREHENSIVE (LOSS) INCOME | ||||||||||||
| Unrealized (losses) gains on cash flow hedge, net of tax | (1,374 | ) | (971 | ) | 3,274 | |||||||
| COMPREHENSIVE LOSS | $ | (58,817 | ) | $ | (187,233 | ) | $ | (212,290 | ) | |||
| CONSOLIDATED STATEMENTS OF CASH FLOWS | ||||||||||||
| (unaudited) | ||||||||||||
| (In thousands) | ||||||||||||
| Year Ended December 31, | ||||||||||||
| 2024 | 2023 | 2022 | ||||||||||
| CASH FLOWS FROM OPERATING ACTIVITIES | ||||||||||||
| Net loss | $ | (57,443 | ) | $ | (186,262 | ) | $ | (215,564 | ) | |||
| Adjustments to reconcile net loss to net cash provided by (used in) operating activities: | ||||||||||||
| Depreciation and amortization | 70,950 | 80,437 | 69,198 | |||||||||
| Non-cash operating lease costs | 39,502 | 39,987 | 38,161 | |||||||||
| Stock-based compensation | 76,172 | 99,388 | 187,430 | |||||||||
| Deferred income taxes | (958 | ) | (21,920 | ) | (16,733 | ) | ||||||
| Loss on debt extinguishment | 5,032 | — | 3,380 | |||||||||
| Amortization of discount and debt issue costs | 1,666 | 2,101 | 1,949 | |||||||||
| (Gain) loss on remeasurement of contingent consideration | (1,725 | ) | (3,972 | ) | 1,688 | |||||||
| Other, net | 1,431 | 7,080 | 218 | |||||||||
| Change in operating assets and liabilities, net of businesses acquired: | ||||||||||||
| Patient accounts receivable, net | (6,397 | ) | (24,175 | ) | (21,663 | ) | ||||||
| Prepaid expenses and other current assets | (3,332 | ) | (3,070 | ) | (3,431 | ) | ||||||
| Accounts payable | 501 | (5,605 | ) | 7,667 | ||||||||
| Accrued payroll expenses | 14,984 | 26,484 | 12,100 | |||||||||
| Operating lease liabilities | (46,748 | ) | (37,564 | ) | (13,169 | ) | ||||||
| Other accrued expenses | 13,625 | 10,207 | 1,558 | |||||||||
| Net cash provided by (used in) operating activities | $ | 107,260 | $ | (16,884 | ) | $ | 52,789 | |||||
| CASH FLOWS FROM INVESTING ACTIVITIES | ||||||||||||
| Purchases of property and equipment | (21,566 | ) | (40,520 | ) | (79,255 | ) | ||||||
| Acquisitions of businesses, net of cash acquired | — | (19,820 | ) | (60,206 | ) | |||||||
| Net cash used in investing activities | $ | (21,566 | ) | $ | (60,340 | ) | $ | (139,461 | ) | |||
| CASH FLOWS FROM FINANCING ACTIVITIES | ||||||||||||
| Proceeds from long-term debt, net of discount | 287,809 | 57,753 | 257,324 | |||||||||
| Payments of debt issue costs | (1,818 | ) | (188 | ) | (7,266 | ) | ||||||
| Payments of long-term debt | (289,494 | ) | (2,470 | ) | (187,766 | ) | ||||||
| Prepayment for debt paydown | — | — | (1,609 | ) | ||||||||
| Payments of contingent consideration | (6,444 | ) | (7,668 | ) | (12,515 | ) | ||||||
| Taxes related to net share settlement of equity awards | — | — | (904 | ) | ||||||||
| Net cash (used in) provided by financing activities | $ | (9,947 | ) | $ | 47,427 | $ | 47,264 | |||||
| NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS | 75,747 | (29,797 | ) | (39,408 | ) | |||||||
| Cash and Cash Equivalents - Beginning of period | 78,824 | 108,621 | 148,029 | |||||||||
| CASH AND CASH EQUIVALENTS – END OF PERIOD | $ | 154,571 | $ | 78,824 | $ | 108,621 | ||||||
| SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION | ||||||||||||
| Cash paid for interest, net | $ | 24,992 | $ | 21,044 | $ | 14,365 | ||||||
| Cash paid for taxes, net of refunds | $ | 57 | $ | 80 | $ | 2,237 | ||||||
| SUPPLEMENTAL DISCLOSURES OF NON CASH INVESTING AND FINANCING ACTIVITIES | ||||||||||||
| Equipment financed through finance leases | $ | — | $ | — | $ | 363 | ||||||
| Contingent consideration incurred in acquisitions of businesses | $ | — | $ | 1,985 | $ | 11,221 | ||||||
| Acquisition of property and equipment included in liabilities | $ | 1,469 | $ | 3,827 | $ | 7,891 | ||||||
| Surrender of common stock | $ | — | $ | — | $ | 982 | ||||||
| RECONCILIATION OF LOSS FROM OPERATIONS TO CENTER MARGIN | ||||||||||||
| Year Ended December 31, | ||||||||||||
| 2024 | 2023 | 2022 | ||||||||||
| (in thousands) | ||||||||||||
| Loss from operations | $ | (31,613 | ) | $ | (189,134 | ) | $ | (210,174 | ) | |||
| Adjusted for: | ||||||||||||
| Depreciation and amortization | 70,950 | 80,437 | 69,198 | |||||||||
| General and administrative expenses(1) | 363,062 | 410,793 | 377,993 | |||||||||
| Center Margin | $ | 402,399 | $ | 302,096 | $ | 237,017 | ||||||
| (1) | Represents salaries, wages and employee benefits for our executive leadership, finance, human resources, marketing, billing and credentialing support and technology infrastructure and stock-based compensation for all employees. |
| RECONCILIATION OF NET LOSS TO ADJUSTED EBITDA | ||||||||||||
| Year Ended December 31, | ||||||||||||
| 2024 | 2023 | 2022 | ||||||||||
| (in thousands) | ||||||||||||
| Net loss | $ | (57,443 | ) | $ | (186,262 | ) | $ | (215,564 | ) | |||
| Adjusted for: | ||||||||||||
| Interest expense, net | 26,535 | 21,220 | 19,928 | |||||||||
| Depreciation and amortization | 70,950 | 80,437 | 69,198 | |||||||||
| Income tax benefit | (170 | ) | (20,321 | ) | (17,166 | ) | ||||||
| (Gain) loss on remeasurement of contingent consideration | (1,725 | ) | (3,972 | ) | 1,688 | |||||||
| Stock-based compensation expense | 76,172 | 99,388 | 187,430 | |||||||||
| Loss on disposal of assets | 363 | 112 | 218 | |||||||||
| Transaction costs (1) | 827 | 89 | 722 | |||||||||
| Executive transition costs | 644 | 636 | 1,274 | |||||||||
| Litigation costs (2) | 1,591 | 51,034 | 851 | |||||||||
| Strategic initiatives (3) | 1,292 | 3,925 | — | |||||||||
| Real estate optimization and restructuring charges (4) | (309 | ) | 10,970 | — | ||||||||
| Amortization of cloud-based software implementation costs (5) | 843 | — | — | |||||||||
| Other expenses (6) | 172 | 1,786 | 4,091 | |||||||||
| Adjusted EBITDA | $ | 119,742 | $ | 59,042 | $ | 52,670 | ||||||
| (1) | Primarily includes capital markets advisory, consulting, accounting and legal expenses related to our acquisitions and to our underwritten public offering completed in the second quarter of 2024. | |
| (2) | Litigation costs include only those costs which are considered non-recurring and outside of the ordinary course of business based on the following considerations, which we assess regularly: (i) the frequency of similar cases that have been brought to date, or are expected to be brought within two years, (ii) the complexity of the case (e.g., complex class action litigation), (iii) the nature of the remedy(ies) sought, including the size of any monetary damages sought, (iv) the counterparty involved, and (v) our overall litigation strategy. During the years ended December 31, 2024, 2023 and 2022, litigation costs included cash expenses related to three distinct litigation matters, including (x) a securities class action litigation, (y) a privacy class action litigation and (z) a compensation model class action litigation. | |
| (3) | Strategic initiatives consist of expenses directly related to a multi-phase system upgrade in connection with our recent and significant expansion. During the years ended December 31, 2024 and 2023, we continued a process of evaluating and adopting critical enterprise-wide systems for (i) human resources management, (ii) clinician credentialing and onboarding process, and for the year ended December 31, 2023, (iii) a scalable electronic health resources system. Strategic initiatives represents costs, such as third-party consulting costs and one-time costs, that are not part of our ongoing operations related to these enterprise-wide systems. We considered the frequency and scale of this multi-part enterprise upgrade when determining that the expenses were not normal, recurring operating expenses. | |
| (4) | Real estate optimization and restructuring charges consist of cash expenses and non-cash charges related to our real estate optimization initiative, which include certain asset impairment and disposal costs, certain gains and losses related to early lease terminations, and exit and disposal costs related to our real estate optimization initiative to consolidate our physical footprint for the year ended December 31, 2023. As the decision to close these centers was part of a significant strategic project driven by a historic shift in behavior, the magnitude of center closures was greater than what would be expected as part of ordinary business operations and did not constitute normal recurring operating activities. During the year ended December 31, 2024, real estate optimization and restructuring charges consisted of certain gains and losses related to early lease terminations of previously abandoned real estate leases in 2023. | |
| (5) | Represents amortization of capitalized implementation costs related to cloud-based software arrangements that are included within general and administrative expenses included in our consolidated statements of operations and comprehensive loss. | |
| (6) | Primarily includes costs incurred to consummate or integrate acquired centers, certain of which are wholly-owned and certain of which are supported practices, in addition to the compensation paid to former owners of acquired centers and related expenses that are not reflective of the ongoing operating expenses of our centers. Acquired center integration and other are components of general and administrative expenses included in our consolidated statements of operations and comprehensive loss. Former owner fees is a component of center costs, excluding depreciation and amortization included in our consolidated statements of operations and comprehensive loss. |
FAQ
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