UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-Q
(MARK ONE)
☒
QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR THE QUARTERLY PERIOD ENDED June 30, 2020
 OR

☐
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
FOR THE TRANSITION PERIOD FROM _____TO _____

COMMISSION FILE NUMBER 1-11151


U.S. PHYSICAL THERAPY, INC.
(EXACT NAME OF REGISTRANT AS SPECIFIED IN ITS CHARTER)


NEVADA
  
76-0364866
(STATE OR OTHER JURISDICTION OF INCORPORATION OR ORGANIZATION)
  
(I.R.S. EMPLOYER IDENTIFICATION NO.)

1300 WEST SAM HOUSTON PARKWAY SOUTH, SUITE 300, HOUSTON, TEXAS
  
77042
(ADDRESS OF PRINCIPAL EXECUTIVE OFFICES)
  
(ZIP CODE)

REGISTRANT’S TELEPHONE NUMBER, INCLUDING AREA CODE: (713) 297-7000

Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days.    ☒  Yes     ☐  No

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted and pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit and such files).   ☒  Yes     ☐  No

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer”, “smaller reporting company” and “emerging growth company” in Rule 12b-2 of the Exchange Act.

Large accelerated filer
☑
Accelerated filer
☐
Non-accelerated filer
☐ (Do not check if a smaller reporting company)
Smaller reporting company
☐
   
Emerging growth company
☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act).    ☐  Yes    ☒  No

 Title of each class
Trading
Symbol(s)
 Name of each exchange on which registered
Common Stock, $.01 par value
USPH
New York Stock Exchange

As of August 6, 2020, the number of shares outstanding (issued less treasury stock) of the registrant’s common stock, par value $.01 per share, was: 12,843,047.

Table of Contents
PART I—FINANCIAL INFORMATION - UNAUDITED

Item 1.
3
     
 
3
     
 
4
     
 
5
     
 
6
     
 
8
     
Item 2.
30
     
Item 3.
46
     
Item 4.
47
   
PART II—OTHER INFORMATION
  
   
Item 1.
48
     
Item 6.
50
     
 
51
     
 
Certifications
  

2
Table of Contents
ITEM 1.
FINANCIAL STATEMENTS.

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED BALANCE SHEETS
(IN THOUSANDS, EXCEPT SHARE DATA)

  
June 30, 2020
    
December 31, 2019
  
ASSETS
  
(unaudited)
        
Current assets:
            
Cash and cash equivalents
  
$
43,555
    
$
23,548
  
Patient accounts receivable, less allowance for doubtful accounts of $2,470  and $2,698, respectively
    
36,029
      
46,228
  
Accounts receivable - other
    
9,983
      
9,823
  
Other current assets
    
2,572
      
5,787
  
Total current assets
    
92,139
      
85,386
  
Fixed assets:
                
Furniture and equipment
    
55,914
      
54,942
  
Leasehold improvements
    
33,631
      
33,247
  
Fixed assets, gross
    
89,545
      
88,189
  
Less accumulated depreciation and amortization
    
67,011
      
66,099
  
Fixed assets, net
    
22,534
      
22,090
  
Operating lease right-of-use assets
    
82,965
      
81,586
  
Goodwill
    
330,894
      
317,676
  
Other identifiable intangible assets, net
    
54,895
      
52,588
  
Other assets
    
1,591
      
1,519
  
Total assets
  
$
585,018
    
$
560,845
  
                 
LIABILITIES, REDEEMABLE NON-CONTROLLING INTERESTS, USPH SHAREHOLDERS’ EQUITY AND NON-CONTROLLING INTERESTS
                
Current liabilities:
                
Accounts payable - trade
  
$
1,802
    
$
2,494
  
Accrued expenses
    
51,325
      
30,855
  
Current portion of operating lease liabilities
    
29,591
      
26,486
  
Current portion of notes payable
    
4,635
      
728
  
Total current liabilities
    
87,353
      
60,563
  
Notes payable, net of current portion
    
685
      
4,361
  
Revolving line of credit
    
33,000
      
46,000
  
Deferred taxes
    
8,930
      
10,071
  
Operating lease liabilities, net of current portion
    
61,242
      
60,258
  
Other long-term liabilities
    
392
      
141
  
Total liabilities
    
191,602
      
181,394
  
                 
Redeemable non-controlling interests - temporary equity
    
136,728
      
137,750
  
                 
U.S. Physical Therapy, Inc. (“USPH”) shareholders’ equity:
                
Preferred stock, $0.01 par value, 500,000 shares authorized, no shares issued and outstanding
    
-
      
-
  
Common stock, $0.01 par value, 20,000,000 shares authorized, 15,057,859 and 14,989,337 shares issued, respectively
    
151
      
150
  
Additional paid-in capital
    
91,258
      
87,383
  
Retained earnings
    
195,473
      
184,352
  
Treasury stock at cost, 2,214,737 shares
    
(31,628
)
    
(31,628
)
Total USPH shareholders’ equity
    
255,254
      
240,257
  
Non-controlling interests- permanent equity
    
1,434
      
1,444
  
Total USPH shareholders’ equity and non-controlling interests
    
256,688
      
241,701
  
Total liabilities, redeemable non-controlling interests, USPH shareholders’ equity and non-controlling interests
  
$
585,018
    
$
560,845
  

See notes to consolidated financial statements.

3
Table of Contents

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF INCOME
(IN THOUSANDS, EXCEPT PER SHARE DATA)
(unaudited)

  
For the Three Months Ended
    
For the Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30,2020
    
June 30, 2019
  
                         
Net patient revenues
  
$
72,279
    
$
113,363
    
$
172,405
    
$
220,013
  
Other revenues
    
11,578
      
13,010
      
24,169
      
22,591
  
Net revenues
    
83,857
      
126,373
      
196,574
      
242,604
  
Operating costs:
                                
Salaries and related costs
    
43,429
      
70,669
      
112,433
      
136,936
  
Rent, supplies, contract labor and other
    
20,311
      
23,026
      
43,220
      
45,070
  
Provision for doubtful accounts
    
739
      
1,240
      
2,100
      
2,446
  
Closure costs - lease and other
    
94
      
13
      
1,987
      
9
  
Closure costs - write-off of goodwill
    
-
      
-
      
1,859
      
-
  
Total operating costs
    
64,573
      
94,948
      
161,599
      
184,461
  
                                 
Gross profit
    
19,284
      
31,425
      
34,975
      
58,143
  
                                 
Corporate office costs
    
9,022
      
11,527
      
20,699
      
22,820
  
Operating income
    
10,262
      
19,898
      
14,276
      
35,323
  
                                 
Other income and expense:
                                
Relief Funds
    
7,959
      
-
      
7,959
      
-
  
Gain on sale of partnership interest and clinics
    
1,073
      
5,823
      
1,073
      
5,823
  
Interest and other income, net
    
4
      
4
      
47
      
20
  
Interest expense - debt and other
    
(653
)
    
(607
)
    
(1,080
)
    
(965
)
Total other income and expense
    
8,383
      
5,220
      
7,999
      
4,878
  
Income before taxes
    
18,645
      
25,118
      
22,275
      
40,201
  
Provision for income taxes
    
3,882
      
5,318
      
4,174
      
8,026
  
                                 
Net income
    
14,763
      
19,800
      
18,101
      
32,175
  
                                 
Less: net income attributable to non-controlling interests:
                                
Non-controlling interests - permanent equity
    
(1,535
)
    
(1,802
)
    
(2,061
)
    
(3,339
)
Redeemable non-controlling interests - temporary equity
    
(2,996
)
    
(3,378
)
    
(4,792
)
    
(5,773
)
     
(4,531
)
    
(5,180
)
    
(6,853
)
    
(9,112
)
                                 
Net income attributable to USPH shareholders
  
$
10,232
    
$
14,620
    
$
11,248
    
$
23,063
  
                                 
Basic and diluted earnings per share attributable to USPH shareholders
  
$
0.99
    
$
0.85
    
$
1.19
    
$
1.24
  
                                 
Shares used in computation - basic and diluted
    
12,843
      
12,767
      
12,820
      
12,738
  
                                 
Dividends declared per common share
  
$
-
    
$
0.27
    
$
0.32
    
$
0.54
  

See notes to consolidated financial statements.

4
Table of Contents

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CASH FLOWS
(IN THOUSANDS)
(unaudited)

  
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
  
OPERATING ACTIVITIES
            
Net income including non-controlling interests
  
$
18,101
    
$
32,175
  
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:
                
Depreciation and amortization
    
5,333
      
4,958
  
Provision for doubtful accounts
    
2,100
      
2,446
  
Equity-based awards compensation expense
    
3,389
      
3,558
  
Deferred income taxes
    
(1,737
)
    
5,421
  
Loss on sale of fixed assets
    
429
      
-
  
Gain on sale of partnership interest, net of tax
    
(1,073
)
    
(5,514
)
Write-off of goodwill - closed clinics
    
1,859
      
-
  
Other
    
-
      
21
  
Changes in operating assets and liabilities:
                
Decrease (increase) in patient accounts receivable
    
8,880
      
(4,956
)
Decrease(increase) in accounts receivable - other
    
283
      
(2,468
)
Decrease (increase) in other assets
    
5,969
      
(2,759
)
Increase (decrease) in accounts payable and accrued expenses
    
4,478
      
(3,560
)
Increase (decrease) in other liabilities
    
345
      
(701
)
Net cash provided by operating activities
    
48,356
      
28,621
  
                 
INVESTING ACTIVITIES
                
Purchase of fixed assets
    
(4,628
)
    
(4,876
)
Purchase of majority interest in businesses, net of cash acquired
    
(11,633
)
    
(18,239
)
Purchase of redeemable non-controlling interest, temporary equity
    
(2,388
)
    
(2,053
)
Purchase of non-controlling interest, permanent equity
    
(144
)
    
(138
)
Proceeds on sale of redeemable non-controlling interest, temporary equity
    
19
      
-
  
Proceeds on sales of partnership interest and clinics
    
674
      
-
  
Proceeds on sale of fixed assets
    
21
      
65
  
Net cash used in investing activities
    
(18,079
)
    
(25,241
)
                 
FINANCING ACTIVITIES
                
Distributions to non-controlling interests, permanent and temporary equity
    
(5,707
)
    
(7,934
)
Cash dividends paid to shareholders
    
(4,110
)
    
(6,891
)
Proceeds from revolving line of credit
    
99,000
      
80,000
  
Payments on revolving line of credit
    
(112,000
)
    
(56,000
)
Principal payments on notes payable
    
(314
)
    
(1,057
)
Medicare Accelerated and Advance Payment Funds
    
12,861
      
-
  
Other
    
-
      
(7
)
Net cash provided by (used in) financing activities
    
(10,270
)
    
8,111
  
                 
Net increase in cash and cash equivalents
    
20,007
      
11,491
  
Cash and cash equivalents - beginning of period
    
23,548
      
23,368
  
Cash and cash equivalents - end of period
  
$
43,555
    
$
34,859
  
                 
SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION
                
Cash paid during the period for:
                
Income taxes
  
$
57
    
$
4,339
  
Interest
  
$
944
    
$
902
  
Non-cash investing and financing transactions during the period:
                
Purchase of businesses - seller financing portion
  
$
300
    
$
4,000
  
Purchase of business - payable to common shareholders of acquired business
  
$
-
    
$
502
  
Purchase of redeemable non-controlling interest - notes payable
  
$
137
    
$
-
  
Payable due to purchase of redeemable non-controlling interest
  
$
699
    
$
-
  
Receivables related to sale of partnership interest
  
$
-
    
$
11,601
  
Notes receivables related to sale of partnership interest
  
$
386
    
$
2,780
  
Payable related to purchase of partnership interest - settlement of redeemable non-controlling interest
  
$
-
    
$
2,200
  

See notes to consolidated financial statements.

5
Table of Contents

U. S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY
(IN THOUSANDS)
(unaudited)

   
U.S.Physical Therapy, Inc.
              
 
Common Stock
    
Additional
    
Retained
    
Treasury Stock
    
Total Shareholders’
    
Non-Controlling
        
For the three months ended June 30, 2020
  
Shares
    
Amount
    
Paid-In Capital
    
Earnings
    
Shares
    
Amount
    
Equity
    
Interests
    
Total
  
                                                       
Balance March 31, 2020
    
15,059
    
$
151
    
$
89,756
    
$
182,785
      
(2,215
)
  
$
(31,628
)
  
$
241,064
    
$
1,240
    
$
242,304
  
Issuance of restricted stock, net of cancellations
    
(1
)
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
  
Revaluation of redeemable non-controlling interest, net of tax
    
-
      
-
      
-
      
2,466
      
-
      
-
      
2,466
      
-
      
2,466
  
Compensation expense - equity-based awards
    
-
      
-
      
1,502
      
-
      
-
      
-
      
1,502
      
-
      
1,502
  
Distributions to non-controlling interest partners - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
(1,313
)
    
(1,313
)
Other
    
-
      
-
      
-
      
(10
)
    
-
      
-
      
(10
)
    
(28
)
    
(38
)
Net income attributable to non-controlling interest - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
1,535
      
1,535
  
Net income attributable to USPH shareholders
    
-
      
-
      
-
      
10,232
      
-
      
-
      
10,232
      
-
      
10,232
  
Balance June 30, 2020
    
15,058
    
$
151
    
$
91,258
    
$
195,473
      
(2,215
)
  
$
(31,628
)
  
$
255,254
    
$
1,434
    
$
256,688
  

   
U.S.Physical Therapy, Inc.
              
 
Common Stock
    
Additional
    
Retained
    
Treasury Stock
    
Total Shareholders’
    
Non-Controlling
        
For the six months ended June 30, 2020
  
Shares
    
Amount
    
Paid-In Capital
    
Earnings
    
Shares
    
Amount
    
Equity
    
Interests
    
Total
  
                                                       
Balance December 31, 2019
    
14,989
    
$
150
    
$
87,383
    
$
184,352
      
(2,215
)
  
$
(31,628
)
  
$
240,257
    
$
1,444
    
$
241,701
  
Issuance of restricted stock, net of cancellations
    
69
      
1
      
-
      
-
      
-
      
-
      
1
      
-
      
1
  
Revaluation of redeemable non-controlling interest, net of tax
    
-
      
-
      
-
      
4,036
      
-
      
-
      
4,036
      
-
      
4,036
  
Compensation expense - equity-based awards
    
-
      
-
      
3,389
      
-
      
-
      
-
      
3,389
      
-
      
3,389
  
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans
    
-
      
-
      
486
      
-
      
-
      
-
      
486
      
-
      
486
  
Dividends paid to USPT shareholders
    
-
      
-
      
-
      
(4,110
)
    
-
      
-
      
(4,110
)
    
-
      
(4,110
)
Distributions to non-controlling interest partners - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
(2,043
)
    
(2,043
)
Other
    
-
      
-
      
-
      
(53
)
    
-
      
-
      
(53
)
    
(28
)
    
(81
)
Net income attributable to non-controlling interest - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
2,061
      
2,061
  
Net income attributable to USPH shareholders
    
-
      
-
      
-
      
11,248
      
-
      
-
      
11,248
      
-
      
11,248
  
Balance June 30, 2020
    
15,058
    
$
151
    
$
91,258
    
$
195,473
      
(2,215
)
  
$
(31,628
)
  
$
255,254
    
$
1,434
    
$
256,688
  

See notes to consolidated financial statements.
6
Table of Contents

   
U.S.Physical Therapy, Inc.
              
 
Common Stock
    
Additional
    
Retained
    
Treasury Stock
    
Total Shareholders’
    
Non-Controlling
        
For the three months ended June 30, 2019
  
Shares
    
Amount
    
Paid-In Capital
    
Earnings
    
Shares
    
Amount
    
Equity
    
Interests
    
Total
  
                                                       
Balance March 31, 2019
    
14,976
    
$
149
    
$
82,295
    
$
168,952
      
(2,215
)
  
$
(31,628
)
  
$
219,768
    
$
1,405
    
$
221,173
  
Issuance of restricted stock, net of cancellations
    
13
      
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
  
Revaluation of redeemable non-controlling interest, net of tax
    
-
      
-
      
-
      
(3,813
)
    
-
      
-
      
(3,813
)
    
-
      
(3,813
)
Compensation expense - equity-based awards
    
-
      
-
      
1,830
      
-
      
-
      
-
      
1,830
      
-
      
1,830
  
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
  
Purchase of non-controlling interest
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
  
Dividends paid to USPH shareholders
    
-
      
-
      
-
      
(3,446
)
    
-
      
-
      
(3,446
)
    
-
      
(3,446
)
Purchase of partnership interests - redeemable non-controlling interests
    
-
      
-
      
-
      
298
      
-
      
-
      
298
      
-
      
298
  
Other
    
-
      
-
      
-
      
(1
)
    
-
      
-
      
(1
)
    
1
      
-
  
Distributions to non-controlling interest partners - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
(1,717
)
    
(1,717
)
Net income attributable to non-controlling interests - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
1,802
      
1,802
  
Net income attributable to USPH shareholders
    
-
      
-
      
-
      
14,620
      
-
      
-
      
14,620
      
-
      
14,620
  
Balance June 30, 2019
    
14,989
    
$
149
    
$
84,125
    
$
176,610
      
(2,215
)
  
$
(31,628
)
  
$
229,256
    
$
1,491
    
$
230,747
  

   
U.S.Physical Therapy, Inc.
              
 
Common Stock
    
Additional
    
Retained
    
Treasury Stock
    
Total Shareholders’
    
Non-Controlling
        
For the six months ended June 30, 2019
  
Shares
    
Amount
    
Paid-In Capital
    
Earnings
    
Shares
    
Amount
    
Equity
    
Interests
    
Total
  
                                                       
Balance December 31, 2018
    
14,899
    
$
149
    
$
80,028
    
$
167,396
      
(2,215
)
  
$
(31,628
)
  
$
215,945
    
$
930
    
$
216,875
  
Issuance of restricted stock, net of cancellations
    
90
      
-
      
-
      
-
      
-
      
-
      
-
      
-
      
-
  
Revaluation of redeemable non-controlling interest, net of tax
    
-
      
-
      
-
      
(7,250
)
    
-
      
-
      
(7,250
)
    
-
      
(7,250
)
Compensation expense - equity-based awards
    
-
      
-
      
3,558
      
-
      
-
      
-
      
3,558
      
-
      
3,558
  
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans
    
-
      
-
      
636
      
-
      
-
      
-
      
636
      
-
      
636
  
Purchase of non-controlling interest
    
-
      
-
      
(97
)
    
-
      
-
      
-
      
(97
)
    
(7
)
    
(104
)
Dividends paid to USPH shareholders
    
-
      
-
      
-
      
(6,891
)
    
-
      
-
      
(6,891
)
    
-
      
(6,891
)
Purchase of partnership interests - redeemable non-controlling interests
    
-
      
-
      
-
      
298
      
-
      
-
      
298
      
-
      
298
  
Other
    
-
      
-
      
-
      
(6
)
    
-
      
-
      
(6
)
    
-
      
(6
)
Distributions to non-controlling interest partners - permanent equity
    
-
      
-
      
-
      
-
      
-
      
-
      
-
      
(2,771
)
    
(2,771
)
Net income attributable to non-controlling interests - permanent equity
            
-
      
-
      
-
      
-
      
-
      
-
      
3,339
      
3,339
  
Net income attributable to USPH shareholders
    
-
      
-
      
-
      
23,063
      
-
      
-
      
23,063
      
-
      
23,063
  
Balance June 30, 2019
    
14,989
    
$
149
    
$
84,125
    
$
176,610
      
(2,215
)
  
$
(31,628
)
  
$
229,256
    
$
1,491
    
$
230,747
  

See notes to consolidated financial statements.
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U.S. PHYSICAL THERAPY, INC. AND SUBSIDIARIES
NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
June 30, 2020
(unaudited)

1. BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

The consolidated financial statements include the accounts of U.S. Physical Therapy, Inc. and its subsidiaries (the “Company”). All significant intercompany transactions and balances have been eliminated.

The Company operates its business through two reportable business segments.  The Company’s reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. The Company’s physical therapy operations consist of physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventive care, rehabilitation of injured workers and neurological injuries. Services provided by industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments. Prior to the second quarter of 2020, the Company operated as a single segment. All prior year segment information has been reclassified to conform to the 2020 presentation. See Note 12. Segment Information.

Physical Therapy Operations

The physical therapy operations segment primarily operates through subsidiary clinic partnerships, in which the Company generally owns a 1% general partnership interest in all the Clinic Partnerships. Our limited partnership interests typically range from 49% to 99% in the Clinic Partnerships.  The managing therapist of each clinic owns, directly or indirectly, the remaining limited partnership interest in most of the clinics (hereinafter referred to as “Clinic Partnerships”). To a lesser extent, the Company operates some clinics, through wholly-owned subsidiaries, under profit sharing arrangements with therapists (hereinafter referred to as “Wholly-Owned Facilities”).

The Company continues to seek to attract for employment physical therapists who have established relationships with physicians and other referral sources, by offering these therapists a competitive salary and incentives based on the profitability of the clinic that they manage. For multi-site clinic practices in which a controlling interest is acquired by the Company, the prior owners typically continue on as employees to manage the clinic operations, retaining a non-controlling ownership interest in the clinics and receiving a competitive salary for managing the clinic operations. In addition, the Company has developed satellite clinic facilities as part of existing Clinic Partnerships and Wholly-Owned Facilities, with the result that a substantial number of Clinic Partnerships and Wholly-Owned Facilities operate more than one clinic location.

On February 27, 2020, the Company acquired interests in a four-clinic physical therapy practice. The four clinics are operated in four separate partnerships.  The Company’s interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in the form of a seller note.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.

On September 30, 2019, the Company acquired a 67% interest in an eleven-clinic physical therapy practice. The purchase price for the 67% interest was $12.4 million, of which $12.1 million was paid in cash and $0.3 million in the form of a seller note that is payable in two principal installments totaling $150,000 each, plus accrued interest in September 2020 and September 2021. The note accrues interest at 5.0% per annum.

During the six months ended June 30, 2020, the Company sold 11 previously closed clinics.  The aggregate sales price was $1.1 million, of which $0.7 million was paid in cash and $0.4 million in a note receivable payable in two equal installments of principal and any accrued interest on June 15, 2021 and 2022.

As of June 30, 2020, the Company operated 554 clinics in 39 states. The Company also manages physical therapy facilities for third parties, primarily hospital and physicians, with 29 third-party facilities under management as of June 30, 2020.

Clinic Partnerships

For non-acquired Clinic Partnerships, the earnings and liabilities attributable to the non-controlling interests, typically owned by the managing therapist, directly or indirectly, are recorded within the balance sheets as non-controlling interests and within the income statements as non-controlling interests – permanent equity.

For acquired Clinic Partnerships with redeemable non-controlling interests, the earnings attributable to the redeemable non-controlling interests are recorded within the consolidated statements of income line item – net income attributable to non-controlling interests – redeemable non-controlling interests – temporary equity and the equity interests are recorded on the consolidated balance sheet as redeemable non-controlling interests.  In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is not included in net income but charged directly to retained earnings and is included in the earnings per basic and diluted share calculation.

Wholly-Owned Facilities

For Wholly-Owned Facilities with profit sharing arrangements, an appropriate accrual is recorded for the amount of profit sharing due to the profit sharing therapists. The amount is expensed as compensation and included in operating costs – salaries and related costs. The respective liability is included in current liabilities – accrued expenses on the balance sheets.

Industrial Injury Prevention Services

Since March 2017, the Company has acquired a majority interest in two industrial injury prevention businesses and acquired all of another company in the industrial injury prevention sector.  In March 2017, the Company acquired a 55% interest in the initial industrial injury prevention business. On April 30, 2018, the Company acquired a 65% interest in another business in the industrial injury prevention sector. On April 30, 2018, the Company combined the two businesses.  After the combination, the Company owned a 59.45% interest in the combined business, Briotix Health, Limited Partnership (“Briotix Health”), the Company’s industrial injury prevention operation.

On April 11, 2019, the Company acquired a third company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network in 45 states including onsite at eleven client locations. The business was then combined with Briotix Health increasing the Company’s ownership position in the partnership to approximately 76.0%.

Services provided in the industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization, post offer employment testing, functional capacity evaluations, and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. The Company performs these services through Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs).

The results of operations of the acquired clinics and businesses have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

Basis of Presentation

The accompanying unaudited consolidated financial statements were prepared in accordance with accounting principles generally accepted in the United States of America for interim financial information and in accordance with the instructions for Form 10-Q. However, the statements do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America for complete financial statements. Management believes this report contains all necessary adjustments (consisting only of normal recurring adjustments) to present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented. For further information regarding the Company’s accounting policies, please read the audited financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 filed with the Securities and Exchange Commission on February 28, 2020 (“2019 Annual Report”).
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The Company believes, and the Chief Executive Officer, Chief Financial Officer and Corporate Controller have certified, that the financial statements included in this report present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented.

Operating results for the three months and six months ended June 30, 2020 are not necessarily indicative of the results the Company expects for the entire year.

The Company included the following Risk Factor which should be read in conjunction with the risk factors described in our Annual Report on Form 10-K for the year ended December 31, 2019 filed with the SEC on February 28, 2020.

We are subject to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (“COVID-19”).
Our operations expose us to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (COVID-19) that has spread globally. Since February, the continued spread has led to disruption and volatility in the global capital markets, which increases the cost of, and adversely impacts access to, capital and increases economic uncertainty. The pandemic has caused an economic slowdown of potentially extended duration, and it is possible that it could cause a global recession.

COVID-19 is having, and will continue to have, an adverse impact on our operations and supply chains, including an increase in cancellations of physical therapy patient appointments and a decline in the scheduling of new or additional patient appointments.  Due to these impacts and measures, we have experienced, and will continue to experience, significant and unpredictable reductions and cancellations of our patient visits.

Impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interests (minority interests)

As described in Note 6, the redeemable non-controlling interests in our partnerships are held by our partners.  Upon the occurrence of certain events, such as retirement or other termination of employment, partners from acquired partnerships may have the right to exercise a “put” to cause the Company to purchase their redeemable non-controlling interests.  Depending on the amount and timing of the exercise of any “put” rights, the funds required could have an adverse impact on the Company’s capital structure.

Impact of COVID-19

As previously disclosed in a series of filings with the SEC and further described in detail in its Quarterly Report on Form 10-Q for the quarter ended March 31, 2020 filed with the SEC on May 21, 2020, the Company’s results have been negatively impacted by the effects of the COVID-19 pandemic. Management has taken a number of steps to reduce costs, stem operating losses incurred in March and April and increase profits subsequently.

In March, with the onset of the COVID-19 pandemic, the Company, began to furlough or terminate approximately 40% of its 5,500 full and part-time workforce. Since early May, over 750 of the furloughed employees have returned to work on a full or part-time basis.

As of the filing of this quarterly report, the Company continues to experience lower physical therapy revenues; however the Company has seen recent improvement. As stay at home orders and other restrictions have been lifted, we have seen our physical therapy volumes trending upwards, however should stay at home orders or other restrictions be reenacted, we could see the Company’s patient volume and revenues decline.

The Company’s industrial injury prevention business has been less affected by the pandemic and is currently operating at approximately 90% of normal.

We have put preparedness plans in place at our facilities to maintain continuity of operations, while also taking steps to keep employees and patients safe. In line with recommendations to reduce large gatherings and increase social distancing, we have, where practical, transitioned a large number of office-based employees to a remote work environment.

In March 2020, in response to the COVID-19 pandemic, the CARES Act was signed into law. The CARES Act provides numerous tax provisions and other stimulus measures, including temporary changes regarding the prior and future utilization of net operating losses, temporary changes to the prior and future limitations on interest deductions, temporary suspension of certain payment requirements for the employer portion of Social Security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property, and the creation of certain payroll tax credits associated with the retention of employees.

The Company has received, or expect to receive a number of benefits under The CARES Act including, but not limited to:

•
The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded these payments of $12.8 million as a liability until all performance obligations have been met as the payments were made on behalf of patients before services were provided. Currently, MAAPP funds received will be applied to future Medicare billings commencing in August 2020, with all such remaining amounts required to be repaid by November 2020. Beginning November 2020, any unpaid balance will begin accruing interest.

•
The Company elected to defer depositing the employer’s share of Social Security taxes for payments due from March 27, 2020 through December 31, 2020, interest-free and penalty-free.  As of June 30, 2020, included in accrued liabilities is $2.2 million related to these deferred payments;

•
The Company received approximately $7.9 million during the six months ended June 30, 2020 from the initial tranche of funds that was distributed to healthcare providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic. The Company recognized the $7.9 million grant in other revenues for the six months ended June 30, 2020.

Significant Accounting Policies

Cash Equivalents

The Company maintains its cash and cash equivalents at financial institutions.  The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents.  The combined account balances at several institutions typically exceed Federal Deposit Insurance Corporation (“FDIC”) insurance coverage and, as a result, there is a concentration of credit risk related on deposits in excess of FDIC insurance coverage. Management believes that the risk is not significant.

Long-Lived Assets

Fixed assets are stated at cost. Depreciation is computed using the straight-line method over the estimated useful lives of the assets. Estimated useful lives for furniture and equipment range from three to eight years and for purchased software from three to seven years. Leasehold improvements are amortized over the shorter of the lease term or estimated useful lives of the assets, which is generally three to five years. The Company did not note an impairment to long-lived assets during this quarter.

Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of

The Company reviews property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances which indicate that the amounts may be impaired. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell. The Company did not note an impairment to long-lived assets during this quarter.
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Goodwill

Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.

The fair value of goodwill and other identifiable intangible assets with indefinite lives are tested for impairment annually and upon the occurrence of certain events, and are written down to fair value if considered impaired. The Company evaluates goodwill for impairment on at least an annual basis (normally in its third quarter) by comparing the fair value of its reporting units to the carrying value of each reporting unit including related goodwill. The Company evaluates indefinite lived tradenames using the relief from royalty method in conjunction with its annual goodwill impairment test or when other triggering events are identified. The Company operates a one segment business which is made up of various clinics within partnerships. The partnerships are components of regions and are aggregated to the operating segment level for the purpose of determining the Company’s reporting units when performing its annual goodwill impairment test. In 2019, there were six regions.  In addition to the six regions, in 2019, the impairment test included a separate analysis for the industrial injury prevention business, a separate reporting unit.

An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the estimated fair value of the reporting unit. The estimated fair value of a reporting unit is determined using two factors: (i) earnings prior to taxes, depreciation and amortization for the reporting unit multiplied by a price/earnings ratio used in the industry and (ii) a discounted cash flow analysis. A weight is assigned to each factor and the sum of each weight times the factor is considered the estimated fair value. For 2019, the factors (i.e., price/earnings ratio, discount rate and residual capitalization rate) were updated to reflect current market conditions. The evaluation of goodwill in 2019 did not result in any goodwill amounts that were deemed impaired.

Based on the current economic conditions and the decline in patient visits due to the pandemic, the Company evaluated whether events or circumstances indicated that it was more likely than not that the fair value of the reporting units were reduced below their carrying value as of June 30, 2020. As a result of the assessment, the Company determined that it was not more likely than not that goodwill and tradenames of the reporting units was impaired as of June 30, 2020.

As the Company did not note an impairment, no additional disclosures were deemed to be required by management.  The Company also considered the impact of these judgments and estimates as they pertain to the disclosure requirements for such items within this Form 10-Q and risks and uncertainties discussions and believes that such disclosure is adequate.

Due to the uncertainty of the current economic conditions resulting from the COVID-19 pandemic, the Company will continue to review its carrying amounts of goodwill and other intangibles.

For the six months ended June 30, 2020, the Company derecognized (wrote-off) goodwill in the amount of $1.9 million related to closed clinics due to COVID-19.

The Company will continue to monitor for any triggering events or other indicators of impairment.

Redeemable Non-Controlling Interests

The non-controlling interests that are reflected as redeemable non-controlling interests in the consolidated financial statements consist of those that the owners and the Company have certain redemption rights, whether currently exercisable or not, and which currently, or in the future, require that the Company purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met.  The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership agreements.  The redemption rights can be triggered by the owner or the Company at such time as both of the following events have occurred: 1) termination of the owner’s employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement.  The redemption rights are not automatic or mandatory (even upon death) and require either the owner or the Company to exercise its rights when the conditions triggering the redemption rights have been satisfied.
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On the date the Company acquires a controlling interest in a partnership, and the limited partnership agreement for such partnership contains redemption rights not under the control of the Company, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption – Redeemable non-controlling interests.  Then, in each reporting period thereafter until it is purchased by the Company, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial carrying value, based on the predetermined formula defined in the respective limited partnership agreement.  As a result, the value of the non-controlling interest is not adjusted below its initial carrying value.  The Company records any adjustment in the redemption value, net of tax, directly to retained earnings and are not reflected in the consolidated statements of income.  Although the adjustments are not reflected in the consolidated statements of income, current accounting rules require that the Company reflects the adjustments, net of tax, in the earnings per share calculation.  The amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statements of net income. Management believes the redemption value (i.e. the carrying amount) and fair value are the same.

Non-Controlling Interests

The Company recognizes non-controlling interests, in which the Company has no obligation but the right to purchase the non-controlling interests, as permanent equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the statements of net income. Changes in a parent entity’s ownership interest in a subsidiary that do not result in deconsolidation are treated as equity transactions if the parent entity retains its controlling financial interest. The Company recognizes a gain or loss in net income when a subsidiary is deconsolidated. Such gain or loss is measured using the fair value of the non-controlling equity investment on the deconsolidation date.

When the purchase price of a non-controlling interest by the Company exceeds the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital. Additionally, operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner.

Revenue Recognition

Revenues are recognized in the period in which services are rendered. See Footnote 3 – Revenue Recognition, for further discussion of revenue recognition.

Allowance for Doubtful Accounts

The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in operating costs in the consolidated statements of net income. Net accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible.

Income Taxes

Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.
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The Company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount to be recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority.

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Securities Act (“CARES Act”) was enacted. The CARES Act includes changes to certain tax law related to net operating losses and the deductibility of interest expense and depreciation. ASC 740, Income Taxes requires the effects of changes in tax rates and laws on deferred tax balances to be recognized in the period in which the legislation is enacted. The legislation had no effect on the Company’s deferred income taxes and current income taxes payable during the six months ended June 30, 2020.

The Company did not have any accrued interest or penalties associated with any unrecognized tax benefits nor was any interest expense recognized during the six months ended June 30, 2020. The Company records any interest or penalties, if required, in interest and other expense, as appropriate.

Fair Value of Financial Instruments

The carrying amounts reported in the balance sheets for cash and cash equivalents, accounts receivable, accounts payable and notes payable approximate their fair values due to the short-term maturity of these financial instruments. The carrying amount under the Amended Credit Agreement and the redemption value of Redeemable non-controlling interests approximate the respective fair values. The fair value of the Company’s redeemable non-controlling interests is determined based on “Level 3” inputs. The interest rate on the Amended Credit Agreement, which is tied to LIBOR, is set at various short-term intervals, as detailed in the Amended Credit Agreement.

Segment Reporting

Operating segments are components of an enterprise for which separate financial information is available that is evaluated regularly by chief operating decision makers in determining the allocation of resources and in assessing performance.  The Company currently operates through two segments: physical therapy operations and industrial injury prevention services.
Use of Estimates

In preparing the Company’s consolidated financial statements, management makes certain estimates and assumptions, especially in relation to, but not limited to, goodwill impairment, tradenames, allocations of purchase price, allowance for receivables, tax provision and contractual allowances, that affect the amounts reported in the consolidated financial statements and related disclosures. Actual results may differ from these estimates.

Self-Insurance Program

The Company utilizes a self-insurance plan for its employee group health insurance coverage administered by a third party. Predetermined loss limits have been arranged with an insurance company to minimize the Company’s maximum liability and cash outlay. Accrued expenses include the estimated incurred but unreported costs to settle unpaid claims and estimated future claims. Management believes that the current accrued amounts are sufficient to pay claims arising from self-insurance claims incurred through June 30, 2020.

Restricted Stock

Restricted stock issued to employees and directors is subject to continued employment or continued service on the board, respectively. Generally, restrictions on the stock granted to employees lapse in equal annual installments on the following four anniversaries of the date of grant. For those shares granted to directors, the restrictions will lapse in equal quarterly installments during the first year after the date of grant. For those granted to officers, the restrictions will lapse in equal quarterly installments during the four years following the date of grant. Compensation expense for grants of restricted stock is recognized based on the fair value per share on the date of grant amortized over the vesting period. The Company recognizes any forfeitures as they occur. The restricted stock issued is included in basic and diluted shares for the earnings per share computation.
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Recently Adopted Accounting Guidance

In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses, which added a new impairment model (known as the current expected credit loss (CECL) model) that is based on expected losses rather than incurred losses. Under the new guidance, an entity recognizes as an allowance its estimate of expected credit losses. The CECL model applies to most debt instruments, including trade receivables. The CECL model does not have a minimum threshold for recognition of impairment losses and entities will need to measure expected credit losses on assets that have a low risk of loss. The standard is required to be applied using the modified retrospective approach with a cumulative-effect adjustment to retained earnings, if any, upon adoption.

The Company has completed the adoption of the standard on January 1, 2020. The financial instruments subject to ASU 2016-13 are the Company’s accounts receivable derived from contracts with customers. A significant portion of the Company’s accounts receivable are from highly-solvent, creditworthy payors including governmental programs such as Medicare and Medicaid, and highly regulated commercial insurers. The Company’s estimate of expected credit losses as of January 1, 2020, using its expected credit loss evaluation process, resulted in no adjustments to the allowance for credit losses and no cumulative-effect adjustment to retained earnings on the adoption date of the standard.

In January 2017, the FASB issued ASU 2017-04, Simplifying the Test for Goodwill Impairment (Topic 350), which eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment change. ASU 2017-04 is effective prospectively for fiscal years, and the interim periods within those years, beginning after December 15, 2019. The Company has completed the adoption of the standard on January 1, 2020 and there was no impact to goodwill from the Company’s adoption of this change.

Recently Issued Accounting Guidance

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. This ASU provides temporary optional expedients and exceptions to the guidance on contract modifications and hedge accounting to ease the financial reporting burdens of the expected market transition from the London Interbank Offered Rate and other interbank offered rates to alternative reference rates. The new guidance was effective upon issuance, and the Company is allowed to elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact this standard will have on its combined financial statements.

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) – Simplifying the Accounting for Income Taxes (“ASU 2019-12”). The objective of ASU 2019-12 is to simplify the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and to provide more consistent application to improve the comparability of financial statements. The amendments in this ASU are effective for fiscal years beginning after December 15, 2020, and early adoption is permitted. We are currently evaluating the impact this guidance may have on our consolidated financial statements and related footnote disclosures.

2. ACQUISITIONS OF BUSINESSES

On February 27, 2020, the Company acquired interests in a four-clinic physical therapy practice. The four clinics are in four separate partnerships.  The Company’s interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in the form of a seller note.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.
 
The purchase price plus the fair value of the non-controlling interests for the acquisitions in 2020 was allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. trade names, referral relationships and non-compete agreements, and liabilities assumed based on the estimated fair values at the acquisition date, with the amount in excess of fair values being recorded as goodwill. The Company is in the process of completing its formal valuation analysis of the acquisitions, to identify and determine the fair value of tangible and identifiable intangible assets acquired and the liabilities assumed. Thus, the final allocation of the purchase price may differ from the preliminary estimates used at June 30, 2020 based on additional information obtained and completion of the valuation of the identifiable intangible assets. Changes in the estimated valuation of the tangible assets acquired, the completion of the valuation of identifiable intangible assets and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.

For the acquisitions in 2020, the values assigned to the referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives.  For referral relationships, the amortization period is 11.0 years.  For non-compete agreements, the amortization period is 6.0 years.

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition. 

The purchase price for the 2020 acquisitions has been preliminarily allocated as follows (in thousands):

   
Physical
Therapy
Operations
  
Cash paid, net of cash acquired
  
$
11,633
  
Seller note
    
300
  
Total consideration
  
$
11,933
  
         
Estimated fair value of net tangible assets acquired:
        
Total current assets
  
$
778
  
Total non-current assets
    
400
  
Total liabilities
    
(469
)
Net tangible assets acquired
  
$
709
  
Referral relationships
    
1,600
  
Non-compete
    
750
  
Tradename
    
1,500
  
Goodwill
    
13,845
  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)
    
(6,471
)
   
$
11,933
  

On September 30, 2019, the Company acquired a 67% interest in an eleven-clinic physical therapy practice. The purchase price for the 67% interest was $12.4 million, of which $12.1 million was paid in cash and $0.3 million in the form of a seller note that is payable in two principal installments totaling $150,000 each, plus accrued interest in September 2020 and September 2021. The note accrues interest at 5.0% per annum.

On April 11, 2019, the Company acquired a company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network of 45 states including onsite at eleven client locations. The business was then combined with Briotix Health, the Company’s industrial injury prevention operation, increasing the Company’s ownership position in the Briotix Health partnership to approximately 76.0%. The purchase price for the acquired company was $22.9 million ($23.6 million less cash acquired of $0.7 million), which consisted of $18.9 million in cash, (of which $0.5 million will be paid to certain shareholders), and a $4.0 million seller note.  The note accrues interest at 5.5% and the principal and accrued interest is payable, on April 9, 2021.

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

For the 2019 acquisitions, a majority of total current assets primarily represents accounts receivable. Total non-current assets are fixed assets and equipment used in the practice.

The purchase price for the 2019 acquisitions has been allocated as follows (in thousands):

 
IIPS*
    
Physical
Therapy
Operations
    
Total
  
Cash paid, net of cash acquired
  
$
18,427
    
$
12,170
    
$
30,597
  
Payable to shareholders of seller
  
$
486
    
$
-
      
486
  
Seller note
    
4,000
      
300
      
4,300
  
Total consideration
  
$
22,913
    
$
12,470
    
$
35,383
  
                         
Estimated fair value of net tangible assets acquired:
                        
Total current assets
  
$
1,641
    
$
693
    
$
2,334
  
Total non-current assets
    
878
      
3,019
      
3,897
  
Total liabilities
    
(2,979
)
    
(2,816
)
    
(5,795
)
Net tangible assets acquired
  
$
(460
)
  
$
896
    
$
436
  
Referral relationships
    
3,400
      
2,600
      
6,000
  
Non-compete
    
250
      
270
      
520
  
Tradename
    
1,300
      
740
      
2,040
  
Goodwill
    
18,423
      
14,193
      
32,616
  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)
    
-
      
(6,229
)
    
(6,229
)
   
$
22,913
    
$
12,470
    
$
35,383
  

* Industrial injury prevention services 

The purchase prices plus the fair value of the non-controlling interests for the acquisitions in 2019 were allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. trade names, referral relationships and non-compete agreements, and liabilities assumed based on the fair values at the acquisition date, with the amount exceeding the fair values being recorded as goodwill. The Company has completed its formal valuation analyses for the IIPS acquisition in 2019 with immaterial changes to the values. The Company is in the process of completing its formal valuation analysis of the 2019 physical therapy operations acquisition, to identify and determine the fair value of tangible and identifiable intangible assets acquired and the liabilities assumed. Thus, the final allocation of the purchase price may differ from the preliminary estimates used at June 30, 2020 based on additional information obtained and completion of the valuation of the identifiable intangible assets. Changes in the estimated valuation of the tangible assets acquired, the completion of the valuation of identifiable intangible assets and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.

For the acquisitions in 2019, the values assigned to the referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives.  For referral relationships, the weighted average amortization period was 11.0 years at December 31, 2019.  For non-compete agreements, the weighted average amortization period was 6.0 years at December 31, 2019. The values assigned to tradenames are tested annually for impairment.

The consideration paid for each of the acquisitions was derived through arm’s length negotiations. Funding for the cash portions was derived from proceeds from the Company’s revolving credit facility. The results of operations of the acquisitions have been included in the Company’s consolidated financial statements since their respective date of acquisition. Unaudited proforma consolidated financial information for the acquisitions in the 2020 and 2019 acquisitions have not been included as the results, individually and in the aggregate, were not material to current operations.

During 2019, the Company acquired additional interests in four partnerships which are included in non-controlling interest. The additional interests purchased in each of the partnerships ranged from 1% and 55%. Also in 2019, the Company sold a 1% interest in a partnership. The net after tax difference between the payments and the portion of undistributed earnings of $196,000 was credited to additional paid-in capital.

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3. REVENUE RECOGNITION

Categories

Revenues are recognized in the period in which services are rendered.

Net patient revenues consists of revenues for physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenues (patient revenues less estimated contractual adjustments) are recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied. There is an implied contract between us and the patient upon each patient visit. Generally, this occurs as the Company provides physical and occupational therapy services, as each service provided is distinct and future services rendered are not dependent on previously rendered services. The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. The allowance for estimated contractual adjustments is based on terms of payor contracts and historical collection and write-off experience.

Management contract revenues, which are included in other revenues in the consolidated statements of net income, are derived from contractual arrangements whereby the Company manages a clinic owned by a third party. The Company does not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for our employees, are recorded when incurred.

Revenues from the industrial injury prevention services segment, which are also included in other revenues in the consolidated statements of net income, are derived from onsite services the Company provides to clients’ employees including injury prevention, rehabilitation, ergonomic assessments and performance optimization. Revenue from the industrial injury prevention services segment is recognized when obligations under the terms of the contract are satisfied. Revenues are recognized at an amount equal to the consideration the Company expects to receive in exchange for providing injury prevention services to its clients. The revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period.

Additionally, other revenues include services the Company provides on-site, such as schools, for physical or occupational therapy services, and fees from athletic trainers. Contract terms and rates are agreed to in advance between the Company and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in advance, revenue is recorded as a liability over the period of the agreement and recognized at the point in time, when the services are performed.

The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in clinic operating costs in the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible.

The following table details the revenue related to the various categories (in thousands):

 
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Net patient revenues
  
$
72,279
    
$
113,363
    
$
172,405
    
$
220,013
  
Management contract revenues
    
1,592
      
2,215
      
3,740
      
4,360
  
Other revenues
    
328
      
507
      
895
      
1,043
  
Physical therapy operations
  
$
74,199
    
$
116,085
    
$
177,040
    
$
225,416
  
Industrial injury prevention services revenues
    
9,658
      
10,288
      
19,534
      
17,188
  
   
$
83,857
    
$
126,373
    
$
196,574
    
$
242,604
  
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Medicare Reimbursement

The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (‘‘MPFS’’). For services provided in 2018, a 0.5% increase was applied to the fee schedule payment rates; for services provided in 2019, a 0.25% increase was applied to the fee schedule payment rates before applying the mandatory budget neutrality adjustment. For services provided in 2020 through 2025, a 0.0% update will be applied each year to the fee schedule payment rates, before applying the mandatory budget neutrality adjustment. However, in the 2021 MPFS Final Rule, CMS proposed an increase to the code values for office/outpatient evaluation and management (E/M) codes and cuts to other codes to maintain budget neutrality of the MPFS. This change in code valuations would be effective January 1, 2021. Under the proposal, physical/occupational therapy services could see code reductions that may result in an estimated 9% decrease in payment. In announcing this possible reduction in the applicable physical/occupational therapy codes, CMS indicated that it would further consider and address industry and provider concerns before finalizing the 2021 code values.

Our physical therapists and occupational therapists are able to provide services to patients on a remote basis, using a variety of technologies. This has been particularly helpful during the COVID-19 pandemic, as some patients are reluctant to travel. Reimbursement and coverage for these services vary among payors. Effective as of March 1, 2020, CMS provided a temporary waiver to allow physical therapists and occupational therapists (and their respective assistants) to perform and be reimbursed for the full scope of services performed remotely as “telehealth visits”. The foregoing telehealth temporary waiver will continue until the end of the COVID-19 pandemic as determined by HHS. HHS has the authority extend the public health emergency, which it did on July 23, 2020.

Beginning in 2021, payments to individual therapists (Physical/Occupational Therapist in Private Practice) paid under the fee schedule may be subject to adjustment based on performance in the Merit Based Incentive Payment System (“MIPS”), which measures performance based on certain quality metrics, resource use, and meaningful use of electronic health records. Under the MIPS requirements, a provider's performance is assessed according to established performance standards each year and then is used to determine an adjustment factor that is applied to the professional's payment for the corresponding payment year. The provider’s MIPS performance in 2019 will determine the payment adjustment in 2021. Each year from 2019 through 2024, professionals who receive a significant share of their revenues through an alternate payment model (“APM”), (such as accountable care organizations or bundled payment arrangements) that involves risk of financial losses and a quality measurement component will receive a 5% bonus in the corresponding payment year. The bonus payment for APM participation is intended to encourage participation and testing of new APMs and to promote the alignment of incentives across payors. The specifics of the MIPS and APM adjustments will be subject to future notice and comment rule-making.

The Budget Control Act of 2011 increased the federal debt ceiling in connection with deficit reductions over the next ten years, and requires automatic reductions in federal spending by approximately $1.2 trillion. Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap. On April 1, 2013, a 2% reduction to Medicare payments was implemented. The Bipartisan Budget Act of 2015, enacted on November 2, 2015, extended the 2% reductions to Medicare payments through fiscal year 2025. The Bipartisan Budget Act of 2018, enacted on February 9, 2018, extends the 2% reductions to Medicare payments through fiscal year 2027.The CARES Act, enacted on March 27, 2020, temporarily suspended the 2% payment adjustment, effective for claims with dates of service from May 1, 2020 through December 31, 2020.

Historically, the total amount paid by Medicare in any one year for outpatient physical therapy, occupational therapy, and/or speech-language pathology services provided to any Medicare beneficiary was subject to an annual dollar limit (i.e., the ‘‘Therapy Cap’’ or ‘‘Limit’’). For 2017, the annual Limit on outpatient therapy services was $1,980 for combined Physical Therapy and Speech Language Pathology services and $1,980 for Occupational Therapy services. As a result of Bipartisan Budget Act of 2018, the Therapy Caps have been eliminated, effective as of January 1, 2018.

Under the Middle Class Tax Relief and Job Creation Act of 2012 (‘‘MCTRA’’), since October 1, 2012, patients who met or exceeded $3,700 in therapy expenditures during a calendar year have been subject to a manual medical review to determine whether applicable payment criteria are satisfied. The $3,700 threshold is applied to Physical Therapy and Speech Language Pathology Services; a separate $3,700 threshold is applied to the Occupational Therapy. The MACRA directed CMS to modify the manual medical review process such that those reviews will no longer apply to all claims exceeding the $3,700 threshold and instead will be determined on a targeted basis based on a variety of factors that CMS considers appropriate. The Bipartisan Budget Act of 2018 extends the targeted medical review indefinitely, but reduces the threshold to $3,000 through December 31, 2027.  For 2028, the threshold amount will be increased by the percentage increase in the Medicare Economic Index (“MEI”) for 2028 and in subsequent years the threshold amount will increase based on the corresponding percentage increase in the MEI for such subsequent year.

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CMS adopted a multiple procedure payment reduction (‘‘MPPR’’) for therapy services in the final update to the MPFS for calendar year 2011. The MPPR applied to all outpatient therapy services paid under Medicare Part B — occupational therapy, physical therapy and speech-language pathology. Under the policy, the Medicare program pays 100% of the practice expense component of the Relative Value Unit (‘‘RVU’’) for the therapy procedure with the highest practice expense RVU, then reduces the payment for the practice expense component for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions. Since 2013, the practice expense component for the second and subsequent therapy service furnished during the same day for the same patient was reduced by 50%. In addition, the MCTRA directed CMS to implement a claims-based data collection program to gather additional data on patient function during the course of therapy in order to better understand patient conditions and outcomes. All practice settings that provide outpatient therapy services are required to include this data on the claim form. Since 2013, therapists have been required to report new codes and modifiers on the claim form that reflect a patient’s functional limitations and goals at initial evaluation, periodically throughout care, and at discharge. Reporting of these functional limitation codes and modifiers are required on the claim for payment.

Medicare claims for outpatient therapy services furnished by therapy assistants on or after January 1, 2020 must include a modifier indicating the service was furnished by a therapy assistant. Outpatient therapy services furnished on or after January 1, 2022 in whole or part by a therapy assistant will be paid at an amount equal to 85% of the payment amount otherwise applicable for the service.

Statutes, regulations, and payment rules governing the delivery of therapy services to Medicare beneficiaries are complex and subject to interpretation. We believe that we are in compliance in all material respects with all applicable laws and regulations and are not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on our financial statements as of June 30, 2020. Compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from the Medicare program. For the six months ended June 30, 2020 and 2019, net patient revenue from Medicare accounted for approximately $44.4 million and $59.4 million, respectively.

Contractual Allowances

Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in Company clinics. The Company estimates contractual allowances based on its interpretation of the applicable regulations, payor contracts and historical calculations. Each month the Company estimates its contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on the Company’s historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow the Company to provide the necessary detail and accuracy with its collectability estimates. However, the services authorized and provided and related reimbursement are subject to interpretation that could result in payments that differ from the Company’s estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. The Company’s billing system does not capture the exact change in its contractual allowance reserve estimate from period to period in order to assess the accuracy of its revenues and hence its contractual allowance reserves. Management regularly compares its cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, historically the difference between net revenues and corresponding cash collections has generally reflected a difference within approximately 1% of net revenues. Additionally, analysis of subsequent periods’ contractual write-offs on a payor basis reflects a difference within approximately 1% between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, the Company believes that a change in the contractual allowance reserve estimate would not likely be more than 1% at June 30, 2020.

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A contract’s transaction price is allocated to each distinct performance obligation and recognized when, or as, the performance obligation is satisfied. To determine the transaction price, the Company includes the effects of any variable consideration, such as the probability of collecting that amount.  The Company applies established rates to the services provided, and adjusts for the terms of payor contracts, as applicable.  These contracted amounts are different from the Company’s established rates.  The Company has established a “contractual allowance” for this difference. The allowance is based on the terms of payor contracts, historical and current reimbursement information and current experience with the clinic and partners. The Company’s established rates less the contractual allowance is the revenue that is recognized in the period in which the service is rendered. This revenue is deemed the transaction price and stated as “Net Patient Revenue” on the Company’s consolidated statements of income.

The Company’s performance obligations are satisfied at a point in time. After the clinic has provided services and satisfied its obligation to the customer for the reimbursement rates stipulated in the payor contracts (i.e. the transaction price), the Company recognizes the revenue, net of contractual allowances, in the period in which the services are rendered. The Company recognizes the full amount of revenue and reports the contractual allowances as a contra (or offset) revenue account to report a net revenue number based on the expected collections.

4. OTHER INCOME

Sale of clinics

The Company recognized a gain of $1.1 million in the second quarter of 2020, included in other income, resulting from the sale of 11 previously closed clinics.

Receipts of Relief Funds

The Company received $7.9 million of funds from the Public Health and Social Services Emergency Fund (“Relief Fund”) as part of the CARES Act.   The Relief Fund monies do not have to be repaid, were used for operations and to offset losses due to the COVID-19 pandemic in the second quarter of 2020.

5. EARNINGS PER SHARE

In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest (see Footnote 6 – Redeemable Non-Controlling Interest), net of tax, charged directly to retained earnings is included in the earnings per basic and diluted share calculation.  The following table provides a detail of the basic and diluted earnings per share computation (in thousands, except per share data).

 
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Computation of earnings per share - USPH shareholders:
                        
Net income attributable to USPH shareholders
  
$
10,232
    
$
14,620
    
$
11,248
    
$
23,063
  
Credit (charges) to retained earnings:
                                
Revaluation of redeemable non-controlling interest
    
3,344
      
(5,169
)
    
5,473
      
(9,830
)
Tax effect at statutory rate (federal and state) of 26.25%
    
(878
)
    
1,356
      
(1,437
)
    
2,580
  
   
$
12,698
    
$
10,807
    
$
15,284
    
$
15,813
  
                                 
Earnings per share (basic and diluted)
  
$
0.99
    
$
0.85
    
$
1.19
    
$
1.24
  
                                 
Shares used in computation:
                                
Basic and diluted earnings per share - weighted-average shares
    
12,843
      
12,767
      
12,820
      
12,738
  

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6. REDEEMABLE NON-CONTROLLING INTEREST

Since October 2017, when the Company acquires a majority interest (the “Acquisition”) in a physical therapy clinic business (referred to as “Therapy Practice”), these Acquisitions occur in a series of steps which are described below.

1.
Prior to the Acquisition, the Therapy Practice exists as a separate legal entity (the “Seller Entity”). The Seller Entity is owned by one or more individuals (the “Selling Shareholders”) most of whom are physical therapists that work in the Therapy Practice and provide physical therapy services to patients.
2.
In conjunction with the Acquisition, the Seller Entity contributes the Therapy Practice into a newly-formed limited partnership (“NewCo”), in exchange for one hundred percent (100%) of the limited and general partnership interests in NewCo. Therefore, in this step, NewCo becomes a wholly-owned subsidiary of the Seller Entity.
3.
The Company enters into an agreement (the “Purchase Agreement”) to acquire from the Seller Entity a majority (ranges from 50% to 90%) of the limited partnership interest and in all cases 100% of the general partnership interest in NewCo. The Company does not purchase 100% of the limited partnership interest because the Selling Shareholders, through the Seller Entity, want to maintain an ownership percentage. The consideration for the Acquisition is primarily payable in the form of cash at closing and a small, two-year note in lieu of an escrow (the “Purchase Price”). The Purchase Agreement does not contain any future earn-out or other contingent consideration that is payable to the Seller Entity or the Selling Shareholders.
4.
The Company and the Seller Entity also execute a partnership agreement (the “Partnership Agreement”) for NewCo that sets forth the rights and obligations of the limited and general partners of NewCo. After the Acquisition, the Company is the general partner of NewCo.
5.
As noted above, the Company does not purchase 100% of the limited partnership interests in NewCo and the Seller Entity retains a portion of the limited partnership interest in NewCo (“Seller Entity Interest”).
6.
In most cases, some or all of the Selling Shareholders enter into an employment agreement (the “Employment Agreement”) with NewCo with an initial term that ranges from three to five years (the “Employment Term”), with automatic one-year renewals, unless employment is terminated prior to the end of the Employment Term. As a result, a Selling Shareholder becomes an employee (“Employed Selling Shareholder”) of NewCo. The employment of an Employed Selling Shareholder can be terminated by the Employed Selling Shareholder or NewCo, with or without cause, at any time. In a few situations, a Selling Shareholder does not become employed by NewCo and is not involved with NewCo following the closing; in those situations, such Selling Shareholders sell their entire ownership interest in the Seller Entity as of the closing of the Acquisition.
7.
The compensation of each Employed Selling Shareholder is specified in the Employment Agreement and is customary and commensurate with his or her responsibilities based on other employees in similar capacities within NewCo, the Company and the industry.
8.
The Company and the Selling Shareholder (including both Employed Selling Shareholders and Selling Shareholders not employed by NewCo) execute a non-compete agreement (the “Non-Compete Agreement”) which restricts the Selling Shareholder from engaging in competing business activities for a specified period of time (the “Non-Compete Term”). A Non-Compete Agreement is executed with the Selling Shareholders in all cases. That is, even if the Selling Shareholder does not become an Employed Selling Shareholder, the Selling Shareholder is restricted from engaging in a competing business during the Non-Compete Term.
9.
The Non-Compete Term commences as of the date of the Acquisition and  expires on the later of :
a.
Two years after the date an Employed Selling Shareholders’ employment is terminated (if the Selling Shareholder becomes an Employed Selling Shareholder) or
b.
Five to six years  from the date of the Acquisition, as defined in the Non-Compete Agreement, regardless of whether the Selling Shareholder is employed by NewCo.
10.
The Non-Compete Agreement applies to a restricted region which is defined as a 15-mile radius from the Therapy Practice. That is, an Employed Selling Shareholder is permitted to engage in competing businesses or activities outside the 15-mile radius (after such Employed Selling Shareholder no longer is employed by NewCo) and a Selling Shareholder who is not employed by NewCo immediately is permitted to engage in the competing business or activities outside the 15-mile radius.

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The Partnership Agreement contains provisions for the redemption of the Seller Entity Interest, either at the option of the Company (the “Call Right”) or at the option of the Seller Entity (the “Put Right”) as follows:

1.
Put Right
a.
In the event that any Selling Shareholder’s employment is terminated under certain circumstances prior to a specified date (the “Specified Date”), the Seller Entity thereafter may have an irrevocable right to cause the Company to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest at the purchase price described in “3” below.
b.
In the event that any Selling Shareholder is not employed by NewCo as of the Specified Date and the Company has not exercised its Call Right with respect to the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest, Seller Entity thereafter shall have the Put Right to cause the Company to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest at the purchase price described in “3” below.
c.
In the event that any Selling Shareholder’s employment with NewCo is terminated for any reason on or after the Specified Date, the Seller Entity shall have the Put Right, and upon the exercise of the Put Right, the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest shall be redeemed by the Company at the purchase price described in “3” below.

2.
Call Right
a.
If any Selling Shareholder’s employment by NewCo is terminated prior to the Specified Date, the Company thereafter shall have an irrevocable right to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest, in each case at the purchase price described in “3” below.
b.
In the event that any Selling Shareholder’s employment with NewCo is terminated for any reason on or after Specified Date, the Company shall have the Call Right, and upon the exercise of the Call Right, the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest shall be redeemed by the Company at the purchase price described in “3” below.
3.
For the Put Right and the Call Right, the purchase price is derived from a formula based on a specified multiple of NewCo’s trailing twelve months of earnings before interest, taxes, depreciation, amortization, and the Company’s internal management fee, plus an Allocable Percentage of any undistributed earnings of NewCo (the “Redemption Amount”). NewCo’s earnings are distributed monthly based on available cash within NewCo; therefore, the undistributed earnings amount is small, if any.
4.
The Purchase Price for the initial equity interest purchased by the Company is also based on the same specified multiple of the trailing twelve-month earnings that is used in the Put Right and the Call Right noted above.
5.
The Put Right and the Call Right do not have an expiration date, and the Seller Entity Interest is not required to be purchased by the Company or sold by the Seller Entity unless either the Put Right and the Call Right is exercised.
6.
The Put Right and the Call Right never apply to Selling Shareholders who do not become employed by NewCo, since the Company requires that such Selling Shareholders sell their entire ownership interest in the Seller Entity at the closing of the Acquisition.

An Employed Selling Shareholder’s ownership of his or her equity interest in the Seller Entity predates the Acquisition and the Company’s purchase of its partnership interest in NewCo. The Employment Agreement and the Non-Compete Agreement do not contain any provision to escrow or “claw back” the equity interest in the Seller Entity held by such Employed Selling Shareholder, nor the Seller Entity Interest in NewCo, in the event of a breach of the employment or non-compete terms. More specifically, even if the Employed Selling Shareholder is terminated for “cause” by NewCo, such Employed Selling Shareholder does not forfeit his or her right to his or her full equity interest in the Seller Entity and the Seller Entity does not forfeit its right to any portion of the Seller Entity Interest. The Company’s only recourse against the Employed Selling Shareholder for breach of either the Employment Agreement or the Non-Compete Agreement is to seek damages and other legal remedies under such agreements. There are no conditions in any of the arrangements with an Employed Selling Shareholder that would result in a forfeiture of the equity interest held in the Seller Entity or of the Seller Entity Interest.
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For the three and six months ended June 30, 2020, the following table details the changes in the carrying amount (fair value) of the redeemable non-controlling interests (in thousands):

 
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
                         
Beginning balance
  
$
140,498
    
$
137,196
    
$
137,750
    
$
133,943
  
Operating results allocated to redeemable non-controlling interest partners
    
2,996
      
3,378
      
4,792
      
5,773
  
Distributions to redeemable non-controlling interest partners
    
(2,054
)
    
(3,641
)
    
(3,665
)
    
(5,163
)
Changes in the fair value of redeemable non-controlling interest
    
(3,344
)
    
5,169
      
(5,473
)
    
9,830
  
Purchases of redeemable non-controlling interest
    
(1,372
)
    
(2,604
)
    
(3,224
)
    
(4,885
)
Acquired interest
    
-
      
-
      
6,471
      
-
  
Reduction of non-controlling interest due to sale of USPH partnership interest
    
-
      
(6,132
)
    
-
      
(6,132
)
Sales of redeemable non-controlling interest - temporary equity
    
564
      
2,870
      
564
      
2,870
  
Notes receivable related to sales of redeemable non-controlling interest - temporary equity
    
(545
)
    
(2,870
)
    
(545
)
    
(2,870
)
Adjustments in notes receivable related to the the sales of redeemable non-controlling interest - temporary equity
    
(15
)
    
-
      
58
      
-
  
Ending balance
  
$
136,728
    
$
133,366
    
$
136,728
    
$
133,366
  

The following table categorizes the carrying amount (fair value) of the redeemable non-controlling interests (in thousands):

 
June 30, 2020
    
June 30, 2019
  
             
Contractual time period has lapsed but holder's employment has not been terminated
  
$
72,815
    
$
52,937
  
Contractual time period has not lapsed and holder's employment has not been terminated
    
63,913
      
80,429
  
Holder's employment has terminated and contractual time period has expired
    
-
      
-
  
Holder's employment has terminated and contractual time period has not expired
    
-
      
-
  
   
$
136,728
    
$
133,366
  

7. GOODWILL

The changes in the carrying amount of goodwill consisted of the following (in thousands):

   
Six Months Ended
    
Year Ended
  
 
June 30, 2020
    
December 31, 2019
  
             
Beginning balance
  
$
317,676
    
$
293,525
  
Goodwill acquired
    
13,845
      
31,330
  
Goodwill related to partnership interest sold
    
-
      
(7,325
)
Goodwill write-off related to closed clinics
    
(1,859
)
    
-
  
Goodwill adjustments for purchase price allocation of businesses acquired in prior year
    
1,232
      
146
  
Ending balance
  
$
330,894
    
$
317,676
  

The derecognition (write-off) of goodwill in the amount of $1.9 million was related to certain clinics that have been permanently closed.

8. INTANGIBLE ASSETS, NET

Intangible assets, net as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

 
June 30, 2020
    
December 31, 2019
  
Tradenames
  
$
31,490
    
$
32,049
  
Referral relationships, net of accumulated amortization of $13,126 and $11,677, respectively
    
21,517
      
18,367
  
Non-compete agreements, net of accumulated amortization of $5,687 and $5,424, respectively
    
1,888
      
2,172
  
   
$
54,895
    
$
52,588
  

Tradenames, referral relationships and non-compete agreements are related to the businesses acquired. The value assigned to tradenames has an indefinite life and is tested at least annually for impairment using the relief from royalty method in conjunction with the Company’s annual goodwill impairment test. The value assigned to referral relationships is being amortized over their respective estimated useful lives which range from six to sixteen years. Non-compete agreements are amortized over the respective term of the agreements which range from five to six years.
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The following table details the amount of amortization expense recorded for intangible assets for the three months and six months ended June 30, 2020 and 2019 (in thousands):

 
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Referral relationships
  
$
836
    
$
581
    
$
1,449
    
$
1,114
  
Non-compete agreements
    
87
      
169
      
264
      
338
  
   
$
923
    
$
750
    
$
1,713
    
$
1,452
  

Based on the balance of referral relationships and non-compete agreements as of June 30, 2020, the expected amount to be amortized in 2020 and thereafter by year is as follows (in thousands):

Referral Relationships
  
Non-Compete Agreements
  
Years
  
Annual Amount
  
Years
  
Annual Amount
  
Ending December 31,
      
Ending December 31,
      
2020 (excluding the six months ended June 30, 2020)
$
1,369
  
2020 (excluding the six months ended June 30, 2020)
$
300
  
2021
$
2,737
  
2021
$
552
  
2022
$
2,689
  
2022
$
375
  
2023
$
2,581
  
2023
$
305
  
2024
$
2,417
  
2024
$
250
  
Thereafter
$
9,724
  
Thereafter
$
193
  

9. ACCRUED EXPENSES

Accrued expenses as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

 
June 30, 2020
    
December 31, 2019
  
Salaries and related costs
  
$
16,809
    
$
19,340
  
Credit balances due to patients and payors
    
6,871
      
4,303
  
Group health insurance claims
    
2,180
      
2,277
  
Closure costs
    
1,987
      
116
  
Federal income taxes payable
    
4,637
      
-
  
MAAPP funds payable
    
12,861
      
-
  
Deferred employer payroll taxes - CARES ACT
    
2,155
      
-
  
Other
    
3,825
      
4,819
  
Total
  
$
51,325
    
$
30,855
  

In response to the COVID-19 pandemic, the federal government approved the CARES Act. The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded these payments as a liability until all performance obligations have been met as the payments were made on behalf of patients before services were provided. Currently, MAAPP funds received will be applied to future Medicare billings commencing in August 2020, with all such remaining amounts required to be repaid by November 2020. Beginning November 2020, any unpaid balance will begin accruing interest. Failure to repay the advanced payments when due will result in interest charges on the outstanding balance owed.

Closure costs consist primarily of remaining lease commitments.
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10. NOTES PAYABLE AND AMENDED CREDIT AGREEMENT

Amounts outstanding under the Amended Credit Agreement (as defined below) and notes payable as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

 
June 30, 2020
    
December 31, 2019
  
Credit Agreement average effective interest rate of 2.3% inclusive of unused fee
  
$
33,000
    
$
46,000
  
Various notes payable with $4,635 plus accrued interest due in the next year, interest accrues in the range of 3.25% through 5.50% per annum
    
5,320
      
5,089
  
   
$
38,320
    
$
51,089
  
Less current portion
    
(4,635
)
    
(728
)
Long term portion
  
$
33,685
    
$
50,361
  

Effective December 5, 2013, the Company entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended in August 2015, January 2016, March 2017 and November 2017 (hereafter referred to as “Amended Credit Agreement”). The Amended Credit Agreement is unsecured and has loan covenants, including requirements that the Company comply with a consolidated fixed charge coverage ratio and consolidated leverage ratio. Proceeds from the Amended Credit Agreement may be used for working capital, acquisitions, purchases of the Company’s common stock, dividend payments to the Company’s common stockholders, capital expenditures and other corporate purposes. The pricing grid which is based on the Company’s consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.25% to 2.0% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Fees under the Amended Credit Agreement include an unused commitment fee ranging from 0.25% to 0.3% depending on the Company’s consolidated leverage ratio and the amount of funds outstanding under the Amended Credit Agreement.

The January 2016 amendment to the Amended Credit Agreement increased the cash and noncash consideration that the Company could pay with respect to acquisitions permitted under the Amended Credit Agreement to $50.0 million for any fiscal year, and increased the amount the Company may pay in cash dividends to its shareholders in an aggregate amount not to exceed $10.0 million in any fiscal year.  The March 2017 amendment, among other items, increased the amount the Company may pay in cash dividends to its shareholders in an aggregate amount not to exceed $15.0 million in any fiscal year. The November 2017 amendment, among other items, adjusted the pricing grid as described above, increased the aggregate amount the Company may pay in cash dividends to its shareholders to an amount not to exceed $20.0 million and extended the maturity date to November 30, 2021.

On June 30, 2020, $33.0 million was outstanding on the Amended Credit Agreement resulting in $92.0 million of availability. As of June 30, 2020, the Company was in compliance with all of the covenants contained in the Amended Credit Agreement. Given the uncertainty inherent in operating results due to the COVID-19 pandemic, the Company continues to closely monitor covenant compliance. The Company will engage as required in discussions with its lender regarding an amendment to the facility so as to maintain compliance with all covenants.

The Company generally enters into various notes payable as a means of financing a portion of its acquisitions and purchases of non-controlling interests. In conjunction with the acquisitions on February 27, 2020, the Company entered into a note payable in the amount of $300,000 payable in February 2022 plus accrued interest. During the quarter ended June 30, 2020, the Company entered into various notes payable as a means of financing a portion of its acquisition of partner’s non-controlling interest in the amount of $0.2 million. Interest accrues at the rate of 4.75% per annum. In conjunction with the 2019 acquisitions, the Company entered into notes payable in the aggregate amount of $4.8 million of which an aggregate principal payment of $4.6 million is due in 2021 and $0.2 million is due in 2022. Interest accrues in the range of 3.25% to 5.50% per annum and is payable with each principal installment.
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Subsequent aggregate annual payments of principal required pursuant to the Amended Credit Agreement and outstanding notes payable at June 30, 2020 are as follows (in thousands):

During the twelve months ended June 30, 2021
  
$
4,635
  
During the twelve months ended June 30, 2022
    
33,642
  
During the twelve months ended June 30, 2023
    
43
  
   
$
38,320
  

The outstanding amounts under the Amended Credit Agreement facility (balance at June 30, 2020 of $33.0 million) mature on November 30, 2021.

11. LEASES

The Company has operating leases for its corporate offices and operating facilities. The Company determines if an arrangement is a lease at the inception of a contract.  Effective January 1, 2019, right-of-use assets and operating lease liabilities are included in its consolidated balance sheet. Right-of-use assets represent the Company’s right to use an underlying asset during the lease term and operating lease liabilities represent net present value of the Company’s obligation to make lease payments arising from the lease. Right-of-use assets and operating lease liabilities are recognized at commencement date based on the net present value of the fixed lease payments over the lease term. The Company’s operating lease terms are generally five years or less. The Company’s lease terms include options to extend or terminate the lease when it is reasonably certain that the option will be exercised. As most of the Company’s operating leases do not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating fixed lease expense is recognized on a straight-line basis over the lease term.

In accordance with ASC 842, the Company records on its consolidated balance sheet leases with a term greater than 12 months.  The Company has elected, in compliance with current accounting standards, not to record leases with an initial terms of 12 months or less in the consolidated balance sheet.  ASC 842 requires the separation of the fixed lease components from the variable lease components. The Company has elected the practical expedient to account for separate lease components of a contract as a single lease cost thus causing all fixed payments to be capitalized. Non-lease and variable cost components are not included in the measurement of the right-of-use assets or operating lease liabilities. The Company also elected the package of practical expedients permitted within ASC 842, which among other things, allows the Company to carry forward historical lease classification. Variable lease payment amounts that cannot be determined at the commencement of the lease such as increases in lease payments based on changes in index rates or usage are not included in the right-of- use assets or operating lease liabilities. These are expensed as incurred and recorded as variable lease expense.

For the three months and six months ended June 30, 2020, the components of lease expense were as follows (in thousands):

 
Three Months Ended June 30,
    
Six Months Ended June 30,
  
   
2020
    
2019
    
2020
    
2019
  
Operating lease cost
  
$
7,815
    
$
7,708
    
$
15,627
    
$
15,295
  
Short-term lease cost
    
215
      
297
      
509
      
668
  
Variable lease cost
    
1,514
      
1,547
      
3,046
      
3,128
  
Total lease cost *
  
$
9,544
    
$
9,552
    
$
19,182
    
$
19,091
  

* Sublease income was immaterial

Lease cost is reflected in the consolidated statement of net income in the line item – rent, supplies, contract labor and other.

Supplemental information related to leases was as follows (in thousands):

 
Three Months Ended June 30,
    
Six Months Ended June 30,
  
   
2020
    
2019
    
2020
    
2019
  
                         
Cash paid for amounts included in the measurement of operating lease liabilities (in thousands)
  
$
6,555
    
$
7,686
    
$
14,345
    
$
15,392
  
                                 
Right-of-use assets obtained in exchange for new operating lease liabilities (in thousands) *
  
$
7,535
    
$
8,629
    
$
19,075
    
$
98,514
  

* Includes the right-of-use assets obtained in exchange for lease liabilities of $82.6 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019.
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The aggregate future lease payments for operating leases as of June 30, 2020 were as follows (in thousands):

Fiscal Year
  
Amount
  
2020 (excluding the six months ended June 30, 2020)
  
$
15,568
  
2021
    
26,363
  
2022
    
20,565
  
2023
    
14,968
  
2024
    
9,439
  
2025 and therafter
    
10,288
  
Total lease payments
  
$
97,191
  
Less: imputed  interest
    
6,359
  
Total operating lease liabilities
  
$
90,832
  

Average lease terms and discount rates were as follows:

 
Three Months Ended
June 30, 2020
    
Six Months Ended
June 30, 2020
  
Weighted-average remaining lease term - Operating leases
  
4.21 Years
    
4.21 Years
  
             
Weighted-average discount rate - Operating leases
    
3.2
%
    
3.2
%

12. SEGMENT INFORMATION

The Company’s reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. Included in the physical therapy operations segment are revenues from management contract services and other services which include services the Company provides on-site, such as schools for athletic trainers.

The Company evaluates performance of the segments based on gross profit. The Company has provided additional information regarding its reportable segments, which contributes to the understanding of the Company and provides useful information.

The following table summarizes selected financial data for the Company’s reportable segments. Prior year results presented herein have been changed to conform to the current presentation.

 
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
   
(in thousands)
    
(in thousands)
  
Net operating revenues:
                        
Physical therapy operations
  
$
74,199
    
$
116,085
    
$
177,040
    
$
225,416
  
Industrial injury prevention services
    
9,658
      
10,288
      
19,534
      
17,188
  
Total Company
  
$
83,857
    
$
126,373
    
$
196,574
    
$
242,604
  
 
                                
Gross profit:
                                
Physical therapy operations (excluding closure costs)
  
$
16,199
    
$
28,433
    
$
33,978
    
$
53,610
  
Industrial injury prevention services
    
3,179
      
3,005
      
4,843
      
4,542
  
 
  
$
19,378
    
$
31,438
    
$
38,821
    
$
58,152
  
Physical therapy operations - closure costs
    
94
      
13
      
3,846
      
9
  
Gross profit
  
$
19,284
    
$
31,425
    
$
34,975
    
$
58,143
  
 
                                
Total assets:
                                
Physical therapy operations
                  
$
534,238
    
$
512,657
  
Industrial injury prevention services
                    
50,780
      
48,188
  
Total Company
                  
$
585,018
    
$
560,845
  

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13. COMMON STOCK

From September 2001 through December 31, 2008, the Board authorized the Company to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of the Company’s common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of its common stock (“March 2009 Authorization”). The Amended Credit Agreement permits share repurchases of up to $15,000,000, subject to compliance with covenants. The Company is required to retire shares purchased under the March 2009 Authorization.

Under the March 2009 Authorization, the Company has purchased a total of 859,499 shares. There is no expiration date for the share repurchase program. There are currently an additional estimated 185,139 shares (based on the closing price of $81.02 on June 30, 2020) that may be purchased from time to time in the open market or private transactions depending on price, availability and the Company’s cash position. The Company did not purchase any shares of its common stock during the six months ended June 30, 2020.

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Item 2.
MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS.

The following is a discussion of our historical consolidated financial condition and results of operations, and should be read in conjunction with (i) our historical consolidated financial statements and accompanying notes thereto included elsewhere in this Quarterly Report on Form 10-Q; (ii) our Annual Report on Form 10-K for the year ended December 31, 2019 filed with the Securities and Exchange Commission (the “SEC”) on February 28, 2020 (“2019 Annual Report”); and (iii) our management’s discussion and analysis of financial condition and results of operations included in our 2019 Annual Report. This discussion includes forward-looking statements that are subject to risk and uncertainties. Actual results may differ substantially from the statements we make in this section due to a number of factors that are discussed in “Forward-Looking Statements” herein and in Part II, Item 1A. Risk Factors of this report.

References to “we,” “us,” “our” and the “Company” shall mean U.S. Physical Therapy, Inc. and its subsidiaries.

EXECUTIVE SUMMARY

Our Business

We operate outpatient physical therapy clinics that provide pre- and post-operative care and treatment for a variety of orthopedic-related disorders and sports-related injuries, neurologically-related injuries and rehabilitation of injured workers. We also operate an industrial injury prevention services business which include onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments services.

Business Update Related to COVID-19

As previously disclosed in a series of filings with the SEC and further described in detail in its Quarterly Report on Form 10-Q for the quarter ended March 31, 2020 filed with the SEC on May 21, 2020, the our results have been negatively impacted by the effects of the COVID-19 pandemic. Management has taken a number of steps to reduce costs, stem operating losses incurred in March and April and increase profits subsequently. In March, with the onset of the COVID-19 pandemic, we began to furlough or terminate approximately 40% of its 5,500 full and part-time workforce. Since early May, over 750 of the furloughed employees have returned to work on a full or part-time basis. As of the filing of this quarterly report, we continue to experience lower physical therapy revenues; however we have seen recent improvement. The Company’s physical therapy daily patient volumes in April declined to as low as 45% of normal. For the month of April recent average visits per day per clinic were 16.4, in May that increased to 18.6 and in June rose to an average of 21.8 visits per day per clinic. Our industrial injury prevention business has been less effected by the pandemic and is currently running at approximately 90% of normal. Management estimates that the physical therapy visits in the month of July 2020, reached 80% to 85% of pre-COVID-19 volume.

Selected Operating and Financial Data

At June 30, 2020, we operated 554 clinics (of which 8 are not currently seeing patients) in 39 states.  In addition to our ownership and operation of outpatient physical therapy clinics, we also manage physical therapy facilities for third parties, such as physicians and hospitals, with 29 such third-party facilities under management as of June 30, 2020.

Our reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. Our physical operations consist of physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventive care, rehabilitation of injured workers and neurological injuries. Services provided by industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments.  The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. We perform these services through Industrial Sports Medicine Professionals, consisting of both physical therapists and highly specialized certified athletic trainers (ATCs).

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In March 2017, we acquired a 55% interest in an initial industrial injury prevention business. On April 30, 2018, we made a second acquisition and subsequently combined the two businesses.   After the combination, we owned a 59.45% interest in the combined business, Briotix Health, Limited Partnership (“Briotix Health”). Services provided include onsite injury and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. We perform these services through Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs). On April 11, 2019, we acquired a third company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network in 45 states including onsite at eleven client locations. The acquired business was then combined with Briotix Health increasing our ownership position in the partnership to approximately 76.0%.

On February 27, 2020, we acquired interests in a four-clinic physical therapy practice. The four clinics are in four separate partnerships.  Our interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The purchase price was $11.9 million, of which $11.6 million was paid in cash and a $0.3 million seller note.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.

On September 30, 2019, we acquired a 67% interest in eleven-clinic physical therapy practice. The purchase price for the 67% interest was $12.4 million of which $12.1 million was paid in cash and $0.3 million in a seller note that is payable in two principal installments totaling $150,000 each, plus accrued interest in September 2020 and September 2021. The note accrues interest at 5.0% per annum.

During the six months ended June 30, 2020, we sold 11 previously closed clinics.  The aggregate sales price was $1.1 million, of which $0.7 million was paid in cash and $0.4 million in a note receivable payable in two equal installments of principal and any accrued interest on June 15, 2021 and 2022.

RESULTS OF OPERATIONS

Three Months Ended June 30, 2020 Compared to the Three Months Ended June 30, 2019

•
For the second quarter ended June 30, 2020 (“2020 Second Quarter”), our Operating Results (as defined below) was $10.9 million, or $0.85 per diluted share, inclusive of relief funds received from the Public Health and Social Services Emergency Fund as part of the CARES Act (“Relief Funds”), as compared to $10.3 million, or $0.81 per diluted share, in quarter ended June 30, 2019 (“2019 Second Quarter”).  For the 2020 Second Quarter, our Operating Results was $5.0 million, or $0.39 per diluted share, without the Relief Funds.  Operating Results, a non-GAAP measure, equals net income attributable to our shareholders per the consolidated statement of net income plus charges incurred for closure costs less gain on sale of partnership interest and clinics and Relief Funds, all net of tax.  The earnings per share from Operating Results also excludes the impact of the revaluation of redeemable non-controlling interest.

•
For the 2020 Second Quarter, our net income attributable to its shareholders, in accordance with GAAP, was $10.3 million as compared to $14.6 million for the comparable period of 2019.  Inclusive of the credit or charge for the revaluation of non-controlling interest, net of tax, used to compute diluted earnings per share, in accordance with GAAP, in the 2020 Second Quarter, the amount is $12.7 million, or $0.99 per share, as compared to $10.8 million, or $0.85 per share in the 2019 Second Quarter.  In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is not included in net income but charged or credited directly to retained earnings; however, the charge or credit for this change is included in the earnings per basic and diluted share calculation.

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The following table provides details of the diluted earnings per share computation and reconciles net income attributable to our shareholders calculated in accordance with GAAP to Operating Results. Management believes providing Operating Results to investors is useful information for comparing our period-to-period results. Operating Results, a non-GAAP measure, equals net income attributable to our shareholders per the consolidated statement of net income plus charges incurred for closure costs less gain on sale of partnership interest and clinics and Relief Funds, all net of tax.  The earnings per share from Operating Results also excludes the impact of the revaluation of redeemable non-controlling interest. In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is included in the earnings per basic and diluted share calculation, although it is not included in net income but charged directly to retained earnings.  Management uses Operating Results, which eliminates certain items described above that can be subject to volatility and unusual costs, as one of the principal measures to evaluate and monitor financial performance period over period.  Management believes that Operating Results is useful information for investors to use in comparing our period-to-period results as well as for comparing with other similar businesses since most do not have redeemable non-controlling interest instruments and therefore have different liability and equity structures.

Operating Results is not a measure of financial performance under GAAP. Operating Results should not be considered in isolation or as an alternative to, or substitute for, net income attributable to our shareholders presented in the consolidated financial statements.

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Three Months Ended June 30,
  
   
2020
    
2019
  
Computation of earnings per share - USPH shareholders:
            
Net income attributable to USPH shareholders
  
$
10,232
    
$
14,620
  
Credit (charges) to retained earnings:
                
Revaluation of redeemable non-controlling interest
    
3,344
      
(5,169
)
Tax effect at statutory rate (federal and state) of 26.25%
    
(878
)
    
1,356
  
   
$
12,698
    
$
10,807
  
                 
Earnings per share (basic and diluted)
  
$
0.99
    
$
0.85
  
                 
Adjustments:
                
Charges incurred for CFO search
    
-
      
-
  
Closure costs
    
94
      
-
  
Gain on sale of partnership interest and clinics
    
(1,073
)
    
(5,823
)
Receipts from the CARES Act Provider Relief Fund ("Relief Fund")
    
(7,958
)
    
-
  
Allocation to non-controlling interest
    
1,900
      
-
  
Revaluation of redeemable non-controlling interest
    
(3,344
)
    
5,169
  
Tax effect at statutory rate (federal and state) of 26.25%
    
2,725
      
172
  
Operating Results (without receipts from Relief Fund)
  
$
5,042
    
$
10,325
  
                 
Receipts from Relief Fund
    
7,958
      
-
  
Tax effect at statutory rate (federal and state) of 26.25%
    
(2,089
)
    
-
  
Operating Results (including receipts from Relief Fund)
  
$
10,911
    
$
10,325
  
                 
Basic and diluted Operating Results (without receipts from Relief Fund) per share
  
$
0.39
    
$
0.81
  
Basic and diluted Operating Results (including receipts from Relief Fund) per share
  
$
0.85
    
$
0.81
  
                 
Shares used in computation - basic and diluted
    
12,843
      
12,767
  

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The following table summarizes financial data by segment for the periods indicated and reconciles the data to our consolidated financial statements:

  
Three Months Ended
  
   
June 30, 2020
    
June 30, 2019
  
   
(in thousands)
  
Net operating revenues:
            
Physical therapy operations
  
$
74,199
    
$
116,085
  
Industrial injury prevention services
    
9,658
      
10,288
  
Total Company
  
$
83,857
    
$
126,373
  
                 
Gross profit:
                
Physical therapy operations (excluding closure costs)
  
$
16,199
    
$
28,433
  
Industrial injury prevention services
    
3,179
      
3,005
  
   
$
19,378
    
$
31,438
  
Physical therapy operations - closure costs
    
94
      
13
  
Gross profit
  
$
19,284
    
$
31,425
  

Revenues

•
Reported net revenues in the 2020 Second Quarter was $83.9 million as compared to $126.4 million in the 2019 Second Quarter.  Adjusted for the clinics sold in 2019 and 2020, net patient revenues were $83.7 million ($83.9 million less $0.2 million related to sold clinics) in the 2020 Second Quarter compared to $118.8 million ($126.4 million less $7.6 million related to sold clinics) in the 2019 Second Quarter.  The remaining reduction in revenue of $35.1 million is due to the adverse effects of the COVID-19 pandemic. Please see table below.

 
  
Three Months Ended
  
 
  
June 30, 2020
    
June 30, 2019
  
 
  
(in thousands)
  
 Reported net revenues
  
$
83,857
    
$
126,373
  
2019 sold clinics
    
-
      
(6,552
)
2020 sold clinics
    
(112
)
    
(1,039
)
 
  
$
83,745
    
$
118,782
  

•
Net patient revenues from physical therapy operations were approximately $72.3 million in the 2020 Second Quarter and $113.4 million in the 2019 Second Quarter. Included in net patient revenues for the 2020 Second Quarter was $5.0 million related to clinics opened or acquired after June 30, 2019 (“New Clinics”).  Included in net patient revenues for the 2019 Second Quarter was $7.8 million related to clinics sold in the six months ended June 30, 2019 and 2020.  During the 2019 Second Quarter, the Company sold its interest in a partnership that included 30 clinics and during the 2020 Second Quarter, the Company sold its interest in eleven closed clinics.

•
The average net patient revenue per visit was $106.97 for the 2020 Second Quarter and $107.16 for the 2019 Second Quarter. Total patient visits were 675,700 in the 2020 Second Quarter and 1,058,000 for the 2019 Second Quarter. Adjusted for the clinics sold in 2020 and 2019, total patient visits were 674,600 in the 2020 Second Quarter and 992,200 for the 2019 Second Quarter.  The reduction in adjusted total patient visits is due to the adverse effects of the COVID-19 pandemic. Net patient revenues are based on established billing rates less allowances for patients covered by contractual programs and workers’ compensation. Net patient revenues are determined after contractual and other adjustments relating to patient discounts from certain payors. Payments received under contractual programs and workers’ compensation are based on predetermined rates and are generally less than the established billing rates.

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•
Also included in physical therapy operations was revenue from physical therapy management contracts which was $1.6 million for the 2020 Second Quarter and $2.2 million in 2019 Second Quarter. Other miscellaneous revenue from physical therapy operations was $0.3 million in the 2020 Second Quarter and $0.5 million in the 2019 Second Quarter.  Other miscellaneous revenue include physical therapy services, including athletic trainers, provided on-site such as for schools.

•
Revenue from the industrial injury prevention services business decreased 6.1% to $9.7 million in the 2020 Second Quarter compared to $10.3 million in the 2019 Second Quarter.  The reduction is primarily attributable to the adverse effects of the COVID-19 pandemic.  Currently, the industrial injury prevention services business is running at slightly over 90% of normal.

Operating Costs

Total operating costs, excluding closure costs, were $64.5 million in  the 2020 Second Quarter, or 76.9% of net revenues, as compared to $94.9 million in the 2019 Second Quarter, or 75.1% of net revenues. Total operating costs for the physical therapy operations, excluding closure costs, were $58.0 million in the 2020 Second Quarter, or 78.2% of physical therapy operations revenues, as compared to $87.7 million in the 2019 Second Quarter, or 75.5% of physical therapy operations revenues. Included in operating costs for the physical therapy operations for the 2020 Second Quarter was $3.8 million related to New Clinics, of which $2.6 million related the clinics acquired in September 2019 and February 2020.  Adjusted for the operating costs for clinics related to the partnership interest sold in 2019 and 2020 of $6.6 million in 2019 Second Quarter and $0.5 million in 2020 Second Quarter, operating costs for clinic opened or acquired prior to July 1, 2019 (“Mature Clinics”) decreased by $26.5 million in the 2020 Second Quarter compared to the 2019 Second Quarter.  Operating costs, included in physical therapy operations, related to management contracts decreased by $0.7 million.  Closure costs of $0.1 million include estimates of remaining lease obligations and other costs offset by settlement of certain lease commitments recorded in the first quarter of 2019 due to closed clinics.

Total operating costs for the industrial injury prevention services business, were $6.5 million in the 2020 Second Quarter, or 67.1% of industrial injury prevention services revenues, as compared to $7.3 million in the 2019 Second Quarter, or 70.8% of net industrial injury prevention revenues.

Each component of operating costs is discussed below:

Operating Costs—Salaries and Related Costs

Salaries and related costs, including physical therapy operations and the industrial injury prevention services business, were 51.8% of net revenues in the 2020 Second Quarter versus 55.9% in the 2019 Second Quarter primarily due to a reduction in staffing and salary reductions due to management response to the COVID-19 pandemic.  Please see discussion in Business Update Related to COVID-19 for further information. Salaries and related costs for the physical therapy operations were $37.9 million in the 2020 Second Quarter, or 51.1% of physical therapy operations revenues, as compared to $64.6 million in the 2019 Second Quarter, or 55.6% of physical therapy operations revenues. Included in salaries and related costs for the physical therapy operations for the 2020 Second Quarter was $2.2 million related to New Clinics.  Adjusted for the salaries and related costs for clinics related to the partnership interest sold in 2019 and 2020 of $4.9 million in the 2019 Second Quarter and $0.1 million in the 2020 Second Quarter, salaries and related costs for Mature Clinics decreased by $23.5 million in the Second Quarter 2020 compared to the Second Quarter 2019 .  Salaries and related costs, included in physical therapy operations, related to management contracts decreased by $0.6 million.

Salaries and related costs for the industrial injury prevention services business, were $5.5 million in the 2020 Second Quarter, or 56.9% of industrial injury prevention services revenues, as compared to $6.0 million in the 2019 Second Quarter, or 58.7% of net industrial injury prevention services revenues.

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Operating Costs—Rent, Supplies, Contract Labor and Other

Rent, supplies, contract labor and other costs, including physical therapy operations and the industrial injury prevention services business, were 24.2% of net revenues in the 2020 Second Quarter versus 18.2% in the 2019 Second Quarter. Rent, supplies, contract labor and other costs for the physical therapy operations were $19.3 million in the 2020 Second Quarter, or 26.0% of physical therapy operations revenues, as compared to $21.8 million in the 2019 Second Quarter, or 18.8% of physical therapy operations revenues. Included in rent, supplies, contract labor and other costs for the physical therapy operations for the 2020 Second Quarter was $1.5 million related to New Clinics.  Adjusted for the rent, supplies, contract labor and other costs for clinics related to the partnership interest sold in 2019 and 2020 of $1.6 million in the 2019 Second Quarter and $0.4 million in the 2020 second quarter, rent, supplies, contract labor and other costs for Mature Clinics decreased by $2.6 million in the Second Quarter 2020 compared to the Second Quarter 2019 .  Rent, supplies, contract labor and other costs, included in physical therapy operations, related to management contracts decreased slightly.

Rent, supplies, contract labor and other costs for the industrial injury prevention services business, were $1.0 million in the 2020 Second Quarter, or 10.2% of industrial injury prevention services revenues, as compared to $1.2 million in the 2019 Second Quarter, or 12.1% of net industrial injury prevention services revenues.

Operating Costs—Provision for Doubtful Accounts

The provision for doubtful accounts as a percentage of net revenue was 0.9% in the 2020 Second Quarter and 1.0% for the comparable period in 2019.

Our provision for doubtful accounts for patient accounts receivable as a percentage of total patient accounts receivable was 6.4% at June 30, 2020, as compared to 5.6% at December 31, 2019. Our days’ sales outstanding were 36 days at June 30, 2020 and 33 days at December 31, 2019.

Gross Profit

Gross profit, including physical therapy operations, without closure costs, and the industrial injury prevention service business, was $19.4 million, or 23.1% of net revenue, as compared to $31.4 million, or 24.9% of net revenues, in the 2019 Second Quarter. Gross profit for the physical therapy operations was $16.2 million in the 2020 Second Quarter, or 21.8% of physical therapy operations revenues, as compared to $28.4 million in the 2019 Second Quarter, or 24.5% of physical therapy operations revenues. Gross profit for the physical therapy operations, excluding management contracts, was $15.8 million in the 2020 Second Quarter, or 21.7% of net patient revenues, as compared to $28.1 million in the 2019 Second Quarter, or 24.7% of net patient revenues. Gross profit for management contracts was $0.4 million in the 2020 Second Quarter, or 26.9% of management contract revenues, as compared to $0.3 million in the 2019 Second Quarter, or 15.4% of net patient revenues.

The gross profit for the industrial injury prevention service business was $3.2 million, or 32.9%, in the 2020 Second Quarter as compared to $3.0 million, or 29.2%, in the 2019 Second Quarter.

Corporate Office Costs

Corporate office costs, consisting primarily of salaries, incentive compensation, and benefits of corporate office personnel, rent, insurance costs, depreciation and amortization, travel, legal, accounting, professional, and recruiting fees, were $9.0 million for the 2020 Second Quarter and $11.5 million for the 2019 Second Quarter primarily due to a reduction in staffing and salary reductions due to management response to the COVID-19 pandemic.  Please see discussion in Business Update Related to COVID-19 for further information. As a percentage of net revenues, corporate office costs were 10.8% for the 2020 Second Quarter and 9.1% for the 2019 Second Quarter.

Operating Income

Operating income for the 2020 Second Quarter was $10.3 million as compared to $19.9 million for the 2019 Second Quarter. Operating income as a percentage of net revenue decreased from 15.7% in the 2019 period to 12.2% in 2020.  For the 2020 Second Quarter, operating income increased $6.2 million or 3.6% compared to the first quarter of 2020. See discussion above related to the effects of COVID-19 on our business and results of operation.

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Relief Funds

Included in other income in the 2020 Second Quarter was $7.9 million of Relief Funds.  The Relief Funds do not have to be repaid and were used for operations and offset of losses due to the COVID-19 pandemic.

Gain on Sale of Partnership Interest and Clinics

Included in other income was a gain of $1.1 million in the 2020 Second Quarter resulting from the sale of 11 previously closed clinics. A gain of $5.8 million was recognized in the 2019 Second Quarter resulting from the sale of a partnership interest which included 30 clinics.

Interest Expense

Interest expense was $653,000 in the 2020 Second Quarter and $607,000 in the 2019 Second Quarter due to higher average borrowings under the Company’s Amended Credit Agreement. At June 30, 2020, $33.0 million was outstanding under our Amended Credit Agreement (as defined below). See “—Liquidity and Capital Resources” below for a discussion of the terms of our Amended Credit Agreement.

Provision for Income Taxes

The provision for income tax was $3.9 million for the 2020 Second Quarter and $5.3 million for the 2019 Second Quarter. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest was 27.5% for the 2020 Second Quarter and 26.7% for the 2019 Second Quarter.

See table below detailing calculation of the provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest ($ in thousands):

  
Three Months Ended
  
   
June 30, 2020
    
June 30, 2019
  
             
Income before taxes
  
$
18,645
    
$
25,118
  
                 
Less: net income attributable to non-controlling interests:
                
Non-controlling interests - permanent equity
    
(1,535
)
    
(1,802
)
Redeemable non-controlling interests - temporary equity
    
(2,996
)
    
(3,378
)
   
$
(4,531
)
  
$
(5,180
)
                 
Income before taxes less net income attributable to non-controlling interests
  
$
14,114
    
$
19,938
  
                 
Provision for income taxes
  
$
3,882
    
$
5,318
  
                 
Percentage
    
27.5
%
    
26.7
%

Net Income Attributable to Non-controlling Interests

Net income attributable to non-controlling interests (permanent equity) was $1.5 million in the 2020 Second Quarter and $1.8 million in the 2019 Second Quarter.  Net income attributable to redeemable non-controlling interests (temporary equity) was $3.0 million in the 2020 Second Quarter and $3.4 million in the 2019 Second Quarter.

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Six Months Ended June 30, 2020 Compared to the Six Months Ended June 30, 2019

•
For the six months ended June 30, 2020 (“2020 Six Months”), our Operating Results (as defined below), was $14.8 million, or $1.15 per diluted share, inclusive of Relief Funds, as compared to $18.8 million, or $1.47 per diluted share in the six months ended June 30, 2019 (“2019 Six Months”).  For the 2020 Six Months, our Operating Results, was $8.9 million, or $0.70 per diluted share, without the Relief Funds.  Please see page 32 for the definition of Operating Results.

•
For the 2020 Six Months, our net income attributable to its shareholders, in accordance with GAAP, was $11.2 million as compared to $23.0 million for the 2019 Six Months.  Inclusive of the credit or charge for the revaluation of non-controlling interest, net of tax, used to compute diluted earnings per share, in accordance with GAAP, in the 2020 Six Months, the amount is $15.3 million, or $1.19 per share, as compared to $15.8 million, or $1.24 per share, in the 2019 Six Months.  In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is not included in net income but charged or credited directly to retained earnings; however, the charge or credit for this change is included in the earnings per basic and diluted share calculation.

The following table provides details of the diluted earnings per share computation and reconciles net income attributable to our shareholders calculated in accordance with GAAP to Operating Results. Management believes providing Operating Results to investors is useful information for comparing our period-to-period results. Operating Results, a non-GAAP measure, equals net income attributable to our shareholders per the consolidated statement of net income plus charges incurred for closure costs less gain on sale of partnership interest and clinics and Relief Funds, and excludes the ongoing CFO search, all net of tax.  The earnings per share from Operating Results also excludes the impact of the revaluation of redeemable non-controlling interest. In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is included in the earnings per basic and diluted share calculation, although it is not included in net income but charged directly to retained earnings.  Management uses Operating Results, which eliminates certain items described above that can be subject to volatility and unusual costs, as one of the principal measures to evaluate and monitor financial performance period over period.  Management believes that Operating Results is useful information for investors to use in comparing our period-to-period results as well as for comparing with other similar businesses since most do not have redeemable non-controlling interest instruments and therefore have different liability and equity structures.

Operating Results is not a measure of financial performance under GAAP. Operating Results should not be considered in isolation or as an alternative to, or substitute for, net income attributable to our shareholders presented in the consolidated financial statements.

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Six Months Ended June 30,
  
   
2020
    
2019
  
Computation of earnings per share - USPH shareholders:
            
Net income attributable to USPH shareholders
  
$
11,248
    
$
23,063
  
Credit (charges) to retained earnings:
                
Revaluation of redeemable non-controlling interest
    
5,473
      
(9,830
)
Tax effect at statutory rate (federal and state) of 26.25%
    
(1,437
)
    
2,580
  
   
$
15,284
    
$
15,813
  
                 
Earnings per share (basic and diluted)
  
$
1.19
    
$
1.24
  
                 
Adjustments:
                
Charges incurred for CFO search
    
133
      
-
  
Closure costs
    
3,846
      
-
  
Gain on sale of partnership interest and clinics
    
(1,073
)
    
(5,823
)
Receipts from the CARES Act Provider Relief Fund ("Relief Fund")
    
(7,958
)
    
-
  
Allocation to non-controlling interest
    
1,900
      
-
  
Revaluation of redeemable non-controlling interest
    
(5,473
)
    
9,830
  
Tax effect at statutory rate (federal and state) of 26.25%
    
2,264
      
(1,052
)
Operating Results (without receipts from Relief Fund)
  
$
8,923
    
$
18,768
  
                 
Receipts from Relief Fund
    
7,958
      
-
  
Tax effect at statutory rate (federal and state) of 26.25%
    
(2,089
)
    
-
  
Operating Results (including receipts from Relief Fund)
  
$
14,792
    
$
18,768
  
                 
Basic and diluted Operating Results (without receipts from Relief Fund) per share
  
$
0.70
    
$
1.47
  
Basic and diluted Operating Results (including receipts from Relief Fund) per share
  
$
1.15
    
$
1.47
  
                 
Shares used in computation - basic and diluted
    
12,820
      
12,738
  

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The following table summarizes financial data by segment for the periods indicated and reconciles the data to our consolidated financial statements:

  
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
  
   
(in thousands)
  
Net operating revenues:
            
Physical therapy operations
  
$
177,040
    
$
225,416
  
Industrial injury prevention services
    
19,534
      
17,188
  
Total Company
  
$
196,574
    
$
242,604
  
                 
Gross profit:
                
Physical therapy operations (excluding closure costs)
  
$
33,978
    
$
53,610
  
Industrial injury prevention services
    
4,843
      
4,542
  
   
$
38,821
    
$
58,152
  
Physical therapy operations - closure costs
    
3,846
      
9
  
Gross profit
  
$
34,975
    
$
58,143
  
                 
Total Assets:
                
Physical therapy operations
  
$
534,238
    
$
512,657
  
Industrial injury prevention services
    
50,780
      
48,188
  
Total Company
  
$
585,018
    
$
560,845
  

Revenues

•
Reported net revenues in the 2020 Six Months was $196.6 million as compared to $242.6 million in the 2019 Six Months.  Adjusted for the clinics sold in 2019 and 2020, net patient revenues were $195.6 million ($196.6 million less $1.0 million related to sold clinics) in the 2020 Six Months compared to $228.4 million ($242.6 million less $14.2 million related to sold clinics) in the 2019 Six Months.  The remaining reduction in revenue of $32.8 million is due to the adverse effects of the COVID-19 pandemic. Please see table below.

 
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
  
   
(in thousands)
  
Reported net revenues
  
$
196,574
    
$
242,604
  
2019 sold clinics
    
-
      
(12,237
)
2020 sold clinics
    
(949
)
    
(1,997
)
   
$
195,625
    
$
228,370
  

•
Net patient revenues from physical therapy operations were approximately $172.4 million in the 2020 Six Months and $220.0 million in the 2019 Six Months. Included in net patient revenues for the 2020 Six Months was $9.1 million related to New Clinics.  Included in net patient revenues for the 2020 Six Months was $1.0 million related to the clinics sold in 2020.  For the 2019 Six Months, net patient revenue included $7.8 million related to the clinics sold in the six months ended June 30, 2019 and 2020.  During the 2019 Six Months, the Company sold its interest in a partnership that included 30 clinics and during the 2020 six month period, the Company sold its interest in 11 closed clinics.

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•
The average net patient revenue per visit was $104.70 for the 2020 Six Months and $106.83 for the 2019 Six Months. Total patient visits were 1,646,700 in the 2020 Six Months and 2,059,000 for the 2019 Six Months. Adjusted for the clinics sold in 2020 and 2019, total patient visits were 1,637,800 in the 2020 Six Months and 1,934,500 for the 2019 Six Months.  The reduction in adjusted total patient visits is due to the adverse effects of the COVID-19 pandemic. Net patient revenues are based on established billing rates less allowances for patients covered by contractual programs and workers’ compensation. Net patient revenues are determined after contractual and other adjustments relating to patient discounts from certain payors. Payments received under contractual programs and workers’ compensation are based on predetermined rates and are generally less than the established billing rates.

•
Also included in physical therapy operations was revenue from physical therapy management contracts which was $3.7 million for the 2020 Six Months and $4.4 million in 2019 Six Months. Other miscellaneous revenue from physical therapy operations was $0.9 million in the 2020 Six Months and $1.0 million in the 2019 Six Months.  Other miscellaneous revenue include physical therapy services, including athletic trainers, provided on-site such as for schools.

•
Revenue from the industrial injury prevention services business increased 13.6% to $19.5 million in the 2020 Six Months compared to $17.2 million in the 2019 Six Months.  The increase is primarily attributable to the acquisition in April 2019 offset by the adverse effects of the COVID-19 pandemic.  Currently, the industrial injury prevention services business is running at slightly over 90% of normal.

Operating Costs

Total operating costs, excluding closure costs, were $157.8 million in the 2020 Six Months, or 80.3% of net revenues, as compared to $184.5 million in the 2019 Six Months, or 76.0% of net revenues. Total operating costs for the physical therapy operations, excluding closure costs, were $143.1 million in the 2020 Six Months, or 80.8% of physical therapy operations revenues, as compared to $171.8 million in the 2019 Six Months, or 76.2% of physical therapy operations revenues. Included in operating costs for the physical therapy operations for the 2020 Six Months was $7.3 million related to New Clinics, of which $4.7 million related the clinics acquired in September 2019 and February 2020.  Adjusted for the operating costs for clinics related to the partnership interests sold in 2019 and 2020 of $6.6 million in the 2019 Six Months and $0.5 million in  the 2020 Six Months, operating costs for clinic opened or acquired prior to July 1, 2019 (“Mature Clinics”) decreased by $26.5 million in the Second Quarter 2020 compared to the Second Quarter 2019.  Operating costs, included in physical therapy operations, related to management contracts decreased by $0.7 million.  Closure costs of $0.1 million include estimates of remaining lease obligations and other costs offset by settlement of certain lease commitments recorded in the 2019 First Quarter due to closed clinics.

Operating costs for the industrial injury prevention services business, were $14.7 million in the 2020 Six Months, or 74.7% of industrial injury prevention services revenues, as compared to $12.7 million in the 2019 Six Months, or 52.1% of net industrial injury prevention revenues.

Each component of operating costs is discussed below:

Operating Costs—Salaries and Related Costs

Salaries and related costs, including physical therapy operations and the industrial injury prevention services business, were 57.2% of net revenues in the 2020 Six Months versus 56.4% in the 2019 Six Months primarily due to a reduction in staffing and salary reductions due to management response to the COVID-19 pandemic.  Please see discussion in Business Update Related to COVID-19 for further information.  Salaries and related costs for the physical therapy operations were $100.0 million in the 2020 Six Months, or 56.5% of physical therapy operations revenues, as compared to $126.5 million in the 2019 Six Months, or 56.1% of physical therapy operations revenues. Included in salaries and related costs for the physical therapy operations for the 2020 Six Months was $4.5 million related to New Clinics.  Adjusted for the salaries and related costs for clinics related to the partnership interest sold in 2019 and 2020 of $9.6 million in the 2019 Six Months and $0.6 million in the 2020 Six Months, salaries and related costs for Mature Clinics decreased by $21.4 million in the Second Quarter 2020 compared to the Second Quarter 2019.  Salaries and related costs, included in physical therapy operations, related to management contracts decreased by $0.7 million.

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Salaries and related costs for the industrial injury prevention services business, were $12.4 million in the 2020 Six Months, or 63.6% of industrial injury prevention services revenues, as compared to $10.4 million in the 2019 Six Months, or 60.4% of net industrial injury prevention services revenues.

Operating Costs—Rent, Supplies, Contract Labor and Other

Rent, supplies, contract labor and other costs, including physical therapy operations and the industrial injury prevention services business, were 22.0% of net revenues in the 2020 Six Months versus 18.6% in the 2019 Six Months. Rent, supplies, contract labor and other costs for the physical therapy operations were $40.9 million in the 2020 Six Months, or 23.1% of physical therapy operations revenues, as compared to $45.1 million in the 2019 Six Months, or 20.0% of physical therapy operations revenues. Included in rent, supplies, contract labor and other costs for the physical therapy operations for the 2020 Six Months was $2.4 million related to New Clinics.  Adjusted for the rent, supplies, contract labor and other costs for clinics related to the partnership interest sold in 2019 and 2020 of $3.1 million in the 2019 Six Months and $0.2 million in the 2020 Six Months, rent, supplies, contract labor and other costs for Mature Clinics decreased by $1.4 million in the Second Quarter 2020 compared to the Second Quarter 2019.  Rent, supplies, contract labor and other costs, included in physical therapy operations, related to management contracts increased slightly.

Rent, supplies, contract labor and other costs for the industrial injury prevention services business, were $2.3 million in both the 2020 and 2019 Six Months.  As a percentage of industrial injury prevention services revenues, rent, supplies, contract labor and other costs were 11.6% and 13.1% of net industrial injury prevention services revenues for the 2020 and 2019 Six Months, respectively.

Operating Costs—Provision for Doubtful Accounts

The provision for doubtful accounts as a percentage of net revenue was 1.1% in the 2020 Six Months and 1.0% for the 2019 Six Months.

Our provision for doubtful accounts for patient accounts receivable as a percentage of total patient accounts receivable was 6.4% at June 30, 2020, as compared to 5.6% at December 31, 2019. Our days’ sales outstanding were 36 days at June 30, 2020 and 33 days at December 31, 2019.

Gross Profit

Gross profit, including physical therapy operations, without closure costs, and the industrial injury prevention services business, was $38.8 million, or 19.7% of net revenue, as compared to $58.2 million, or 24.0% of net revenues, in the 2019 Six Months. Gross profit for the physical therapy operations was $34.0 million in the 2020 Six Months, or 19.2% of physical therapy operations revenues, as compared to $53.6 million in the 2019 Six Months, or 23.8% of physical therapy operations revenues. Gross profit for the physical therapy operations, excluding management contracts, was $33.2 million in the 2020 Six Months, or 19.2% of net patient revenues, as compared to $52.9 million in the 2019 Six Months, or 23.9% of net patient revenues. Gross profit for management contracts was $0.8 million in the 2020 Six Months, or 20.5% of management contract revenues, as compared to $0.7 million in the 2019 Six Months, or 16.9% of net patient revenues.

The gross profit for the industrial injury prevention services business was $4.8 million, or 24.8%, in the 2020 Six Months as compared to $4.5 million, or 26.4%, in the 2019 Six Months.

Corporate Office Costs

Corporate office costs, consisting primarily of salaries, incentive compensation, and benefits of corporate office personnel, rent, insurance costs, depreciation and amortization, travel, legal, accounting, professional, and recruiting fees, were $20.7 million for the 2020 Six Months and $22.8 million for the 2019 Six Months primarily due to a reduction in staffing and salary reductions due to management response to the COVID-19 pandemic. As a percentage of net revenues, corporate office costs were 10.5% for the 2020 Six Months and 9.4% for the 2019 Six Months.

Operating Income

Operating income for the 2020 Six Months was $14.3 million as compared to $35.3 million for the 2019 Six Months. Operating income as a percentage of net revenue decreased from 14.6% in the 2019 Six Months to 7.3% in 2020.  See discussion above related to the effects of COVID-19 on our business and results of operations.

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Relief Funds

Included in other income in the 2020 Six Months was $7.9 million of Relief Funds.  The Relief Funds do not have to be repaid and were used for operations and offset of losses due to the COVID-19 pandemic.

Gain on Sale of Partnership Interest and Clinics

Included in other income was a gain of $1.1 million in the 2020 Six Months resulting from the sale of 11 previously closed clinics and, as previously disclosed, a gain of $5.8 million in the 2019 Six Months resulting from the sale of a partnership interest which included 30 clinics.

Interest Expense

Interest expense was $1.1 million in the 2020 Six Months and $1.0 in the 2019 Six Months due to higher average borrowings under the Company’s Amended Credit Agreement. At June 30, 2020, $33.0 million was outstanding under our Amended Credit Agreement (as defined below). See “—Liquidity and Capital Resources” below for a discussion of the terms of our Amended Credit Agreement.

Provision for Income Taxes

The provision for income tax was $4.2 million for the 2020 Six Months and $8.0 million for the 2019 Six Months. The provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest was 27.1% for the 2020 Six Months and 25.8% for the 2019 Six Months.

See table below detailing calculation of the provision for income tax as a percentage of income before taxes less net income attributable to non-controlling interest ($ in thousands):

  
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
  
             
Income before taxes
  
$
22,275
    
$
40,201
  
                 
Less: net income attributable to non-controlling interests:
                
Non-controlling interests - permanent equity
    
(2,061
)
    
(3,339
)
Redeemable non-controlling interests - temporary equity
    
(4,792
)
    
(5,773
)
   
$
(6,853
)
  
$
(9,112
)
                 
Income before taxes less net income attributable to non-controlling interests
  
$
15,422
    
$
31,089
  
                 
Provision for income taxes
  
$
4,174
    
$
8,026
  
                 
Percentage
    
27.1
%
    
25.8
%

Net Income Attributable to Non-controlling Interests

Net income attributable to non-controlling interests (permanent equity) was $2.0 million in the 2020 Six Months and $3.3 million in the 2019 Six Months.  Net income attributable to redeemable non-controlling interests (temporary equity) was $4.8 million in the 2020 Six Months and $5.8 million in the 2019 Six Months.

LIQUIDITY AND CAPITAL RESOURCES

We believe that our business has sufficient cash to allow us to meet our short-term cash requirements. At June 30, 2020 and December 31, 2019, we had $43.5 million and $23.5 million, respectively, in cash.  We believe that our cash is sufficient to fund the working capital needs of our operating subsidiaries through at least June 30, 2021.

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Included in our cash at June 30, 2020 are the receipts from the Medicare Accelerated and Advance Payment Program (“MAAPP”) of $12.4 million.  Based on current regulations, MAAPP funds received will be applied to future Medicare billings commencing in August 2020, with all such remaining amounts required to be repaid by us by November 2020.  Beginning November 2020, any unpaid balance will begin accruing interest.

Cash and cash equivalents increased by $20.0 million from December 31, 2019 to June 30, 2020.  During the 2020 Six Months, $48.4 million was provided by operations and $12.9 million from MAAPP, as described above. The major uses of cash for investing and financing activities included: net reduction in credit line ($33.0 million), distributions to non-controlling interests inclusive of those classified as redeemable non-controlling interests ($5.7 million), purchase of business ($11.6 million), purchase of fixed assets ($4.6 million), cash dividends paid to our shareholders ($4.1 million), and a purchase of redeemable non-controlling interests ($2.4 million). During the 2020 Second Quarter, we were able to negotiate rent abatements and deferrals totaling $1.6 million.

Effective December 5, 2013, we entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended in August 2015, January 2016, March 2017 and November 2017 (hereafter referred to as “Amended Credit Agreement”). The Amended Credit Agreement is unsecured and has loan covenants, including requirements that we comply with a consolidated fixed charge coverage ratio and consolidated leverage ratio. Proceeds from the Amended Credit Agreement may be used for working capital, acquisitions, purchases of our common stock, dividend payments to our common stockholders, capital expenditures and other corporate purposes. The pricing grid is based on our consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.25% to 2.0% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Fees under the Amended Credit Agreement include an unused commitment fee ranging from 0.25% to 0.3% depending on our consolidated leverage ratio and the amount of funds outstanding under the Amended Credit Agreement.

The January 2016 amendment to the Amended Credit Agreement increased the cash and noncash consideration that we could pay with respect to acquisitions permitted under the Amended Credit Agreement to $50.0 million for any fiscal year, and increased the amount we may pay in cash dividends to our shareholders in an aggregate amount not to exceed $10.0 million in any fiscal year.  The March 2017 amendment, among other items, increased the amount we may pay in cash dividends to our shareholders in an aggregate amount not to exceed $15.0 million in any fiscal year. The November 2017 amendment, among other items, adjusted the pricing grid as described above, increased the aggregate amount we may pay in cash dividends to $20.0 million to our shareholders and extended the maturity date to November 30, 2021.  As of June 30, 2020, we were in compliance with all of the covenants contained in the credit agreement. Given the uncertainty inherent in operating results due to the COVID-19 pandemic, the Company continues to closely monitor covenant compliance. The Company will engage as required in discussions with its lender regarding an amendment to the facility so as to maintain compliance with all covenants.

On February 27, 2020, we acquired interests in a four-clinic physical therapy practice. The four clinics are in four separate partnerships.  Our interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and a $0.3 million seller note.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.

On September 30, 2019, we acquired a 67% interest in eleven-clinic physical therapy practice. The purchase price for the 67% interest was $12.4 million, of which $12.1 million was in cash and $0.3 million in a seller note that is payable in two principal installments totaling $150,000 each, plus accrued interest in September 2020 and September 2021. The note accrues interest at 5.0% per annum.

On April 11, 2019, we acquired a company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network of 45 states including onsite at eleven client locations. The business was then combined with Briotix Health, our industrial injury prevention operation, increasing our ownership position in the Briotix Health partnership to approximately 76.0%. The purchase price for the acquired company was $22.9 million ($23.6 million less cash acquired of $0.7 million), which consisted of $18.9 million in cash, (of which $0.5 million will be paid to certain shareholders), and a $4.0 million seller note.  The note accrues interest at 5.5% and the principal and accrued interest is payable, on April 9, 2021.

On March 4, 2019, in conjunction with the purchase of a redeemable non-controlling interest, we entered into a note payable in the amount of $228,120 that was payable in two equal installments of $114,080 each, plus accrued interest. The first installment was paid in March 2020 and the second installment remains payable in March 2021.

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We make reasonable and appropriate efforts to collect accounts receivable, including applicable deductible and co-payment amounts, in a consistent manner for all payor types. Claims are submitted to payors daily, weekly or monthly in accordance with our policy or payor’s requirements. When possible, we submit our claims electronically. The collection process is time consuming and typically involves the submission of claims to multiple payors whose payment of claims may be dependent upon the payment of another payor. Claims under litigation and vehicular incidents can take a year or longer to collect. Medicare and other payor claims relating to new clinics awaiting Medicare Rehab Agency status approval initially may be delayed for a relatively short transition period. When all reasonable internal collection efforts have been exhausted, accounts are written off prior to sending them to outside collection firms. With managed care, commercial health plans and self-pay payor type receivables, the write-off generally occurs after the accounts receivable has been outstanding for at least 120 days.

We generally enter into various notes payable as a means of financing our acquisitions. Our outstanding notes payable as of June 30, 2020 relate to certain of the acquisitions of businesses and purchases of redeemable non-controlling interests that occurred in 2018 through June 2020. Typically, the notes are payable over two years plus any accrued and unpaid interest. Interest accrues at various interest rates ranging from 3.25% to 5.5% per annum, subject to adjustment. At June 30, 2020, the balance on these notes payable was $5.3 million.  In addition, we assumed leases with remaining terms of 1 month to 6 years for the operating facilities.

In conjunction with the above mentioned acquisitions, in the event that a limited minority partner’s employment ceases at any time after a specified date that is typically between three and five years from the acquisition date, we have agreed to certain contractual provisions which enable such minority partners to exercise their right to trigger our repurchase of that partner’s non-controlling interest at a predetermined multiple of earnings before interest and taxes.

As of June 30, 2020, we have accrued $6.9 million related to credit balances due to patients and payors.  This amount is expected to be paid in the next twelve months.

From September 2001 through December 31, 2008, our Board of Directors (“Board”) authorized us to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of our common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of our common stock (“March 2009 Authorization”). Our Amended Credit Agreement permits share repurchases of up to $15,000,000, subject to compliance with covenants. We are required to retire shares purchased under the March 2009 Authorization.

There is no expiration date for the share repurchase program. As of June 30, 2020, there are currently an additional estimated 185,139 shares (based on the closing price of $81.02 on June 30, 2020) that may be purchased from time to time in the open market or private transactions depending on price, availability and our cash position. We did not purchase any shares of our common stock during the six months ended June 30, 2020.

FACTORS AFFECTING FUTURE RESULTS

The risks related to our business and operations include:

•
the multiple effects of the impact of public health crises and epidemics/pandemics, such as the novel strain of  COVID-19, for which the financial magnitude cannot be currently estimated;
•
changes as the result of government enacted national healthcare reform;
•
changes in Medicare rules and guidelines and reimbursement or failure of our clinics to maintain their Medicare certification and/or enrollment status;
•
revenue we receive from Medicare and Medicaid being subject to potential retroactive reduction;
•
business and regulatory conditions including federal and state regulations;
•
governmental and other third party payor inspections, reviews, investigations and audits, which may result in sanctions or reputational harm and increased costs;
•
compliance with federal and state laws and regulations relating to the privacy of individually identifiable patient information, and associated fines and penalties for failure to comply;
•
changes in reimbursement rates or payment methods from third party payors including government agencies, and changes in the deductibles and co-pays owed by patients;
•
revenue and earnings expectations;
•
legal actions, which could subject us to increased operating costs and uninsured liabilities;

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•
general economic conditions;
•
availability and cost of qualified physical therapists;
•
personnel productivity and retaining key personnel;
•
competitive, economic or reimbursement conditions in our markets which may require us to reorganize or close certain clinics and thereby incur losses and/or closure costs including the possible write-down or write-off of goodwill and other intangible assets;
•
competitive environment in the industrial injury prevention business, which could result in the termination or non-renewal of contractual service arrangements and other adverse financial consequences for that service line;
•
acquisitions, and the successful integration of the operations of the acquired businesses;
•
impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non controlling interests (minority interests);
•
maintaining our information technology systems with adequate safeguards to protect against cyber-attacks;
•
a security breach of our or our third party vendors’ information technology systems may subject us to potential legal action and reputational harm and may result in a violation of the Health Insurance Portability and Accountability Act of 1996 of the Health Information Technology for Economic and Clinical Health Act;
•
maintaining adequate internal controls;
•
maintaining necessary insurance coverage;
•
availability, terms, and use of capital; and
•
weather and other seasonal factors.

See Risk Factors in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2019 and our subsequent current and periodic reports, including the additional risk factor noted in our Current Report on Form 8-K filed on April 24, 2020.

Forward-Looking Statements

We make statements in this report that are considered to be forward-looking statements within the meaning given such term under Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). These statements contain forward-looking information relating to the financial condition, results of operations, plans, objectives, future performance and business of our Company. These statements (often using words such as “believes”, “expects”, “intends”, “plans”, “appear”, “should” and similar words) involve risks and uncertainties that could cause actual results to differ materially from those we project. Included among such statements are those relating to opening new clinics, availability of personnel and the reimbursement environment.  The forward-looking statements are based on our current views and assumptions and actual results could differ materially from those anticipated in such forward-looking statements as a result of certain risks, uncertainties, and factors, which include, but are not limited to the risks listed above.

Many factors are beyond our control. Given these uncertainties, you should not place undue reliance on our forward-looking statements. Please see the other sections of this report and our other periodic reports filed with the Securities and Exchange Commission (the “SEC”) for more information on these factors. Our forward-looking statements represent our estimates and assumptions only as of the date of this report. Except as required by law, we are under no obligation to update any forward-looking statement, regardless of the reason the statement may no longer be accurate.

ITEM 3.
QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK.

We do not maintain any derivative instruments, interest rate swap arrangements, hedging contracts, futures contracts or the like. Our primary market risk exposure is the changes in interest rates obtainable on our Amended Credit Agreement. The interest on our Amended Credit Agreement is based on a variable rate. At June 30, 2020, $33.0 million was outstanding under our Amended Credit Agreement. Based on the balance of the Amended Credit Agreement at June 30, 2020, any change in the interest rate of 1% would yield a decrease or increase in annual interest expense of $330,000.

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ITEM 4.
CONTROLS AND PROCEDURES.

(a)
Evaluation of Disclosure Controls and Procedures

As of the end of the period covered by this report, the Company’s management completed an evaluation, under the supervision and with the participation of our principal executive officer and principal financial officer, of the effectiveness of our disclosure controls and procedures. Based on this evaluation, our principal executive officer and principal financial officer concluded (i) that our disclosure controls and procedures are designed to ensure that information required to be disclosed in the reports that we file or submit under the Securities Exchange Act of 1934, as amended, is recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and forms and that such information is accumulated and communicated to our management, including our principal executive officer and principal financial officer, or persons performing similar functions, as appropriate to allow timely decisions regarding required disclosure and (ii) that our disclosure controls and procedures are effective.

(b)
Changes in Internal Control Over Financial Reporting

In the second quarter ended June 30, 2020, we have added and/or modified certain internal controls and processes to address risks related to COVID-19. Additionally, in the second quarter of 2020, as a result of both quantitative and qualitative tests performed as part of the existing quarterly reporting process, it was determined that Briotix met the requirements to be considered a reportable segment. Accordingly, we have added and/or modified certain internal controls and processes to address required changes in reporting. There have not been any additional changes in our internal control over financial reporting during the period covered by this report that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

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PART II—OTHER INFORMATION

ITEM 1.
LEGAL PROCEEDINGS.

We are a party to various legal actions, proceedings, and claims (some of which are not insured), and regulatory and other governmental audits and investigations in the ordinary course of our business. We cannot predict the ultimate outcome of pending litigation, proceedings, and regulatory and other governmental audits and investigations. These matters could potentially subject us to sanctions, damages, recoupments, fines, and other penalties. The Department of Justice, CMS, or other federal and state enforcement and regulatory agencies may conduct additional investigations related to our businesses in the future that may, either individually or in the aggregate, have a material adverse effect on our business, financial position, results of operations, and liquidity.

Healthcare providers are subject to lawsuits under the qui tam provisions of the federal False Claims Act. Qui tam lawsuits typically remain under seal for some time while the government decides whether or not to intervene on behalf of a private qui tam plaintiff (known as a relator) and take the lead in the litigation. These lawsuits can involve significant monetary damages and penalties and award bounties to private plaintiffs who successfully bring the suits. We are and have been a defendant in these cases in the past, and may be named as a defendant in similar cases from time to time in the future.

Florida Litigation

On August 19, 2019, we received notice of a qui tam lawsuit filed by a relator on behalf of the United States, titled U.S. ex rel. Bonnie Elsdon, v. U.S. Physical Therapy, Inc., U.S. Physical Therapy, Ltd., Rehab Partners #2, Inc., The Hale Hand Center, Limited Partnership (the “Hale Partnership”), and Suzanne Hale.   This whistleblower lawsuit was filed in the U.S. District Court for the Southern District of Texas, seeking damages and civil penalties under the federal False Claim Act.  This lawsuit was originally filed under seal by a former employee of The Hale Hand Center, Limited Partnership (“Hale Partnership”), a majority-owned subsidiary of the Company, on May 25, 2018.  The U.S Government declined to intervene in the case and unsealed the Complaint on July 17, 2019.  The plaintiff - relator served the Complaint on us and the other named defendants on August 19, 2019.

The Complaint alleges that the Hale Partnership engaged in conduct to purposely “upcode” its billings for services provided to Medicare patients. The plaintiff - relator points to three dates of service and provides examples of what it alleges are inflated billings by the Hale Partnership; the relator then claims that similar false claims must have occurred on other days and at other Company-owned partnerships.

On October 3, 2019, we filed Motions to Dismiss based on numerous grounds on behalf of each of the named defendants. On October 29, 2019, the plaintiff-relator dismissed three of the named defendants, Rehab Partners #2, Inc., U.S. Physical Therapy, Ltd., and Suzanne Hale. The Motions to Dismiss as to the remaining two defendants has been fully briefed and is pending before the Court for a ruling.

We have engaged counsel and fully investigated the matter, and believe that the allegations in the Complaint have no merit. We intend to vigorously defend this action, but at this time we are unable to predict the timing and outcome of the matter.

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ITEM 1A.
RISK FACTORS.

The risk factors set forth in this report update, and should be read in conjunction with, the risk factors discussed in Item 1A of our Annual Report on Form 10-K for the year ended December 31, 2019 filed with the SEC on February 28, 2020.

We are subject to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (COVID-19).

Our operations expose us to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (COVID-19) that has spread globally. Since February, the continued spread has led to disruption and volatility in the global capital markets, which increases the cost of, and adversely impacts access to, capital and increases economic uncertainty. The pandemic has caused an economic slowdown of potentially extended duration, and it is possible that it could cause a global recession.

COVID-19 is having, and will continue to have, an adverse impact on our operations and supply chains, including an increase in cancellations of physical therapy patient appointments and a decline in the scheduling of new or additional patient appointments.  Due to these impacts and measures, we have experienced, and will continue to experience, significant and unpredictable reductions and cancellations of our patient visits.

As a result, given the rapid and evolving nature of the virus, COVID-19 will negatively affect our revenue, and it is uncertain how materially COVID-19 will affect operations generally if these impacts persist or worsen over an extended period of time. Any of these impacts would have a significant adverse effect on our business, financial condition and results of operations, and at this point, the extent of the impact of COVID-19 remains uncertain.

Impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interests (minority interests)

As described in Note 6, the redeemable non-controlling interests in our partnerships are held by our partners.  Upon the occurrence of certain events, such as retirement or other termination of employment, partners from acquired partnerships may have the right to exercise a “put” to cause the Company to purchase their redeemable non-controlling interests.  Depending on the amount and timing of the exercise of any “put” rights, the funds required could have an adverse impact on the Company’s capital structure.

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ITEM 6.
EXHIBITS.

Exhibit
Number
Description
 
 
Rule 13a-14(a)/15d-14(a) Certification of Chief Executive Officer.
Rule 13a-14(a)/15d-14(a) Certification of Chief Financial Officer.
Rule 13a-14(a)/15d-14(a) Certification of Corporate Controller.
Certification Pursuant to 18 U.S.C 1350, as Adopted Pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.INS*
XBRL Instance Document
101.SCH*
XBRL Taxonomy Extension Schema Document
101.CAL*
XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF*
XBRL Taxonomy Extension Definition Linkbase Document
101.LAB*
XBRL Taxonomy Extension Label Linkbase Documen
101.PRE*
XBRL Taxonomy Extension Presentation Linkbase Document

*
Filed herewith

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SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on our behalf by the undersigned thereunto duly authorized.

 
U.S. PHYSICAL THERAPY, INC.
 
 
 
Date: August 7, 2020
By:
/s/ LAWRANCE W. MCAFEE
 
 
Lawrance W. McAfee
 
 
Chief Financial Officer
 
 
(duly authorized officer and principal financial and accounting officer)
 
 
 
 
By:
 /s/ JON C. BATES
 
 
Jon C. Bates
 
 
Vice President/Corporate Controller


51
EXHIBIT 31.1
 CERTIFICATION

I, Christopher Reading, certify that:


 1.
I have reviewed this quarterly report on Form 10-Q of U.S. Physical Therapy, Inc.;


2.
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;


3.
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;


4.
The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:


a.
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;


b.
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;


c.
Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and


d.
Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and


5.
The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):


a.
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and


b.
Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

 
/s/ CHRISTOPHER READING
 
Christopher Reading
 
President and Chief Executive Officer
(principal executive officer)

Date: August 7, 2020


EXHIBIT 31.2
CERTIFICATION

I, Lawrance W. McAfee, certify that:


 1.
I have reviewed this quarterly report on Form 10-Q of U.S. Physical Therapy, Inc.;


2.
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;


3.
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;


4.
The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:


a.
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;


b.
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;


c.
Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and


d.
Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and


5.
The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):


a.
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and


b.
Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

 
/s/ LAWRANCE W. MCAFEE
 
Lawrance W. McAfee
 
Chief Financial Officer
 
(principal financial and accounting officer)

Date: August 7, 2020


EXHIBIT 31.3
CERTIFICATION

I, Jon C. Bates, certify that:


 1.
I have reviewed this quarterly report on Form 10-Q of U.S. Physical Therapy, Inc.;


2.
Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;


3.
Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;


4.
The registrant’s other certifying officer(s) and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:


a.
Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;


b.
Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;


c.
Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and


d.
Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and


5.
The registrant’s other certifying officer(s) and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):


a.
All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and


b.
Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

 
/s/ JON C. BATES
 
Jon C. Bates
 
Vice President/Corporate Controller

Date: August 7, 2020


EXHIBIT 32
CERTIFICATION OF PERIODIC REPORT

In connection with the Quarterly Report of U.S. Physical Therapy, Inc. (the “Company”) on Form 10-Q for the quarterly period ended June 30, 2020, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Christopher J. Reading, President and Chief Executive Officer of the Company, Lawrance W. McAfee, Chief Financial Officer of the Company, and Jon C. Bates, Vice President and Corporate Controller of the Company, certify, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that:

(1) the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

(2) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

August 7, 2020

/s/ CHRISTOPHER J. READING
  
Christopher J. Reading
  
Chief Executive Officer
  
   
/s/ LAWRANCE W. MCAFEE
  
Lawrance W. McAfee
  
Chief Financial Officer
  
   
/s/ JON C. BATES
  
Jon C. Bates
  
Vice President/Corporate Controller
  

This certification is made solely pursuant to the requirement of Section 1350 of 18 U.S.C., and is not for any other purpose. A signed original of this written statement required by Section 906 has been provided to U. S. Physical Therapy, Inc. and will be retained by U. S. Physical Therapy, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.


v3.20.2
Document and Entity Information - shares
 6 Months Ended
Jun. 30, 2020
Aug. 06, 2020
Cover [Abstract]    
Entity Registrant Name U S PHYSICAL THERAPY INC /NV  
Entity Central Index Key 0000885978  
Current Fiscal Year End Date --12-31  
Entity Current Reporting Status Yes  
Entity Interactive Data Current Yes  
Entity Shell Company false  
Entity Filer Category Large Accelerated Filer  
Entity Small Business false  
Entity Emerging Growth Company false  
Entity Common Stock, Shares Outstanding   12,843,047
Document Type 10-Q  
Amendment Flag false  
Document Period End Date Jun. 30, 2020  
Document Fiscal Year Focus 2020  
Document Fiscal Period Focus Q2  
Document Quarterly Report true  
Document Transition Report false  
Entity File Number 1-11151  
Entity Tax Identification Number 76-0364866  
Entity Incorporation, State or Country Code NV  
Entity Address, Address Line One 1300 WEST SAM HOUSTON PARKWAY SOUTH  
Entity Address, Address Line Two SUITE 300  
Entity Address, City or Town HOUSTON  
Entity Address, State or Province TX  
Entity Address, Postal Zip Code 77042  
City Area Code 713  
Local Phone Number 297-7000  
Title of 12(b) Security Common Stock, $.01 par value  
Trading Symbol USPH  
Security Exchange Name NYSE  
v3.20.2
CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($)
$ in Thousands
Jun. 30, 2020
Dec. 31, 2019
Current assets:    
Cash and cash equivalents $ 43,555 $ 23,548
Patient accounts receivable, less allowance for doubtful accounts of $2,470 and $2,698, respectively 36,029 46,228
Accounts receivable - other 9,983 9,823
Other current assets 2,572 5,787
Total current assets 92,139 85,386
Fixed assets:    
Furniture and equipment 55,914 54,942
Leasehold improvements 33,631 33,247
Fixed assets, gross 89,545 88,189
Less accumulated depreciation and amortization 67,011 66,099
Fixed assets, net 22,534 22,090
Operating lease right-of-use assets 82,965 81,586
Goodwill 330,894 317,676
Other identifiable intangible assets, net 54,895 52,588
Other assets 1,591 1,519
Total assets 585,018 560,845
Current liabilities:    
Accounts payable - trade 1,802 2,494
Accrued expenses 51,325 30,855
Current portion of operating lease liabilities 29,591 26,486
Current portion of notes payable 4,635 728
Total current liabilities 87,353 60,563
Notes payable, net of current portion 685 4,361
Revolving line of credit 33,000 46,000
Deferred taxes 8,930 10,071
Operating lease liabilities, net of current portion 61,242 60,258
Other long-term liabilities 392 141
Total liabilities 191,602 181,394
Redeemable non-controlling interests - temporary equity 136,728 137,750
U.S. Physical Therapy, Inc. ("USPH") shareholders' equity:    
Preferred stock, $.01 par value, 500,000 shares authorized, no shares issued and outstanding 0 0
Common stock, $.01 par value, 20,000,000 shares authorized, 15,057,859 and 14,989,337 shares issued, respectively 151 150
Additional paid-in capital 91,258 87,383
Retained earnings 195,473 184,352
Treasury stock at cost, 2,214,737 shares (31,628) (31,628)
Total USPH shareholders' equity 255,254 240,257
Non-controlling interests - permanent equity 1,434 1,444
Total USPH shareholders' equity and non-controlling interests 256,688 241,701
Total liabilities, redeemable non-controlling interests, USPH shareholders' equity and non-controlling interests $ 585,018 $ 560,845
v3.20.2
CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($)
$ in Thousands
Jun. 30, 2020
Dec. 31, 2019
Current assets:    
Allowance for doubtful accounts, patient accounts receivable $ 2,470 $ 2,698
U.S. Physical Therapy, Inc. ("USPH") shareholders' equity:    
Preferred stock, par value (in dollars per share) $ 0.01 $ 0.01
Preferred stock, shares authorized (in shares) 500,000 500,000
Preferred stock, shares issued (in shares) 0 0
Preferred stock, shares outstanding (in shares) 0 0
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock, shares authorized (in shares) 20,000,000 20,000,000
Common stock, shares issued (in shares) 15,057,859 14,989,337
Treasury stock (in shares) 2,214,737 2,214,737
v3.20.2
CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($)
shares in Thousands, $ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Revenues [Abstract]        
Net revenues $ 83,857 $ 126,373 $ 196,574 $ 242,604
Operating costs:        
Salaries and related costs 43,429 70,669 112,433 136,936
Rent, supplies, contract labor and other 20,311 23,026 43,220 45,070
Provision for doubtful accounts 739 1,240 2,100 2,446
Closure costs - lease and other 94 13 1,987 9
Closure costs - write-off of goodwill 0 0 1,859 0
Total operating costs 64,573 94,948 161,599 184,461
Gross profit 19,284 31,425 34,975 58,143
Corporate office costs 9,022 11,527 20,699 22,820
Operating income 10,262 19,898 14,276 35,323
Other income and expense:        
Relief Funds 7,959 0 7,959 0
Gain on sale of partnership interest and clinics 1,073 5,823 1,073 5,823
Interest and other income, net 4 4 47 20
Interest expense - debt and other (653) (607) (1,080) (965)
Total other income and expense 8,383 5,220 7,999 4,878
Income before taxes 18,645 25,118 22,275 40,201
Provision for income taxes 3,882 5,318 4,174 8,026
Net income 14,763 19,800 18,101 32,175
Less: net income attributable to non-controlling interests:        
Non-controlling interests - permanent equity (1,535) (1,802) (2,061) (3,339)
Redeemable non-controlling interests - temporary equity (2,996) (3,378) (4,792) (5,773)
Net income attributable to non-controlling interests (4,531) (5,180) (6,853) (9,112)
Net income attributable to USPH shareholders $ 10,232 $ 14,620 $ 11,248 $ 23,063
Basic and diluted earnings per share attributable to USPH shareholders (in dollars per share) $ 0.99 $ 0.85 $ 1.19 $ 1.24
Shares used in computation - basic and diluted (in shares) 12,843 12,767 12,820 12,738
Dividends declared per common share (in dollars per share) $ 0 $ 0.27 $ 0.32 $ 0.54
Net Patient Revenues [Member]        
Revenues [Abstract]        
Net revenues $ 72,279 $ 113,363 $ 172,405 $ 220,013
Other Revenues [Member]        
Revenues [Abstract]        
Net revenues $ 11,578 $ 13,010 $ 24,169 $ 22,591
v3.20.2
CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended 12 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Dec. 31, 2019
OPERATING ACTIVITIES          
Net income including non-controlling interests $ 14,763 $ 19,800 $ 18,101 $ 32,175  
Adjustments to reconcile net income including non-controlling interests to net cash provided by operating activities:          
Depreciation and amortization     5,333 4,958  
Provision for doubtful accounts 739 1,240 2,100 2,446  
Equity-based awards compensation expense     3,389 3,558  
Deferred income taxes     (1,737) 5,421  
Loss on sale of fixed assets     429 0  
Gain on sale of partnership interest, net of tax     (1,073) (5,514)  
Write-off of goodwill - closed clinics 0 0 1,859 0 $ 0
Other     0 21  
Changes in operating assets and liabilities:          
Decrease (increase) in patient accounts receivable     8,880 (4,956)  
Decrease (increase) in accounts receivable - other     283 (2,468)  
Decrease (increase) in other assets     5,969 (2,759)  
Increase (decrease) in accounts payable and accrued expenses     4,478 (3,560)  
Increase (decrease) in other liabilities     345 (701)  
Net cash provided by operating activities     48,356 28,621  
INVESTING ACTIVITIES          
Purchase of fixed assets     (4,628) (4,876)  
Purchase of majority interest in businesses, net of cash acquired     (11,633) (18,239)  
Purchase of redeemable non-controlling interest, temporary equity     (2,388) (2,053)  
Purchase of non-controlling interest, permanent equity     (144) (138)  
Proceeds on sale of redeemable non-controlling interest, temporary equity     19 0  
Proceeds on sales of partnership interest and clinics     674 0  
Proceeds on sale of fixed assets     21 65  
Net cash used in investing activities     (18,079) (25,241)  
FINANCING ACTIVITIES          
Distributions to non-controlling interests, permanent and temporary equity     (5,707) (7,934)  
Cash dividends paid to shareholders     (4,110) (6,891)  
Proceeds from revolving line of credit     99,000 80,000  
Payments on revolving line of credit     (112,000) (56,000)  
Principal payments on notes payable     (314) (1,057)  
Medicare Accelerated and Advance Payment Funds     12,861 0  
Other     0 (7)  
Net cash provided by (used in) financing activities     (10,270) 8,111  
Net increase in cash and cash equivalents     20,007 11,491  
Cash and cash equivalents - beginning of period     23,548 23,368 23,368
Cash and cash equivalents - end of period 43,555 34,859 43,555 34,859 $ 23,548
Cash paid during the period for:          
Income taxes     57 4,339  
Interest     944 902  
Non-cash investing and financing transactions during the period:          
Purchase of businesses - seller financing portion     300 4,000  
Purchase of business - payable to common shareholders of acquired business     0 502  
Purchase of redeemable non-controlling interest - notes payable 137 0 137 0  
Payable due to purchase of redeemable non-controlling interest $ 699 $ 0 699 0  
Receivables related to sale of partnership interest     0 11,601  
Notes receivables related to sale of partnership interest     386 2,780  
Payable related to purchase of partnership interest - settlement of redeemable non-controlling interest     $ 0 $ 2,200  
v3.20.2
CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY (unaudited) - USD ($)
shares in Thousands, $ in Thousands
Common Stock [Member]
Additional Paid-In Capital [Member]
Retained Earnings [Member]
Treasury Stock [Member]
Total Shareholders' Equity [Member]
Non-Controlling Interests [Member]
Total
Beginning balance at Dec. 31, 2018 $ 149 $ 80,028 $ 167,396 $ (31,628) $ 215,945 $ 930 $ 216,875
Beginning balance (in shares) at Dec. 31, 2018 14,899     (2,215)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of restricted stock, net of cancellations $ 0 0 0 $ 0 0 0 0
Issuance of restricted stock, net of cancellations (in shares) 90     0      
Revaluation of redeemable non-controlling interest, net of tax $ 0 0 (7,250) $ 0 (7,250) 0 (7,250)
Compensation expense - equity-based awards 0 3,558 0 0 3,558 0 3,558
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans 0 636 0 0 636 0 636
Purchase of non-controlling interest 0 (97) 0 0 (97) (7) (104)
Dividends paid to USPT shareholders 0 0 (6,891) 0 (6,891) 0 (6,891)
Purchase of partnership interests - redeemable non-controlling interests 0 0 298 0 298 0 298
Other 0 0 (6) 0 (6) 0 (6)
Distributions to non-controlling interest partners, permanent equity 0 0 0 0 0 (2,771) (2,771)
Net income attributable to non-controlling interest - permanent equity 0 0 0 0 0 3,339 3,339
Net income attributable to USPH shareholders 0 0 23,063 0 23,063 0 23,063
Ending balance at Jun. 30, 2019 $ 149 84,125 176,610 $ (31,628) 229,256 1,491 230,747
Ending balance (in shares) at Jun. 30, 2019 14,989     (2,215)      
Beginning balance at Mar. 31, 2019 $ 149 82,295 168,952 $ (31,628) 219,768 1,405 221,173
Beginning balance (in shares) at Mar. 31, 2019 14,976     (2,215)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of restricted stock, net of cancellations $ 0 0 0 $ 0 0 0 0
Issuance of restricted stock, net of cancellations (in shares) 13     0      
Revaluation of redeemable non-controlling interest, net of tax $ 0 0 (3,813) $ 0 (3,813) 0 (3,813)
Revaluation of redeemable non-controlling interest, net of tax (in shares) 0     0      
Compensation expense - equity-based awards $ 0 1,830 0 $ 0 1,830 0 1,830
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans 0 0 0 0 0 0 0
Purchase of non-controlling interest 0 0 0 0 0 0 0
Dividends paid to USPT shareholders 0 0 (3,446) 0 (3,446) 0 (3,446)
Purchase of partnership interests - redeemable non-controlling interests 0 0 298 0 298 0 298
Other 0 0 (1) 0 (1) 1 0
Distributions to non-controlling interest partners, permanent equity 0 0 0 0 0 (1,717) (1,717)
Net income attributable to non-controlling interest - permanent equity 0 0 0 0 0 1,802 1,802
Net income attributable to USPH shareholders 0 0 14,620 0 14,620 0 14,620
Ending balance at Jun. 30, 2019 $ 149 84,125 176,610 $ (31,628) 229,256 1,491 230,747
Ending balance (in shares) at Jun. 30, 2019 14,989     (2,215)      
Beginning balance at Dec. 31, 2019 $ 150 87,383 184,352 $ (31,628) 240,257 1,444 241,701
Beginning balance (in shares) at Dec. 31, 2019 14,989     (2,215)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of restricted stock, net of cancellations $ 1 0 0 $ 0 1 0 1
Issuance of restricted stock, net of cancellations (in shares) 69     0      
Revaluation of redeemable non-controlling interest, net of tax $ 0 0 4,036 $ 0 4,036 0 4,036
Compensation expense - equity-based awards 0 3,389 0 0 3,389 0 3,389
Transfer of compensation liability for certain stock issued pursuant to long-term incentive plans 0 486 0 0 486 0 486
Dividends paid to USPT shareholders 0 0 (4,110) 0 (4,110) 0 (4,110)
Other 0 0 (53) 0 (53) (28) (81)
Distributions to non-controlling interest partners, permanent equity 0 0 0 0 0 (2,043) (2,043)
Net income attributable to non-controlling interest - permanent equity 0 0 0 0 0 2,061 2,061
Net income attributable to USPH shareholders 0 0 11,248 0 11,248 0 11,248
Ending balance at Jun. 30, 2020 $ 151 91,258 195,473 $ (31,628) 255,254 1,434 256,688
Ending balance (in shares) at Jun. 30, 2020 15,058     (2,215)      
Beginning balance at Mar. 31, 2020 $ 151 89,756 182,785 $ (31,628) 241,064 1,240 242,304
Beginning balance (in shares) at Mar. 31, 2020 15,059     (2,215)      
Increase (Decrease) in Stockholders' Equity [Roll Forward]              
Issuance of restricted stock, net of cancellations $ 0 0 0 $ 0 0 0 0
Issuance of restricted stock, net of cancellations (in shares) (1)     0      
Revaluation of redeemable non-controlling interest, net of tax $ 0 0 2,466 $ 0 2,466 0 $ 2,466
Revaluation of redeemable non-controlling interest, net of tax (in shares) 0           0
Compensation expense - equity-based awards $ 0 1,502 0 0 1,502 0 $ 1,502
Other 0 0 (10) 0 (10) (28) (38)
Distributions to non-controlling interest partners, permanent equity 0 0 0 0 0 (1,313) (1,313)
Net income attributable to non-controlling interest - permanent equity 0 0 0 0 0 1,535 1,535
Net income attributable to USPH shareholders 0 0 10,232 0 10,232 0 10,232
Ending balance at Jun. 30, 2020 $ 151 $ 91,258 $ 195,473 $ (31,628) $ 255,254 $ 1,434 $ 256,688
Ending balance (in shares) at Jun. 30, 2020 15,058     (2,215)      
v3.20.2
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES
 6 Months Ended
Jun. 30, 2020
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES [Abstract]  
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES
1. BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES

The consolidated financial statements include the accounts of U.S. Physical Therapy, Inc. and its subsidiaries (the “Company”). All significant intercompany transactions and balances have been eliminated.

The Company operates its business through two reportable business segments.  The Company’s reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. The Company’s physical therapy operations consist of physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventive care, rehabilitation of injured workers and neurological injuries. Services provided by industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization and ergonomic assessments. Prior to the second quarter of 2020, the Company operated as a single segment. All prior year segment information has been reclassified to conform to the 2020 presentation. See Note 12. Segment Information.

Physical Therapy Operations

The physical therapy operations segment primarily operates through subsidiary clinic partnerships, in which the Company generally owns a 1% general partnership interest in all the Clinic Partnerships. Our limited partnership interests typically range from 49% to 99% in the Clinic Partnerships.  The managing therapist of each clinic owns, directly or indirectly, the remaining limited partnership interest in most of the clinics (hereinafter referred to as “Clinic Partnerships”). To a lesser extent, the Company operates some clinics, through wholly-owned subsidiaries, under profit sharing arrangements with therapists (hereinafter referred to as “Wholly-Owned Facilities”).

The Company continues to seek to attract for employment physical therapists who have established relationships with physicians and other referral sources, by offering these therapists a competitive salary and incentives based on the profitability of the clinic that they manage. For multi-site clinic practices in which a controlling interest is acquired by the Company, the prior owners typically continue on as employees to manage the clinic operations, retaining a non-controlling ownership interest in the clinics and receiving a competitive salary for managing the clinic operations. In addition, the Company has developed satellite clinic facilities as part of existing Clinic Partnerships and Wholly-Owned Facilities, with the result that a substantial number of Clinic Partnerships and Wholly-Owned Facilities operate more than one clinic location.

On February 27, 2020, the Company acquired interests in a four-clinic physical therapy practice. The four clinics are operated in four separate partnerships.  The Company’s interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in the form of a seller note.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.

On September 30, 2019, the Company acquired a 67% interest in an eleven-clinic physical therapy practice. The purchase price for the 67% interest was $12.4 million, of which $12.1 million was paid in cash and $0.3 million in the form of a seller note that is payable in two principal installments totaling $150,000 each, plus accrued interest in September 2020 and September 2021. The note accrues interest at 5.0% per annum.

During the six months ended June 30, 2020, the Company sold 11 previously closed clinics.  The aggregate sales price was $1.1 million, of which $0.7 million was paid in cash and $0.4 million in a note receivable payable in two equal installments of principal and any accrued interest on June 15, 2021 and 2022.

As of June 30, 2020, the Company operated 554 clinics in 39 states. The Company also manages physical therapy facilities for third parties, primarily hospital and physicians, with 29 third-party facilities under management as of June 30, 2020.

Clinic Partnerships

For non-acquired Clinic Partnerships, the earnings and liabilities attributable to the non-controlling interests, typically owned by the managing therapist, directly or indirectly, are recorded within the balance sheets as non-controlling interests and within the income statements as non-controlling interests – permanent equity.

For acquired Clinic Partnerships with redeemable non-controlling interests, the earnings attributable to the redeemable non-controlling interests are recorded within the consolidated statements of income line item – net income attributable to non-controlling interests – redeemable non-controlling interests – temporary equity and the equity interests are recorded on the consolidated balance sheet as redeemable non-controlling interests.  In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest, net of tax, is not included in net income but charged directly to retained earnings and is included in the earnings per basic and diluted share calculation.

Wholly-Owned Facilities

For Wholly-Owned Facilities with profit sharing arrangements, an appropriate accrual is recorded for the amount of profit sharing due to the profit sharing therapists. The amount is expensed as compensation and included in operating costs – salaries and related costs. The respective liability is included in current liabilities – accrued expenses on the balance sheets.

Industrial Injury Prevention Services

Since March 2017, the Company has acquired a majority interest in two industrial injury prevention businesses and acquired all of another company in the industrial injury prevention sector.  In March 2017, the Company acquired a 55% interest in the initial industrial injury prevention business. On April 30, 2018, the Company acquired a 65% interest in another business in the industrial injury prevention sector. On April 30, 2018, the Company combined the two businesses.  After the combination, the Company owned a 59.45% interest in the combined business, Briotix Health, Limited Partnership (“Briotix Health”), the Company’s industrial injury prevention operation.

On April 11, 2019, the Company acquired a third company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network in 45 states including onsite at eleven client locations. The business was then combined with Briotix Health increasing the Company’s ownership position in the partnership to approximately 76.0%.

Services provided in the industrial injury prevention services segment include onsite injury prevention and rehabilitation, performance optimization, post offer employment testing, functional capacity evaluations, and ergonomic assessments. The majority of these services are contracted with and paid for directly by employers, including a number of Fortune 500 companies. Other clients include large insurers and their contractors. The Company performs these services through Industrial Sports Medicine Professionals, consisting of both physical therapists and specialized certified athletic trainers (ATCs).

The results of operations of the acquired clinics and businesses have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

Basis of Presentation

The accompanying unaudited consolidated financial statements were prepared in accordance with accounting principles generally accepted in the United States of America for interim financial information and in accordance with the instructions for Form 10-Q. However, the statements do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America for complete financial statements. Management believes this report contains all necessary adjustments (consisting only of normal recurring adjustments) to present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented. For further information regarding the Company’s accounting policies, please read the audited financial statements included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 filed with the Securities and Exchange Commission on February 28, 2020 (“2019 Annual Report”).

The Company believes, and the Chief Executive Officer, Chief Financial Officer and Corporate Controller have certified, that the financial statements included in this report present fairly, in all material respects, the Company’s financial position, results of operations and cash flows for the interim periods presented.

Operating results for the three months and six months ended June 30, 2020 are not necessarily indicative of the results the Company expects for the entire year.

The Company included the following Risk Factor which should be read in conjunction with the risk factors described in our Annual Report on Form 10-K for the year ended December 31, 2019 filed with the SEC on February 28, 2020.

We are subject to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (“COVID-19”).

Our operations expose us to risks associated with public health crises and epidemics/pandemics, such as the novel strain of coronavirus (COVID-19) that has spread globally. Since February, the continued spread has led to disruption and volatility in the global capital markets, which increases the cost of, and adversely impacts access to, capital and increases economic uncertainty. The pandemic has caused an economic slowdown of potentially extended duration, and it is possible that it could cause a global recession.

COVID-19 is having, and will continue to have, an adverse impact on our operations and supply chains, including an increase in cancellations of physical therapy patient appointments and a decline in the scheduling of new or additional patient appointments.  Due to these impacts and measures, we have experienced, and will continue to experience, significant and unpredictable reductions and cancellations of our patient visits.

Impact on the business and cash reserves resulting from retirement or resignation of key partners and resulting purchase of their non-controlling interests (minority interests)

As described in Note 6, the redeemable non-controlling interests in our partnerships are held by our partners.  Upon the occurrence of certain events, such as retirement or other termination of employment, partners from acquired partnerships may have the right to exercise a “put” to cause the Company to purchase their redeemable non-controlling interests.  Depending on the amount and timing of the exercise of any “put” rights, the funds required could have an adverse impact on the Company’s capital structure.

Impact of COVID-19

As previously disclosed in a series of filings with the SEC and further described in detail in its Quarterly Report on Form 10-Q for the quarter ended March 31, 2020 filed with the SEC on May 21, 2020, the Company’s results have been negatively impacted by the effects of the COVID-19 pandemic. Management has taken a number of steps to reduce costs, stem operating losses incurred in March and April and increase profits subsequently.

In March, with the onset of the COVID-19 pandemic, the Company, began to furlough or terminate approximately 40% of its 5,500 full and part-time workforce. Since early May, over 750 of the furloughed employees have returned to work on a full or part-time basis.

As of the filing of this quarterly report, the Company continues to experience lower physical therapy revenues; however the Company has seen recent improvement. As stay at home orders and other restrictions have been lifted, we have seen our physical therapy volumes trending upwards, however should stay at home orders or other restrictions be reenacted, we could see the Company’s patient volume and revenues decline.

The Company’s industrial injury prevention business has been less affected by the pandemic and is currently operating at approximately 90% of normal.

We have put preparedness plans in place at our facilities to maintain continuity of operations, while also taking steps to keep employees and patients safe. In line with recommendations to reduce large gatherings and increase social distancing, we have, where practical, transitioned a large number of office-based employees to a remote work environment.

In March 2020, in response to the COVID-19 pandemic, the CARES Act was signed into law. The CARES Act provides numerous tax provisions and other stimulus measures, including temporary changes regarding the prior and future utilization of net operating losses, temporary changes to the prior and future limitations on interest deductions, temporary suspension of certain payment requirements for the employer portion of Social Security taxes, technical corrections from prior tax legislation for tax depreciation of certain qualified improvement property, and the creation of certain payroll tax credits associated with the retention of employees.

The Company has received, or expect to receive a number of benefits under The CARES Act including, but not limited to:

•
The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded these payments of $12.8 million as a liability until all performance obligations have been met as the payments were made on behalf of patients before services were provided. Currently, MAAPP funds received will be applied to future Medicare billings commencing in August 2020, with all such remaining amounts required to be repaid by November 2020. Beginning November 2020, any unpaid balance will begin accruing interest.

•
The Company elected to defer depositing the employer’s share of Social Security taxes for payments due from March 27, 2020 through December 31, 2020, interest-free and penalty-free.  As of June 30, 2020, included in accrued liabilities is $2.2 million related to these deferred payments;

•
The Company received approximately $7.9 million during the six months ended June 30, 2020 from the initial tranche of funds that was distributed to healthcare providers for related expenses or lost revenues that are attributable to the COVID-19 pandemic. The Company recognized the $7.9 million grant in other revenues for the six months ended June 30, 2020.

Significant Accounting Policies

Cash Equivalents

The Company maintains its cash and cash equivalents at financial institutions.  The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents.  The combined account balances at several institutions typically exceed Federal Deposit Insurance Corporation (“FDIC”) insurance coverage and, as a result, there is a concentration of credit risk related on deposits in excess of FDIC insurance coverage. Management believes that the risk is not significant.

Long-Lived Assets

Fixed assets are stated at cost. Depreciation is computed using the straight-line method over the estimated useful lives of the assets. Estimated useful lives for furniture and equipment range from three to eight years and for purchased software from three to seven years. Leasehold improvements are amortized over the shorter of the lease term or estimated useful lives of the assets, which is generally three to five years. The Company did not note an impairment to long-lived assets during this quarter.

Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of

The Company reviews property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances which indicate that the amounts may be impaired. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell. The Company did not note an impairment to long-lived assets during this quarter.

Goodwill

Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.

The fair value of goodwill and other identifiable intangible assets with indefinite lives are tested for impairment annually and upon the occurrence of certain events, and are written down to fair value if considered impaired. The Company evaluates goodwill for impairment on at least an annual basis (normally in its third quarter) by comparing the fair value of its reporting units to the carrying value of each reporting unit including related goodwill. The Company evaluates indefinite lived tradenames using the relief from royalty method in conjunction with its annual goodwill impairment test or when other triggering events are identified. The Company operates a one segment business which is made up of various clinics within partnerships. The partnerships are components of regions and are aggregated to the operating segment level for the purpose of determining the Company’s reporting units when performing its annual goodwill impairment test. In 2019, there were six regions.  In addition to the six regions, in 2019, the impairment test included a separate analysis for the industrial injury prevention business, a separate reporting unit.

An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the estimated fair value of the reporting unit. The estimated fair value of a reporting unit is determined using two factors: (i) earnings prior to taxes, depreciation and amortization for the reporting unit multiplied by a price/earnings ratio used in the industry and (ii) a discounted cash flow analysis. A weight is assigned to each factor and the sum of each weight times the factor is considered the estimated fair value. For 2019, the factors (i.e., price/earnings ratio, discount rate and residual capitalization rate) were updated to reflect current market conditions. The evaluation of goodwill in 2019 did not result in any goodwill amounts that were deemed impaired.

Based on the current economic conditions and the decline in patient visits due to the pandemic, the Company evaluated whether events or circumstances indicated that it was more likely than not that the fair value of the reporting units were reduced below their carrying value as of June 30, 2020. As a result of the assessment, the Company determined that it was not more likely than not that goodwill and tradenames of the reporting units was impaired as of June 30, 2020.

As the Company did not note an impairment, no additional disclosures were deemed to be required by management.  The Company also considered the impact of these judgments and estimates as they pertain to the disclosure requirements for such items within this Form 10-Q and risks and uncertainties discussions and believes that such disclosure is adequate.

Due to the uncertainty of the current economic conditions resulting from the COVID-19 pandemic, the Company will continue to review its carrying amounts of goodwill and other intangibles.

For the six months ended June 30, 2020, the Company derecognized (wrote-off) goodwill in the amount of $1.9 million related to closed clinics due to COVID-19.

The Company will continue to monitor for any triggering events or other indicators of impairment.

Redeemable Non-Controlling Interests

The non-controlling interests that are reflected as redeemable non-controlling interests in the consolidated financial statements consist of those that the owners and the Company have certain redemption rights, whether currently exercisable or not, and which currently, or in the future, require that the Company purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met.  The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership agreements.  The redemption rights can be triggered by the owner or the Company at such time as both of the following events have occurred: 1) termination of the owner’s employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement.  The redemption rights are not automatic or mandatory (even upon death) and require either the owner or the Company to exercise its rights when the conditions triggering the redemption rights have been satisfied.
On the date the Company acquires a controlling interest in a partnership, and the limited partnership agreement for such partnership contains redemption rights not under the control of the Company, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption – Redeemable non-controlling interests.  Then, in each reporting period thereafter until it is purchased by the Company, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial carrying value, based on the predetermined formula defined in the respective limited partnership agreement.  As a result, the value of the non-controlling interest is not adjusted below its initial carrying value.  The Company records any adjustment in the redemption value, net of tax, directly to retained earnings and are not reflected in the consolidated statements of income.  Although the adjustments are not reflected in the consolidated statements of income, current accounting rules require that the Company reflects the adjustments, net of tax, in the earnings per share calculation.  The amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statements of net income. Management believes the redemption value (i.e. the carrying amount) and fair value are the same.

Non-Controlling Interests

The Company recognizes non-controlling interests, in which the Company has no obligation but the right to purchase the non-controlling interests, as permanent equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the statements of net income. Changes in a parent entity’s ownership interest in a subsidiary that do not result in deconsolidation are treated as equity transactions if the parent entity retains its controlling financial interest. The Company recognizes a gain or loss in net income when a subsidiary is deconsolidated. Such gain or loss is measured using the fair value of the non-controlling equity investment on the deconsolidation date.

When the purchase price of a non-controlling interest by the Company exceeds the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital. Additionally, operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner.

Revenue Recognition

Revenues are recognized in the period in which services are rendered. See Footnote 3 – Revenue Recognition, for further discussion of revenue recognition.

Allowance for Doubtful Accounts

The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in operating costs in the consolidated statements of net income. Net accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible.

Income Taxes

Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.
The Company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount to be recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority.

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Securities Act (“CARES Act”) was enacted. The CARES Act includes changes to certain tax law related to net operating losses and the deductibility of interest expense and depreciation. ASC 740, Income Taxes requires the effects of changes in tax rates and laws on deferred tax balances to be recognized in the period in which the legislation is enacted. The legislation had no effect on the Company’s deferred income taxes and current income taxes payable during the six months ended June 30, 2020.

The Company did not have any accrued interest or penalties associated with any unrecognized tax benefits nor was any interest expense recognized during the six months ended June 30, 2020. The Company records any interest or penalties, if required, in interest and other expense, as appropriate.

Fair Value of Financial Instruments

The carrying amounts reported in the balance sheets for cash and cash equivalents, accounts receivable, accounts payable and notes payable approximate their fair values due to the short-term maturity of these financial instruments. The carrying amount under the Amended Credit Agreement and the redemption value of Redeemable non-controlling interests approximate the respective fair values. The fair value of the Company’s redeemable non-controlling interests is determined based on “Level 3” inputs. The interest rate on the Amended Credit Agreement, which is tied to LIBOR, is set at various short-term intervals, as detailed in the Amended Credit Agreement.

Segment Reporting

Operating segments are components of an enterprise for which separate financial information is available that is evaluated regularly by chief operating decision makers in determining the allocation of resources and in assessing performance.  The Company currently operates through two segments: physical therapy operations and industrial injury prevention services.

Use of Estimates

In preparing the Company’s consolidated financial statements, management makes certain estimates and assumptions, especially in relation to, but not limited to, goodwill impairment, tradenames, allocations of purchase price, allowance for receivables, tax provision and contractual allowances, that affect the amounts reported in the consolidated financial statements and related disclosures. Actual results may differ from these estimates.

Self-Insurance Program

The Company utilizes a self-insurance plan for its employee group health insurance coverage administered by a third party. Predetermined loss limits have been arranged with an insurance company to minimize the Company’s maximum liability and cash outlay. Accrued expenses include the estimated incurred but unreported costs to settle unpaid claims and estimated future claims. Management believes that the current accrued amounts are sufficient to pay claims arising from self-insurance claims incurred through June 30, 2020.

Restricted Stock

Restricted stock issued to employees and directors is subject to continued employment or continued service on the board, respectively. Generally, restrictions on the stock granted to employees lapse in equal annual installments on the following four anniversaries of the date of grant. For those shares granted to directors, the restrictions will lapse in equal quarterly installments during the first year after the date of grant. For those granted to officers, the restrictions will lapse in equal quarterly installments during the four years following the date of grant. Compensation expense for grants of restricted stock is recognized based on the fair value per share on the date of grant amortized over the vesting period. The Company recognizes any forfeitures as they occur. The restricted stock issued is included in basic and diluted shares for the earnings per share computation.
Recently Adopted Accounting Guidance

In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses, which added a new impairment model (known as the current expected credit loss (CECL) model) that is based on expected losses rather than incurred losses. Under the new guidance, an entity recognizes as an allowance its estimate of expected credit losses. The CECL model applies to most debt instruments, including trade receivables. The CECL model does not have a minimum threshold for recognition of impairment losses and entities will need to measure expected credit losses on assets that have a low risk of loss. The standard is required to be applied using the modified retrospective approach with a cumulative-effect adjustment to retained earnings, if any, upon adoption.

The Company has completed the adoption of the standard on January 1, 2020. The financial instruments subject to ASU 2016-13 are the Company’s accounts receivable derived from contracts with customers. A significant portion of the Company’s accounts receivable are from highly-solvent, creditworthy payors including governmental programs such as Medicare and Medicaid, and highly regulated commercial insurers. The Company’s estimate of expected credit losses as of January 1, 2020, using its expected credit loss evaluation process, resulted in no adjustments to the allowance for credit losses and no cumulative-effect adjustment to retained earnings on the adoption date of the standard.

In January 2017, the FASB issued ASU 2017-04, Simplifying the Test for Goodwill Impairment (Topic 350), which eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment change. ASU 2017-04 is effective prospectively for fiscal years, and the interim periods within those years, beginning after December 15, 2019. The Company has completed the adoption of the standard on January 1, 2020 and there was no impact to goodwill from the Company’s adoption of this change.

Recently Issued Accounting Guidance

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. This ASU provides temporary optional expedients and exceptions to the guidance on contract modifications and hedge accounting to ease the financial reporting burdens of the expected market transition from the London Interbank Offered Rate and other interbank offered rates to alternative reference rates. The new guidance was effective upon issuance, and the Company is allowed to elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact this standard will have on its combined financial statements.

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) – Simplifying the Accounting for Income Taxes (“ASU 2019-12”). The objective of ASU 2019-12 is to simplify the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and to provide more consistent application to improve the comparability of financial statements. The amendments in this ASU are effective for fiscal years beginning after December 15, 2020, and early adoption is permitted. We are currently evaluating the impact this guidance may have on our consolidated financial statements and related footnote disclosures.
v3.20.2
ACQUISITIONS OF BUSINESSES
 6 Months Ended
Jun. 30, 2020
ACQUISITIONS OF BUSINESSES [Abstract]  
ACQUISITIONS OF BUSINESSES
2. ACQUISITIONS OF BUSINESSES

On February 27, 2020, the Company acquired interests in a four-clinic physical therapy practice. The four clinics are in four separate partnerships.  The Company’s interests in the four partnerships range from 10.0% to 83.8%, with an overall 65.0% based on the initial purchase transaction. The aggregate purchase price was $11.9 million, of which $11.6 million was paid in cash and $0.3 million in the form of a seller note.  The note accrues interest at 4.75% per annum and the principal and interest is payable on February 2022.
 
The purchase price plus the fair value of the non-controlling interests for the acquisitions in 2020 was allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. trade names, referral relationships and non-compete agreements, and liabilities assumed based on the estimated fair values at the acquisition date, with the amount in excess of fair values being recorded as goodwill. The Company is in the process of completing its formal valuation analysis of the acquisitions, to identify and determine the fair value of tangible and identifiable intangible assets acquired and the liabilities assumed. Thus, the final allocation of the purchase price may differ from the preliminary estimates used at June 30, 2020 based on additional information obtained and completion of the valuation of the identifiable intangible assets. Changes in the estimated valuation of the tangible assets acquired, the completion of the valuation of identifiable intangible assets and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.

For the acquisitions in 2020, the values assigned to the referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives.  For referral relationships, the amortization period is 11.0 years.  For non-compete agreements, the amortization period is 6.0 years.

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition. 

The purchase price for the 2020 acquisitions has been preliminarily allocated as follows (in thousands):

   
Physical
Therapy
Operations
  
Cash paid, net of cash acquired
  
$
11,633
  
Seller note
    
300
  
Total consideration
  
$
11,933
  
         
Estimated fair value of net tangible assets acquired:
        
Total current assets
  
$
778
  
Total non-current assets
    
400
  
Total liabilities
    
(469
)
Net tangible assets acquired
  
$
709
  
Referral relationships
    
1,600
  
Non-compete
    
750
  
Tradename
    
1,500
  
Goodwill
    
13,845
  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)
    
(6,471
)
   
$
11,933
  

On September 30, 2019, the Company acquired a 67% interest in an eleven-clinic physical therapy practice. The purchase price for the 67% interest was $12.4 million, of which $12.1 million was paid in cash and $0.3 million in the form of a seller note that is payable in two principal installments totaling $150,000 each, plus accrued interest in September 2020 and September 2021. The note accrues interest at 5.0% per annum.

On April 11, 2019, the Company acquired a company that is a provider of industrial injury prevention services. The acquired company specializes in delivering injury prevention and care, post offer employment testing, functional capacity evaluations and return-to-work services. It performs these services across a network of 45 states including onsite at eleven client locations. The business was then combined with Briotix Health, the Company’s industrial injury prevention operation, increasing the Company’s ownership position in the Briotix Health partnership to approximately 76.0%. The purchase price for the acquired company was $22.9 million ($23.6 million less cash acquired of $0.7 million), which consisted of $18.9 million in cash, (of which $0.5 million will be paid to certain shareholders), and a $4.0 million seller note.  The note accrues interest at 5.5% and the principal and accrued interest is payable, on April 9, 2021.

The results of operations of the acquired clinics have been included in the Company’s consolidated financial statements since the date of their respective acquisition.

For the 2019 acquisitions, a majority of total current assets primarily represents accounts receivable. Total non-current assets are fixed assets and equipment used in the practice.

The purchase price for the 2019 acquisitions has been allocated as follows (in thousands):

  
IIPS*
    
Physical
Therapy
Operations
    
Total
  
Cash paid, net of cash acquired
  
$
18,427
    
$
12,170
    
$
30,597
  
Payable to shareholders of seller
  
$
486
    
$
-
      
486
  
Seller note
    
4,000
      
300
      
4,300
  
Total consideration
  
$
22,913
    
$
12,470
    
$
35,383
  
                         
Estimated fair value of net tangible assets acquired:
                        
Total current assets
  
$
1,641
    
$
693
    
$
2,334
  
Total non-current assets
    
878
      
3,019
      
3,897
  
Total liabilities
    
(2,979
)
    
(2,816
)
    
(5,795
)
Net tangible assets acquired
  
$
(460
)
  
$
896
    
$
436
  
Referral relationships
    
3,400
      
2,600
      
6,000
  
Non-compete
    
250
      
270
      
520
  
Tradename
    
1,300
      
740
      
2,040
  
Goodwill
    
18,423
      
14,193
      
32,616
  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)
    
-
      
(6,229
)
    
(6,229
)
   
$
22,913
    
$
12,470
    
$
35,383
  

* Industrial injury prevention services 

The purchase prices plus the fair value of the non-controlling interests for the acquisitions in 2019 were allocated to the fair value of the assets acquired, inclusive of identifiable intangible assets, i.e. trade names, referral relationships and non-compete agreements, and liabilities assumed based on the fair values at the acquisition date, with the amount exceeding the fair values being recorded as goodwill. The Company has completed its formal valuation analyses for the IIPS acquisition in 2019 with immaterial changes to the values. The Company is in the process of completing its formal valuation analysis of the 2019 physical therapy operations acquisition, to identify and determine the fair value of tangible and identifiable intangible assets acquired and the liabilities assumed. Thus, the final allocation of the purchase price may differ from the preliminary estimates used at June 30, 2020 based on additional information obtained and completion of the valuation of the identifiable intangible assets. Changes in the estimated valuation of the tangible assets acquired, the completion of the valuation of identifiable intangible assets and the completion by the Company of the identification of any unrecorded pre-acquisition contingencies, where the liability is probable and the amount can be reasonably estimated, will likely result in adjustments to goodwill. The Company does not expect the adjustments to be material.

For the acquisitions in 2019, the values assigned to the referral relationships and non-compete agreements are being amortized to expense equally over the respective estimated lives.  For referral relationships, the weighted average amortization period was 11.0 years at December 31, 2019.  For non-compete agreements, the weighted average amortization period was 6.0 years at December 31, 2019. The values assigned to tradenames are tested annually for impairment.

The consideration paid for each of the acquisitions was derived through arm’s length negotiations. Funding for the cash portions was derived from proceeds from the Company’s revolving credit facility. The results of operations of the acquisitions have been included in the Company’s consolidated financial statements since their respective date of acquisition. Unaudited proforma consolidated financial information for the acquisitions in the 2020 and 2019 acquisitions have not been included as the results, individually and in the aggregate, were not material to current operations.

During 2019, the Company acquired additional interests in four partnerships which are included in non-controlling interest. The additional interests purchased in each of the partnerships ranged from 1% and 55%. Also in 2019, the Company sold a 1% interest in a partnership. The net after tax difference between the payments and the portion of undistributed earnings of $196,000 was credited to additional paid-in capital.
v3.20.2
REVENUE RECOGNITION
 6 Months Ended
Jun. 30, 2020
REVENUE RECOGNITION [Abstract]  
REVENUE RECOGNITION
3. REVENUE RECOGNITION

Categories

Revenues are recognized in the period in which services are rendered.

Net patient revenues consists of revenues for physical therapy and occupational therapy clinics that provide pre-and post-operative care and treatment for orthopedic related disorders, sports-related injuries, preventative care, rehabilitation of injured workers and neurological-related injuries. Net patient revenues (patient revenues less estimated contractual adjustments) are recognized at the estimated net realizable amounts from third-party payors, patients and others in exchange for services rendered when obligations under the terms of the contract are satisfied. There is an implied contract between us and the patient upon each patient visit. Generally, this occurs as the Company provides physical and occupational therapy services, as each service provided is distinct and future services rendered are not dependent on previously rendered services. The Company has agreements with third-party payors that provide for payments to the Company at amounts different from its established rates. The allowance for estimated contractual adjustments is based on terms of payor contracts and historical collection and write-off experience.

Management contract revenues, which are included in other revenues in the consolidated statements of net income, are derived from contractual arrangements whereby the Company manages a clinic owned by a third party. The Company does not have any ownership interest in these clinics. Typically, revenues are determined based on the number of visits conducted at the clinic and recognized at the point in time when services are performed. Costs, typically salaries for our employees, are recorded when incurred.

Revenues from the industrial injury prevention services segment, which are also included in other revenues in the consolidated statements of net income, are derived from onsite services the Company provides to clients’ employees including injury prevention, rehabilitation, ergonomic assessments and performance optimization. Revenue from the industrial injury prevention services segment is recognized when obligations under the terms of the contract are satisfied. Revenues are recognized at an amount equal to the consideration the Company expects to receive in exchange for providing injury prevention services to its clients. The revenue is determined and recognized based on the number of hours and respective rate for services provided in a given period.

Additionally, other revenues include services the Company provides on-site, such as schools, for physical or occupational therapy services, and fees from athletic trainers. Contract terms and rates are agreed to in advance between the Company and the third parties. Services are typically performed over the contract period and revenue is recorded at the point of service. If the services are paid in advance, revenue is recorded as a liability over the period of the agreement and recognized at the point in time, when the services are performed.

The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in clinic operating costs in the statements of net income. Patient accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible.

The following table details the revenue related to the various categories (in thousands):

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Net patient revenues
  
$
72,279
    
$
113,363
    
$
172,405
    
$
220,013
  
Management contract revenues
    
1,592
      
2,215
      
3,740
      
4,360
  
Other revenues
    
328
      
507
      
895
      
1,043
  
Physical therapy operations
  
$
74,199
    
$
116,085
    
$
177,040
    
$
225,416
  
Industrial injury prevention services revenues
    
9,658
      
10,288
      
19,534
      
17,188
  
   
$
83,857
    
$
126,373
    
$
196,574
    
$
242,604
  

Medicare Reimbursement

The Medicare program reimburses outpatient rehabilitation providers based on the Medicare Physician Fee Schedule (‘‘MPFS’’). For services provided in 2018, a 0.5% increase was applied to the fee schedule payment rates; for services provided in 2019, a 0.25% increase was applied to the fee schedule payment rates before applying the mandatory budget neutrality adjustment. For services provided in 2020 through 2025, a 0.0% update will be applied each year to the fee schedule payment rates, before applying the mandatory budget neutrality adjustment. However, in the 2021 MPFS Final Rule, CMS proposed an increase to the code values for office/outpatient evaluation and management (E/M) codes and cuts to other codes to maintain budget neutrality of the MPFS. This change in code valuations would be effective January 1, 2021. Under the proposal, physical/occupational therapy services could see code reductions that may result in an estimated 9% decrease in payment. In announcing this possible reduction in the applicable physical/occupational therapy codes, CMS indicated that it would further consider and address industry and provider concerns before finalizing the 2021 code values.

Our physical therapists and occupational therapists are able to provide services to patients on a remote basis, using a variety of technologies. This has been particularly helpful during the COVID-19 pandemic, as some patients are reluctant to travel. Reimbursement and coverage for these services vary among payors. Effective as of March 1, 2020, CMS provided a temporary waiver to allow physical therapists and occupational therapists (and their respective assistants) to perform and be reimbursed for the full scope of services performed remotely as “telehealth visits”. The foregoing telehealth temporary waiver will continue until the end of the COVID-19 pandemic as determined by HHS. HHS has the authority extend the public health emergency, which it did on July 23, 2020.

Beginning in 2021, payments to individual therapists (Physical/Occupational Therapist in Private Practice) paid under the fee schedule may be subject to adjustment based on performance in the Merit Based Incentive Payment System (“MIPS”), which measures performance based on certain quality metrics, resource use, and meaningful use of electronic health records. Under the MIPS requirements, a provider's performance is assessed according to established performance standards each year and then is used to determine an adjustment factor that is applied to the professional's payment for the corresponding payment year. The provider’s MIPS performance in 2019 will determine the payment adjustment in 2021. Each year from 2019 through 2024, professionals who receive a significant share of their revenues through an alternate payment model (“APM”), (such as accountable care organizations or bundled payment arrangements) that involves risk of financial losses and a quality measurement component will receive a 5% bonus in the corresponding payment year. The bonus payment for APM participation is intended to encourage participation and testing of new APMs and to promote the alignment of incentives across payors. The specifics of the MIPS and APM adjustments will be subject to future notice and comment rule-making.

The Budget Control Act of 2011 increased the federal debt ceiling in connection with deficit reductions over the next ten years, and requires automatic reductions in federal spending by approximately $1.2 trillion. Payments to Medicare providers are subject to these automatic spending reductions, subject to a 2% cap. On April 1, 2013, a 2% reduction to Medicare payments was implemented. The Bipartisan Budget Act of 2015, enacted on November 2, 2015, extended the 2% reductions to Medicare payments through fiscal year 2025. The Bipartisan Budget Act of 2018, enacted on February 9, 2018, extends the 2% reductions to Medicare payments through fiscal year 2027.The CARES Act, enacted on March 27, 2020, temporarily suspended the 2% payment adjustment, effective for claims with dates of service from May 1, 2020 through December 31, 2020.

Historically, the total amount paid by Medicare in any one year for outpatient physical therapy, occupational therapy, and/or speech-language pathology services provided to any Medicare beneficiary was subject to an annual dollar limit (i.e., the ‘‘Therapy Cap’’ or ‘‘Limit’’). For 2017, the annual Limit on outpatient therapy services was $1,980 for combined Physical Therapy and Speech Language Pathology services and $1,980 for Occupational Therapy services. As a result of Bipartisan Budget Act of 2018, the Therapy Caps have been eliminated, effective as of January 1, 2018.

Under the Middle Class Tax Relief and Job Creation Act of 2012 (‘‘MCTRA’’), since October 1, 2012, patients who met or exceeded $3,700 in therapy expenditures during a calendar year have been subject to a manual medical review to determine whether applicable payment criteria are satisfied. The $3,700 threshold is applied to Physical Therapy and Speech Language Pathology Services; a separate $3,700 threshold is applied to the Occupational Therapy. The MACRA directed CMS to modify the manual medical review process such that those reviews will no longer apply to all claims exceeding the $3,700 threshold and instead will be determined on a targeted basis based on a variety of factors that CMS considers appropriate. The Bipartisan Budget Act of 2018 extends the targeted medical review indefinitely, but reduces the threshold to $3,000 through December 31, 2027.  For 2028, the threshold amount will be increased by the percentage increase in the Medicare Economic Index (“MEI”) for 2028 and in subsequent years the threshold amount will increase based on the corresponding percentage increase in the MEI for such subsequent year.

CMS adopted a multiple procedure payment reduction (‘‘MPPR’’) for therapy services in the final update to the MPFS for calendar year 2011. The MPPR applied to all outpatient therapy services paid under Medicare Part B — occupational therapy, physical therapy and speech-language pathology. Under the policy, the Medicare program pays 100% of the practice expense component of the Relative Value Unit (‘‘RVU’’) for the therapy procedure with the highest practice expense RVU, then reduces the payment for the practice expense component for the second and subsequent therapy procedures or units of service furnished during the same day for the same patient, regardless of whether those therapy services are furnished in separate sessions. Since 2013, the practice expense component for the second and subsequent therapy service furnished during the same day for the same patient was reduced by 50%. In addition, the MCTRA directed CMS to implement a claims-based data collection program to gather additional data on patient function during the course of therapy in order to better understand patient conditions and outcomes. All practice settings that provide outpatient therapy services are required to include this data on the claim form. Since 2013, therapists have been required to report new codes and modifiers on the claim form that reflect a patient’s functional limitations and goals at initial evaluation, periodically throughout care, and at discharge. Reporting of these functional limitation codes and modifiers are required on the claim for payment.

Medicare claims for outpatient therapy services furnished by therapy assistants on or after January 1, 2020 must include a modifier indicating the service was furnished by a therapy assistant. Outpatient therapy services furnished on or after January 1, 2022 in whole or part by a therapy assistant will be paid at an amount equal to 85% of the payment amount otherwise applicable for the service.

Statutes, regulations, and payment rules governing the delivery of therapy services to Medicare beneficiaries are complex and subject to interpretation. We believe that we are in compliance in all material respects with all applicable laws and regulations and are not aware of any pending or threatened investigations involving allegations of potential wrongdoing that would have a material effect on our financial statements as of June 30, 2020. Compliance with such laws and regulations can be subject to future government review and interpretation, as well as significant regulatory action including fines, penalties, and exclusion from the Medicare program. For the six months ended June 30, 2020 and 2019, net patient revenue from Medicare accounted for approximately $44.4 million and $59.4 million, respectively.

Contractual Allowances

Contractual allowances result from the differences between the rates charged for services performed and expected reimbursements by both insurance companies and government sponsored healthcare programs for such services. Medicare regulations and the various third party payors and managed care contracts are often complex and may include multiple reimbursement mechanisms payable for the services provided in Company clinics. The Company estimates contractual allowances based on its interpretation of the applicable regulations, payor contracts and historical calculations. Each month the Company estimates its contractual allowance for each clinic based on payor contracts and the historical collection experience of the clinic and applies an appropriate contractual allowance reserve percentage to the gross accounts receivable balances for each payor of the clinic. Based on the Company’s historical experience, calculating the contractual allowance reserve percentage at the payor level is sufficient to allow the Company to provide the necessary detail and accuracy with its collectability estimates. However, the services authorized and provided and related reimbursement are subject to interpretation that could result in payments that differ from the Company’s estimates. Payor terms are periodically revised necessitating continual review and assessment of the estimates made by management. The Company’s billing system does not capture the exact change in its contractual allowance reserve estimate from period to period in order to assess the accuracy of its revenues and hence its contractual allowance reserves. Management regularly compares its cash collections to corresponding net revenues measured both in the aggregate and on a clinic-by-clinic basis. In the aggregate, historically the difference between net revenues and corresponding cash collections has generally reflected a difference within approximately 1% of net revenues. Additionally, analysis of subsequent periods’ contractual write-offs on a payor basis reflects a difference within approximately 1% between the actual aggregate contractual reserve percentage as compared to the estimated contractual allowance reserve percentage associated with the same period end balance. As a result, the Company believes that a change in the contractual allowance reserve estimate would not likely be more than 1% at June 30, 2020.

A contract’s transaction price is allocated to each distinct performance obligation and recognized when, or as, the performance obligation is satisfied. To determine the transaction price, the Company includes the effects of any variable consideration, such as the probability of collecting that amount.  The Company applies established rates to the services provided, and adjusts for the terms of payor contracts, as applicable.  These contracted amounts are different from the Company’s established rates.  The Company has established a “contractual allowance” for this difference. The allowance is based on the terms of payor contracts, historical and current reimbursement information and current experience with the clinic and partners. The Company’s established rates less the contractual allowance is the revenue that is recognized in the period in which the service is rendered. This revenue is deemed the transaction price and stated as “Net Patient Revenue” on the Company’s consolidated statements of income.

The Company’s performance obligations are satisfied at a point in time. After the clinic has provided services and satisfied its obligation to the customer for the reimbursement rates stipulated in the payor contracts (i.e. the transaction price), the Company recognizes the revenue, net of contractual allowances, in the period in which the services are rendered. The Company recognizes the full amount of revenue and reports the contractual allowances as a contra (or offset) revenue account to report a net revenue number based on the expected collections.
v3.20.2
OTHER INCOME
 6 Months Ended
Jun. 30, 2020
OTHER INCOME [Abstract]  
OTHER INCOME
4. OTHER INCOME

Sale of clinics

The Company recognized a gain of $1.1 million in the second quarter of 2020, included in other income, resulting from the sale of 11 previously closed clinics.

Receipts of Relief Funds

The Company received $7.9 million of funds from the Public Health and Social Services Emergency Fund (“Relief Fund”) as part of the CARES Act.   The Relief Fund monies do not have to be repaid, were used for operations and to offset losses due to the COVID-19 pandemic in the second quarter of 2020.
v3.20.2
EARNINGS PER SHARE
 6 Months Ended
Jun. 30, 2020
EARNINGS PER SHARE [Abstract]  
EARNINGS PER SHARE
5. EARNINGS PER SHARE

In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest (see Footnote 6 – Redeemable Non-Controlling Interest), net of tax, charged directly to retained earnings is included in the earnings per basic and diluted share calculation.  The following table provides a detail of the basic and diluted earnings per share computation (in thousands, except per share data).

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Computation of earnings per share - USPH shareholders:
                        
Net income attributable to USPH shareholders
  
$
10,232
    
$
14,620
    
$
11,248
    
$
23,063
  
Credit (charges) to retained earnings:
                                
Revaluation of redeemable non-controlling interest
    
3,344
      
(5,169
)
    
5,473
      
(9,830
)
Tax effect at statutory rate (federal and state) of 26.25%
    
(878
)
    
1,356
      
(1,437
)
    
2,580
  
   
$
12,698
    
$
10,807
    
$
15,284
    
$
15,813
  
                                 
Earnings per share (basic and diluted)
  
$
0.99
    
$
0.85
    
$
1.19
    
$
1.24
  
                                 
Shares used in computation:
                                
Basic and diluted earnings per share - weighted-average shares
    
12,843
      
12,767
      
12,820
      
12,738
  
v3.20.2
REDEEMABLE NON-CONTROLLING INTEREST
 6 Months Ended
Jun. 30, 2020
REDEEMABLE NON-CONTROLLING INTEREST [Abstract]  
REDEEMABLE NON-CONTROLLING INTEREST
6. REDEEMABLE NON-CONTROLLING INTEREST

Since October 2017, when the Company acquires a majority interest (the “Acquisition”) in a physical therapy clinic business (referred to as “Therapy Practice”), these Acquisitions occur in a series of steps which are described below.

1.
Prior to the Acquisition, the Therapy Practice exists as a separate legal entity (the “Seller Entity”). The Seller Entity is owned by one or more individuals (the “Selling Shareholders”) most of whom are physical therapists that work in the Therapy Practice and provide physical therapy services to patients.
2.
In conjunction with the Acquisition, the Seller Entity contributes the Therapy Practice into a newly-formed limited partnership (“NewCo”), in exchange for one hundred percent (100%) of the limited and general partnership interests in NewCo. Therefore, in this step, NewCo becomes a wholly-owned subsidiary of the Seller Entity.
3.
The Company enters into an agreement (the “Purchase Agreement”) to acquire from the Seller Entity a majority (ranges from 50% to 90%) of the limited partnership interest and in all cases 100% of the general partnership interest in NewCo. The Company does not purchase 100% of the limited partnership interest because the Selling Shareholders, through the Seller Entity, want to maintain an ownership percentage. The consideration for the Acquisition is primarily payable in the form of cash at closing and a small, two-year note in lieu of an escrow (the “Purchase Price”). The Purchase Agreement does not contain any future earn-out or other contingent consideration that is payable to the Seller Entity or the Selling Shareholders.
4.
The Company and the Seller Entity also execute a partnership agreement (the “Partnership Agreement”) for NewCo that sets forth the rights and obligations of the limited and general partners of NewCo. After the Acquisition, the Company is the general partner of NewCo.
5.
As noted above, the Company does not purchase 100% of the limited partnership interests in NewCo and the Seller Entity retains a portion of the limited partnership interest in NewCo (“Seller Entity Interest”).
6.
In most cases, some or all of the Selling Shareholders enter into an employment agreement (the “Employment Agreement”) with NewCo with an initial term that ranges from three to five years (the “Employment Term”), with automatic one-year renewals, unless employment is terminated prior to the end of the Employment Term. As a result, a Selling Shareholder becomes an employee (“Employed Selling Shareholder”) of NewCo. The employment of an Employed Selling Shareholder can be terminated by the Employed Selling Shareholder or NewCo, with or without cause, at any time. In a few situations, a Selling Shareholder does not become employed by NewCo and is not involved with NewCo following the closing; in those situations, such Selling Shareholders sell their entire ownership interest in the Seller Entity as of the closing of the Acquisition.
7.
The compensation of each Employed Selling Shareholder is specified in the Employment Agreement and is customary and commensurate with his or her responsibilities based on other employees in similar capacities within NewCo, the Company and the industry.
8.
The Company and the Selling Shareholder (including both Employed Selling Shareholders and Selling Shareholders not employed by NewCo) execute a non-compete agreement (the “Non-Compete Agreement”) which restricts the Selling Shareholder from engaging in competing business activities for a specified period of time (the “Non-Compete Term”). A Non-Compete Agreement is executed with the Selling Shareholders in all cases. That is, even if the Selling Shareholder does not become an Employed Selling Shareholder, the Selling Shareholder is restricted from engaging in a competing business during the Non-Compete Term.
9.
The Non-Compete Term commences as of the date of the Acquisition and  expires on the later of :
a.
Two years after the date an Employed Selling Shareholders’ employment is terminated (if the Selling Shareholder becomes an Employed Selling Shareholder) or
b.
Five to six years  from the date of the Acquisition, as defined in the Non-Compete Agreement, regardless of whether the Selling Shareholder is employed by NewCo.
10.
The Non-Compete Agreement applies to a restricted region which is defined as a 15-mile radius from the Therapy Practice. That is, an Employed Selling Shareholder is permitted to engage in competing businesses or activities outside the 15-mile radius (after such Employed Selling Shareholder no longer is employed by NewCo) and a Selling Shareholder who is not employed by NewCo immediately is permitted to engage in the competing business or activities outside the 15-mile radius.

The Partnership Agreement contains provisions for the redemption of the Seller Entity Interest, either at the option of the Company (the “Call Right”) or at the option of the Seller Entity (the “Put Right”) as follows:

1.
Put Right
a.
In the event that any Selling Shareholder’s employment is terminated under certain circumstances prior to a specified date (the “Specified Date”), the Seller Entity thereafter may have an irrevocable right to cause the Company to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest at the purchase price described in “3” below.
b.
In the event that any Selling Shareholder is not employed by NewCo as of the Specified Date and the Company has not exercised its Call Right with respect to the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest, Seller Entity thereafter shall have the Put Right to cause the Company to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest at the purchase price described in “3” below.
c.
In the event that any Selling Shareholder’s employment with NewCo is terminated for any reason on or after the Specified Date, the Seller Entity shall have the Put Right, and upon the exercise of the Put Right, the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest shall be redeemed by the Company at the purchase price described in “3” below.

2.
Call Right
a.
If any Selling Shareholder’s employment by NewCo is terminated prior to the Specified Date, the Company thereafter shall have an irrevocable right to purchase from Seller Entity the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest, in each case at the purchase price described in “3” below.
b.
In the event that any Selling Shareholder’s employment with NewCo is terminated for any reason on or after Specified Date, the Company shall have the Call Right, and upon the exercise of the Call Right, the Terminated Selling Shareholder’s Allocable Percentage of Seller Entity’s Interest shall be redeemed by the Company at the purchase price described in “3” below.
3.
For the Put Right and the Call Right, the purchase price is derived from a formula based on a specified multiple of NewCo’s trailing twelve months of earnings before interest, taxes, depreciation, amortization, and the Company’s internal management fee, plus an Allocable Percentage of any undistributed earnings of NewCo (the “Redemption Amount”). NewCo’s earnings are distributed monthly based on available cash within NewCo; therefore, the undistributed earnings amount is small, if any.
4.
The Purchase Price for the initial equity interest purchased by the Company is also based on the same specified multiple of the trailing twelve-month earnings that is used in the Put Right and the Call Right noted above.
5.
The Put Right and the Call Right do not have an expiration date, and the Seller Entity Interest is not required to be purchased by the Company or sold by the Seller Entity unless either the Put Right and the Call Right is exercised.
6.
The Put Right and the Call Right never apply to Selling Shareholders who do not become employed by NewCo, since the Company requires that such Selling Shareholders sell their entire ownership interest in the Seller Entity at the closing of the Acquisition.

An Employed Selling Shareholder’s ownership of his or her equity interest in the Seller Entity predates the Acquisition and the Company’s purchase of its partnership interest in NewCo. The Employment Agreement and the Non-Compete Agreement do not contain any provision to escrow or “claw back” the equity interest in the Seller Entity held by such Employed Selling Shareholder, nor the Seller Entity Interest in NewCo, in the event of a breach of the employment or non-compete terms. More specifically, even if the Employed Selling Shareholder is terminated for “cause” by NewCo, such Employed Selling Shareholder does not forfeit his or her right to his or her full equity interest in the Seller Entity and the Seller Entity does not forfeit its right to any portion of the Seller Entity Interest. The Company’s only recourse against the Employed Selling Shareholder for breach of either the Employment Agreement or the Non-Compete Agreement is to seek damages and other legal remedies under such agreements. There are no conditions in any of the arrangements with an Employed Selling Shareholder that would result in a forfeiture of the equity interest held in the Seller Entity or of the Seller Entity Interest.

For the three and six months ended June 30, 2020, the following table details the changes in the carrying amount (fair value) of the redeemable non-controlling interests (in thousands):

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
                         
Beginning balance
  
$
140,498
    
$
137,196
    
$
137,750
    
$
133,943
  
Operating results allocated to redeemable non-controlling interest partners
    
2,996
      
3,378
      
4,792
      
5,773
  
Distributions to redeemable non-controlling interest partners
    
(2,054
)
    
(3,641
)
    
(3,665
)
    
(5,163
)
Changes in the fair value of redeemable non-controlling interest
    
(3,344
)
    
5,169
      
(5,473
)
    
9,830
  
Purchases of redeemable non-controlling interest
    
(1,372
)
    
(2,604
)
    
(3,224
)
    
(4,885
)
Acquired interest
    
-
      
-
      
6,471
      
-
  
Reduction of non-controlling interest due to sale of USPH partnership interest
    
-
      
(6,132
)
    
-
      
(6,132
)
Sales of redeemable non-controlling interest - temporary equity
    
564
      
2,870
      
564
      
2,870
  
Notes receivable related to sales of redeemable non-controlling interest - temporary equity
    
(545
)
    
(2,870
)
    
(545
)
    
(2,870
)
Adjustments in notes receivable related to the the sales of redeemable non-controlling interest - temporary equity
    
(15
)
    
-
      
58
      
-
  
Ending balance
  
$
136,728
    
$
133,366
    
$
136,728
    
$
133,366
  

The following table categorizes the carrying amount (fair value) of the redeemable non-controlling interests (in thousands):

  
June 30, 2020
    
June 30, 2019
  
             
Contractual time period has lapsed but holder's employment has not been terminated
  
$
72,815
    
$
52,937
  
Contractual time period has not lapsed and holder's employment has not been terminated
    
63,913
      
80,429
  
Holder's employment has terminated and contractual time period has expired
    
-
      
-
  
Holder's employment has terminated and contractual time period has not expired
    
-
      
-
  
   
$
136,728
    
$
133,366
  
v3.20.2
GOODWILL
 6 Months Ended
Jun. 30, 2020
GOODWILL [Abstract]  
GOODWILL
7. GOODWILL

The changes in the carrying amount of goodwill consisted of the following (in thousands):

   
Six Months Ended
    
Year Ended
  
 
June 30, 2020
    
December 31, 2019
  
             
Beginning balance
  
$
317,676
    
$
293,525
  
Goodwill acquired
    
13,845
      
31,330
  
Goodwill related to partnership interest sold
    
-
      
(7,325
)
Goodwill write-off related to closed clinics
    
(1,859
)
    
-
  
Goodwill adjustments for purchase price allocation of businesses acquired in prior year
    
1,232
      
146
  
Ending balance
  
$
330,894
    
$
317,676
  

The derecognition (write-off) of goodwill in the amount of $1.9 million was related to certain clinics that have been permanently closed.
v3.20.2
INTANGIBLE ASSETS, NET
 6 Months Ended
Jun. 30, 2020
INTANGIBLE ASSETS, NET [Abstract]  
INTANGIBLE ASSETS, NET
8. INTANGIBLE ASSETS, NET

Intangible assets, net as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

  
June 30, 2020
    
December 31, 2019
  
Tradenames
  
$
31,490
    
$
32,049
  
Referral relationships, net of accumulated amortization of $13,126 and $11,677, respectively
    
21,517
      
18,367
  
Non-compete agreements, net of accumulated amortization of $5,687 and $5,424, respectively
    
1,888
      
2,172
  
   
$
54,895
    
$
52,588
  

Tradenames, referral relationships and non-compete agreements are related to the businesses acquired. The value assigned to tradenames has an indefinite life and is tested at least annually for impairment using the relief from royalty method in conjunction with the Company’s annual goodwill impairment test. The value assigned to referral relationships is being amortized over their respective estimated useful lives which range from six to sixteen years. Non-compete agreements are amortized over the respective term of the agreements which range from five to six years.

The following table details the amount of amortization expense recorded for intangible assets for the three months and six months ended June 30, 2020 and 2019 (in thousands):

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Referral relationships
  
$
836
    
$
581
    
$
1,449
    
$
1,114
  
Non-compete agreements
    
87
      
169
      
264
      
338
  
   
$
923
    
$
750
    
$
1,713
    
$
1,452
  

Based on the balance of referral relationships and non-compete agreements as of June 30, 2020, the expected amount to be amortized in 2020 and thereafter by year is as follows (in thousands):

Referral Relationships
  
Non-Compete Agreements
  
Years
  
Annual Amount
  
Years
  
Annual Amount
  
Ending December 31,
      
Ending December 31,
      
2020 (excluding the six months ended June 30, 2020)
$
1,369
  
2020 (excluding the six months ended June 30, 2020)
$
300
  
2021
$
2,737
  
2021
$
552
  
2022
$
2,689
  
2022
$
375
  
2023
$
2,581
  
2023
$
305
  
2024
$
2,417
  
2024
$
250
  
Thereafter
$
9,724
  
Thereafter
$
193
  
v3.20.2
ACCRUED EXPENSES
 6 Months Ended
Jun. 30, 2020
ACCRUED EXPENSES [Abstract]  
ACCRUED EXPENSES
9. ACCRUED EXPENSES

Accrued expenses as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

  
June 30, 2020
    
December 31, 2019
  
Salaries and related costs
  
$
16,809
    
$
19,340
  
Credit balances due to patients and payors
    
6,871
      
4,303
  
Group health insurance claims
    
2,180
      
2,277
  
Closure costs
    
1,987
      
116
  
Federal income taxes payable
    
4,637
      
-
  
MAAPP funds payable
    
12,861
      
-
  
Deferred employer payroll taxes - CARES ACT
    
2,155
      
-
  
Other
    
3,825
      
4,819
  
Total
  
$
51,325
    
$
30,855
  

In response to the COVID-19 pandemic, the federal government approved the CARES Act. The CARES Act allowed for qualified healthcare providers to receive advanced payments under the existing Medicare Accelerated and Advance Payments Program (“MAAPP funds”) during the COVID-19 pandemic. Under this program, healthcare providers could choose to receive advanced payments for future Medicare services provided. The Company applied for and received approval from Centers for Medicare & Medicaid Services (“CMS”) in April 2020. The Company recorded these payments as a liability until all performance obligations have been met as the payments were made on behalf of patients before services were provided. Currently, MAAPP funds received will be applied to future Medicare billings commencing in August 2020, with all such remaining amounts required to be repaid by November 2020. Beginning November 2020, any unpaid balance will begin accruing interest. Failure to repay the advanced payments when due will result in interest charges on the outstanding balance owed.

Closure costs consist primarily of remaining lease commitments.
v3.20.2
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT
 6 Months Ended
Jun. 30, 2020
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT [Abstract]  
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT
10. NOTES PAYABLE AND AMENDED CREDIT AGREEMENT

Amounts outstanding under the Amended Credit Agreement (as defined below) and notes payable as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

  
June 30, 2020
    
December 31, 2019
  
Credit Agreement average effective interest rate of 2.3% inclusive of unused fee
  
$
33,000
    
$
46,000
  
Various notes payable with $4,635 plus accrued interest due in the next year, interest accrues in the range of 3.25% through 5.50% per annum
    
5,320
      
5,089
  
   
$
38,320
    
$
51,089
  
Less current portion
    
(4,635
)
    
(728
)
Long term portion
  
$
33,685
    
$
50,361
  

Effective December 5, 2013, the Company entered into an Amended and Restated Credit Agreement with a commitment for a $125.0 million revolving credit facility. This agreement was amended in August 2015, January 2016, March 2017 and November 2017 (hereafter referred to as “Amended Credit Agreement”). The Amended Credit Agreement is unsecured and has loan covenants, including requirements that the Company comply with a consolidated fixed charge coverage ratio and consolidated leverage ratio. Proceeds from the Amended Credit Agreement may be used for working capital, acquisitions, purchases of the Company’s common stock, dividend payments to the Company’s common stockholders, capital expenditures and other corporate purposes. The pricing grid which is based on the Company’s consolidated leverage ratio with the applicable spread over LIBOR ranging from 1.25% to 2.0% or the applicable spread over the Base Rate ranging from 0.1% to 1%. Fees under the Amended Credit Agreement include an unused commitment fee ranging from 0.25% to 0.3% depending on the Company’s consolidated leverage ratio and the amount of funds outstanding under the Amended Credit Agreement.

The January 2016 amendment to the Amended Credit Agreement increased the cash and noncash consideration that the Company could pay with respect to acquisitions permitted under the Amended Credit Agreement to $50.0 million for any fiscal year, and increased the amount the Company may pay in cash dividends to its shareholders in an aggregate amount not to exceed $10.0 million in any fiscal year.  The March 2017 amendment, among other items, increased the amount the Company may pay in cash dividends to its shareholders in an aggregate amount not to exceed $15.0 million in any fiscal year. The November 2017 amendment, among other items, adjusted the pricing grid as described above, increased the aggregate amount the Company may pay in cash dividends to its shareholders to an amount not to exceed $20.0 million and extended the maturity date to November 30, 2021.

On June 30, 2020, $33.0 million was outstanding on the Amended Credit Agreement resulting in $92.0 million of availability. As of June 30, 2020, the Company was in compliance with all of the covenants contained in the Amended Credit Agreement. Given the uncertainty inherent in operating results due to the COVID-19 pandemic, the Company continues to closely monitor covenant compliance. The Company will engage as required in discussions with its lender regarding an amendment to the facility so as to maintain compliance with all covenants.

The Company generally enters into various notes payable as a means of financing a portion of its acquisitions and purchases of non-controlling interests. In conjunction with the acquisitions on February 27, 2020, the Company entered into a note payable in the amount of $300,000 payable in February 2022 plus accrued interest. During the quarter ended June 30, 2020, the Company entered into various notes payable as a means of financing a portion of its acquisition of partner’s non-controlling interest in the amount of $0.2 million. Interest accrues at the rate of 4.75% per annum. In conjunction with the 2019 acquisitions, the Company entered into notes payable in the aggregate amount of $4.8 million of which an aggregate principal payment of $4.6 million is due in 2021 and $0.2 million is due in 2022. Interest accrues in the range of 3.25% to 5.50% per annum and is payable with each principal installment.

Subsequent aggregate annual payments of principal required pursuant to the Amended Credit Agreement and outstanding notes payable at June 30, 2020 are as follows (in thousands):

During the twelve months ended June 30, 2021
  
$
4,635
  
During the twelve months ended June 30, 2022
    
33,642
  
During the twelve months ended June 30, 2023
    
43
  
   
$
38,320
  

The outstanding amounts under the Amended Credit Agreement facility (balance at June 30, 2020 of $33.0 million) mature on November 30, 2021.
v3.20.2
LEASES
 6 Months Ended
Jun. 30, 2020
LEASES [Abstract]  
LEASES
11. LEASES

The Company has operating leases for its corporate offices and operating facilities. The Company determines if an arrangement is a lease at the inception of a contract.  Effective January 1, 2019, right-of-use assets and operating lease liabilities are included in its consolidated balance sheet. Right-of-use assets represent the Company’s right to use an underlying asset during the lease term and operating lease liabilities represent net present value of the Company’s obligation to make lease payments arising from the lease. Right-of-use assets and operating lease liabilities are recognized at commencement date based on the net present value of the fixed lease payments over the lease term. The Company’s operating lease terms are generally five years or less. The Company’s lease terms include options to extend or terminate the lease when it is reasonably certain that the option will be exercised. As most of the Company’s operating leases do not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of lease payments. Operating fixed lease expense is recognized on a straight-line basis over the lease term.

In accordance with ASC 842, the Company records on its consolidated balance sheet leases with a term greater than 12 months.  The Company has elected, in compliance with current accounting standards, not to record leases with an initial terms of 12 months or less in the consolidated balance sheet.  ASC 842 requires the separation of the fixed lease components from the variable lease components. The Company has elected the practical expedient to account for separate lease components of a contract as a single lease cost thus causing all fixed payments to be capitalized. Non-lease and variable cost components are not included in the measurement of the right-of-use assets or operating lease liabilities. The Company also elected the package of practical expedients permitted within ASC 842, which among other things, allows the Company to carry forward historical lease classification. Variable lease payment amounts that cannot be determined at the commencement of the lease such as increases in lease payments based on changes in index rates or usage are not included in the right-of- use assets or operating lease liabilities. These are expensed as incurred and recorded as variable lease expense.

For the three months and six months ended June 30, 2020, the components of lease expense were as follows (in thousands):

  
Three Months Ended June 30,
    
Six Months Ended June 30,
  
   
2020
    
2019
    
2020
    
2019
  
Operating lease cost
  
$
7,815
    
$
7,708
    
$
15,627
    
$
15,295
  
Short-term lease cost
    
215
      
297
      
509
      
668
  
Variable lease cost
    
1,514
      
1,547
      
3,046
      
3,128
  
Total lease cost *
  
$
9,544
    
$
9,552
    
$
19,182
    
$
19,091
  

* Sublease income was immaterial

Lease cost is reflected in the consolidated statement of net income in the line item – rent, supplies, contract labor and other.

Supplemental information related to leases was as follows (in thousands):

  
Three Months Ended June 30,
    
Six Months Ended June 30,
  
   
2020
    
2019
    
2020
    
2019
  
                         
Cash paid for amounts included in the measurement of operating lease liabilities (in thousands)
  
$
6,555
    
$
7,686
    
$
14,345
    
$
15,392
  
                                 
Right-of-use assets obtained in exchange for new operating lease liabilities (in thousands) *
  
$
7,535
    
$
8,629
    
$
19,075
    
$
98,514
  

* Includes the right-of-use assets obtained in exchange for lease liabilities of $82.6 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019.

The aggregate future lease payments for operating leases as of June 30, 2020 were as follows (in thousands):

Fiscal Year
  
Amount
  
2020 (excluding the six months ended June 30, 2020)
  
$
15,568
  
2021
    
26,363
  
2022
    
20,565
  
2023
    
14,968
  
2024
    
9,439
  
2025 and therafter
    
10,288
  
Total lease payments
  
$
97,191
  
Less: imputed  interest
    
6,359
  
Total operating lease liabilities
  
$
90,832
  

Average lease terms and discount rates were as follows:

  
Three Months Ended
June 30, 2020
    
Six Months Ended
June 30, 2020
  
Weighted-average remaining lease term - Operating leases
  
4.21 Years
    
4.21 Years
  
             
Weighted-average discount rate - Operating leases
    
3.2
%
    
3.2
%
v3.20.2
SEGMENT INFORMATION
 6 Months Ended
Jun. 30, 2020
SEGMENT INFORMATION [Abstract]  
SEGMENT INFORMATION
12. SEGMENT INFORMATION

The Company’s reportable segments include the physical therapy operations segment and the industrial injury prevention services segment. Included in the physical therapy operations segment are revenues from management contract services and other services which include services the Company provides on-site, such as schools for athletic trainers.

The Company evaluates performance of the segments based on gross profit. The Company has provided additional information regarding its reportable segments, which contributes to the understanding of the Company and provides useful information.

The following table summarizes selected financial data for the Company’s reportable segments. Prior year results presented herein have been changed to conform to the current presentation.

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
   
(in thousands)
    
(in thousands)
  
Net operating revenues:
                        
Physical therapy operations
  
$
74,199
    
$
116,085
    
$
177,040
    
$
225,416
  
Industrial injury prevention services
    
9,658
      
10,288
      
19,534
      
17,188
  
Total Company
  
$
83,857
    
$
126,373
    
$
196,574
    
$
242,604
  
 
                                
Gross profit:
                                
Physical therapy operations (excluding closure costs)
  
$
16,199
    
$
28,433
    
$
33,978
    
$
53,610
  
Industrial injury prevention services
    
3,179
      
3,005
      
4,843
      
4,542
  
 
  
$
19,378
    
$
31,438
    
$
38,821
    
$
58,152
  
Physical therapy operations - closure costs
    
94
      
13
      
3,846
      
9
  
Gross profit
  
$
19,284
    
$
31,425
    
$
34,975
    
$
58,143
  
 
                                
Total assets:
                                
Physical therapy operations
                  
$
534,238
    
$
512,657
  
Industrial injury prevention services
                    
50,780
      
48,188
  
Total Company
                  
$
585,018
    
$
560,845
  
v3.20.2
COMMON STOCK
 6 Months Ended
Jun. 30, 2020
COMMON STOCK [Abstract]  
COMMON STOCK
13. COMMON STOCK

From September 2001 through December 31, 2008, the Board authorized the Company to purchase, in the open market or in privately negotiated transactions, up to 2,250,000 shares of the Company’s common stock. In March 2009, the Board authorized the repurchase of up to 10% or approximately 1,200,000 shares of its common stock (“March 2009 Authorization”). The Amended Credit Agreement permits share repurchases of up to $15,000,000, subject to compliance with covenants. The Company is required to retire shares purchased under the March 2009 Authorization.

Under the March 2009 Authorization, the Company has purchased a total of 859,499 shares. There is no expiration date for the share repurchase program. There are currently an additional estimated 185,139 shares (based on the closing price of $81.02 on June 30, 2020) that may be purchased from time to time in the open market or private transactions depending on price, availability and the Company’s cash position. The Company did not purchase any shares of its common stock during the six months ended June 30, 2020.
v3.20.2
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Policies)
 6 Months Ended
Jun. 30, 2020
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES [Abstract]  
Cash Equivalents
Cash Equivalents

The Company maintains its cash and cash equivalents at financial institutions.  The Company considers all highly liquid investments with a maturity of three months or less when purchased to be cash equivalents.  The combined account balances at several institutions typically exceed Federal Deposit Insurance Corporation (“FDIC”) insurance coverage and, as a result, there is a concentration of credit risk related on deposits in excess of FDIC insurance coverage. Management believes that the risk is not significant.
Long-Lived Assets
Long-Lived Assets

Fixed assets are stated at cost. Depreciation is computed using the straight-line method over the estimated useful lives of the assets. Estimated useful lives for furniture and equipment range from three to eight years and for purchased software from three to seven years. Leasehold improvements are amortized over the shorter of the lease term or estimated useful lives of the assets, which is generally three to five years. The Company did not note an impairment to long-lived assets during this quarter.
Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of
Impairment of Long-Lived Assets and Long-Lived Assets to Be Disposed Of

The Company reviews property and equipment and intangible assets with finite lives for impairment upon the occurrence of certain events or circumstances which indicate that the amounts may be impaired. Assets to be disposed of are reported at the lower of the carrying amount or fair value less costs to sell. The Company did not note an impairment to long-lived assets during this quarter.
Goodwill
Goodwill

Goodwill represents the excess of the amount paid and fair value of the non-controlling interests over the fair value of the acquired business assets, which include certain identifiable intangible assets. Historically, goodwill has been derived from acquisitions and, prior to 2009, from the purchase of some or all of a particular local management’s equity interest in an existing clinic. Effective January 1, 2009, if the purchase price of a non-controlling interest by the Company exceeds or is less than the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital.

The fair value of goodwill and other identifiable intangible assets with indefinite lives are tested for impairment annually and upon the occurrence of certain events, and are written down to fair value if considered impaired. The Company evaluates goodwill for impairment on at least an annual basis (normally in its third quarter) by comparing the fair value of its reporting units to the carrying value of each reporting unit including related goodwill. The Company evaluates indefinite lived tradenames using the relief from royalty method in conjunction with its annual goodwill impairment test or when other triggering events are identified. The Company operates a one segment business which is made up of various clinics within partnerships. The partnerships are components of regions and are aggregated to the operating segment level for the purpose of determining the Company’s reporting units when performing its annual goodwill impairment test. In 2019, there were six regions.  In addition to the six regions, in 2019, the impairment test included a separate analysis for the industrial injury prevention business, a separate reporting unit.

An impairment loss generally would be recognized when the carrying amount of the net assets of a reporting unit, inclusive of goodwill and other identifiable intangible assets, exceeds the estimated fair value of the reporting unit. The estimated fair value of a reporting unit is determined using two factors: (i) earnings prior to taxes, depreciation and amortization for the reporting unit multiplied by a price/earnings ratio used in the industry and (ii) a discounted cash flow analysis. A weight is assigned to each factor and the sum of each weight times the factor is considered the estimated fair value. For 2019, the factors (i.e., price/earnings ratio, discount rate and residual capitalization rate) were updated to reflect current market conditions. The evaluation of goodwill in 2019 did not result in any goodwill amounts that were deemed impaired.

Based on the current economic conditions and the decline in patient visits due to the pandemic, the Company evaluated whether events or circumstances indicated that it was more likely than not that the fair value of the reporting units were reduced below their carrying value as of June 30, 2020. As a result of the assessment, the Company determined that it was not more likely than not that goodwill and tradenames of the reporting units was impaired as of June 30, 2020.

As the Company did not note an impairment, no additional disclosures were deemed to be required by management.  The Company also considered the impact of these judgments and estimates as they pertain to the disclosure requirements for such items within this Form 10-Q and risks and uncertainties discussions and believes that such disclosure is adequate.

Due to the uncertainty of the current economic conditions resulting from the COVID-19 pandemic, the Company will continue to review its carrying amounts of goodwill and other intangibles.

For the six months ended June 30, 2020, the Company derecognized (wrote-off) goodwill in the amount of $1.9 million related to closed clinics due to COVID-19.

The Company will continue to monitor for any triggering events or other indicators of impairment.
Redeemable Non-Controlling Interests
Redeemable Non-Controlling Interests

The non-controlling interests that are reflected as redeemable non-controlling interests in the consolidated financial statements consist of those that the owners and the Company have certain redemption rights, whether currently exercisable or not, and which currently, or in the future, require that the Company purchase or the owner sell the non-controlling interest held by the owner, if certain conditions are met.  The purchase price is derived at a predetermined formula based on a multiple of trailing twelve months earnings performance as defined in the respective limited partnership agreements.  The redemption rights can be triggered by the owner or the Company at such time as both of the following events have occurred: 1) termination of the owner’s employment, regardless of the reason for such termination, and 2) the passage of specified number of years after the closing of the transaction, typically three to five years, as defined in the limited partnership agreement.  The redemption rights are not automatic or mandatory (even upon death) and require either the owner or the Company to exercise its rights when the conditions triggering the redemption rights have been satisfied.
On the date the Company acquires a controlling interest in a partnership, and the limited partnership agreement for such partnership contains redemption rights not under the control of the Company, the fair value of the non-controlling interest is recorded in the consolidated balance sheet under the caption – Redeemable non-controlling interests.  Then, in each reporting period thereafter until it is purchased by the Company, the redeemable non-controlling interest is adjusted to the greater of its then current redemption value or initial carrying value, based on the predetermined formula defined in the respective limited partnership agreement.  As a result, the value of the non-controlling interest is not adjusted below its initial carrying value.  The Company records any adjustment in the redemption value, net of tax, directly to retained earnings and are not reflected in the consolidated statements of income.  Although the adjustments are not reflected in the consolidated statements of income, current accounting rules require that the Company reflects the adjustments, net of tax, in the earnings per share calculation.  The amount of net income attributable to redeemable non-controlling interest owners is included in consolidated net income on the face of the consolidated statements of net income. Management believes the redemption value (i.e. the carrying amount) and fair value are the same.
Non-Controlling Interests
Non-Controlling Interests

The Company recognizes non-controlling interests, in which the Company has no obligation but the right to purchase the non-controlling interests, as permanent equity in the consolidated financial statements separate from the parent entity’s equity. The amount of net income attributable to non-controlling interests is included in consolidated net income on the face of the statements of net income. Changes in a parent entity’s ownership interest in a subsidiary that do not result in deconsolidation are treated as equity transactions if the parent entity retains its controlling financial interest. The Company recognizes a gain or loss in net income when a subsidiary is deconsolidated. Such gain or loss is measured using the fair value of the non-controlling equity investment on the deconsolidation date.

When the purchase price of a non-controlling interest by the Company exceeds the book value at the time of purchase, any excess or shortfall is recognized as an adjustment to additional paid-in capital. Additionally, operating losses are allocated to non-controlling interests even when such allocation creates a deficit balance for the non-controlling interest partner.
Revenue Recognition
Revenue Recognition

Revenues are recognized in the period in which services are rendered. See Footnote 3 – Revenue Recognition, for further discussion of revenue recognition.
Allowance for Doubtful Accounts
Allowance for Doubtful Accounts

The Company determines allowances for doubtful accounts based on the specific agings and payor classifications at each clinic. The provision for doubtful accounts is included in operating costs in the consolidated statements of net income. Net accounts receivable, which are stated at the historical carrying amount net of contractual allowances, write-offs and allowance for doubtful accounts, includes only those amounts the Company estimates to be collectible.
Income Taxes
Income Taxes

Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases and operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date.
The Company recognizes the financial statement benefit of a tax position only after determining that the relevant tax authority would more likely than not sustain the position following an audit. For tax positions meeting the more-likely-than-not threshold, the amount to be recognized in the financial statements is the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement with the relevant tax authority.

On March 27, 2020, the Coronavirus Aid, Relief, and Economic Securities Act (“CARES Act”) was enacted. The CARES Act includes changes to certain tax law related to net operating losses and the deductibility of interest expense and depreciation. ASC 740, Income Taxes requires the effects of changes in tax rates and laws on deferred tax balances to be recognized in the period in which the legislation is enacted. The legislation had no effect on the Company’s deferred income taxes and current income taxes payable during the six months ended June 30, 2020.

The Company did not have any accrued interest or penalties associated with any unrecognized tax benefits nor was any interest expense recognized during the six months ended June 30, 2020. The Company records any interest or penalties, if required, in interest and other expense, as appropriate.
Fair Value of Financial Instruments
Fair Value of Financial Instruments

The carrying amounts reported in the balance sheets for cash and cash equivalents, accounts receivable, accounts payable and notes payable approximate their fair values due to the short-term maturity of these financial instruments. The carrying amount under the Amended Credit Agreement and the redemption value of Redeemable non-controlling interests approximate the respective fair values. The fair value of the Company’s redeemable non-controlling interests is determined based on “Level 3” inputs. The interest rate on the Amended Credit Agreement, which is tied to LIBOR, is set at various short-term intervals, as detailed in the Amended Credit Agreement.
Segment Reporting
Segment Reporting

Operating segments are components of an enterprise for which separate financial information is available that is evaluated regularly by chief operating decision makers in determining the allocation of resources and in assessing performance.  The Company currently operates through two segments: physical therapy operations and industrial injury prevention services.
Use of Estimates
Use of Estimates

In preparing the Company’s consolidated financial statements, management makes certain estimates and assumptions, especially in relation to, but not limited to, goodwill impairment, tradenames, allocations of purchase price, allowance for receivables, tax provision and contractual allowances, that affect the amounts reported in the consolidated financial statements and related disclosures. Actual results may differ from these estimates.
Self-Insurance Program
Self-Insurance Program

The Company utilizes a self-insurance plan for its employee group health insurance coverage administered by a third party. Predetermined loss limits have been arranged with an insurance company to minimize the Company’s maximum liability and cash outlay. Accrued expenses include the estimated incurred but unreported costs to settle unpaid claims and estimated future claims. Management believes that the current accrued amounts are sufficient to pay claims arising from self-insurance claims incurred through June 30, 2020.
Restricted Stock
Restricted Stock

Restricted stock issued to employees and directors is subject to continued employment or continued service on the board, respectively. Generally, restrictions on the stock granted to employees lapse in equal annual installments on the following four anniversaries of the date of grant. For those shares granted to directors, the restrictions will lapse in equal quarterly installments during the first year after the date of grant. For those granted to officers, the restrictions will lapse in equal quarterly installments during the four years following the date of grant. Compensation expense for grants of restricted stock is recognized based on the fair value per share on the date of grant amortized over the vesting period. The Company recognizes any forfeitures as they occur. The restricted stock issued is included in basic and diluted shares for the earnings per share computation.
Recently Adopted Accounting Guidance
Recently Adopted Accounting Guidance

In June 2016, the FASB issued ASU 2016-13, Financial Instruments – Credit Losses, which added a new impairment model (known as the current expected credit loss (CECL) model) that is based on expected losses rather than incurred losses. Under the new guidance, an entity recognizes as an allowance its estimate of expected credit losses. The CECL model applies to most debt instruments, including trade receivables. The CECL model does not have a minimum threshold for recognition of impairment losses and entities will need to measure expected credit losses on assets that have a low risk of loss. The standard is required to be applied using the modified retrospective approach with a cumulative-effect adjustment to retained earnings, if any, upon adoption.

The Company has completed the adoption of the standard on January 1, 2020. The financial instruments subject to ASU 2016-13 are the Company’s accounts receivable derived from contracts with customers. A significant portion of the Company’s accounts receivable are from highly-solvent, creditworthy payors including governmental programs such as Medicare and Medicaid, and highly regulated commercial insurers. The Company’s estimate of expected credit losses as of January 1, 2020, using its expected credit loss evaluation process, resulted in no adjustments to the allowance for credit losses and no cumulative-effect adjustment to retained earnings on the adoption date of the standard.

In January 2017, the FASB issued ASU 2017-04, Simplifying the Test for Goodwill Impairment (Topic 350), which eliminates the requirement to calculate the implied fair value of goodwill to measure a goodwill impairment change. ASU 2017-04 is effective prospectively for fiscal years, and the interim periods within those years, beginning after December 15, 2019. The Company has completed the adoption of the standard on January 1, 2020 and there was no impact to goodwill from the Company’s adoption of this change.
Recently Issued Accounting Guidance
Recently Issued Accounting Guidance

In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting. This ASU provides temporary optional expedients and exceptions to the guidance on contract modifications and hedge accounting to ease the financial reporting burdens of the expected market transition from the London Interbank Offered Rate and other interbank offered rates to alternative reference rates. The new guidance was effective upon issuance, and the Company is allowed to elect to apply the amendments prospectively through December 31, 2022. The Company is currently evaluating the impact this standard will have on its combined financial statements.

In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740) – Simplifying the Accounting for Income Taxes (“ASU 2019-12”). The objective of ASU 2019-12 is to simplify the accounting for income taxes by removing certain exceptions to the general principles in Topic 740 and to provide more consistent application to improve the comparability of financial statements. The amendments in this ASU are effective for fiscal years beginning after December 15, 2020, and early adoption is permitted. We are currently evaluating the impact this guidance may have on our consolidated financial statements and related footnote disclosures.
v3.20.2
ACQUISITIONS OF BUSINESSES (Tables)
 6 Months Ended
Jun. 30, 2020
ACQUISITIONS OF BUSINESSES [Abstract]  
Preliminary Purchase Prices Allocation
The purchase price for the 2020 acquisitions has been preliminarily allocated as follows (in thousands):

   
Physical
Therapy
Operations
  
Cash paid, net of cash acquired
  
$
11,633
  
Seller note
    
300
  
Total consideration
  
$
11,933
  
         
Estimated fair value of net tangible assets acquired:
        
Total current assets
  
$
778
  
Total non-current assets
    
400
  
Total liabilities
    
(469
)
Net tangible assets acquired
  
$
709
  
Referral relationships
    
1,600
  
Non-compete
    
750
  
Tradename
    
1,500
  
Goodwill
    
13,845
  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)
    
(6,471
)
   
$
11,933
  

The purchase price for the 2019 acquisitions has been allocated as follows (in thousands):

  
IIPS*
    
Physical
Therapy
Operations
    
Total
  
Cash paid, net of cash acquired
  
$
18,427
    
$
12,170
    
$
30,597
  
Payable to shareholders of seller
  
$
486
    
$
-
      
486
  
Seller note
    
4,000
      
300
      
4,300
  
Total consideration
  
$
22,913
    
$
12,470
    
$
35,383
  
                         
Estimated fair value of net tangible assets acquired:
                        
Total current assets
  
$
1,641
    
$
693
    
$
2,334
  
Total non-current assets
    
878
      
3,019
      
3,897
  
Total liabilities
    
(2,979
)
    
(2,816
)
    
(5,795
)
Net tangible assets acquired
  
$
(460
)
  
$
896
    
$
436
  
Referral relationships
    
3,400
      
2,600
      
6,000
  
Non-compete
    
250
      
270
      
520
  
Tradename
    
1,300
      
740
      
2,040
  
Goodwill
    
18,423
      
14,193
      
32,616
  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)
    
-
      
(6,229
)
    
(6,229
)
   
$
22,913
    
$
12,470
    
$
35,383
  

* Industrial injury prevention services 
v3.20.2
REVENUE RECOGNITION (Tables)
 6 Months Ended
Jun. 30, 2020
REVENUE RECOGNITION [Abstract]  
Disaggregation of Revenue, Categories
The following table details the revenue related to the various categories (in thousands):

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Net patient revenues
  
$
72,279
    
$
113,363
    
$
172,405
    
$
220,013
  
Management contract revenues
    
1,592
      
2,215
      
3,740
      
4,360
  
Other revenues
    
328
      
507
      
895
      
1,043
  
Physical therapy operations
  
$
74,199
    
$
116,085
    
$
177,040
    
$
225,416
  
Industrial injury prevention services revenues
    
9,658
      
10,288
      
19,534
      
17,188
  
   
$
83,857
    
$
126,373
    
$
196,574
    
$
242,604
  
v3.20.2
EARNINGS PER SHARE (Tables)
 6 Months Ended
Jun. 30, 2020
EARNINGS PER SHARE [Abstract]  
Computations of Basic and Diluted Earnings Per Share
In accordance with current accounting guidance, the revaluation of redeemable non-controlling interest (see Footnote 6 – Redeemable Non-Controlling Interest), net of tax, charged directly to retained earnings is included in the earnings per basic and diluted share calculation.  The following table provides a detail of the basic and diluted earnings per share computation (in thousands, except per share data).

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Computation of earnings per share - USPH shareholders:
                        
Net income attributable to USPH shareholders
  
$
10,232
    
$
14,620
    
$
11,248
    
$
23,063
  
Credit (charges) to retained earnings:
                                
Revaluation of redeemable non-controlling interest
    
3,344
      
(5,169
)
    
5,473
      
(9,830
)
Tax effect at statutory rate (federal and state) of 26.25%
    
(878
)
    
1,356
      
(1,437
)
    
2,580
  
   
$
12,698
    
$
10,807
    
$
15,284
    
$
15,813
  
                                 
Earnings per share (basic and diluted)
  
$
0.99
    
$
0.85
    
$
1.19
    
$
1.24
  
                                 
Shares used in computation:
                                
Basic and diluted earnings per share - weighted-average shares
    
12,843
      
12,767
      
12,820
      
12,738
  
v3.20.2
REDEEMABLE NON-CONTROLLING INTEREST (Tables)
 6 Months Ended
Jun. 30, 2020
REDEEMABLE NON-CONTROLLING INTEREST [Abstract]  
Changes in Carrying Amount (Fair Value) of Redeemable Non-Controlling Interest
For the three and six months ended June 30, 2020, the following table details the changes in the carrying amount (fair value) of the redeemable non-controlling interests (in thousands):

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
                         
Beginning balance
  
$
140,498
    
$
137,196
    
$
137,750
    
$
133,943
  
Operating results allocated to redeemable non-controlling interest partners
    
2,996
      
3,378
      
4,792
      
5,773
  
Distributions to redeemable non-controlling interest partners
    
(2,054
)
    
(3,641
)
    
(3,665
)
    
(5,163
)
Changes in the fair value of redeemable non-controlling interest
    
(3,344
)
    
5,169
      
(5,473
)
    
9,830
  
Purchases of redeemable non-controlling interest
    
(1,372
)
    
(2,604
)
    
(3,224
)
    
(4,885
)
Acquired interest
    
-
      
-
      
6,471
      
-
  
Reduction of non-controlling interest due to sale of USPH partnership interest
    
-
      
(6,132
)
    
-
      
(6,132
)
Sales of redeemable non-controlling interest - temporary equity
    
564
      
2,870
      
564
      
2,870
  
Notes receivable related to sales of redeemable non-controlling interest - temporary equity
    
(545
)
    
(2,870
)
    
(545
)
    
(2,870
)
Adjustments in notes receivable related to the the sales of redeemable non-controlling interest - temporary equity
    
(15
)
    
-
      
58
      
-
  
Ending balance
  
$
136,728
    
$
133,366
    
$
136,728
    
$
133,366
  
Carrying Amount of (Fair Value) Redeemable Non-Controlling Interest
The following table categorizes the carrying amount (fair value) of the redeemable non-controlling interests (in thousands):

  
June 30, 2020
    
June 30, 2019
  
             
Contractual time period has lapsed but holder's employment has not been terminated
  
$
72,815
    
$
52,937
  
Contractual time period has not lapsed and holder's employment has not been terminated
    
63,913
      
80,429
  
Holder's employment has terminated and contractual time period has expired
    
-
      
-
  
Holder's employment has terminated and contractual time period has not expired
    
-
      
-
  
   
$
136,728
    
$
133,366
  
v3.20.2
GOODWILL (Tables)
 6 Months Ended
Jun. 30, 2020
GOODWILL [Abstract]  
Changes in Carrying Amount of Goodwill
The changes in the carrying amount of goodwill consisted of the following (in thousands):

   
Six Months Ended
    
Year Ended
  
 
June 30, 2020
    
December 31, 2019
  
             
Beginning balance
  
$
317,676
    
$
293,525
  
Goodwill acquired
    
13,845
      
31,330
  
Goodwill related to partnership interest sold
    
-
      
(7,325
)
Goodwill write-off related to closed clinics
    
(1,859
)
    
-
  
Goodwill adjustments for purchase price allocation of businesses acquired in prior year
    
1,232
      
146
  
Ending balance
  
$
330,894
    
$
317,676
  
v3.20.2
INTANGIBLE ASSETS, NET (Tables)
 6 Months Ended
Jun. 30, 2020
INTANGIBLE ASSETS, NET [Abstract]  
Intangible Assets, Net
Intangible assets, net as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

  
June 30, 2020
    
December 31, 2019
  
Tradenames
  
$
31,490
    
$
32,049
  
Referral relationships, net of accumulated amortization of $13,126 and $11,677, respectively
    
21,517
      
18,367
  
Non-compete agreements, net of accumulated amortization of $5,687 and $5,424, respectively
    
1,888
      
2,172
  
   
$
54,895
    
$
52,588
  
Amortization Expenses
The following table details the amount of amortization expense recorded for intangible assets for the three months and six months ended June 30, 2020 and 2019 (in thousands):

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
Referral relationships
  
$
836
    
$
581
    
$
1,449
    
$
1,114
  
Non-compete agreements
    
87
      
169
      
264
      
338
  
   
$
923
    
$
750
    
$
1,713
    
$
1,452
  
Amortization of Tradename, Referral Relationships and Non-Competition Agreements
Based on the balance of referral relationships and non-compete agreements as of June 30, 2020, the expected amount to be amortized in 2020 and thereafter by year is as follows (in thousands):

Referral Relationships
  
Non-Compete Agreements
  
Years
  
Annual Amount
  
Years
  
Annual Amount
  
Ending December 31,
      
Ending December 31,
      
2020 (excluding the six months ended June 30, 2020)
$
1,369
  
2020 (excluding the six months ended June 30, 2020)
$
300
  
2021
$
2,737
  
2021
$
552
  
2022
$
2,689
  
2022
$
375
  
2023
$
2,581
  
2023
$
305
  
2024
$
2,417
  
2024
$
250
  
Thereafter
$
9,724
  
Thereafter
$
193
  
v3.20.2
ACCRUED EXPENSES (Tables)
 6 Months Ended
Jun. 30, 2020
ACCRUED EXPENSES [Abstract]  
Accrued Expenses
Accrued expenses as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

  
June 30, 2020
    
December 31, 2019
  
Salaries and related costs
  
$
16,809
    
$
19,340
  
Credit balances due to patients and payors
    
6,871
      
4,303
  
Group health insurance claims
    
2,180
      
2,277
  
Closure costs
    
1,987
      
116
  
Federal income taxes payable
    
4,637
      
-
  
MAAPP funds payable
    
12,861
      
-
  
Deferred employer payroll taxes - CARES ACT
    
2,155
      
-
  
Other
    
3,825
      
4,819
  
Total
  
$
51,325
    
$
30,855
  
v3.20.2
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT (Tables)
 6 Months Ended
Jun. 30, 2020
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT [Abstract]  
Credit Agreement and Notes Payable
Amounts outstanding under the Amended Credit Agreement (as defined below) and notes payable as of June 30, 2020 and December 31, 2019 consisted of the following (in thousands):

  
June 30, 2020
    
December 31, 2019
  
Credit Agreement average effective interest rate of 2.3% inclusive of unused fee
  
$
33,000
    
$
46,000
  
Various notes payable with $4,635 plus accrued interest due in the next year, interest accrues in the range of 3.25% through 5.50% per annum
    
5,320
      
5,089
  
   
$
38,320
    
$
51,089
  
Less current portion
    
(4,635
)
    
(728
)
Long term portion
  
$
33,685
    
$
50,361
  
Aggregate Annual Payments of Principal Required to Revolving Credit Facility
Subsequent aggregate annual payments of principal required pursuant to the Amended Credit Agreement and outstanding notes payable at June 30, 2020 are as follows (in thousands):

During the twelve months ended June 30, 2021
  
$
4,635
  
During the twelve months ended June 30, 2022
    
33,642
  
During the twelve months ended June 30, 2023
    
43
  
   
$
38,320
  
v3.20.2
LEASES (Tables)
 6 Months Ended
Jun. 30, 2020
LEASES [Abstract]  
Components of Lease Expense
For the three months and six months ended June 30, 2020, the components of lease expense were as follows (in thousands):

  
Three Months Ended June 30,
    
Six Months Ended June 30,
  
   
2020
    
2019
    
2020
    
2019
  
Operating lease cost
  
$
7,815
    
$
7,708
    
$
15,627
    
$
15,295
  
Short-term lease cost
    
215
      
297
      
509
      
668
  
Variable lease cost
    
1,514
      
1,547
      
3,046
      
3,128
  
Total lease cost *
  
$
9,544
    
$
9,552
    
$
19,182
    
$
19,091
  

* Sublease income was immaterial
Supplemental Information Related to Leases
Supplemental information related to leases was as follows (in thousands):

  
Three Months Ended June 30,
    
Six Months Ended June 30,
  
   
2020
    
2019
    
2020
    
2019
  
                         
Cash paid for amounts included in the measurement of operating lease liabilities (in thousands)
  
$
6,555
    
$
7,686
    
$
14,345
    
$
15,392
  
                                 
Right-of-use assets obtained in exchange for new operating lease liabilities (in thousands) *
  
$
7,535
    
$
8,629
    
$
19,075
    
$
98,514
  

* Includes the right-of-use assets obtained in exchange for lease liabilities of $82.6 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019.
Future Lease Payments for Operating Leases
The aggregate future lease payments for operating leases as of June 30, 2020 were as follows (in thousands):

Fiscal Year
  
Amount
  
2020 (excluding the six months ended June 30, 2020)
  
$
15,568
  
2021
    
26,363
  
2022
    
20,565
  
2023
    
14,968
  
2024
    
9,439
  
2025 and therafter
    
10,288
  
Total lease payments
  
$
97,191
  
Less: imputed  interest
    
6,359
  
Total operating lease liabilities
  
$
90,832
  
Average Lease Terms and Discount Rates
Average lease terms and discount rates were as follows:

  
Three Months Ended
June 30, 2020
    
Six Months Ended
June 30, 2020
  
Weighted-average remaining lease term - Operating leases
  
4.21 Years
    
4.21 Years
  
             
Weighted-average discount rate - Operating leases
    
3.2
%
    
3.2
%
v3.20.2
SEGMENT INFORMATION (Tables)
 6 Months Ended
Jun. 30, 2020
SEGMENT INFORMATION [Abstract]  
Selected Financial Data for Reportable Segments
The following table summarizes selected financial data for the Company’s reportable segments. Prior year results presented herein have been changed to conform to the current presentation.

  
Three Months Ended
    
Six Months Ended
  
   
June 30, 2020
    
June 30, 2019
    
June 30, 2020
    
June 30, 2019
  
   
(in thousands)
    
(in thousands)
  
Net operating revenues:
                        
Physical therapy operations
  
$
74,199
    
$
116,085
    
$
177,040
    
$
225,416
  
Industrial injury prevention services
    
9,658
      
10,288
      
19,534
      
17,188
  
Total Company
  
$
83,857
    
$
126,373
    
$
196,574
    
$
242,604
  
 
                                
Gross profit:
                                
Physical therapy operations (excluding closure costs)
  
$
16,199
    
$
28,433
    
$
33,978
    
$
53,610
  
Industrial injury prevention services
    
3,179
      
3,005
      
4,843
      
4,542
  
 
  
$
19,378
    
$
31,438
    
$
38,821
    
$
58,152
  
Physical therapy operations - closure costs
    
94
      
13
      
3,846
      
9
  
Gross profit
  
$
19,284
    
$
31,425
    
$
34,975
    
$
58,143
  
 
                                
Total assets:
                                
Physical therapy operations
                  
$
534,238
    
$
512,657
  
Industrial injury prevention services
                    
50,780
      
48,188
  
Total Company
                  
$
585,018
    
$
560,845
  
v3.20.2
BASIS OF PRESENTATION AND SIGNIFICANT ACCOUNTING POLICIES (Details)
 3 Months Ended 6 Months Ended 12 Months Ended
Feb. 27, 2020
USD ($)
Clinic
Partnership
Sep. 30, 2019
USD ($)
Installment
Clinic
Apr. 11, 2019
USD ($)
State
Location
Apr. 30, 2018
Business
Jun. 30, 2020
USD ($)
Clinic
State
Mar. 31, 2020
Employee
Jun. 30, 2019
USD ($)
Jun. 30, 2020
USD ($)
Installment
Clinic
Segment
Facility
State
Jun. 30, 2019
USD ($)
Dec. 31, 2019
USD ($)
Partnership
Region
May 02, 2020
Employee
Apr. 30, 2020
USD ($)
Mar. 31, 2017
Basis of Presentation [Abstract]                          
Number of reportable segments | Segment               2          
Percentage of general partnership interest owned               1.00%          
Number of partnerships | Partnership                   4      
Number of closed clinics sold | Clinic         11     11          
Aggregate sale price of clinics               $ 1,100,000          
Cash received related to sale of closed clinics         $ 700,000     700,000          
Note receivable related to sale of closed clinics         $ 400,000     $ 400,000          
Number of installments for note receivable | Installment               2          
Number of clinics operated | Clinic         554     554          
Number of states where clinics are operated | State         39     39          
Number of third party facilities | Facility               29          
Percentage of employees furloughed or terminated           40.00%              
Number of full and part-time workforce | Employee           5,500              
Number of furloughed employees returned | Employee                     750    
Percentage of business operational               90.00%          
Deferment of depositing employer's share social security taxes included in accrued liabilities         $ 2,200,000     $ 2,200,000          
Long-Lived Assets [Abstract]                          
Impairment of long lived assets         0                
Impairment of long lived assets to be disposed of         0                
Goodwill [Abstract]                          
Number of business segments | Segment               1          
Number of regions | Region                   6      
Write-off of goodwill - closed clinics         0   $ 0 $ 1,859,000 $ 0 $ 0      
Income Taxes [Abstract]                          
Unrecognized tax benefit               0          
Accrued interest and penalties associated with any unrecognized tax benefits         0     0          
Interest expense recognized               $ 0          
Segment Reporting [Abstract]                          
Number of operating segments | Segment               2          
Medicare Accelerated and Advance Payments Program [Member]                          
Basis of Presentation [Abstract]                          
Funds received                       $ 12,800,000  
Public Health and Social Services Emergency Fund [Member]                          
Basis of Presentation [Abstract]                          
Funds received         $ 7,900,000     $ 7,900,000          
Clinic Practice [Member]                          
Basis of Presentation [Abstract]                          
Percentage of interest acquired 65.00% 67.00%                      
Number of partnerships | Partnership 4                        
Aggregate purchase price for the acquired clinic practices $ 11,900,000 $ 12,400,000                      
Cash paid for acquisition of interest in clinic 11,600,000 12,100,000                      
Seller note $ 300,000 $ 300,000                      
Percentage of interest accrued 4.75% 5.00%                      
Number of installments | Installment   2                      
Principal installments   $ 150,000                      
Number of businesses acquired | Clinic 4 11                      
IIPS [Member]                          
Basis of Presentation [Abstract]                          
Number of states of network services | State     45                    
Number of onsite client locations | Location     11                    
Percentage of interest acquired     76.00% 65.00%                 55.00%
Aggregate purchase price for the acquired clinic practices     $ 23,600,000                    
Cash paid for acquisition of interest in clinic     18,900,000                    
Seller note   $ 4,000,000.0 $ 4,000,000 [1]                    
Percentage of interest accrued     5.50%                    
Number of businesses merged | Business       2                  
Percentage of combined business interest owned       59.45%                  
Number of businesses acquired | Business       2                  
Employee [Member]                          
Restricted Stock [Abstract]                          
Period in which restrictions lapse on stock granted               4 years          
Director [Member]                          
Restricted Stock [Abstract]                          
Period in which restrictions lapse on stock granted               1 year          
Officer [Member]                          
Restricted Stock [Abstract]                          
Period in which restrictions lapse on stock granted               4 years          
Minimum [Member]                          
Basis of Presentation [Abstract]                          
Percentage of limited partnership interest owned               49.00%          
Percentage of interest acquired                   1.00%      
Redeemable Non-Controlling Interests [Abstract]                          
Redeemable non-controlling interest, redemption rights, commencement period               3 years          
Minimum [Member] | Furniture & Equipment [Member]                          
Long-Lived Assets [Abstract]                          
Estimated useful lives               3 years          
Minimum [Member] | Software [Member]                          
Long-Lived Assets [Abstract]                          
Estimated useful lives               3 years          
Minimum [Member] | Leasehold Improvements [Member]                          
Long-Lived Assets [Abstract]                          
Estimated useful lives               3 years          
Minimum [Member] | Clinic Practice [Member]                          
Basis of Presentation [Abstract]                          
Percentage of interest acquired 10.00%                        
Maximum [Member]                          
Basis of Presentation [Abstract]                          
Percentage of limited partnership interest owned               99.00%          
Percentage of interest acquired                   55.00%      
Redeemable Non-Controlling Interests [Abstract]                          
Redeemable non-controlling interest, redemption rights, commencement period               5 years          
Maximum [Member] | Furniture & Equipment [Member]                          
Long-Lived Assets [Abstract]                          
Estimated useful lives               8 years          
Maximum [Member] | Software [Member]                          
Long-Lived Assets [Abstract]                          
Estimated useful lives               7 years          
Maximum [Member] | Leasehold Improvements [Member]                          
Long-Lived Assets [Abstract]                          
Estimated useful lives               5 years          
Maximum [Member] | Clinic Practice [Member]                          
Basis of Presentation [Abstract]                          
Percentage of interest acquired 83.80%                        
[1] Industrial injury prevention services
v3.20.2
ACQUISITIONS OF BUSINESSES (Details)
 6 Months Ended 12 Months Ended
Feb. 27, 2020
USD ($)
Clinic
Partnership
Sep. 30, 2019
USD ($)
Installment
Clinic
Apr. 11, 2019
USD ($)
State
Location
Apr. 30, 2018
Business
Jun. 30, 2020
USD ($)
Jun. 30, 2019
USD ($)
Dec. 31, 2019
USD ($)
Partnership
Mar. 31, 2017
Business Combination, Description [Abstract]                
Number of partnerships in which interest acquired | Partnership             4  
Cash paid, net of cash acquired         $ 11,633,000 $ 18,239,000    
Estimated fair value of net tangible assets acquired [Abstract]                
Sale of non-controlling interest percentage in partnership one             1.00%  
Tax effect on sale price             $ 196,000  
Minimum [Member]                
Business Combination, Description [Abstract]                
Percentage of interest acquired             1.00%  
Maximum [Member]                
Business Combination, Description [Abstract]                
Percentage of interest acquired             55.00%  
Referral Relationships [Member]                
Estimated fair value of net tangible assets acquired [Abstract]                
Estimated useful lives of acquired intangibles         11 years   11 years  
Non-compete Agreements [Member]                
Estimated fair value of net tangible assets acquired [Abstract]                
Estimated useful lives of acquired intangibles         6 years   6 years  
Physical Therapy Operations [Member]                
Business Combination, Description [Abstract]                
Cash paid, net of cash acquired   $ 12,170,000            
Payable to shareholders of seller   0            
Seller note   300,000            
Total consideration   12,470,000            
Estimated fair value of net tangible assets acquired [Abstract]                
Total current assets   693,000            
Total non-current assets   3,019,000            
Total liabilities   (2,816,000)            
Net tangible assets acquired   896,000            
Referral relationships   2,600,000            
Non-compete   270,000            
Tradename   740,000            
Goodwill   14,193,000            
Fair value of non-controlling interest (classified as redeemable non-controlling interests)   (6,229,000)            
Total consideration   12,470,000            
IIPS [Member]                
Business Combination, Description [Abstract]                
Number of states of network services | State     45          
Number of onsite client locations | Location     11          
Percentage of interest acquired     76.00% 65.00%       55.00%
Number of clinics | Business       2        
Aggregate purchase price for the acquired clinic practices     $ 23,600,000          
Cash paid for acquisition of interest in clinic     $ 18,900,000          
Percentage of interest accrued     5.50%          
Net of cash acquired     $ 700,000          
Cash paid, net of cash acquired [1]     18,427,000          
Payable to shareholders of seller [1]     486,000          
Seller note   $ 4,000,000.0 4,000,000 [1]          
Total consideration [1]     22,913,000          
Estimated fair value of net tangible assets acquired [Abstract]                
Total current assets [1]     1,641,000          
Total non-current assets [1]     878,000          
Total liabilities [1]     (2,979,000)          
Net tangible assets acquired [1]     (460,000)          
Referral relationships [1]     3,400,000          
Non-compete [1]     250,000          
Tradename [1]     1,300,000          
Goodwill [1]     18,423,000          
Fair value of non-controlling interest (classified as redeemable non-controlling interests) [1]     0          
Total consideration [1]     $ 22,913,000          
Clinic Practice [Member]                
Business Combination, Description [Abstract]                
Percentage of interest acquired 65.00% 67.00%            
Number of clinics | Clinic 4 11            
Aggregate purchase price for the acquired clinic practices $ 11,900,000 $ 12,400,000            
Cash paid for acquisition of interest in clinic $ 11,600,000 $ 12,100,000            
Number of installments | Installment   2            
Principal installments   $ 150,000            
Number of partnerships in which interest acquired | Partnership 4              
Percentage of interest accrued 4.75% 5.00%            
Seller note $ 300,000 $ 300,000            
Clinic Practice [Member] | Minimum [Member]                
Business Combination, Description [Abstract]                
Percentage of interest acquired 10.00%              
Clinic Practice [Member] | Maximum [Member]                
Business Combination, Description [Abstract]                
Percentage of interest acquired 83.80%              
Acquisitions [Member]                
Business Combination, Description [Abstract]                
Cash paid, net of cash acquired             $ 30,597,000  
Payable to shareholders of seller             486,000  
Seller note             4,300,000  
Total consideration             35,383,000  
Estimated fair value of net tangible assets acquired [Abstract]                
Total current assets             2,334,000  
Total non-current assets             3,897,000  
Total liabilities             (5,795,000)  
Net tangible assets acquired             436,000  
Referral relationships             6,000,000  
Non-compete             520,000  
Tradename             2,040,000  
Goodwill             32,616,000  
Fair value of non-controlling interest (classified as redeemable non-controlling interests)             (6,229,000)  
Total consideration             $ 35,383,000  
Acquisitions [Member] | Physical Therapy Operations [Member]                
Business Combination, Description [Abstract]                
Cash paid, net of cash acquired $ 11,633,000              
Seller note 300,000              
Total consideration 11,933,000              
Estimated fair value of net tangible assets acquired [Abstract]                
Total current assets 778,000              
Total non-current assets 400,000              
Total liabilities (469,000)              
Net tangible assets acquired 709,000              
Referral relationships 1,600,000              
Non-compete 750,000              
Tradename 1,500,000              
Goodwill 13,845,000              
Fair value of non-controlling interest (classified as redeemable non-controlling interests) (6,471,000)              
Total consideration $ 11,933,000              
[1] Industrial injury prevention services
v3.20.2
REVENUE RECOGNITION (Details) - USD ($)
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Feb. 09, 2018
Nov. 02, 2015
Apr. 01, 2013
Revenue from Contract with Customer, Excluding Assessed Tax [Abstract]              
Revenue related to the various categories $ 83,857,000 $ 126,373,000 $ 196,574,000 $ 242,604,000      
Medicare Reimbursement [Abstract]              
Estimated percentage of decrease in payment     9.00%        
Federal debt ceiling in connection with deficit reductions     10 years        
Reductions in federal spending     $ 1,200,000,000,000        
Medicare spending cut percentage     2.00%        
Expected reduction in Medicare spending percentage         2.00% 2.00% 2.00%
Percentage of payment adjustment temporary suspended     2.00%        
Combined physical therapy/speech language pathology expenses     $ 3,700        
Reduction in combined physical therapy/speech language pathology expenses     $ 3,000        
Percentage of practice expense component     100.00%        
Percentage reduction for service     50.00%        
Percentage of payment for outpatient therapy services     85.00%        
Net patient revenue from Medicare accounts     $ 44,400,000 59,400,000      
Contractual Allowances [Abstract]              
Difference between net revenues and corresponding cash collections, approximately of net revenues     1.00%        
Difference between actual aggregate contractual reserve and estimated contractual allowance reserve percentage     1.00%        
Maximum contractual allowance reserve estimate     1.00%        
Year 2017 [Member] | Maximum [Member]              
Medicare Reimbursement [Abstract]              
Annual limit on physical therapy and speech language pathology services     $ 1,980        
Annual limit occupational therapy services     $ 1,980        
Year 2018 [Member]              
Medicare Reimbursement [Abstract]              
Percentage of increase in Medicare payment rates     0.50%        
Year 2019 [Member]              
Medicare Reimbursement [Abstract]              
Percentage of increase in Medicare payment rates     0.25%        
From 2019 through 2024 [Member]              
Medicare Reimbursement [Abstract]              
Percentage of bonus payment by APM     5.00%        
From 2020 through 2025 [Member]              
Medicare Reimbursement [Abstract]              
Percentage of increase in Medicare payment rates     0.00%        
Net Patient Revenues [Member]              
Revenue from Contract with Customer, Excluding Assessed Tax [Abstract]              
Revenue related to the various categories 72,279,000 113,363,000 $ 172,405,000 220,013,000      
Management Contract Revenues [Member]              
Revenue from Contract with Customer, Excluding Assessed Tax [Abstract]              
Revenue related to the various categories 1,592,000 2,215,000 3,740,000 4,360,000      
Other Revenues [Member]              
Revenue from Contract with Customer, Excluding Assessed Tax [Abstract]              
Revenue related to the various categories 328,000 507,000 895,000 1,043,000      
Physical Therapy Operations [Member]              
Revenue from Contract with Customer, Excluding Assessed Tax [Abstract]              
Revenue related to the various categories 74,199,000 116,085,000 177,040,000 225,416,000      
Industrial Injury Prevention Services Revenues [Member]              
Revenue from Contract with Customer, Excluding Assessed Tax [Abstract]              
Revenue related to the various categories $ 9,658,000 $ 10,288,000 $ 19,534,000 $ 17,188,000      
v3.20.2
OTHER INCOME (Details)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
USD ($)
Clinic
Jun. 30, 2019
USD ($)
Jun. 30, 2020
USD ($)
Clinic
Jun. 30, 2019
USD ($)
Other Income [Abstract]        
Gain on sale of closed clinics $ 1,100      
Number of clinics closed | Clinic 11   11  
Relief funds received $ 7,959 $ 0 $ 7,959 $ 0
Public Health and Social Services Emergency Fund [Member]        
Other Income [Abstract]        
Relief funds received     $ 7,900  
v3.20.2
EARNINGS PER SHARE (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Computation of earnings per share - USPH shareholders [Abstract]        
Net income attributable to USPH shareholders $ 10,232 $ 14,620 $ 11,248 $ 23,063
Credit (charges) to retained earnings [Abstract]        
Revaluation of redeemable non-controlling interest 3,344 (5,169) 5,473 (9,830)
Tax effect at statutory rate (federal and state) of 26.25% (878) 1,356 (1,437) 2,580
Net income attributable to common shareholders $ 12,698 $ 10,807 $ 15,284 $ 15,813
Earnings per share (basic and diluted) (in dollars per share) $ 0.99 $ 0.85 $ 1.19 $ 1.24
Shares used in computation [Abstract]        
Basic and diluted earnings per share - weighted-average shares (in shares) 12,843 12,767 12,820 12,738
Federal and state statutory income tax rate     26.25%  
v3.20.2
REDEEMABLE NON-CONTROLLING INTEREST (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Changes in Carrying Amount of Redeemable Non-Controlling Interests [Roll Forward]            
Beginning balance     $ 137,750      
Operating results allocated to redeemable non-controlling interest partners $ 2,996 $ 3,378 4,792 $ 5,773    
Ending balance 136,728   136,728      
Carrying Amount (Fair Value) of Redeemable Non-Controlling Interest [Abstract]            
Fair value 136,728   137,750   $ 136,728  
Redeemable Non-Controlling Interest [Member]            
Changes in Carrying Amount of Redeemable Non-Controlling Interests [Roll Forward]            
Beginning balance 140,498 137,196 137,750 133,943    
Operating results allocated to redeemable non-controlling interest partners 2,996 3,378 4,792 5,773    
Distributions to redeemable non-controlling interest partners (2,054) (3,641) (3,665) (5,163)    
Changes in the fair value of redeemable non-controlling interest (3,344) 5,169 (5,473) 9,830    
Purchases of redeemable non-controlling interest (1,372) (2,604) (3,224) (4,885)    
Acquired interest 0 0 6,471 0    
Reduction of non-controlling interest due to sale of USPH partnership interest 0 (6,132) 0 (6,132)    
Sales of redeemable non-controlling interest - temporary equity 564 2,870 564 2,870    
Notes receivable related to sales of redeemable non-controlling interest - temporary equity (545) (2,870) (545) (2,870)    
Adjustments in notes receivable related to the sales of redeemable non-controlling interest - temporary equity (15) 0 58 0    
Ending balance 136,728 133,366 136,728 133,366    
Carrying Amount (Fair Value) of Redeemable Non-Controlling Interest [Abstract]            
Contractual time period has lapsed but holder's employment has not been terminated         72,815 $ 52,937
Contractual time period has not lapsed and holder's employment has not been terminated         63,913 80,429
Holder's employment has terminated and contractual time period has expired         0 0
Holder's employment has terminated and contractual time period has not expired         0 0
Fair value $ 136,728 $ 133,366 $ 136,728 $ 133,366 $ 136,728 $ 133,366
Therapy Practice [Member] | Minimum [Member]            
Business Combination, Description [Abstract]            
Business acquisition, percentage of limited partnership acquired         50.00%  
Therapy Practice [Member] | Maximum [Member]            
Business Combination, Description [Abstract]            
Business acquisition, percentage of limited partnership acquired         90.00%  
Therapy Practice [Member] | NewCo. [Member]            
Business Combination, Description [Abstract]            
Percentage of equity interest of subsidiary contributed for acquisition         100.00%  
Business acquisition, percentage of general partnership interest acquired         100.00%  
Business acquisition, consideration payable, term of note     2 years      
Employment agreement renewal term     1 year      
Non-Compete agreement term under condition of termination of employment of employed selling shareholder     2 years      
Therapy Practice [Member] | NewCo. [Member] | Minimum [Member]            
Business Combination, Description [Abstract]            
Employment agreement term     3 years      
Non-Compete agreement term regardless of whether the selling shareholder is employed     5 years      
Therapy Practice [Member] | NewCo. [Member] | Maximum [Member]            
Business Combination, Description [Abstract]            
Employment agreement term     5 years      
Non-Compete agreement term regardless of whether the selling shareholder is employed     6 years      
v3.20.2
GOODWILL (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended 12 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Dec. 31, 2019
Goodwill [Roll Forward]          
Beginning balance     $ 317,676 $ 293,525 $ 293,525
Goodwill acquired     13,845   31,330
Goodwill related to partnership interest sold     0   (7,325)
Goodwill write-off related to closed clinics $ 0 $ 0 (1,859) $ 0 0
Goodwill adjustments for purchase price allocation of businesses acquired in prior year     1,232   146
Ending balance $ 330,894   $ 330,894   $ 317,676
v3.20.2
INTANGIBLE ASSETS, NET - Intangible Assets, Net (Details) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2020
Dec. 31, 2019
Finite-Lived Intangible Assets, Net [Abstract]    
Total $ 54,895 $ 52,588
Tradenames [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Total 31,490 32,049
Referral Relationships [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Total 21,517 18,367
Accumulated amortization $ 13,126 11,677
Referral Relationships [Member] | Minimum [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated useful life 6 years  
Referral Relationships [Member] | Maximum [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated useful life 16 years  
Non-compete Agreements [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Total $ 1,888 2,172
Accumulated amortization $ 5,687 $ 5,424
Non-compete Agreements [Member] | Minimum [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated useful life 5 years  
Non-compete Agreements [Member] | Maximum [Member]    
Finite-Lived Intangible Assets, Net [Abstract]    
Estimated useful life 6 years  
v3.20.2
INTANGIBLE ASSETS, NET - Amortization Expenses (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Amortization of Deferred Charges [Abstract]        
Total amortization expenses $ 923 $ 750 $ 1,713 $ 1,452
Referral Relationships [Member]        
Amortization of Deferred Charges [Abstract]        
Total amortization expenses 836 581 1,449 1,114
Non-compete Agreements [Member]        
Amortization of Deferred Charges [Abstract]        
Total amortization expenses $ 87 $ 169 $ 264 $ 338
v3.20.2
INTANGIBLE ASSETS, NET - Amortization of Referral Relationships and Non-Competition Agreements (Details)
$ in Thousands
Jun. 30, 2020
USD ($)
Referral Relationships [Member]  
Finite-Lived Intangible Assets, Amortization Expense, Maturity [Abstract]  
2020 (excluding the six months ended June 30, 2020) $ 1,369
2021 2,737
2022 2,689
2023 2,581
2024 2,417
Thereafter 9,724
Non-compete Agreements [Member]  
Finite-Lived Intangible Assets, Amortization Expense, Maturity [Abstract]  
2020 (excluding the six months ended June 30, 2020) 300
2021 552
2022 375
2023 305
2024 250
Thereafter $ 193
v3.20.2
ACCRUED EXPENSES (Details) - USD ($)
$ in Thousands
Jun. 30, 2020
Dec. 31, 2019
Payables and Accruals [Abstract]    
Salaries and related costs $ 16,809 $ 19,340
Credit balances due to patients and payors 6,871 4,303
Group health insurance claims 2,180 2,277
Closure costs 1,987 116
Federal income taxes payable 4,637 0
MAAPP Funds Payable 12,861 0
Deferred employer payroll taxes - CARES ACT 2,155 0
Other 3,825 4,819
Total $ 51,325 $ 30,855
v3.20.2
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT - Summary of Notes Payable and Credit Agreement (Details) - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2020
Dec. 31, 2019
Debt Instruments [Abstract]    
Payments/Long term debt, Total $ 38,320 $ 51,089
Less current portion (4,635) (728)
Long term portion 33,685 50,361
Credit Facility [Member]    
Debt Instruments [Abstract]    
Payments/Long term debt, Total $ 33,000 46,000
Average effective interest rate 2.30%  
3.25% through 5.50% Notes Payable due in Next Year [Member]    
Debt Instruments [Abstract]    
Payments/Long term debt, Total $ 5,320 $ 5,089
Annual installments $ 4,635  
3.25% through 5.50% Notes Payable due in Next Year [Member] | Minimum [Member]    
Debt Instruments [Abstract]    
Percentage of interest accrued 3.25%  
3.25% through 5.50% Notes Payable due in Next Year [Member] | Maximum [Member]    
Debt Instruments [Abstract]    
Percentage of interest accrued 5.50%  
v3.20.2
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT (Details) - USD ($)
 1 Months Ended 3 Months Ended 6 Months Ended
Nov. 30, 2017
Mar. 31, 2017
Jan. 31, 2016
Jun. 30, 2020
Jun. 30, 2020
Dec. 05, 2013
Debt Instruments [Abstract]            
Aggregate principal payment due in 2022       $ 4,635,000 $ 4,635,000  
Notes Payable [Member]            
Debt Instruments [Abstract]            
Seller note       $ 300,000 $ 300,000  
Percentage of interest accrued       4.75% 4.75%  
Aggregate amount of notes payable       $ 4,800,000 $ 4,800,000  
Aggregate principal payment due in 2021       4,600,000 4,600,000  
Aggregate principal payment due in 2022       200,000 200,000  
Notes Payable [Member] | Redeemable Non-Controlling Interest [Member]            
Debt Instruments [Abstract]            
Seller note       $ 200,000 $ 200,000  
Minimum [Member]            
Debt Instruments [Abstract]            
Spread on Libor variable rate       1.25% 1.25%  
Spread on variable rate         0.10%  
Percentage of unused commitment fee         0.25%  
Minimum [Member] | Notes Payable [Member]            
Debt Instruments [Abstract]            
Average effective interest rate       3.25%    
Maximum [Member]            
Debt Instruments [Abstract]            
Spread on Libor variable rate       2.00% 2.00%  
Spread on variable rate         1.00%  
Percentage of unused commitment fee         0.30%  
Maximum [Member] | Notes Payable [Member]            
Debt Instruments [Abstract]            
Average effective interest rate       5.50%    
Credit Facility [Member]            
Debt Instruments [Abstract]            
Revolving credit facility commitment           $ 125,000,000.0
Revolving credit facility maturity date         Nov. 30, 2021  
Remaining revolving credit outstanding       $ 92,000,000.0 $ 92,000,000.0  
Average effective interest rate         2.30%  
Credit Agreement [Member]            
Debt Instruments [Abstract]            
Cash and noncash consideration with respect to acquisition after amendment     $ 50,000,000.0      
Credit Agreement [Member] | Maximum [Member]            
Debt Instruments [Abstract]            
Cash dividends after amendment $ 20,000,000.0 $ 15,000,000.0 $ 10,000,000.0      
v3.20.2
NOTES PAYABLE AND AMENDED CREDIT AGREEMENT- Summary of Aggregate Annual Payments of Principal Required to Revolving Credit Facility (Details) - USD ($)
$ in Thousands
Jun. 30, 2020
Dec. 31, 2019
Long Term Debt By Maturity [Abstract]    
During the twelve months ended June 30, 2021 $ 4,635  
During the twelve months ended June 30, 2022 33,642  
During the twelve months ended June 30, 2023 43  
Payments/Long term debt, Total $ 38,320 $ 51,089
v3.20.2
LEASES (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Components of Lease Expense [Abstract]        
Operating lease cost $ 7,815 $ 7,708 $ 15,627 $ 15,295
Short-term lease cost 215 297 509 668
Variable lease cost 1,514 1,547 3,046 3,128
Total lease cost [1] 9,544 9,552 19,182 19,091
Supplemental Information Related to Leases [Abstract]        
Cash paid for amounts included in the measurement of operating lease liabilities 6,555 7,686 14,345 15,392
Right-of-use assets obtained in exchange for new operating lease liabilities [2] 7,535 $ 8,629 19,075 $ 98,514
Future Lease Payments for Operating Leases [Abstract]        
2020 (excluding the six months ended June 30, 2020) 15,568   15,568  
2021 26,363   26,363  
2022 20,565   20,565  
2023 14,968   14,968  
2024 9,439   9,439  
2025 and thereafter 10,288   10,288  
Total lease payments 97,191   97,191  
Less: imputed interest 6,359   6,359  
Total operating lease liabilities $ 90,832   $ 90,832  
Average Lease Terms and Discount Rates [Abstract]        
Weighted-average remaining lease term - Operating leases 4 years 2 months 15 days   4 years 2 months 15 days  
Weighted-average discount rate - Operating leases 3.20%   3.20%  
ASU 2016-02 [Member]        
Future Lease Payments for Operating Leases [Abstract]        
Total operating lease liabilities $ 82,600   $ 82,600  
Maximum [Member]        
Operating Lease [Abstract]        
Lease term 5 years   5 years  
[1] Sublease income was immaterial
[2] Includes the right-of-use assets obtained in exchange for lease liabilities of $82.6 million which were recognized upon adoption of ASC Topic 842 at January 1, 2019.
v3.20.2
SEGMENT INFORMATION (Details) - USD ($)
$ in Thousands
 3 Months Ended 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Jun. 30, 2020
Jun. 30, 2019
Dec. 31, 2019
Segment Information [Abstract]          
Net operating revenues $ 83,857 $ 126,373 $ 196,574 $ 242,604  
Gross profit 19,284 31,425 34,975 58,143  
Closure costs 94 13 1,987 9  
Total assets 585,018 560,845 585,018 560,845 $ 560,845
Reportable Segments [Member]          
Segment Information [Abstract]          
Gross profit 19,378 31,438 38,821 58,152  
Reportable Segments [Member] | Physical Therapy Operations [Member]          
Segment Information [Abstract]          
Net operating revenues 74,199 116,085 177,040 225,416  
Closure costs 94 13 3,846 9  
Total assets 534,238 512,657 534,238 512,657  
Reportable Segments [Member] | Industrial Injury Prevention Services [Member]          
Segment Information [Abstract]          
Net operating revenues 9,658 10,288 19,534 17,188  
Gross profit 3,179 3,005 4,843 4,542  
Total assets 50,780 48,188 50,780 48,188  
Reportable Segments [Member] | Physical Therapy Operations (Excluding Closure Costs) [Member]          
Segment Information [Abstract]          
Gross profit $ 16,199 $ 28,433 $ 33,978 $ 53,610  
v3.20.2
COMMON STOCK (Details) - USD ($)
 1 Months Ended 6 Months Ended
Mar. 31, 2009
Jun. 30, 2020
Dec. 31, 2008
Class of Treasury Stock [Abstract]      
Common stock authorized by the Board of Directors (in shares) 1,200,000   2,250,000
Total purchased shares (in shares) 859,499 0  
Additional estimated shares (in shares)   185,139  
Closing price (in dollars per share)   $ 81.02  
Maximum [Member]      
Class of Treasury Stock [Abstract]      
Percentage of repurchase of common stock 10.00%    
Bank credit agreement to permit share repurchases of common stock $ 15,000,000