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Nutex Health Reports Fourth Quarter And Full Year 2022 Financial Results

March 02, 2023 | Last Trade: US$30.28 1.49 -4.69
  • TOTAL REVENUE OF $219.3 MILLION FOR THE YEAR ENDED 2022
  • NET CASH FROM OPERATING ACTIVITIES OF $50.6 MILLION FOR THE YEAR ENDED 2022
  • COMPANY EXPECTS TO OPEN 19 NEW FACILITIES BY MID-2025

HOUSTON, March 2, 2023 /PRNewswire/ -- Nutex Health Inc. ("Nutex Health" or the "Company") (NASDAQ: NUTX), a physician-led, technology-enabled integrated healthcare delivery system comprised of 19 state-of-the-art micro hospitals in 8 states and primary care-centric, risk-bearing physician networks, today announced fourth quarter and fiscal year 2022 financial results for the twelve months ended December 31, 2022.

Financial Highlights for the Year Ended December 31, 2022:

  • Total revenue of $219.3 million.
  • Net loss attributable to Nutex Health Inc. of $424.8 million. In Q3, the Company recognized a one-time non-cash impairment charge of $398.1 million to reduce the carrying amount of goodwill representing the excess over fair value of the assets acquired in the reverse business combination. Please read "Management's Discussion and Analysis of Financial Condition and Results of Operations" in our 10-K.
  • Adjusted EBITDA of $12.5 million.
  • Net cash from operating activities of $50.6 million.
  • As of December 31, 2022, the Company had total assets of $431.8 million, including cash and cash equivalents of $34.3 million.

Financial Highlights for the Three Months Ended December 31, 2022:

  • Total revenue of $53.7 million.
  • Net loss attributable to Nutex Health of $14.7 million.
  • Adjusted EBITDA of ($5.9) million.
  • Net cash from operating activities of $4.5 million.

Note:  EBITDA and Adjusted EBITDA are non-GAAP financial metrics.  A reconciliation of non-GAAP to GAAP measures is included below in this earnings release.

"Several factors affected our operating and financial results in 2022, including a significant non-cash goodwill impairment charge recognized in our third quarter, lower net revenue per patient visit due to the No Surprises Act and lower patient volumes due to fewer Covid-related visits," stated Jon Bates, Chief Financial Officer of Nutex Health. 

"We had a challenging 2022 but emerged as a stronger organization.  Looking forward, we remain focused on strategic and operating initiatives that we believe will yield positive results in the future.  First, we have solidified our revenue cycle management efforts specifically to cope with the IDR process related to NSA.  Second, we are increasing efforts to collect co-pays and co-insurance.  Third, we are making efforts to sign favorable contracts with insurers.  Fourth, we are accelerating contracting with local physicians to join our IPAs. Fifth, we are ramping up our marketing efforts. And finally, our Board has started a portfolio rationalization initiative to review a few underperforming facilities," stated Tom Vo, M.D., MBA, Chairman and Chief Executive Officer of Nutex Health.

"We are intensely focused on executing on our long-term growth strategy.  On the micro-hospital side, one new facility went operational about three weeks ago.  We expect to open 5-6 more facilities this year, then 7-8 new facilities in 2024 and at least 5 more in 2025.  On the independent practice association ("IPA") side, we are happy to report that over 45 primary care physicians have joined our IPA in Houston, over 25 have joined in South Florida and we are just getting underway in Phoenix.  We also plan to increase our investor relations efforts in 2023 by attending more healthcare investor conferences.  We would also like to note that we now have two banking analysts covering our Company and stock," stated Warren Hosseinion, M.D., President of Nutex Health.

Notes to the Financial Highlights for the Twelve Months Ended December 31, 2022:

  • Nutex Health recognized a one-time non-cash goodwill impairment charge of $398.1 million in Q3 to reduce the carrying amount of goodwill representing the excess over fair value of the assets acquired in the reverse business combination.
  • The Company recognized a one-time non-cash charge of $18.4 million, net to income tax expense during the three months ended June 30, 2022 for the change in tax status of Nutex Health Holdco LLC and release of acquired valuation allowance for Clinigence. Prior to the merger with Clinigence, Nutex Health Holdco LLC and the Nutex Subsidiaries were pass-through entities treated as partnerships for U.S. federal income tax purposes. No provision for federal income taxes was provided for these periods as federal taxes were obligations of these companies' members. After the merger, Nutex Health Holdco LLC became a wholly-owned subsidiary of Clinigence and will be included in its future consolidated corporate tax filings.
  • In our experience to date with the No Surprises Act ("NSA"), insurers often initially pay amounts lower than the Qualifying Payment Amount ("QPA") which generally is the median in-network amount paid by the insurer without regard for other information relevant to the claim. This requires us to make appeals using the Independent Dispute Resolution ("IDR") process. We are working within the established processes for the IDR and are having varying success at achieving collections higher than the established QPA. The NSA final rule, which became effective on October 25, 2022, is the subject of multiple legal challenges. It is difficult to predict the outcome of efforts to challenge or amend the final rule. Please read "Management's Discussion and Analysis of Financial Condition and Results of Operations" in our 10-Q.
  • On February 6, 2023, a Federal judge in Texas handed another win to the Texas Medical Association ("TMA") and medical providers nationwide against the Department of Health and Human Services ("HHS") over a challenge to the arbitration process between out-of-network providers and insurers that was established under the No Surprises Act. The judge vacated all of the revised regulations challenged by the TMA, including the HHS's rule that arbitrators must primarily consider the QPA.
  • In the three months ended September 30, 2022, we reduced our estimate of the ultimate amounts of accounts receivable we will collect for prior periods due to the NSA. This change in estimate reduced revenue for the three months ended September 30, 2022 by approximately $29 million. Similar changes in estimates made in the first half of 2022 reduced accounts receivable and revenue by approximately $9.6 million.
  • The Company anticipates opening 19 new facilities by mid-2025. These facilities are either under construction or in advanced planning stages. There can be no assurance that these new facilities will open in the anticipated timeframes or that they will open at all.
  • The Company has a committed investment agreement for up to $100 million with Lincoln Park Capital which it has not used yet.

For more details on the Company's Fourth Quarter and Fiscal Year 2022 financial results, please refer to our Annual Report on Form 10-K filed with the U.S. Securities & Exchange Commission and accessible at www.sec.gov.

NUTEX HEALTH INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

       
  

December 31, 

  

2022

 

2021

Assets

      

Current assets:

      

Cash and cash equivalents

 

$

34,255,264

 

$

36,118,284

Accounts receivable

  

57,777,386

  

112,766,317

Accounts receivable - related parties

  

538,183

  

1,993,117

Inventories

  

3,533,285

  

2,814,178

Prepaid expenses and other current assets

  

1,869,806

  

323,283

Total current assets

  

97,973,924

  

154,015,179

Property and equipment, net

  

82,094,352

  

151,912,500

Operating right-of-use assets

  

20,466,632

  

21,829,552

Financing right-of-use assets

  

192,591,624

  

64,614,781

Intangible assets, net

  

21,191,390

  

682,649

Goodwill, net

  

17,010,637

  

1,139,297

Other assets

  

423,426

  

456,085

       

Total assets

 

$

431,751,985

 

$

394,650,043

       

Liabilities and Equity

      

Current liabilities:

      

Accounts payable

 

$

23,614,387

 

$

13,582,664

Accounts payable - related parties

  

3,915,661

  

4,070,438

Lines of credit

  

2,623,479

  

72,055

Current portion of long-term debt

  

12,546,097

  

10,158,932

Operating lease liabilities, current portion

  

1,703,014

  

1,489,997

Financing lease liabilities, current portion

  

4,219,518

  

1,452,447

Accrued expenses and other current liabilities

  

6,240,813

  

6,864,426

Total current liabilities

  

54,862,969

  

37,690,959

Long-term debt, net

  

23,051,152

  

78,821,985

Operating lease liabilities, net

  

19,438,497

  

20,820,588

Financing lease liabilities, net

  

203,619,756

  

65,735,501

Deferred tax liabilities

  

10,452,211

  

-

Total liabilities

  

311,424,585

  

203,069,033

       

Commitments and contingencies

      
       

Equity:

      

Common stock, $0.001 par value; 900,000,000 shares authorized; 650,223,840 and 592,791,712 shares issued and outstanding as of December 31, 2022 and 2021, respectively

  

650,224

  

592,792

Additional paid-in capital

  

458,498,402

  

11,742,891

Retained earnings (accumulated deficit)

  

(363,285,925)

  

102,315,623

Nutex Health Inc. equity

  

95,862,701

  

114,651,306

Noncontrolling interests

  

24,464,699

  

76,929,704

Total equity

  

120,327,400

  

191,581,010

       

Total liabilities and equity

 

$

431,751,985

 

$

394,650,043

NUTEX HEALTH INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

             
  

Three months ended December 31

 

Year ended December 31

  

2022

 

2021

 

2022

 

2021

  

Unaudited

      

Revenue:

            

Hospital division

 

$

46,532,019

 

$

63,401,665

 

$

198,508,245

 

$

331,531,311

Population health management division

  

7,192,054

  

-

  

20,786,061

  

-

Total revenue

  

53,724,073

  

63,401,665

  

219,294,306

  

331,531,311

             

Operating costs and expenses:

            

Payroll

  

26,466,650

  

27,204,359

  

102,892,734

  

86,349,088

Contract services

  

9,809,286

  

5,554,599

  

37,567,131

  

17,050,957

Medical supplies

  

2,791,779

  

2,598,746

  

12,118,893

  

12,514,367

Insurance expense

  

2,284,377

  

970,241

  

9,718,723

  

7,643,224

Depreciation and amortization

  

3,271,861

  

1,789,025

  

13,131,374

  

7,662,464

Other

  

8,569,796

  

5,799,380

  

30,413,069

  

21,030,253

Total operating costs and expenses

  

53,193,749

  

43,916,350

  

205,841,924

  

152,250,353

             

Gross profit

  

530,324

  

19,485,315

  

13,452,382

  

179,280,958

             

Corporate and other costs:

            

Acquisition costs

  

-

  

3,553,716

  

3,885,666

  

3,553,716

Impairment of goodwill

  

-

  

-

  

398,135,038

  

-

General and administrative expenses

  

6,309,235

  

394,619

  

18,030,832

  

5,462,344

Total corporate and other costs

  

6,309,235

  

3,948,335

  

420,051,536

  

9,016,060

             

Operating income (loss)

  

(5,778,911)

  

15,536,980

  

(406,599,154)

  

170,264,898

             

Interest expense, net

  

2,862,071

  

1,944,749

  

12,490,260

  

6,196,026

Other expense (income)

  

212,426

  

244,489

  

559,299

  

(5,422,144)

Income (loss) before taxes

  

(8,853,408)

  

13,347,742

  

(419,648,713)

  

169,491,016

             

Income tax expense (benefit)

  

1,805,176

  

(126,244)

  

13,090,905

  

965,731

             

Net income (loss)

  

(10,658,584)

  

13,473,986

  

(432,739,618)

  

168,525,285

             

Less: net income (loss) attributable to noncontrolling interests

  

4,093,593

  

(504,528)

  

(7,959,172)

  

35,931,957

             

Net income (loss) attributable to Nutex Health Inc.

 

$

(14,752,177)

 

$

13,978,514

 

$

(424,780,446)

 

$

132,593,328

             

Earnings (loss) per common share

            

Basic

  

(0.02)

  

0.02

  

(0.67)

  

0.22

Diluted

  

(0.02)

  

0.02

  

(0.67)

  

0.22

NUTEX HEALTH INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

          
  

Year ended December 31, 

  

2022

 

2021

 

2020

Cash flows from operating activities:

         

Net income (loss)

 

$

(432,739,618)

 

$

168,525,285

 

$

145,557,894

Adjustment to reconcile net income (loss) to net cash from operating activities:

         

Depreciation and amortization

  

13,131,374

  

7,662,464

  

5,898,361

Amortization of debt issuance costs

  

50,354

  

-

  

-

Impairment of goodwill

  

398,135,038

  

-

  

-

Stock-based compensation expense

  

189,581

  

-

  

-

Rescission of warrant exercise expense

  

561,651

  

-

  

-

Other income - gain on PPP loan forgiveness

  

-

  

(5,546,597)

  

-

Deferred tax expense

  

4,996,209

  

-

  

-

Debt accretion expense

  

1,902,475

  

50,273

  

62,405

(Gain) loss on lease termination

  

-

  

(109,494)

  

1,118,303

Non-cash lease expense

  

64,143

  

97,578

  

58,241

Changes in operating assets and liabilities:

         

Accounts receivable

  

56,622,133

  

(5,392,614)

  

(71,234,706)

Accounts receivable - related party

  

1,454,934

  

(1,229,940)

  

-

Inventories

  

(719,107)

  

(1,088,489)

  

(825,773)

Prepaid expenses and other current assets

  

(1,419,139)

  

(233,114)

  

533,294

Accounts payable

  

10,018,100

  

6,365,978

  

3,826,271

Accounts payable - related party

  

(329,155)

  

(97,985)

  

2,404,307

Accrued expenses and other current liabilities

  

(1,311,865)

  

4,429,141

  

(726,840)

Net cash from operating activities

  

50,607,108

  

173,432,486

  

86,671,757

          

Cash flows from investing activities:

         

Acquisitions of property and equipment

  

(14,632,414)

  

(36,926,591)

  

(61,188,768)

Acquired cash in reverse acquisition with Clinigence

  

12,716,228

  

-

  

-

Cash related to deconsolidation of Real Estates Entities

  

(2,421,212)

  

(48,853)

  

-

Net cash from investing activities

  

(4,337,398)

  

(36,975,444)

  

(61,188,768)

          

Cash flows from financing activities:

         

Proceeds from lines of credit

  

2,623,479

  

-

  

1,000,000

Proceeds from notes payable

  

815,881

  

19,614,372

  

57,172,769

Repayments of lines of credit

  

(72,055)

  

(864,659)

  

(2,666,656)

Repayments of notes payable

  

(7,237,094)

  

(20,715,235)

  

(12,687,903)

Repayments of finance leases

  

(1,721,224)

  

(1,255,486)

  

(1,552,942)

Payment of debt issuance costs

  

-

  

(47,875)

  

(213,588)

Rescission of warrant exercise

  

(588,042)

  

-

  

-

Common stock issued for exercise of warrants

  

4,119,141

  

-

  

-

Common stock issued for exercise of options

  

644,974

  

-

  

-

Members' contributions

  

4,513,867

  

21,753,773

  

10,026,621

Members' distributions

  

(51,231,657)

  

(144,337,923)

  

(59,051,265)

Net cash from financing activities

  

(48,132,730)

  

(125,853,033)

  

(7,972,964)

Net change in cash and cash equivalents

  

(1,863,020)

  

10,604,009

  

17,510,025

Cash and cash equivalents - beginning of the year

  

36,118,284

  

25,514,275

  

8,004,250

Cash and cash equivalents - end of the year

 

$

34,255,264

 

$

36,118,284

 

$

25,514,275

Non-GAAP Financial Measures

Adjusted EBITDA. Adjusted EBITDA is used as a supplemental non-GAAP financial measure by management and external users of our financial statements, such as industry analysts, investors, lenders and rating agencies. We believe Adjusted EBITDA is useful because it allows us to more effectively evaluate our operating performance.

We define Adjusted EBITDA as net income (loss) attributable to Nutex Health Inc. plus net interest expense, income taxes, depreciation and amortization, further adjusted for stock-based compensation, certain defined items of expense, any acquisition-related costs and impairments. A reconciliation of net income to Adjusted EBITDA is included below. Adjusted EBITDA is not intended to serve as an alternative to U.S. GAAP measures of performance and may not be comparable to similarly-titled measures presented by other companies.

          
  

Year ended December 31, 

  

2022

 

2021

 

2020

Reconciliation of net income (loss) attributable to Nutex Health Inc. to Adjusted EBITDA:

         

Net income (loss) attributable to Nutex Health Inc.

 

$

(424,780,446)

 

$

132,593,328

 

$

105,969,885

Depreciation and amortization

  

13,131,374

  

7,662,464

  

5,898,361

Interest expense, net

  

12,490,260

  

6,196,026

  

6,432,941

Income tax expense

  

13,090,905

  

965,731

  

181,341

Allocation to noncontrolling interests

  

(4,837,514)

  

(5,751,066)

  

(3,615,787)

EBITDA

  

(390,905,421)

  

141,666,483

  

114,866,741

Stock-based compensation expense

  

189,581

  

-

  

-

Rescission of warrant exercise

  

1,243,059

  

-

  

-

Impairment of goodwill

  

398,135,038

  

-

  

-

Acquisition costs

  

3,885,666

  

3,553,716

  

-

Adjusted EBITDA

 

$

12,547,923

 

$

145,220,199

 

$

114,866,741

    
  

3 months Ended

  

December 31, 2022

Reconciliation of net income (loss) attributable to Nutex Health Inc. to Adjusted EBITDA:

   

Net loss attributable to Nutex Health Inc.

 

$

(14,752,177)

Depreciation and amortization

  

3,271,861

Interest expense, net

  

2,862,071

Income tax expense

  

1,805,176

Allocation to noncontrolling interests

  

(392,290)

EBITDA

  

(7,205,359)

Stock-based compensation expense

  

54,166

Rescission of warrant exercise

  

1,243,059

Adjusted EBITDA

 

$

(5,908,134)

About Nutex Health Inc.

Headquartered in Houston, Texas and founded in 2011, Nutex Health Inc. (NASDAQ: NUTX) is a healthcare management and operations company with two divisions: a Hospital Division and a Population Health Management Division.

The Hospital Division owns, develops and operates innovative health care models, including micro-hospitals, specialty hospitals, and hospital outpatient departments (HOPDs). This division owns and operates 19 facilities in 8 states.

The Population Health Management division owns and operates provider networks such as Independent Physician Associations (IPAs). Through our Management Services Organization (MSO), we provide management, administrative and other support services to our affiliated hospitals and physician groups. Our cloud-based proprietary technology platform aggregates clinical and claims data across multiple settings, information systems and sources to create a holistic view of patients and providers, allowing us to deliver greater quality care more efficiently. 

Forward-Looking Statements

Certain statements and information included in this press release constitute "forward-looking statements" within the meaning of the Private Securities Litigation Act of 1995. When used in this press release, the words or phrases "will", "will likely result," "expected to," "will continue," "anticipated," "estimate," "projected," "intend," "goal," or similar expressions are intended to identify "forward-looking statements" within the meaning of the Private Securities Litigation Reform Act of 1995. Such statements are subject to certain risks, known and unknown, and uncertainties, many of which are beyond the control of the Company.  Such uncertainties and risks include, but are not limited to, our ability to successfully execute our growth strategy, changes in laws or regulations, including the interim final and final rules implemented under the No Surprises Act , economic conditions, dependence on management, dilution to stockholders, lack of capital, the effects of rapid growth upon the Company and the ability of management to effectively respond to the growth and demand for products and services of the Company, newly developing technologies, the Company's ability to compete, conflicts of interest in related party transactions, regulatory matters, protection of technology, lack of industry standards, the effects of competition and the ability of the Company to obtain future financing. An extensive list of factors that can affect future results are discussed in the Current Report on Form 10-Q for the period ended June 30, 2022 under the heading "Risk Factors" in Part I, Item IA thereof, and other documents filed from time to time with the Securities and Exchange Commission. Such factors could materially adversely affect the Company's financial performance and could cause the Company's actual results for future periods to differ materially from any opinions or statements expressed within this press release.

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