美國
證券交易委員會
華盛頓特區20549
表格
（標記一）
根據1934年證券交易法第13或15(d)節的季度報告 |
截至季度結束日期的財務報告
or
根據1934年證券交易法第13或15(d)節的轉型報告書 |
在從 到過渡期間
委託文件編號：001-39866
(根據其章程規定的註冊人準確名稱)
(所在州或其他司法管轄區) | （IRS僱主 |
成立或組織的州） | 唯一識別號碼） |
，（主要行政辦公地址） | （郵政編碼） |
( | |
(註冊人電話號碼，包括區號) 根據證券法第12(b)條註冊的證券： | |
每一類的名稱 |
| 交易代碼 |
| 在其上註冊的交易所的名稱 |
請在以下方框內打勾：(1) 在過去的12個月內(或者在註冊公司需要提交此類報告的較短時期內)，公司已經提交了根據證券交易法1934年第13或15(d)條規定需要提交的所有報告；以及 (2) 在過去的90天內，公司一直受到了此類報告提交的要求。
在過去的12個月內（或Registrant需要提交此類文件的更短期限內），是否已提交按照S-T法規405條規定需要提交的每個交互式數據文件？
請在交易所法規則120.2規定的「大型加速申報人」、「加速申報人」、「小型報告公司」和「新興成長公司」的定義中選中相應選項。
大型加速報告人 | ☐ | ☒ | |
非加速文件提交人 | ☐ | 較小的報告公司 | |
新興成長公司 |
如果是新興成長型企業，請勾選是否選擇不使用按照《證券交易法》第13(a)條規定的新或修訂財務會計準則的過渡期。 ☐
請在選項前打勾表示該註冊公司是外殼公司（定義在《證券交易法》規則120億.2條款中）。是
截至2024年11月4日，註冊人員已
簡介
除非上下文另有規定，在本十號表格季度報告中，「公司」、「我們」、「我們」、「我們」的類似詞語均指Nutex Health Inc.（前身爲Clinigence Holdings, Inc.），一家特拉華州公司，以及其合併子公司和關聯實體，如適用，包括其合併的可變利益實體（「VIEs」），而「Nutex」指的是Nutex Health Inc。
自2024年4月9日晚上11:59起，公司實施了1-15拆股合併，並自2024年7月2日晚上11:59起，公司實施了額外的1-10拆股合併（「2024年拆股並股」）.
除非另有說明，在本十號表格季度報告中提到的所有授權、發行和已發行股票以及每股金額已經經過調整，以反映所有之前期間展示的2024年拆股並股。對於2024年拆股並股，已對公司的股權激勵計劃下的行權價格和可發行股數以及未行使股權獎勵下的股數進行了成比例調整，如適用。請參閱附註19，獲取有關與2024年拆股並股相關的調整的信息和披露。
有關前瞻性聲明的說明
本十號表格季度報告包含根據1933年證券法修正案第27A條和根據1934年證券交易法修正案第21E條的「前瞻性陳述」。除了歷史事實陳述以外的所有陳述均爲聯邦和州證券法的「前瞻性陳述」，包括但不限於適用於我們業務的法律或法規的變化，對我們的業務、財務狀況、經營結果、計劃、目標、期望和意圖的任何陳述，對收益、營業收入或其他財務項目的任何指導或預測，以及我們未來的流動性，包括現金流量;管理層對未來業務運營計劃、策略和目標的任何陳述，我們認爲爲公司存在的重大機會;任何有關擬議服務、發展、合併或收購的陳述;或戰略性交易;有關管理層對我們未來預期和前景的觀點的陳述;有關擬採納新會計準則或會計準則變化影響的陳述;有關未來經濟狀況或績效的陳述;有關信念的陳述;任何上述任何陳述的基礎假設的陳述;以及非歷史事實的其他陳述。前瞻性陳述可能通過使用前瞻性術語如「預期」、「可能」、「可以」、「可能」、「潛在」、「預測」、「應該」、「估計」、「期望」、「項目」、「相信」、「思考」、「規劃」、「展望」、「打算」、「繼續」、「目標」、「尋求」、「考慮」、「預算」、「將」、「願」及這些術語的否定形式、這些術語的其他變體或類似或可比的詞語、短語或術語來識別。這些前瞻性陳述僅根據本十號表格季度報告日期的估計和假設提出，並可能發生變化。
展望性聲明涉及風險和不確定性，並基於管理層目前的信念、期望和某些假設。這些信念、期望和假設的部分或全部可能不會實現，或與實際結果存在重大差異。這些聲明受重要的經濟、競爭、政府和技術因素的限制，這些因素可能導致我們的業務、策略或實際結果或事件與我們的展望性聲明有重大不同。在考慮展望性聲明時，您應牢記包括但不限於本季度報告中「第1A項。風險因素」下描述的風險因素和其他謹慎聲明，截至2024年6月30日季度報告的表格10-Q，截至2024年3月31日季度報告的表格10-Q，以及截至2023年12月31日年度報告，Nutex Health Inc.關於Form 10-k的年度報告，以及公司在美國證券交易委員會的其他申報文件。儘管我們認爲我們展望性聲明中反映的期望是合理的，但實際結果可能與我們任何展望性聲明中投射或假設的結果存在重大差異。我們未來的財務狀況和經營結果，以及任何展望性聲明，都可能發生變化，並存在導致實際狀況、結果和成果與這些聲明所指示的有重大不同的重大風險和不確定性。因此，本季度報告中所作的所有展望性聲明均受到這些警示性聲明的限制，公司無法保證將實現公司預期的實際結果或發展，甚至如果實際上實現了，也無法保證其對公司或其業務或運營產生預期的後果或影響。公司對更新任何此類展望性聲明不負任何義務。
第一部分 — 財務信息
第 1 項。財務報表
NUTEX 健康公司
簡明的合併資產負債表
（未經審計）
2024 年 9 月 30 日 | 2023年12月31日 | |||||
資產 | ||||||
流動資產： | ||||||
現金和現金等價物 | $ | | $ | | ||
應收賬款 |
| |
| | ||
應收賬款-關聯方 |
| |
| | ||
庫存 |
| |
| | ||
預付費用和其他流動資產 | | | ||||
流動資產總額 | | | ||||
財產和設備，淨額 | | | ||||
運營使用權資產 | | | ||||
爲使用權資產融資 |
| |
| | ||
無形資產，淨額 | | | ||||
商譽，淨額 |
| |
| | ||
其他資產 | | | ||||
總資產 | $ | | $ | | ||
負債和權益 |
|
|
|
| ||
流動負債： |
|
|
|
| ||
應付賬款 | $ | | $ | | ||
應付賬款-關聯方 |
| |
| | ||
信貸額度 |
| |
| | ||
長期債務的當前部分 |
| |
| | ||
經營租賃負債，流動部分 | | | ||||
融資租賃負債，流動部分 | | | ||||
應計費用和其他流動負債 | |
| | |||
流動負債總額 |
| |
| | ||
長期債務，淨額 | | | ||||
認股權證責任 | | - | ||||
經營租賃負債，淨額 | | | ||||
融資租賃負債，淨額 | | | ||||
遞延所得稅負債 | | | ||||
負債總額 |
| |
| | ||
承付款和意外開支 | ||||||
股權： | ||||||
普通股，$ | | | ||||
額外的實收資本 | | | ||||
累計赤字 | ( | ( | ||||
Nutex 健康公司股權 | | | ||||
非控股權益 |
| | | |||
權益總額 | | | ||||
負債和權益總額 | $ | | $ | | ||
參見未經審計的簡明合併財務報表的附註。
4
Nutex Health Inc.（「公司」）
簡明合併利潤表
（未經審計）
截至9月30日，三個月的結束 | 截至9月30日的前九個月 | |||||||||||
| 2024 |
| 2023 |
| 2024 |
| 2023 | |||||
營業收入： | ||||||||||||
醫院部門 | $ | | $ | | $ | | $ | | ||||
人群健康管理部門 | | | | | ||||||||
總收入 | | | | | ||||||||
經營成本和費用： |
|
| ||||||||||
工資和福利 | | | | | ||||||||
合同服務 | | | | | ||||||||
寵物-醫療產品 | | | | | ||||||||
折舊和攤銷 |
| |
| |
| |
| | ||||
其他 | | | | | ||||||||
總運營成本和費用 | | | | | ||||||||
毛利潤 | | | | | ||||||||
公司和其他費用: | ||||||||||||
設施關閉成本 | - | - | - | | ||||||||
收購成本 | - | | - | | ||||||||
股票補償費用 | | | | | ||||||||
資產減值 | | - | | - | ||||||||
商譽減值 | - | - | | - | ||||||||
一般及管理費用 | | | | | ||||||||
總公司和其他費用 | | | | | ||||||||
業務利潤（虧損） |
| | ( |
| | ( | ||||||
利息費用，淨額 | | | | | ||||||||
權證責任減值 | | - | | - | ||||||||
其他（收入）費用 |
| |
| ( |
| ( |
| | ||||
稅前收入（虧損） | ( | ( | | ( | ||||||||
所得稅費用（收益） | | ( | | ( | ||||||||
淨損失 | ( | ( | ( | ( | ||||||||
淨利潤（損失）歸屬於非控股權益的減少 | | | | ( | ||||||||
歸屬於Nutex Health Inc.的淨虧損。 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
每股普通股虧損： | ||||||||||||
基本 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
攤薄 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
請查看附註的未經審計的簡明合併財務報表。
5
Nutex Health Inc.（「公司」）
資本變動表簡明綜合
（未經審計）
普通股 | 實收資本公積 | 累積的 | 非控制權益 | 總計 | |||||||||||||
| 股份 |
| 數量 |
| 資本 |
| $ |
| 利益 |
| 股權 | ||||||
2022年12月31日結存餘額 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
房地產業實體的脫合併 | — | — | — | — | ( | ( | |||||||||||
爲行權認股權而發行的普通股股份 | | | ( | — | — | — | |||||||||||
發行給阿波羅醫療控股公司的普通股 | | | | — | — | | |||||||||||
捐款 | — | — | — | — | | | |||||||||||
分佈。在根據本收據條款的規定結束本收據所體現的協議之前，託管人將在確定餘額之後以某種方式在底定時間向持有人分配或提供有關本美國存託憑證所體現的存入證券的任何現金股利、其他現金分派、股票分派、認購或其他權利或任何其他有關性質的分派，經過託管人在第十九條中描述的費用和支出的扣除或者付款，並扣除任何相關稅款； ，不過需要指出，託管人不會分配可能會違反1933年證券法或任何其他適用法律的分配，並且對於任何可能違反此類法律的情況，該人不會收到相應的保證。對於這種情況，託管人可以售出這樣的股份、認購或其他權利、證券或其他財產。如果託管人選擇不進行任何此類分配，則託管人只需要通知持有人有關其處置的事宜及任何此類銷售的收益，而任何以現金形式以外的方式通過託管人收到的任何現金股息或其他分配的，不受本第十二條的限制。託管人可以自行決定不分配任何分銷或者認購權，證券或者其他財產在行使時，託管人授權此類發行人可能不得在法律上向任何持有人或者處置此類權利，以及使任何發售此類權利且在託管人處出售這類權利的淨收益對這樣的持有人可用。任何由託管人出售的認購權、證券或者其他財產的銷售可能在託管人認爲適當的時間和方式進行，並且在這種情況下，託管人應將在第十九條中描述的費用和支出扣除後分配給持有人該淨收益以及在相應的代扣稅或其他政府收費中將，。 | — | — | — | — | ( | ( | |||||||||||
淨損失 | — | — | — | ( | ( | ( | |||||||||||
2023年3月31日餘額 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
發行普通股以行使認股權證 | | | ( | — | — | — | |||||||||||
債務轉換爲普通股 | | | | — | — | | |||||||||||
發放用於報酬的受限股票獎勵 | | | | — | — | | |||||||||||
捐款 | — | — | — | — | | | |||||||||||
分佈。在根據本收據條款的規定結束本收據所體現的協議之前，託管人將在確定餘額之後以某種方式在底定時間向持有人分配或提供有關本美國存託憑證所體現的存入證券的任何現金股利、其他現金分派、股票分派、認購或其他權利或任何其他有關性質的分派，經過託管人在第十九條中描述的費用和支出的扣除或者付款，並扣除任何相關稅款； ，不過需要指出，託管人不會分配可能會違反1933年證券法或任何其他適用法律的分配，並且對於任何可能違反此類法律的情況，該人不會收到相應的保證。對於這種情況，託管人可以售出這樣的股份、認購或其他權利、證券或其他財產。如果託管人選擇不進行任何此類分配，則託管人只需要通知持有人有關其處置的事宜及任何此類銷售的收益，而任何以現金形式以外的方式通過託管人收到的任何現金股息或其他分配的，不受本第十二條的限制。託管人可以自行決定不分配任何分銷或者認購權，證券或者其他財產在行使時，託管人授權此類發行人可能不得在法律上向任何持有人或者處置此類權利，以及使任何發售此類權利且在託管人處出售這類權利的淨收益對這樣的持有人可用。任何由託管人出售的認購權、證券或者其他財產的銷售可能在託管人認爲適當的時間和方式進行，並且在這種情況下，託管人應將在第十九條中描述的費用和支出扣除後分配給持有人該淨收益以及在相應的代扣稅或其他政府收費中將，。 | — | — | — | — | ( | ( | |||||||||||
淨損失 | — | — | — | ( | ( | ( | |||||||||||
2023年6月30日的餘額 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
債務轉換爲普通股 | | | | — | — | | |||||||||||
以股票爲基礎的補償 | — | — | | — | — | | |||||||||||
發行用於收購的普通股 | | | | — | — | | |||||||||||
使用可轉換債券發行的認股權證 | — | — | | — | — | | |||||||||||
分佈。在根據本收據條款的規定結束本收據所體現的協議之前，託管人將在確定餘額之後以某種方式在底定時間向持有人分配或提供有關本美國存託憑證所體現的存入證券的任何現金股利、其他現金分派、股票分派、認購或其他權利或任何其他有關性質的分派，經過託管人在第十九條中描述的費用和支出的扣除或者付款，並扣除任何相關稅款； ，不過需要指出，託管人不會分配可能會違反1933年證券法或任何其他適用法律的分配，並且對於任何可能違反此類法律的情況，該人不會收到相應的保證。對於這種情況，託管人可以售出這樣的股份、認購或其他權利、證券或其他財產。如果託管人選擇不進行任何此類分配，則託管人只需要通知持有人有關其處置的事宜及任何此類銷售的收益，而任何以現金形式以外的方式通過託管人收到的任何現金股息或其他分配的，不受本第十二條的限制。託管人可以自行決定不分配任何分銷或者認購權，證券或者其他財產在行使時，託管人授權此類發行人可能不得在法律上向任何持有人或者處置此類權利，以及使任何發售此類權利且在託管人處出售這類權利的淨收益對這樣的持有人可用。任何由託管人出售的認購權、證券或者其他財產的銷售可能在託管人認爲適當的時間和方式進行，並且在這種情況下，託管人應將在第十九條中描述的費用和支出扣除後分配給持有人該淨收益以及在相應的代扣稅或其他政府收費中將，。 | — | — | — | — | ( | ( | |||||||||||
| — | — | — | ( | | ( | |||||||||||
2023年9月30日餘額 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
（續）
請查看附註的未經審計的簡明合併財務報表。
6
Nutex Health Inc.（「公司」）
資本變動表簡明綜合
（未經審計）
普通股 | 實收資本公積 | 未分配利潤 | 非控制權益 | 總計 | |||||||||||||
股份 |
| 數量 |
| 資本 |
| (累計虧損) |
| 利益 |
| 股權 | |||||||
2023年12月31日結餘爲 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
員工股票購買計劃發行普通股 | | | | — | — | | |||||||||||
普通股發行 | | | | — | — | | |||||||||||
債務轉換爲普通股 | | | | — | — | | |||||||||||
以股票爲基礎的補償 | — | — | | — | — | | |||||||||||
限制性股票單位的釋放 | | | ( | — | — | — | |||||||||||
股票拆分調整 | | | ( | — | — | — | |||||||||||
分佈。在根據本收據條款的規定結束本收據所體現的協議之前，託管人將在確定餘額之後以某種方式在底定時間向持有人分配或提供有關本美國存託憑證所體現的存入證券的任何現金股利、其他現金分派、股票分派、認購或其他權利或任何其他有關性質的分派，經過託管人在第十九條中描述的費用和支出的扣除或者付款，並扣除任何相關稅款； ，不過需要指出，託管人不會分配可能會違反1933年證券法或任何其他適用法律的分配，並且對於任何可能違反此類法律的情況，該人不會收到相應的保證。對於這種情況，託管人可以售出這樣的股份、認購或其他權利、證券或其他財產。如果託管人選擇不進行任何此類分配，則託管人只需要通知持有人有關其處置的事宜及任何此類銷售的收益，而任何以現金形式以外的方式通過託管人收到的任何現金股息或其他分配的，不受本第十二條的限制。託管人可以自行決定不分配任何分銷或者認購權，證券或者其他財產在行使時，託管人授權此類發行人可能不得在法律上向任何持有人或者處置此類權利，以及使任何發售此類權利且在託管人處出售這類權利的淨收益對這樣的持有人可用。任何由託管人出售的認購權、證券或者其他財產的銷售可能在託管人認爲適當的時間和方式進行，並且在這種情況下，託管人應將在第十九條中描述的費用和支出扣除後分配給持有人該淨收益以及在相應的代扣稅或其他政府收費中將，。 | — | — | — | — | ( | ( | |||||||||||
淨損失 | — | — | — | ( | ( | ( | |||||||||||
截至2023年6月30日的前六個月 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
在出售業務中獲得的普通股 | ( | ( | ( | — | — | ( | |||||||||||
員工股票購買計劃發行的普通股 | | | | — | — | | |||||||||||
發行用於收購的普通股 | | | | — | — | | |||||||||||
以股票爲基礎的補償 | — | — | ( | — | — | ( | |||||||||||
股票拆分調整 | | | ( | — | — | — | |||||||||||
捐款 | — | — | — | — | | | |||||||||||
分佈。在根據本收據條款的規定結束本收據所體現的協議之前，託管人將在確定餘額之後以某種方式在底定時間向持有人分配或提供有關本美國存託憑證所體現的存入證券的任何現金股利、其他現金分派、股票分派、認購或其他權利或任何其他有關性質的分派，經過託管人在第十九條中描述的費用和支出的扣除或者付款，並扣除任何相關稅款； ，不過需要指出，託管人不會分配可能會違反1933年證券法或任何其他適用法律的分配，並且對於任何可能違反此類法律的情況，該人不會收到相應的保證。對於這種情況，託管人可以售出這樣的股份、認購或其他權利、證券或其他財產。如果託管人選擇不進行任何此類分配，則託管人只需要通知持有人有關其處置的事宜及任何此類銷售的收益，而任何以現金形式以外的方式通過託管人收到的任何現金股息或其他分配的，不受本第十二條的限制。託管人可以自行決定不分配任何分銷或者認購權，證券或者其他財產在行使時，託管人授權此類發行人可能不得在法律上向任何持有人或者處置此類權利，以及使任何發售此類權利且在託管人處出售這類權利的淨收益對這樣的持有人可用。任何由託管人出售的認購權、證券或者其他財產的銷售可能在託管人認爲適當的時間和方式進行，並且在這種情況下，託管人應將在第十九條中描述的費用和支出扣除後分配給持有人該淨收益以及在相應的代扣稅或其他政府收費中將，。 | — | — | — | — | ( | ( | |||||||||||
| — | — | — | ( | | | |||||||||||
2024年6月30日的餘額 | | | | ( | | | |||||||||||
員工股票購買計劃發行普通股 | | | | — | — | | |||||||||||
發行用於收購的普通股 | | | | — | — | | |||||||||||
以股票爲基礎的補償 | | | | — | — | | |||||||||||
認股權行權 | | | | — | — | | |||||||||||
捐款 | — | — | | — | | | |||||||||||
分佈。在根據本收據條款的規定結束本收據所體現的協議之前，託管人將在確定餘額之後以某種方式在底定時間向持有人分配或提供有關本美國存託憑證所體現的存入證券的任何現金股利、其他現金分派、股票分派、認購或其他權利或任何其他有關性質的分派，經過託管人在第十九條中描述的費用和支出的扣除或者付款，並扣除任何相關稅款； ，不過需要指出，託管人不會分配可能會違反1933年證券法或任何其他適用法律的分配，並且對於任何可能違反此類法律的情況，該人不會收到相應的保證。對於這種情況，託管人可以售出這樣的股份、認購或其他權利、證券或其他財產。如果託管人選擇不進行任何此類分配，則託管人只需要通知持有人有關其處置的事宜及任何此類銷售的收益，而任何以現金形式以外的方式通過託管人收到的任何現金股息或其他分配的，不受本第十二條的限制。託管人可以自行決定不分配任何分銷或者認購權，證券或者其他財產在行使時，託管人授權此類發行人可能不得在法律上向任何持有人或者處置此類權利，以及使任何發售此類權利且在託管人處出售這類權利的淨收益對這樣的持有人可用。任何由託管人出售的認購權、證券或者其他財產的銷售可能在託管人認爲適當的時間和方式進行，並且在這種情況下，託管人應將在第十九條中描述的費用和支出扣除後分配給持有人該淨收益以及在相應的代扣稅或其他政府收費中將，。 | — | — | — | — | ( | ( | |||||||||||
| — | — | — | ( | | ( | |||||||||||
2024年9月30日的餘額 | | $ | | $ | | $ | ( | $ | | $ | | ||||||
請查看附註的未經審計的簡明合併財務報表。
7
Nutex Health Inc.（「公司」）
現金流量表簡明綜合報表
（未經審計）
截至9月30日的前九個月 | ||||||
| 2024 |
| 2023 | |||
經營活動現金流量： | ||||||
| $ | ( | $ | ( | ||
調整爲了將淨虧損調節爲經營活動現金流： |
| |||||
折舊和攤銷 |
| | | |||
權證責任減值 | | - | ||||
商譽減值 | | - | ||||
資產減值 | | - | ||||
商譽去除 | | - | ||||
股票補償費用 | | | ||||
遞延所得稅收益 |
| ( | ( | |||
負債累積費用 |
| | | |||
租賃終止損失 | - | | ||||
非現金租賃費用（收入） | ( | | ||||
運營資產和負債變動，除收購影響外淨值： | ||||||
應收賬款 | ( | | ||||
應收賬款 - 關聯方 |
| | ( | |||
存貨 | | | ||||
預付費用和其他流動資產 |
| ( | ( | |||
應付賬款 |
| ( | ( | |||
應付賬款-關聯方 | ( | | ||||
應計費用及其他流動負債 | | | ||||
經營活動產生的現金流量淨額 | | | ||||
| ||||||
投資活動現金流量： |
| |||||
物業和設備的收購 |
| ( | ( | |||
與業務出售有關的現金流 | ( | - | ||||
收購業務支付淨現金 | - | ( | ||||
與房地產業實體分拆有關的現金流 | - | ( | ||||
投資活動產生的淨現金流量 | ( | ( | ||||
籌資活動產生的現金流量： | ||||||
信用額度籌集的資金 | | | ||||
票據應收款的收入 | | | ||||
可轉換票據的收益 | - | | ||||
各類信貸款項償還 | ( | ( | ||||
還款應付票據 | ( | ( | ||||
償還融資租賃 |
| ( | ( | |||
普通股發行所得淨額，淨髮行成本 | | - | ||||
行使認股權收到的款項 |
| | - | |||
成員出資 | | | ||||
成員分配 | ( | ( | ||||
融資活動產生的淨現金流量 | | | ||||
現金及現金等價物淨變動額 | | ( | ||||
期初現金及現金等價物餘額 | | | ||||
現金及現金等價物期末餘額 | $ | | $ | | ||
請查看附註的未經審計的簡明合併財務報表。
8
NUTEX 健康公司
簡明合併財務報表附註
（未經審計）
備註 1– 組織和運營
Nutex Health Inc.（「Nutex Health」 或 「公司」）是一家由醫生領導的醫療保健服務和運營公司，擁有
我們僱用了大約
Nutex Health Holdco LLC 和 Clinigence Holdings, Inc. 合。2022年4月1日，Nutex Health Holdco LLC和Clinigence Holdings, Inc.（「Clinigence」）的合併（「合併」）已根據特拉華州有限責任公司Clinigence、Nutex、Micro Holdings LLC的全資子公司Clinigence、Nutex、Micro Hospital Holdings LLC於2021年11月23日簽訂的協議和合並計劃（「合併協議」）完成（「合併」）（僅限於合併協議某些部分的目的）、Nutex Health Holdco LLC和Thomas Vowand.D.，僅以其股東代表的身份Nutex Health Holdco 有限責任公司
關於合併協議，Nutex Health Holdco LLC與子公司和關聯公司（「Nutex子公司」）的股權持有人（「Nutex所有者」）簽訂了某些出資協議，根據該協議，這些Nutex所有者同意向Nutex Health Holdco LLC出資Nutex子公司的某些股權，以換取Nutex Health Holdco LLC的特定股權（統稱爲 「出資交易」）。Nutex 所有者的所有權權益約爲
根據合併協議，代表Nutex Health Holdco LLC股權的每個單位在合併生效前夕但在出資交易（統稱爲 「Nutex會員權益」）之後發行和未償還的股權均轉換爲收款權
合併完成後，Clinigence更名爲Nutex Health Inc.
2024 年反向股票拆分。
1:15 反向股票拆分。 公司董事會決定對普通股進行反向分割 -for15 的比例（”:15 反向股票拆分”）自美國東部時間2024年4月9日晚上 11:59 起生效。該公司的股東在2023年6月29日的年會上批准了反向股票拆分，範圍爲 :2 和 :15 將在董事會酌情批准後的一年內生效。該公司的普通股在一篇文章中開始在納斯達克資本市場上交易:15 在2024年4月10日開盤時，以公司現有交易代碼 「NUTX」 進行反向股票拆分。這個 :15 實施反向股票拆分的目的是重新遵守公司普通股繼續在納斯達克資本市場上市的最低出價要求。
1:10 反向股票拆分。 此外，公司董事會決定對普通股進行反向分割 -for10 的比例（”:10 反向股票拆分”）自美國東部時間2024年7月2日晚上 11:59 起生效。在2024年6月17日的年會上，該公司的股東批准了在以下範圍內進行反向股票分割 :2 和 :16 將在董事會酌情批准後的一年內生效。這個 :10 反向股票拆分是對公司之前的股票拆分的補充 :15 反向股票拆分如上所述。該公司的普通股在一篇文章中開始在納斯達克股票市場上交易:10 公司現有股票拆分基礎下的反向股票拆分制
9
於2024年7月3日開市時，該標的交易符號爲「NUTX」。 爲了恢復符合納斯達克資本市場公司普通股繼續上市的最低買賣價格要求，還實施了1:10拆股並股。
由於2024年拆股並股（簡稱「2024年拆股並股」），普通股的流通股數量得以減少。 及1:5拆股並股 截至2024年6月30日，流通的普通股數量減少到了股，包括用於補償碎股的整數股，而普通股的授權股數量仍然爲。
除非另有說明，附帶的簡明合併財務報表中包含的所有授權的、已發行的和流通的股票以及每股金額已經調整，以反映所有之前報告期間的2024年拆股並股。 對於2024年拆股並股，公司股權激勵計劃行權價格和可發行股數以及已發行股權獎勵的股數等比例調整已完成。
根據適用的指導原則，2024年拆股並股的影響已追溯應用於遞交的所有期間。因此，之前的金額與之前報告的不同。由於取整，以下表格中的某些金額可能不符合。
以下表格說明了在2024年拆股並股的影響追溯調整之前和之後公司的股權變化，適用於遞交的各期間：
2023年9月30日 | |||||||||
如先前 | 2024年反向拆股的影響 | 依照 | |||||||
報告 | 拆股並股 | 修改 | |||||||
普通股 - 股數 | | ( | | ||||||
普通股 - 金額 | $ | | $ | ( | $ | | |||
股本外溢價 | $ | | $ | | $ | | |||
2023年12月31日 | |||||||||
如前 | 2024年拆股並股的影響 | 依照 | |||||||
報告 | 拆股並股 | 修改 | |||||||
普通股 - 股份 | | ( | | ||||||
普通股 - 金額 | $ | | $ | ( | $ | | |||
股本外溢價 | $ | | $ | | $ | | |||
2022年12月31日 | |||||||||
如前所述 | 2024年逆轉的影響 | 依照 | |||||||
報告 | 拆股並股 | 修改 | |||||||
普通股 - 股份 | | ( | | ||||||
普通股 - 金額 | $ | | $ | ( | $ | | |||
股本外溢價 | $ | | $ | | $ | | |||
以下表格說明了虧損每股和加權平均流通股份的變化，如在2024年拆股並股的影響之前、之後按照修正後對先前的報告以及對呈現期間進行了調整的情況。
2023年9月30日結束的三個月 | |||||||||
如之前 | 2024年拆股並股的影響 | 依照 | |||||||
報告 | 拆股並股 | 修改 | |||||||
歸屬於普通股股東的淨虧損 | $ | ( | $ | - | $ | ( | |||
加權平均股份用於計算基本和攤薄後每股收益 | | ( | | ||||||
基本和稀釋每股虧損 | $ | ( | $ | ( | $ | ( | |||
10
| |||||||||
如之前 | 2024年拆股並股的影響 | 依照 | |||||||
報告 | 拆股並股 | 修改 | |||||||
歸屬於普通股股東的淨虧損 | $ | ( | $ | - | $ | ( | |||
加權平均股份用於計算基本和攤薄後每股收益 | | ( | | ||||||
基本和稀釋每股虧損 | $ | ( | $ | ( | $ | ( | |||
由於產生抵消效應，未計入攤薄後的已發行股份中的以下未行使或可行使的優先股期權和認股權證：
2023年9月30日結束的三個月和九個月 | |||||||||
如之前 | 2024年拆股並股的影響 | 依照 | |||||||
報告 | 拆股並股 | 修改 | |||||||
普通股期權 | | ( | | ||||||
普通股認股權證 | | ( | | ||||||
股票期權已經進行了回溯調整，以反映2024年9月30日結束的九個月的拆股並股情況：
728.3 | 2024年拆股並股的影響 | 修改 | ||||||||||||||||
期權 | 加權平均 | 期權 | 加權平均 | 期權 | 加權平均 | |||||||||||||
未償還金額 | 行使價格 | 未償還金額 | 行使價格 | 未償還金額 | 行使價格 | |||||||||||||
2022 年 12 月未行使的期權 | | $ | | ( | $ | | | $ | | |||||||||
期權行權 | — | — | — | — | — | — | ||||||||||||
已取消的期權 | — | — | — | — | — | — | ||||||||||||
2023年9月30日尚未行使的期權 | | $ | | ( | $ | | | $ | | |||||||||
權證已經進行了調整，以反映2023年9月30日結束的九個月內進行的2024年的拆股並股。
728.3 | 2024年拆股並股的影響 | 修改 | ||||||||||||||||
權證 | 加權平均 | 權證 | 加權平均 | 權證 | 加權平均 | |||||||||||||
未償還金額 | 行權價格 | 未償還金額 | 行使價格 | 未償還金額 | 行使價格 | |||||||||||||
2022年12月31日未行使的認股權證 | | $ | | ( | $ | | | $ | | |||||||||
權證發行 | | | ( | | | | ||||||||||||
行權證行使 | ( | | | | ( | | ||||||||||||
認股權證到期 | ( | | | | ( | | ||||||||||||
2023年9月30日未行使的權證 | | $ | | ( | $ | | | $ | | |||||||||
2024年7月24日，公司收到了納斯達克證券交易所（「納斯達克」）發來的書面通知（「合規通知」），通知公司已符合納斯達克規則5550(a)(2)，該規則要求在納斯達克證券交易所上市的公司維持每股最低買盤價爲1.00美元。 納斯達克在合規通知中通知公司，自2024年7月3日至2024年7月23日，公司普通股的收盤買入價已達到或超過1.00美元，並且，公司已符合納斯達克規則5550(a)(2)，此事已經解決。
公司修訂後的章程。（依據公司於2024年8月6日向SEC提交的8-k表格上附表3.1）
表示方式。這些基本報表展示了公司的綜合財務狀況和經營業績，包括控股子公司和我們爲其主要受益人的變量利益實體（「VIEs」）的情況。
醫院部門包括我們的醫療保健賬單和收款組織以及醫院實體。此外，我們與多家專業實體（「醫療人員有限責任公司」）有財務和運營關係。
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實體（「房地產實體」）。醫師有限責任公司僱用在我們醫院工作的醫生。公司將這些實體合併爲VIE，因爲它們沒有大量股權處於風險之中，而且我們歷來爲Physicial LLC提供現金短缺時的支持。
房地產實體擁有土地和醫院建築，這些土地和醫院建築物出租給我們的醫院實體。房地產實體有可支付給第三方的抵押貸款，這些貸款由土地和建築物抵押。如果我們的醫院實體是其未償抵押貸款的擔保人或共同借款人，我們將房地產實體合併爲VIE。自2022年第二季度以來，我們已經解體
公司在合併後的Physicial LLC或房地產實體中沒有直接或間接的所有權權益，因此
人口健康管理部門包括我們的管理服務組織。此外，人口健康管理部門擁有並運營獨立醫生協會（「IPA」）等提供者網絡。我們不擁有的IPA合併爲VIE，因爲我們是這些IPA業務的主要受益者，並且有
在合併中，所有重要的公司間餘額和交易均已清除。
中期財務報表。這些未經審計的簡明合併財務報表是根據美國證券交易委員會（「SEC」）關於中期財務報告的規章制度編制的。因此，它們不包括美利堅合衆國普遍接受的會計原則（「GAAP」）要求的所有披露。未經審計的簡明合併財務報表包括所有具有正常經常性質的重大調整，管理層認爲，這些調整是公允列報所列中期經營業績所必需的。這些中期財務報表應與我們截至2023年12月31日和2022年12月31日止年度的經審計財務報表中包含的合併財務報表及其附註一起閱讀。
估計值的使用。根據公認會計原則編制財務報表要求管理層做出估算和假設，這些估計和假設會影響財務報表日報告的資產負債金額和或有資產負債的披露以及報告期內報告的收入和支出金額。受此類估計和假設影響的重要項目包括（i）淨收入和應收賬款的估計，（ii）企業合併中收購資產和負債的公允價值，以及（iii）長期資產和商譽的減值。實際結果可能與這些估計有所不同。
現金和現金等價物。 公司將所有原定到期日爲三個月或更短的高流動性投資視爲現金和現金等價物。該公司在受保銀行機構持有的現金金額有時是可觀的，超過了保險金額，但認爲損失風險不大。該公司有 $
公允價值測量。公允價值定義爲在市場參與者之間的有序交易中出售資產或爲轉移負債而支付的價格。我們根據用於計算交易公允價值的投入的分類對公允價值餘額進行分類。與公允價值計量相關的三個級別如下：
級別 1 — 可觀察的輸入，例如相同資產或負債在活躍市場的報價。
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二級—觀察到的除報價外的輸入，如活躍市場中類似資產和負債的報價；不活躍市場中相同或類似資產和負債的報價或其他可觀察到或可通過可觀察到的市場數據證實的輸入。
三級—受到很少或沒有市場活動支持的不可觀察輸入，對資產或負債的公允價值具有重要影響。這包括某些定價模型、折現現金流量方法和使用重要不可觀察輸入的類似技術。
應收帳款、應付帳款、應計費用和應付票據的估計公允價值大致接近於其賬面價值，因爲這些工具的到期時間相對較短或到期時間較短。與關聯方之間的應收和應付帳款可能不是獨立交易，因此可能不反映公允價值。
未有在呈現期間以非重複性的基礎重新計量爲公允價值的資產或負債。
分部報告。公開公司需要報告有關其可報告經營部門的描述性信息。定義上，經營部門是企業的組成部分，關於其可獲得分開財務信息，由首席經營決策者定期評估用於資源分配和績效評估。如果業務具有類似經濟特徵並符合既定標準，允許將類似經營部門聚合爲單個可報告的經營部門。公司的經營
重新分類以前期間呈現的財務報表包括爲符合當前年度呈現而進行的重新分類。
最近的會計準則。
2023年11月，FASb發佈了《會計準則更新2023-07》，即「可報告部門披露改進」（「ASU 2023-07」），該標準要求按部門披露重大費用，並披露之前僅要求年度披露的項目的中期披露。ASU 2023-07要以追溯法適用，適用於2024年度財務報表和2025年起始的中期報告期。
2023年12月，FASB發佈了《會計準則更新2023-09》，「改進所得稅披露」（ASU 2023-09），提供額外的所得稅稅率調解和已支付所得稅的披露。ASU 2023-09可以根據前瞻或追溯基礎採納，自2024年12月15日後開始的財政年度有效，允許提前採納。
我們正在評估ASU 2023-07和2023-09對我們財務報表披露的影響。
註釋3 – 剝離
Procare Health, Inc.出售業務 在2024年5月30日，公司完成了對Procare Health, Inc.（「Procare」）的出售，該公司是Nutex的全資子公司，賣方爲個人買家。作爲交易的考慮，買方將從2024年6月到2024年10月每月支付給公司$
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impairment) for Procare was recorded for the three months ended September 30, 2024. The Company does not deem this transaction to be significant.
Sale of Clinigence Health, Inc. On August 31, 2024, the Company completed the sale of Clinigence Health, Inc. (「Clinigence Health」), a wholly-owned subsidiary of Nutex to a third-party limited liability company. As consideration for the transaction, the buyer will pay the Company $
附註4 - 營業收入
我們根據報告的板塊將與客戶簽訂的合同所產生的營業收入細分爲以下類型的服務或產品：
截至9月30日，三個月的結束 | 截至9月30日的前九個月 | |||||||||||
| 2024 |
| 2023 |
| 2024 |
| 2023 | |||||
醫院部門營業收入 | | | | | ||||||||
人群健康管理部門的營業收入 | | | | | ||||||||
總收入 | $ | | $ | | $ | | $ | | ||||
Hospital division revenue. We receive payment for facility services rendered by us from federal agencies, private insurance carriers, and patients. The Physician LLCs receive payment for doctor services from these same sources. On average, greater than
The following tables present the allocation of the estimated transaction price with the patient among the primary patient classification of insurance coverage:
截至9月30日，三個月的結束 | 截至9月30日的前九個月 | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
保險 | ||||||||||||
自費 | ||||||||||||
工傷賠償 |
|
| ||||||||||
醫療保險/醫療補助 | ||||||||||||
總計 | ||||||||||||
人口健康管理部門的營業收入。 我們確認對獨立實踐協會（IPA）和醫生團體提供服務的定額收入和管理費用的收入。 定額收入主要包括我們作爲可變利益實體（VIEs）合併的由醫生擁有的實體提供的醫療服務的固定費用。 定額安排直接與各種託管保健提供商（包括HMOs）進行，通常是根據參保人數每月預付給我們的。
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選擇我們作爲他們的醫療保健提供者。按人頭支付是按照預先支付的固定金額，每個患者每個時間單位的健康護理服務的交付，其中服務提供者一般對超額醫療成本負責。我們根據我們管理的聯合健康組織或醫生團體的總體按人支付收入收取管理費。我們的服務每月確認並收到收入。
注5 - 物業和設備
物業和設備的主要類別，淨額總結如下：
有用 | 2021年9月30日 | 運營租賃負債： | ||||||
Life (years) | 2024 |
| 2023 | |||||
建築物和改善 | $ | | $ | | ||||
土地 | - |
| |
| | |||
租賃改良 |
| |
| | ||||
施工進度 | - |
| |
| | |||
醫療設備 |
| |
| | ||||
辦公傢俱和設備 |
| |
| | ||||
電腦硬件和軟件 | | | ||||||
汽車 |
| |
| | ||||
標牌 |
| |
| | ||||
總成本 |
| |
| | ||||
減：累計折舊 |
| ( | ( | |||||
淨房地產和設備總資產 | $ | | $ | | ||||
We consolidate
2024年9月30日和2023年結束的三個月內，房地產和設備的折舊和攤銷總計爲$
注6 - 無形資產和商譽
無形資產。 以下表格詳細介紹了公司的無形資產：
毛利 | 累積 | 淨資產 | 加權平均 | |||||||||
2024年9月30日 | 20.1 | 攤銷 | 金額 | 有用壽命（年） | ||||||||
攤銷無形資產： | ||||||||||||
會員關係 | $ | | $ | | $ | | ||||||
商標 | | | | |||||||||
總計 | $ | | $ | | $ | | ||||||
2023年12月31日 | ||||||||||||
攤銷無形資產： | ||||||||||||
會員關係 | $ | | $ | | $ | | ||||||
管理合同 | | | | |||||||||
客戶合同 | | | | |||||||||
商標 | | | | |||||||||
PHP 科技 | | | | |||||||||
總計 | $ | | $ | | $ | | ||||||
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2024年9月30日結束的三個月，無形資產攤銷總額分別爲$
Procare和Clinigence Health出售時，特定的無形資產減值總額爲$
商譽。 按經營部門區分的商譽賬面價值如下：
醫院部門 | 人口健康管理部門 | 總計 | |||||||
截至2023年12月31日的餘額 | |||||||||
商譽 | $ | | $ | | $ | | |||
累計減值損失 | ( | ( | ( | ||||||
- | | | |||||||
採購會計調整 | - | | | ||||||
商譽減值 | - | ( | ( | ||||||
商譽去除 | - | ( | ( | ||||||
2024年9月30日的餘額 | |||||||||
商譽 | | | | ||||||
累計減值損失 | ( | ( | ( | ||||||
$ | - | $ | | $ | | ||||
對人口健康管理部門商譽帶來的購置會計調整爲美元
商譽減值$
由於Procare的銷售，公司對人口健康管理部門剩餘的商譽進行減值測試，金額爲$。
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注7-應計費用及其他流動負債
應計費用和其他流動負債包括以下內容：
| 2021年9月30日 | 運營租賃負債： | ||||
2024 |
| 2023 | ||||
應計工資和福利 | $ | | $ | | ||
累計供應商費用 | | - | ||||
醫療保險理賠款項 | | | ||||
應計稅費 | | | ||||
應計其他 |
| | | |||
累計費用及其他流動負債總計 | $ | | $ | | ||
Note 8 – 債務
公司未清的債務列在下表中：
到期日 | 利息 | 2021年9月30日 | 運營租賃負債： | ||||||
日期 | 利率 | 2024 | 2023 | ||||||
所有資產擔保的定期貸款 | 09/2024 - 09/2029 | $ | | $ | | ||||
房地產和設備擔保的定期貸款 | 10/2024 - 01/2030 | | | ||||||
存款擔保的定期貸款 | 04/2025 | | - | ||||||
所有資產擔保的信用額度 | 01/2025 - 01/2026 | | | ||||||
整合房地產業實體的長期貸款 | 05/2028 - 03/2037 | | | ||||||
無擔保可轉換期票據 | 10/2025 | | | ||||||
預付款預付（可轉債） | 03/2024 | - | | ||||||
總計 | | | |||||||
減少：未攤銷發行成本和折扣 | | | |||||||
少：短期信貸額度 | | | |||||||
減：長期債務的流動部分 | | | |||||||
所有長期債務 | $ | | $ | | |||||
貸款和授信額度我們已與銀行機構達成私人債務安排，用於購買設備，並通過現金和授信額度提供營運資金和流動性。除非另有規定，這些債務安排是Nutex及/或其絕大多數擁有的子公司的義務。合併的房地產實體已與銀行機構達成私人債務安排，用於購買土地、建設新急診室設施並建立可租賃給我們醫院實體的租賃改進。Nutex對房地產實體的債務安排擔保或在有限情況下，作爲在所示期間的共同借款人。自2022年第二季度以來，我們進行了去除合併
某些未償債務安排需要最低債務償付覆蓋比率和其他財務契約。截至2023年12月31日，我們未能符合
17
預付先期協議（可轉換債務）。
2023年4月11日，公司與YA II PN有限公司（「Yorkville」）簽訂了一份預付先期協議（「PPA」），根據該協議公司請求了一筆來自Yorkville的預付款$
公司有權但無義務在任何預付預付項下的所有或部分未償付款項中提前用現金償還，前提是普通股的成交價格小於固定價格的連續交易日期間。
2023年4月11日，公司根據PPA請求了一筆金額爲$的預付款。
As a result of the Pre-Paid Advance, the Company (i) issued
2023年9月可轉換債券發行。
從2023年9月到2023年12月，公司進行了一次可轉換票據的私人發行（「無抵押可轉換期票據」）和warrants（“認證投資者（「持有人」）定義在1933年法案規則501下）。 於發行無抵押可轉換期票據，每張期票據可轉換成一定數量的普通股股票（在2024年拆股並股之前），轉換價格爲$
2024年3月26日，公司和持有人同意修改無抵押可轉換期票據的轉換價格和認股權證的行權價格爲$
不附抵押轉換期票據的年利率爲
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每股以轉換價格$轉換普通股。
公司任命Emerson Equity LLC爲2023年9月私人發行的配售代理。根據配售代理協議，公司同意支付（i）等於總收益%的現金佣金和（ii）可購買與普通股相等數量的權證。
無擔保可轉換期限票據的淨賬面金額爲$
附註9 - 租賃 我們已與各種出租方（包括關聯方）簽訂了醫院物業、辦公室和設備租賃協議。以下表格披露了我們租賃物業和設備的信息：
我們已與各種出租方（包括關聯方）簽訂了醫院物業、辦公室和設備租賃協議。以下表格披露了我們租賃物業和設備的信息：
截至9月30日，三個月的結束 | 截至9月30日的前九個月 | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
營業租賃成本 | $ | | $ | | $ | | $ | | ||||
融資租賃費用： | ||||||||||||
攤銷租賃權資產 | $ | | $ | | $ | | $ | | ||||
租賃負債利息 | | | | | ||||||||
總體融資租賃成本 | $ | | $ | | $ | | $ | | ||||
備註10 - 承諾和 contingencies
訴訟公司及其合併子公司或可變利益實體可能在業務正常進行過程中被提起各種索賠和法律訴訟。根據律師和管理層的意見，這些事項的結果不會對合並財務報表產生重大不利影響。
注11 - 股權補償
2023年，公司股東批准了修訂版的Nutex Health Inc. 2023年股權激勵計劃（「2023計劃」），總計提供
未完工和正在啓動醫院的債務。根據貢獻協議的條款，未完工醫院和正在啓動醫院的出資人有資格獲得公司普通股的一次額外發行。
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| ● | 關於在兼併之前收購的醫院的擴建，適用的醫院開業日期（「確定日期」）後24個月，該所有者有資格收到公司普通股數量相等於（i）在各自確定日期的最近十二個月利息稅前利潤和折舊攤銷之積，乘以（ii） |
| ● | With respect to under construction hospitals that were acquired before the Merger, contributing owners of under construction hospitals will be eligible to receive, on the Determination Date, such owner’s pro rata share of a number of shares of Company common stock equal to (a)(i) the trailing twelve months earnings before interest, taxes, depreciation and amortization as of the Determination Date multiplied by (ii) |
We recognized stock-based compensation expense related to obligations for under-construction and ramping hospitals for three and nine months ended September 30, 2024 of $
Options下表總結了基於股票的獎勵活動：
加權平均 | |||||||||
期權 | 加權平均 | 剩餘合同期限 | |||||||
未償還金額 | 行使價格 | 壽命（年） | |||||||
2022 年 12 月未行使的期權 | | $ | | ||||||
期權行權 | — | — | |||||||
已取消的期權 | — | — | |||||||
2023年9月30日尚未行使的期權 | | $ | | ||||||
2024年3月31日的未行使期權（未經審計） | | $ | | ||||||
期權行權 | — | — | |||||||
已取消的期權 | ( | | |||||||
2024年9月30日持有的期權 | | $ | | ||||||
20
2024年9月30日尚未行使的期權包括：
有效期 | 數量 | 數量 | 行權 | ||||||
日期 | 未償還金額 | 可行使的 | 價格 | ||||||
2025年1月21日 | $ | | |||||||
2025年1月21日 | | ||||||||
2025年1月21日 | | ||||||||
2027年1月27日 | | ||||||||
2027年5月11日 | | ||||||||
2027年6月9日 | | ||||||||
2028年1月28日 | | ||||||||
2029年8月4日 | | ||||||||
2030年1月27日 | | ||||||||
2030年6月30日 | | ||||||||
2031年1月28日 | | ||||||||
2031年9月9日 | | ||||||||
2031年12月17日 | | ||||||||
總計 | | | |||||||
受限股票單位在2023年4月1日，公司發行了
2024年6月16日，公司發行
對於限制股單位的授予，我們在適用的解禁期內確認與授予日公允價值相等的報酬支出。 一般而言，限制股單位的授予會在首年每年解禁三分之一。 每年解禁三分之一。
股份 |
| 每股授予日加權平均公允價值 | ||||
2022年12月31日未授予的獎勵 | — | — | ||||
授予 | | $ | | |||
34,105 |
| ( | | |||
2023年9月30日非授予股份 | | $ | | |||
到期未歸屬的獎勵，截至2023年12月31日 | | $ | | |||
授予 | | | ||||
取消贖回 | ( | | ||||
34,105 | ( | | ||||
2024年9月30日前未定股息 | | $ | | |||
21
截至2024年9月30日，我們估計未確認的與發放給員工的受限股票單位有關的補償成本爲美元。
員工股票購買計劃的股票，
注12 - 股本
我們被授權發行總共
普通股發行以下討論了所列期間內的普通股發行情況：
證券購買協議。
2024年1月22日，公司與一家健康關注型的單一機構投資者簽訂了證券購買協議（「購買協議」），由公司出售
每股
公司從本次發行中獲得的總收益爲$
公司採用Black-Scholes期權定價模型計算了權證的公允價值（三級），輸入包括波動率（約爲%
22
截至2024年9月30日，公司對價證務負債$
成交量加權平均價格的%
warrants 截至2024年9月30日的三個月和九個月內，作爲證券購買協議的一部分，公司發行了購買權證
加權平均 | |||||||||
權證 | 加權平均 | 剩餘合同期限 | |||||||
未償還金額 | 行權價格 | Life (years) | |||||||
2022年12月31日未行使的認股權證 | | $ | | ||||||
權證發行 | | | |||||||
行權證行使 | ( | | |||||||
認股權證到期 | ( | | |||||||
2023年9月30日未行使的權證 | | $ | | ||||||
2023年12月31日未行使的權證 | | $ | | ||||||
權證發行 | | | |||||||
修改了認股權證 | | | |||||||
行權證行使 | ( | | |||||||
2024年9月30日未行使的認股權證 | | $ | | ||||||
2024年9月30日尚未行權的權證包括：
有效期 | 數量 | 數量 | 行權 | ||||||
日期 | 未償還金額 | 可行使的 | 價格 | ||||||
2024年12月31日 | | | $ | | |||||
2025年10月31日 | | | | ||||||
2025年10月31日 | | | | ||||||
2026年2月26日 | | | | ||||||
. 這筆交易被視爲租賃修改，自生效日起，在新租賃負債和資產中承認約 | | | | ||||||
2027年5月31日 | | | | ||||||
2029年9月30日 | | | | ||||||
2029年10月31日 | | | | ||||||
2029年11月30日 | | | | ||||||
2029年12月31日 | | | | ||||||
2029年1月25日 | | | | ||||||
Total | | | |||||||
23
附註13 – 所得稅
中期季度的所得稅備抵通常基於估計的年度有效所得稅率，該比率單獨計算，不包括與中期期間特別相關的重大、偶發或飛凡項目的影響。離散項目的所得稅影響將在發生時期確認。
我們截至2024年9月30日的三個月和九個月的有效稅率分別爲(
附註14 - 每股收益
以下是基本和攤薄每股虧損的計算：
截至9月30日，三個月的結束 | 截至9月30日的前九個月 | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
Nutex Health Inc.相應金額： | ||||||||||||
分子： | ||||||||||||
歸屬於普通股股東的淨虧損 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
分母： | ||||||||||||
用於計算基本每股收益的加權平均股份 | | | | | ||||||||
每股虧損: | ||||||||||||
基本 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
攤薄 | $ | ( | $ | ( | $ | ( | $ | ( | ||||
由於防稀釋，稀釋後每股收益計算不包括
24
附註15 - 補充現金流量信息
截至9月30日的前九個月 | ||||||
2024 |
| 2023 | ||||
支付的利息現金 | $ | | $ | | ||
支付的所得稅費用 | | | ||||
非現金投資和籌資活動: | ||||||
資本支出的融資 | | | ||||
融資租賃的收購 | | | ||||
現金less基礎上行使認股權證 | - | | ||||
發行受限制的股票單位 | - | | ||||
向Apollo Medical Holdings, Inc.發行普通股 | - | | ||||
房地產業實體的脫合併 | - | | ||||
與普通股發行相關的權證負債 | | - | ||||
股票拆分調整 | | - | ||||
員工股票購買計劃發行普通股 | | - | ||||
可轉換債務轉換爲普通股 | | | ||||
使用可轉換債券發行的認股權證 | - | | ||||
用普通股支付收購款項 | | | ||||
在出售業務中獲得的普通股 | | - | ||||
Note 16 – Segment Information
We report the results of our operations as
Reportable segment information, including intercompany transactions, is presented below:
2021年9月30日 | 運營租賃負債： | |||||
2024 | 2023 | |||||
資產： | ||||||
醫院部門 | $ | | $ | | ||
人群健康管理部門 | | | ||||
房地產業務部門。 | | | ||||
總資產 | $ | | $ | | ||
25
截至9月30日，三個月的結束 | 截至9月30日的前九個月 | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
來自外部客戶的營業收入: | ||||||||||||
醫院部門 | $ | | $ | | $ | | $ | | ||||
人群健康管理部門 | | | | | ||||||||
總收入 | $ | | $ | | $ | | $ | | ||||
業務部門營收(虧損): | ||||||||||||
醫院部門 | | | | | ||||||||
人群健康管理部門 | | ( | ( | | ||||||||
總分部營業收入 | $ | | $ | | $ | | $ | | ||||
我們已經確定了財務報告內部控制的重大缺陷。重大缺陷是指財務報告內部控制的缺陷或多個缺陷，導致公司年度或中期財務報表可能存在重大錯誤的合理可能性，並且不會及時被預防或檢測到。 | ||||||||||||
醫院部門 | | | | | ||||||||
房地產業務部門。 | - | - | - | - | ||||||||
總資本支出 | $ | | $ | | $ | | $ | | ||||
內部部門活動的營業收入: | ||||||||||||
房地產業務部門。 | $ | - | $ | | $ | | $ | | ||||
折舊和攤銷費用： | ||||||||||||
醫院部門 | | | | | ||||||||
人群健康管理部門 | | | | | ||||||||
房地產業務部門。 | | | | | ||||||||
總折舊和攤銷 | $ | | $ | | $ | | $ | | ||||
附註17-相關方交易
關聯方交易包括以下內容:
| ● | 醫生有限責任公司聘用在我們醫院工作的醫生。 我們對這些實體沒有直接所有權，但它們是由相關方（包括我們的首席執行官Thomas Vo博士）擁有，並在某些情況下受控制。這些醫生有限責任公司被公司作爲VIEs合併，因爲它們沒有重大的權益風險，而且我們過去一直在現金短缺時爲它們提供支持，並獲得了它們現金盈餘的利益。 |
醫生有限責任公司向其成員所有者尚未償還的債務，這些成員也是公司股東。這些尚未償還的債務主要代表了爲目前正在建設中的設施提供的貢獻，總額爲$
| ● | 我們的醫院部門大部分設施是從房地產實體租賃的，這些實體由相關方擁有。 這些租賃通常是按三重淨租金的方式，我們的醫院部門負責設施的所有運營成本、維修和稅費。我們在這些租賃協議下的責任陳述如下 注9。在2024年9月30日結束的三個月和九個月期間，我們爲這些租賃責任支付了相應的現金款項 $ |
| ● | 當房地產業實體的權益不足以承擔風險，且我們的醫院實體是其未償按揭貸款的擔保人或共同借款人時，我們將房地產業實體彙總爲VIE。這些被彙總的房地產業實體對第三方有應付按揭貸款，該貸款以土地和建築物作抵押。我們對這些實體沒有直接所有權利益，但它們由關聯方擁有，並在某些情況下受其控制 |
26
| including our CEO. We deconsolidated |
| ● | Accounts receivable – related party included $ |
| ● | Micro Hospital Holding LLC, an affiliate controlled by our CEO, and 2GT PLLC, an affiliate controlled by a physician partner, made advances to one of our hospital facilities, SE Texas ER. These advances totaled $ |
| ● | Accounts payable – related party in our consolidated balance sheets included $ |
| ● | We provided managerial services to emergency centers owned and, in some instances, controlled by related parties including an entity controlled by our CEO during 2023. In the three and nine months ended September 30, 2023, we recognized $ |
| ● |
Note 18 – Variable Interest Entities
The following tables provide the balance sheet amounts for consolidated VIEs:
September 30, 2024 | ||||||||
Real Estate | Physician | AHISP | ||||||
Entities | LLCs | IPA | ||||||
Current assets | $ | | $ | | $ | | ||
Property and equipment, net | - | | | |||||
Long-term assets | | - | - | |||||
Total assets | $ | | $ | | $ | | ||
Current liabilities | - | | | |||||
Long-term liabilities | | - | - | |||||
Total liabilities | | | | |||||
Equity | | | - | |||||
Total liabilities and equity | $ | | $ | | $ | | ||
27
December 31, 2023 | ||||||||
Real Estate | Physician | AHISP | ||||||
Entities | LLCs | IPA | ||||||
Current assets | $ | | $ | | $ | | ||
Property and equipment, net | - | | | |||||
Long-term assets | | - | | |||||
Total assets | $ | | $ | | $ | | ||
Current liabilities | | | | |||||
Long-term liabilities | | - | - | |||||
Total liabilities | | | | |||||
Equity | | | - | |||||
Total liabilities and equity | $ | | $ | | $ | | ||
The assets of each of the ER Entities may only be used to settle the liabilities of that entity or its consolidated VIEs and may not be required to be used to settle the liabilities of any of the other ER Entities, other VIEs, or corporate entity. Additionally, the assets of corporate entities cannot be used to settle the liabilities of VIEs. The Company has aggregated all of the Physician LLCs and Real Estate Entities into two categories above, because they have similar risk characteristics, and presenting distinct financial information for each VIE would not add more useful information.
Real Estate Entities are consolidated by the Company as VIEs because they do not have sufficient equity at risk and our hospital entities are guarantors of their outstanding mortgage loans. We have been working with the third-party lenders to remove our guarantees of their outstanding mortgage loans. As these guarantees are released, the associated Real Estate Entity no longer qualifies as a VIE and is deconsolidated. As of September 30, 2024,
The Real Estate Entity we deconsolidated in the first quarter of 2023 had $
Note 19 - Subsequent Events
The Company has evaluated subsequent events through the filing of this report and determined that there have been no events that have occurred that would require adjustments to our disclosures in the consolidated financial statements, except the following:
Common stock issued. Subsequent to September 30, 2024, the Company issued
* * * * *
28
Item 2 – Management’s Discussion and Analysis of Financial Condition and Results of Operations
The following Management’s Discussion and Analysis of Financial Condition and Results of Operations should be read in conjunction with the unaudited consolidated financial statements and the notes thereto included in Part I, Item 1, “Financial Statements” of this Quarterly Report on Form 10-Q.
Explanatory Note
On April 1, 2022 (the “Merger Date”), Nutex Health Holdco LLC and Clinigence Holdings, Inc. (“Clinigence”) completed the merger (the “Merger”) contemplated by the Agreement and Plan of Merger (the “Merger Agreement”) dated as of November 23, 2021 between Clinigence, Nutex Acquisition LLC, a Delaware limited liability company and wholly-owned subsidiary of Clinigence, Nutex, Micro Hospital Holding LLC (solely for the purposes of certain sections of the Merger Agreement), Nutex Health Holdco LLC and Thomas Vo, M.D., solely in his capacity as the representative of the equity holders of Nutex. Immediately following the completion of the Merger, Clinigence amended its certificate of incorporation and bylaws to change its name to “Nutex Health Inc.” In connection with the Merger, each outstanding equity interest of Nutex Health Holdco LLC was exchanged for 3.571428575 shares of Clinigence common stock. The Merger was accounted for as a reverse business combination under U.S. GAAP. Therefore, Nutex Health Holdco LLC was treated as the accounting acquirer in the Merger. Our financial statements presented for periods prior to the Merger Date are those of Nutex Health Holdco, LLC, as the Company’s predecessor entity. Beginning with the second quarter of 2022, our financial statements are presented on a consolidated basis and include Clinigence.
Except where the context indicates otherwise, (i) references to “we,” “us,” “our,” or the “Company” refer, for periods prior to the completion of the Merger, to Nutex Health Holdco LLC and its subsidiaries, (ii) references the “Nutex Health” for periods following the completion of the Merger, refer to Nutex Health Inc. and its subsidiaries and (iii) references to “Clinigence” refer to Clinigence Holdings, Inc. and its subsidiaries prior to the completion of the Merger.
Overview
Nutex Health Inc. is a physician-led, healthcare services and operations company with 22 hospital facilities in ten states (hospital division), and a primary care-centric, risk-bearing population health management division. Our hospital division implements and operates different innovative health care models, including micro-hospitals, specialty hospitals and hospital outpatient departments (“HOPDs”). The population health management division owns and operates provider networks such as independent physician associations (“IPAs”).
We employ approximately 800 full time employees, contract 230 doctors at our facilities and partner with over 1,700 physicians within our networks. Our corporate headquarters is based in Houston, Texas. We were incorporated on April 13, 2000 in the state of Delaware.
Our financial statements present the Company’s consolidated financial condition and results of operations including those of majority-owned subsidiaries and variable interest entities (“VIEs”) for which we are the primary beneficiary.
The hospital division includes our healthcare hospital management platform, billing and collections organization and hospital entities. In addition, we have financial and operating relationships with multiple professional entities (the “Physician LLCs”) and real estate entities (the “Real Estate Entities”). The Physician LLCs employ the doctors who work in our hospitals. These entities are consolidated by the Company as VIEs because they do not have significant equity at risk, and we have historically provided support to the Physician LLCs in the event of cash shortages and received the benefit of their cash surpluses.
The Real Estate Entities own the land and hospital buildings which are leased to our hospital entities. The Real Estate Entities have mortgage loans payable to third parties which are collateralized by the land and buildings. We consolidate the Real Estate Entities as VIEs in instances where our hospital entities are guarantors or co-borrowers under their outstanding mortgage loans. Since the second quarter of 2022, we deconsolidated 18 Real Estate Entities after the third-party lenders released our guarantees of associated mortgage loans.
29
The Company has no direct or indirect ownership interest in the Physician LLCs or Real Estate Entities, so 100% of the equity for these entities is shown as noncontrolling interest in the consolidated balance sheets and statements of operations.
The population health management division includes our management services organization. Additionally, the population health management division owns and operates provider networks such as independent physician associations (“IPAs”). IPAs not owned by us are consolidated as VIEs because we are the primary beneficiary of these IPAs operations and have 100% control of these IPAs operations through management services agreements with each applicable IPA.
Sources of revenue. Our hospital division recognizes net patient service revenue for contracts with patients and in most cases a third-party payor (commercial insurance, workers compensation insurance or, in limited cases, Medicare/Medicaid).
We receive payment for facility services rendered by us from federal agencies, private insurance carriers, and patients. The Physician LLCs receive payment for doctor services from these same sources. On average, greater than 90% of our net patient service revenue is paid by insurers, federal agencies, and other non-patient third parties. The remaining revenue is paid by our patients in the form of copays, deductibles, and self-payment. The following tables present the allocation of the estimated transaction price with the patient between the primary patient classification of insurance coverage:
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
Insurance | 95% | 92% | 93% | 93% | ||||||||
Self pay | 2% | 5% | 4% | 4% | ||||||||
Workers compensation |
| 2% | 2% |
| 2% | 2% | ||||||
Medicare/Medicaid | 1% | 1% | 1% | 1% | ||||||||
Total | 100% | 100% | 100% | 100% | ||||||||
The population health management division recognizes revenue for capitation and management fees for services to IPAs and physician groups. Capitation revenue consists primarily of capitated fees for medical services provided by physician-owned entities we consolidate as VIEs. Capitated arrangements are made directly with various managed care providers including HMOs. Capitation revenues are typically prepaid monthly to us based on the number of enrollees selecting us as their healthcare provider. Capitation is a fixed payment amount per patient per unit of time paid in advance for the delivery of health care services, whereby the service providers are generally liable for excess medical costs. We receive management fees that are received based on gross capitation revenues of the IPAs or physician groups we manage.
Our growth plans. We plan to expand our operations by entering new market areas either through the development of new hospitals, formation of new IPAs or by making acquisitions.
We identify new market areas for hospitals based on the area’s need for access to emergency health services and growth expectations. We identify and partner with local physicians who will operate and manage the new location in conjunction with our internal management team. When developing new hospitals, we have a turn-key process for location selection, real estate acquisition, design, and development of the facility including staffing, training and operations. We extend our existing comprehensive suite of centralized services to operating hospitals, including executive management, billing, collections, recruiting, human resources, legal and marketing.
30
Overview of Legislative Developments
The U.S. Congress and many state legislatures have introduced and passed a large number of proposals and legislation designed to make major changes in the healthcare system, including changes that have impacted access to health insurance. The most prominent of these efforts, the Affordable Care Act, affects how healthcare services are covered, delivered and reimbursed. The Affordable Care Act increased health insurance coverage through a combination of public program expansion and private sector health insurance reforms. There is uncertainty regarding the ongoing net effect of the Affordable Care Act due to the potential for continued changes to the law’s implementation and its interpretation by government agencies and courts. There is also uncertainty regarding the potential impact of other health reform efforts at the federal and state levels.
In response to the COVID-19 pandemic, federal and state governments passed legislation, promulgated regulations, and have taken other administrative actions intended to assist healthcare providers in providing care to COVID-19 and other patients during the public health emergency and to provide financial relief. Among these, the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”) had the most impact on our business.
The CARES Act included a waiver of insurance copayments, coinsurance, and annual deductibles for laboratory tests to diagnose COVID-19 and visits to diagnose COVID-19 at an emergency department of a hospital. These provisions of the CARES Act expired on June 30, 2021. While these provisions were effective, we experienced higher levels of revenue due to a shift of payor mix. The larger number and acuity of patient claims for COVID-19 also resulted in higher revenue.
No Surprises Act
The No Surprises Act (“NSA”) is a federal law that took effect January 1, 2022, to protect consumers from most instances of “surprise” balance billing. With respect to the Company, the NSA limits the amount an insured patient will pay for emergency services furnished by an out-of-network provider. The NSA addresses the payment of these out-of-network providers by group health plans or health insurance issuers (collectively, “insurers”). In particular, the NSA requires insurers to reimburse out-of-network providers at a statutorily calculated “out-of-network rate.” In states without an all-payor model agreement or specified state law, the out-of-network rate is either the amount agreed to by the insurer and the out-of-network provider or an amount determined through an independent dispute resolution (“IDR”) process.
Under the NSA, insurers must issue an initial payment or notice of denial of payment to a provider within thirty days after the provider submits a bill for an out-of-network service. If the provider disagrees with the insurer’s determination, the provider may initiate a thirty-day period of open negotiation with the insurer over the claim. If the parties cannot resolve the dispute through negotiation, the parties may then proceed to IDR arbitration.
Independent Dispute Resolution. The provider and insurer each submit a proposed payment amount and explanation to the arbitrator. The arbitrator must select one of the two proposed payment amounts taking into account the “qualifying payment amount” and additional circumstances including among other things the level of training, outcomes measurements of the facility, the acuity of the individual treated, and the case mix and scope of services of the facility providing the service. The NSA prohibits the arbitrator from considering the provider’s usual and customary charges for an item or service, or the amount the provider would have billed for the item or service in the absence of the NSA.
Qualifying Payment Amount. The “qualifying payment amount” or “QPA” is generally “the median of the contracted rates recognized by the plan or issuer under such plans or coverage, respectively, on January 31, 2019, for the same or a similar item or service that is provided by a provider in the same or similar specialty and provided in the geographic region in which the items or service is furnished,” with annual increases based on the consumer price index. In other words, the qualifying payment amount is typically the median rate the insurer would have paid for the service if provided by an in-network provider or facility.
HHS Final Rule. As required by the NSA, the United States Department of Health and Human Services (“HHS”) has established an IDR process under which a certified IDR entity determines the ultimate amount of payment. The HHS’
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final rule became effective October 25, 2022. The final rule eliminated the rebuttable presumption that the qualified payment amount is the correct price and also abandoned the requirement that the certified IDR entity must select the offer closest to the qualifying payment amount. These key provisions were initially part of the interim rule issued in 2021 and were challenged by several court cases. Under the final rule, the certified IDR entity must instead select the offer that best reflects the value of the item or service provided, by first considering the QPA and then considering “additional information” that is relevant to the dispute.
Legal challenges to HHS Final Rule. The final rule was the subject of legal challenges. The Texas Medical Association (TMA) in September of 2022 filed motions for summary judgment in the U.S. Eastern District of Texas, Tyler Division, seeking to invalidate the IDR related provisions of the final rule, arguing that the QPA does not represent the fair value of the services rendered by the physicians and providers and that the final rule illegally favors the QPA over the fair value of the provider services in contravention of the statutory language of the NSA. On February 6, 2023, the U.S. District Court ruled in favor of the TMA by granting its motion for summary judgment against the HHS and stating that the revised IDR process in the final rule "continues to place a thumb on the scale" in favor of insurers and conflicts with the statutory provisions of the NSA, is unlawful and must be set aside. The Courts decision vacated all of the revised regulations challenged by the TMA, including HHS’ rule that arbiters must primarily consider the QPA in the IDR process.
The TMA on January 1, 2023 filed a lawsuit (“TMA IV”) challenging two items related to the NSA and its implementation: (1) increases in the administrative fees payable in the IDR process from $50 to $350, a 600% increase, and (2) one requirement included in the batching rules for IDR. On August 3, 2023, the U.S. District Court agreed with the TMA and vacated the offending portions of the batching rule that only permitted batching for items with the same service code, allowing for the batching of similar items as allowed by the NSA. Additionally, the fee increase guidance that increased the administrative fees from $50 to $350 was vacated, with the administrative fee of $50 in effect moving forward.
The TMA on November 30, 2022 filed a lawsuit (“TMA III”) challenging how insurers are establishing the QPA under the final rules, alleging that the final rules allow insurers to include what is referred to in the healthcare industry as “ghost rates,” which are rates included in contracts with providers who do not actually provide the specified service and as a result are lower than rates a provider would have incentive to meaningfully negotiate, thus artificially lowering the QPA. On August 24, 2023, the U.S. District Court in the Eastern District of Texas in TMA III ruled to vacate several aspects of the regulations mandating the methodology for the QPA calculation. In particular, the court prohibited the inclusion of “ghost rates” as part of the QPA calculation and QPA calculations that are not based on the same or similar specialty. This is the fourth time the federal court has ruled in favor of the TMA effective nationwide. On October 20, 2023, the Department of Justice filed a notice of appeal against the court’s ruling. This appeal was submitted to the Fifth Circuit Court of Appeals.
On August 2, 2024, the 5th Circuit Court of Appeals vacated provisions of the No Surprises Act (NSA) that favored insurers. The court affirmed a lower court's ruling. The court held that these rules imposed an unfair advantage on insurers, as arbitrators were instructed to consider the QPA before any other factors, such as the complexity of the medical service or the provider's expertise. The ruling removes these procedural "guardrails," meaning arbitrators now have more discretion and are no longer bound to prioritize the QPA in their decisions. This could result in more arbitrators selecting providers' offers, which tend to be higher than those favored by insurers. The Departments of Health and Human Services, Labor, and Treasury may appeal this decision, potentially bringing the case to the U.S. Supreme Court.
Nutex and NSA. While we are working within the established processes for IDR, we have had varying successes at achieving collections at or higher than the established QPA. We have undertaken several strategic actions designed to improve our collections results. These include:
| o | maximizing our claims coding efficiency, |
| o | increasing efforts to collect co-pays and co-insurance, |
| o | adding additional administrative staff to handle the increased administrative IDR burden, |
| o | having a dedicated IDR team to accelerate resubmission of claims under the IDR process, |
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| o | making appeals for additional payment of claims for periods before and after the NSA final rule was adopted through the IDR process, |
| o | making efforts to sign favorable contracts with new insurers, |
| o | working to sign more favorable contracted rates with existing contracted providers, |
| o | working with both local and national legislatures to enforce the NSA rules and guidelines for Insurers, and |
| o | focusing on the value-base IPA side of our business, which is less affected by the NSA. |
After the NSA became effective January 1, 2022, our average payment by insurers of adjudicated patient claims by date of service for emergency services had declined by approximately 26% at the end of 2022. At the end of 2023, that overall decline was reduced to 19% from January 1, 2022, thereby showing an incremental improvement of 7% from the end of 2022 to the end of 2023. In our experience, insurers often initially pay amounts lower than the QPA without regard for other information relevant to the claim. This requires us to make appeals using the IDR process. As of the end of September 2024, we submitted 89,960 cases for IDR open negotiation or arbitration, whereas in the full year of 2023, we submitted 98,000 cases for IDR open negotiation only. In the first half of 2024, there were delays in payor processing due to outages caused by the 2024 Change Healthcare ransomware attack. As the outages have been resolved, we expect IDR filings to increase in the fourth quarter of 2024. We anticipate approximately 60-70% of our claims to be submitted through the IDR process by year end. The IDR process, subsequent appeals and insurance payor delays require extensive administrative time and delays in collections. While we are working within the established processes for IDR, we have had varying successes at achieving collections at or higher than the established QPA.
On July 1, 2024, we engaged with a third-party IDR vendor to further support all of our out of network claims and determine which claims would be beneficial to arbitrate. The IDR arbitration process can take up to four to six months to receive payments. Based on the available data we have analyzed from the third and fourth quarters of 2023, providers have submitted higher offers and have prevailed 80% of the time through IDR. As we work with the third-party IDR vendor, we will have more data on the actual collections and reimbursement from IDR by the end of 2024.
Other NSA Developments. Effective January 1, 2024, in consultation with the Departments of Labor and HHS, the Internal Revenue Service (IRS) announced the annual increase that health plans must apply to the calculation of the QPA for insurance reimbursements to account for inflation from 2023 to 2024 (Notice 2024-1). Under the No Surprises Act, QPAs are calculated based on median contracted rates for the same or similar service as they existed in 2019. Treasury Regulations direct the IRS to anchor the annual inflationary update in the Consumer Price Index for All Urban Consumers (CPI-U). In Notice 2024-1, the IRS directs health plans to update QPAs in 2024 by an increase of 5.4% over 2023 QPAs. Alternatively, to update 2023 rates, health plans may return to the original 2019 calculation and apply a cumulative update factor to account for the IRS inflationary updates from 2019 to 2024. Under that approach, the cumulative update that must be applied to 2019 base year rates is 20.9%.
We are supportive of industry efforts challenging NSA. Our experience, like that of many other healthcare providers, is that the final rule continues to unfairly favor insurers in the determination of the QPA we receive for our healthcare services. It is difficult to predict the ultimate outcome of efforts to challenge or amend the final rule. As well, there can be no assurance that third-party payors will not attempt to further reduce the rates they pay for our services or that additional rules issued under the NSA will not have adverse consequences to our business.
Recent Developments
2024 Reverse Stock Splits
1:15 Reverse stock split. The Company’s Board of Directors determined to effect a reverse stock split of the common stock at a 1-for-15 ratio (the “1:15 Reverse Stock Split”) effective as of 11:59 pm Eastern time on April 9, 2024. The stockholders of the Company at its annual meeting on June 29, 2023 had approved a reverse stock split within a range of 1:2 and 1:15 to be effected within one year of approval at the discretion of the Board. The Company’s common stock began trading on The Nasdaq Capital Market on a post-1:15 Reverse Stock Split basis under the Company’s existing trading symbol “NUTX” at the open of the market on April 10, 2024. The 1:15 Reverse Stock Split was implemented for the purpose of regaining compliance with the minimum bid price requirement for continued listing of the Company’s common stock on The Nasdaq Capital Market.
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1:10 Reverse stock split. In addition, the Company’s Board of Directors determined to effect a reverse stock split of the common stock at a 1-for-10 ratio (the “1:10 Reverse Stock Split”) effective as of 11:59 pm Eastern time on July 2, 2024. The Company’s stockholders, at the annual meeting on June 17, 2024, had approved a reverse stock split within a range of 1:2 and 1:16 to be effected within one year of approval at the discretion of the Board. This 1:10 Reverse Stock Split is in addition to the Company’s previous 1:15 Reverse Stock Split as discussed above. The Company’s common stock began trading on The Nasdaq Stock Market on a post-1:10 Reverse Stock Split basis under the Company’s existing trading symbol “NUTX” at the open of the market on July 3, 2024. The 1:10 Reverse Stock Split was also implemented for the purpose of regaining compliance with the minimum bid price requirement for continued listing of the Company’s common stock on The Nasdaq Capital Market.
As a result of both the 1:15 Reverse Stock Split, and 1:10 Reverse Stock Split (collectively, the “2024 Reverse Stock Splits”) the number of shares of common stock outstanding was reduced to 4,987,268 shares, inclusive of whole shares issued for fractional shares, and the number of authorized shares of common stock remains 950,000,000 shares.
Unless otherwise indicated, all authorized, issued, and outstanding stock and per share amounts contained in the accompanying condensed consolidated financial statements have been adjusted to reflect the 2024 Reverse Stock Splits for all prior periods presented. Proportionate adjustments for the 2024 Reverse Stock Splits were made to the exercise prices and number of shares issuable under the Company’s equity incentive plans, and the number of shares underlying outstanding equity awards, as applicable.
On July 24, 2024, the Company received written notice (the “Compliance Notice”) from The Nasdaq Stock Market LLC (“Nasdaq”) informing the Company that it has regained compliance with Nasdaq Listing Rule 5550(a)(2), which requires that companies listed on the Nasdaq Stock Market maintain a minimum bid price of $1.00 per share. Nasdaq notified the Company in the Compliance Notice that, from July 3, 2024 to July 23, 2024, the closing bid price of the Company’s common stock had been $1.00 per share or greater and, accordingly, the Company had regained compliance with Nasdaq Listing Rule 5550(a)(2) and that the matter was now closed.
Results of Operations
We report the results of our operations as three segments in our consolidated financial statements: (i) the hospital division, (ii) the population health management division and (ii) the real estate division. Activity within our business segments is significantly impacted by demand for healthcare services we provide, competition for these services in each of the market areas we serve, and the legislative changes discussed above.
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Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
Revenue: | ||||||||||||
Hospital division | $ | 71,732,529 | $ | 54,585,263 | $ | 199,366,776 | $ | 155,485,230 | ||||
Population health management division | 7,062,340 | 8,137,709 | 22,964,141 | 22,491,613 | ||||||||
Total revenue | 78,794,869 | 62,722,972 | 222,330,917 | 177,976,843 | ||||||||
Segment operating income: | ||||||||||||
Hospital division | 21,437,835 | 7,238,738 | 54,700,084 | 21,122,489 | ||||||||
Population health management division | 478,979 | (172,525) | (64,861) | 438,370 | ||||||||
Total segment operating income | 21,916,814 | 7,066,213 | 54,635,223 | 21,560,859 | ||||||||
Corporate and other costs: | ||||||||||||
Facilities closing costs | - | - | - | 217,266 | ||||||||
Acquisition costs | - | 43,464 | - | 43,464 | ||||||||
Stock-based compensation expense | 1,963,518 | 49,167 | 1,951,444 | 2,198,812 | ||||||||
Impairment of assets | 425,221 | - | 3,898,856 | - | ||||||||
Impairment of goodwill | - | - | 3,197,391 | - | ||||||||
General and administrative expenses | 9,865,330 | 7,794,808 | 29,176,130 | 24,730,168 | ||||||||
Total corporate and other costs | 12,254,069 | 7,887,439 | 38,223,821 | 27,189,710 | ||||||||
Interest expense | 5,381,040 | 4,098,179 | 14,879,934 | 12,081,316 | ||||||||
Loss on warrant liability | 6,733,552 | - | 1,072,709 | - | ||||||||
Other (income) expense | 128,645 | (53,206) | (712,049) | 70,721 | ||||||||
Income (loss) before taxes | (2,580,492) | (4,866,199) | 1,170,808 | (17,780,888) | ||||||||
Income tax expense (benefit) | 4,584,518 | (342,259) | 5,868,075 | (2,068,530) | ||||||||
Net income (loss) | (7,165,010) | (4,523,940) | (4,697,267) | (15,712,358) | ||||||||
Less: net income (loss) attributable to noncontrolling interests | 1,623,303 | 1,018,451 | 4,819,169 | (1,543,641) | ||||||||
Net loss attributable to Nutex Health Inc. | $ | (8,788,313) | $ | (5,542,391) | $ | (9,516,436) | $ | (14,168,717) | ||||
Adjusted EBITDA(1) | $ | 13,463,592 | $ | 1,279,193 | $ | 30,063,033 | $ | 7,711,586 | ||||
(1) See reconciliation of net loss attributable to Nutex Health Inc. to Adjusted EBITDA under Non-GAAP Financial Measures. | ||||||||||||
Three Months Ended September 30, 2024 Compared to Three Months Ended September 30, 2023
Net loss attributable to Nutex Health Inc. increased to $8.8 million, or a loss of $1.72 per share, for the three months ended September 30, 2024 from a net loss attributable to Nutex Health Inc. of $5.5 million, or a loss of $1.25 per share, for the same period of 2023. Our 2024 results were principally affected by higher revenue and cost due to:
| ● | Higher patient visits, which increased by 11.3% during the three months ended September 30, 2024 as compared with the same period of 2023. Same store mature hospitals increased visits an average of 3.8% versus prior year as well as the opening of four new hospitals in 2023; |
| ● | Increased revenue per visit due to success in efforts to obtain higher rates through the Independent Dispute Resolution (“IDR”) process and increased utilization of higher paid services such as increased observation and in-patient stays. |
| ● | Higher stock-based compensation to ramping hospitals of $2.0 million for the three months ended September 30, 2024, an increase of $2.0 million compared to the same period last year. |
| ● | Higher income tax expense of $4.6 million for the three months ended September 30, 2024 compared to a tax benefit of $0.3 million for the three months ended September 30, 2023, an increase of $4.9 million. |
| ● | Higher interest expense of $5.4 million for the three months ended September 30, 2024, an increase of $1.3 million compared to the same period last year. |
| ● | Loss on warrant liability of $6.7 million for the three months ended September 30, 2024. |
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Adjusted EBITDA for the three months ended September 30, 2024 increased to $13.5 million from $1.3 million for the comparable period of 2023. Refer to Non-GAAP Financial Measures discussed below for a definition and reconciliation of Adjusted EBITDA. The items affecting revenue contributed significantly to the increase in Adjusted EBITDA in the 2024 period.
A discussion of our segment results is included below.
Hospital Division. Our revenue for the three months ended September 30, 2024 totaled $71.7 million as compared to $54.6 million for the same period of 2023, an increase of $17.1 million or 31.3%. This increase was attributed to an increase in visits, an increase in revenue per visit due to success in efforts to obtain higher rates through the IDR process and increased utilization of higher paid services such as increased observation and in-patient stays. Of this revenue increase, 20.7% related to mature hospitals, which are hospitals that were opened by December 31, 2021.
The following table shows the number of patient visits during the periods:
Three Months Ended September 30, | ||||||
2024 | 2023 | |||||
Patient visits: | ||||||
Hospital | 41,668 | 37,443 | ||||
Total patient visits increased 11.3% during the three months ended September 30, 2024 as compared with the same period of 2023 including the opening of four facilities throughout 2023 which are fully operating in 2024. Of this visit increase, 3.8% related to mature hospitals, which are hospitals opened by December 31, 2021.
The hospital division’s operating income was $21.4 million during the three months ended September 30, 2024, compared with an operating income of $7.2 million in the same period of 2023, an increase of 197.2%. Our revenue and operating income for the third quarter of 2024 was positively affected by the increase in visits and increase in rate paid by insurers discussed above.
Population Health Management Division. Our total revenue for the three months ended September 30, 2024 was $7.1 million as compared with $8.1 million for the same period of 2023. The decrease in revenue was due to no revenue amounts attributed to Clinigence and Procare businesses as those businesses were sold in 2024.
The population health management division had $0.5 million of operating income for the three months ended September 30, 2024 as compared with $0.2 million of operating loss for the same period of 2023. Strategically, we are focused on the growth of this division principally through the addition of new independent physician associations and have staffed our organization to manage larger numbers of such organizations.
Real Estate Division. This division reports the operations of consolidated Real Estate Entities where we provide guarantees of their indebtedness or are co-borrowers.
Revenue and operating expenses of consolidated Real Estate Entities are not significant since the extent of these entities’ operations is to own facilities leased to our hospital division entities which are financed by a combination of contributed equity by related parties and third-party mortgage indebtedness. Such leases are typically on a triple net basis where our hospital division is responsible for all operating costs, repairs and taxes on the facilities. Finance lease income is recognized outside of segment operating income as other income by the Real Estate Entities. However, these amounts are largely eliminated in the consolidation of these entities into our financial statements.
As of September 30, 2024, two Real Estate Entities continue to be consolidated in our financial statements. We expect that hospitals we open in the future may be leased from new Real Estate Entities which may be owned in whole or part by related parties. Third-party lenders to these entities may require that we provide a guarantee or become co-borrowers under mortgage indebtedness and financings for such facilities. In such instances, we may be required to consolidate these new Real Estate Entities in our financial statements as VIEs.
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Corporate and other costs. Corporate and other costs in the three months ended September 30, 2024 totaled $12.3 million as compared to $7.9 million for the same period of 2023, an increase of 55.7%. General and administrative costs include our executive management, accounting, human resources, corporate technology, insurance and professional fees. The increase in corporate and other costs is primarily due to an increase in stock-based compensation of $2.0 million, and an increase in general and administrative expenses of $2.1 million, of which $0.8 million is due to an increase accrued wages and bonuses.
Nonoperating items
Interest expense. Interest expense was $5.4 million in the three months ended September 30, 2024 as compared with $4.1 million for the same period of 2023. The increase in interest expense for the 2024 period is principally due to discount amortization expense, the opening of new facilities in 2023 and interest expense associated with the Unsecured Convertible Term Debt.
Loss on warrant liability. Loss on warrant liability was $6.7 million in the three months ended September 30, 2024 is the remeasurement of the warrant liability required at each reporting period and for every warrant exercise. The loss is influenced by changes in our common stock market price.
Income tax expense. Income tax provisions for interim quarterly periods are generally based on an estimated annual effective income tax rate calculated separately from the effect of significant, infrequent or unusual items related specifically to interim periods. The income tax impact of discrete items is recognized in the period these occur.
Our effective tax rate for the three months ended September 30, 2024 was approximately (177.7)%. The primary difference from the federal statutory rate of 21% is related to state taxes, income of noncontrolling interests in flow-through entities and permanent differences for non-deductible expenses.
Nine Months Ended September 30, 2024 Compared to Nine Months Ended September 30, 2023
Net loss attributable to Nutex Health Inc. decreased to $9.5 million, or a loss of $1.91 per share, for the nine months ended September 30, 2024 from a net loss attributable to Nutex Health Inc. of $14.2 million, or a loss of $3.23 per share, for the same period of 2023. Our 2024 results were principally affected by higher revenue and cost due to:
| ● | Higher patient visits, which increased by 19.6% during the nine months ended September 30, 2024 as compared with the same period of 2023; same store mature hospitals increased visits an average of 7.7% versus prior year as well as the opening of four new hospitals in 2023. |
| ● | Increased revenue per visit due to payor payment rates through the IDR process and increased utilization of higher paid services such as increased observation and in-patient stays. |
| ● | Impairment of assets of $3.9 million and impairment of goodwill of 3.2 million (both non-cash) due to the divesture of two smaller population health entities for the nine months ended September 30, 2024 further discussed in Note 3. |
| ● | Higher income tax expense of $5.9 million for the nine months ended September 30, 2024 compared to a tax benefit of $2.1 million for the nine months ended September 30, 2023, an increase of $7.8 million or 381%. |
| ● | Loss on warrant liability of $1.1 million for the nine months ended September 30, 2024. |
Adjusted EBITDA for the nine months ended September 30, 2024 increased to $30.1 million from $7.7 million for the comparable period of 2023. Refer to Non-GAAP Financial Measures discussed below for a definition and reconciliation of Adjusted EBITDA. The items affecting revenue contributed significantly to the increase in Adjusted EBITDA in the 2024 period.
A discussion of our segment results is included below.
Hospital Division. Our revenue for the nine months ended September 30, 2024 totaled $199.4 million as compared to $155.5 million for the same period of 2023, an increase of $43.9 million or 28.2%. This increase was attributed to an increase in visits, and an increase in revenue per visit due to success in efforts to obtain higher rates through the IDR
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process and increased utilization of higher paid services such as increased observation and in-patient stays. Of this revenue increase, 13.5% related to mature hospitals, which are hospitals that were opened by December 31, 2021.
The following table shows the number of patient visits during the periods:
Nine Months Ended September 30, | ||||||
2024 | 2023 | |||||
Patient visits: | ||||||
Hospital | 122,944 | 102,798 | ||||
Total patient visits increased 19.6% during the nine months ended September 30, 2024 as compared with the same period of 2023 due mostly to the opening of four facilities throughout 2023 which are fully operating in 2024. Of this visit increase, 7.7% related to mature hospitals, which are hospitals opened by December 31, 2021.
The hospital division’s operating income was $54.7 million during the nine months ended September 30, 2024, compared with an operating income of $21.1 million in the same period of 2023, an increase of 159.2%. Our revenue and operating income for the third quarter of 2024 was positively affected by the increase in visits and revenue per visit discussed above.
Population Health Management Division. Our total revenue for the nine months ended September 30, 2024 was $23.0 million as compared with $22.5 million for the same period of 2023. The increase was due to higher capitation revenue earned.
The population health management division had $0.1 million of operating loss for the nine months ended September 30, 2024 as compared with $0.4 million of operating income for the same period of 2023. Strategically, we are focused on the growth of this division principally through the addition of new independent physician associations and have staffed our organization to manage larger numbers of such organizations.
Real Estate Division. This division reports the operations of consolidated Real Estate Entities where we provide guarantees of their indebtedness or are co-borrowers.
Revenue and operating expenses of consolidated Real Estate Entities are not significant since the extent of these entities’ operations is to own facilities leased to our hospital division entities which are financed by a combination of contributed equity by related parties and third-party mortgage indebtedness. Such leases are typically on a triple net basis where our hospital division is responsible for all operating costs, repairs and taxes on the facilities. Finance lease income is recognized outside of segment operating income as other income by the Real Estate Entities. However, these amounts are largely eliminated in the consolidation of these entities into our financial statements.
As of September 30, 2024, two Real Estate Entities continue to be consolidated in our financial statements. We expect that hospitals we open in the future may be leased from new Real Estate Entities which may be owned in whole or part by related parties. Third-party lenders to these entities may require that we provide a guarantee or become co-borrowers under mortgage indebtedness and financings for such facilities. In such instances, we may be required to consolidate these new Real Estate Entities in our financial statements as VIEs.
Corporate and other costs. Corporate and other costs in the nine months ended September 30, 2024 was $38.2 million as compared to $27.2 million for the same period of 2023, an increase of 40.4%. General and administrative costs include our executive management, accounting, human resources, corporate technology, insurance and professional fees. The increase in corporate and other costs is primarily due to impairment of assets of $3.9 million, impairment of goodwill of $3.2 million, and accrued wages and bonuses of $1.3 million. These impairments are related to the sale of Procare and Clinigence Health.
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Nonoperating items
Interest expense. Interest expense was $14.9 million in the nine months ended September 30, 2024 as compared with $12.1 million for the same period of 2023. The increase in interest expense for the 2024 period is principally due to discount amortization expense, the opening of new facilities and interest expense associated with the Unsecured Convertible Term Debt.
Loss on warrant liability. Loss on warrant liability was $1.1 million in the nine months ended September 30, 2024 from the remeasurement of the warrant liability required at every warrant exercise and each reporting period. The remeasurement is influenced by changes in our common stock market price.
Income tax expense. Income tax provisions for interim quarterly periods are generally based on an estimated annual effective income tax rate calculated separately from the effect of significant, infrequent or unusual items related specifically to interim periods. The income tax impact of discrete items is recognized in the period these occur.
Our effective tax rate for the nine months ended September 30, 2024 was approximately 501.2%. The primary difference from the federal statutory rate of 21% is related to state taxes, income of noncontrolling interests in flow-through entities and permanent differences for non-deductible expenses.
Liquidity and Capital Resources
As of September 30, 2024, we had $46.9 million of cash and equivalents, compared to $22.0 million of cash and equivalents at December 31, 2023.
Significant sources and uses of cash during the first nine months of 2024.
Sources of cash:
| ● | Cash from operating activities was $23.1 million, which included $4.8 million from the primary components of our working capital (receivables, inventories, accounts payable and expenses) |
| ● | Proceeds from common stock issuance of $9.2 million, net issuance costs |
| ● | Proceeds from note payable $7.0 million; and |
| ● | Proceeds from exercise of warrants $0.8 million. |
Uses of cash:
| ● | Repayments of lines of credit and notes payable $9.4 million |
| ● | Capital expenditures were $1.9 million |
| ● | Cash related to sale of business $0.4 million |
| ● | Distributions, net of contributions, to noncontrolling interests totaled $2.7 million |
| ● | Repayments of finance leases totaled $1.9 million; and |
Future sources and uses of cash. Our operating activities are financed with cash on hand, which is generated from revenues, which may vary significantly based on regulatory changes affecting the timing and amounts of insurance reimbursements for our services. Most of our hospital facilities are leased from various lessors including related parties. These leases are presented in our consolidated balance sheets unless the lease is from a consolidated Real Estate Entity. Our growth plans include the development of new hospital locations. We expect that in many of these locations we will lease facilities from newly established entities partially owned by related parties.
We routinely enter into equipment lease agreements to procure new or replacement equipment and may also finance these purchases with term debt. We have smaller lines of credits available for working capital purposes and are presently working to supplement or replace these with larger financing commitments. These larger financing commitments are subject to market conditions, and we may not be able to obtain such larger financing commitments with favorable economic terms or at all. We also believe that our existing cash, cash equivalents, and marketable securities, and available borrowing capacity, will be sufficient to meet our anticipated cash needs requirements for operations and
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growth objectives for at least the next twelve months. If the assumptions underlying our business plan regarding future revenue and expenses change or if unexpected opportunities or needs arise, we may seek to raise additional cash by selling equity or debt securities.
Indebtedness. As discussed above, we enter into debt arrangements, classified as long-term debt on our financial statements, to address equipment purchases and working capital purposes. We also enter into lease agreements for our hospital facilities, classified as lease liabilities on our financial statements. The Company’s indebtedness as of September 30, 2024 is presented in Item I, “Financial Statements – Note 8 – Debt” and our lease obligations are presented in Item I, “Financial Statements—Note 9 – Leases.”
Off-Balance Sheet Arrangements
As of September 30, 2024, we had no material off-balance sheet arrangements.
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 an allocation to noncontrolling interests, (gain)/loss on warrant liability, stock-based compensation, any facilities closing costs, 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.
Three Months Ended September 30, | Nine Months Ended September 30, | |||||||||||
2024 |
| 2023 | 2024 |
| 2023 | |||||||
Reconciliation of net loss attributable to Nutex Health Inc. to Adjusted EBITDA: | ||||||||||||
Net loss attributable to Nutex Health Inc. | $ | (8,788,313) | $ | (5,542,391) | $ | (9,516,436) | $ | (14,168,717) | ||||
Depreciation and amortization | 4,972,478 | 4,745,941 | 13,691,484 | 12,908,848 | ||||||||
Interest expense, net | 5,381,040 | 4,098,179 | 14,879,934 | 12,081,316 | ||||||||
Income tax expense (benefit) | 4,584,518 | (342,259) | 5,868,075 | (2,068,530) | ||||||||
Allocation to noncontrolling interests | (1,808,422) | (1,772,908) | (4,980,424) | (3,500,873) | ||||||||
EBITDA attributable to Nutex Health Inc. | 4,341,301 | 1,186,562 | 19,942,633 | 5,252,044 | ||||||||
Facilities closing costs | - | - | - | 217,266 | ||||||||
Loss on warrant liability | 6,733,552 | - | 1,072,709 | - | ||||||||
Impairment of assets | 425,221 | 3,898,856 | ||||||||||
Impairment of goodwill | - | - | 3,197,391 | - | ||||||||
Acquisition costs | - | 43,464 | - | 43,464 | ||||||||
Stock-based compensation expense | 1,963,518 | 49,167 | 1,951,444 | 2,198,812 | ||||||||
Adjusted EBITDA attributable to Nutex Health Inc. | $ | 13,463,592 | $ | 1,279,193 | $ | 30,063,033 | $ | 7,711,586 | ||||
Significant Accounting Policies
The preparation of financial statements and related disclosures in accordance with GAAP requires management to make judgments, assumptions and estimates that affect the amounts reported in the consolidated financial statements and accompanying notes. Note 1 to the Consolidated Financial Statements included in the Form 10-K for the year ended
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December 31, 2023 describes the significant accounting policies and methods used in the preparation of the consolidated financial statements. The Company’s critical accounting policies that are impacted by judgments, assumptions and estimates are described in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations in our Annual Report on Form 10-K for the year ended December 31, 2023. Since December 31, 2023, there have been no material changes in the Company’s accounting policies that are impacted by judgments, assumptions and estimates.
Item 3. Quantitative and Qualitative Disclosures about Market Risk
With respect to the three months ended September 30, 2024, there have been no material changes in our primary market risk exposures or how those exposures are managed since the information disclosed in our 2023 Form 10-K.
Item 4. Controls and Procedures
Evaluation of Disclosure Controls and Procedures. We maintain disclosure controls and procedures as that term is defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act that are designed to ensure that information required to be disclosed by the Company in reports that it files or submits under the Exchange Act, 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 Chief Executive Officer (“CEO”) and our Chief Financial Officer (“CFO”), as appropriate, to allow timely decisions regarding required disclosures. Any controls and procedures, no matter how well designed and operated, can provide only reasonable assurance of achieving the desired control objectives. In accordance with Rule 13a-15(b) of the Exchange Act, we have evaluated, under the supervision of our CEO and our CFO, the effectiveness of disclosure controls and procedures as of September 30, 2024. Based on this evaluation, the Company concluded that our disclosure controls and procedures were not effective as of September 30, 2024 due to the material weakness previously identified as described below.
Previously Reported Material Weaknesses. We previously identified material weaknesses in our internal control over financial reporting in our Form 10-K for the year ended December 31, 2023, based on criteria established in the Internal Control-Integrated Framework (2013) issued by the Committee of Sponsoring Organizations of the Treadway Commission (the “COSO criteria”). Based on our assessment, the following material weaknesses were identified:
| ● | The Company had ineffective design, implementation, and operation controls over logical access, program change management, and vendor management controls: |
| 1) | appropriate restrictions that would adequately prevent users from gaining inappropriate access to the financially relevant systems. |
| 2) | IT program and data changes affecting the Company’s financial IT applications and underlying accounting records, are identified, tested, authorized and implemented appropriately to validate that data produced by its relevant IT systems were complete and accurate. Automated process-level and manual controls that are dependent upon the information derived from such financially relevant systems were also determined to be ineffective as a result of such deficiency. |
| 3) | key third party service provider SOC reports were obtained and reviewed. |
| ● | Business process controls across all financial reporting processes were not effectively designed and implemented to properly address the risk of material misstatement, including controls without proper segregation of duties between preparer and reviewer and key management review controls. |
| ● | Ineffective design and implementation of controls over the completeness and accuracy of information included in key spreadsheets supporting the financial statements. |
Management has concluded that, based on applying the COSO criteria, as of December 31, 2023, the Company’s internal control over financial reporting was not effective to provide reasonable assurance of the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with U.S. generally accepted accounting principles.
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Remediation Plans. These material weaknesses did not result in a material misstatement of the Company’s consolidated financial statements for the periods presented. In 2023, the Company started the process of designing and implementing effective internal control measures to remediate the reported material weaknesses. The Company’s efforts included implementing a new enterprise-wide system to reduce reliance on manual processes and spreadsheets supporting the financial statements. Additionally, the Company engaged an accounting firm in 2023 to assist in the proper design, implementation and testing of internal controls over financial reporting. We added key senior management positions including a Chief Operating Officer and made additions to our accounting and financial reporting teams throughout 2023. Throughout 2024, we added a director of information technology and we have strengthened our internal audit program to review and monitor the Company’s progress with our remediation plans.
While we believe that these efforts will improve our internal control over financial reporting, our remediation efforts are ongoing and will require validation and testing of the design and operating effectiveness of internal controls. The actions that we are taking are subject to ongoing senior management review, as well as audit committee oversight. We will not be able to conclude whether the steps we are taking will fully remediate the remaining material weakness in our internal control over financial reporting until we have completed our remediation efforts and subsequent evaluation of their effectiveness. We may also conclude that additional measures may be required to remediate the material weakness in our internal control over financial reporting.
Changes in Internal Control Over Financial Reporting. We are taking actions to remediate the material weakness relating to our internal control over financial reporting, as described above. Except as otherwise described herein, there were no changes in our internal control over financial reporting (as defined in Rule 13a-15(f) under the Exchange Act) that occurred during the period covered by this Quarterly Report that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.
Inherent Limitations on Effectiveness of Disclosure Controls and Procedures. Our senior members of management do not expect that our disclosure controls and procedures or our internal control over financial reporting will prevent all errors and all fraud. A control system, no matter how well designed and operated, can provide only reasonable, not absolute, assurance that the objectives of the control system are met. Because of its inherent limitations, internal control over financial reporting may not prevent or detect misstatements. Also, projections of any evaluation of effectiveness to future periods are subject to the risk that controls may become inadequate because of changes in conditions, or that the degree of compliance with the policies or procedures may deteriorate.
PART II — OTHER INFORMATION
Item 1. Legal Proceedings.
From time to time, the Company, its consolidated subsidiaries or VIEs may be named in various claims and legal actions in the normal course of business. The Company is not involved in any legal proceedings that it believes would have a material effect on its business or financial condition.
Item 1A. Risk Factors.
In addition to the other information set forth in this Quarterly Report, you should carefully consider the risk factors and other cautionary statements described under the heading “Risk Factors” included in our Form 10-K for the year ended December 31, 2023 and the risk factors and other cautionary statements contained in our other SEC filings, which could materially affect our businesses, financial condition or future results. Additional risks and uncertainties not currently known to us or that we currently deem to be immaterial also may materially adversely affect our business, financial condition or future results.
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Item 2. Unregistered Sales of Equity Securities and Use of Proceeds.
Recent Sales of Unregistered Securities; use of proceeds from registered securities.
Not applicable.
Item 3. Defaults upon Senior Securities.
Not Applicable
Item 4. Mine Safety Disclosures
Not Applicable
Item 5. Other Information.
Trading Arrangements
During the fiscal quarter ended September 30, 2024, none of the Company’s directors or officers (as defined in Rule 16a-1(f) of the Securities Exchange Act of 1934, as amended)
Item 6. Exhibits
Exhibit No. | Description |
31.1* | |
31.2* | |
32.1* | |
32.2* | |
101.INS* | XBRL Instance Document - the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL 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 Document. |
101.PRE* | XBRL Taxonomy Extension Presentation Linkbase Document. |
104 | Cover Page Interactive Data File - The cover page interactive data file does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL 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 its behalf by the undersigned, thereunto duly authorized, on November 7, 2024.
| Nutex Health Inc. | |||
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By: | /s/ Thomas T. Vo | |||
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| Thomas T. Vo | ||
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| Chief Executive Officer and Chairman of the Board (principal executive officer) | ||
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By: | /s/ Jon C. Bates | |||
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| Jon C. Bates | ||
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| Chief Financial Officer (principal financial officer and principal accounting officer) | ||
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