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ADUS Addus HomeCare

Document And Entity Information

Document And Entity Information - shares3 Months Ended
Mar. 31, 2021Apr. 30, 2021
Cover [Abstract]
Document Type10-Q
Amendment Flagfalse
Document Period End DateMar. 31,
2021
Document Fiscal Period FocusQ1
Document Fiscal Year Focus2021
Entity Registrant NameADDUS HOMECARE CORPORATION
Entity Central Index Key0001468328
Trading SymbolADUS
Current Fiscal Year End Date--12-31
Entity Filer CategoryLarge Accelerated Filer
Entity Small Businessfalse
Entity Emerging Growth Companyfalse
Entity Shell Companyfalse
Entity Current Reporting StatusYes
Entity Address, State or ProvinceTX
Entity File Number001-34504
Entity Tax Identification Number20-5340172
Entity Address, Address Line One6303 Cowboys Way
Entity Address, Address Line TwoSuite 600
Entity Address, City or TownFrisco
Entity Address, Postal Zip Code75034
City Area Code469
Local Phone Number535-8200
Entity Common Stock, Shares Outstanding15,903,434
Document Quarterly Reporttrue
Document Transition Reportfalse
Entity Interactive Data CurrentYes
Entity Incorporation, State or Country CodeDE
Title of 12(b) SecurityCommon Stock, $0.001 par value
Security Exchange NameNASDAQ

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Current assets
Cash $ 125,547 $ 145,078
Accounts receivable, net138,806 132,650
Prepaid expenses and other current assets10,787 9,969
Total current assets275,140 287,697
Property and equipment, net of accumulated depreciation and amortization19,322 19,749
Other assets
Goodwill469,036 469,072
Intangibles, net of accumulated amortization69,395 71,549
Deferred tax assets, net6,359 6,524
Operating lease assets, net38,325 37,991
Total other assets583,115 585,136
Total assets877,577 892,582
Current liabilities
Accounts payable23,459 23,705
Accrued payroll20,255 35,815
Accrued expenses38,654 37,564
Government stimulus advances20,368 32,087
Accrued workers' compensation insurance14,380 13,759
Current portion of long-term debt972 971
Total current liabilities118,088 143,901
Long-term liabilities
Long-term debt, less current portion, net of debt issuance costs193,839 193,901
Long-term operating lease liabilities35,623 35,516
Other long-term liabilities117 588
Total long-term liabilities229,579 230,005
Total liabilities347,667 373,906
Stockholders' equity
Common stock—$.001 par value; 40,000 authorized and 15,903 and 15,826 shares issued and outstanding as of March 31, 2021 and December 31, 2020, respectively16 16
Additional paid-in capital371,835 369,495
Retained earnings158,059 149,165
Total stockholders' equity529,910 518,676
Total liabilities and stockholders' equity $ 877,577 $ 892,582

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / sharesMar. 31, 2021Dec. 31, 2020
Statement Of Financial Position [Abstract]
Common stock, par value $ 0.001 $ 0.001
Common stock, shares authorized40,000,000 40,000,000
Common stock, shares issued15,903,000 15,826,000
Common stock, shares outstanding15,903,000 15,826,000

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) shares in Thousands, $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Income Statement [Abstract]
Net service revenues $ 205,302 $ 190,216
Cost of service revenues144,105 134,381
Gross profit61,197 55,835
General and administrative expenses45,426 42,287
Depreciation and amortization3,601 2,887
Total operating expenses49,027 45,174
Operating income12,170 10,661
Interest income(22)(334)
Interest expense1,216 908
Total interest expense, net1,194 574
Income before income taxes10,976 10,087
Income tax expense2,082 1,429
Net income $ 8,894 $ 8,658
Net income per common share
Basic income per share $ 0.57 $ 0.56
Diluted income per share $ 0.55 $ 0.54
Weighted average number of common shares and potential common shares outstanding:
Basic15,694 15,519
Diluted16,069 15,907

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) shares in Thousands, $ in ThousandsTotalCommon Stock [Member]Additional Paid-in Capital [Member]Retained Earnings [Member]
Balance at Dec. 31, 2019 $ 475,592 $ 15 $ 359,545 $ 116,032
Balance, shares at Dec. 31, 201915,617
Forfeiture of shares of common stock under restricted stock award agreements, shares(5)
Stock-based compensation1,407 1,407
Shares issued for exercise of stock options1,151 $ 1 1,150
Shares issued for exercise of stock options, shares48
Net income8,658 8,658
Balance at Mar. 31, 2020486,808 $ 16 362,102 124,690
Balance, shares at Mar. 31, 202015,660
Balance at Dec. 31, 2020518,676 $ 16 369,495 149,165
Balance, shares at Dec. 31, 202015,826
Issuance of shares of common stock under restricted stock award agreements, shares75
Stock-based compensation2,239 2,239
Shares issued for exercise of stock options101 101
Shares issued for exercise of stock options, shares2
Net income8,894 8,894
Balance at Mar. 31, 2021 $ 529,910 $ 16 $ 371,835 $ 158,059
Balance, shares at Mar. 31, 202115,903

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Cash flows from operating activities:
Net income $ 8,894 $ 8,658
Adjustments to reconcile net income to net cash (used in) provided by operating activities, net of acquisitions:
Depreciation and amortization3,601 2,887
Deferred income taxes165 42
Stock-based compensation2,239 1,407
Amortization of debt issuance costs under the credit facility184 186
Provision for doubtful accounts252 224
Changes in operating assets and liabilities, net of acquisitions:
Accounts receivable(6,397)8,777
Prepaid expenses and other current assets(1,007)973
Government stimulus(11,719)
Accounts payable(290)(1,976)
Accrued payroll(15,313)5,228
Accrued expenses and other long-term liabilities1,025 (5,964)
Net cash (used in) provided by operating activities(18,366)20,442
Cash flows from investing activities:
Acquisitions of businesses, net of cash acquired(87)
Purchases of property and equipment(1,021)(2,747)
Net cash used in investing activities(1,021)(2,834)
Cash flows from financing activities:
Payments on term loan — credit facility(245)
Payments on financing lease obligations(10)
Cash received from exercise of stock options101 1,151
Net cash (used in) provided by financing activities(144)1,141
Net change in cash(19,531)18,749
Cash, at beginning of period145,078 111,714
Cash, at end of period125,547 130,463
Supplemental disclosures of cash flow information:
Cash paid for interest $ 1,174 731
Cash paid for income taxes $ 1,954

Nature of Operations, Consolida

Nature of Operations, Consolidation, and Presentation of Financial Statements3 Months Ended
Mar. 31, 2021
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Nature of Operations, Consolidation, and Presentation of Financial Statements1. Nature of Operations, Consolidation, and Presentation of Financial Statements Addus HomeCare Corporation (“Holdings”) and its subsidiaries (together with Holdings, the “Company”, “we”, “us” or “our”) operate as a multi-state provider of three distinct but related business segments providing in-home services. In its personal care services segment, the Company provides non-medical assistance with activities of daily living, primarily to persons who are at increased risk of hospitalization or institutionalization, such as the elderly, chronically ill or disabled. In its hospice segment, the Company provides physical, emotional and spiritual care for people who are terminally ill as well as related services for their families. In its home health segment, the Company provides services that are primarily medical in nature to individuals who may require assistance during an illness or after hospitalization and include skilled nursing and physical, occupational and speech therapy. The Company’s payors include federal, state and local governmental agencies, managed care organizations, commercial insurers and private individuals. Basis of Presentation The accompanying Unaudited Condensed Consolidated Financial Statements and related notes have been prepared in accordance with the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”) for Quarterly Reports on Form 10-Q. The accompanying balance sheet as of December 31, 2020 has been derived from the Company’s audited financial statements for the year ended December 31, 2020 previously filed with the SEC. Accordingly, these financial statements do not include all of the information and note disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for annual financial statements and should be read in conjunction with our consolidated financial statements and notes thereto for the year ended December 31, 2020 included in our Annual Report on Form 10-K, which includes information and disclosures not included herein. In the opinion of management, these financial statements reflect all adjustments of a normal, recurring nature necessary for the fair statement of our financial position, results of operations, and cash flows for the interim periods presented in conformity with GAAP. Our results for any interim period are not necessarily indicative of results for a full year or any other interim period. Principles of Consolidation These Unaudited Condensed Consolidated Financial Statements include the accounts of Addus HomeCare Corporation, and its subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.

Summary of Significant Accounti

Summary of Significant Accounting Policies3 Months Ended
Mar. 31, 2021
Accounting Policies [Abstract]
Summary of Significant Accounting Policies2. Summary of Significant Accounting Policies Estimates The financial statements are prepared by management in conformity with U.S. Generally Accepted Accounting Principles (“GAAP”) and include estimated amounts and certain disclosures based on assumptions about future events. The Company’s critical accounting estimates include the following areas: revenue recognition, Diluted Net Income Per Common Share Diluted net income per common share, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The Company’s outstanding securities that may potentially dilute the common stock are stock options and restricted stock awards. As of March 31, 2021 and 2020, dilutive stock options outstanding were approximately 503,000 and 585,000, respectively, and dilutive restricted stock awards outstanding were approximately 168,000 and 77,000, respectively. Included in the Company’s calculation of diluted earnings per share for the three months ended March 31, 2021, dilutive stock options outstanding were approximately 311,000. In addition, dilutive restricted stock awards outstanding were 64,000 for the three months ended March 31, 2021. Included in the Company’s calculation of diluted earnings per share for the three months ended March 31, 2020, dilutive stock options outstanding were approximately 311,000. In addition, dilutive restricted stock awards outstanding were 84,000 for the three months ended March 31, 2020. Recently Adopted Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes Recently Issued Accounting Pronouncements In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting

Leases

Leases3 Months Ended
Mar. 31, 2021
Leases [Abstract]
Leases3. Leases Amounts reported in the Company’s Unaudited Condensed
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Operating lease assets, net
$
38,325
$
37,991
Short-term operating lease liabilities (in accrued expenses)
9,498
9,283
Long-term operating lease liabilities
35,623
35,516
Total operating lease liabilities
$
45,121
$
44,799
Lease Costs Components of lease cost were reported in general and administrative expenses in the Company’s Unaudited Condensed Consolidated Statements of Income as follows:
For the Three Months Ended March 31, (Amounts in Thousands)
2021
2020
Operating lease costs
$
2,777
$
2,118
Short-term lease costs
181
266
Less: sublease income
(151
)
(74
)
Total lease cost, net
$
2,807
$
2,310
Lease Term and Discount Rate Weighte d average remaining lease terms and discount rates were as follows:
March 31, 2021
December 31, 2020
Operating leases:
Weighted average remaining lease term
6.83
6.97
Weighted average discount rate
4.04
%
4.18
% Maturity of Lease Liabilities A summary of our remaining operating lease payments as of March 31, 2021 were as follows:
Operating Leases
(Amounts in Thousands)
Due in the 12-month period ended March 31,
2022
$
10,919
2023
9,228
2024
7,308
2025
5,424
2026
3,266
Thereafter
15,771
Total future minimum rental commitments
51,916
Less: Imputed interest
(6,795
)
Total lease liabilities
$
45,121
Supplemental cash flows information
For the Three Months Ended March 31, (Amounts in Thousands)
2021
2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases
$
2,517
$
2,171
Right-of-use assets obtained in exchange for lease obligations:
Operating leases
2,675
1,439

Acquisitions

Acquisitions3 Months Ended
Mar. 31, 2021
Business Combinations [Abstract]
Acquisitions4. Acquisitions The Company’s acquisitions have been accounted for in accordance with ASC Topic 805, Business Combinations Goodwill and Other Intangible Assets Management’s assessment of qualitative factors affecting goodwill for each acquisition includes estimates of market share at the date of purchase, ability to grow in the market, synergy with existing Company operations and the payor profile in the markets. Queen City Hospice On December 4, 2020, we completed the acquisition of Queen City Hospice, LLC and its affiliate Miracle City Hospice, LLC (together “Queen City Hospice”) Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities acquired are as follows:
Total (Amounts in Thousands)
Goodwill
$
169,107
Identifiable intangible assets
20,015
Cash
15,444
Property and equipment
759
Accounts receivable
5,835
Operating lease assets, net
3,028
Other assets
160
Accounts payable
(2,278
)
Accrued expenses
(503
)
Accrued payroll
(1,351
)
Long-term operating lease liabilities
(2,765
)
Government stimulus advances
(12,694
)
Total purchase price
$
194,757
Identifiable intangible assets acquired included $11.0 million in trade names, $1.5 million of non-competition agreements with estimated useful lives of fifteen years and five years, respectively, and $7.5 million of indefinite lived state licenses. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes. County Homemakers On November 1, 2020, we completed the acquisition of County Homemakers. The purchase price was approximately $15.8 million, including the amount of acquired excess cash held by County Homemakers at the closing of the acquisition (approximately $1.1 million). The purchase of County Homemakers was funded with the Company’s available cash. With the purchase of County Homemakers, the Company expanded its personal care services in the state of Pennsylvania. The related integration costs were $0.1 million for the three months ended March 31, 2021. These costs were included in general and administrative expenses on the Unaudited Condensed Consolidated Statements of Income and were expensed as incurred. Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities acquired are as follows:
Total (Amounts in Thousands)
Goodwill
$
13,403
Identifiable intangible assets
474
Cash
1,104
Property and equipment
52
Accounts receivable
1,395
Operating lease assets, net
485
Other assets
40
Accounts payable
(67
)
Accrued expenses
(37
)
Accrued payroll
(543
)
Long-term operating lease liabilities
(485
)
Total purchase price
$
15,821
Identifiable intangible assets acquired included approximately $0.3 million in state licenses and $0.1 million in trade names with estimated useful lives of eight years and one year, respectively. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes. A Plus Health Care On July 1, 2020, we completed the acquisition of A Plus Health Care, Inc. (“A Plus”). The purchase price was approximately $14.5 million, including the amount of acquired excess cash held by A Plus at the closing of the acquisition (approximately $2.8 million). The purchase of A Plus was funded with the Company’s available cash. With the purchase of A Plus, the Company expanded its personal care services in the state of Montana. The related integration costs were $0.1 million for the three months ended March 31, 2021. These costs were included in general and administrative expenses on the Unaudited Condensed Consolidated Statements of Income and were expensed as incurred. Based upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities acquired are as follows:
Total (Amounts in Thousands)
Goodwill
$
9,711
Identifiable intangible assets
1,523
Cash
2,819
Accounts receivable
1,075
Operating lease assets, net
180
Other assets
26
Accounts payable
(34
)
Accrued expenses
(362
)
Accrued payroll
(311
)
Long-term operating lease liabilities
(100
)
Total purchase price
$
14,527
Identifiable intangible assets acquired included $1.4 million in trade names with an estimated useful life of fifteen years. The preliminary estimated fair value of identifiable intangible assets was determined with the assistance of a valuation specialist, using Level 3 inputs as defined under ASC Topic 820. The fair value analysis and related valuations reflect the conclusions of management. All estimates, key assumptions, and forecasts were either provided by or reviewed by the Company. The goodwill and intangible assets acquired are deductible for tax purposes. SunLife Home Care On December 1, 2020, we completed the acquisition of SunLife Home Care (“SunLife”) for approximately $1.7 million and recorded goodwill of $1.6 million. With the purchase of SunLife, we expanded our personal care services in the state of Arizona. The following table contains unaudited pro forma condensed consolidated income statement information of the Company for the three months ended March 31, 2020 as if each of the acquisitions of Queen City Hospice, County Homemakers and A Plus closed on January 1, 2020.
For the Three Months Ended March 31, 2020 (Amounts in Thousands)
Net service revenues
$
208,967
Operating income
47,112
Net income
10,319
Net income per common share
Basic income per share
$
0.66
Diluted income per share
$
0.65
The pro forma disclosures in the table above include adjustments for amortization of intangible assets, tax expense and acquisition costs to reflect results that are more representative of the combined results of the transactions as if Queen City Hospice, County Homemakers and A Plus had been acquired effective January 1, 2020. This pro forma information is presented for illustrative purposes only and may not be indicative of the results of operations that would have actually occurred. In addition, future results may vary significantly from the results reflected in the pro forma information. The unaudited pro forma financial information does not reflect the impact of future events that may occur after the acquisition, such as anticipated cost savings from operating synergies.

Goodwill and Intangible Assets

Goodwill and Intangible Assets3 Months Ended
Mar. 31, 2021
Goodwill And Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets5. Goodwill and Intangible Assets The goodwill for the Company was $469.0 million and $469.1 million as of March 31, 2021 and December 31, 2020, respectively. A summary of the goodwill activity for the three months ended March 31, 2021 is provided below:
Goodwill
Hospice
Personal Care
Home Health
Total
(Amounts in Thousands)
Goodwill as of December 31, 2020
$
314,833
$
152,448
$
1,791
$
469,072
Adjustments to previously recorded goodwill
(100
)
64

(36
)
Goodwill as of March 31, 2021
$
314,733
$
152,512
$
1,791
$
469,036
The Company’s identifiable intangible assets consist of customer and referral relationships, trade names and trademarks, non-competition agreements and state licenses. Amortization is computed using straight-line and accelerated methods based upon the estimated useful lives of the respective assets, which range from one to twenty-five years. Customer and referral relationships are amortized systematically over the periods of expected economic benefit, which range from five to ten years. The carrying amount and accumulated amortization of each identifiable intangible asset category consisted of the following as of March 31, 2021:
Customer and referral relationships
Trade names and trademarks
Non- competition agreements
State Licenses
Total
(Amounts in Thousands)
Intangible assets with indefinite lives
$

$

$

$
20,791
$
20,791
Intangible assets subject to amortization:
Gross carrying amount
44,672
42,926
6,225
12,507
106,330
Accumulated amortization
(34,915
)
(16,152
)
(3,111
)
(3,548
)
(57,726
)
Intangible assets subject to amortization, net
9,757
26,774
3,114
8,959
48,604
Total intangible assets at March 31, 2021
$
9,757
$
26,774
$
3,114
$
29,750
$
69,395
Amortization expense related to the identifiable intangible assets amounted to $2.2 million and $1.8 million for the three months ended March 31, 2021 and 2020, respectively. The weighted average remaining useful lives of identifiable intangible assets as of March 31, 2021 is 9.6 years.

Details of Certain Balance Shee

Details of Certain Balance Sheet Accounts3 Months Ended
Mar. 31, 2021
Details Of Certain Balance Sheet Accounts [Abstract]
Details of Certain Balance Sheet Accounts6. Details of Certain Balance Sheet Accounts Prepaid expenses and other current assets consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Workers' compensation insurance receivable
$
1,924
$
1,860
Prepaid workers' compensation and liability insurance
1,875
2,838
Health insurance receivable
1,379
528
Other
5,609
4,743
Total prepaid expenses and other current assets
$
10,787
$
9,969
Accrued expenses consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Current portion of operating lease liabilities
$
9,498
$
9,283
Accrued health insurance
5,063
5,607
Accrued payroll taxes
6,978
4,543
Accrued professional fees
2,935
4,220
Payor advances (1)
5,052
4,206
Other
9,128
9,705
Total accrued expenses
$
38,654
$
37,564
(1)
Represents the deferred portion of payments received from payors for COVID-19 reimbursements which will be recognized as we incur specific COVID-19 related expenses (including expenses related to securing and maintaining adequate personnel) or will be returned if such related expenses are not incurred . Government stimulus advances consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Provider Relief Fund
$
11,334
$
12,252
CMS advanced payment program — Queen City Hospice

10,801
Payroll tax deferral
7,141
7,141
Provider Relief Fund — Queen City Hospice
1,893
1,893
Total government stimulus advances
$
20,368
$
32,087
In recognition of the significant threat to the liquidity of financial markets posed by the COVID-19 pandemic, the Federal Reserve and Congress have taken dramatic actions to provide liquidity to businesses and the banking system in the United States. One of the primary sources of relief for healthcare providers is the CARES Act, which was expanded by the PPPHCE Act, and the CAA. The American Rescue Plan Act of 2021 (“ARPA”), another relief package with numerous provisions that affect healthcare providers, was signed into law in March 2021. See Note 9 for additional information regarding government actions to mitigate COVID-19’s impact. Provider Relief Fund In total, the CARES Act and other relief legislation include over $178 billion in funding to be distributed through the Provider Relief Fund to eligible providers, including public entities and Medicare- and/or Medicaid-enrolled providers. In November 2020, the Company received grants in an aggregate principal amount of $13.7 million from the Provider Relief Fund, for which we had previously applied. The Company utilized $0.9 million of these funds for healthcare related expenses attributable to COVID-19 that were unreimbursed by other sources in the three months ended March 31, 2021 and, in accordance with the current guidance issued by HHS, expects to utilize additional funds through June 30, 2021, at which point any unused funds will be returned. We are required to properly and fully document the use of such funds in reports to HHS. The Company’s ability to utilize and retain some or all of such funds will depend on the magnitude, timing and nature of the impact of the COVID-19 pandemic, as well as the terms and conditions of the funds received. Queen City Hospice intends to administer retention payments of $1.9 million to caregivers in the second quarter of 2021, which we believe to be necessary to secure and maintain adequate personnel. Commercial organizations that receive and expend annual total awards of $750,000 or more in federal funding, including payments received through the Provider Relief Fund, are subject to federal audit requirements. Medicare Accelerated and Advance Payment Program – Queen City Hospice The CARES Act expanded the Medicare Accelerated and Advance Payment Program to increase cash flow to providers impacted by the COVID-19 pandemic. Hospice and home health providers were able to request an advance or accelerated payment of up to 100% of the Medicare payment amount for a three-month Payroll tax deferral The CARES Act also provides for certain federal income and other tax changes, including allowing for the deferral of the employer portion of Social Security payroll taxes through December 31, 2020. The Company received a cash benefit of approximately $7.1 million related to the deferral of employer payroll taxes for 2020 under the CARES Act, for the period April 2, 2020 through June 30, 2020. Effective July 1, 2020, the Company began paying its deferred portion of employer Social Security payroll taxes and expects to repay the $7.1 million in 2021.

Long-Term Debt

Long-Term Debt3 Months Ended
Mar. 31, 2021
Long Term Debt [Abstract]
Long-Term Debt7. Long-Term Debt Long-term debt consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Revolving loan under the credit facility
$
178,458
$
178,458
Term loan under the credit facility
17,885
18,130
Less unamortized issuance costs
(1,532
)
(1,716
)
Total
$
194,811
$
194,872
Less current maturities
(972
)
(971
)
Long-term debt
$
193,839
$
193,901
Amended and Restated Senior Secured Credit Facility On October 31, 2018, the Company entered into the Amended and Restated Credit Agreement, dated as of October 31, 2018, with certain lenders and Capital One, National Association, as a lender and as agent for all lenders (as amended by the Amendment (as hereinafter defined), the “Credit Agreement”). This credit facility totaled $269.6 million, inclusive of a $250.0 million revolving loan and a $19.6 million delayed draw term loan, and is evidenced by the Credit Agreement. 0.75 4.25 Addus HealthCare, Inc. (“Addus HealthCare”) is the borrower, and its parent, Holdings, and substantially all of Holdings’ subsidiaries are guarantors under this credit facility, and it is collateralized by a first priority security interest in all of the Company’s and the other credit parties’ current and future tangible and intangible assets, including the shares of stock of the borrower and subsidiaries. The Credit Agreement contains affirmative and negative covenants customary for credit facilities of this type, including limitations on the Company with respect to liens, indebtedness, guaranties, investments, distributions, mergers and acquisitions and dispositions of assets. The Company pays a fee ranging from 0.20% to 0.35% based on the applicable senior net leverage ratio times the unused portion of the revolving loan portion of the credit facility. The Credit Agreement contains customary affirmative covenants regarding, among other things, the maintenance of records, compliance with laws, maintenance of permits, maintenance of insurance and property and payment of taxes. The Credit Agreement also contains certain customary financial covenants and negative covenants that, among other things, include a requirement to maintain a minimum Interest Coverage Ratio (as defined in the Credit Agreement), a requirement to stay below a maximum Total Net Leverage Ratio (as defined in the Credit Agreement) and a requirement to stay below a maximum permitted amount of capital expenditures. The Credit Agreement also contains restrictions on guarantees, indebtedness, liens, investments and loans, subject to customary carve outs, a restriction on dividends (provided that Addus HealthCare may make distributions to the Company in an amount that does not exceed $7.5 million in any year absent of an event of default, plus limited exceptions for tax and administrative distributions), a restriction on the ability to consummate acquisitions (without the consent of the lenders) under its credit facility subject to compliance with the Total Net Leverage Ratio (as defined in the Credit Agreement thresholds), restrictions on mergers, dispositions of assets, and affiliate transactions, and restrictions on fundamental changes and lines of business. As of March 31, 2021, the Company was in compliance with all financial covenants under the Credit Agreement. On September 12, 2019, the Company entered into a First Amendment (the “Amendment”) to its Credit Agreement. The Amendment increased the Company’s credit facility by $50.0 million in incremental revolving loans, for an aggregate $300.0 million in revolving loans. The Amendment provides that future incremental loans may be for term loans or an increase to the revolving loan commitments. The Amendment further provides that the proceeds of the incremental revolving loan commitments may be used for, among other things, general corporate purposes. During the three months ended March 31, 2021 and 2020, the Company had no draws under its credit facility. At March 31, 2021 , the Company had a total of $ 178.5 million of revolving loans, with an interest rate of 1.86 % and $ 17.9 million of term loans, with an interest rate of 1.86 %, outstanding on its credit facility . After giving effect to the amount drawn on its credit facility, approximately $ 8.7 million of outstanding letters of credit and borrowing limits based on an advance multiple of adjusted EBITDA (as defined in the Credit Agreement), the Company had $ 112.8 million available for borrowing under its credit facility. As of December 31, 2020 , the Company had a total of $ 178.5 million of revolving loans, with an interest rate of 1.90 %, and $ 18.1 million of term loans, with an interest rate of 1.90 %, outstanding on its credit facility.

Income Taxes

Income Taxes3 Months Ended
Mar. 31, 2021
Income Tax Disclosure [Abstract]
Income Taxes8. Income Taxes The effective income tax rate was 19.0% and 14.2% for the three months ended March 31, 2021 and 2020, respectively. The difference between our federal statutory and effective income tax rates is principally due to excess tax benefit and the use of federal employment tax credits, offset by the inclusion of state taxes and non-deductible compensation. The excess tax benefit is a discrete item, related to the vesting of equity shares, which requires the Company to recognize the benefit fully in the period. An excess tax benefit results if the Company’s income tax deduction exceeds the cumulative costs of the award recognized on the Unaudited Condensed Consolidated Statements of Income.

Commitments and Contingencies

Commitments and Contingencies3 Months Ended
Mar. 31, 2021
Commitments And Contingencies Disclosure [Abstract]
Commitments and Contingencies9. Commitments and Contingencies Government Actions to Mitigate COVID-19’s Impact On January 31, 2020, the Secretary of the U.S. Department of Health and Human Services (“HHS”) declared a national public health emergency due to a novel coronavirus. In March 2020, the World Health Organization declared the outbreak of COVID-19, a disease caused by this novel coronavirus, a pandemic. This disease continues to impact the United States and other parts of the world. In recognition of the significant threat to the liquidity of financial markets posed by the COVID-19 pandemic, the Federal Reserve and Congress have taken dramatic actions to provide liquidity to businesses and the banking system in the United States. For example, on March 27, 2020, the CARES Act, a sweeping stimulus bill intended to bolster the U.S. economy, was enacted. The PPPHCE Act and the CAA both expansions of the CARES Act, were signed into law on April 24, 2020 and December 27, 2020, respectively. In total, the CARES Act, the PPPHCE Act and CAA authorize $178 billion in funding to be distributed to health care providers through the Provider Relief Fund. This funding is intended to support healthcare providers by reimbursing them for healthcare-related expenses or lost revenues attributable to COVID-19. On March 11, 2021, the ARPA was signed into law, another COVID-19 relief package with numerous provisions that affect healthcare providers, including additional funding targeted to specified healthcare providers and to improve coronavirus testing and vaccine-related activities. In addition to the Provider Relief Fund, the CARES Act and related laws include temporary changes to Medicare and Medicaid payment rules and relief from certain accounting provisions, for example temporarily lifting the Medicare sequester, which would have otherwise reduced payments to Medicare providers by 2% as required by the Budget Control Act of 2011, from May 1, 2020, through December 31, 2021 (but also extending sequestration through 2030). This Medicare sequester relief resulted in an increase of $0.1 million to home health net service revenues and $0.7 million to hospice net service revenues for the three months ended March 31, 2021. . While conditions related to the COVID-19 pandemic have improved in recent months in the United States as vaccinations have become more widely available, it is impossible to predict the effect and ultimate impact of the COVID-19 pandemic on the Company as the situation continues to evolve. See Note 6 for additional information regarding government stimulus advances the Company has received. Legal Proceedings From time to time, the Company is subject to legal and/or administrative proceedings incidental to its business. It is the opinion of management that the outcome of pending legal and/or administrative proceedings will not have a material effect on the Company’s Unaudited Condensed Consolidated Balance Sheets and Unaudited Condensed Consolidated Statements of Income.

Segment Information

Segment Information3 Months Ended
Mar. 31, 2021
Segment Reporting [Abstract]
Segment Information10. Segment Information Operating segments are defined as components of a company that engage in business activities from which it may earn revenues and incur expenses, and for which separate financial information is available and is regularly reviewed by the Company’s chief operating decision makers, to assess the performance of the individual segments and make decisions about resources to be allocated to the segments. The Company operates as a multi-state provider of three distinct but related business segments providing in-home services. In its personal care segment, the Company provides non-medical assistance with activities of daily living, primarily to persons who are at increased risk of hospitalization or institutionalization, such as the elderly, chronically ill or disabled. In its hospice segment, the Company provides physical, emotional and spiritual care for people who are terminally ill as well as related services for their families. In its home health segment, the Company provides services that are primarily medica l in nature to individuals who may require assistance during an illness or after hospitalization and include skilled nursing and physical, occupational and speech therapy. The tables below set forth information about the Company’s reportable segments for the three months ended March 31, 2021 and 2020 along with the items necessary to reconcile the segment information to the totals reported in the accompanying condensed consolidated financial statements. Segment assets are not reviewed by the Company’s chief operating decision maker function and therefore are not disclosed below. Segment operating income consists of revenue generated by a segment, less the direct costs of service revenues and general and administrative expenses that are incurred directly by the segment. Unallocated general and administrative costs are those costs for functions performed in a centralized manner and therefore not attributable to a particular segment. These costs include accounting, finance, human resources, legal, information technology, corporate office support and facility costs and overall corporate management.
For the Three Months Ended March 31, 2021
(Amounts in Thousands)
Personal Care
Hospice
Home Health
Total
Net service revenues
$
164,868
$
36,094
$
4,340
$
205,302
Cost of services revenues
122,839
18,596
2,670
144,105
Gross profit
42,029
17,498
1,670
61,197
General and administrative expenses
15,283
8,463
965
24,711
Segment operating income
$
26,746
$
9,035
$
705
$
36,486
For the Three Months Ended March 31, 2020
(Amounts in Thousands)
Personal Care
Hospice
Home Health
Total
Net service revenues
$
160,665
$
25,212
$
4,339
$
190,216
Cost of services revenues
119,027
12,318
3,036
134,381
Gross profit
41,638
12,894
1,303
55,835
General and administrative expenses
15,603
6,457
1,022
23,082
Segment operating income
$
26,035
$
6,437
$
281
$
32,753
For the Three Months Ended March 31,
2021
2020
(Amounts in Thousands)
Segment reconciliation:
Total segment operating income
$
36,486
$
32,753
Items not allocated at segment level:
Other general and administrative expenses
20,715
19,205
Depreciation and amortization
3,601
2,887
Interest income
(22
)
(334
)
Interest expense
1,216
908
Income before income taxes
$
10,976
$
10,087

Significant Payors

Significant Payors3 Months Ended
Mar. 31, 2021
Significant Payors [Abstract]
Significant Payors11. Significant Payors For the three months ended March 31, 2021 and 2020, the Company’s revenue by payor type was as follows:
Personal Care
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
State, local and other governmental programs
$
80,849
49.0
%
$
79,346
49.4
%
Managed care organizations
75,456
45.8
72,110
44.9
Private pay
4,903
3.0
5,270
3.3
Commercial insurance
2,346
1.4
2,576
1.6
Other
1,314
0.8
1,363
0.8
Total personal care segment net service revenues
$
164,868
100.0
%
$
160,665
100.0
%
Hospice
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Medicare
$
33,985
94.2
%
$
23,219
92.1
%
Managed care organizations
1,487
4.1
1,385
5.5
Other
622
1.7
608
2.4
Total hospice segment net service revenues
$
36,094
100.0
%
$
25,212
100.0
%
Home Health
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Medicare
$
3,502
80.7
%
$
3,470
80.0
%
Managed care organizations
798
18.4
807
18.6
Other
40
0.9
62
1.4
Total home health segment net service revenues
$
4,340
100.0
%
$
4,339
100.0
% The Company derives a significant amount of its revenue from its operations in Illinois, New York and New Mexico. The percentages of segment revenue for each of these significant states for the three months ended March 31, 2021 and 2020 were as follows:
Personal Care
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Illinois
$
73,385
44.5
%
$
71,545
44.5
%
New York
27,575
16.7
31,838
19.8
New Mexico
23,593
14.3
20,694
12.9
All other states
40,315
24.5
36,588
22.8
Total personal care segment net service revenues
$
164,868
100.0
%
$
160,665
100.0
%
Hospice
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Ohio
$
14,114
39.1
%
$


%
New Mexico
9,230
25.6
11,009
43.7
All other states
12,750
35.3
14,203
56.3
Total hospice segment net service revenues
$
36,094
100.0
%
$
25,212
100.0
%
With the acquisition of Queen City Hospice, the Company expanded our hospice services in the state of Ohio.
Home Health
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
New Mexico
$
4,340
100.0
%
$
4,339
100.0
%
Total home health segment net service revenues
$
4,340
100.0
%
$
4,339
100.0
% A substantial portion of the Company’s revenue and accounts receivable are derived from services performed for federal, state and local governmental agencies. We derive a significant amount of our net service revenues in Illinois, which represented 35.8%, and 37.7% of our net service revenues for the three months ended March 31, 2021, and 2020, respectively. The related receivables due from the Illinois Department on Aging represented 23.8% and 15.9% of the Company’s net accounts receivable at March 31, 2021 and December 31, 2020, respectively.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)3 Months Ended
Mar. 31, 2021
Accounting Policies [Abstract]
Basis of PresentationBasis of Presentation The accompanying Unaudited Condensed Consolidated Financial Statements and related notes have been prepared in accordance with the rules and regulations of the U.S. Securities and Exchange Commission (“SEC”) for Quarterly Reports on Form 10-Q. The accompanying balance sheet as of December 31, 2020 has been derived from the Company’s audited financial statements for the year ended December 31, 2020 previously filed with the SEC. Accordingly, these financial statements do not include all of the information and note disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for annual financial statements and should be read in conjunction with our consolidated financial statements and notes thereto for the year ended December 31, 2020 included in our Annual Report on Form 10-K, which includes information and disclosures not included herein. In the opinion of management, these financial statements reflect all adjustments of a normal, recurring nature necessary for the fair statement of our financial position, results of operations, and cash flows for the interim periods presented in conformity with GAAP. Our results for any interim period are not necessarily indicative of results for a full year or any other interim period.
Principles of ConsolidationPrinciples of Consolidation These Unaudited Condensed Consolidated Financial Statements include the accounts of Addus HomeCare Corporation, and its subsidiaries. All intercompany balances and transactions have been eliminated in consolidation.
EstimatesEstimates The financial statements are prepared by management in conformity with U.S. Generally Accepted Accounting Principles (“GAAP”) and include estimated amounts and certain disclosures based on assumptions about future events. The Company’s critical accounting estimates include the following areas: revenue recognition,
Diluted Net Income Per Common ShareDiluted Net Income Per Common Share Diluted net income per common share, calculated on the treasury stock method, is based on the weighted average number of shares outstanding during the period. The Company’s outstanding securities that may potentially dilute the common stock are stock options and restricted stock awards. As of March 31, 2021 and 2020, dilutive stock options outstanding were approximately 503,000 and 585,000, respectively, and dilutive restricted stock awards outstanding were approximately 168,000 and 77,000, respectively. Included in the Company’s calculation of diluted earnings per share for the three months ended March 31, 2021, dilutive stock options outstanding were approximately 311,000. In addition, dilutive restricted stock awards outstanding were 64,000 for the three months ended March 31, 2021. Included in the Company’s calculation of diluted earnings per share for the three months ended March 31, 2020, dilutive stock options outstanding were approximately 311,000. In addition, dilutive restricted stock awards outstanding were 84,000 for the three months ended March 31, 2020.
Recently Issued and Adopted Accounting PronouncementsRecently Adopted Accounting Pronouncements In December 2019, the FASB issued ASU 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes Recently Issued Accounting Pronouncements In March 2020, the FASB issued ASU 2020-04, Reference Rate Reform (Topic 848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting

Leases (Tables)

Leases (Tables)3 Months Ended
Mar. 31, 2021
Leases [Abstract]
Amounts Reported in Unaudited and Audited Condensed Consolidated Balance Sheets for Operating LeasesAmounts reported in the Company’s Unaudited Condensed
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Operating lease assets, net
$
38,325
$
37,991
Short-term operating lease liabilities (in accrued expenses)
9,498
9,283
Long-term operating lease liabilities
35,623
35,516
Total operating lease liabilities
$
45,121
$
44,799
Components of Lease Cost Reported in General and Administrative Expenses in Unaudited Condensed Consolidated Statements of IncomeComponents of lease cost were reported in general and administrative expenses in the Company’s Unaudited Condensed Consolidated Statements of Income as follows:
For the Three Months Ended March 31, (Amounts in Thousands)
2021
2020
Operating lease costs
$
2,777
$
2,118
Short-term lease costs
181
266
Less: sublease income
(151
)
(74
)
Total lease cost, net
$
2,807
$
2,310
Schedule of Weighted Average Remaining Lease Terms and Discount RatesWeighte d average remaining lease terms and discount rates were as follows:
March 31, 2021
December 31, 2020
Operating leases:
Weighted average remaining lease term
6.83
6.97
Weighted average discount rate
4.04
%
4.18
%
Summary of Remaining Operating Lease PaymentsA summary of our remaining operating lease payments as of March 31, 2021 were as follows:
Operating Leases
(Amounts in Thousands)
Due in the 12-month period ended March 31,
2022
$
10,919
2023
9,228
2024
7,308
2025
5,424
2026
3,266
Thereafter
15,771
Total future minimum rental commitments
51,916
Less: Imputed interest
(6,795
)
Total lease liabilities
$
45,121
Supplemental Cash Flows InformationFor the Three Months Ended March 31, (Amounts in Thousands)
2021
2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases
$
2,517
$
2,171
Right-of-use assets obtained in exchange for lease obligations:
Operating leases
2,675
1,439

Acquisitions (Tables)

Acquisitions (Tables)3 Months Ended
Mar. 31, 2021
Business Acquisition [Line Items]
Unaudited Pro Forma Condensed Consolidated Income Statement InformationThe following table contains unaudited pro forma condensed consolidated income statement information of the Company for the three months ended March 31, 2020 as if each of the acquisitions of Queen City Hospice, County Homemakers and A Plus closed on January 1, 2020.
For the Three Months Ended March 31, 2020 (Amounts in Thousands)
Net service revenues
$
208,967
Operating income
47,112
Net income
10,319
Net income per common share
Basic income per share
$
0.66
Diluted income per share
$
0.65
Queen City Hospice [Member]
Business Acquisition [Line Items]
Schedule of Fair Values of Assets and LiabilitiesBased upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities acquired are as follows:
Total (Amounts in Thousands)
Goodwill
$
169,107
Identifiable intangible assets
20,015
Cash
15,444
Property and equipment
759
Accounts receivable
5,835
Operating lease assets, net
3,028
Other assets
160
Accounts payable
(2,278
)
Accrued expenses
(503
)
Accrued payroll
(1,351
)
Long-term operating lease liabilities
(2,765
)
Government stimulus advances
(12,694
)
Total purchase price
$
194,757
County Homemakers [Member]
Business Acquisition [Line Items]
Schedule of Fair Values of Assets and LiabilitiesBased upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities acquired are as follows:
Total (Amounts in Thousands)
Goodwill
$
13,403
Identifiable intangible assets
474
Cash
1,104
Property and equipment
52
Accounts receivable
1,395
Operating lease assets, net
485
Other assets
40
Accounts payable
(67
)
Accrued expenses
(37
)
Accrued payroll
(543
)
Long-term operating lease liabilities
(485
)
Total purchase price
$
15,821
A Plus Health Care, Inc [Member]
Business Acquisition [Line Items]
Schedule of Fair Values of Assets and LiabilitiesBased upon management’s valuations, which are preliminary and subject to completion of working capital adjustments, the fair values of the assets and liabilities acquired are as follows:
Total (Amounts in Thousands)
Goodwill
$
9,711
Identifiable intangible assets
1,523
Cash
2,819
Accounts receivable
1,075
Operating lease assets, net
180
Other assets
26
Accounts payable
(34
)
Accrued expenses
(362
)
Accrued payroll
(311
)
Long-term operating lease liabilities
(100
)
Total purchase price
$
14,527

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)3 Months Ended
Mar. 31, 2021
Goodwill And Intangible Assets Disclosure [Abstract]
Summary of Goodwill and Related AdjustmentsA summary of the goodwill activity for the three months ended March 31, 2021 is provided below:
Goodwill
Hospice
Personal Care
Home Health
Total
(Amounts in Thousands)
Goodwill as of December 31, 2020
$
314,833
$
152,448
$
1,791
$
469,072
Adjustments to previously recorded goodwill
(100
)
64

(36
)
Goodwill as of March 31, 2021
$
314,733
$
152,512
$
1,791
$
469,036
Schedule of Carrying Amount and Accumulated Amortization of Intangible AssetThe carrying amount and accumulated amortization of each identifiable intangible asset category consisted of the following as of March 31, 2021:
Customer and referral relationships
Trade names and trademarks
Non- competition agreements
State Licenses
Total
(Amounts in Thousands)
Intangible assets with indefinite lives
$

$

$

$
20,791
$
20,791
Intangible assets subject to amortization:
Gross carrying amount
44,672
42,926
6,225
12,507
106,330
Accumulated amortization
(34,915
)
(16,152
)
(3,111
)
(3,548
)
(57,726
)
Intangible assets subject to amortization, net
9,757
26,774
3,114
8,959
48,604
Total intangible assets at March 31, 2021
$
9,757
$
26,774
$
3,114
$
29,750
$
69,395

Details of Certain Balance Sh_2

Details of Certain Balance Sheet Accounts (Tables)3 Months Ended
Mar. 31, 2021
Details Of Certain Balance Sheet Accounts [Abstract]
Schedule of Prepaid Expenses and Other Current AssetsPrepaid expenses and other current assets consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Workers' compensation insurance receivable
$
1,924
$
1,860
Prepaid workers' compensation and liability insurance
1,875
2,838
Health insurance receivable
1,379
528
Other
5,609
4,743
Total prepaid expenses and other current assets
$
10,787
$
9,969
Schedule of Accrued ExpensesAccrued expenses consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Current portion of operating lease liabilities
$
9,498
$
9,283
Accrued health insurance
5,063
5,607
Accrued payroll taxes
6,978
4,543
Accrued professional fees
2,935
4,220
Payor advances (1)
5,052
4,206
Other
9,128
9,705
Total accrued expenses
$
38,654
$
37,564
Schedule of Government Stimulus AdvancesGovernment stimulus advances consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Provider Relief Fund
$
11,334
$
12,252
CMS advanced payment program — Queen City Hospice

10,801
Payroll tax deferral
7,141
7,141
Provider Relief Fund — Queen City Hospice
1,893
1,893
Total government stimulus advances
$
20,368
$
32,087

Long-Term Debt (Tables)

Long-Term Debt (Tables)3 Months Ended
Mar. 31, 2021
Long Term Debt [Abstract]
Schedule of Long-Term DebtLong-term debt consisted of the following:
March 31, 2021
December 31, 2020
(Amounts in Thousands)
Revolving loan under the credit facility
$
178,458
$
178,458
Term loan under the credit facility
17,885
18,130
Less unamortized issuance costs
(1,532
)
(1,716
)
Total
$
194,811
$
194,872
Less current maturities
(972
)
(971
)
Long-term debt
$
193,839
$
193,901

Segment Information (Tables)

Segment Information (Tables)3 Months Ended
Mar. 31, 2021
Segment Reporting [Abstract]
Summary of Segment InformationFor the Three Months Ended March 31, 2021
(Amounts in Thousands)
Personal Care
Hospice
Home Health
Total
Net service revenues
$
164,868
$
36,094
$
4,340
$
205,302
Cost of services revenues
122,839
18,596
2,670
144,105
Gross profit
42,029
17,498
1,670
61,197
General and administrative expenses
15,283
8,463
965
24,711
Segment operating income
$
26,746
$
9,035
$
705
$
36,486
For the Three Months Ended March 31, 2020
(Amounts in Thousands)
Personal Care
Hospice
Home Health
Total
Net service revenues
$
160,665
$
25,212
$
4,339
$
190,216
Cost of services revenues
119,027
12,318
3,036
134,381
Gross profit
41,638
12,894
1,303
55,835
General and administrative expenses
15,603
6,457
1,022
23,082
Segment operating income
$
26,035
$
6,437
$
281
$
32,753
For the Three Months Ended March 31,
2021
2020
(Amounts in Thousands)
Segment reconciliation:
Total segment operating income
$
36,486
$
32,753
Items not allocated at segment level:
Other general and administrative expenses
20,715
19,205
Depreciation and amortization
3,601
2,887
Interest income
(22
)
(334
)
Interest expense
1,216
908
Income before income taxes
$
10,976
$
10,087

Significant Payors (Tables)

Significant Payors (Tables)3 Months Ended
Mar. 31, 2021
Significant Payors [Abstract]
Schedule of Revenue by Payor TypeFor the three months ended March 31, 2021 and 2020, the Company’s revenue by payor type was as follows:
Personal Care
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
State, local and other governmental programs
$
80,849
49.0
%
$
79,346
49.4
%
Managed care organizations
75,456
45.8
72,110
44.9
Private pay
4,903
3.0
5,270
3.3
Commercial insurance
2,346
1.4
2,576
1.6
Other
1,314
0.8
1,363
0.8
Total personal care segment net service revenues
$
164,868
100.0
%
$
160,665
100.0
%
Hospice
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Medicare
$
33,985
94.2
%
$
23,219
92.1
%
Managed care organizations
1,487
4.1
1,385
5.5
Other
622
1.7
608
2.4
Total hospice segment net service revenues
$
36,094
100.0
%
$
25,212
100.0
%
Home Health
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Medicare
$
3,502
80.7
%
$
3,470
80.0
%
Managed care organizations
798
18.4
807
18.6
Other
40
0.9
62
1.4
Total home health segment net service revenues
$
4,340
100.0
%
$
4,339
100.0
%
Schedule of Revenue by Geographic LocationThe percentages of segment revenue for each of these significant states for the three months ended March 31, 2021 and 2020 were as follows:
Personal Care
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Illinois
$
73,385
44.5
%
$
71,545
44.5
%
New York
27,575
16.7
31,838
19.8
New Mexico
23,593
14.3
20,694
12.9
All other states
40,315
24.5
36,588
22.8
Total personal care segment net service revenues
$
164,868
100.0
%
$
160,665
100.0
%
Hospice
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
Ohio
$
14,114
39.1
%
$


%
New Mexico
9,230
25.6
11,009
43.7
All other states
12,750
35.3
14,203
56.3
Total hospice segment net service revenues
$
36,094
100.0
%
$
25,212
100.0
%
With the acquisition of Queen City Hospice, the Company expanded our hospice services in the state of Ohio.
Home Health
For the Three Months Ended March 31,
2021
2020
Amount (in Thousands)
% of Segment Net Service Revenues
Amount (in Thousands)
% of Segment Net Service Revenues
New Mexico
$
4,340
100.0
%
$
4,339
100.0
%
Total home health segment net service revenues
$
4,340
100.0
%
$
4,339
100.0
%

Nature of Operations, Consoli_2

Nature of Operations, Consolidation, and Presentation of Financial Statements (Narrative) (Details)3 Months Ended
Mar. 31, 2021segment
Organization Consolidation And Presentation Of Financial Statements [Abstract]
Number of operating segments3

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Narrative) (Details) - shares3 Months Ended
Mar. 31, 2021Mar. 31, 2020
ASU 2019-12 [Member]
Summary Of Significant Accounting Policies [Line Items]
Change in accounting principle, accounting standards update, adoptedtrue
Change in accounting principle, accounting standards update, immaterial effecttrue
Change in accounting principle, accounting standards update, adoption dateJan. 1,
2021
Stock Options [Member]
Summary Of Significant Accounting Policies [Line Items]
Number of potential diluted securities outstanding503,000 585,000
Number of securities included in calculation of diluted earnings per share311,000 311,000
Restricted Stock [Member]
Summary Of Significant Accounting Policies [Line Items]
Number of potential diluted securities outstanding168,000 77,000
Number of securities included in calculation of diluted earnings per share64,000 84,000

Leases (Amounts Reported in Una

Leases (Amounts Reported in Unaudited and Audited Condensed Consolidated Balance Sheets for Operating Leases) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Leases [Abstract]
Operating lease assets, net $ 38,325 $ 37,991
Short-term operating lease liabilities (in accrued expenses) $ 9,498 $ 9,283
Operating lease, liability, current, statement of financial position [Extensible List]Accrued expensesAccrued expenses
Long-term operating lease liabilities $ 35,623 $ 35,516
Total operating lease liabilities $ 45,121 $ 44,799

Leases (Components of Lease Cos

Leases (Components of Lease Cost Reported in General and Administrative Expenses in Unaudited Condensed Consolidated Statements of Income) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Leases [Abstract]
Operating lease costs $ 2,777 $ 2,118
Short-term lease costs181 266
Less: sublease income151 74
Total lease cost, net $ 2,807 $ 2,310

Leases (Schedule of Weighted Av

Leases (Schedule of Weighted Average Remaining Lease Terms and Discount Rates) (Details)Mar. 31, 2021Dec. 31, 2020
Leases [Abstract]
Weighted average remaining lease term6 years 9 months 29 days6 years 11 months 19 days
Weighted average discount rate4.04%4.18%

Leases (Summary of Remaining Op

Leases (Summary of Remaining Operating Lease Payments) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Leases [Abstract]
2022 $ 10,919
20239,228
20247,308
20255,424
20263,266
Thereafter15,771
Total future minimum rental commitments51,916
Less: Imputed interest(6,795)
Total lease liabilities $ 45,121 $ 44,799

Leases (Supplemental Cash Flows

Leases (Supplemental Cash Flows Information) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases $ 2,517 $ 2,171
Right-of-use assets obtained in exchange for lease obligations:
Operating leases $ 2,675 $ 1,439

Acquisitions (Narrative) (Detai

Acquisitions (Narrative) (Details) - USD ($) $ in ThousandsDec. 04, 2020Dec. 01, 2020Nov. 01, 2020Jul. 01, 2020Mar. 31, 2021Mar. 31, 2020Dec. 31, 2020
Business Acquisition [Line Items]
Total purchase price for business acquisition $ 87
Goodwill $ 469,036 $ 469,072
Queen City Hospice [Member]
Business Acquisition [Line Items]
Goodwill $ 169,107
Queen City Hospice [Member] | Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives15 years
Identifiable intangible assets acquired $ 11,000
Queen City Hospice [Member] | Non-competition Agreements [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives5 years
Identifiable intangible assets acquired $ 1,500
Queen City Hospice [Member] | State Licenses [Member]
Business Acquisition [Line Items]
Indefinite lived intangible assets acquired7,500
Queen City Hospice [Member] | Ohio [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition194,800
Integration costs900
Excess cash held by acquired business $ 15,400
County Homemakers [Member]
Business Acquisition [Line Items]
Goodwill $ 13,403
County Homemakers [Member] | Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives1 year
Identifiable intangible assets acquired $ 100
County Homemakers [Member] | State Licenses [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives8 years
Identifiable intangible assets acquired $ 300
County Homemakers [Member] | Pennsylvania [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition15,800
Integration costs100
Excess cash held by acquired business $ 1,100
A Plus Health Care, Inc [Member]
Business Acquisition [Line Items]
Goodwill $ 9,711
A Plus Health Care, Inc [Member] | Trade Names [Member]
Business Acquisition [Line Items]
Intangible assets, estimated useful lives15 years
Identifiable intangible assets acquired $ 1,400
A Plus Health Care, Inc [Member] | Montana [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition14,500
Integration costs $ 100
Excess cash held by acquired business $ 2,800
SunLife Hospice [Member]
Business Acquisition [Line Items]
Total purchase price for business acquisition1,700
Goodwill $ 1,600

Acquisitions (Schedule of Fair

Acquisitions (Schedule of Fair Values of Assets and Liabilities) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020Dec. 04, 2020Dec. 01, 2020Jul. 01, 2020
Business Acquisition [Line Items]
Goodwill $ 469,036 $ 469,072
Queen City Hospice [Member]
Business Acquisition [Line Items]
Goodwill $ 169,107
Identifiable intangible assets20,015
Cash15,444
Property and equipment759
Accounts receivable5,835
Operating lease assets, net3,028
Other assets160
Accounts payable(2,278)
Accrued expenses(503)
Accrued payroll(1,351)
Long-term operating lease liabilities(2,765)
Government stimulus advances(12,694)
Total purchase price $ 194,757
County Homemakers [Member]
Business Acquisition [Line Items]
Goodwill $ 13,403
Identifiable intangible assets474
Cash1,104
Property and equipment52
Accounts receivable1,395
Operating lease assets, net485
Other assets40
Accounts payable(67)
Accrued expenses(37)
Accrued payroll(543)
Long-term operating lease liabilities(485)
Total purchase price $ 15,821
A Plus Health Care, Inc [Member]
Business Acquisition [Line Items]
Goodwill $ 9,711
Identifiable intangible assets1,523
Cash2,819
Accounts receivable1,075
Operating lease assets, net180
Other assets26
Accounts payable(34)
Accrued expenses(362)
Accrued payroll(311)
Long-term operating lease liabilities(100)
Total purchase price $ 14,527

Acquisitions (Unaudited Pro For

Acquisitions (Unaudited Pro Forma Condensed Consolidated Income Statement Information) (Details) $ / shares in Units, $ in Thousands3 Months Ended
Mar. 31, 2021USD ($)$ / shares
Business Combinations [Abstract]
Net service revenues $ 208,967
Operating income47,112
Net income $ 10,319
Basic income per share | $ / shares $ 0.66
Diluted income per share | $ / shares $ 0.65

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets (Narrative) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020Dec. 31, 2020
Goodwill [Line Items]
Goodwill $ 469,036 $ 469,072
Amortization expense $ 2,200 $ 1,800
Weighted average remaining useful lives of identifiable intangible assets9 years 7 months 6 days
Minimum [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives1 year
Minimum [Member] | Customer and Referral Relationships [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives5 years
Maximum [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives25 years
Maximum [Member] | Customer and Referral Relationships [Member]
Goodwill [Line Items]
Intangible assets, estimated useful lives10 years

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets (Summary of Goodwill and Related Adjustments) (Details) $ in Thousands3 Months Ended
Mar. 31, 2021USD ($)
Goodwill [Line Items]
Goodwill, at Beginning of Period $ 469,072
Adjustments to previously recorded goodwill(36)
Goodwill, at End of Period469,036
Hospice [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period314,833
Adjustments to previously recorded goodwill(100)
Goodwill, at End of Period314,733
Personal Care [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period152,448
Adjustments to previously recorded goodwill64
Goodwill, at End of Period152,512
Home Health [Member]
Goodwill [Line Items]
Goodwill, at Beginning of Period1,791
Goodwill, at End of Period $ 1,791

Goodwill and Intangible Asset_4

Goodwill and Intangible Assets (Schedule of Carrying Amount and Accumulated Amortization of Intangible Asset) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives $ 20,791
Intangible assets subject to amortization:
Gross carrying amount106,330
Accumulated amortization(57,726)
Intangible assets subject to amortization, net48,604
Total intangible assets at March 31, 202169,395 $ 71,549
Customer and Referral Relationships [Member]
Intangible assets subject to amortization:
Gross carrying amount44,672
Accumulated amortization(34,915)
Intangible assets subject to amortization, net9,757
Total intangible assets at March 31, 20219,757
Trade Names and Trademarks [Member]
Intangible assets subject to amortization:
Gross carrying amount42,926
Accumulated amortization(16,152)
Intangible assets subject to amortization, net26,774
Total intangible assets at March 31, 202126,774
Non-competition Agreements [Member]
Intangible assets subject to amortization:
Gross carrying amount6,225
Accumulated amortization(3,111)
Intangible assets subject to amortization, net3,114
Total intangible assets at March 31, 20213,114
State Licenses [Member]
Finite Lived Intangible Assets [Line Items]
Intangible assets with indefinite lives20,791
Intangible assets subject to amortization:
Gross carrying amount12,507
Accumulated amortization(3,548)
Intangible assets subject to amortization, net8,959
Total intangible assets at March 31, 2021 $ 29,750

Details of Certain Balance Sh_3

Details of Certain Balance Sheet Accounts (Schedule of Prepaid Expenses and Other Current Assets) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Details Of Certain Balance Sheet Accounts [Abstract]
Workers' compensation insurance receivable $ 1,924 $ 1,860
Prepaid workers' compensation and liability insurance1,875 2,838
Health insurance receivable1,379 528
Other5,609 4,743
Total prepaid expenses and other current assets $ 10,787 $ 9,969

Details of Certain Balance Sh_4

Details of Certain Balance Sheet Accounts (Schedule of Accrued Expenses) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Details Of Certain Balance Sheet Accounts [Abstract]
Current portion of operating lease liabilities $ 9,498 $ 9,283
Accrued health insurance5,063 5,607
Accrued payroll taxes6,978 4,543
Accrued professional fees2,935 4,220
Payor advances5,052 4,206
Other9,128 9,705
Total accrued expenses $ 38,654 $ 37,564

Details of Certain Balance Sh_5

Details of Certain Balance Sheet Accounts (Schedule of Government Stimulus Advances) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Details Of Certain Balance Sheet Accounts [Line Items]
Provider Relief Fund $ 11,334 $ 12,252
Payroll tax deferral7,141 7,141
Total government stimulus advances20,368 32,087
Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Provider Relief Fund $ 1,893 1,893
CMS advanced payment program — Queen City Hospice $ 10,801

Details of Certain Balance Sh_6

Details of Certain Balance Sheet Accounts (Narrative) (Details) - USD ($)1 Months Ended3 Months Ended
Nov. 30, 2020Apr. 30, 2020Mar. 31, 2021Dec. 31, 2020
Details Of Certain Balance Sheet Accounts [Line Items]
Payroll tax deferral $ 7,141,000 $ 7,141,000
Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
CMS advanced payment program — Queen City Hospice $ 10,801,000
CARES Act [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Payroll tax deferral $ 7,100,000
Repayment of deferred payroll taxes in 20217,100,000
CARES Act [Member] | Provider Relief Fund [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
CARES Act and other relief legislation178,000,000,000
Aggregate principal amount of grants received $ 13,700,000
Fund distributed to health care related expenses900,000
CARES Act [Member] | Provider Relief Fund [Member] | Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Intends to pay retention payments $ 1,900,000
CARES Act [Member] | Provider Relief Fund [Member] | Minimum [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Annual awards for commercial organizations750,000
CARES Act [Member] | Medicare Accelerated And Advance Payment Program [Member] | Queen City Hospice [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
CMS advanced payment program — Queen City Hospice10,800,000
Repayment of grants $ 0
Repayment of funds period2021-03
CARES Act [Member] | Medicare Accelerated And Advance Payment Program [Member] | Hospice and Home Health [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Medicare payment period3 months
CARES Act [Member] | Medicare Accelerated And Advance Payment Program [Member] | Maximum [Member] | Hospice and Home Health [Member]
Details Of Certain Balance Sheet Accounts [Line Items]
Request percentage of advance or accelerated payment100.00%

Long-Term Debt (Schedule of Lon

Long-Term Debt (Schedule of Long-Term Debt) (Details) - USD ($) $ in ThousandsMar. 31, 2021Dec. 31, 2020
Debt Instrument [Line Items]
Less unamortized issuance costs $ (1,532) $ (1,716)
Total194,811 194,872
Less current maturities(972)(971)
Long-term debt193,839 193,901
Revolving Credit Loan [Member] | Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt gross178,458 178,458
Term Loan [Member] | Senior Secured Credit Facility [Member]
Debt Instrument [Line Items]
Long-term debt gross $ 17,885 $ 18,130

Long-Term Debt (Narrative) (Det

Long-Term Debt (Narrative) (Details) - Credit Agreement [Member] - Capital One, National Association [Member] - USD ($)Sep. 12, 2019Oct. 31, 2018Oct. 30, 2018Mar. 31, 2021Mar. 31, 2020Dec. 31, 2020
Debt Instrument [Line Items]
Maximum aggregate loan amount available $ 269,600,000 $ 112,800,000
Debt instrument, maturity dateMay 8,
2023
Debt instrument total net leverage ratio4.25%
Line of credit outstanding amount8,700,000
Delayed Draw Term Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available $ 19,600,000
Term Loan [Member]
Debt Instrument [Line Items]
Line of credit outstanding amount $ 17,900,000 $ 18,100,000
Debt instrument stated interest rate1.86%1.90%
Maximum [Member]
Debt Instrument [Line Items]
Debt instrument total net leverage ratio3.75%
Federal Funds Rate [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin0.50%
London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Debt instrument variable interest rate margin1.00%
London Interbank Offered Rate (LIBOR) | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin0.00%
Based On Applicable Senior Leverage Ratio | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin0.75%
Based On Applicable Senior Leverage Ratio | Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin1.50%
Based On Applicable Leverage Ratio [Member] | Minimum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin1.75%
Based On Applicable Leverage Ratio [Member] | Maximum [Member]
Debt Instrument [Line Items]
Debt instrument variable interest rate margin2.50%
Restriction on Dividends [Member] | Maximum [Member]
Debt Instrument [Line Items]
Aggregate amount of dividends and distributions $ 7,500,000
Revolving Credit Loan [Member]
Debt Instrument [Line Items]
Maximum aggregate loan amount available $ 300,000,000 $ 250,000,000
Increase in credit facility $ 50,000,000
Proceeds from line of credit0 $ 0
Line of credit outstanding amount $ 178,500,000 $ 178,500,000
Debt instrument stated interest rate1.86%1.90%
Revolving Credit Loan [Member] | Minimum [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility0.20%
Revolving Credit Loan [Member] | Maximum [Member]
Debt Instrument [Line Items]
Fee charged on unused portion of revolving credit facility0.35%

Income Taxes (Narrative) (Detai

Income Taxes (Narrative) (Details)3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Income Tax Disclosure [Abstract]
Effective income tax rate19.00%14.20%

Commitments and Contingencies (

Commitments and Contingencies (Narrative) (Details) - USD ($) $ in Thousands3 Months Ended8 Months Ended12 Months Ended20 Months Ended
Mar. 31, 2021Mar. 31, 2020Dec. 27, 2020Dec. 31, 2022Dec. 31, 2021
Commitments And Contingencies [Line Items]
Net service revenues $ 205,302 $ 190,216
Home Health [Member]
Commitments And Contingencies [Line Items]
Net service revenues4,340 4,339
Hospice [Member]
Commitments And Contingencies [Line Items]
Net service revenues36,094 $ 25,212
PPPHCE Act [Member]
Commitments And Contingencies [Line Items]
Authorized fund to be distributed to health care providers $ 178,000,000
PPPHCE Act [Member] | Forecast [Member]
Commitments And Contingencies [Line Items]
Percentage of reduced payments to Medicare providers2.00%
Percentage of reduction in spending by Medicare providers4.00%
PPPHCE Act [Member] | Home Health [Member]
Commitments And Contingencies [Line Items]
Net service revenues100
PPPHCE Act [Member] | Hospice [Member]
Commitments And Contingencies [Line Items]
Net service revenues $ 700

Segment Information (Narrative)

Segment Information (Narrative) (Details)3 Months Ended
Mar. 31, 2021segment
Segment Reporting [Abstract]
Number of business segments3

Segment Information (Summary Of

Segment Information (Summary Of Segment Information) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Segment Reporting Information [Line Items]
Net service revenues $ 205,302 $ 190,216
Cost of services revenues144,105 134,381
Gross profit61,197 55,835
General and administrative expenses45,426 42,287
Operating income12,170 10,661
Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses24,711 23,082
Operating income36,486 32,753
Personal Care [Member]
Segment Reporting Information [Line Items]
Net service revenues164,868 160,665
Cost of services revenues122,839 119,027
Gross profit42,029 41,638
Personal Care [Member] | Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses15,283 15,603
Operating income26,746 26,035
Hospice [Member]
Segment Reporting Information [Line Items]
Net service revenues36,094 25,212
Cost of services revenues18,596 12,318
Gross profit17,498 12,894
Hospice [Member] | Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses8,463 6,457
Operating income9,035 6,437
Home Health [Member]
Segment Reporting Information [Line Items]
Net service revenues4,340 4,339
Cost of services revenues2,670 3,036
Gross profit1,670 1,303
Home Health [Member] | Operating Segments [Member]
Segment Reporting Information [Line Items]
General and administrative expenses965 1,022
Operating income $ 705 $ 281

Segment Information (Segment Re

Segment Information (Segment Reconciliation to Totals reported in the accompanying Consolidated Financial Statements) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Segment Reporting Information [Line Items]
Operating income $ 12,170 $ 10,661
Other general and administrative expenses20,715 19,205
Depreciation and amortization3,601 2,887
Interest income(22)(334)
Interest expense1,216 908
Income before income taxes10,976 10,087
Operating Segments [Member]
Segment Reporting Information [Line Items]
Operating income $ 36,486 $ 32,753

Significant Payors (Revenue by

Significant Payors (Revenue by Payor Type) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Net service revenues $ 205,302 $ 190,216
Personal Care [Member]
Net service revenues164,868 160,665
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member]
Net service revenues $ 164,868 $ 160,665
Concentration risk, percentage100.00%100.00%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | State, Local And Other Governmental Programs [Member]
Net service revenues $ 80,849 $ 79,346
Concentration risk, percentage49.00%49.40%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Managed Care Organizations [Member]
Net service revenues $ 75,456 $ 72,110
Concentration risk, percentage45.80%44.90%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Private Pay [Member]
Net service revenues $ 4,903 $ 5,270
Concentration risk, percentage3.00%3.30%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Commercial Insurance [Member]
Net service revenues $ 2,346 $ 2,576
Concentration risk, percentage1.40%1.60%
Personal Care [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Other [Member]
Net service revenues $ 1,314 $ 1,363
Concentration risk, percentage0.80%0.80%
Hospice [Member]
Net service revenues $ 36,094 $ 25,212
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member]
Net service revenues $ 36,094 $ 25,212
Concentration risk, percentage100.00%100.00%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Medicare [Member]
Net service revenues $ 33,985 $ 23,219
Concentration risk, percentage94.20%92.10%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Managed Care Organizations [Member]
Net service revenues $ 1,487 $ 1,385
Concentration risk, percentage4.10%5.50%
Hospice [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Other [Member]
Net service revenues $ 622 $ 608
Concentration risk, percentage1.70%2.40%
Home Health [Member]
Net service revenues $ 4,340 $ 4,339
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member]
Net service revenues $ 4,340 $ 4,339
Concentration risk, percentage100.00%100.00%
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Medicare [Member]
Net service revenues $ 3,502 $ 3,470
Concentration risk, percentage80.70%80.00%
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Managed Care Organizations [Member]
Net service revenues $ 798 $ 807
Concentration risk, percentage18.40%18.60%
Home Health [Member] | Revenues [Member] | Customer Concentration Risk [Member] | Other [Member]
Net service revenues $ 40 $ 62
Concentration risk, percentage0.90%1.40%

Significant Payors (Revenue b_2

Significant Payors (Revenue by Geographic Location) (Details) - USD ($) $ in Thousands3 Months Ended
Mar. 31, 2021Mar. 31, 2020
Net service revenues $ 205,302 $ 190,216
Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Concentration risk, percentage35.80%37.70%
Personal Care [Member]
Net service revenues $ 164,868 $ 160,665
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member]
Net service revenues $ 164,868 $ 160,665
Concentration risk, percentage100.00%100.00%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Net service revenues $ 73,385 $ 71,545
Concentration risk, percentage44.50%44.50%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New York [Member]
Net service revenues $ 27,575 $ 31,838
Concentration risk, percentage16.70%19.80%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New Mexico [Member]
Net service revenues $ 23,593 $ 20,694
Concentration risk, percentage14.30%12.90%
Personal Care [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | All Other States [Member]
Net service revenues $ 40,315 $ 36,588
Concentration risk, percentage24.50%22.80%
Hospice [Member]
Net service revenues $ 36,094 $ 25,212
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member]
Net service revenues $ 36,094 $ 25,212
Concentration risk, percentage100.00%100.00%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New Mexico [Member]
Net service revenues $ 9,230 $ 11,009
Concentration risk, percentage25.60%43.70%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | All Other States [Member]
Net service revenues $ 12,750 $ 14,203
Concentration risk, percentage35.30%56.30%
Hospice [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | Ohio [Member]
Net service revenues $ 14,114
Concentration risk, percentage39.10%
Home Health [Member]
Net service revenues $ 4,340 $ 4,339
Home Health [Member] | Revenues [Member] | Geographic Concentration Risk [Member]
Net service revenues $ 4,340 $ 4,339
Concentration risk, percentage100.00%100.00%
Home Health [Member] | Revenues [Member] | Geographic Concentration Risk [Member] | New Mexico [Member]
Net service revenues $ 4,340 $ 4,339
Concentration risk, percentage100.00%100.00%

Significant Payors (Narrative)

Significant Payors (Narrative) (Details)3 Months Ended12 Months Ended
Mar. 31, 2021Mar. 31, 2020Dec. 31, 2020
Revenues [Member] | Illinois Department On Aging [Member]
Concentration Risk [Line Items]
Concentration risk, percentage20.40%23.20%
Revenues [Member] | Geographic Concentration Risk [Member] | Illinois [Member]
Concentration Risk [Line Items]
Concentration risk, percentage35.80%37.70%
Accounts Receivable [Member] | Illinois Department On Aging [Member]
Concentration Risk [Line Items]
Concentration risk, percentage23.80%15.90%