Cover Page
Cover Page | 12 Months Ended |
Dec. 31, 2020shares | |
Cover [Abstract] | |
Document Type | 40-F/A |
Amendment Flag | true |
Document Period End Date | Dec. 31, 2020 |
Document Fiscal Year Focus | 2020 |
Document Fiscal Period Focus | FY |
Trading Symbol | AKU |
Entity Registrant Name | AKUMIN INC. |
Entity Central Index Key | 0001776197 |
Current Fiscal Year End Date | --12-31 |
Entity Current Reporting Status | Yes |
Entity Emerging Growth Company | true |
Entity Ex Transition Period | false |
Title of 12(b) Security | Common Shares |
Security Exchange Name | NASDAQ |
Document Annual Report | true |
Document Registration Statement | false |
Entity Interactive Data Current | Yes |
Entity Common Stock, Shares Outstanding | 70,178,428 |
Amendment Description | This Amendment No. 2 to the Annual Report on Form 40-F/A (“Amendment No. 2”) amends the Annual Report on Form 40-F filed with the Securities and Exchange Commission (“SEC” or the “Commission”) on April 1, 2021, and Amendment No. 1 to the Annual Report on Form 40-F/A filed with the SEC on April 29, 2021 (collectively, the “Original Annual Report”) of Akumin Inc. (the “Registrant”) for the year ended December 31, 2020, in order to (i) file amendments to (A) Management’s Discussion and Analysis for the year ended December 31, 2020 (the “MD&A”), and (B) Audited Consolidated Financial Statements for the year ended December 31, 2020; and (ii) amend and restate in its entirety the information set forth below under “A. Disclosure Controls and Procedures,” “B. Management’s Annual Report on Internal Control Over Financial Reporting” and “D. Changes in Internal Control Over Financial Reporting.” Other than as discussed above and included herein, all information in the Original Annual Report is unchanged and is not reproduced in this Amendment No. 2. This Amendment No. 2 does not reflect events occurring after the filing of the Original Annual Report or modify or update the disclosure contained in the Original Annual Report in any way other than as discussed above and included herein. Accordingly, this Amendment No. 2 should be read in conjunction with the Original Annual Report. Capitalized terms used but not defined in this Amendment No. 2 shall have the meanings set forth in the Original Annual Report. |
Entity Address, State or Province | FL |
ICFR Auditor Attestation Flag | false |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Current assets | ||
Cash | $ 44,395,988 | $ 23,388,916 |
Accounts receivable | 62,258,757 | 53,325,516 |
Prepaid expenses and other current assets | 4,431,647 | 5,001,032 |
Assets, Current | 111,086,392 | 81,715,464 |
Security deposits and other assets | 4,832,048 | 1,750,303 |
Property and equipment (note 5) | 63,713,509 | 64,176,795 |
Operating lease right-of-use assets (note 4) | 127,061,894 | 126,675,770 |
Goodwill (notes 4 and 7) | 351,609,561 | 355,667,004 |
Intangible assets (note 6) | 6,748,073 | 9,432,480 |
Total assets | 665,051,477 | 639,417,816 |
Current liabilities | ||
Accounts payable and accrued liabilities (note 8) | 34,295,256 | 26,325,508 |
Finance lease liabilities (note 10) | 3,264,806 | 1,789,995 |
Operating lease liabilities (right-of-use) (notes 4 and 10) | 9,345,656 | 9,276,298 |
Senior loans payable (note 11) | 405,698 | 3,705,952 |
Earn-out liability (note 9) | 4,688,553 | 7,529,962 |
Liabilities, Current | 51,999,969 | 48,627,715 |
Finance lease liabilities (note 10) | 12,308,780 | 6,625,409 |
Operating lease liabilities (right-of-use) (notes 4 and 10) | 122,953,656 | 119,773,692 |
Senior loans payable (note 11) | 389,580,046 | 336,276,370 |
Derivative financial instruments (note 11) | 643,620 | |
Subordinated notes payable – earn-out (note 12) | 184,485 | |
Earn-out liability (note 9) | 7,304,105 | |
Accrued payroll taxes (note 26) | 1,346,088 | |
Deferred tax liability | 1,693,011 | 993,175 |
Total liabilities | 579,881,550 | 520,428,571 |
Shareholders' equity | ||
Additional paid-in capital (common shares: no par value, unlimited authorized number of shares, 70,178,428 and 69,840,928 shares issued and outstanding as of December 31, 2020 and December 31, 2019, respectively) (notes 13 and 16) | 160,965,034 | 158,881,120 |
Deficit | (80,132,559) | (43,392,028) |
Equity attributable to shareholders of Akumin Inc. | 80,832,475 | 115,489,092 |
Non-controlling interests (note 25) | 4,337,452 | 3,500,153 |
Total shareholders' equity | 85,169,927 | 118,989,245 |
Total liabilities and shareholders' equity | $ 665,051,477 | $ 639,417,816 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - $ / shares | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Statement of Financial Position [Abstract] | ||
Common Stock, No Par Value | $ 0 | $ 0 |
Common Stock, Shares Authorized, Unlimited | Unlimited | Unlimited |
Common Stock, Shares, Issued | 70,178,428 | 70,178,428 |
Common Stock, Shares, Outstanding | 69,840,928 | 69,840,928 |
Consolidated Statements of Oper
Consolidated Statements of Operations and Comprehensive Income (Loss) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Income Statement [Abstract] | ||
Service fees - net of allowances and discounts | $ 238,324,319 | $ 218,449,704 |
Other revenue | 7,301,666 | 2,594,903 |
Revenues | 245,625,985 | 221,044,607 |
Operating expenses | ||
Cost of operations, excluding depreciation and amortization (note 23) | 205,634,606 | 193,336,730 |
Depreciation and amortization (notes 5 and 6) | 17,060,151 | 13,491,369 |
Stock-based compensation (notes 13 and 16) | 2,083,914 | 3,554,765 |
Operational financial instruments revaluation and other (gains) losses (note 21) | (4,129,473) | 979,928 |
Total operating expenses | 220,649,198 | 211,362,792 |
Income from operations | 24,976,787 | 9,681,815 |
Other income and expenses | ||
Interest expense (notes 11 and 12) | 32,781,210 | 20,783,438 |
Other financial instruments revaluation and other (gains) losses (note 21) | 22,386,827 | 1,497,734 |
Settlement costs and other (recoveries) (note 24) | 2,324,151 | (1,881,233) |
Acquisition-related costs | 1,079,255 | 3,403,160 |
Total other expenses | 58,571,443 | 23,803,099 |
Loss before income taxes | (33,594,656) | (14,121,284) |
Income tax provision (benefit) (note 14) | 561,555 | (2,797,559) |
Net loss and comprehensive loss for the period | (34,156,211) | (11,323,725) |
Non-controlling interests (note 25) | 2,584,320 | 1,606,025 |
Net loss attributable to common shareholders | $ (36,740,531) | $ (12,929,750) |
Net loss per share (note 20) | ||
Basic and diluted | $ (0.52) | $ (0.19) |
Consolidated Statements of Chan
Consolidated Statements of Changes in Equity - USD ($) | Total | Additional paid-in capital [Member] | Accumulated Deficit [Member] | Non-controlling interest [Member] |
Beginning Balance at Dec. 31, 2018 | $ 103,772,538 | $ 130,577,709 | $ (30,462,278) | $ 3,657,107 |
Net income and comprehensive income | (11,323,725) | (12,929,750) | 1,606,025 | |
Issuance of common shares – net of issuance costs Acquisition consideration (note 13) | 23,437,500 | 23,437,500 | ||
RSUs and Warrants exercised (note 13) | 1,311,146 | 1,311,146 | ||
Stock-based compensation expense (notes 13 and 16) | 3,554,765 | 3,554,765 | ||
Payment to non-controlling interests (note 25) | (1,762,979) | (1,762,979) | ||
Ending Balance at Dec. 31, 2019 | 118,989,245 | 158,881,120 | (43,392,028) | 3,500,153 |
Net income and comprehensive income | (34,156,211) | (36,740,531) | 2,584,320 | |
Stock-based compensation expense (notes 13 and 16) | 2,083,914 | 2,083,914 | ||
Payment to non-controlling interests (note 25) | (1,747,021) | (1,747,021) | ||
Ending Balance at Dec. 31, 2020 | $ 85,169,927 | $ 160,965,034 | $ (80,132,559) | $ 4,337,452 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Operating activities | ||
Net income (loss) for the period | $ (34,156,211) | $ (11,323,725) |
Adjustments for: | ||
Depreciation and amortization | 17,060,151 | 13,491,369 |
Stock-based compensation (notes 13 and 16) | 2,083,914 | 3,554,765 |
Interest expense-accretion of debt and paid-in-kind interest | 5,482,307 | 2,047,214 |
Deferred income tax expense (benefit) | 699,836 | (1,419,481) |
Financial instruments revaluation and other (gains) losses | 18,257,354 | 2,477,662 |
Changes in operating assets and liabilities | ||
Accounts receivable | (3,074,720) | 413,124 |
Prepaid expenses, security deposits and other assets | 272,720 | (5,012,756) |
Accounts payable and accrued liabilities | 9,036,934 | (578,460) |
Operating lease liabilities and right-of-use assets | 2,952,575 | 2,379,575 |
Net Cash Provided by (Used in) Operating Activities | 18,614,860 | 6,029,287 |
Investing activities | ||
Purchase of property and equipment and intangible assets | (5,344,682) | (5,895,844) |
Business acquisitions – net of cash acquired (note 4) | (3,198,634) | (218,659,981) |
Other investments | (463,789) | 0 |
Net Cash Provided by (Used in) Investing Activities | (9,007,105) | (224,555,825) |
Financing activities | ||
Loan proceeds (note 11) | 406,300,000 | 354,114,000 |
Loan repayments (note 11) | (371,524,423) | (113,887,167) |
Issuance costs – loans | (15,216,138) | (14,781,765) |
Finance leases – principal payments | (1,524,548) | (904,193) |
Subordinated notes or earn-out (note 12) | (200,000) | (1,500,000) |
Earn-out liability (note 9) | (4,688,553) | 0 |
Common shares (note 13) | 0 | 1,311,146 |
Payment to non-controlling interests | (1,747,021) | (1,762,979) |
Net Cash Provided by (Used in) Financing Activities | 11,399,317 | 222,589,042 |
Increase in cash during the period | 21,007,072 | 4,062,504 |
Cash – Beginning of period | 23,388,916 | 19,326,412 |
Cash – End of period | 44,395,988 | 23,388,916 |
Supplementary information | ||
Interest expense paid | 22,844,479 | 18,882,263 |
Income taxes paid | $ 1,172,464 | $ 487,598 |
Presentation of Consolidated Fi
Presentation of Consolidated Financial Statements and Nature of Operations | 12 Months Ended |
Dec. 31, 2020 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Presentation of Consolidated Financial Statements and Nature of Operations | 1 Presentation of consolidated financial statements and nature of operations The operations of Akumin Inc. (Akumin or the Company) and its Subsidiaries (defined below) primarily consist of operating outpatient diagnostic imaging centres located in Delaware, Florida, Georgia, Illinois, Kansas, Pennsylvania and Texas. Substantially all of the centres operated by Akumin were obtained through acquisition. Related to its imaging centre operations, Akumin also operates a medical equipment business, SyncMed, LLC (SyncMed), which provides maintenance services to Akumin’s imaging centres in Illinois, Kansas and Texas and a billing and revenue cycle management business, as a division of Akumin’s wholly owned indirect subsidiary, Akumin Corp., which was previously operated by a subsidiary, Rev Flo Inc., which was merged into Akumin Corp. on December 31, 2018. The services offered by the Company (through the Subsidiaries) include magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), nuclear medicine, mammography, ultrasound, digital radiography (X-ray), The Company has a diverse mix of payers, including private, managed care, capitated and government payers. The registered and Canadian head office of Akumin is located at 151 Bloor Street West, Suite 603, Toronto, Ontario, M5S 1S4. The United States head office is located at 8300 W. Sunrise Boulevard, Plantation, Florida, 33322. All operating activities are conducted through its wholly owned US subsidiary, Akumin Holdings Corp. and its wholly owned subsidiary, Akumin Corp. Akumin Corp. operates its business directly and through its key wholly owned direct and indirect subsidiaries, which include Akumin Florida Holdings, LLC, formerly known as Tri-State |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2020 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | 2 Summary of significant accounting policies The Company adopted the accounting principles generally accepted in the United States of America (GAAP) as the basis of preparation for the comparative 2020 and 2019 annual financial statements effective for the fiscal year-ended December 31, 2020. Previously, the Company’s financial statements were prepared in accordance with International Financial Reporting Standards (IFRS) as issued by the International Accounting Standards Board (IASB), for the period up to and including the 9-months 40-F 51-102 The preparation of consolidated financial statements in accordance with GAAP requires the use of estimates and assumptions that affect the reported amounts of revenue, expenses, assets, liabilities and contingencies. Although actual results in subsequent periods may differ from these estimates, such estimates are developed based on the best information available to management and based on management’s best judgments at the time. The Company bases its estimates on historical experience, observable trends and various other assumptions that we believe are reasonable under the circumstances. All significant assumptions and estimates underlying the amounts reported in the consolidated financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected prospectively in the consolidated financial statements based upon on-going The most significant assumptions and estimates underlying these consolidated financial statements involve accounts receivable, impairments of long-lived assets including goodwill, operating lease right-of-use-assets, The significant accounting policies described below have been applied consistently to all periods presented. Principles of consolidation The consolidated financial statements include all of the accounts of the Company, the Subsidiaries and the Revenue Practices. All intercompany transactions and balances have been eliminated on consolidation. Variable interest entities In accordance with the FASB’s ASC Topic 810, Consolidation As a result of the financial relationship established between the Company and the Revenue Practices through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, The Company has a variable interest in a single purpose entity in Texas which operates an imaging center. The Company also has a variable interest in certain operations of an imaging center of another Texas entity. In both cases, the Company is not a primary beneficiary of the variable interest since it does not have any equity ownership in these entities nor does it have the power to direct the activities of either of these entities that most significantly impact the entities’ economic performance. Rather, in both cases, the Company is entitled to a management fee based upon written agreements in exchange for certain agreed upon management services. The assets and liabilities and revenue and expenses of these entities are not included in the consolidated financial statements of the Company. Functional and reporting currency and foreign currency translation The functional and reporting currency of the Company, the Subsidiaries and the Revenue Practices is US dollars. Monetary assets and liabilities denominated in foreign currencies are translated into US dollars at the rates of exchange prevailing at the consolidated balance sheet dates. Non-monetary Cash Cash includes cash on hand and cash held with banks. Property and equipment Property and equipment are recorded at cost and are depreciated over their estimated useful lives using the straight line method, as follows: Medical equipment and equipment under finance leases six years Computer and office equipment four to five years Furniture and fittings nine years Leasehold improvements over term of lease Expenditures for maintenance and repairs are charged to operations as incurred. Operating lease right-of-use equipment buyouts and significant upgrades are capitalized. Intangible assets The Company classifies intangible assets, obtained through acquisitions or developed internally, as definite lived. Intangible assets consist of software costs, trade name, license arrangements and covenants not to compete; these intangible assets are recorded at cost and are amortized over their estimated useful lives, using the straight line method, as follows: Software costs, trade name and license arrangements five to six years Covenant not to compete over term of contract The Company reviews the appropriateness of the amortization period related to the definite lived intangible assets annually. Goodwill In January 2017, FASB issued Accounting Standards Update (ASU) 2017-04, Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment (ASU 2017-04) 2017-04 2017-04 2017-04 2017-04. Goodwill is recognized as the fair value of the consideration transferred, less the fair value of the net identifiable assets acquired and liabilities assumed, as at the acquisition date. Subsequent to initial recognition, goodwill is measured at cost less accumulated impairment losses. Goodwill acquired in business combinations is allocated to reporting units that are expected to benefit from the synergies of the combination. The determination of reporting units and the level at which goodwill is monitored requires judgment by management. The Company’s reporting units generally represent individual business units below the level of the Company’s operating segment. Goodwill is tested annually for impairment as at October 1 or whenever indicators of impairment are present by comparing the carrying amount of the reporting units against its fair value. Impairment of long-lived assets The Company reviews long-lived assets for impairment when events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. If any indication exists, the Company estimates the recoverable amount. The Company assesses the recoverability of the assets based on the undiscounted future cash flows expected from the use and eventual disposition of the asset. If the carrying amount of the asset is determined not to be recoverable, a write-down to fair value is recorded. Fair values are determined based on quoted market values, discounted cash flows, or external appraisals, as applicable. Long-lived assets to be disposed of are reported at the lower of carrying amount or fair value less costs to sell. The amount of the impairment charge is calculated as the excess of the asset’s carrying value over its fair value, which generally represents the discounted future cash flows from that asset or in the case of assets we expect to sell, at fair value less costs to sell. Segment reporting Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company has one reportable segment, which is outpatient diagnostic imaging services. Revenue recognition On January 1, 2019, the Company adopted ASU 2014-09, Revenue from Contracts with Customers (Topic 606) The Company adopted ASC 606 with a full retrospective application. As a result, at the adoption of ASC 606, the majority of what was previously classified as the provision for bad debts in the consolidated statement of operations is now reflected as implicit price concessions (as defined in ASC 606) and therefore included as a reduction to revenue. Net service fee revenue consists of net patient fees received from various payers and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. It primarily comprises fees for the use of the Company’s diagnostic imaging equipment and provision of medical supplies. Service fee revenue is recorded during the period in which the Company’s performance obligations are satisfied, based on the estimated collectible amounts from the patients and third party payers. The Company’s performance obligations are satisfied when services are rendered to the patient. Since the gap between payment and delivery of services to patients is generally expected to be less than one year, the Company does not adjust the service fee revenue for a significant financing component, as a practical expedient. Third party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, attorneys, and employers. Estimates of contractual allowances and the transaction price are based on the terms specified in the related contractual agreements, negotiated rates and historical and expected payment patterns. The Company estimates its expected reimbursement for patients based on the applicable contract terms and negotiated rates. The Company believes its review process enables it to identify instances on a timely basis where such estimates need to be revised. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third party payers, management fees, government grants and fees for other services provided to third parties. Revenue is recorded during the period in which the Company’s performance obligations under the contract are satisfied by the Company. For 2020, the Company received grants from the U.S. Health and Human Services (HHS). Such grants are outside the scope of ASC 606 and are further discussed in note 26. ASC 606 applies a single model for recognizing revenue from contracts with customers. It requires revenue to be recognized in a manner that depicts the transfer of promised goods or services to a customer and at an amount that reflects the consideration expected to be received in exchange for transferring those goods or services. This is achieved by applying the following five steps: i) identify the contract with a customer; ii) identify the performance obligation in the contract; iii) determine the transaction price; iv) allocate the transaction price to the performance obligations in the contract; and v) recognize revenue when (or as) the entity satisfies a performance obligation. Earnings per share Basic earnings per common share (EPS) is calculated by dividing the net earnings available to common shareholders by the weighted average number of common shares outstanding during the year. Diluted EPS is calculated by adjusting the net earnings available to common shareholders and the weighted average number of common shares outstanding for the effects of all dilutive instruments. Income taxes Income tax expense comprises current and deferred tax. Income tax is recognized in the consolidated statements of operations and comprehensive income (loss). Current income tax expense represents the amount of income taxes payable based on tax law that is enacted at the reporting date and is adjusted for changes in estimates of tax expense recognized in prior periods. A current tax liability or asset is recognized for income taxes payable, or paid but recoverable, in respect of all periods to date. The Company uses the asset and liability method of accounting for income taxes. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. A deferred tax asset is recognized for unused tax losses, tax credits and deductible temporary differences, to the extent that it is more likely than not that future taxable income will be available to utilize such amounts. Deferred tax assets are reviewed at each reporting date and are adjusted to the extent that it is no longer probable that the related tax benefits will be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets, estimates of future taxable income are considered in determining whether net deferred tax assets are more likely than not to be realized. Deferred tax assets and liabilities are offset when they relate to income taxes levied by the same tax authority and the Company intends to settle its current tax assets and liabilities on a net basis. The Company reports a liability for unrecognized tax benefits resulting from uncertain tax positions taken or expected to be taken in a tax return. The Company recognizes interest and penalties, if any, related to unrecognized tax benefits in income tax expense. Financial instruments Financial assets (such as accounts receivable) and liabilities (such as accounts payable, accrued liabilities, leases and loans) at amortized cost are initially recognized at fair value, and subsequently are carried at amortized cost (using the effective interest rate method) less any impairment. Any premium or discount between amortized cost and fair value is amortized to the consolidated statements of operations and comprehensive income (loss). Derivative financial instruments and earn-outs are initially recognized and subsequently measured at fair value. No derivatives have been designated as a cash flow hedge under ASC 815, Derivatives and Hedging Leases In February 2016, the FASB issued ASU 2016-02. 2016-02’s 2016-02 2016-02 2016-02 On January 1, 2019, the Company recorded right-of-use The Company’s operating lease portfolio primarily consists of real estate leases for its imaging centres and corporate offices. A smaller portion consists of medical and office equipment leases. The Company elected to use the package of practical expedients offered in the transition guidance that allows management not to reassess lease identification, lease classification and initial direct costs. The Company also elected to use the accounting policy practical expedients by class of underlying asset to (i) combine associated lease and non-lease right-of-use Operating lease liabilities were recorded as the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease right-of-use right-of-use Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the income statement in the period in which the change occurs. Variable payments for maintenance such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore to measure lease liabilities, the Company used its incremental borrowing rates at the later of the lease commencement date or January 1, 2019. Lease liabilities will be remeasured when there is a significant change in the lease contracts. Warrants Financial instruments issued by the Company are classified as equity only to the extent they do not meet the definition of a financial liability or financial asset. The Company has issued warrants that are convertible into common stock; these warrants are classified as equity instruments. Restricted share units Restricted share units (RSUs) are issued in accordance with the Company’s RSU Plan, which entitles a holder of one RSU to receive one common share of the Company. RSUs are assigned a value based on the market value of the common shares of the Company on the grant date (or the nearest working day prior to the grant date). Such value is classified as stock-based compensation over the vesting period for all RSUs awarded to employees or the Board (note 13). For RSUs awarded to non-employees Stock-based compensation The Company’s stock-based compensation consists of stock options, which are described in note 16 and RSUs, which are discussed in note 13. Each tranche of a share option award is considered a separate award with its own vesting period and recorded at fair value on the date of grant. The fair value of each tranche is measured at the date of grant using the Black-Scholes option pricing model. Compensation expense is recognized over the tranche’s vesting period based on the number of awards expected to vest by increasing contributed surplus. Any consideration paid upon the exercise of stock options is credited to common stock and the related fair value of those stock options is transferred from the contributed surplus to common stock. Business combinations In January 2019, the Company adopted FASB issued ASU 2017-01, Clarifying the Definition of a Business (2017-01) The Company accounts for business combinations using the acquisition accounting method. The total purchase price is allocated to the assets acquired and liabilities assumed based on fair values as at the date of acquisition. Goodwill as at the acquisition date is measured as the excess of the aggregate of the consideration transferred and the amount of any non-controlling non-controlling Changes in non-controlling The Company treats transactions with non-controlling non-controlling non-controlling Contingencies Loss contingency is an existing condition, situation, or set of circumstances involving uncertainty as to possible loss to an entity that will ultimately be resolved when one or more future events occur or fail to occur. The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. In assessing loss contingencies related to legal proceedings that are pending against the Company or unasserted claims that may result in such proceedings, the Company, with assistance from its legal counsel, evaluates the perceived merits of any legal proceedings or unasserted claims as well as the perceived merits of the amount of relief sought or expected to be sought. Accrued legal costs for legal contingencies are recorded when they are probable and estimable. Accounts receivable Accounts receivable are generally non-interest non-individual COVID-19 COVID-19 Accounts receivable are considered to be in default when customers have failed to make the contractually required payments when due. Implicit price concessions are recorded as a reduction in revenue with an offsetting amount reducing the carrying value of the receivable. When a receivable is considered uncollectible, the receivable is written off against the allowance for bad debts account. |
Restatement of Financial Statem
Restatement of Financial Statements | 12 Months Ended |
Dec. 31, 2020 | |
Prior Period Adjustment [Abstract] | |
Restatement of Financial Statements | 3 Restatement of financial statements Accounts Receivable During the quarter ended June 30, 2021, in conjunction with performing its quarter-end The impact of these errors was (i) a decrease of accounts receivable of $28.9 million, $29.5 million and $5.6 million as of December 31, 2020, December 31, 2019 and January 1, 2019, respectively, (ii) a decrease of goodwill of $9.6 million, $3.7 million and $2.6 million as of December 31, 2020, December 31, 2019 and January 1, 2019, respectively, and (iii) a decrease of revenue of $5.7 million and $26.4 million for the years ending December 31, 2020 and December 31, 2019 respectively. Repairs and Maintenance While performing its review of the interim financial statements for the quarter ended June 30, 2021, management identified costs associated with certain replacement components on equipment when repaired were capitalized and recorded in property and equipment in the Company’s consolidated balance sheets as of December 31, 2020 and 2019 and prior periods. Management determined the costs of the replacement components should have been expensed as repairs and maintenance, rather than capitalized. This analysis resulted in a reduction to the carrying value of property and equipment (and the associated amounts of accumulated depreciation), as well as an increase in repairs and maintenance costs and decreases in depreciation expense and loss on disposal of property and equipment, which are included in operating expenses. These are considered errors in accordance with ASC 250, and are material to prior periods and required the consolidated financial statements to be restated. The impact of these errors was (i) a decrease of property and equipment, net, of $16.6 million, $11.8 million and $7.3 million as of December 31, 2020, December 31, 2019 and January 1, 2019, respectively, (ii) an increase in the cost of operations of $8.5 million and $6.6 million for the years ended December 31, 2020 and December 31, 2019, respectively, (iii) a decrease in depreciation expense of $3.4 million and $2.1 million for the years ended December 31, 2020 and December 31, 2019, respectively, and (iv) a decrease to the loss on disposal of property and equipment of $0.2 million and $0.04 million for the years ended December 31, 2020 and December 31, 2019, respectively. The tax impact of the above-noted changes, along with other previously uncorrected immaterial misstatements to certain balance sheet and income statement accounts, are included in the total adjustments described in the tables below. The cumulative impact of these items was a decrease in shareholders’ equity of $54.6 million and $38.1 million at December 31, 2020 and 2019, respectively. Line items in the restated consolidated balance sheets As at December 31, As at December 31, 2020 Adjustment 2020 - Restated Accounts receivable 91,126,923 (28,868,166) 62,258,757 Prepaid expenses and other current assets 3,942,268 489,379 4,431,647 Current assets 139,465,179 (28,378,787) 111,086,392 Security deposits and other assets 4,876,208 (44,160) 4,832,048 Property and equipment 79,929,574 (16,216,065) 63,713,509 Goodwill 360,603,613 (8,994,052) 351,609,561 Total assets 718,684,541 (53,633,064) 665,051,477 Accounts payable and accrued liabilities 34,233,142 62,114 34,295,256 Deferred tax liability 826,566 866,445 1,693,011 Total liabilities 578,952,991 928,559 579,881,550 Deficit (26,759,151) (53,373,408) (80,132,559) Equity attributable to shareholders of Akumin Inc. 134,205,883 (53,373,408) 80,832,475 Non-controlling 5,525,667 (1,188,215) 4,337,452 Total shareholders’ equity 139,731,550 (54,561,623) 85,169,927 Total liabilities and shareholders’ equity 718,684,541 (53,633,064) 665,051,477 Line items in the restated consolidated statement of operations and comprehensive income (loss) Year ended December Year ended December 31, 2020 Adjustment 31, 2020 - Restated Service fees - net of allowances and discounts 243,981,183 (5,656,864) 238,324,319 Total revenue 251,282,849 (5,656,864) 245,625,985 Cost of operations, excluding depreciation and amortization 197,803,388 7,831,218 205,634,606 Depreciation and amortization 20,459,767 (3,399,616) 17,060,151 Operational financial instruments revaluation and other (gains) losses (3,907,666) (221,807) (4,129,473) Total operating expenses 216,439,403 4,209,795 220,649,198 Income from operations 34,843,446 (9,866,659) 24,976,787 Other financial instruments revaluation and other (gains) losses 22,078,745 308,082 22,386,827 Loss before income taxes (23,419,915) (10,174,741) (33,594,656) Income tax provision (benefit) (5,751,070) 6,312,625 561,555 Net loss and comprehensive loss for the period (17,668,845) (16,487,366) (34,156,211) Non-controlling 2,728,539 (144,219) 2,584,320 Net loss attributable to common shareholders (20,397,384) (16,343,147) (36,740,531) Net loss per share - basic and diluted (0.29) (0.23) (0.52) Line items in the restated consolidated statement of cash flows Year ended December Year ended December 31, 2020 Adjustment 31, 2020 - Restated Net loss for the period (17,668,845) (16,487,366) (34,156,211) Depreciation and amortization 20,459,767 (3,399,616) 17,060,151 Deferred income tax expense (benefit) (5,430,254) 6,130,090 699,836 Financial instruments revaluation and other (gains) losses 18,171,079 86,275 18,257,354 Changes in accounts receivable (8,259,697) 5,184,977 (3,074,720) Changes in prepaid expenses, security deposits and other assets (138,395) 411,115 272,720 Changes in accounts payable and accrued liabilities 9,038,102 (1,168) 9,036,934 Cash flows from operating activities 26,690,553 (8,075,693) 18,614,860 Purchase of property and equipment and intangible assets (13,420,375) 8,075,693 (5,344,682) Cash flows from investing activities (17,082,798) 8,075,693 (9,007,105) Line items in the restated consolidated balance sheets As at December 31, As at December 31, 2019 Adjustment 2019 - Restated Accounts receivable 82,867,225 (29,541,709) 53,325,516 Prepaid expenses and other current assets 3,927,949 1,073,083 5,001,032 Current assets 110,184,090 (28,468,626) 81,715,464 Security deposits and other assets 1,967,053 (216,750) 1,750,303 Property and equipment 75,938,590 (11,761,795) 64,176,795 Goodwill 358,802,534 (3,135,530) 355,667,004 Total assets 683,000,517 (43,582,701) 639,417,816 Accounts payable and accrued liabilities 26,262,225 63,283 26,325,508 Derivative financial instruments 951,702 (308,082) 643,620 Deferred tax liability 6,256,820 (5,263,645) 993,175 Total liabilities 525,937,015 (5,508,444) 520,428,571 Deficit (6,361,767) (37,030,261) (43,392,028) Equity attributable to shareholders of Akumin Inc. 152,519,353 (37,030,261) 115,489,092 Non-controlling 4,544,149 (1,043,996) 3,500,153 Total shareholders’ equity 157,063,502 (38,074,257) 118,989,245 Total liabilities and shareholders’ equity 683,000,517 (43,582,701) 639,417,816 Line items in the restated consolidated statement of operations and comprehensive income (loss) Year ended December Year ended December 31, 2019 Adjustment 31, 2019 - Restated Service fees - net of allowances and discounts 244,841,400 (26,391,696) 218,449,704 Total revenue 247,436,303 (26,391,696) 221,044,607 Cost of operations, excluding depreciation and amortization 187,802,601 5,534,129 193,336,730 Depreciation and amortization 15,587,200 (2,095,831) 13,491,369 Operational financial instruments revaluation and other (gains) losses 1,017,401 (37,473) 979,928 Total operating expenses 207,961,967 3,400,825 211,362,792 Income from operations 39,474,336 (29,792,521) 9,681,815 Other financial instruments revaluation and other (gains) losses 1,805,816 (308,082) 1,497,734 Income (loss) before income taxes 15,363,155 (29,484,439) (14,121,284) Income tax provision (benefit) 3,735,548 (6,533,107) (2,797,559) Net income (loss) and comprehensive income (loss) for the period 11,627,607 (22,951,332) (11,323,725) Non-controlling 2,199,629 (593,604) 1,606,025 Net income (loss) attributable to common shareholders 9,427,978 (22,357,728) (12,929,750) Net income (loss) per share - basic and diluted 0.14 (0.34) (0.19) Line items in the restated consolidated statement of cash flows Year ended December Year ended December 31, 2019 Adjustment 31, 2019 - Restated Net income (loss) for the period 11,627,607 (22,951,332) (11,323,725) Depreciation and amortization 15,587,200 (2,095,831) 13,491,369 Deferred income tax expense (benefit) 2,092,504 (3,511,985) (1,419,481) Financial instruments revaluation and other (gains) losses 2,823,217 (345,555) 2,477,662 Changes in accounts receivable (25,243,156) 25,656,280 413,124 Changes in prepaid expenses, security deposits and other assets (3,657,429) (1,355,327) (5,012,756) Changes in accounts payable and accrued liabilities 1,369,580 (1,948,040) (578,460) Cash flows from operating activities 12,581,077 (6,551,790) 6,029,287 Purchase of property and equipment and intangible assets (12,447,634) 6,551,790 (5,895,844) Cash flows from investing activities (231,107,615) 6,551,790 (224,555,825) Line items in the restated consolidated statement changes in equity Accumulated Deficit Non-controlling Total Shareholders’ As at January 1, 2019 (15,789,745) 4,107,499 118,895,463 Adjustment (14,672,533) (450,392) (15,122,925) As at January 1, 2019 - Restated (30,462,278) 3,657,107 103,772,538 As at December 31, 2019 (6,361,767) 4,544,149 157,063,502 Adjustment (37,030,261) (1,043,996) (38,074,257) As at December 31, 2019 - Restated (43,392,028) 3,500,153 118,989,245 As at December 31, 2020 (26,759,151) 5,525,667 139,731,550 Adjustment (53,373,408) (1,188,215) (54,561,623) As at December 31, 2020 - Restated (80,132,559) 4,337,452 85,169,927 |
Business Combinations
Business Combinations | 12 Months Ended |
Dec. 31, 2020 | |
Business Combinations [Abstract] | |
Business Combinations | 4 Business combinations i) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Coral Springs, Florida, for cash consideration of approximately $2.1 million (Coral Springs Acquisition). In accordance with the transaction agreement, $100,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Current assets Prepaid expenses 32,961 Non-current Security deposits 368,601 Property and equipment 412,400 Operating lease right-of-use 2,427,618 3,241,580 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 2,427,618 Net assets acquired 813,962 Goodwill 1,274,764 Purchase price 2,088,726 This acquisition was an opportunity for the Company to increase its economies of scale across Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $4.1 million and income before tax of approximately $0.6 million (restated) to the Company’s consolidated results for the twelve months ended December 31, 2020. In our estimation, this acquisition would have contributed revenue of approximately $5.4 million and income before tax of approximately $0.9 million to the Company’s consolidated results for the twelve months ended December 31, 2019. ii) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Crystal Lake, Illinois, for cash consideration of approximately $1.2 million (Crystal Lake Acquisition). In accordance with the transaction agreement, $60,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Non-current Security deposits 5,799 Property and equipment 820,000 Operating lease right-of-use 554,830 1,380,629 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 554,830 Net assets acquired 825,799 Goodwill 400,000 Purchase price 1,225,799 This acquisition was an opportunity for the Company to increase its presence in Illinois. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $1.0 million and income before tax of approximately $0.2 million to the Company’s consolidated results for the twelve months ended December 31, 2020. In our estimation, this acquisition would have contributed revenue of approximately $1.1 million and income before tax of approximately $0.2 million to the Company’s consolidated results for the twelve months ended December 31, 2019. iii) On April 1, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Davie, Florida, for cash consideration of $ 450,000 50,000 $ Assets acquired Non-current Property and equipment 170,000 Operating lease right-of-use 427,558 597,558 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 427,558 Net assets acquired 170,000 Goodwill 280,000 Purchase price 450,000 This acquisition was an opportunity for the Company to increase its economies of scale across Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $0.4 million and loss before tax of approximately $41 thousand to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $0.4 million (restated) in revenue and $100 thousand (restated) in loss before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and loss before tax for the same period would have been approximately $221.1 million (restated) and $15.8 million (restated), respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. iv) On April 15, 2019, the Company announced that it had, through a subsidiary, entered into purchase agreements to acquire 27 21 6 The total purchase price (excluding earn-out) earn-out The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. Intangible assets include covenant not to compete, trade name and license arrangements. A deferred tax liability was assumed as part of the net assets acquired in the ADG Acquisitions. (Restated- Note 3) 2020 $ 2019 $ Assets acquired Current assets Cash 3,585,672 3,585,672 Accounts receivable 25,277,336 19,418,814 Prepaid expenses 269,012 269,012 29,132,020 23,273,498 Non-current Property and equipment 11,508,940 11,508,940 Intangible assets 5,870,000 5,870,000 Operating lease right-of-use 16,912,896 16,912,896 34,291,836 34,291,836 63,423,856 57,565,334 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 5,634,661 5,634,661 Non-current Deferred tax liability 422,056 422,056 Operating lease liabilities (right-of-use) 16,912,896 16,912,896 17,334,952 17,334,952 22,969,613 22,969,613 Net assets acquired 40,454,243 34,595,721 Goodwill 190,078,533 195,937,055 Purchase price (cash and shares) 215,784,755 215,784,755 Purchase price (ADG Acquisition – earn-out 14,748,021 14,748,021 These acquisitions were an opportunity for the Company to increase its economies of scale across Florida and enter the Georgia market. The goodwill assessed on acquisition, expected to not be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of these acquisitions have been included in the Company’s consolidated statements of operations and comprehensive loss from the acquisition date. Since the acquisition date, these acquisitions contributed revenue of approximately $39.5 million (restated) and income before tax of approximately $14.6 million (restated) to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from these acquisitions had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $63.8 million (restated) in revenue and $20.9 million (restated) in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and loss before tax for the same period would have been approximately $245.3 million (restated) and $9.4 million (restated), respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. v) On May 31, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Deltona, Florida, for a cash consideration of $ 648,387 $ Assets acquired Non-current Property and equipment 295,000 Operating lease right-of-use 154,136 449,136 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 57,880 Non-current Operating lease liabilities (right-of-use) 154,136 212,016 Net assets acquired 237,120 Goodwill 411,267 Purchase price 648,387 This acquisition was an opportunity for the Company to increase its economies of scale across Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $1.9 million and income before tax of approximately $0.6 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $2.9 million (restated) in revenue and $0.6 million (restated) in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and loss before tax for the same period would have been approximately $222.1 million (restated) and $15.7 million (restated), respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. vi) On August 16, 2019, the Company acquired, through a subsidiary, five outpatient diagnostic imaging centres in El Paso, Texas, for cash consideration of $ 11 16 2020 2019 $ $ Assets acquired Current assets Accounts receivable 1,275,726 1,275,726 Prepaid expenses 19,789 19,789 1,295,515 1,295,515 Non-current Property and equipment 3,922,481 3,922,481 Operating lease right-of-use 3,683,989 3,683,989 Intangible assets 720,000 720,000 9,621,985 9,621,985 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,174,040 1,024,631 Non-current Operating lease liabilities (right-of-use) 3,683,989 3,683,989 4,858,029 4,708,620 Net assets acquired 4,763,956 4,913,365 Goodwill 6,220,153 6,086,635 Purchase price 10,984,109 11,000,000 This acquisition was an opportunity for the Company to increase its economies of scale in Texas. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $5.3 million and income before tax of approximately $1.1 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $12.6 million (restated) in revenue and $1.6 million (restated) in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and loss before tax for the same period would have been approximately $228.4 million (restated) and $15.3 million (restated), respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. vii) On October 4, 2019, the Company acquired, through a subsidiary, three outpatient diagnostic imaging centres in West Palm Beach, Florida, for cash consideration of approximately $ 18 0.1 2020 2019 $ $ Assets acquired Current assets Accounts receivable 2,085,491 2,085,491 Prepaid expenses 90,454 90,454 2,175,945 2,175,945 Non-current Security deposits 9,000 9,000 Property and equipment 2,432,234 2,432,234 Operating lease right-of-use 13,625,521 13,625,521 Intangible assets 1,080,000 1,080,000 19,322,700 19,322,700 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,404,268 1,311,471 Non-current Finance leases 587,434 587,434 Operating lease liabilities (right-of-use) 13,625,521 13,625,521 15,617,223 15,524,426 Net assets acquired 3,705,477 3,798,274 Goodwill 14,064,109 14,071,312 Purchase price 17,769,586 17,869,586 This acquisition was an opportunity for the Company to increase its economies of scale in Florida. The goodwill assessed on acquisition, expected to be deductible for income tax purposes, reflects the Company’s expectation of future benefits from the acquired business and workforce, and potential synergies from cost savings. The results of operations of this acquisition have been included in the Company’s consolidated statements of operations and comprehensive income (loss) from the acquisition date. Since the acquisition date, this acquisition contributed revenue of approximately $4.8 million and income before tax of approximately $0.4 million to the Company’s consolidated results for the twelve months ended December 31, 2019. The Company has estimated the contribution to the Company’s consolidated results from this acquisition had the business combination occurred at the beginning of the year. Had the business combination occurred at the beginning of fiscal 2019, this business combination would have contributed approximately $17.9 million (restated) in revenue and $0.6 million (restated) in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and loss before tax for the same period would have been approximately $234.1 million (restated) and $15.5 million (restated), respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition. |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2020 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | 5 Property and equipment (Restated- Note 3) 2020 $ (Restated- Note 3) 2019 $ Medical equipment 62,405,632 60,266,531 Equipment under finance leases 23,168,355 14,971,916 Leasehold improvements 19,360,169 17,393,839 Furniture and fixtures 1,479,320 1,088,236 Office equipment 211,032 214,612 Computer equipment 240,919 194,770 Total property and equipment – cost 106,865,427 94,129,904 Less: Accumulated depreciation (43,151,918 ) (29,953,109 ) Total property and equipment – net 63,713,509 64,176,795 As at December 31, 2020, the equipment under finance leases had a net book value of $14,981,186 (2019 - $9,404,765). Depreciation expense for the twelve months ended December 31, 2020 was $14,370,332 (restated) (2019 – $11,609,821 (restated)). As part of ongoing operations, during the twelve months ended December 31, 2020, the Company had net disposals of $1,557,819 (restated) (2019 – $992,533 (restated)). The loss on these disposals was $1,327,488 (restated) (2019 - $893,883 (restated)) and is included in the consolidated statements of operations and comprehensive income (loss) in the expense category “financial instruments revaluation and other gains (losses)” and in note 22. |
Intangible Assets
Intangible Assets | 12 Months Ended |
Dec. 31, 2020 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Intangible Assets | 6 Intangible assets Covenants not to compete $ Software costs $ Trade name $ License Arrange- $ Total $ Cost Balance – January 1, 2019 1,127,917 241,855 3,283,000 - 4,652,772 Additions - 2,675 - - 2,675 Business acquisitions (note 5) 2,010,000 - 4,540,000 1,120,000 7,670,000 Balance – December 31, 2019 3,137,917 244,530 7,823,000 1,120,000 12,325,447 Additions - 5,412 - - 5,412 Balance – December 31, 2020 3,137,917 249,942 7,823,000 1,120,000 12,330,859 Accumulated amortization Balance – January 1, 2019 323,611 119,225 568,584 - 1,011,420 Amortization 594,307 31,973 1,124,601 130,666 1,881,547 Balance – December 31, 2019 917,918 151,198 1,693,185 130,666 2,892,967 Amortization 868,572 32,648 1,564,599 224,000 2,689,819 Balance – December 31, 2020 1,786,490 183,846 3,257,784 354,666 5,582,786 Net book value December 31, 2019 2,219,999 93,332 6,129,815 989,334 9,432,480 December 31, 2020 1,351,427 66,096 4,565,216 765,334 6,748,073 Weighted average remaining amortization period (years) 1.5 2.0 2.8 3.5 2.5 For the twelve months ended December 31, 2020, the Company identified no impairment indicators and hence, there was no impairment of intangible assets. Estimated aggregate amortization expense for definite-lived intangible assets for each of the next five years ended December 31 is as follows: 2021 $2,710,490 2022 2,190,685 2023 1,275,099 2024 570,223 2025 1,125 Total 6,747,622 |
Goodwill
Goodwill | 12 Months Ended |
Dec. 31, 2020 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | 7 Goodwill The carrying amounts of goodwill at the beginning and end of the current and previous periods are set out below. (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Balance – Beginning of period 355,667,004 145,101,212 Adjustments (note 4) (5,732,207 ) (6,220,477) Business acquisitions (note 4) 1,674,764 216,786,269 Balance – End of period 351,609,561 355,667,004 The carrying amount of goodwill attributed to each reporting unit was as follows: 2020 $ 2019 $ Florida 249,630,120 254,221,080 Northeast 3,569,801 3,569,801 Texas 90,921,837 90,788,320 Other 7,487,803 7,087,803 351,609,561 355,667,004 The fair value of each reporting unit was estimated by use of the income approach. The methodology used to test impairment is classified as Level 3 per the fair value hierarchy described in note 17. The fair value for a reporting unit is determined by discounting five-year cash flow projections (cash flows beyond the five-year period are extrapolated using perpetuity growth rates). These projections reflect management’s expectations based on past experience and future estimates of operating performance. The discount rates are applied to the cash flow projections and are derived from the weighted average cost of capital for each reporting unit or group of reporting units. The Company’s discount rates are based on market rates of return, debt to equity ratios, and certain risk premiums, among other things. The perpetuity growth rates are based on expected economic conditions and a general outlook for the industry. An impairment charge is recognized to the extent that the carrying amount exceeds the fair value. No impairment charges have arisen as a result of the reviews performed as at October 1, 2020. Reasonably possible changes in key assumptions would not cause the recoverable amount of goodwill to fall below the carrying amount. As there were no indicators of impairment for any of the reporting units, management has not updated any of the other impairment calculations as at December 31, 2020. |
Accounts Payable and Accrued Li
Accounts Payable and Accrued Liabilities | 12 Months Ended |
Dec. 31, 2020 | |
Payables and Accruals [Abstract] | |
Accounts Payable and Accrued Liabilities | 8 Accounts payable and accrued liabilities The accounts payable and accrued liabilities are as follows: (Restated- Note 3) (Restated- Note 3) 2020 2019 $ $ Accounts payable 20,400,949 21,707,080 Accrued other expenses 10,096,523 2,665,575 Accrued payroll expenses 3,797,784 1,952,853 34,295,256 26,325,508 |
Earn-Out Liability (ADG Acquisi
Earn-Out Liability (ADG Acquisition) | 12 Months Ended |
Dec. 31, 2020 | |
Business Combinations [Abstract] | |
Earn-Out Liability (ADG Acquisition) | 9 Earn-out 2020 2019 $ $ ADG Acquisition – earn-out 4,688,553 14,834,067 Less: Current portion of ADG Acquisition – earn-out (4,688,553 ) (7,529,962 ) Non-current earn-out - 7,304,105 A portion of the purchase price payable in respect of the ADG Acquisitions in 2019, specifically for SFL Radiology Holdings, LLC (Georgia business), was subject to an earn-out earn-out 50 The value of the ADG Acquisition – earn-out earn-out 14.7 7 earn-out 1.0 0.2 earn-out 14.8 9.4 5.5 earn-out 0.1 |
Lease liabilities
Lease liabilities | 12 Months Ended |
Dec. 31, 2020 | |
Leases [Abstract] | |
Lease liabilities | 10 Lease liabilities Finance The information pertaining to finance lease liabilities on the consolidated balance sheets is as follows: 2020 2019 $ $ Finance lease liabilities 15,573,586 8,415,404 Less: Current portion of finance lease liabilities (3,264,806 ) (1,789,995 ) Non-current 12,308,780 6,625,409 The components of finance lease cost recognized in the consolidated statements of operations and comprehensive loss are as follows: 2020 2019 $ $ Amortization expense for equipment under finance leases 2,927,249 1,794,673 Interest expense on finance lease liabilities 637,191 296,603 Finance lease cost 3,564,440 2,091,276 Undiscounted cash flows for finance leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 3,910,052 2022 3,768,295 2023 3,347,796 2024 2,749,931 2025 1,893,323 Thereafter 1,762,745 Total minimum lease payments 17,432,142 Less: Amount of lease payments representing interest (1,858,556) Present value of future minimum lease payments 15,573,586 Less: Current portion of finance lease liabilities (3,264,806) Non-current 12,308,780 The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-finance leases (years) 4.9 4.8 Weighted average discount rate-finance leases 4.6% 5.1% Supplemental cash flow information related to finance leases is as follows: 2020 2019 $ $ Operating cash flows from finance leases 637,191 296,603 Financing cash flows from finance leases 1,524,548 904,193 Right-of-use 8,816,902 5,309,686 Operating The information pertaining to operating lease liabilities on the consolidated balance sheet is as follows: 2020 2019 $ $ Operating lease liabilities 132,299,312 129,049,990 Less: Current portion of operating lease liabilities (9,345,656 ) (9,276,298 ) Non-current 122,953,656 119,773,692 The components of operating lease cost recognized in the consolidated statement of operations and comprehensive income (loss) are as follows: 2020 2019 $ $ Operating lease cost 20,624,622 18,040,356 Variable lease cost 4,109,277 3,478,748 Short-term lease cost 246,785 170,366 Total operating lease cost 24,980,684 21,689,470 Undiscounted cash flows for operating leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 18,380,966 2022 18,075,153 2023 17,224,588 2024 16,355,082 2025 15,659,482 Thereafter 137,590,224 Total minimum lease payments 223,285,495 Less: Amount of lease payments representing interest (90,986,183 ) Present value of future minimum lease payments 132,299,312 Less: Current portion of operating lease liabilities (9,345,656 ) Non-current 122,953,656 The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-operating leases (years) 12.7 14.1 Weighted average discount rate-operating leases 7.4% 7.1% Supplemental cash flow information related to operating leases is as follows: 2020 2019 $ $ Operating cash flows from operating leases 17,672,048 15,660,780 Right-of-use 13,800,876 137,301,712 |
Senior loans payable
Senior loans payable | 12 Months Ended |
Dec. 31, 2020 | |
Debt Disclosure [Abstract] | |
Senior Loans Payable | 11 Senior loans payable The 2025 Loans and Wesley Chapel Loan are collectively referred to as the Senior Loans. The minimum annual principal payments with respect to the Senior Loans (face value) as at December 31, 2020 are as follows: $ 2021 405,698 2022 426,454 2023 296,356 2024 - 2025 400,000,000 401,128,508 2025 Senior Notes On November 2, 2020, the Company closed its previously announced offering of $ 400 7.0 November 1, 2025 19 pari passu 400 11.5 400 389 2020 2019 $ $ 2025 Senior Notes 388,906,059 - Less: Current portion - - 388,906,059 - The 2025 Senior Notes indenture provides for the following (capitalized terms used below in this note and not defined elsewhere in these notes have the respective meanings given to them in the 2025 Senior Notes indenture): • Payments The principal payment is due at maturity on November 1, 2025 • Restrictive The 2025 Senior Notes indenture restricts the Company’s ability to, among other things: incur certain additional indebtedness and issue preferred stock; make certain distributions, investments and other restricted payments; sell certain assets; agree to any restrictions on the ability of Subsidiaries (including the Revenue Practices) to make payments to the Company; create certain liens; merge, consolidate or sell substantially all of the Company’s assets; and enter into certain transactions with affiliates. These covenants are subject to exceptions and qualifications and many of these covenants will not be applicable during any period when the 2025 Senior Notes have an investment grade rating. • Financial There are no maintenance financial covenants. There are incurrence-based covenants related to the restrictive covenants noted above. The Company is in compliance with the covenants and has no events of default under this indenture as at December 31, 2020. • Events of default Events of default under the 2025 Senior Notes indenture include, among others, failure to pay principal of or interest on the 2025 Senior Notes and certain final judgments when due (subject to appropriate periods and conditions); failure to comply, within appropriate period, with obligations under certain covenants or any provision in the 2025 Senior Notes indenture; certain events of bankruptcy or insolvency and if any Guarantee by a Significant Subsidiary is held in a judicial proceeding to be unenforceable or invalid. The occurrence of an event of default would permit the Trustee or holders of at least 25% of the 2025 Senior Notes to declare all of the 2025 Senior Notes together with unpaid accrued interest, to be immediately due and payable and to exercise other default remedies. 2020 Revolving Facility Concurrently with the closing of the 2025 Senior Notes, the Company entered into a new revolving credit agreement (the 2020 Revolving Credit Agreement) with a US financial institution, as administrative and collateral agent, and other financial institutions, as lenders, to provide a senior secured revolving credit facility in an aggregate principal amount of $55 million (the 2020 Revolving Facility, and together with 2025 Senior Notes, the 2025 Loans), with sub-limits pari passu five The availability of borrowings under the 2020 Revolving Facility is subject to customary terms and conditions. The 2020 Revolving Facility was undrawn at November 2, 2020 (it is considered a Level 3 liability as described in note 17). The issuance costs related to this credit facility were approximately $2.0 million (including approximately $0.9 million related to the prior Revolving Facility since the settlement of the Revolving Facility was considered debt modification for accounting purposes). These costs are included in security deposits and other assets in the balance sheet and are being amortized to interest expense over the term of the 2020 Revolving Facility. The annual commitment fee related to the 2020 Revolving Facility is capped at 0.5% of the aggregate principal amount of $55 million. As at December 31, 2020, the 2020 Revolving Facility had a face value and amortized cost balance of $nil (2019 - $nil). 2020 $ 2019 $ 2020 Revolving Facility - - The 2020 Revolving Credit Agreement provides for the following (capitalized terms used below in this note and not defined elsewhere in these notes have the respective meanings given to them in the 2020 Revolving Credit Agreement): • Interest The interest rates payable on the 2020 Revolving Facility are as follows: (i) each Eurodollar Rate Loan bears interest on the outstanding principal amount at Adjusted Eurodollar Rate (effectively, LIBOR) plus the Applicable Rate; (ii) each Base Rate Loan bears interest on the outstanding principal amount at the Base Rate (the highest of (a) the Prime Rate, (b) the Federal Reserve Bank of New York Rate plus 0.5% and (c) one-month no nil nil nil • Restrictive In addition to certain covenants, the 2020 Revolving Credit Agreement places limits on the Company’s ability to declare dividends or redeem or repurchase capital stock (including options or warrants), prepay, redeem or purchase debt, incur liens and engage in sale-leaseback transactions, make loans and investments, incur additional indebtedness, amend or otherwise alter debt and other material agreements, engage in mergers, acquisitions and asset sales, enter into transactions with affiliates and alter the business the Company and the Subsidiaries currently conduct. • Financial The 2020 Revolving Credit Agreement contains a financial covenant related to a leverage ratio that is tested on the last day of any fiscal quarter (commencing with the fiscal quarter ending March 31, 2021) only if on the last day of any such fiscal quarter, the outstanding amount under the 2020 Revolving Facility (excluding certain letter of credit obligations) exceeds 30% of the total commitment under the 2020 Revolving Facility of $55 million. Borrowings under the 2020 Revolving Facility were nil as at December 31, 2020 and therefore did not exceed 30% of the total commitment under the 2020 Revolving Facility. As a result, the Company is in compliance with the financial covenant. No event of default under the 2020 Revolving Credit Agreement had occurred as at December 31, 2020. • Events of default Events of default under the 2020 Revolving Credit Agreement include, among others, failure to pay principal of or interest on the 2020 Revolving Facility when due, failure to pay any fee or other amount due, failure of any loan party to comply with any covenants or agreements in the loan documents (subject to applicable grace periods and/or notice requirements), a representation or warranty contained in the loan documents is incorrect or misleading in a material respect when made, events of bankruptcy and a change of control. The occurrence of an event of default would permit the lenders under the 2020 Revolving Credit Agreement to declare all amounts borrowed, together with accrued interest and fees, to be immediately due and payable and to exercise other default remedies. Amended May 2019 Loans On June 2, 2020, the Company entered into an amendment to its senior credit agreement which amended the credit agreement signed effective May 31, 2019 (such amended credit agreement, the Amended May 2019 Credit Agreement). Under the terms of the Amended May 2019 Credit Agreement, the Company received in May 2019 a term loan A and term loan B (Term Loan A, Term Loan B and collectively, Term Loans) of $66,000,000 and $266,000,000, respectively (face value) and a revolving credit facility of $50,000,000, which was increased to $69,000,000 on June 2, 2020 (the Revolving Facility, and together with the Term Loans, the Amended May 2019 Loans). In addition, among other things, the amendment adjusted Akumin’s leverage and fixed charge ratios for the four quarters ended March 31, 2021, providing the Company with greater flexibility in its financial ratio covenants. Sixteen five May 31, 2019 2020 $ 2019 $ Term Loan A and Revolving Facility - 87,824,000 Term Loan B - 250,710,995 Less: Current portion - (3,320,000) - 335,214,995 Effective November 14, 2018, the Company entered into a derivative financial instrument contract with a financial institution in order to mitigate interest rate risk under the variable interest rate Syndicated Loans (which were settled in 2019). The derivative financial instrument is an interest rate cap rate of 3.75% (LIBOR) per annum on a notional amount of 50% of the face value of the Syndicated Term Loan ($50,000,000 as at November 14, 2018). The termination date of this arrangement is August 31, 2021 nil In addition, effective July 31, 2019, the Company entered into a derivative financial instrument, an interest rate collar contract (further amended in November 2019 and February 2020), with a financial institution in order to mitigate interest rate risk under the variable interest rate Term Loans. This derivative financial instrument has an underlying notional amount of 100% of the face value of Term Loan B ($266,000,000 as at July 31, 2019) and a termination date of July 31, 2022 with (i) a cap rate of 3.00% (LIBOR) per annum, and (ii) a floor rate of 1.1475% (LIBOR) per annum. There was no nil Wesley Chapel Loan As part of the Rose Acquisition in 2018, the Company, through a subsidiary, assumed a senior secured loan (Wesley Chapel Loan) of $2,000,000 (face value) as of August 15, 2018 to finance the purchase of equipment and related installation at a clinic location around Tampa Bay, Florida. It has an annual interest rate of 5.0%, matures on August 15, 2023 and has monthly repayments of $37,742. The Wesley Chapel Loan was recognized at fair value of $1,908,456 on August 15, 2018 using an effective interest rate. The fair value was determined based on management’s estimation of assumptions that market participants would use in pricing similar liabilities (it is considered a Level 3 liability as described in note 17). As at December 31, 2020, the Wesley Chapel Loan had an amortized cost balance of approximately, $1.1 million. 2020 $ 2019 $ Wesley Chapel Loan 1,079,684 1,447,327 Less: Current portion (405,698 ) (385,952) 673,986 1,061,375 Subject to the provisions described below, the minimum annual principal payments with respect to the Wesley Chapel Loan (face value) are as follows: $ 2021 405,698 2022 426,454 2023 296,356 1,128,508 The Wesley Chapel Loan provides for the following terms: • Interest 5.0%. • Payments Monthly payments (principal and interest) of $37,742. The minimum principal payment schedule for the Wesley Chapel Loan is noted herein. • Termination August 15, 2023. • Restrictive covenants In addition to certain covenants, the Wesley Chapel Loan limits the Company’s ability to dispose of the assets of Akumin Corp., which is the guarantor to the Wesley Chapel Loan. • Financial covenants None. • Events of default Events of default under the Wesley Chapel Loan include, among others, failure to repay the Wesley Chapel Loan in full at maturity, or to pay any other sum due hereunder within ten days of the date when the payment is due, events of insolvency or disposition of all or substantially all of the assets related to the Rose Acquisition. The occurrence of an event of default would permit the lender to declare all amounts borrowed, together with accrued interest and fees, to be immediately due and payable and to exercise other default remedies. The Company has no events of default under the Wesley Chapel Loan as at December 31, 2020. • Security The Company has granted first security interest to the lender over the equipment and leasehold improvements acquired using the proceeds of the Wesley Chapel Loan. |
Subordinated notes payable - ea
Subordinated notes payable - earn -out | 12 Months Ended |
Dec. 31, 2020 | |
Debt Disclosure [Abstract] | |
Subordinated notes payable - earn-out | 12 Subordinated notes payable – earn-out 2020 $ 2019 $ Subordinated note – earn-out - 184,485 As part of the Tampa Acquisition, Akumin FL entered into a subordinated 6% note and security agreement with the seller’s secured lender on May 11, 2018 (the Subordinated Note and Subordinated Note Lender, respectively) with a face value of $1,500,000 and a term of four In accordance with the terms of the Subordinated Note, the Company used part of the proceeds of the Term Loans to settle the principal outstanding under the Subordinated Note on May 31, 2019, together with accrued and unpaid interest, for $1,596,250 (face value of $1,500,000 and accrued interest of $96,250). The Company also recorded a fair value loss of $6,830 on the extinguishment of the Subordinated Note, which was reflected in the 2019 consolidated statements of operations and comprehensive income (loss). According to the Subordinated Note, the Company was subject to an earn-out Earn-out) Earn-out a) The Subordinated Note – Earn-out Earn-out Earn-out b) The Subordinated Note – Earn-out Earn-out c) If Subordinated Note – Earn-out Earn-out Earn-out d) The maximum aggregate amount of the Subordinated Note – Earn-out Earn-out The value of Subordinated Note – Earn-out Earn-out Earn-out Earn-out Earn-out Earn-out |
Capital stock and warrants
Capital stock and warrants | 12 Months Ended |
Dec. 31, 2020 | |
Equity [Abstract] | |
Capital stock and warrants | 13 Capital stock and warrants The authorized share capital of the Company consists of an unlimited number of voting common shares, with no par value. Common shares Warrants RSUs Total Number Amount $ Number Amount $ Number Amount $ Number Amount $ January 1, 2019 62,371,275 123,746,423 1,249,512 1,742,910 1,120,656 2,671,147 64,741,443 128,160,480 Issuance (i) 6,250,000 23,437,500 - - - 1,559,418 6,250,000 24,996,918 RSUs and warrants exercised 1,219,653 4,813,632 (436,497) (569,733) (783,156) (2,932,753) - 1,311,146 Warrants expired - - (288,015) (438,798) - - (288,015) (438,798) December 31, 2019 69,840,928 151,997,555 525,000 734,379 337,500 1,297,812 70,703,428 154,029,746 Issuance (i) - - - - - 14,138 - 14,138 RSUs settled 337,500 1,311,950 - - (337,500) (1,311,950) - - Warrants expired - - (525,000) (734,379) - - (525,000) (734,379) December 31, 2020 70,178,428 153,309,505 - - - - 70,178,428 153,309,505 (i) RSU issuance amount includes stock-based compensation and costs related to RSUs during the period of the consolidated financial statements. RSUs are issued in accordance with the Company’s RSU Plan, which entitles a holder of one RSU to receive one common share of the Company. RSUs are assigned a value based on the market value of the common shares of the Company on the grant date (or the nearest working day prior to the grant date). Such value is classified as stock-based compensation over the vesting period for all RSUs awarded to employees or the Board. During the twelve months ended December 31, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company. a) During the three months ended March 31, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) During March 2017, the Company issued 300,825 warrants to purchase common shares on a 1:1 basis at an exercise price of $2.30 per common share. These warrants were scheduled to expire on March 10 and 17, 2019. During the three months ended September 30, 2018, 120,330 of these warrants were exercised into common shares. The remaining 180,495 warrants were exercised into common shares prior to expiry during the three months ended March 31, 2019. ii) The Board had granted 315,000 RSUs to certain employees of the Company between January 1 and March 12, 2018. Fifty percent of these RSUs vested between January 1 and March 12, 2019 in accordance with the terms of the RSU Plan and 25,000 of these vested RSUs were settled for common shares prior to March 31, 2019. b) During the three months ended June 30, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) The Company issued approximately $23 million in equity (6,250,000 common shares at $3.75 per share, the closing price as of May 31, 2019) to certain sellers in connection with the ADG Acquisitions. ii) During August 2017, the Company issued 512,004 warrants to purchase common shares on a 1:1 basis at an exercise price of $3.50 per common share. The expiry date for these warrants was August 8, 2019. During the three months ended June 30, 2019, 256,002 of these warrants were exercised into common shares. iii) The Board had granted 315,000 RSUs to certain employees of the Company between January 1 and March 12, 2018. Fifty percent of these RSUs vested between January 1 and March 12, 2019 in accordance with the terms of the RSU Plan and 25,000 of these vested RSUs were settled for common shares prior to March 31, 2019. The remaining 132,500 of these vested RSUs were settled for common shares prior to June 30, 2019. c) During the three months ended September 30, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) During August 2017, the Company issued 512,004 warrants to purchase common shares on a 1:1 basis at an exercise price of $3.50 per common share. The expiry date for these warrants was August 8, 2019. During the three months ended June 30, 2019, 256,002 of these warrants were exercised into common shares. The remaining 256,002 of these warrants were not exercised into common shares and expired on August 8, 2019. d) During the three months ended December 31, 2019, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) During November 2017, the Company issued 32,013 warrants to purchase common shares on a 1:1 basis at an exercise price of $3.50 per common share. These warrants were not exercised into common shares and expired on November14, 2019. ii) The Board had granted 1,611,316 RSUs to certain employees of the Company and members of the Board on November 15, 2017. In accordance with the terms of the RSU Plan, 50% of these RSUs vested and were settled for common shares in November 2018. Of the remaining RSUs, 600,656 RSUs vested and were settled for common shares on November 18, 2019 and the remaining RSUs vested on January 1, 2020 in accordance with the terms of the RSU Plan. iii) The Board had granted 315,000 RSUs to certain employees of the Company between January 1 and March 12, 2018. Fifty percent of these RSUs vested between January 1 and March 12, 2019 and were subsequently settled for common shares in accordance with the terms of the RSU Plan. Of the remaining RSUs: I. Twenty-five thousand RSUs were settled for common shares on October 1, 2019 in accordance with the terms of the RSU Plan; and II. Ninety thousand RSUs vested on January 1, 2020 and 42,500 RSUs vested in March 2020. During the twelve months ended December 31, 2020, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company. a) During the three months ended March 31, 2020, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) As at December 31, 2019, the Company had 337,500 RSUs outstanding. All of these RSUs vested between January 1, 2020 and March 12, 2020. 285,000 of these RSUs were settled for common shares on March 12, 2020 in accordance with the terms of the RSU Plan. As at March 31, 2020, the Company had 52,500 RSUs outstanding. b) During the three months ended June 30, 2020, the following equity issuances or exercise or expiry of equity related instruments occurred at the Company: i) As at March 31, 2020, the Company had 52,500 RSUs outstanding. All of these RSUs vested between January 1, 2020 and March 12, 2020 and they were settled for common shares in accordance with the terms of the RSU Plan as follows. 10,000 of these RSUs were settled for common shares in April 2020 and the remaining RSUs were settled for common shares in June 2020. As at June 30, 2020 and through the balance of fiscal 2020, the Company had no RSUs outstanding. The Company granted RSUs in March 2021 as discussed in note 27. ii) During May 2018, the Company had issued 525,000 warrants to purchase common shares on a 1:1 basis at an exercise price of $4.00 per common share. These warrants were not exercised into common shares and expired on May 2, 2020. c) During the three months ended September 30, 2020 and three months ended December 31, 2020, there were no equity issuances or exercise or expiry of equity related instruments at the Company. The stock-based compensation related to RSUs, recognized in the consolidated statements of operations and comprehensive income (loss) for the twelve months ended December 31, 2020 was $14,137 (2019 – $1,559,418). The stock-based compensation related to stock options is noted in note 17. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 14 Income taxes The reconciliation of income tax expense (benefit) computed at the Canadian federal statutory rate to income tax expense (benefit) is as follows: (Restated- Note 3) $ (Restated- Note 3) $ Income attributable to common shareholders before income taxes (36,178,975 ) (15,727,308) Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%) (9,587,428 ) (4,167,737) Increase (decrease) in income taxes resulting from Stock-based compensation 396,528 942,013 State franchise tax, net of federal benefit 395,220 (45,860) US tax rate differential 882,767 375,883 Return to provision adjustment (204,701 ) 1,130,204 Other (236,378 ) (483,792) Valuation allowance 8,915,547 (548,270) Income tax expense (benefit) 561,555 (2,797,559) U.S. Federal current tax expense (benefit) - - U.S. State current tax expense (benefit) (138,281 ) (1,378,079) U.S. Federal deferred tax expense (benefit) 699,836 (823,416) U.S. State deferred tax expense (benefit) - (596,064) Total income tax expense (benefit) 561,555 (2,797,559) The Company’s effective tax rate for the year ended December 31, 2020 was (1.55)% (restated) (2019 – 17.79% (restated)). The tax rate is affected by recurring items, such as tax rates in the United States and the relative amounts of income earned in this jurisdiction, which management expects to be fairly consistent in the near term. It is also affected by discrete items that may occur in any given year but are not consistent from year to year. Deferred income taxes reflect the net tax effects of temporary differences between the carrying amount of assets and liabilities for financial reporting purposes and the amount used for income tax purposes. The Company’s deferred tax assets and liabilities are made up of the following components: (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Deferred tax assets Lease liabilities 31,615,510 33,474,270 Net operating losses 16,559,000 7,249,097 163(j) carryforward 2,024,652 1,268,076 Debt issuance costs 2,419,687 4,412,375 Capital acquisition costs 2,011,450 779,367 Other 16,001,597 13,763,638 Total deferred tax assets 70,631,896 60,946,823 Less: Valuation allowance (16,851,707 ) (7,928,553 ) Net deferred tax assets 53,780,189 53,018,270 Deferred tax liabilities Right-of-use (30,349,474 ) (32,855,049 ) Fixed assets (11,196,500 ) (9,763,083 ) Goodwill (10,660,618 ) (8,430,589 ) Other (3,266,608 ) (2,962,724 ) Total deferred tax liabilities (55,473,200 ) (54,011,445 ) Net deferred tax liabilities (1,693,011 ) (993,175 ) Management regularly assesses the available positive and negative evidence to estimate whether sufficient future taxable income will be generated to permit use of the existing deferred tax assets in Canada and the US. Based on management’s assessment of the future profitability of the Company’s operations, as at December 31, 2020, a valuation allowance of $16,851,707 (restated) (2019 – $7,928,553 (restated)) has been recorded to recognize only the portion of the deferred tax asset that is more likely than not to be realized. The amount of the deferred tax assets considered realizable, however, could be adjusted if estimates of future taxable income during the carry-forward period are reduced or increased. The Company has made a significant investment in its US operations and asserts that earnings from such operations will be indefinitely reinvested in the US. Therefore, determination of unrecognized deferred tax liability on outside basis differences is not practicable at this time. The Company has operating loss carry-forwards of $68,145,713 (restated) (2019 – $29,553,246 (restated)), of which $19,742,894 (restated) begin to expire in 2036. Of these loss-carryforwards, $48,402,819 (restated) do not expire but are subject to utilization restrictions. The Company also has a Section 163(j) interest expense carryforward of $8,415,013 (restated) (2019 – $5,259,543 (restated)) which does not expire but is subject to utilization restrictions. Tax years 2017-2019 and 2016-2019 remain subject to examination by the tax authorities in the US and Canada, respectively. |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2020 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and contingencies | 15 Commitments and contingencies The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. With respect to these matters, the management evaluates the developments on a regular basis and accrues a liability when it believes a loss is probable and the amount can be reasonably estimated. We believe that the amount or any estimable range of reasonably possible or probable loss will not, either individually or in the aggregate, have a material adverse effect on our business and consolidated financial statements. However, the outcome of these matters is inherently uncertain. Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management’s expectations, our results of operations and financial condition, including in a particular reporting period in which any such outcome becomes probable and estimable, could be materially adversely affected. Commencing during Q1 2020 and continuing through the present and beyond, a pandemic relating to the novel coronavirus known as COVID-19 Imaging centers are healthcare facilities and as such are generally considered an essential service and expected to continue to operate during any epidemic or pandemic. However, there is potential that actions taken by government, referring physicians or individual actions, in response to containment or avoidance of this coronavirus could impact a patient’s ability or decision to seek imaging services at a given time which could have a significant impact on volume at our imaging centers leading to temporary or prolonged staff layoffs, reduced hours, closures and other cost containment efforts. Further, there is potential that certain services which are not urgent and can be deferred without significant harm to a patient’s health may be delayed, either by the Company in response to local laws or good public health practice or voluntarily by the patient. In addition, there is potential that the outbreak of the coronavirus could impact supply chains, including the Company’s supply of personal protective equipment, and lead to personnel shortages, each of which could impact the ability of the Company to safely perform imaging services. It is also possible that social distancing efforts and sanitization and decontamination procedures could cause delays in the performance of imaging services. Depending on the severity and duration of the COVID-19 |
Stock-based Compensation –
Stock-based Compensation – Options | 12 Months Ended |
Dec. 31, 2020 | |
Share-based Payment Arrangement [Abstract] | |
Stock-based compensation – options | 16 Stock-based compensation – options The Company operates an equity-settled, stock options based payment compensation plan, under which the Company pays equity instruments of the Company as consideration in exchange for services received. The fair value of the grant of options is recognized in the consolidated statements of operations and comprehensive income (loss) as an expense. The total amount to be expensed is determined by reference to the fair value of the options granted. The total expense is recognized over the vesting period, which is the period over which all of the service vesting conditions are to be satisfied. The maximum number of common shares reserved for issuance, in the aggregate, under the Company’s option plan (and under any other share compensation arrangements of the Company) is 10% of the aggregate number of common shares which are outstanding from time to time. As at December 31, 2020, this represented 7,017,842 (2019 – 6,984,092) common shares. Number of stock options Weighted average exercise price $ Aggregate grant date fair value $ Weighted average remaining contractual term (years) Outstanding – January 1, 2019 4,213,268 $2.18 $5,353,785 7.0 Cancelled (100,000) 3.74 (146,790) - Expired - - - - Exercised - - - - Granted 1,664,852 3.29 2,391,393 - Outstanding – December 31, 2019 5,778,120 2.47 7,598,388 6.3 Cancelled (18,000) 3.74 (26,422) - Expired - - - - Exercised - - - - Granted - - - - Outstanding – December 31, 2020 5,760,120 $2.47 $7,571,966 5.3 Exercisable at December 31, 2020 3,978,218 $2.03 $4,990,924 5.2 During the twelve months ended December 31, 2020, the Company did not grant any stock options. During the twelve months ended December 31, 2019, the Company granted approximately 1.7 million stock options on November 18, 2019, to purchase common shares on a 1:1 basis with an exercise price of $3.29 per share. The fair value of the stock options granted during 2019 was determined to be $2.4 million. These options will vest over a three-year period from the date of issue (34%, 33% and 33% per year, respectively) and have an expiry date of seven years from the date of issue. The fair value of the stock options granted during the twelve months ended December 31, 2019 was estimated to be $1.4364 per option using the Black-Scholes option pricing model based on the following assumptions. The Company granted stock options in March 2021 as discussed in note 27. Date of options grant November 18, 2019 Underlying stock price 3.29 Exercise price 3.29 Term of options (years) 7.0 Volatility of underlying stock price 40% Expected dividend yield on underlying stock nil Annual risk free interest rate 1.48% At December 31, 2020, 1.8 million options were outstanding but not yet exercisable with a weighted average exercise price of $3.46, weighted average remaining contractual term of 5.5 years and weighted average grant date fair value of approximately $1.4 million. At December 31, 2019, 3.0 million options were outstanding but not yet exercisable with a weighted average exercise price of $3.49, weighted average remaining contractual term of 6.4 years and weighted average grant date fair value of approximately $2.2 million. During the twelve months ended December 31, 2020, the weighted average grant date fair value of stock options that: a) vested was $0.9 million (2019 – $0.9 million); and b) were cancelled was $26 thousand (2019 – $0.1 million). The total grant date fair value of stock options that vested during the twelve months ended December 31, 2020 was $1.8 million (2019 – $1.7 million). During the twelve months ended December 31, 2020, the Company recorded a total stock-based options compensation expense of approximately $2,069,777 (2019 – $1,995,347). The total compensation cost related to unvested options awards not yet recognized is approximately $1,089,614 (2019 – $3,185,813) and will be recognized over a remaining vesting period of 1.88 years (2019 – 2.88 years). |
Risk Management Arising From Fi
Risk Management Arising From Financial Instruments | 12 Months Ended |
Dec. 31, 2020 | |
Fair Value Disclosures [Abstract] | |
Risk management arising from financial instruments | 17 Risk management arising from financial instruments The carrying value of cash, accounts receivable, accounts payable and accrued liabilities and leases (current portion) approximates their fair value given their short-term nature. The carrying value of the non-current non-current (Restated- Note 3) 2020 $ 2019 $ 2025 Senior Notes 424,016,044 - Amended May 2019 loans payable - 360,596,500 Wesley Chapel Loan payable 1,122,400 1,483,830 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 643,023 429,826,997 377,741,905 Financial instruments recorded at fair value on the consolidated balance sheets are classified using a fair value hierarchy that reflects the significance of the inputs used in making the measurements. The fair value hierarchy has the following levels: • Level 1 – quoted prices (unadjusted) in active markets for identical assets or liabilities Inputs are unadjusted quoted prices in active markets for identical assets or liabilities. Pricing inputs are based on quoted prices in active markets for identical assets or liabilities that the reporting entity has the ability to access at the measurement date. For securities, the valuations are based on quoted prices of the securities that are readily and regularly available in an active market, and accordingly, a significant degree of judgment is not required. As at December 31, 2020, the Company did not have any financial assets or liabilities measured at fair value under the Level 1 category. • Level 2 – inputs other than quoted prices included in Level 1 that are observable for the asset or liability; either directly (i.e., as prices) or indirectly (i.e., derived from prices) Pricing inputs are based on quoted prices for similar instruments in active markets, quoted prices for identical or similar instruments in markets that are not active, and model based valuation techniques for which all significant assumptions are observable in the market or can be corroborated by observable market data for substantially the full term of the assets or liabilities. The estimated fair value of the liabilities that are recognized at fair value, and subsequently measured at amortized cost, are determined using Level 2 inputs primarily related to comparable market prices. As at December 31, 2020, the 2025 Senior Notes and derivative financial instruments were measured at fair value under the Level 2 category on recognition. The derivative financial instruments are subsequently remeasured at fair value under the Level 2 category. • Level 3 – inputs for the asset or liability that are not based on observable market data (unobservable inputs) Pricing inputs are generally unobservable for the assets or liabilities and include situations where there is little, if any, market activity for the investment. The inputs into the determination of fair value require management’s judgment or estimation of assumptions that market participants would use in pricing the assets or liabilities. The fair values are therefore determined using model based techniques that include option pricing models, discounted cash flow models, and similar techniques. The Amended May 2019 Loans, Wesley Chapel Loan, Subordinated Note – Earn-out, Earn-out Earn-out Earn-out Earn-out Earn-out The following table summarizes information regarding the change in carrying value of the Company’s financial instruments carried at fair value. (Restated- Derivative Subordinated ADG financial Notes Acquisition instruments Earn-out Earn-out $ $ $ January 1, 2019 (16,014 ) 169,642 - Issuance - - 14,748,022 Financial instruments revaluation loss (gain) Realized - - - Unrealized 659,037 14,843 86,045 December 31, 2019 643,023 184,485 14,834,067 Payment (4,805,000 ) (200,000 ) (4,688,553) Financial instruments revaluation loss (gain) Realized 4,161,977 15,515 (2,728,480) Unrealized - - (2,728,481) December 31, 2020 - - 4,688,553 There were no transfers between levels during the twelve months ended December 31, 2020 and the twelve months ended December 31, 2019. A transfer is made between levels during the period that a financial instrument meets the relevant criteria. Financial instruments are classified into one of the following categories: amortized cost, fair value through profit or loss and fair value through other comprehensive income. The following table summarizes information regarding the carrying value of the Company’s financial instruments: (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Cash 44,395,988 23,388,916 Accounts receivable 62,258,757 53,325,516 Financial assets measured at amortized cost 106,654,745 76,714,432 Accounts payable and accrued liabilities 34,295,256 26,325,508 Short-term portion of senior loans payable 405,698 3,705,952 Short-term portion of leases 12,610,462 11,066,293 Long-term portion of senior loans payable 389,580,046 336,276,370 Long-term portion of leases 135,262,436 126,399,101 Financial liabilities measured at amortized cost 572,153,898 503,773,224 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 643,023 Measured at fair value through profit or loss 4,688,553 15,661,575 Credit risk The Company has a diverse mix of payers, including private, managed care, capitated and government payers. Credit risk arises from the potential a counterparty will fail to perform its obligations. The Company is exposed to credit risk from customers. The Company grants credit to its customers in the normal course of business. The consolidated financial statements take into account an allowance for bad debts. The Company is exposed to credit risk from its customers but the concentration of the risk is minimized because of the large customer base and its dispersion across different payers. During the year, the Company may have deposits with financial institutions that exceed Federal Deposit Insurance Corporation limits. As at December 31, 2020, the Company had cash of $44.4 million (2019 – $23.4 million) and accounts receivable of $62.3 million (restated) (2019 – $53.3 million (restated)). Collectability of the receivables is actively monitored on an ongoing basis and an allowance or a write-off write-off non-individual COVID-19 COVID-19 Currency risk Currency risk is the risk to the Company’s earnings that arises from fluctuations in foreign exchange rates and the degree of volatility of those rates. In the normal course of business, the Company may enter into foreign exchange contracts with financial institutions to hedge the value of foreign currency denominated assets. Gains and losses arising from these contracts offset the losses and gains from the underlying hedged transactions. As at December 31, 2020 and December 31, 2019, the Company did not enter into any foreign exchange contracts that would expose the Company to currency risk. Interest rate risk Interest rate risk is the risk the fair value or future cash flows of a financial instrument will fluctuate because of changes in market interest rates. Changes in lending rates can cause fluctuations in interest payments and cash flows. The Company does not use derivative financial instruments to alter the effects of this risk, except as noted in note 11. As at December 31, 2020, the Company’s variable interest rate debt only related to the 2020 Revolving Facility (note 11), which was not drawn during 2020. The following table shows the Company’s exposure to interest rate risk and the effects on comprehensive income for the twelve months ended December 31, 2020 and 2019 of a 1% increase or decrease in the variable interest rates. 2020 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (n/a as settled in November 2020) - - - 2019 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (originated in May 2019) 338,534,995 1,180,247 (1,979,043) Syndicated Loans (n/a as settled in May 2019) - - - 338,534,995 1,180,247 (1,979,043) |
Related Party Transactions
Related Party Transactions | 12 Months Ended |
Dec. 31, 2020 | |
Related Party Transactions [Abstract] | |
Related Party Transactions | 18 Related party transactions The Company transacts with key individuals including directors and executive management who have authority and responsibility to plan, direct, and control the activities of the Company. On November 1, 2020, the Company acquired an MRI machine from an entity in which an officer of a subsidiary of the Company holds a significant interest for $400,000 , which has been paid in full. The MRI machine is to be installed in one of the Company’s diagnostic imaging facilities in Florida. There are no ongoing contractual or other commitments resulting from the transaction. On February 8, 2018, Akumin Corp. entered into a contract with the President and Chief Executive Officer, Executive Vice President and Chief Operating Officer and Chief Financial Officer and Corporate Secretary (collectively, the Pledgors) to loan an aggregate of $500,000 in connection with the purchase by such Pledgors of a total of 142,857 common shares of the Company from certain selling security holders of PMI, pursuant to the terms of a put and call option agreement made as of August 9, 2017 between Z Strategies Inc., a company controlled by the President and Chief Executive Officer, and certain selling security holders of PMI. This loan charged interest at 6% per annum and was payable on maturity at February 8, 2021. During 2019, the Pledgors completely paid off this loan and accrued interest. |
New Accounting Standards
New Accounting Standards | 12 Months Ended |
Dec. 31, 2020 | |
Accounting Standards Update and Change in Accounting Principle [Abstract] | |
New accounting standards | 19 New accounting standards The standards and interpretations that are issued, but not yet effective, up to the date of issuance of the Company’s consolidated financial statements are disclosed below. The Company intends to adopt these standards, if applicable, when they become effective. ASU 2018-15, 350-40) In August 2018, the FASB issued ASU 2018-15, Intangibles – Goodwill and Other – Internal-Use 350-40) internal-use internal-use ASU 2016-13, In June 2016, the FASB issued ASU 2016-13 , Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments |
Basic And Diluted Income (Loss)
Basic And Diluted Income (Loss) Per Share | 12 Months Ended |
Dec. 31, 2020 | |
Earnings Per Share [Abstract] | |
Basic and diluted income (loss) per share | 20 Basic and diluted income (loss) per share (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Net loss attributable to common shareholders (36,740,531) (12,929,750) Weighted average common shares outstanding Basic 70,101,618 66,528,051 Add: additional shares issuable upon exercise of employee stock options, warrants and restricted share units - - Diluted 70,101,618 66,528,051 Net loss per share Basic and diluted (0.52) (0.19) Employee stock options warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,664,231 2,066,938 |
Financial Instruments Revaluati
Financial Instruments Revaluation And Other Gains (Losses) | 12 Months Ended |
Dec. 31, 2020 | |
Financial Instruments Revaluation And Other Gains Losses [Abstract] | |
Financial instruments revaluation and other gains (losses) | 21 Financial instruments revaluation and other gains (losses) a) Operational Financial instruments revaluation and other gains (losses) (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Gain (loss) on revaluation of ADG Acquisition – Earn-out 5,456,961 (86,045) Loss on disposal of property and equipment (1,327,488 ) (893,883) 4,129,473 (979,928) b) Other Financial instruments revaluation and other gains (losses) (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Loss on debt revaluation (note 11) (18,278,845 ) (829,208) Loss on revaluation of derivatives (note 11) (4,161,977 ) (659,037) Other gains (losses) 53,995 (9,489) (22,386,827 ) (1,497,734) |
Revenue Information
Revenue Information | 12 Months Ended |
Dec. 31, 2020 | |
Revenue from Contract with Customer [Abstract] | |
Revenue information | 22 Revenue information (Restated- Note 3) 2020 $ (Restated- Note 3) 2019 $ Commercial 159,862,661 154,916,949 Medicare 27,873,980 25,799,652 Medicaid 7,699,859 6,637,274 Attorney 24,343,273 13,283,222 Workers comp 9,711,177 9,459,955 Other patient revenue 8,833,369 8,352,652 Service fees - net of allowances and discounts 238,324,319 218,449,704 Other revenue (management and ancillary fees and government grants) 7,301,666 2,594,903 245,625,985 221,044,607 |
Cost Of Operations, Excluding D
Cost Of Operations, Excluding Depreciation And Amortization | 12 Months Ended |
Dec. 31, 2020 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization | 23 Cost of operations, excluding depreciation and amortization (Restated- Note 3) 2020 $ (Restated- Note 3) 2019 $ Employee compensation 84,038,371 85,899,654 Reading fees 37,817,457 35,243,843 Rent and utilities 30,203,346 26,332,049 Third party services and professional fees 30,182,599 25,636,187 Administrative 12,231,131 11,441,620 Medical supplies and other 11,161,702 8,783,377 205,634,606 193,336,730 |
Settlement Costs And Other (Rec
Settlement Costs And Other (Recoveries) | 12 Months Ended |
Dec. 31, 2020 | |
Business Litigation Settlement Costs And Other Recoveries [Abstract] | |
Settlement costs and other (recoveries) | 24 Settlement costs and other (recoveries) During the twelve months ended December 31, 2020, the Company experienced net settlement costs of approximately $2.3 million (2019 – settlement recoveries of $1.9 million) mainly related to the following items. i) Approximately, $0.8 million related to a settlement of a government investigation that relates predominantly to historical reimbursements paid under federal healthcare programs to subsidiaries or the Revenue Practices. This settlement was reached in January 2021. ii) Approximately $1.1 million comprised of a few settlement costs related to four vendors. |
Non-Controlling Interests
Non-Controlling Interests | 12 Months Ended |
Dec. 31, 2020 | |
Noncontrolling Interest Items [Abstract] | |
Non-controlling interests | 25 Non-controlling As part of the Texas Acquisition in 2017, certain of PMI’s subsidiaries acquired were non-wholly non-wholly non-controlling non-controlling non-controlling The Company currently holds effective ownership interests in the following non-wholly Ownership interest Entity 2020 2019 % % Phoenix Imaging, LLC 60 60 Preferred Imaging of Amarillo, LLC 57 57 |
CARES Act
CARES Act | 12 Months Ended |
Dec. 31, 2020 | |
Coronavirus Aid Relief And Economic Security Act [Abstract] | |
Coronavirus Aid Relief And Economic Security Act [Text Block] | 26 CARES Act i) During April 2020, the Company received approximately $1.1 million in grant under the first appropriation made by the HHS to Medicare providers pursuant to the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Subsequently, in December 2020, the Company received an additional grant from the HHS of approximately $4.1 million. Additional grants may be available to the Company through subsequent appropriations under this program. The Company applied for these grants after determining that it was eligible to do so. Also, the Company has incurred expenses and experienced loss of revenue that are eligible to be reimbursed under these grants. The grants received are recorded in the consolidated statements of operations comprehensive loss in the category “Other revenue”. ii) During April 2020, the Company received approximately $3.1 million of accelerated Medicare payments under the expanded Accelerated and Advance Payments Program from Centers for Medicare & Medicaid Service (CMS). These payments are currently required to be applied to claims beginning one year after their receipt through the adjudication of Medicare claims over a future period. These payments to the Company are recorded in the consolidated balance sheets in the category “Accounts payable and accrued liabilities” until earned. iii) The CARES Act allows employers to defer the deposit and payment of the employer’s share of Social Security taxes. As of December 31, 2020, such taxes were approximately $2.7 million and approximately $1.3 million are recorded in the consolidated balance sheets in the category “Accrued payroll taxes” and the remaining balance in the category “Accounts payable and accrued liabilities”. |
Subsequent Events
Subsequent Events | 12 Months Ended |
Dec. 31, 2020 | |
Subsequent Events [Abstract] | |
Subsequent Events | 27 Subsequent events i) The Company announced on February 11, 2021 that it completed its private offering of $75 million aggregate principal amount of additional 7.00% senior secured notes due November 2025 (the “New Notes”). The New Notes were offered as additional notes under the same indenture as the previously issued 2025 Senior Notes and will be treated as a single series with the 2025 Senior Notes. The Company expects to use the net proceeds from this offering for future acquisitions, with any unused proceeds to be used for working capital and other general corporate purposes, which may include reducing debt. The New Notes are fully and unconditionally guaranteed, jointly and severally, on a senior secured basis by each wholly owned subsidiary of the Company, including the Revenue Practices and the guarantors. ii) Effective March 1, 2021, the Company completed a common equity investment in an artificial intelligence business as part of a private placement offering for approximately $4.6 million. The target develops artificial intelligence aided software programs for use in medical businesses, including outpatient imaging services of the sort provided by the Company. As a result of the investment, a previous investment in a convertible note instrument issued by the target to the Company in May 2020 converted for common equity. The Company’s total investment is estimated to be valued at approximately $8.0 million and represents a 34.5% interest in the target. In addition, the Company holds share purchase warrants which, subject to the occurrence of certain events, and the payment of approximately $0.4 million, would entitle the Company to acquire a further 2.4% interest in the target’s common equity. iii) On March 9, 2021, the Board granted 645,000 RSUs and 70,000 options to certain employees and consultants of the Company pursuant to the Company’s RSU plan and stock option plan, respectively, in connection with the Company’s equity bonus awards. In addition, 84,032 RSUs were granted to non-executive 5-day iv) On May 1, 2021, the Company acquired, through a subsidiary, six outpatient diagnostic imaging centers in Florida in six simultaneous transactions with related sellers, for aggregate cash consideration of approximately $34.6 million and share consideration of approximately $3.0 million through issuance of approximately 0.97 million common shares of the Company at a price of $3.09 per share based on the share price at the close of April 30, 2021 (the “Florida Acquisition”). Under the purchase agreements, the share consideration was based on a price of $4.00 per common share of the Company. In addition, on May 1, 2021, the Company acquired a single clinic in South Florida. In addition, effective June 1, 2021, the Company, through a subsidiary, acquired InMed Diagnostic Services of MA, LLC (Akumin Massachusetts). Akumin Massachusetts operates three imaging centers in Massachusetts focused on women’s health. v) On August 15, 2021, the Company announced that both management and its external auditors, Ernst & Young LLP, agreed that additional information and analysis was necessary to complete the interim financial report for the quarter ended June 30, 2021 and Ernst & Young’s review of such report and the production of this additional information and analysis would not be completed prior to the filing deadline of August 16, 2021. As a result, Akumin did not file such financial report, or the related management’s discussion and analysis and CEO and CFO certificates (such filings, collectively, the Required Documents) before the August 16, 2021 deadline and only filed the Required Documents on November 15, 2021. The Company applied to the Ontario Securities Commission, its principal regulator, for the imposition of a management cease trade order under National Policy 12-203 (NP 12-203). In connection with its failure to file the Required Documents, and its inability to deliver the related compliance certificate under the 2020 Revolving Credit Agreement, the Company entered into an amendment and waiver with the lenders of the 2020 Revolving Credit Agreement on September 11, 2021 and a further amendment and waiver on October 22, 2021. Pursuant to the amendments and waivers, the lenders have waived any default related to the Company having not delivered the Required Reports to the lenders in accordance with the 2020 Revolving Credit Agreement until November 15, 2021. Further, until the Required Reports are delivered to the lenders, the amount available to draw under the 2020 Revolving Credit Facility was reduced from $55 million to $10 million. vi) On August 9, 2021, the Company closed its offering of $375 million of aggregate principal amount of 7.5% senior secured notes due August 1, 2028 (the 2028 Senior Notes). The offering was completed by Akumin Escrow Inc., a wholly-owned subsidiary of the Company, in escrow. The proceeds of the offering were used to fund the acquisition of Alliance (as discussed below) and were released from escrow contemporaneously with the completion of that acquisition. Upon closing of the acquisition, the Company assumed all obligations of Akumin Escrow Inc., including all obligations due under the 2028 Senior Notes, and all assets of Akumin Escrow Inc. were liquidated to the Company. The 2028 Senior Notes are fully and unconditionally guaranteed, jointly and severally, by the Company and each of its direct or indirect wholly owned subsidiaries, including the Revenue Practices and Alliance and its wholly owned subsidiaries, and secured against substantially all of the assets of the Company and the guarantors pari passu with the security granted in connection with the 2025 Senior Notes and 2020 Revolving Facility. The 2028 Senior Notes indenture is substantially similar to the indenture for the 2025 Senior Notes, except that the principal payment is due at maturity on August 1, 2028. Interest is accrued and payable every six months on February 1 and August 1, respectively, at a rate of 7.5% per annum. vii) On September 1, 2021, the Company acquired all of the issued and outstanding equity interests of Alliance, a leading national provider of radiology and oncology solutions to hospitals, health systems and physician groups, through a wholly-owned indirect subsidiary, for $820 million, subject to customary closing adjustments. The purchase price for Alliance was funded with cash on hand, assumption of debt, equity issued to the seller, debt and equity commitments from Stonepeak (the Stonepeak Financing) and proceeds from the 2028 Senior Notes. For the Stonepeak Financing, Stonepeak Magnet Holdings LP (Stonepeak Magnet) purchased on September 1, 2021 $340,000,000 principal amount of unsecured notes of Akumin Corp., a wholly-owned indirect subsidiary of the Company (the Stonepeak Notes), together with warrants to purchase 17,114,093 common shares of Akumin (the Stonepeak Warrants) with a strike price of $2.98 per share and 3,500,000 common shares of the Company (the Stonepeak Shares) at a price of $2.98 per share for total consideration of $10,430,000. No consideration was paid for the Stonepeak Warrants. The Stonepeak Notes, Stonepeak Warrants, Stonepeak Shares, and additional draws were made available on the terms of the Series A Notes and Common Share Purchase Agreement dated June 25, 2021 between the Company, Akumin Corp., and Stonepeak Magnet. As part of the purchase price for Alliance, 14,223,570 common shares of the Company were issued to the seller of Alliance at a price of $2.98 per share for aggregate consideration of $42,386,238.60. |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2020 | |
Accounting Policies [Abstract] | |
Principles of Consolidation | Principles of consolidation The consolidated financial statements include all of the accounts of the Company, the Subsidiaries and the Revenue Practices. All intercompany transactions and balances have been eliminated on consolidation. |
Variable Interest Entities | Variable interest entities In accordance with the FASB’s ASC Topic 810, Consolidation As a result of the financial relationship established between the Company and the Revenue Practices through respective management service agreements, the Revenue Practices individually qualify as VIEs as the Company, which provides them non-medical, The Company has a variable interest in a single purpose entity in Texas which operates an imaging center. The Company also has a variable interest in certain operations of an imaging center of another Texas entity. In both cases, the Company is not a primary beneficiary of the variable interest since it does not have any equity ownership in these entities nor does it have the power to direct the activities of either of these entities that most significantly impact the entities’ economic performance. Rather, in both cases, the Company is entitled to a management fee based upon written agreements in exchange for certain agreed upon management services. The assets and liabilities and revenue and expenses of these entities are not included in the consolidated financial statements of the Company. |
Functional and Reporting Currency and Foreign Currency Translation | Functional and reporting currency and foreign currency translation The functional and reporting currency of the Company, the Subsidiaries and the Revenue Practices is US dollars. Monetary assets and liabilities denominated in foreign currencies are translated into US dollars at the rates of exchange prevailing at the consolidated balance sheet dates. Non-monetary |
Cash | Cash Cash includes cash on hand and cash held with banks. |
Property and Equipment | Property and equipment Property and equipment are recorded at cost and are depreciated over their estimated useful lives using the straight line method, as follows: Medical equipment and equipment under finance leases six years Computer and office equipment four to five years Furniture and fittings nine years Leasehold improvements over term of lease Expenditures for maintenance and repairs are charged to operations as incurred. Operating lease right-of-use equipment buyouts and significant upgrades are capitalized. |
Intangible Assets | Intangible assets The Company classifies intangible assets, obtained through acquisitions or developed internally, as definite lived. Intangible assets consist of software costs, trade name, license arrangements and covenants not to compete; these intangible assets are recorded at cost and are amortized over their estimated useful lives, using the straight line method, as follows: Software costs, trade name and license arrangements five to six years Covenant not to compete over term of contract The Company reviews the appropriateness of the amortization period related to the definite lived intangible assets annually. |
Goodwill | Goodwill In January 2017, FASB issued Accounting Standards Update (ASU) 2017-04, Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment (ASU 2017-04) 2017-04 2017-04 2017-04 2017-04. Goodwill is recognized as the fair value of the consideration transferred, less the fair value of the net identifiable assets acquired and liabilities assumed, as at the acquisition date. Subsequent to initial recognition, goodwill is measured at cost less accumulated impairment losses. Goodwill acquired in business combinations is allocated to reporting units that are expected to benefit from the synergies of the combination. The determination of reporting units and the level at which goodwill is monitored requires judgment by management. The Company’s reporting units generally represent individual business units below the level of the Company’s operating segment. Goodwill is tested annually for impairment as at October 1 or whenever indicators of impairment are present by comparing the carrying amount of the reporting units against its fair value. |
Impairment of Long-Lived Assets | Impairment of long-lived assets The Company reviews long-lived assets for impairment when events or changes in circumstances indicate the carrying amount of an asset may not be recoverable. If any indication exists, the Company estimates the recoverable amount. The Company assesses the recoverability of the assets based on the undiscounted future cash flows expected from the use and eventual disposition of the asset. If the carrying amount of the asset is determined not to be recoverable, a write-down to fair value is recorded. Fair values are determined based on quoted market values, discounted cash flows, or external appraisals, as applicable. Long-lived assets to be disposed of are reported at the lower of carrying amount or fair value less costs to sell. The amount of the impairment charge is calculated as the excess of the asset’s carrying value over its fair value, which generally represents the discounted future cash flows from that asset or in the case of assets we expect to sell, at fair value less costs to sell. |
Segment Reporting | Segment reporting Operating segments are reported in a manner consistent with the internal reporting provided to the chief operating decision maker. The chief operating decision maker, who is responsible for allocating resources and assessing performance of the operating segments, has been identified as the Chief Executive Officer. The Company has one reportable segment, which is outpatient diagnostic imaging services. |
Revenue Recognition | Revenue recognition On January 1, 2019, the Company adopted ASU 2014-09, Revenue from Contracts with Customers (Topic 606) The Company adopted ASC 606 with a full retrospective application. As a result, at the adoption of ASC 606, the majority of what was previously classified as the provision for bad debts in the consolidated statement of operations is now reflected as implicit price concessions (as defined in ASC 606) and therefore included as a reduction to revenue. Net service fee revenue consists of net patient fees received from various payers and patients based on established contractual billing rates, less allowances for contractual adjustments and implicit price concessions. It primarily comprises fees for the use of the Company’s diagnostic imaging equipment and provision of medical supplies. Service fee revenue is recorded during the period in which the Company’s performance obligations are satisfied, based on the estimated collectible amounts from the patients and third party payers. The Company’s performance obligations are satisfied when services are rendered to the patient. Since the gap between payment and delivery of services to patients is generally expected to be less than one year, the Company does not adjust the service fee revenue for a significant financing component, as a practical expedient. Third party payers include federal and state agencies (under the Medicare and Medicaid programs), managed care health plans, commercial insurance companies, attorneys, and employers. Estimates of contractual allowances and the transaction price are based on the terms specified in the related contractual agreements, negotiated rates and historical and expected payment patterns. The Company estimates its expected reimbursement for patients based on the applicable contract terms and negotiated rates. The Company believes its review process enables it to identify instances on a timely basis where such estimates need to be revised. Other revenue consists of miscellaneous fees under contractual arrangements, including service fee revenue under capitation arrangements with third party payers, management fees, government grants and fees for other services provided to third parties. Revenue is recorded during the period in which the Company’s performance obligations under the contract are satisfied by the Company. For 2020, the Company received grants from the U.S. Health and Human Services (HHS). Such grants are outside the scope of ASC 606 and are further discussed in note 26. ASC 606 applies a single model for recognizing revenue from contracts with customers. It requires revenue to be recognized in a manner that depicts the transfer of promised goods or services to a customer and at an amount that reflects the consideration expected to be received in exchange for transferring those goods or services. This is achieved by applying the following five steps: i) identify the contract with a customer; ii) identify the performance obligation in the contract; iii) determine the transaction price; iv) allocate the transaction price to the performance obligations in the contract; and v) recognize revenue when (or as) the entity satisfies a performance obligation. |
Earnings per Share | Earnings per share Basic earnings per common share (EPS) is calculated by dividing the net earnings available to common shareholders by the weighted average number of common shares outstanding during the year. Diluted EPS is calculated by adjusting the net earnings available to common shareholders and the weighted average number of common shares outstanding for the effects of all dilutive instruments. |
Income Taxes | Income taxes Income tax expense comprises current and deferred tax. Income tax is recognized in the consolidated statements of operations and comprehensive income (loss). Current income tax expense represents the amount of income taxes payable based on tax law that is enacted at the reporting date and is adjusted for changes in estimates of tax expense recognized in prior periods. A current tax liability or asset is recognized for income taxes payable, or paid but recoverable, in respect of all periods to date. The Company uses the asset and liability method of accounting for income taxes. Under this method, deferred tax assets and liabilities are determined based on differences between the financial reporting and tax bases of assets and liabilities and are measured using the enacted tax rates and laws that will be in effect when the differences are expected to reverse. A deferred tax asset is recognized for unused tax losses, tax credits and deductible temporary differences, to the extent that it is more likely than not that future taxable income will be available to utilize such amounts. Deferred tax assets are reviewed at each reporting date and are adjusted to the extent that it is no longer probable that the related tax benefits will be realized. When it appears more likely than not that deferred taxes will not be realized, a valuation allowance is recorded to reduce the deferred tax asset to its estimated realizable value. For net deferred tax assets, estimates of future taxable income are considered in determining whether net deferred tax assets are more likely than not to be realized. Deferred tax assets and liabilities are offset when they relate to income taxes levied by the same tax authority and the Company intends to settle its current tax assets and liabilities on a net basis. The Company reports a liability for unrecognized tax benefits resulting from uncertain tax positions taken or expected to be taken in a tax return. The Company recognizes interest and penalties, if any, related to unrecognized tax benefits in income tax expense. |
Financial Instruments | Financial instruments Financial assets (such as accounts receivable) and liabilities (such as accounts payable, accrued liabilities, leases and loans) at amortized cost are initially recognized at fair value, and subsequently are carried at amortized cost (using the effective interest rate method) less any impairment. Any premium or discount between amortized cost and fair value is amortized to the consolidated statements of operations and comprehensive income (loss). Derivative financial instruments and earn-outs are initially recognized and subsequently measured at fair value. No derivatives have been designated as a cash flow hedge under ASC 815, Derivatives and Hedging |
Leases | Leases In February 2016, the FASB issued ASU 2016-02. 2016-02’s 2016-02 2016-02 2016-02 On January 1, 2019, the Company recorded right-of-use The Company’s operating lease portfolio primarily consists of real estate leases for its imaging centres and corporate offices. A smaller portion consists of medical and office equipment leases. The Company elected to use the package of practical expedients offered in the transition guidance that allows management not to reassess lease identification, lease classification and initial direct costs. The Company also elected to use the accounting policy practical expedients by class of underlying asset to (i) combine associated lease and non-lease right-of-use Operating lease liabilities were recorded as the present value of remaining lease payments not yet paid for the lease term discounted using the incremental borrowing rate associated with each lease. Operating lease right-of-use right-of-use Variable components of lease payments fluctuating with a future index or rate are estimated at lease commencement based on the index or rate at lease commencement. If the payments change as the result of a change in an index or rate subsequent to lease commencement, the difference is recognized in the income statement in the period in which the change occurs. Variable payments for maintenance such as common area maintenance costs and taxes, are not included in determining lease payments and are expensed as incurred. Most of the Company’s leases do not contain implicit borrowing rates, and therefore to measure lease liabilities, the Company used its incremental borrowing rates at the later of the lease commencement date or January 1, 2019. Lease liabilities will be remeasured when there is a significant change in the lease contracts. |
Warrants | Warrants Financial instruments issued by the Company are classified as equity only to the extent they do not meet the definition of a financial liability or financial asset. The Company has issued warrants that are convertible into common stock; these warrants are classified as equity instruments. |
Restricted Share Units | Restricted share units Restricted share units (RSUs) are issued in accordance with the Company’s RSU Plan, which entitles a holder of one RSU to receive one common share of the Company. RSUs are assigned a value based on the market value of the common shares of the Company on the grant date (or the nearest working day prior to the grant date). Such value is classified as stock-based compensation over the vesting period for all RSUs awarded to employees or the Board (note 13). For RSUs awarded to non-employees |
Stock-Based Compensation | Stock-based compensation The Company’s stock-based compensation consists of stock options, which are described in note 16 and RSUs, which are discussed in note 13. Each tranche of a share option award is considered a separate award with its own vesting period and recorded at fair value on the date of grant. The fair value of each tranche is measured at the date of grant using the Black-Scholes option pricing model. Compensation expense is recognized over the tranche’s vesting period based on the number of awards expected to vest by increasing contributed surplus. Any consideration paid upon the exercise of stock options is credited to common stock and the related fair value of those stock options is transferred from the contributed surplus to common stock. |
Business Combinations | Business combinations In January 2019, the Company adopted FASB issued ASU 2017-01, Clarifying the Definition of a Business (2017-01) The Company accounts for business combinations using the acquisition accounting method. The total purchase price is allocated to the assets acquired and liabilities assumed based on fair values as at the date of acquisition. Goodwill as at the acquisition date is measured as the excess of the aggregate of the consideration transferred and the amount of any non-controlling non-controlling |
Changes in Non-Controlling Interests | Changes in non-controlling The Company treats transactions with non-controlling non-controlling non-controlling |
Contingencies | Contingencies Loss contingency is an existing condition, situation, or set of circumstances involving uncertainty as to possible loss to an entity that will ultimately be resolved when one or more future events occur or fail to occur. The Company is party to various legal proceedings, claims, and regulatory, tax or government inquiries and investigations that arise in the ordinary course of business. In assessing loss contingencies related to legal proceedings that are pending against the Company or unasserted claims that may result in such proceedings, the Company, with assistance from its legal counsel, evaluates the perceived merits of any legal proceedings or unasserted claims as well as the perceived merits of the amount of relief sought or expected to be sought. Accrued legal costs for legal contingencies are recorded when they are probable and estimable. |
Accounts Receivable | Accounts receivable Accounts receivable are generally non-interest non-individual COVID-19 COVID-19 Accounts receivable are considered to be in default when customers have failed to make the contractually required payments when due. Implicit price concessions are recorded as a reduction in revenue with an offsetting amount reducing the carrying value of the receivable. When a receivable is considered uncollectible, the receivable is written off against the allowance for bad debts account. |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Accounting Policies [Abstract] | |
Summary of Property and Equipment and Estimated Useful Lives Using the Straight Line Method | Property and equipment are recorded at cost and are depreciated over their estimated useful lives using the straight line method, as follows: Medical equipment and equipment under finance leases six years Computer and office equipment four to five years Furniture and fittings nine years Leasehold improvements over term of lease |
Summary of Definite Lived Intangible Assets Useful Life | The Company classifies intangible assets, obtained through acquisitions or developed internally, as definite lived. Intangible assets consist of software costs, trade name, license arrangements and covenants not to compete; these intangible assets are recorded at cost and are amortized over their estimated useful lives, using the straight line method, as follows: Software costs, trade name and license arrangements five to six years Covenant not to compete over term of contract |
Restatement of Financial Stat_2
Restatement of Financial Statements (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Prior Period Adjustment [Abstract] | |
Summary of restatement of financial statements | Line items in the restated consolidated balance sheets As at December 31, As at December 31, 2020 Adjustment 2020 - Restated Accounts receivable 91,126,923 (28,868,166) 62,258,757 Prepaid expenses and other current assets 3,942,268 489,379 4,431,647 Current assets 139,465,179 (28,378,787) 111,086,392 Security deposits and other assets 4,876,208 (44,160) 4,832,048 Property and equipment 79,929,574 (16,216,065) 63,713,509 Goodwill 360,603,613 (8,994,052) 351,609,561 Total assets 718,684,541 (53,633,064) 665,051,477 Accounts payable and accrued liabilities 34,233,142 62,114 34,295,256 Deferred tax liability 826,566 866,445 1,693,011 Total liabilities 578,952,991 928,559 579,881,550 Deficit (26,759,151) (53,373,408) (80,132,559) Equity attributable to shareholders of Akumin Inc. 134,205,883 (53,373,408) 80,832,475 Non-controlling 5,525,667 (1,188,215) 4,337,452 Total shareholders’ equity 139,731,550 (54,561,623) 85,169,927 Total liabilities and shareholders’ equity 718,684,541 (53,633,064) 665,051,477 Line items in the restated consolidated statement of operations and comprehensive income (loss) Year ended December Year ended December 31, 2020 Adjustment 31, 2020 - Restated Service fees - net of allowances and discounts 243,981,183 (5,656,864) 238,324,319 Total revenue 251,282,849 (5,656,864) 245,625,985 Cost of operations, excluding depreciation and amortization 197,803,388 7,831,218 205,634,606 Depreciation and amortization 20,459,767 (3,399,616) 17,060,151 Operational financial instruments revaluation and other (gains) losses (3,907,666) (221,807) (4,129,473) Total operating expenses 216,439,403 4,209,795 220,649,198 Income from operations 34,843,446 (9,866,659) 24,976,787 Other financial instruments revaluation and other (gains) losses 22,078,745 308,082 22,386,827 Loss before income taxes (23,419,915) (10,174,741) (33,594,656) Income tax provision (benefit) (5,751,070) 6,312,625 561,555 Net loss and comprehensive loss for the period (17,668,845) (16,487,366) (34,156,211) Non-controlling 2,728,539 (144,219) 2,584,320 Net loss attributable to common shareholders (20,397,384) (16,343,147) (36,740,531) Net loss per share - basic and diluted (0.29) (0.23) (0.52) Line items in the restated consolidated statement of cash flows Year ended December Year ended December 31, 2020 Adjustment 31, 2020 - Restated Net loss for the period (17,668,845) (16,487,366) (34,156,211) Depreciation and amortization 20,459,767 (3,399,616) 17,060,151 Deferred income tax expense (benefit) (5,430,254) 6,130,090 699,836 Financial instruments revaluation and other (gains) losses 18,171,079 86,275 18,257,354 Changes in accounts receivable (8,259,697) 5,184,977 (3,074,720) Changes in prepaid expenses, security deposits and other assets (138,395) 411,115 272,720 Changes in accounts payable and accrued liabilities 9,038,102 (1,168) 9,036,934 Cash flows from operating activities 26,690,553 (8,075,693) 18,614,860 Purchase of property and equipment and intangible assets (13,420,375) 8,075,693 (5,344,682) Cash flows from investing activities (17,082,798) 8,075,693 (9,007,105) Line items in the restated consolidated balance sheets As at December 31, As at December 31, 2019 Adjustment 2019 - Restated Accounts receivable 82,867,225 (29,541,709) 53,325,516 Prepaid expenses and other current assets 3,927,949 1,073,083 5,001,032 Current assets 110,184,090 (28,468,626) 81,715,464 Security deposits and other assets 1,967,053 (216,750) 1,750,303 Property and equipment 75,938,590 (11,761,795) 64,176,795 Goodwill 358,802,534 (3,135,530) 355,667,004 Total assets 683,000,517 (43,582,701) 639,417,816 Accounts payable and accrued liabilities 26,262,225 63,283 26,325,508 Derivative financial instruments 951,702 (308,082) 643,620 Deferred tax liability 6,256,820 (5,263,645) 993,175 Total liabilities 525,937,015 (5,508,444) 520,428,571 Deficit (6,361,767) (37,030,261) (43,392,028) Equity attributable to shareholders of Akumin Inc. 152,519,353 (37,030,261) 115,489,092 Non-controlling 4,544,149 (1,043,996) 3,500,153 Total shareholders’ equity 157,063,502 (38,074,257) 118,989,245 Total liabilities and shareholders’ equity 683,000,517 (43,582,701) 639,417,816 Line items in the restated consolidated statement of operations and comprehensive income (loss) Year ended December Year ended December 31, 2019 Adjustment 31, 2019 - Restated Service fees - net of allowances and discounts 244,841,400 (26,391,696) 218,449,704 Total revenue 247,436,303 (26,391,696) 221,044,607 Cost of operations, excluding depreciation and amortization 187,802,601 5,534,129 193,336,730 Depreciation and amortization 15,587,200 (2,095,831) 13,491,369 Operational financial instruments revaluation and other (gains) losses 1,017,401 (37,473) 979,928 Total operating expenses 207,961,967 3,400,825 211,362,792 Income from operations 39,474,336 (29,792,521) 9,681,815 Other financial instruments revaluation and other (gains) losses 1,805,816 (308,082) 1,497,734 Income (loss) before income taxes 15,363,155 (29,484,439) (14,121,284) Income tax provision (benefit) 3,735,548 (6,533,107) (2,797,559) Net income (loss) and comprehensive income (loss) for the period 11,627,607 (22,951,332) (11,323,725) Non-controlling 2,199,629 (593,604) 1,606,025 Net income (loss) attributable to common shareholders 9,427,978 (22,357,728) (12,929,750) Net income (loss) per share - basic and diluted 0.14 (0.34) (0.19) Line items in the restated consolidated statement of cash flows Year ended December Year ended December 31, 2019 Adjustment 31, 2019 - Restated Net income (loss) for the period 11,627,607 (22,951,332) (11,323,725) Depreciation and amortization 15,587,200 (2,095,831) 13,491,369 Deferred income tax expense (benefit) 2,092,504 (3,511,985) (1,419,481) Financial instruments revaluation and other (gains) losses 2,823,217 (345,555) 2,477,662 Changes in accounts receivable (25,243,156) 25,656,280 413,124 Changes in prepaid expenses, security deposits and other assets (3,657,429) (1,355,327) (5,012,756) Changes in accounts payable and accrued liabilities 1,369,580 (1,948,040) (578,460) Cash flows from operating activities 12,581,077 (6,551,790) 6,029,287 Purchase of property and equipment and intangible assets (12,447,634) 6,551,790 (5,895,844) Cash flows from investing activities (231,107,615) 6,551,790 (224,555,825) Line items in the restated consolidated statement changes in equity Accumulated Deficit Non-controlling Total Shareholders’ As at January 1, 2019 (15,789,745) 4,107,499 118,895,463 Adjustment (14,672,533) (450,392) (15,122,925) As at January 1, 2019 - Restated (30,462,278) 3,657,107 103,772,538 As at December 31, 2019 (6,361,767) 4,544,149 157,063,502 Adjustment (37,030,261) (1,043,996) (38,074,257) As at December 31, 2019 - Restated (43,392,028) 3,500,153 118,989,245 As at December 31, 2020 (26,759,151) 5,525,667 139,731,550 Adjustment (53,373,408) (1,188,215) (54,561,623) As at December 31, 2020 - Restated (80,132,559) 4,337,452 85,169,927 |
Business Combinations (Tables)
Business Combinations (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Coral Springs [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | i) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Coral Springs, Florida, for cash consideration of approximately $2.1 million (Coral Springs Acquisition). In accordance with the transaction agreement, $100,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Current assets Prepaid expenses 32,961 Non-current Security deposits 368,601 Property and equipment 412,400 Operating lease right-of-use 2,427,618 3,241,580 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 2,427,618 Net assets acquired 813,962 Goodwill 1,274,764 Purchase price 2,088,726 |
Crystal Lake [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | ii) On January 1, 2020, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Crystal Lake, Illinois, for cash consideration of approximately $1.2 million (Crystal Lake Acquisition). In accordance with the transaction agreement, $60,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller during June 2020. This asset acquisition was considered a business combination. The Company has made a fair value determination of the acquired assets and assumed liabilities as follows: $ Assets acquired Non-current Security deposits 5,799 Property and equipment 820,000 Operating lease right-of-use 554,830 1,380,629 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 554,830 Net assets acquired 825,799 Goodwill 400,000 Purchase price 1,225,799 |
Davie Acquisition [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | iii) On April 1, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Davie, Florida, for cash consideration of $ 450,000 50,000 $ Assets acquired Non-current Property and equipment 170,000 Operating lease right-of-use 427,558 597,558 Liabilities assumed Non-current Operating lease liabilities (right-of-use) 427,558 Net assets acquired 170,000 Goodwill 280,000 Purchase price 450,000 |
ADG Acquisitions [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. Intangible assets include covenant not to compete, trade name and license arrangements. A deferred tax liability was assumed as part of the net assets acquired in the ADG Acquisitions. (Restated- Note 3) 2020 $ 2019 $ Assets acquired Current assets Cash 3,585,672 3,585,672 Accounts receivable 25,277,336 19,418,814 Prepaid expenses 269,012 269,012 29,132,020 23,273,498 Non-current Property and equipment 11,508,940 11,508,940 Intangible assets 5,870,000 5,870,000 Operating lease right-of-use 16,912,896 16,912,896 34,291,836 34,291,836 63,423,856 57,565,334 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 5,634,661 5,634,661 Non-current Deferred tax liability 422,056 422,056 Operating lease liabilities (right-of-use) 16,912,896 16,912,896 17,334,952 17,334,952 22,969,613 22,969,613 Net assets acquired 40,454,243 34,595,721 Goodwill 190,078,533 195,937,055 Purchase price (cash and shares) 215,784,755 215,784,755 Purchase price (ADG Acquisition – earn-out 14,748,021 14,748,021 |
Deltona Acquisition [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | v) On May 31, 2019, the Company acquired, through a subsidiary, a single outpatient diagnostic imaging centre in Deltona, Florida, for a cash consideration of $ 648,387 $ Assets acquired Non-current Property and equipment 295,000 Operating lease right-of-use 154,136 449,136 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 57,880 Non-current Operating lease liabilities (right-of-use) 154,136 212,016 Net assets acquired 237,120 Goodwill 411,267 Purchase price 648,387 |
El Paso Acquisition [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | vi) On August 16, 2019, the Company acquired, through a subsidiary, five outpatient diagnostic imaging centres in El Paso, Texas, for cash consideration of $ 11 16 2020 2019 $ $ Assets acquired Current assets Accounts receivable 1,275,726 1,275,726 Prepaid expenses 19,789 19,789 1,295,515 1,295,515 Non-current Property and equipment 3,922,481 3,922,481 Operating lease right-of-use 3,683,989 3,683,989 Intangible assets 720,000 720,000 9,621,985 9,621,985 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,174,040 1,024,631 Non-current Operating lease liabilities (right-of-use) 3,683,989 3,683,989 4,858,029 4,708,620 Net assets acquired 4,763,956 4,913,365 Goodwill 6,220,153 6,086,635 Purchase price 10,984,109 11,000,000 |
West Palm Beach Acquisition [Member] | |
Business Acquisition [Line Items] | |
Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows | vii) On October 4, 2019, the Company acquired, through a subsidiary, three outpatient diagnostic imaging centres in West Palm Beach, Florida, for cash consideration of approximately $ 18 0.1 2020 2019 $ $ Assets acquired Current assets Accounts receivable 2,085,491 2,085,491 Prepaid expenses 90,454 90,454 2,175,945 2,175,945 Non-current Security deposits 9,000 9,000 Property and equipment 2,432,234 2,432,234 Operating lease right-of-use 13,625,521 13,625,521 Intangible assets 1,080,000 1,080,000 19,322,700 19,322,700 Liabilities assumed Current liabilities Accounts payable and accrued liabilities 1,404,268 1,311,471 Non-current Finance leases 587,434 587,434 Operating lease liabilities (right-of-use) 13,625,521 13,625,521 15,617,223 15,524,426 Net assets acquired 3,705,477 3,798,274 Goodwill 14,064,109 14,071,312 Purchase price 17,769,586 17,869,586 |
Property and Equipment (Tables
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Property, Plant and Equipment [Abstract] | |
Summary of Detailed Information of Property and Equipment | (Restated- Note 3) 2020 $ (Restated- Note 3) 2019 $ Medical equipment 62,405,632 60,266,531 Equipment under finance leases 23,168,355 14,971,916 Leasehold improvements 19,360,169 17,393,839 Furniture and fixtures 1,479,320 1,088,236 Office equipment 211,032 214,612 Computer equipment 240,919 194,770 Total property and equipment – cost 106,865,427 94,129,904 Less: Accumulated depreciation (43,151,918 ) (29,953,109 ) Total property and equipment – net 63,713,509 64,176,795 |
Intangible Assets (Tables)
Intangible Assets (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Summary of Intangible Assets | Covenants not to compete $ Software costs $ Trade name $ License Arrange- $ Total $ Cost Balance – January 1, 2019 1,127,917 241,855 3,283,000 - 4,652,772 Additions - 2,675 - - 2,675 Business acquisitions (note 5) 2,010,000 - 4,540,000 1,120,000 7,670,000 Balance – December 31, 2019 3,137,917 244,530 7,823,000 1,120,000 12,325,447 Additions - 5,412 - - 5,412 Balance – December 31, 2020 3,137,917 249,942 7,823,000 1,120,000 12,330,859 Accumulated amortization Balance – January 1, 2019 323,611 119,225 568,584 - 1,011,420 Amortization 594,307 31,973 1,124,601 130,666 1,881,547 Balance – December 31, 2019 917,918 151,198 1,693,185 130,666 2,892,967 Amortization 868,572 32,648 1,564,599 224,000 2,689,819 Balance – December 31, 2020 1,786,490 183,846 3,257,784 354,666 5,582,786 Net book value December 31, 2019 2,219,999 93,332 6,129,815 989,334 9,432,480 December 31, 2020 1,351,427 66,096 4,565,216 765,334 6,748,073 Weighted average remaining amortization period (years) 1.5 2.0 2.8 3.5 2.5 |
Summary of Finite-Lived Intangible Assets Net Amortization Expense | For the twelve months ended December 31, 2020, the Company identified no impairment indicators and hence, there was no impairment of intangible assets. Estimated aggregate amortization expense for definite-lived intangible assets for each of the next five years ended December 31 is as follows: 2021 $2,710,490 2022 2,190,685 2023 1,275,099 2024 570,223 2025 1,125 Total 6,747,622 |
Goodwill (Tables)
Goodwill (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Goodwill | The carrying amounts of goodwill at the beginning and end of the current and previous periods are set out below. (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Balance – Beginning of period 355,667,004 145,101,212 Adjustments (note 4) (5,732,207 ) (6,220,477) Business acquisitions (note 4) 1,674,764 216,786,269 Balance – End of period 351,609,561 355,667,004 |
Schedule of Carrying amount of goodwill | The carrying amount of goodwill attributed to each reporting unit was as follows: 2020 $ 2019 $ Florida 249,630,120 254,221,080 Northeast 3,569,801 3,569,801 Texas 90,921,837 90,788,320 Other 7,487,803 7,087,803 351,609,561 355,667,004 |
Accounts Payable and Accrued _2
Accounts Payable and Accrued Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Payables and Accruals [Abstract] | |
Summary of Accounts Payable and Accrued Liabilities | The accounts payable and accrued liabilities are as follows: (Restated- Note 3) (Restated- Note 3) 2020 2019 $ $ Accounts payable 20,400,949 21,707,080 Accrued other expenses 10,096,523 2,665,575 Accrued payroll expenses 3,797,784 1,952,853 34,295,256 26,325,508 |
Earn-Out Liability (ADG Acqui_2
Earn-Out Liability (ADG Acquisition) (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Business Combinations [Abstract] | |
Summary of Earn-Out Liability | 2020 2019 $ $ ADG Acquisition – earn-out 4,688,553 14,834,067 Less: Current portion of ADG Acquisition – earn-out (4,688,553 ) (7,529,962 ) Non-current earn-out - 7,304,105 |
Lease Liabilities (Tables)
Lease Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Leases [Abstract] | |
Summary of Finance Lease Liabilities | The information pertaining to finance lease liabilities on the consolidated balance sheets is as follows: 2020 2019 $ $ Finance lease liabilities 15,573,586 8,415,404 Less: Current portion of finance lease liabilities (3,264,806 ) (1,789,995 ) Non-current 12,308,780 6,625,409 |
Summary of Finance Lease Cost | The components of finance lease cost recognized in the consolidated statements of operations and comprehensive loss are as follows: 2020 2019 $ $ Amortization expense for equipment under finance leases 2,927,249 1,794,673 Interest expense on finance lease liabilities 637,191 296,603 Finance lease cost 3,564,440 2,091,276 |
Summary of Undiscounted Cash Flows For Finance Leases | Undiscounted cash flows for finance leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 3,910,052 2022 3,768,295 2023 3,347,796 2024 2,749,931 2025 1,893,323 Thereafter 1,762,745 Total minimum lease payments 17,432,142 Less: Amount of lease payments representing interest (1,858,556) Present value of future minimum lease payments 15,573,586 Less: Current portion of finance lease liabilities (3,264,806) Non-current 12,308,780 |
Summary of Finance Lease Term and Discount Rates | The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-finance leases (years) 4.9 4.8 Weighted average discount rate-finance leases 4.6% 5.1% |
Summary of Supplemental Cash Flow Information Related to Finance Leases | Supplemental cash flow information related to finance leases is as follows: 2020 2019 $ $ Operating cash flows from finance leases 637,191 296,603 Financing cash flows from finance leases 1,524,548 904,193 Right-of-use 8,816,902 5,309,686 |
Summary of Operating Lease Liabilities | The information pertaining to operating lease liabilities on the consolidated balance sheet is as follows: 2020 2019 $ $ Operating lease liabilities 132,299,312 129,049,990 Less: Current portion of operating lease liabilities (9,345,656 ) (9,276,298 ) Non-current 122,953,656 119,773,692 |
Summary of Operating Lease Cost | The components of operating lease cost recognized in the consolidated statement of operations and comprehensive income (loss) are as follows: 2020 2019 $ $ Operating lease cost 20,624,622 18,040,356 Variable lease cost 4,109,277 3,478,748 Short-term lease cost 246,785 170,366 Total operating lease cost 24,980,684 21,689,470 |
Summary of Undiscounted Cash Flows For Operating Leases | Undiscounted cash flows for operating leases recorded in the consolidated balance sheets were as follows at December 31, 2020. $ 2021 18,380,966 2022 18,075,153 2023 17,224,588 2024 16,355,082 2025 15,659,482 Thereafter 137,590,224 Total minimum lease payments 223,285,495 Less: Amount of lease payments representing interest (90,986,183 ) Present value of future minimum lease payments 132,299,312 Less: Current portion of operating lease liabilities (9,345,656 ) Non-current 122,953,656 |
Summary of Operating Lease Term and Discount Rates | The lease term and discount rates are as follows: 2020 2019 Weighted average remaining lease term-operating leases (years) 12.7 14.1 Weighted average discount rate-operating leases 7.4% 7.1% |
Summary of Supplemental Cash Flow Information Related to Operating Leases | Supplemental cash flow information related to operating leases is as follows: 2020 2019 $ $ Operating cash flows from operating leases 17,672,048 15,660,780 Right-of-use 13,800,876 137,301,712 |
Senior loans payable (Tables)
Senior loans payable (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Summary of Maturities of Long-term Debt | $ 2021 405,698 2022 426,454 2023 296,356 2024 - 2025 400,000,000 401,128,508 |
2025 Senior Notes [Member] | |
Summary of debt | As at December 31, 2020, the 2025 Senior Notes had a face value of $ 400 389 2020 2019 $ $ 2025 Senior Notes 388,906,059 - Less: Current portion - - 388,906,059 - |
2020 Revolving Facility [Member] | |
Summary of debt | As at December 31, 2020, the 2020 Revolving Facility had a face value and amortized cost balance of $nil (2019 - $nil). 2020 $ 2019 $ 2020 Revolving Facility - - |
Amended May 2019 Loans [Member] | |
Summary of debt | The settlement of the Revolving Facility was considered debt modification for accounting purposes and a cost of approximately $0.9 million was added to the issuance costs of the 2020 Revolving Facility. 2020 $ 2019 $ Term Loan A and Revolving Facility - 87,824,000 Term Loan B - 250,710,995 Less: Current portion - (3,320,000) - 335,214,995 |
Wesley Chapel Loan [Member] | |
Summary of Maturities of Long-term Debt | Subject to the provisions described below, the minimum annual principal payments with respect to the Wesley Chapel Loan (face value) are as follows: $ 2021 405,698 2022 426,454 2023 296,356 1,128,508 |
Summary of debt | As at December 31, 2020, the Wesley Chapel Loan had an amortized cost balance of approximately, $1.1 million. 2020 $ 2019 $ Wesley Chapel Loan 1,079,684 1,447,327 Less: Current portion (405,698 ) (385,952) 673,986 1,061,375 |
Subordinated notes payable - _2
Subordinated notes payable - earn-out (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Debt Disclosure [Abstract] | |
Summary of subordinated debt | 2020 $ 2019 $ Subordinated note – earn-out - 184,485 |
Capital stock and warrants (Tab
Capital stock and warrants (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Equity [Abstract] | |
Summary of an unlimited number of voting common shares | The authorized share capital of the Company consists of an unlimited number of voting common shares, with no par value. Common shares Warrants RSUs Total Number Amount $ Number Amount $ Number Amount $ Number Amount $ January 1, 2019 62,371,275 123,746,423 1,249,512 1,742,910 1,120,656 2,671,147 64,741,443 128,160,480 Issuance (i) 6,250,000 23,437,500 - - - 1,559,418 6,250,000 24,996,918 RSUs and warrants exercised 1,219,653 4,813,632 (436,497) (569,733) (783,156) (2,932,753) - 1,311,146 Warrants expired - - (288,015) (438,798) - - (288,015) (438,798) December 31, 2019 69,840,928 151,997,555 525,000 734,379 337,500 1,297,812 70,703,428 154,029,746 Issuance (i) - - - - - 14,138 - 14,138 RSUs settled 337,500 1,311,950 - - (337,500) (1,311,950) - - Warrants expired - - (525,000) (734,379) - - (525,000) (734,379) December 31, 2020 70,178,428 153,309,505 - - - - 70,178,428 153,309,505 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Income Tax Disclosure [Abstract] | |
Summary of reconciliation of income tax expense (benefit) | The reconciliation of income tax expense (benefit) computed at the Canadian federal statutory rate to income tax expense (benefit) is as follows: (Restated- Note 3) $ (Restated- Note 3) $ Income attributable to common shareholders before income taxes (36,178,975 ) (15,727,308) Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%) (9,587,428 ) (4,167,737) Increase (decrease) in income taxes resulting from Stock-based compensation 396,528 942,013 State franchise tax, net of federal benefit 395,220 (45,860) US tax rate differential 882,767 375,883 Return to provision adjustment (204,701 ) 1,130,204 Other (236,378 ) (483,792) Valuation allowance 8,915,547 (548,270) Income tax expense (benefit) 561,555 (2,797,559) U.S. Federal current tax expense (benefit) - - U.S. State current tax expense (benefit) (138,281 ) (1,378,079) U.S. Federal deferred tax expense (benefit) 699,836 (823,416) U.S. State deferred tax expense (benefit) - (596,064) Total income tax expense (benefit) 561,555 (2,797,559) |
Summary of the Company's deferred tax assets and liabilities | The Company’s deferred tax assets and liabilities are made up of the following components: (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Deferred tax assets Lease liabilities 31,615,510 33,474,270 Net operating losses 16,559,000 7,249,097 163(j) carryforward 2,024,652 1,268,076 Debt issuance costs 2,419,687 4,412,375 Capital acquisition costs 2,011,450 779,367 Other 16,001,597 13,763,638 Total deferred tax assets 70,631,896 60,946,823 Less: Valuation allowance (16,851,707 ) (7,928,553 ) Net deferred tax assets 53,780,189 53,018,270 Deferred tax liabilities Right-of-use (30,349,474 ) (32,855,049 ) Fixed assets (11,196,500 ) (9,763,083 ) Goodwill (10,660,618 ) (8,430,589 ) Other (3,266,608 ) (2,962,724 ) Total deferred tax liabilities (55,473,200 ) (54,011,445 ) Net deferred tax liabilities (1,693,011 ) (993,175 ) |
Stock-Based Compensation R_2
Stock-Based Compensation – Options (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Share-based Payment Arrangement [Abstract] | |
Summary of stock options | Number of stock options Weighted average exercise price $ Aggregate grant date fair value $ Weighted average remaining contractual term (years) Outstanding – January 1, 2019 4,213,268 $2.18 $5,353,785 7.0 Cancelled (100,000) 3.74 (146,790) - Expired - - - - Exercised - - - - Granted 1,664,852 3.29 2,391,393 - Outstanding – December 31, 2019 5,778,120 2.47 7,598,388 6.3 Cancelled (18,000) 3.74 (26,422) - Expired - - - - Exercised - - - - Granted - - - - Outstanding – December 31, 2020 5,760,120 $2.47 $7,571,966 5.3 Exercisable at December 31, 2020 3,978,218 $2.03 $4,990,924 5.2 |
Summary of Fair Value Assumptions of Stock-based Option Awards | Date of options grant November 18, 2019 Underlying stock price 3.29 Exercise price 3.29 Term of options (years) 7.0 Volatility of underlying stock price 40% Expected dividend yield on underlying stock nil Annual risk free interest rate 1.48% |
Risk Management Arising From _2
Risk Management Arising From Financial Instruments (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Fair Value Disclosures [Abstract] | |
Summary of estimated fair values of other non-current liabilities | The estimated fair values of other non-current (Restated- Note 3) 2020 $ 2019 $ 2025 Senior Notes 424,016,044 - Amended May 2019 loans payable - 360,596,500 Wesley Chapel Loan payable 1,122,400 1,483,830 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 643,023 429,826,997 377,741,905 |
Summary of Information Regarding the Change in Carrying Value of the Financial instruments at Fair Value | The following table summarizes information regarding the change in carrying value of the Company’s financial instruments carried at fair value. (Restated- Derivative Subordinated ADG financial Notes Acquisition instruments Earn-out Earn-out $ $ $ January 1, 2019 (16,014 ) 169,642 - Issuance - - 14,748,022 Financial instruments revaluation loss (gain) Realized - - - Unrealized 659,037 14,843 86,045 December 31, 2019 643,023 184,485 14,834,067 Payment (4,805,000 ) (200,000 ) (4,688,553) Financial instruments revaluation loss (gain) Realized 4,161,977 15,515 (2,728,480) Unrealized - - (2,728,481) December 31, 2020 - - 4,688,553 |
Summary of Information Regarding The Carrying Value Of Financial Instruments | The following table summarizes information regarding the carrying value of the Company’s financial instruments: (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Cash 44,395,988 23,388,916 Accounts receivable 62,258,757 53,325,516 Financial assets measured at amortized cost 106,654,745 76,714,432 Accounts payable and accrued liabilities 34,295,256 26,325,508 Short-term portion of senior loans payable 405,698 3,705,952 Short-term portion of leases 12,610,462 11,066,293 Long-term portion of senior loans payable 389,580,046 336,276,370 Long-term portion of leases 135,262,436 126,399,101 Financial liabilities measured at amortized cost 572,153,898 503,773,224 Subordinated note – earn-out - 184,485 ADG Acquisition – earn-out 4,688,553 14,834,067 Derivative financial instruments - 643,023 Measured at fair value through profit or loss 4,688,553 15,661,575 |
Schedule of Exposure to Interest Rate Risk And Effect On Other Comprehensive Income Loss | 2020 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (n/a as settled in November 2020) - - - 2019 Carrying value $ 1% decrease in interest rates $ 1% increase in interest rates $ Amended May 2019 Loans (originated in May 2019) 338,534,995 1,180,247 (1,979,043) Syndicated Loans (n/a as settled in May 2019) - - - 338,534,995 1,180,247 (1,979,043) |
Basic And Diluted Income (Los_2
Basic And Diluted Income (Loss) Per Share (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Earnings Per Share [Abstract] | |
Summary Of Earnings Per Share Basic And Diluted | (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Net loss attributable to common shareholders (36,740,531) (12,929,750) Weighted average common shares outstanding Basic 70,101,618 66,528,051 Add: additional shares issuable upon exercise of employee stock options, warrants and restricted share units - - Diluted 70,101,618 66,528,051 Net loss per share Basic and diluted (0.52) (0.19) Employee stock options warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive 1,664,231 2,066,938 |
Financial Instruments Revalua_2
Financial Instruments Revaluation And Other Gains (Losses) (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Financial Instruments Revaluation And Other Gains Losses [Abstract] | |
Operational Financial instruments revaluation and other gains (losses) | a) Operational Financial instruments revaluation and other gains (losses) (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Gain (loss) on revaluation of ADG Acquisition – Earn-out 5,456,961 (86,045) Loss on disposal of property and equipment (1,327,488 ) (893,883) 4,129,473 (979,928) |
Other Financial instruments revaluation and other gains (losses) | b) Other Financial instruments revaluation and other gains (losses) (Restated- Note 3) (Restated- Note 3) 2020 $ 2019 $ Loss on debt revaluation (note 11) (18,278,845 ) (829,208) Loss on revaluation of derivatives (note 11) (4,161,977 ) (659,037) Other gains (losses) 53,995 (9,489) (22,386,827 ) (1,497,734) |
Revenue Information (Tables)
Revenue Information (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Revenue from Contract with Customer [Abstract] | |
Summary of Revenue Information | (Restated- Note 3) 2020 $ (Restated- Note 3) 2019 $ Commercial 159,862,661 154,916,949 Medicare 27,873,980 25,799,652 Medicaid 7,699,859 6,637,274 Attorney 24,343,273 13,283,222 Workers comp 9,711,177 9,459,955 Other patient revenue 8,833,369 8,352,652 Service fees - net of allowances and discounts 238,324,319 218,449,704 Other revenue (management and ancillary fees and government grants) 7,301,666 2,594,903 245,625,985 221,044,607 |
Cost Of Operations, Excluding_2
Cost Of Operations, Excluding Depreciation And Amortization (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Cost Of Operations Excluding Depreciation And Amortization [Abstract] | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization | (Restated- Note 3) 2020 $ (Restated- Note 3) 2019 $ Employee compensation 84,038,371 85,899,654 Reading fees 37,817,457 35,243,843 Rent and utilities 30,203,346 26,332,049 Third party services and professional fees 30,182,599 25,636,187 Administrative 12,231,131 11,441,620 Medical supplies and other 11,161,702 8,783,377 205,634,606 193,336,730 |
Non-Controlling Interests (Tabl
Non-Controlling Interests (Tables) | 12 Months Ended |
Dec. 31, 2020 | |
Noncontrolling Interest Items [Abstract] | |
Summary of Effective Ownership Interest Held in the Non-Wholly Owned Entities | The Company currently holds effective ownership interests in the following non-wholly Ownership interest Entity 2020 2019 % % Phoenix Imaging, LLC 60 60 Preferred Imaging of Amarillo, LLC 57 57 |
Summary of Significant Accoun_4
Summary of Significant Accounting Policies - Summary of Property and Equipment and Estimated Useful Lives Using the Straight Line Method (Detail) | 12 Months Ended |
Dec. 31, 2020 | |
Medical equipment and equipment under finance leases [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, plant and equipment, useful life | 6 years |
Furniture and fittings [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, plant and equipment, useful life | 9 years |
Leasehold improvements [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, plant and equipment, useful life | over term of lease |
Minimum [Member] | Computer and office equipment [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, plant and equipment, useful life | 4 years |
Maximum [Member] | Computer and office equipment [Member] | |
Property, Plant and Equipment [Line Items] | |
Property, plant and equipment, useful life | 5 years |
Summary of Significant Accoun_5
Summary of Significant Accounting Policies - Summary of Definite Lived Intangible Assets Useful Life (Detail) | 12 Months Ended |
Dec. 31, 2020 | |
Covenant not to compete [Member] | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-lived intangible asset, useful life | over term of contract |
Minimum [Member] | Software costs trade name and license arrangements [Member] | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-lived intangible asset, useful life | 5 years |
Maximum [Member] | Software costs trade name and license arrangements [Member] | |
Finite-Lived Intangible Assets [Line Items] | |
Finite-lived intangible asset, useful life | 6 years |
Summary of Significant Accoun_6
Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Jan. 01, 2019 | |
Significant Accounting Policies [Line Items] | |||
Assets | $ 665,051,477 | $ 639,417,816 | |
Liabilities | 579,881,550 | 520,428,571 | |
Revenues | 7,301,666 | 2,594,903 | |
Net cash provided by (used in) operating activities | 18,614,860 | 6,029,287 | |
Operating lease, right-of-use asset | 127,061,894 | 126,675,770 | $ 98,912,687 |
Operating lease, liability | $ 132,299,312 | 129,049,990 | $ 98,912,687 |
Minimum [Member] | |||
Significant Accounting Policies [Line Items] | |||
Lessee, operating lease, term of contract | 3 years | ||
Lessee, operating lease, renewal term | 10 years | ||
Maximum [Member] | |||
Significant Accounting Policies [Line Items] | |||
Lessee, operating lease, term of contract | 10 years | ||
Lessee, operating lease, renewal term | 30 years | ||
Variable Interest Entity, Primary Beneficiary [member] | |||
Significant Accounting Policies [Line Items] | |||
Assets | $ 34,100,000 | 37,200,000 | |
Liabilities | 2,400,000 | 0 | |
Revenues | 139,200,000 | 134,200,000 | |
Net cash provided by (used in) operating activities | $ 134,700,000 | $ 112,000,000 |
Restatement of Financial Stat_3
Restatement of Financial Statements - Summary of Restatement of Financial Statements (Detail) - USD ($) | 12 Months Ended | |||
Dec. 31, 2020 | Dec. 31, 2019 | Jan. 01, 2019 | Dec. 31, 2018 | |
Statement of Financial Position [Abstract] | ||||
Accounts receivable | $ 62,258,757 | $ 53,325,516 | ||
Prepaid expenses and other current assets | 4,431,647 | 5,001,032 | ||
Current assets | 111,086,392 | 81,715,464 | ||
Security deposits and other assets | 4,832,048 | 1,750,303 | ||
Property, Plant and Equipment, Net | 63,713,509 | 64,176,795 | ||
Goodwill | 351,609,561 | 355,667,004 | $ 145,101,212 | |
Total assets | 665,051,477 | 639,417,816 | ||
Accounts payable and accrued liabilities | 34,295,256 | 26,325,508 | ||
Deferred tax liability | 1,693,011 | 993,175 | ||
Total liabilities | 579,881,550 | 520,428,571 | ||
Deficit | (80,132,559) | (43,392,028) | ||
Equity attributable to shareholders of Akumin Inc. | 80,832,475 | 115,489,092 | ||
Non-controlling interests | 4,337,452 | 3,500,153 | ||
Total shareholders' equity | 85,169,927 | 118,989,245 | 103,772,538 | |
Total liabilities and shareholders' equity | 665,051,477 | 639,417,816 | ||
Derivative financial instruments | 643,620 | |||
Revenue | ||||
Service fees - net of allowances and discounts | 238,324,319 | 218,449,704 | ||
Total revenue | 245,625,985 | 221,044,607 | ||
Cost of operations, excluding depreciation and amortization | 205,634,606 | 193,336,730 | ||
Depreciation and amortization | 17,060,151 | 13,491,369 | ||
Operational financial instruments revaluation and other (gains) losses | 4,129,473 | (979,928) | ||
Total operating expenses | 220,649,198 | 211,362,792 | ||
Income from operations | 24,976,787 | 9,681,815 | ||
Other financial instruments revaluation and other (gains) losses | (22,386,827) | (1,497,734) | ||
Income (loss) before income taxes | (33,594,656) | (14,121,284) | ||
Income tax provision (benefit) | 561,555 | (2,797,559) | ||
Net income (loss) and comprehensive income (loss) for the period | (34,156,211) | (11,323,725) | ||
Non-controlling interests | 2,584,320 | 1,606,025 | ||
Net income (loss) attributable to common shareholders | $ (36,740,531) | $ (12,929,750) | ||
Net income (loss) per share - basic and diluted | $ (0.52) | $ (0.19) | ||
Statement of Cash Flows [Abstract] | ||||
Net income (loss) for the period | $ (34,156,211) | $ (11,323,725) | ||
Depreciation and amortization | 17,060,151 | 13,491,369 | ||
Deferred income tax expense (benefit) | 699,836 | (1,419,481) | ||
Financial instruments revaluation and other (gains) losses | 18,257,354 | 2,477,662 | ||
Changes in accounts receivable | 3,074,720 | (413,124) | ||
Changes in prepaid expenses, security deposits and other assets | (272,720) | 5,012,756 | ||
Changes in accounts payable and accrued liabilities | 9,036,934 | (578,460) | ||
Cash flows from operating activities | 18,614,860 | 6,029,287 | ||
Cash flows from investing activities | (9,007,105) | (224,555,825) | ||
Equity [Abstract] | ||||
Total shareholders' equity | 85,169,927 | 118,989,245 | 103,772,538 | |
Retained Earnings [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | (80,132,559) | (43,392,028) | (30,462,278) | |
Revenue | ||||
Net income (loss) and comprehensive income (loss) for the period | (36,740,531) | (12,929,750) | ||
Statement of Cash Flows [Abstract] | ||||
Net income (loss) for the period | (36,740,531) | (12,929,750) | ||
Equity [Abstract] | ||||
Total shareholders' equity | (80,132,559) | (43,392,028) | (30,462,278) | |
Noncontrolling Interest [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | 4,337,452 | 3,500,153 | 3,657,107 | |
Revenue | ||||
Net income (loss) and comprehensive income (loss) for the period | 2,584,320 | 1,606,025 | ||
Statement of Cash Flows [Abstract] | ||||
Net income (loss) for the period | 2,584,320 | 1,606,025 | ||
Equity [Abstract] | ||||
Total shareholders' equity | 4,337,452 | 3,500,153 | $ 3,657,107 | |
Previously Reported [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Accounts receivable | 91,126,923 | 82,867,225 | ||
Prepaid expenses and other current assets | 3,942,268 | 3,927,949 | ||
Current assets | 139,465,179 | 110,184,090 | ||
Security deposits and other assets | 4,876,208 | 1,967,053 | ||
Property, Plant and Equipment, Net | 79,929,574 | 75,938,590 | ||
Goodwill | 360,603,613 | 358,802,534 | ||
Total assets | 718,684,541 | 683,000,517 | ||
Accounts payable and accrued liabilities | 34,233,142 | 26,262,225 | ||
Deferred tax liability | 826,566 | 6,256,820 | ||
Total liabilities | 578,952,991 | 525,937,015 | ||
Deficit | (26,759,151) | (6,361,767) | ||
Equity attributable to shareholders of Akumin Inc. | 134,205,883 | 152,519,353 | ||
Non-controlling interests | 5,525,667 | 4,544,149 | ||
Total shareholders' equity | 139,731,550 | 157,063,502 | $ 118,895,463 | |
Total liabilities and shareholders' equity | 718,684,541 | 683,000,517 | ||
Derivative financial instruments | 951,702 | |||
Revenue | ||||
Service fees - net of allowances and discounts | 243,981,183 | 244,841,400 | ||
Total revenue | 251,282,849 | 247,436,303 | ||
Cost of operations, excluding depreciation and amortization | 197,803,388 | 187,802,601 | ||
Depreciation and amortization | 20,459,767 | 15,587,200 | ||
Operational financial instruments revaluation and other (gains) losses | (3,907,666) | 1,017,401 | ||
Total operating expenses | 216,439,403 | 207,961,967 | ||
Income from operations | 34,843,446 | 39,474,336 | ||
Other financial instruments revaluation and other (gains) losses | 22,078,745 | 1,805,816 | ||
Income (loss) before income taxes | (23,419,915) | 15,363,155 | ||
Income tax provision (benefit) | (5,751,070) | 3,735,548 | ||
Net income (loss) and comprehensive income (loss) for the period | (17,668,845) | 11,627,607 | ||
Non-controlling interests | 2,728,539 | 2,199,629 | ||
Net income (loss) attributable to common shareholders | $ (20,397,384) | $ 9,427,978 | ||
Net income (loss) per share - basic and diluted | $ (0.29) | $ 0.14 | ||
Statement of Cash Flows [Abstract] | ||||
Net income (loss) for the period | $ (17,668,845) | $ 11,627,607 | ||
Depreciation and amortization | 20,459,767 | 15,587,200 | ||
Deferred income tax expense (benefit) | (5,430,254) | 2,092,504 | ||
Financial instruments revaluation and other (gains) losses | 18,171,079 | 2,823,217 | ||
Changes in accounts receivable | (8,259,697) | (25,243,156) | ||
Changes in prepaid expenses, security deposits and other assets | (138,395) | (3,657,429) | ||
Changes in accounts payable and accrued liabilities | 9,038,102 | 1,369,580 | ||
Cash flows from operating activities | 26,690,553 | 12,581,077 | ||
Purchase of property and equipment and intangible assets | (13,420,375) | (12,447,634) | ||
Cash flows from investing activities | (17,082,798) | (231,107,615) | ||
Equity [Abstract] | ||||
Total shareholders' equity | 139,731,550 | 157,063,502 | 118,895,463 | |
Previously Reported [Member] | Retained Earnings [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | (26,759,151) | (6,361,767) | (15,789,745) | |
Equity [Abstract] | ||||
Total shareholders' equity | (26,759,151) | (6,361,767) | (15,789,745) | |
Previously Reported [Member] | Noncontrolling Interest [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | 5,525,667 | 4,544,149 | 4,107,499 | |
Equity [Abstract] | ||||
Total shareholders' equity | 5,525,667 | 4,544,149 | 4,107,499 | |
Revision of Prior Period, Adjustment [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Accounts receivable | (28,868,166) | 29,500,000 | 5,600,000 | |
Prepaid expenses and other current assets | 489,379 | 1,073,083 | ||
Current assets | (28,378,787) | (28,468,626) | ||
Security deposits and other assets | (44,160) | (216,750) | ||
Property, Plant and Equipment, Net | (16,216,065) | 11,800,000 | 7,300,000 | |
Goodwill | (8,994,052) | (3,135,530) | 2,600,000 | |
Total assets | (53,633,064) | (43,582,701) | ||
Accounts payable and accrued liabilities | 62,114 | 63,283 | ||
Deferred tax liability | 866,445 | (5,263,645) | ||
Total liabilities | 928,559 | (5,508,444) | ||
Deficit | (53,373,408) | (37,030,261) | ||
Equity attributable to shareholders of Akumin Inc. | (53,373,408) | (37,030,261) | ||
Non-controlling interests | (1,188,215) | (1,043,996) | ||
Total shareholders' equity | (54,561,623) | (38,074,257) | (15,122,925) | |
Total liabilities and shareholders' equity | (53,633,064) | (43,582,701) | ||
Derivative financial instruments | (308,082) | |||
Revenue | ||||
Service fees - net of allowances and discounts | (5,656,864) | (26,391,696) | ||
Total revenue | (5,656,864) | (26,391,696) | ||
Cost of operations, excluding depreciation and amortization | 7,831,218 | 5,534,129 | ||
Depreciation and amortization | (3,399,616) | 2,100,000 | ||
Operational financial instruments revaluation and other (gains) losses | (221,807) | (37,473) | ||
Total operating expenses | 4,209,795 | 3,400,825 | ||
Income from operations | (9,866,659) | (29,792,521) | ||
Other financial instruments revaluation and other (gains) losses | 308,082 | (308,082) | ||
Income (loss) before income taxes | (10,174,741) | (29,484,439) | ||
Income tax provision (benefit) | 6,312,625 | (6,533,107) | ||
Net income (loss) and comprehensive income (loss) for the period | (16,487,366) | (22,951,332) | ||
Non-controlling interests | (144,219) | (593,604) | ||
Net income (loss) attributable to common shareholders | $ (16,343,147) | $ (22,357,728) | ||
Net income (loss) per share - basic and diluted | $ (0.23) | $ (0.34) | ||
Statement of Cash Flows [Abstract] | ||||
Net income (loss) for the period | $ (16,487,366) | $ (22,951,332) | ||
Depreciation and amortization | (3,399,616) | 2,100,000 | ||
Deferred income tax expense (benefit) | 6,130,090 | (3,511,985) | ||
Financial instruments revaluation and other (gains) losses | 86,275 | (345,555) | ||
Changes in accounts receivable | 5,184,977 | 25,656,280 | ||
Changes in prepaid expenses, security deposits and other assets | 411,115 | (1,355,327) | ||
Changes in accounts payable and accrued liabilities | (1,168) | (1,948,040) | ||
Cash flows from operating activities | (8,075,693) | (6,551,790) | ||
Purchase of property and equipment and intangible assets | 8,075,693 | 6,551,790 | ||
Cash flows from investing activities | 8,075,693 | 6,551,790 | ||
Equity [Abstract] | ||||
Total shareholders' equity | (54,561,623) | (38,074,257) | (15,122,925) | |
Revision of Prior Period, Adjustment [Member] | Retained Earnings [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | (53,373,408) | (37,030,261) | (14,672,533) | |
Equity [Abstract] | ||||
Total shareholders' equity | (53,373,408) | (37,030,261) | (14,672,533) | |
Revision of Prior Period, Adjustment [Member] | Noncontrolling Interest [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | (1,188,215) | (1,043,996) | (450,392) | |
Equity [Abstract] | ||||
Total shareholders' equity | (1,188,215) | (1,043,996) | (450,392) | |
As Restated [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Accounts receivable | 62,258,757 | 53,325,516 | ||
Prepaid expenses and other current assets | 4,431,647 | 5,001,032 | ||
Current assets | 111,086,392 | 81,715,464 | ||
Security deposits and other assets | 4,832,048 | 1,750,303 | ||
Property, Plant and Equipment, Net | 63,713,509 | 64,176,795 | ||
Goodwill | 351,609,561 | 355,667,004 | ||
Total assets | 665,051,477 | 639,417,816 | ||
Accounts payable and accrued liabilities | 34,295,256 | 26,325,508 | ||
Deferred tax liability | 1,693,011 | 993,175 | ||
Total liabilities | 579,881,550 | 520,428,571 | ||
Deficit | (80,132,559) | (43,392,028) | ||
Equity attributable to shareholders of Akumin Inc. | 80,832,475 | 115,489,092 | ||
Non-controlling interests | 4,337,452 | 3,500,153 | ||
Total shareholders' equity | 85,169,927 | 118,989,245 | 103,772,538 | |
Total liabilities and shareholders' equity | 665,051,477 | 639,417,816 | ||
Derivative financial instruments | 643,620 | |||
Revenue | ||||
Service fees - net of allowances and discounts | 238,324,319 | 218,449,704 | ||
Total revenue | 245,625,985 | 221,044,607 | ||
Cost of operations, excluding depreciation and amortization | 205,634,606 | 193,336,730 | ||
Depreciation and amortization | 17,060,151 | 13,491,369 | ||
Operational financial instruments revaluation and other (gains) losses | (4,129,473) | 979,928 | ||
Total operating expenses | 220,649,198 | 211,362,792 | ||
Income from operations | 24,976,787 | 9,681,815 | ||
Other financial instruments revaluation and other (gains) losses | 22,386,827 | 1,497,734 | ||
Income (loss) before income taxes | (33,594,656) | (14,121,284) | ||
Income tax provision (benefit) | 561,555 | (2,797,559) | ||
Net income (loss) and comprehensive income (loss) for the period | (34,156,211) | (11,323,725) | ||
Non-controlling interests | 2,584,320 | 1,606,025 | ||
Net income (loss) attributable to common shareholders | $ (36,740,531) | $ (12,929,750) | ||
Net income (loss) per share - basic and diluted | $ (0.52) | $ (0.19) | ||
Statement of Cash Flows [Abstract] | ||||
Net income (loss) for the period | $ (34,156,211) | $ (11,323,725) | ||
Depreciation and amortization | 17,060,151 | 13,491,369 | ||
Deferred income tax expense (benefit) | 699,836 | (1,419,481) | ||
Financial instruments revaluation and other (gains) losses | 18,257,354 | 2,477,662 | ||
Changes in accounts receivable | (3,074,720) | 413,124 | ||
Changes in prepaid expenses, security deposits and other assets | 272,720 | (5,012,756) | ||
Changes in accounts payable and accrued liabilities | 9,036,934 | (578,460) | ||
Cash flows from operating activities | 18,614,860 | 6,029,287 | ||
Purchase of property and equipment and intangible assets | (5,344,682) | (5,895,844) | ||
Cash flows from investing activities | (9,007,105) | (224,555,825) | ||
Equity [Abstract] | ||||
Total shareholders' equity | 85,169,927 | 118,989,245 | 103,772,538 | |
As Restated [Member] | Retained Earnings [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | (80,132,559) | (43,392,028) | (30,462,278) | |
Equity [Abstract] | ||||
Total shareholders' equity | (80,132,559) | (43,392,028) | (30,462,278) | |
As Restated [Member] | Noncontrolling Interest [Member] | ||||
Statement of Financial Position [Abstract] | ||||
Total shareholders' equity | 4,337,452 | 3,500,153 | 3,657,107 | |
Equity [Abstract] | ||||
Total shareholders' equity | $ 4,337,452 | $ 3,500,153 | $ 3,657,107 |
Restatement of Financial Stat_4
Restatement of Financial Statements - Additional Information (Detail) - USD ($) | 12 Months Ended | |||
Dec. 31, 2020 | Dec. 31, 2019 | Jan. 01, 2019 | Dec. 31, 2018 | |
Error Corrections and Prior Period Adjustments Restatement [Line Items] | ||||
Accounts receivable | $ 62,258,757 | $ 53,325,516 | ||
Goodwill | 351,609,561 | 355,667,004 | $ 145,101,212 | |
Revenue | 245,625,985 | 221,044,607 | ||
property and equipment, net | 63,713,509 | 64,176,795 | ||
cost of operations | 205,634,606 | 193,336,730 | ||
depreciation expense | 17,060,151 | 13,491,369 | ||
shareholders' equity | 85,169,927 | 118,989,245 | $ 103,772,538 | |
Revision of Prior Period, Adjustment [Member] | ||||
Error Corrections and Prior Period Adjustments Restatement [Line Items] | ||||
Accounts receivable | (28,868,166) | 29,500,000 | $ 5,600,000 | |
Goodwill | (8,994,052) | (3,135,530) | 2,600,000 | |
Revenue | (5,656,864) | (26,391,696) | ||
property and equipment, net | (16,216,065) | 11,800,000 | 7,300,000 | |
cost of operations | 7,831,218 | 5,534,129 | ||
depreciation expense | (3,399,616) | 2,100,000 | ||
Loss on disposal of property and equipment | 200,000 | 40,000 | ||
shareholders' equity | (54,561,623) | (38,074,257) | $ (15,122,925) | |
Revision of Prior Period, Adjustment [Member] | Repairs And Maintenance [Member] | ||||
Error Corrections and Prior Period Adjustments Restatement [Line Items] | ||||
cost of operations | $ 8,500,000 | $ 6,600,000 |
Business Combination - Summary
Business Combination - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Non-current liabilities | |||
Goodwill | $ 351,609,561 | $ 355,667,004 | $ 145,101,212 |
Coral Springs [Member] | |||
Current assets | |||
Prepaid expenses | 32,961 | ||
Non-current assets | |||
Security deposits | 368,601 | ||
Property and equipment | 412,400 | ||
Operating lease right-of-use assets | 2,427,618 | ||
Assets | 3,241,580 | ||
Non-current liabilities | |||
Operating lease liabilities (right-of-use) | 2,427,618 | ||
Net assets acquired | 813,962 | ||
Goodwill | 1,274,764 | ||
Purchase price | 2,088,726 | ||
Crystal Lake [Member] | |||
Non-current assets | |||
Security deposits | 5,799 | ||
Property and equipment | 820,000 | ||
Operating lease right-of-use assets | 554,830 | ||
Assets | 1,380,629 | ||
Non-current liabilities | |||
Operating lease liabilities (right-of-use) | 554,830 | ||
Net assets acquired | 825,799 | ||
Goodwill | 400,000 | ||
Purchase price | 1,225,799 | ||
Davie Acquisition [Member] | |||
Non-current assets | |||
Property and equipment | 170,000 | ||
Operating lease right-of-use assets | 427,558 | ||
Assets | 597,558 | ||
Non-current liabilities | |||
Operating lease liabilities (right-of-use) | 427,558 | ||
Net assets acquired | 170,000 | ||
Goodwill | 280,000 | ||
Purchase price | 450,000 | ||
ADG Acquisitions [Member] | |||
Current assets | |||
Cash | 3,585,672 | 3,585,672 | |
Accounts receivable | 25,277,336 | 19,418,814 | |
Prepaid expenses | 269,012 | 269,012 | |
Current assets | 29,132,020 | 23,273,498 | |
Non-current assets | |||
Property and equipment | 11,508,940 | 11,508,940 | |
Operating lease right-of-use assets | 16,912,896 | 16,912,896 | |
Intangible assets | 5,870,000 | 5,870,000 | |
Non-current assets | 34,291,836 | 34,291,836 | |
Assets | 63,423,856 | 57,565,334 | |
Current liabilities | |||
Accounts payable and accrued liabilities | 5,634,661 | 5,634,661 | |
Non-current liabilities | |||
Deferred tax liability | 422,056 | 422,056 | |
Operating lease liabilities (right-of-use) | 16,912,896 | 16,912,896 | |
Non-current liabilities | 17,334,952 | 17,334,952 | |
Liabilities | 22,969,613 | 22,969,613 | |
Net assets acquired | 40,454,243 | 34,595,721 | |
Goodwill | 190,078,533 | 195,937,055 | |
Purchase price (cash and shares) | 215,784,755 | 215,784,755 | |
Purchase price (ADG Acquisition – earn-out (note 8)) | 14,748,021 | 14,748,021 | |
Deltona Acquisition [Member] | |||
Non-current assets | |||
Property and equipment | 295,000 | ||
Operating lease right-of-use assets | 154,136 | ||
Non-current assets | 449,136 | ||
Current liabilities | |||
Accounts payable and accrued liabilities | 57,880 | ||
Non-current liabilities | |||
Operating lease liabilities (right-of-use) | 154,136 | ||
Liabilities | 212,016 | ||
Net assets acquired | 237,120 | ||
Goodwill | 411,267 | ||
Purchase price | 648,387 | ||
El Paso Acquisition [Member] | |||
Current assets | |||
Accounts receivable | 1,275,726 | 1,275,726 | |
Prepaid expenses | 19,789 | 19,789 | |
Current assets | 1,295,515 | 1,295,515 | |
Non-current assets | |||
Property and equipment | 3,922,481 | 3,922,481 | |
Operating lease right-of-use assets | 3,683,989 | 3,683,989 | |
Intangible assets | 720,000 | 720,000 | |
Assets | 9,621,985 | 9,621,985 | |
Current liabilities | |||
Accounts payable and accrued liabilities | 1,174,040 | 1,024,631 | |
Non-current liabilities | |||
Operating lease liabilities (right-of-use) | 3,683,989 | 3,683,989 | |
Liabilities | 4,858,029 | 4,708,620 | |
Net assets acquired | 4,763,956 | 4,913,365 | |
Goodwill | 6,220,153 | 6,086,635 | |
Purchase price | 10,984,109 | 11,000,000 | |
West Palm Beach Acquisition [Member] | |||
Current assets | |||
Accounts receivable | 2,085,491 | 2,085,491 | |
Prepaid expenses | 90,454 | 90,454 | |
Current assets | 2,175,945 | 2,175,945 | |
Non-current assets | |||
Security deposits | 9,000 | 9,000 | |
Property and equipment | 2,432,234 | 2,432,234 | |
Operating lease right-of-use assets | 13,625,521 | 13,625,521 | |
Intangible assets | 1,080,000 | 1,080,000 | |
Assets | 19,322,700 | 19,322,700 | |
Current liabilities | |||
Accounts payable and accrued liabilities | 1,404,268 | 1,311,471 | |
Non-current liabilities | |||
Finance leases | 587,434 | 587,434 | |
Operating lease liabilities (right-of-use) | 13,625,521 | 13,625,521 | |
Liabilities | 15,617,223 | 15,524,426 | |
Net assets acquired | 3,705,477 | 3,798,274 | |
Goodwill | 14,064,109 | 14,071,312 | |
Purchase price | $ 17,769,586 | $ 17,869,586 |
Business Combination - Summar_2
Business Combination - Summary of the Fair Value Determination of the Acquired Assets and Assumed Liabilities as Follows (Parenthetical) (Detail) $ / shares in Units, shares in Thousands | Jan. 01, 2020USD ($) | Oct. 04, 2019USD ($) | Oct. 01, 2019USD ($) | Aug. 16, 2019USD ($) | May 31, 2019USD ($)$ / sharesshares | Apr. 15, 2019USD ($)Agreement | Apr. 01, 2019USD ($) | Jun. 30, 2020USD ($) | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($) |
Business Acquisition [Line Items] | ||||||||||
Business acquisition, pro forma revenue | $ 400,000 | |||||||||
Income (loss) from subsidiaries, before tax | 41,000 | |||||||||
Revenues | $ 7,301,666 | 2,594,903 | ||||||||
Number of centres | Agreement | 27 | |||||||||
Fair value of accounts receivable | 62,300,000 | 53,300,000 | ||||||||
FLORIDA | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Number of centres | Agreement | 21 | |||||||||
GEORGIA | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Number of centres | Agreement | 6 | |||||||||
Coral Springs [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 2,100,000 | $ 100,000 | ||||||||
Business acquisition, pro forma revenue | 4,100,000 | 5,400,000 | ||||||||
Income (loss) from subsidiaries, before tax | 600,000 | 900,000 | ||||||||
Crystal Lake [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 1,200,000 | $ 60,000,000,000 | ||||||||
Business acquisition, pro forma revenue | 1,000,000 | 1,100,000 | ||||||||
Income (loss) from subsidiaries, before tax | 200,000 | 200,000 | ||||||||
Davie Acquisition [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 50,000 | $ 450,000 | ||||||||
Business acquisition, pro forma revenue | 221,100,000 | |||||||||
Income (loss) from subsidiaries, before tax | 100,000 | |||||||||
Revenues | 400,000 | |||||||||
Business acquisition, pro forma income before tax | 15,800,000 | |||||||||
ADG Acquisitions [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 216,000,000 | |||||||||
Business acquisition, pro forma revenue | 245,300,000 | |||||||||
Income (loss) from subsidiaries, before tax | 20,900,000 | |||||||||
Revenues | 63,800,000 | |||||||||
Business acquisition, pro forma income before tax | 9,400,000 | |||||||||
Business combination, consideration transferred, equity interests issued and issuable | $ 23,400,000 | |||||||||
Business acquisition, share price | $ / shares | $ 3.75 | |||||||||
Business acquisition, equity interest issued or issuable, number of shares | shares | 6,250 | |||||||||
Business combination consideration transferred decrease in amount | $ 200,000 | |||||||||
Fair value of accounts receivable | $ 5,900,000 | |||||||||
Deltona Acquisition [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 648,387 | |||||||||
Business acquisition, pro forma revenue | 222,100,000 | |||||||||
Income (loss) from subsidiaries, before tax | 600,000 | |||||||||
Revenues | 2,900,000 | |||||||||
Business acquisition, pro forma income before tax | 15,700,000 | |||||||||
Deltona Acquisition [Member] | FLORIDA | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Income (loss) from subsidiaries, before tax | 600,000 | |||||||||
Revenues | 1,900,000 | |||||||||
El Paso Acquisition [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 11,000,000 | |||||||||
Business acquisition, pro forma revenue | 228,400,000 | |||||||||
Income (loss) from subsidiaries, before tax | 1,600,000 | |||||||||
Revenues | 12,600,000 | |||||||||
Business acquisition, pro forma income before tax | 15,300,000 | |||||||||
Business combination consideration transferred decrease in amount | $ 16,000 | |||||||||
El Paso Acquisition [Member] | TEXAS | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Income (loss) from subsidiaries, before tax | 1,100,000 | |||||||||
Revenues | 5,300,000 | |||||||||
West Palm Beach Acquisition [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Business combination, consideration transferred | $ 18,000,000 | |||||||||
Business acquisition, pro forma revenue | 234,100,000 | |||||||||
Income (loss) from subsidiaries, before tax | 600,000 | |||||||||
Revenues | 17,900,000 | |||||||||
Business acquisition, pro forma income before tax | 15,500,000 | |||||||||
Business combination consideration transferred decrease in amount | $ 100,000 | |||||||||
West Palm Beach Acquisition [Member] | FLORIDA | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Income (loss) from subsidiaries, before tax | 400,000 | |||||||||
Revenues | 4,800,000 | |||||||||
ADG Acquisitions, Since Acquisition [Member] | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Income (loss) from subsidiaries, before tax | 14,600,000 | |||||||||
Revenues | $ 39,500,000 |
Property and Equipment - Summar
Property and Equipment - Summary of Detailed Information of Property and Equipment (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | $ 106,865,427 | $ 94,129,904 |
Less: accumulated depreciation | (43,151,918) | (29,953,109) |
Total property and equipment – net | 63,713,509 | 64,176,795 |
Medical equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 62,405,632 | 60,266,531 |
Equipment under finance leases [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 23,168,355 | 14,971,916 |
Total property and equipment – net | 14,981,186 | 9,404,765 |
Leasehold improvements [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 19,360,169 | 17,393,839 |
Furniture and Fixtures [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 1,479,320 | 1,088,236 |
Office equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | 211,032 | 214,612 |
Computer Equipment [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Total property and equipment – cost | $ 240,919 | $ 194,770 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Property, Plant and Equipment [Line Items] | ||
Property and equipment - net | $ 63,713,509 | $ 64,176,795 |
Depreciation | 14,370,332 | 11,609,821 |
Property, plant and equipment, disposals | 1,557,819 | 992,533 |
Financial instruments revaluation and other gains losses [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Gain (loss) on disposition of property plant equipment | (1,327,488) | (893,883) |
Equipment under finance leases [Member] | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment - net | $ 14,981,186 | $ 9,404,765 |
Intangible Assets - Summary of
Intangible Assets - Summary of Intangible Assets (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Beginning balance, Cost | $ 12,325,447 | $ 4,652,772 |
Beginning balance, Accumulated amortization | 2,892,967 | 1,011,420 |
Additions | 5,412 | 2,675 |
Business acquisitions (note 3) | 7,670,000 | |
Amortization | 2,689,819 | 1,881,547 |
Ending balance, Cost | 12,330,859 | 12,325,447 |
Ending balance, Accumulated amortization | 5,582,786 | 2,892,967 |
Net book value | $ 6,748,073 | 9,432,480 |
Weighted average remaining amortization period (years) | 2 years 6 months | |
Covenants not to compete [member] | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Beginning balance, Cost | $ 3,137,917 | 1,127,917 |
Beginning balance, Accumulated amortization | 917,918 | 323,611 |
Business acquisitions (note 3) | 2,010,000 | |
Amortization | 868,572 | 594,307 |
Ending balance, Cost | 3,137,917 | 3,137,917 |
Ending balance, Accumulated amortization | 1,786,490 | 917,918 |
Net book value | $ 1,351,427 | 2,219,999 |
Weighted average remaining amortization period (years) | 1 year 6 months | |
Software Cost [member] | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Beginning balance, Cost | $ 244,530 | 241,855 |
Beginning balance, Accumulated amortization | 151,198 | 119,225 |
Additions | 5,412 | 2,675 |
Amortization | 32,648 | 31,973 |
Ending balance, Cost | 249,942 | 244,530 |
Ending balance, Accumulated amortization | 183,846 | 151,198 |
Net book value | $ 66,096 | 93,332 |
Weighted average remaining amortization period (years) | 2 years | |
Trade Names [member] | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Beginning balance, Cost | $ 7,823,000 | 3,283,000 |
Beginning balance, Accumulated amortization | 1,693,185 | 568,584 |
Business acquisitions (note 3) | 4,540,000 | |
Amortization | 1,564,599 | 1,124,601 |
Ending balance, Cost | 7,823,000 | 7,823,000 |
Ending balance, Accumulated amortization | 3,257,784 | 1,693,185 |
Net book value | $ 4,565,216 | 6,129,815 |
Weighted average remaining amortization period (years) | 2 years 9 months 18 days | |
Licensing Agreements [member] | ||
Acquired Finite-Lived Intangible Assets [Line Items] | ||
Beginning balance, Cost | $ 1,120,000 | |
Beginning balance, Accumulated amortization | 130,666 | |
Business acquisitions (note 3) | 1,120,000 | |
Amortization | 224,000 | 130,666 |
Ending balance, Cost | 1,120,000 | 1,120,000 |
Ending balance, Accumulated amortization | 354,666 | 130,666 |
Net book value | $ 765,334 | $ 989,334 |
Weighted average remaining amortization period (years) | 3 years 6 months |
Intangible Assets - Summary o_2
Intangible Assets - Summary of Finite-Lived Intangible Assets Net Amortization Expense (Detail) | Dec. 31, 2020USD ($) |
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract] | |
2021 | $ 2,710,490 |
2022 | 2,190,685 |
2023 | 1,275,099 |
2024 | 570,223 |
2025 | 1,125 |
Total | $ 6,747,622 |
Goodwill - Summary of Goodwill
Goodwill - Summary of Goodwill (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Goodwill and Intangible Assets Disclosure [Abstract] | ||
Balance – Beginning of period | $ 355,667,004 | $ 145,101,212 |
Adjustments (note 4) | (5,732,207) | (6,220,477) |
Business acquisitions (note 4) | 1,674,764 | 216,786,269 |
Balance – End of period | $ 351,609,561 | $ 355,667,004 |
Goodwill - Summary of Carrying
Goodwill - Summary of Carrying Amount of Goodwill (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 |
Summary of carrying amount of goodwill as follows: | |||
Goodwill | $ 351,609,561 | $ 355,667,004 | $ 145,101,212 |
Florida [member] | |||
Summary of carrying amount of goodwill as follows: | |||
Goodwill | 249,630,120 | 254,221,080 | |
Northeast [member] | |||
Summary of carrying amount of goodwill as follows: | |||
Goodwill | 3,569,801 | 3,569,801 | |
Texas [member] | |||
Summary of carrying amount of goodwill as follows: | |||
Goodwill | 90,921,837 | 90,788,320 | |
Other [member] | |||
Summary of carrying amount of goodwill as follows: | |||
Goodwill | $ 7,487,803 | $ 7,087,803 |
Accounts Payable and Accrued _3
Accounts Payable and Accrued Liabilities - Summary of Accounts Payable and Accrued Liabilities (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Payables and Accruals [Abstract] | ||
Accounts payable | $ 20,400,949 | $ 21,707,080 |
Accrued other expenses | 10,096,523 | 2,665,575 |
Accrued payroll expenses | 3,797,784 | 1,952,853 |
Accounts payable and accrued liabilities | $ 34,295,256 | $ 26,325,508 |
Earn-Out Liability (ADG Acqui_3
Earn-Out Liability (ADG Acquisition) - Summary of Earn-Out Liability (Detail) - Earn-out liability [Member] - ADG [Member] - USD ($) | Dec. 31, 2020 | Nov. 30, 2020 | Dec. 31, 2019 |
Business Acquisition, Contingent Consideration [Line Items] | |||
ADG Acquisition – earn-out | $ 4,688,553 | $ 9,400,000 | $ 14,834,067 |
Less: Current portion of ADG Acquisition – earn-out | (4,688,553) | (7,529,962) | |
Non-current portion of ADG Acquisition – earn-out | $ 0 | $ 7,304,105 |
Earn-Out Liability (ADG Acqui_4
Earn-Out Liability (ADG Acquisition) - Additional Information (Detail) - ADG [Member] - Earn-out liability [Member] | Dec. 31, 2019USD ($) | Dec. 31, 2020USD ($) | Dec. 31, 2020USD ($) | Dec. 31, 2019USD ($) | Nov. 30, 2020USD ($) | May 31, 2019USD ($) |
Business Acquisition, Contingent Consideration [Line Items] | ||||||
Percentage of contingent consideration liability settled | 50.00% | |||||
Business combination contingent consideration liability | $ 14,834,067 | $ 4,688,553 | $ 4,688,553 | $ 14,834,067 | $ 9,400,000 | |
Percentage of increase decrease in discount rate | 1.00% | |||||
Percentage of increase decrease in contingent consideration | $ 200,000 | |||||
Change in amount of contingent consideration liability | $ 5,500,000 | $ (100,000) | ||||
Level 3 [Member] | ||||||
Business Acquisition, Contingent Consideration [Line Items] | ||||||
Business combination contingent consideration liability | $ 14,700,000 | |||||
Level 3 [Member] | Measurement Input, Discount Rate [Member] | ||||||
Business Acquisition, Contingent Consideration [Line Items] | ||||||
Contingent consideration liability measurement input (%) | 7 |
Lease Liabilities - Summary of
Lease Liabilities - Summary of Finance Lease Liabilities (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Leases [Abstract] | ||
Finance lease liabilities | $ 15,573,586 | $ 8,415,404 |
Less: Current portion of finance lease liabilities | (3,264,806) | (1,789,995) |
Non-current portion of finance lease liabilities | $ 12,308,780 | $ 6,625,409 |
Lease Liabilities - Summary o_2
Lease Liabilities - Summary of Finance Lease Cost (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Leases [Abstract] | ||
Amortization expense for equipment under finance leases | $ 2,927,249 | $ 1,794,673 |
Interest expense on finance lease liabilities | 637,191 | 296,603 |
Finance lease cost | $ 3,564,440 | $ 2,091,276 |
Lease Liabilities - Summary o_3
Lease Liabilities - Summary of Undiscounted Cash Flows For Finance Leases (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Finance Lease, Liability, Payment, Due [Abstract] | ||
2021 | $ 3,910,052 | |
2022 | 3,768,295 | |
2023 | 3,347,796 | |
2024 | 2,749,931 | |
2025 | 1,893,323 | |
Thereafter | 1,762,745 | |
Total minimum lease payments | 17,432,142 | |
Less: Amount of lease payments representing interest | (1,858,556) | |
Present value of future minimum lease payments | 15,573,586 | $ 8,415,404 |
Less: Current portion of finance lease liabilities | (3,264,806) | (1,789,995) |
Non-current portion of finance lease liabilities | $ 12,308,780 | $ 6,625,409 |
Lease Liabilities - Summary o_4
Lease Liabilities - Summary of Finance Lease Term and Discount Rates (Detail) | Dec. 31, 2020 | Dec. 31, 2019 |
Leases [Abstract] | ||
Weighted average remaining lease term-finance leases (years) | 4 years 10 months 24 days | 4 years 9 months 18 days |
Weighted average discount rate-finance leases | 4.60% | 5.10% |
Lease Liabilities - Summary o_5
Lease Liabilities - Summary of Supplemental Cash Flow Information Related to Finance Leases (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Leases [Abstract] | ||
Operating cash flows from finance leases | $ 637,191 | $ 296,603 |
Financing cash flows from finance leases | 1,524,548 | 904,193 |
Right-of-use assets obtained in exchange for finance lease obligations | $ 8,816,902 | $ 5,309,686 |
Lease Liabilities - Summary o_6
Lease Liabilities - Summary of Operating Lease Liabilities (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 | Jan. 01, 2019 |
Leases [Abstract] | |||
Operating lease liabilities | $ 132,299,312 | $ 129,049,990 | $ 98,912,687 |
Less: Current portion of operating lease liabilities | (9,345,656) | (9,276,298) | |
Non-current portion of operating lease liabilities | $ 122,953,656 | $ 119,773,692 |
Lease Liabilities - Summary o_7
Lease Liabilities - Summary of Operating Lease Cost (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Leases [Abstract] | ||
Operating lease cost | $ 20,624,622 | $ 18,040,356 |
Variable lease cost | 4,109,277 | 3,478,748 |
Short-term lease cost | 246,785 | 170,366 |
Total operating lease cost | $ 24,980,684 | $ 21,689,470 |
Lease Liabilities - Summary o_8
Lease Liabilities - Summary of Undiscounted Cash Flows For Operating Leases (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 | Jan. 01, 2019 |
Lessee, Operating Lease, Liability, Payment, Due [Abstract] | |||
2021 | $ 18,380,966 | ||
2022 | 18,075,153 | ||
2023 | 17,224,588 | ||
2024 | 16,355,082 | ||
2025 | 15,659,482 | ||
Thereafter | 137,590,224 | ||
Total minimum lease payments | 223,285,495 | ||
Less: Amount of lease payments representing interest | (90,986,183) | ||
Present value of future minimum lease payments | 132,299,312 | $ 129,049,990 | $ 98,912,687 |
Less: Current portion of operating lease liabilities | (9,345,656) | (9,276,298) | |
Non-current portion of operating lease liabilities | $ 122,953,656 | $ 119,773,692 |
Lease Liabilities - Summary o_9
Lease Liabilities - Summary of Operating Lease Term and Discount Rates (Detail) | Dec. 31, 2020 | Dec. 31, 2019 |
Leases [Abstract] | ||
Weighted average remaining lease term-operating leases (years) | 12 years 8 months 12 days | 14 years 1 month 6 days |
Weighted average discount rate-operating leases | 7.40% | 7.10% |
Lease Liabilities - Summary _10
Lease Liabilities - Summary of Supplemental Cash Flow Information Related To Operating Leases (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Leases [Abstract] | ||
Operating cash flows from operating leases | $ 17,672,048 | $ 15,660,780 |
Right-of-use assets obtained in exchange for operating lease obligations | $ 13,800,876 | $ 137,301,712 |
Senior loans payable - Summary
Senior loans payable - Summary of Maturities of Long-term Debt (Detail) | Dec. 31, 2020USD ($) |
Short-term Debt [Line Items] | |
2021 | $ 405,698 |
2022 | 426,454 |
2023 | 296,356 |
2024 | 0 |
2025 | 400,000,000 |
Long-term Debt | 401,128,508 |
Wesley Chapel Loan [Member] | |
Short-term Debt [Line Items] | |
2021 | 405,698 |
2022 | 426,454 |
2023 | 296,356 |
Long-term Debt | $ 1,100,000 |
Senior loans payable - Summar_2
Senior loans payable - Summary of debt (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Debt Instrument [Line Items] | ||
Long-term Debt | $ 401,128,508 | |
2025 Senior Notes [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt | 389,000,000 | $ 0 |
Long-term Debt, Current | 0 | 0 |
Long-term Debt, Non-current | 388,906,059 | 0 |
2020 Revolving Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt | 0 | 0 |
Amended May 2019 Loans [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt, Current | 0 | (3,320,000) |
Long-term Debt, Non-current | 335,214,995 | |
Amended May 2019 Loans [Member] | Term Loan A And Revolving Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt | 87,824,000 | |
Amended May 2019 Loans [Member] | Term Loan B [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt | 0 | 250,710,995 |
Long-term Debt, Non-current | 0 | |
Wesley Chapel Loan [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt | 1,100,000 | |
Long-term Debt, Current | (405,698) | (385,952) |
Long-term Debt, Non-current | 673,986 | 1,061,375 |
Wesley Chapel Loan [Member] | Term Loan A And Revolving Facility [Member] | ||
Debt Instrument [Line Items] | ||
Long-term Debt | $ 1,079,684 | $ 1,447,327 |
Senior loans payable - Addition
Senior loans payable - Additional Information (Detail) - USD ($) | Dec. 31, 2020 | Nov. 02, 2020 | Jul. 31, 2019 | May 31, 2019 | Nov. 14, 2018 | Aug. 15, 2018 | Oct. 31, 2019 | May 31, 2019 | Dec. 31, 2020 | Dec. 31, 2019 | Jun. 02, 2020 |
Debt Instrument [Line Items] | |||||||||||
Long-term Debt | $ 401,128,508 | $ 401,128,508 | |||||||||
Line of Credit facility interest rate description | (i) each Eurodollar Rate Loan bears interest on the outstanding principal amount at Adjusted Eurodollar Rate (effectively, LIBOR) plus the Applicable Rate; (ii) each Base Rate Loan bears interest on the outstanding principal amount at the Base Rate (the highest of (a) the Prime Rate, (b) the Federal Reserve Bank of New York Rate plus 0.5% and (c) one-month Adjusted Eurodollar Rate plus 1.0%) plus the Applicable Rate; and (iii) each Swingline Loan bears interest on the outstanding principal amount at the Base Rate plus the Applicable Rate. | ||||||||||
Debt instrument description of variable rate basis | the Federal Reserve Bank of New York Rate plus 0.5% | ||||||||||
Debt instrument fair value | $ 429,826,997 | $ 429,826,997 | $ 377,741,905 | ||||||||
Syndicated Term Loan [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Proceeds From Derivative Financial Instrument | $ 0 | 597 | |||||||||
Derivative, Gain (Loss) on Derivative | $ 597 | ||||||||||
Amended May 2019 Loans [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | $ 50,000,000 | ||||||||||
Long-term Debt | 338,500,000 | ||||||||||
Proceeds from issuance of debt | $ 16,000,000 | ||||||||||
Debt instrument term | 5 years | ||||||||||
Debt instrument maturity date range start | May 31, 2019 | ||||||||||
Increase in debt instrument for period | $ 100,000,000 | ||||||||||
Debt instrument fair value | $ 319,300,000 | $ 319,300,000 | |||||||||
Debt Issuance cost net | 14,800,000 | 14,800,000 | |||||||||
Take as Extension | 364,000,000 | ||||||||||
Derivative cap interest rate | 3.75% | ||||||||||
Percentage of debt instrument notional amount | 50.00% | ||||||||||
Derivative Maturity Dates | Aug. 31, 2021 | ||||||||||
Derivative financial instrument costs | $ 155,000 | ||||||||||
Loss on extinguishment of debt | $ (18,000,000) | ||||||||||
Amended May 2019 Loans [Member] | Revolving Credit Facility [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Line of credit facility maximum borrowing capacity | 50,000,000 | 50,000,000 | $ 69,000,000 | ||||||||
7.0% senior secured notes [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | $ 400,000,000 | ||||||||||
Debt Interest Rate | 7.00% | ||||||||||
Debt Maturity Date | Nov. 1, 2025 | ||||||||||
2025 Senior Notes [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | 400,000,000 | $ 400,000,000 | $ 400,000,000 | ||||||||
Debt Maturity Date | Nov. 1, 2025 | ||||||||||
Cash | $ 19,000,000 | ||||||||||
Payments For Debt Issuance Costs | $ 11,500,000 | ||||||||||
Frequency of Periodic Payment | six months | ||||||||||
Long-term Debt | 389,000,000 | $ 389,000,000 | 0 | ||||||||
Line of credit facility maximum borrowing capacity | 50,000,000 | 50,000,000 | |||||||||
Minimum debt instrument holders percentage to declare amount immediately due in debt default | 25.00% | ||||||||||
2020 Revolving Facility [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | 0 | 0 | 0 | ||||||||
Long-term Debt | 0 | 0 | 0 | ||||||||
Payments of Debt Restructuring Costs | 900,000 | ||||||||||
Line of credit facility maximum borrowing capacity | 55,000,000 | $ 55,000,000 | |||||||||
Line of credit maturity period | 5 years | ||||||||||
Line of credit maturity date description | if more than $50 million in aggregate principal amount of the 2025 Senior Notes is outstanding on the date that is 181 days prior to the 2020 Revolving Facility Maturity Date, then the 2020 Revolving Facility Maturity Date shall instead be the date that is 181 days prior to the 2020 Revolving Facility Maturity Date. | ||||||||||
Line of credit facility issuance costs | $ 2,000,000 | $ 2,000,000 | |||||||||
Annual Commitment Fee Capped Percentage | 0.50% | ||||||||||
Line of credit facility undrawn amount | $ 0 | $ 0 | 0 | ||||||||
Debt instrument covenant description | leverage ratio that is tested on the last day of any fiscal quarter (commencing with the fiscal quarter ending March 31, 2021) only if on the last day of any such fiscal quarter, the outstanding amount under the 2020 Revolving Facility (excluding certain letter of credit obligations) exceeds 30% of the total commitment under the 2020 Revolving Facility of $55 million. | ||||||||||
Line of credit debt service coverage ratio | 30.00% | 30.00% | |||||||||
Total Commitment amount | $ 55,000,000 | ||||||||||
2020 Revolving Facility [Member] | 1% Increase In Variable Interest rate [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Increase in interest expense | 0 | 0 | |||||||||
2020 Revolving Facility [Member] | Federal Reserve Bank Of New York rate [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Line of Credit Facility Interest rate | 0.50% | ||||||||||
2020 Revolving Facility [Member] | Adjusted Eurodollar Rate Plus Applicable Rate [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt instrument description of variable rate basis | one-month Adjusted Eurodollar Rate plus 1.0%) plus the Applicable Rate | ||||||||||
Line of Credit Facility Interest rate | 1.00% | ||||||||||
Wesley Chapel Loan [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | $ 37,742 | $ 2,000,000 | $ 37,742 | ||||||||
Debt Interest Rate | 5.00% | 5.00% | 5.00% | ||||||||
Debt Maturity Date | Aug. 15, 2023 | ||||||||||
Long-term Debt | $ 1,100,000 | $ 1,100,000 | |||||||||
Debt instrument periodic payment | $ 37,742 | ||||||||||
Long-term debt fair value | $ 1,908,456 | ||||||||||
Prior Revolving Credit Facility [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Line of credit facility issuance costs | 900,000 | 900,000 | |||||||||
Term Loan A [Member] | Amended May 2019 Loans [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | 66,000,000 | 66,000,000 | |||||||||
Term Loan B [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Proceeds From Derivative Financial Instrument | $ 4,805,000 | 643,620 | |||||||||
Derivative, Gain (Loss) on Derivative | 4,200,000 | ||||||||||
Percentage Of Financial Instrument Underlying Notional Amount | 100.00% | ||||||||||
Derivative, Notional Amount | $ 266,000,000 | ||||||||||
Upfront cost | 0 | ||||||||||
Interest expense borrowings | 1,301,854 | 0 | |||||||||
Term Loan B [Member] | Amended May 2019 Loans [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Debt Face Amount | $ 266,000,000 | $ 266,000,000 | |||||||||
Term Loan B [Member] | London Interbank Offered Rate (LIBOR) [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Derivative, Cap Interest Rate | 3.00% | ||||||||||
Derivative, Floor Interest Rate | 1.1475% | ||||||||||
Syndicate Loans [Member] | Amended May 2019 Loans [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Proceeds from issuance of debt used to settle other debt | 112,482,181 | ||||||||||
Debt instrument increase decrease from modification | $ 1 | ||||||||||
Subordinated Note [Member] | Amended May 2019 Loans [Member] | |||||||||||
Debt Instrument [Line Items] | |||||||||||
Proceeds from issuance of debt used to settle other debt | $ 1,596,250 |
Subordinated notes payable - _3
Subordinated notes payable - earn-out - Summary of Subordinated Debt (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Subordinated Notes Earnout [Member] | ||
Debt Instrument [Line Items] | ||
Subordinated debt | $ 0 | $ 184,485 |
Subordinated notes payable -ear
Subordinated notes payable -earn -out - Additional Information (Detail) - USD ($) | Oct. 23, 2020 | May 31, 2019 | May 11, 2018 | Dec. 31, 2020 | Dec. 31, 2019 |
Subordinated Notes Earnout [Member] | |||||
Debt Instrument [Line Items] | |||||
Subordinated notes interest rate | 6.00% | ||||
Subordinate notes face value | $ 1,500,000 | ||||
Subordinated notes term | 4 years | ||||
Settlement of earn out | $ 200,000 | ||||
Loss on extinguishment of debt | $ (15,515) | ||||
Discount rate used for estimating fair value of subordinated notes | 8.75% | ||||
Subordinated note settlement liability outstanding | 0 | $ 184,485 | |||
Gain loss on extinguishment of debt | $ (15,515) | ||||
Subordinated Notes Earnout [Member] | Revenue Based Milestone [Member] | |||||
Debt Instrument [Line Items] | |||||
Period of earnout payment | 3 years | ||||
Subordinated note earn out percentage | 50.00% | 50.00% | |||
Base revenue to be earned for payment of earnout liability | $ 16,000,000 | $ 16,000,000 | |||
Subordinated Notes Earnout [Member] | Revenue Based Milestone [Member] | Tampa [Member] | |||||
Debt Instrument [Line Items] | |||||
Business combination contingent consideration maximum outcome | 4,000,000 | ||||
Subordinated Notes Earnout [Member] | Revenue Based Milestone [Member] | Minimum [Member] | |||||
Debt Instrument [Line Items] | |||||
Base revenue to be earned for payment of earnout liability | $ 16,000,000 | 16,000,000 | |||
Subordinated Notes Earnout [Member] | Level 3 [Member] | Measurement Input, Discount Rate [Member] | |||||
Debt Instrument [Line Items] | |||||
Subordinated notes fair value | $ 160,790 | ||||
Subordinated Notes Earnout [Member] | Level 3 [Member] | Based On Effective Rate [Member] | |||||
Debt Instrument [Line Items] | |||||
Subordinated notes fair value | $ 1,490,932 | ||||
Subordinated Notes due on May 31, 2019 [Member] | |||||
Debt Instrument [Line Items] | |||||
Subordinate notes face value | $ 1,500,000 | ||||
Early repayment of subordinated debt | $ 1,596,250 | ||||
Interest expenses on subordinated debt | 96,250 | ||||
Loss on extinguishment of debt | (6,830) | ||||
Gain loss on extinguishment of debt | $ (6,830) |
Capital stock and warrants - Su
Capital stock and warrants - Summary of an Unlimited Number of Voting Common Shares (Detail) - USD ($) | 1 Months Ended | 12 Months Ended | |
Apr. 30, 2020 | Dec. 31, 2020 | Dec. 31, 2019 | |
Class of Stock [Line Items] | |||
Beginning balance, shares | 69,840,928 | ||
Ending balance, shares | 69,840,928 | 69,840,928 | |
Beginning balance warrants , shares | 52,500 | 525,000 | 1,249,512 |
Beginning balance warrants | $ 734,379 | $ 1,742,910 | |
RSUs and warrants exercised, warrants , shares | (436,497) | ||
RSUs and warrants exercised | $ (569,733) | ||
Warrants expired, shares | (525,000) | (288,015) | |
Warrants expired | $ (734,379) | $ (438,798) | |
Ending balance warrants, shares | 525,000 | ||
Ending balance warrants | $ 734,379 | ||
Beginning balance RSUs, shares | 337,500 | 1,120,656 | |
Beginning balance RSUs | $ 1,297,812 | $ 2,671,147 | |
Issuance RSUs | $ 14,138 | $ 1,559,418 | |
RSUs and warrants exercised, RSUs shares | (337,500) | (783,156) | |
RSUs and warrants exercised | $ (1,311,950) | $ (2,932,753) | |
Ending balance, RUSs | 337,500 | ||
Ending balance | $ 1,297,812 | ||
Beginning balance, total (Shares) | 70,703,428 | 64,741,443 | |
Beginning balance, total (Values) | $ 154,029,746 | $ 128,160,480 | |
Issuance | 6,250,000 | ||
Issuance | $ 14,138 | $ 24,996,918 | |
RSUs and warrants exercised | $ 1,311,146 | ||
Warrants expired | (525,000) | (288,015) | |
Warrants expired | $ (734,379) | $ (438,798) | |
Ending balance , total (Shares) | 70,178,428 | 70,703,428 | |
Ending balance , total (Values) | $ 153,309,505 | $ 154,029,746 | |
Common Stock [Member] | |||
Class of Stock [Line Items] | |||
Beginning balance, shares | 69,840,928 | 62,371,275 | |
Beginning balance | $ 151,997,555 | $ 123,746,423 | |
Issuance, shares | 6,250,000 | ||
Issuance | $ 23,437,500 | ||
RSUs and warrants exercised , shares | 1,219,653 | ||
RSUs and warrants exercised | $ 4,813,632 | ||
RSUs settled | $ 1,311,950 | ||
RSUs settled, shares | 337,500 | ||
Ending balance, shares | 70,178,428 | 69,840,928 | |
Ending balance | $ 153,309,505 | $ 151,997,555 |
Capital stock and warrants - Ad
Capital stock and warrants - Additional Information (Detail) - USD ($) $ / shares in Units, $ in Millions | Nov. 18, 2019 | Nov. 15, 2017 | Apr. 30, 2020 | Mar. 31, 2020 | Nov. 30, 2018 | May 31, 2018 | Nov. 30, 2017 | Aug. 31, 2017 | Mar. 31, 2017 | Mar. 12, 2020 | Mar. 31, 2019 | Mar. 12, 2018 | Jun. 30, 2019 | Mar. 31, 2019 | Sep. 30, 2018 | Dec. 31, 2020 | Dec. 31, 2019 | Nov. 02, 2020 | Nov. 14, 2019 | Aug. 08, 2019 | Dec. 31, 2018 | Aug. 31, 2018 |
Class of Stock [Line Items] | ||||||||||||||||||||||
Common Stock, No Par Value | $ 0 | $ 0 | ||||||||||||||||||||
Class of warrants or rights warrants issued during the period | 525,000 | 32,013 | 512,004 | 300,825 | ||||||||||||||||||
Class of warrants or rights number of shares for each unit of warrant held | 1 | 1 | 1 | 1 | ||||||||||||||||||
Class of warrants or rights exercise price | $ 4 | $ 3.50 | $ 3.50 | $ 2.30 | $ 3.50 | |||||||||||||||||
Share based compensation by share based payment arrangement equity instruments other than options vested shares | 337,500 | 783,156 | ||||||||||||||||||||
Class of warrants or rights expiry date | Aug. 8, 2019 | May 2, 2020 | Nov. 14, 2019 | |||||||||||||||||||
Class of warrants or rights outstanding | 52,500 | 525,000 | 1,249,512 | |||||||||||||||||||
Restricted Stock Units (RSUs) [Member] | ||||||||||||||||||||||
Class of Stock [Line Items] | ||||||||||||||||||||||
Share based compensation by share based payment arrangement equity instruments other than options granted | 1,611,316 | 315,000 | ||||||||||||||||||||
Share based compensation award vesting rights percentage | 50.00% | 50.00% | ||||||||||||||||||||
Share based compensation by share based payment arrangement equity instruments other than options vested shares | 600,656 | 10,000 | 42,500 | 285,000 | 132,500 | 25,000 | ||||||||||||||||
Share based compensation number of common stock issued | 14,137 | 1,559,418 | ||||||||||||||||||||
Share based compensation by share based payment arrangment equity instruments other than options outstanding | 52,500 | 337,500 | ||||||||||||||||||||
Excercise Of Warrants [Member] | ||||||||||||||||||||||
Class of Stock [Line Items] | ||||||||||||||||||||||
Stock shares issued during the period on exercise of warrants | 180,495 | 120,330 | ||||||||||||||||||||
Issue In Connection With Business Acquistions [Member] | ||||||||||||||||||||||
Class of Stock [Line Items] | ||||||||||||||||||||||
Stock shares issued during the period on exercise of warrants | 6,250,000 | |||||||||||||||||||||
Sale of stock issue price per share | $ 3.75 | |||||||||||||||||||||
Stock issued during the period shares new issues value | $ 23 | |||||||||||||||||||||
Stock Issued As A Result Of Warrant Excercises [Member] | ||||||||||||||||||||||
Class of Stock [Line Items] | ||||||||||||||||||||||
Stock shares issued during the period on exercise of warrants | 256,002 | |||||||||||||||||||||
Class of warrants or rights outstanding | 256,002 | |||||||||||||||||||||
Class of warrants or rights expired | 256,002 |
Income Taxes - Summary of Recon
Income Taxes - Summary of Reconciliation of Income Tax Expense (Benefit) (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | ||
Income attributable to common shareholders before income taxes | $ (36,178,975) | $ (15,727,308) |
Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%) | (9,587,428) | (4,167,737) |
Increase (decrease) in income taxes resulting from | ||
Stock-based compensation | 396,528 | 942,013 |
State franchise tax, net of federal benefit | 395,220 | (45,860) |
US tax rate differential | 882,767 | 375,883 |
Return to provision adjustment | (204,701) | 1,130,204 |
Other | (236,378) | (483,792) |
Valuation allowance | 8,915,547 | (548,270) |
Income tax expense (benefit) | 561,555 | (2,797,559) |
U.S. State current tax expense (benefit) | (138,281) | (1,378,079) |
U.S. Federal deferred tax expense (benefit) | 699,836 | (823,416) |
U.S. State deferred tax expense (benefit) | (596,064) | |
Total Income Tax Expense Benefit | $ 561,555 | $ (2,797,559) |
Income Taxes - Summary of Rec_2
Income Taxes - Summary of Reconciliation of Income Tax Expense (Benefit) (Parenthetical) (Detail) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Income Tax Disclosure [Abstract] | ||
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent | 26.50% | 26.50% |
Income Taxes - Summary of Compa
Income Taxes - Summary of Company's Deferred Tax Assets and Liabilities (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Deferred tax assets | ||
Lease liabilities | $ 31,615,510 | $ 33,474,270 |
Net operating losses | 16,559,000 | 7,249,097 |
163(j) carryforward | 2,024,652 | 1,268,076 |
Debt issuance costs | 2,419,687 | 4,412,375 |
Capital acquisition costs | 2,011,450 | 779,367 |
Other | 16,001,597 | 13,763,638 |
Total deferred tax assets | 70,631,896 | 60,946,823 |
Less: Valuation allowance (Canada) | (16,851,707) | (7,928,553) |
Net deferred tax assets | 53,780,189 | 53,018,270 |
Deferred tax liabilities | ||
Right-of-use assets | (30,349,474) | (32,855,049) |
Fixed assets | (11,196,500) | (9,763,083) |
Goodwill | (10,660,618) | (8,430,589) |
Other | (3,266,608) | (2,962,724) |
Total deferred tax liabilities | (55,473,200) | (54,011,445) |
Net deferred tax liabilities | $ (1,693,011) | $ (993,175) |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Operating Loss Carryforwards [Line Items] | ||
Effective Income Tax Rate Reconciliation, Percent | (1.55%) | 17.79% |
Deferred Tax Assets, Valuation Allowance | $ 16,851,707 | $ 7,928,553 |
Operating Loss Carryforwards | 68,145,713 | 29,553,246 |
Interest expense carryforward | 8,415,013 | $ 5,259,543 |
Operating Loss Carry forward Due 2036 | ||
Operating Loss Carryforwards [Line Items] | ||
Operating Loss Carryforwards | 19,742,894 | |
Operating Loss Carrforward Do not Expire | ||
Operating Loss Carryforwards [Line Items] | ||
Operating Loss Carryforwards | $ 48,402,819 |
Stock-Based Compensation Option
Stock-Based Compensation Options - Summary of Stock Options (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Number of stock options - Outstanding Beginning | 5,778,120 | 4,213,268 | |
Number of stock options - Cancelled | (18,000) | (100,000) | |
Number of stock options - Granted | 0 | 1,700,000 | |
Number of stock options - Outstanding Ending | 5,760,120 | 5,778,120 | 4,213,268 |
Number of stock options - Exercisable | 3,978,218 | ||
Weighted average exercise price - Oustanding Beginning | $ 2.47 | $ 2.18 | |
Weighted average exercise price - Cancelled | 3.74 | 3.74 | |
Weighted average exercise price - Granted | 3.29 | ||
Weighted average exercise price - Oustanding Ending | 2.47 | $ 2.47 | $ 2.18 |
Weighted average exercise price - Exercisable | $ 2.03 | ||
Aggregate grant date fair value - Oustanding Beginning | $ 7,598,388 | $ 5,353,785 | |
Aggregate grant date fair value - Cancelled | (26,422) | (146,790) | |
Aggregate grant date fair value - Granted | 2,391,393 | ||
Aggregate grant date fair value - Oustanding Ending | 7,571,966 | $ 7,598,388 | $ 5,353,785 |
Aggregate grant date fair value - Exercisable | $ 4,990,924 | ||
Weighted average remaining contractual - Outstanding | 5 years 3 months 18 days | 6 years 3 months 18 days | 7 years |
Weighted average remaining contractual - Exercisable | 5 years 2 months 12 days |
Stock-Based Compensation Opti_2
Stock-Based Compensation Options - Additional Information (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Share-based Payment Arrangement [Abstract] | ||
Share based compensation percentage of maximum number of common shares reserved for issuance | 10.00% | |
Share based compensation number of common stock reserved for issuance | 7,017,842 | 6,984,092 |
Share-based Compensation Arrangement by Share-based Payment Award, Options, Grants in Period, Gross | 0 | 1,700,000 |
Share based compensation award vesting basis | 1:1 | |
Share-based Compensation Arrangement by Share-based Payment Award, Fair Value Assumptions, Exercise Price | $ 3.29 | $ 3.29 |
Share based compensation award vesting rights percentage | 33.00% | 34.00% |
Share based compensation share based payments award expiration period | 7 years | |
Share based compensation share based payments fair value of stock granted | $ 1.4364 | |
Share based compensation share based payments outstanding but not yet exercisable number | 1,800,000 | 3,000,000 |
Share based compensation share based payments outstanding but not yet exercisable weighted average exercise price | $ 3.46 | $ 3.49 |
Share based compensation share based payments outstanding but not yet exercisableweighted average remaining contractual term | 5 years 6 months | 6 years 4 months 24 days |
Share Based Compensation Arrangement By Share Based Payment Award Options Outstanding But Not Yet Exercisable Weighted Average Grant Date Fair Value | $ 1,400,000 | $ 2,200,000 |
Share Based Compensation Arrangement By Share Based Payment Award Options Vested Weighted Average Grant Date Fair Value | $ 0.9 | $ 0.9 |
Share Based Compensation Arrangement By Share Based Payment Award Options Cancelled Vested Weighted Average Grant Date Fair Value | $ 26,000 | $ 100,000 |
Share based compensation by share based payment arrangement total grant date fair value of stock options vested during the period | 1,800,000 | 1,700,000 |
Stock-based options compensation expense | 2,069,777 | 1,995,347 |
Unrecognized share based compensation expense | $ 1,089,614 | $ 3,185,813 |
Unrecognized share based compensation expense, period for recognition | 1 year 10 months 17 days | 2 years 10 months 17 days |
Share Based Compensation Arrangement By Share Based Payment Award Options Grants In Period Aggregate Grant Date Fair Value | $ 2,391,393 |
Stock-Based Compensation R_3
Stock-Based Compensation – Options - Summary of Fair Value Assumptions of Stock-based Option Awards (Detail) - $ / shares | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Schedule Of Share Based Payment Award Stock Options Valuation Assumptions [Line Items] | ||
Date of options grant | Nov. 18, 2019 | |
Underlying stock price | $ 3.29 | |
Exercise price | $ 3.29 | $ 3.29 |
Term of options (years) | 7 years | |
Volatility of underlying stock price | 40.00% | |
Expected dividend yield on underlying stock | 0.00% | |
Annual risk free interest rate | 1.48% |
Risk Management Arising From _3
Risk Management Arising From Financial Instruments - Summary of Estimated Fair Value of Other Non-Current Liabilities (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | $ 429,826,997 | $ 377,741,905 |
Two Thousand Twenty Five Senior Notes [Member] | ||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | 424,016,044 | |
Amended May Two Thousand Nineteen loans payable [Member] | ||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | 360,596,500 | |
Wesley Chapel Loan payable [Member] | ||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | 1,122,400 | 1,483,830 |
Subordinated Note Earn Out [Member] | ||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | 184,485 | |
ADG Acquisition Earn Out [Member] | ||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | $ 4,688,553 | 14,834,067 |
Derivative Financial Instruments, Liabilities [Member] | ||
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Line Items] | ||
Debt Instrument, Fair Value Disclosure | $ 643,023 |
Risk Management Arising From _4
Risk Management Arising From Financial Instruments - Summary of Information Regarding the Change in Carrying Value of the Financial Instruments at Fair Value (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Subordinated notes payable – earn-out, Opening Balance | $ 184,485 | |
Subordinated notes payable – earn-out, Ending Balance | $ 184,485 | |
Derivative [Member] | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Opening Balance | 643,023 | 16,014 |
Unrealized | 659,037 | |
Payment For Liabilities Change in Fair Value Of Financial Instruments | (4,805,000) | |
Realized | 4,161,977 | |
Ending balance | 643,023 | |
Subordinated Debt [Member] | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Subordinated notes payable – earn-out, Opening Balance | 184,485 | 169,642 |
Unrealized | 14,843 | |
Payment For Liabilities Change in Fair Value Of Financial Instruments | (200,000) | |
Realized | 15,515 | |
Subordinated notes payable – earn-out, Ending Balance | 184,485 | |
ADG Acquisiton Earn Out [Member] | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Opening Balance | 14,834,067 | |
Issuance | 14,748,022 | |
Unrealized | (2,728,481) | 86,045 |
Payment For Liabilities Change in Fair Value Of Financial Instruments | (4,688,553) | |
Realized | (2,728,480) | |
Ending balance | $ 4,688,553 | $ 14,834,067 |
Risk Management Arising From _5
Risk Management Arising From Financial Instruments - Summary of Information Regarding the Carrying Value of Financial Instruments (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018 |
Fair Value Of Assets And Liabilities Carrying Value [Line Items] | |||
Cash | $ 44,395,988 | $ 23,388,916 | $ 19,326,412 |
Accounts receivable | 62,258,757 | 53,325,516 | |
Accounts payable and accrued liabilities | 34,295,256 | 26,325,508 | |
Short-term portion of senior loans payable | 405,698 | 3,705,952 | |
Long-term portion of senior loans payable | 389,580,046 | 336,276,370 | |
Subordinated note – earn-out | 184,485 | ||
Derivative financial instruments | 643,620 | ||
Reported Value Measurement [Member] | |||
Fair Value Of Assets And Liabilities Carrying Value [Line Items] | |||
Cash | 44,395,988 | 23,388,916 | |
Accounts receivable | 62,258,757 | 53,325,516 | |
Financial assets measured at amortized cost | 106,654,745 | 76,714,432 | |
Accounts payable and accrued liabilities | 34,295,256 | 26,325,508 | |
Short-term portion of senior loans payable | 405,698 | 3,705,952 | |
Short-term portion of leases | 12,610,462 | 11,066,293 | |
Long-term portion of senior loans payable | 389,580,046 | 336,276,370 | |
Long-term portion of leases | 135,262,436 | 126,399,101 | |
Financial liabilities measured at amortized cost | 572,153,898 | 503,773,224 | |
Subordinated note – earn-out | 184,485 | ||
ADG Acquisition – earn-out | 4,688,553 | 14,834,067 | |
Derivative financial instruments | 643,023 | ||
Measured at fair value through profit or loss | $ 4,688,553 | $ 15,661,575 |
Risk Management Arising From _6
Risk Management Arising From Financial Instruments - Schedule of Exposure to Interest Rate Risk and Effect on Other Comprehensive Income Loss (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Carrying value | $ 0 | $ 338,534,995 |
Amended May 2019 Loans (originated in May 2019) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Carrying value | 338,534,995 | |
Syndicated Loans (n/a as settled in May 2019) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Carrying value | 0 | |
1% Decrease in Interest Rates [Member] | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | 1,180,247 | |
1% Decrease in Interest Rates [Member] | Amended May 2019 Loans (n/a as settled in November 2020) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | 0 | |
1% Decrease in Interest Rates [Member] | Amended May 2019 Loans (originated in May 2019) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | 1,180,247 | |
1% Decrease in Interest Rates [Member] | Syndicated Loans (n/a as settled in May 2019) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | 0 | |
1 % Increase In Interest Rates [Member] | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | (1,979,043) | |
1 % Increase In Interest Rates [Member] | Amended May 2019 Loans (n/a as settled in November 2020) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | $ 0 | |
1 % Increase In Interest Rates [Member] | Amended May 2019 Loans (originated in May 2019) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | (1,979,043) | |
1 % Increase In Interest Rates [Member] | Syndicated Loans (n/a as settled in May 2019) | ||
Interest Rate Derivatives At Fair Value And Effect On Other Comprehensive Income Loss [Line Items] | ||
Interest rates | $ 0 |
Risk Management Arising From _7
Risk Management Arising From Financial Instruments - Additional Information (Detail) - USD ($) | Dec. 31, 2020 | Dec. 31, 2019 |
Fair Value Disclosures [Abstract] | ||
Cash and Cash Equivalents fair value disclosure | $ 44,400,000 | $ 23,400,000 |
Accounts Receivable fair value disclosure | 62,300,000 | 53,300,000 |
Fair value concentration of risk foreign currency contracts | $ 0 | $ 0 |
Related Party Transactions - Ad
Related Party Transactions - Additional Information (Detail) - USD ($) | Nov. 01, 2020 | Feb. 08, 2018 |
Pledgors [member] | ||
Related Party Transaction [Line Items] | ||
Debt instrument face amount | $ 500,000 | |
Debt instrument interest rate stated percentage | 6.00% | |
Debt instrument maturity date | Feb. 8, 2021 | |
Common Stock [member] | Pledgors [member] | ||
Related Party Transaction [Line Items] | ||
Stock purchase during period | 142,857 | |
MRI Machine [member] | Officer of a Subsidiary [member] | ||
Related Party Transaction [Line Items] | ||
Purchase of asset form an entity | $ 400,000 | |
Put and Call Option [member] | President and Chief Executive Officer and Certain Selling Security Holders of PMI [member] | ||
Related Party Transaction [Line Items] | ||
Description of related party transaction terms | pursuant to the terms of a put and call option agreement made as of August 9, 2017 between Z Strategies Inc., a company controlled by the President and Chief Executive Officer, and certain selling security holders of PMI |
Basic And Diluted Income (Los_3
Basic And Diluted Income (Loss) Per Share - Summary of Earnings Per Share Basic and Diluted (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Earnings Per Share [Abstract] | ||
Net loss attributable to common shareholders | $ (36,740,531) | $ (12,929,750) |
Weighted average common shares outstanding | ||
Basic | 70,101,618 | 66,528,051 |
Add: additional shares issuable upon exercise of employee stock options, warrants and restricted share units | 0 | |
Diluted | 70,101,618 | 66,528,051 |
Net loss per share | ||
Basic and Diluted | $ (0.52) | $ (0.19) |
Employee stock options warrants and restricted share units excluded from the computation of diluted per share amounts as their effect would be antidilutive | 1,664,231 | 2,066,938 |
Financial Instruments Revalua_3
Financial Instruments Revaluation And Other Gains (Losses) - Operational Financial Instruments Revaluation and Other Gains (Losses) (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Operational Financial Instruments Revaluation And Other Gains Losses [Line Items] | ||
Total Operational Financial Instruments Revaluation And Other Gains Losses Amount | $ 4,129,473 | $ (979,928) |
Revaluation of Assets [Member] | ||
Operational Financial Instruments Revaluation And Other Gains Losses [Line Items] | ||
Gain (loss) on revaluation of ADG Acquisition – Earn-out (note 10) | 5,456,961 | (86,045) |
Loss on disposal of property and equipment | $ (1,327,488) | $ (893,883) |
Financial Instruments Revalua_4
Financial Instruments Revaluation And Other Gains (Losses) - Other Financial Instruments Revaluation and Other Gains (Losses) (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Other Financial Instruments Revaluation And Other Gains Losses [Line Items] | ||
Other gains (losses) | $ (22,386,827) | $ (1,497,734) |
Liabilities Revaluation [Member] | ||
Other Financial Instruments Revaluation And Other Gains Losses [Line Items] | ||
Loss on debt revaluation (note 11) | (18,278,845) | (829,208) |
Loss on revaluation of derivatives (note11) | (4,161,977) | (659,037) |
Other gains (losses) | 53,995 | (9,489) |
Total Other Financial Instruments Revaluation and Other Gains Losses | $ (22,386,827) | $ (1,497,734) |
Revenue Information - Summary o
Revenue Information - Summary of Revenue Information (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | $ 238,324,319 | $ 218,449,704 |
Other revenue | 7,301,666 | 2,594,903 |
Revenues | 245,625,985 | 221,044,607 |
Commercial | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 159,862,661 | 154,916,949 |
Medicare | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 27,873,980 | 25,799,652 |
Medicaid | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 7,699,859 | 6,637,274 |
Attorney | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 24,343,273 | 13,283,222 |
Workers comp | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | 9,711,177 | 9,459,955 |
Other patient revenue | ||
Disaggregation of Revenue [Line Items] | ||
Service fees - net of allowances and discounts | $ 8,833,369 | $ 8,352,652 |
Cost Of Operations, Excluding_3
Cost Of Operations, Excluding Depreciation And Amortization - Summary of Cost of Goods and Services Excluding Depletion Depreciation And Amortization (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | $ 205,634,606 | $ 193,336,730 |
Employee compensation | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | 84,038,371 | 85,899,654 |
Reading fees | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | 37,817,457 | 35,243,843 |
Rent and utilities | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | 30,203,346 | 26,332,049 |
Third party services and professional fees | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | 30,182,599 | 25,636,187 |
Administrative | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | 12,231,131 | 11,441,620 |
Medical supplies and other | ||
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items] | ||
Cost of operations, excluding depreciation and amortization (note 22) | $ 11,161,702 | $ 8,783,377 |
Settlement Costs And Other (R_2
Settlement Costs And Other (Recoveries) - Additional Information (Detail) - USD ($) | 12 Months Ended | |
Dec. 31, 2020 | Dec. 31, 2019 | |
Settlement costs and other (recoveries) | $ (2,324,151) | $ 1,881,233 |
Loss Contingency Settlement Maturity Date | Jan. 31, 2021 | |
Settlement cost related to four vendors | $ 1,100,000 | |
Federal Health Care Programs to Subsidiaries or Revenue Practice [Member] | ||
Amount related to a settlement of government investigation | $ 800,000 |
Non-Controlling Interests - Sum
Non-Controlling Interests - Summary of Effective Ownership Interest Held in the Non-Wholly Owned Entities (Detail) - Non Wholly Owned Entities [member] | Dec. 31, 2020 | Dec. 31, 2019 |
Phoenix Imaging, LLC [member] | ||
Noncontrolling Interest [Line Items] | ||
Noncontrolling Interest, Ownership Percentage by Parent | 60.00% | 60.00% |
Preferred Imaging of Amarillo, LLC [member] | ||
Noncontrolling Interest [Line Items] | ||
Noncontrolling Interest, Ownership Percentage by Parent | 57.00% | 57.00% |
CARES Act - Additional Informat
CARES Act - Additional Information (Detail) - USD ($) | 1 Months Ended | |
Dec. 31, 2020 | Apr. 30, 2020 | |
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||
Accrued payroll taxes | $ 1,346,088 | |
Grant [Member] | Akumin Inc [Member] | ||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||
Proceeds from contributions from government | $ 1,100,000 | |
Additional contributions received from government | 4,100,000 | |
Coronavirus Aid Relief And Economic Security Act [Member] | Social Security Tax [Member] | Accounts Payable and Accrued Liabilities [Member] | ||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||
Accrued payroll taxes | 1,300,000 | |
Coronavirus Aid Relief And Economic Security Act [Member] | Social Security Tax [Member] | Accrued Payroll Taxes [Member] | ||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||
Accrued payroll taxes | $ 2,700,000 | |
Centers For Medicare And Medicaid Service [Member] | Expanded Accelerated And Advance Payments Program [Member] | Akumin Inc [Member] | ||
Coronavirus Aid Relief And Economic Security Act [Line Items] | ||
Amount received as accelerated medicare payments | $ 3,100,000 |
Subsequent Events - Additional
Subsequent Events - Additional Information (Detail) - USD ($) | Sep. 01, 2021 | Aug. 09, 2021 | May 01, 2021 | Mar. 09, 2021 | Mar. 01, 2021 | Dec. 31, 2020 | Dec. 31, 2019 | Aug. 15, 2021 | Feb. 11, 2021 |
Subsequent Event [Line Items] | |||||||||
Shared based compensation arrangements by share based payments award options granted in period | 0 | 1,700,000 | |||||||
Share based compensation arrangements by share based payments award expiration period | 7 years | ||||||||
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage | 33.00% | 34.00% | |||||||
Restricted Stock Units (RSUs) [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Shared based compensation arrangements by share based payment award shares issued in period | 14,137 | 1,559,418 | |||||||
Subsequent Event [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Total estimated equity investments | $ 8,000,000 | ||||||||
Payments for purchase of warrants | $ 400,000 | ||||||||
Percentage of warrants or rights to be acquired in the targets common equity | 2.40% | ||||||||
Target percentage of equity investment ownership percentage | 34.50% | ||||||||
Subsequent Event [Member] | 2028 Senior Notes [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Debt instrument face amount | $ 375,000,000 | ||||||||
Debt instrument interest rate stated percentage | 7.50% | ||||||||
Debt instrument maturity date | Aug. 1, 2028 | ||||||||
Subsequent Event [Member] | Two Thousand And Twenty Five Senior Notes [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Debt instrument interest rate stated percentage | 7.50% | ||||||||
Subsequent Event [Member] | Maximum [Member] | Two Thousand And Twenty Revolving Credit Facility [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Line of Credit Facility, Remaining Borrowing Capacity | $ 55,000,000 | ||||||||
Subsequent Event [Member] | Minimum [Member] | Two Thousand And Twenty Revolving Credit Facility [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Line of Credit Facility, Remaining Borrowing Capacity | $ 10,000,000 | ||||||||
Subsequent Event [Member] | Florida Acquisition [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Payments to acquire businesses, gross | $ 34,600,000 | ||||||||
Business Combination, Equity Interests Issued and Issuable | $ 3,000,000 | ||||||||
Business acquisition, share price | $ 4 | ||||||||
Subsequent Event [Member] | Alliance [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Business Combination, Equity Interests Issued and Issuable | $ 820,000,000 | ||||||||
Stock issued during the period shares | 14,223,570 | ||||||||
Sale of stock issue price per share | $ 2.98 | ||||||||
Stock issued during the period value | $ 42,386,238.60 | ||||||||
Subsequent Event [Member] | Stonepeak Magnet Holdings LP [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Class of warrants or rights warrants issued during the period units | 17,114,093 | ||||||||
Class of warrants or rights warrants issued issue price per warrant | $ 2.98 | ||||||||
Stock issued during the period shares | 3,500,000 | ||||||||
Sale of stock issue price per share | $ 2.98 | ||||||||
Business combination, consideration transferred | $ 10,430,000 | ||||||||
Subsequent Event [Member] | Stonepeak Magnet Holdings LP [Member] | Unsecured Debt [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Debt instrument face amount | $ 340,000,000 | ||||||||
Subsequent Event [Member] | Common Stock [Member] | Florida Acquisition [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Business Combination, Equity Interests Issued and Issuable | $ 970,000 | ||||||||
Business acquisition, share price | $ 3.09 | ||||||||
Subsequent Event [Member] | Private Placement [Member] | Artificial Intelligence Business [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Total estimated equity investments | $ 4,600,000 | ||||||||
Subsequent Event [Member] | Private Placement [Member] | Seven Percent Senior Secured Notes Due November 2025 [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Debt instrument face amount | $ 75,000,000 | ||||||||
Debt instrument interest rate stated percentage | 7.00% | ||||||||
Subsequent Event [Member] | Restricted Stock Units (RSUs) [Member] | Non Executive Director [Member] | Twenty Twenty One Compensation [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Shared based compensation arrangements by share based payments non option equity instruments granted | 84,032 | ||||||||
Subsequent Event [Member] | Restricted Stock Units (RSUs) [Member] | Certain Employees [Member] | Equity Bonus Awards [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Shared based compensation arrangements by share based payments non option equity instruments granted | 645,000 | ||||||||
Subsequent Event [Member] | Restricted Stock Units (RSUs) [Member] | Signing Bonus [Member] | Executive Officer [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Shared based compensation arrangements by share based payment award shares issued in period | 50,000 | ||||||||
Subsequent Event [Member] | Vested And Settle For Common Shares One Year After Date Of Grant [Member] | Restricted Stock Units (RSUs) [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage | 50.00% | ||||||||
Subsequent Event [Member] | Remaining Vested And Settle For Common Shares Two Years After Date Of Grant [Member] | Restricted Stock Units (RSUs) [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage | 50.00% | ||||||||
Subsequent Event [Member] | Stock Option Plan [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Share based compensation arrangements by share based payments options granted wit an exercise price | $ 3.58 | ||||||||
Share based compensation arrangements by share based payments award expiration period | 7 years | ||||||||
Subsequent Event [Member] | Stock Option Plan [Member] | Consultants Of The Company [Member] | Equity Bonus Awards [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Shared based compensation arrangements by share based payments award options granted in period | 70,000 | ||||||||
Subsequent Event [Member] | Grant Vest One Year After The Date Of Grant [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage | 34.00% | ||||||||
Subsequent Event [Member] | Grant Vest Two Years After The Date Of Grant [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage | 33.00% | ||||||||
Subsequent Event [Member] | Remaining Grant Vest Three Years After The Date Of Grant [Member] | |||||||||
Subsequent Event [Line Items] | |||||||||
Share based compensation arrangements by share based payment RSUs granted vesting rights percentage | 33.00% |