Income Taxes (Tables)

12 Months Ended

Dec. 31, 2019

Components of Income (Loss) Before Income Taxes

The components of the Company's (loss) income before income taxes are as follows:



	Year Ended December 31,
	2019			2018			2017
	(amounts in thousands)
United States	$	(24,783	)	$	(18,619	)	$	3,826
Foreign	572			424			475
(Loss) income before income taxes	$	(24,211	)	$	(18,195	)	$	4,301

Components of Income Tax Expense (Benefit)

The components of the Company’s income tax expense (benefit) are as follows:



	Year Ended December 31,
	2019			2018			2017
	(amounts in thousands)
Current:
Federal	$	(35	)	$	43		$	(555	)
State	499			620			(273		)
Foreign	109			269			139
Total	573			932			(689		)
Deferred:
Federal	17,406			(2,137		)	(23,245		)
State	13,799			(1,277		)	(10,684		)
Foreign	(46		)	4			117
Total	31,159			(3,410		)	(33,812		)
Income tax expense (benefit)	$	31,732		$	(2,478	)	$	(34,501	)

Significant Components of Deferred Tax Assets and Liabilities

Significant components of the Company’s deferred tax assets and liabilities are as follows:



	December 31,
	2019			2018
	(amounts in thousands)
Deferred Tax Assets:
Accrued other and prepaid expenses	$	1,557		$	2,734
Allowance for doubtful accounts	624			607
Intangible assets (a)	28,889			11,300
Net operating loss carryforwards	19,796			15,717
Accrued professional liability claims	1,794			1,952
Accrued workers’ compensation claims	2,839			2,729
Share-based compensation	381			646
Operating lease liabilities	6,108			—
Credit carryforwards	188			188
Other	128			542
Gross deferred tax assets	62,304			36,415
Valuation allowance	(37,345		)	(1,189		)
	24,959			35,226
Deferred Tax Liabilities:
Depreciation	(224		)	(52		)
Indefinite intangibles (a)	(27,609		)	(11,136		)
Operating lease right-of-use assets	(4,312		)	—
Tax on unrepatriated earnings	(337		)	(383		)
	(32,482		)	(11,571		)
Net deferred taxes	$	(7,523	)	$	23,655

________________

(a) As a result of the valuation allowance recorded in 2019, the Company changed its presentation of deferred tax assets and liabilities related to indefinite-lived intangibles to conform with the methodology used in calculating the valuation allowance.

Reconciliation of Income Tax Computed At U. S. Federal Statutory Rate to Income Tax (Benefit) Expense

The reconciliation of income tax computed at the U.S. federal statutory rate to income tax expense (benefit) is as follows:



	Year Ended December 31,
	2019			2018			2017
	(amounts in thousands)
Tax at U.S. statutory rate	$	(5,084	)	$	(3,821	)	$	1,506
State taxes, net of federal benefit	(554		)	(543		)	(1,374		)
Noncontrolling interest	(372		)	(252		)	(455		)
Non-deductible items (a)	759			625			2,676
Foreign tax (benefit) expense	(58		)	180			175
Valuation allowances	36,224			—			(45,354		)
Uncertain tax positions	400			1,629			1,145
Return to provision	—			(458		)	—
Federal rate change	—			—			8,011
Other	417			162			(831		)
Income tax expense (benefit)	$	31,732		$	(2,478	)	$	(34,501	)

________________

(a) Includes non-deductible meals and incidentals, miscellaneous non-deductible items, and beginning in 2018, non-deductible stock-based compensation.

Reconciliation of Beginning and Ending Amounts of Unrecognized Tax Benefits

A reconciliation of the beginning and ending amounts of unrecognized tax benefits is as follows:



	Year Ended December 31,
	2019			2018		2017
	(amounts in thousands)
Balance at January 1	$	5,412		$	3,807	$	5,180
Additions based on tax positions related to the current year	1,283			1,401		1,145
(Reductions) additions based on tax positions related to prior years	(498		)	204		—
Reductions based on settlements of tax positions related to prior years	—			—		(439		)
Reductions as a result of a lapse of applicable statute of limitations	(405		)	—		—
2017 Tax Act federal tax rate change	—			—		(1,859		)
Other	—			—		(220		)
Balance at December 31	$	5,792		$	5,412	$	3,807