EX-99.3 4 ex99_3.htm EXHIBIT 99.3

NUTEX HEALTH HOLDCO, LLC AND AFFILIATES

COMBINED AND CONSOLIDATED FINANCIAL STATEMENTS

FOR THE THREE MONTHS ENDED MARCH 31, 2022 AND 2021

(UNAUDITED)

 1 

 

 

NUTEX HEALTH HOLDCO, LLC AND AFFILIATES

TABLE OF CONTENTS  

  Page
COMBINED AND CONSOLIDATED FINANCIAL STATEMENTS  
   
Combined and Consolidated Balance Sheets (Unaudited) 3
   
Combined and Consolidated Statements of Income (Unaudited) 4
   
Combined and Consolidated Statements of Changes in Equity (Unaudited) 5
   
Combined and Consolidated Statements of Cash Flows (Unaudited) 6
   
Notes to Combined and Consolidated Financial Statements (Unaudited) 7

 2 

 

 

COMBINED AND CONSOLIDATED BALANCE SHEETS

             
Assets   March 31, 2022   December 31, 2021
Current assets:     (UNAUDITED)      
Cash and cash equivalents   $  35,558,490   $  36,118,284
Accounts receivable      109,917,257      112,766,317
Accounts receivable - related party      125,621      1,993,117
Inventories      2,814,756      2,814,178
Prepaid expenses and other current assets      171,488      323,283
Total current assets      148,587,612      154,015,179
             
Property and equipment, net      159,035,125      151,912,500
Right-of-use assets      95,038,509      86,444,333
Other long-term assets      1,159,476      1,138,734
Goodwill      1,139,297      1,139,297
             
Total assets   $  404,960,019   $  394,650,043
             
Liabilities and Equity            
Current liabilities:            
Accounts payable   $  17,453,779   $  13,582,664
Accounts payable - related party      3,539,372      4,070,438
Lines of credit      2,071,713      72,055
Current portion of long-term debt      8,181,784      10,158,932
Lease liabilities, current portion      3,213,964      2,942,444
Accrued expenses and other current liabilities      7,136,919      6,864,426
Total current liabilities      41,597,531      37,690,959
             
Long-term debt, net      80,373,137      78,821,985
Lease liabilities      95,565,990      86,556,089
Total liabilities      217,536,658      203,069,033
             
Commitments and contingencies            
             
Equity:            
Members' equity      108,979,213      114,651,306
Noncontrolling interest      78,444,148      76,929,704
Total equity      187,423,361      191,581,010
             
Total liabilities and equity   $  404,960,019   $  394,650,043

See accompanying notes to combined and consolidated financial statements.

 3 

 

COMBINED AND CONSOLIDATED STATEMENTS OF INCOME

FOR THE THREE MONTHS ENDED MARCH 31, 2022 AND 2021

(UNAUDITED)

  

             
`   March 31, 2022   March 31, 2021
             
Net revenue   $  79,127,242   $  86,700,006
Selling, general and administrative expenses            
Payroll      25,940,385      19,087,338
Contract services      11,377,432      5,066,973
Medical supplies      4,259,479      2,399,692
Insurance expense      2,658,549      2,043,529
Other      3,255,563      4,296,950
Total selling, general and administrative expenses      47,491,408      32,894,482
Depreciation and amortization      2,396,861      1,787,956
Operating income      29,238,973      52,017,568
             
Interest expense      1,855,974      1,486,157
Other expense (income)      2,380,545      (504,444)
Income before taxes      25,002,454      51,035,855
             
Income tax expense      176,323      156,853
Net income      24,826,131      50,879,002
             
Less: net income attributable to noncontrolling interests      3,383,288      13,116,865
Net income attributable to Nutex Health Holdco members   $  21,442,843   $  37,762,137

 

See accompanying notes to combined and consolidated financial statements.

 4 

 

 

COMBINED AND CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY 

FOR THE THREE MONTHS ENDED MARCH 31, 2022 AND 2021

(UNAUDITED)

 

                   
    Noncontrolling interests   Nutex Health Holdco members   Total equity
Balance at January 1, 2021   $  55,638,769   $  91,730,056   $  147,368,825
Members' contributions      4,176,800      791,610      4,968,410
Members' distributions      (8,831,693)      (30,054,155)      (38,885,848)
Net income      13,116,866      37,762,136      50,879,002
Balance at March 31, 2021      64,100,742      100,229,647      164,330,389
                   
Balance at January 1, 2022      76,929,704      114,651,306      191,581,010
Members' contributions      3,869,201      -      3,869,201
Members' distributions      (5,738,045)      (27,114,936)      (32,852,981)
Net income      3,383,288      21,442,843      24,826,131
Balance at March 31, 2022   $  78,444,148   $  108,979,213   $  187,423,361

See accompanying notes to combined and consolidated financial statements.

 5 

 

 

COMBINED AND CONSOLIDATED STATEMENTS OF CASH FLOWS

FOR THE THREE MONTHS ENDED MARCH 31, 2022 AND 2021

(UNAUDITED)

 

             
    March 31, 2022   March 31, 2021
Cash flows from operating activities:            
Net income   $  24,826,131      50,879,002
Adjustment to reconcile net income to net cash provided by operating activities:            
Depreciation and amortization      2,396,861      1,787,956
Debt issuance cost amortization      -      13,439
Non-cash lease expense      58,857      6,904
Changes in operating assets and liabilities:            
Accounts receivable      2,849,060      8,928,390
Accounts receivable - related party      1,867,496      -
Inventories      (578)      (1,081)
Prepaid expenses and other current assets      131,053      (485,136)
Accounts payable      3,871,115      414,898
Accounts payable - related party      (531,066)      (1,059,194)
Accrued expenses and other current liabilities      272,493      1,174,746
Net cash provided by operating activities      35,741,422      61,659,924
             
Cash flows from investing activities:            
Acquisitions of property and equipment      (8,591,823)      (11,164,752)
Net cash used in investing activities      (8,591,823)      (11,164,752)
             
Cash flows from financing activities:            
Proceeds from lines of credit      2,044,765      -
Proceeds from notes payable      2,192,309      8,400,000
Repayments of lines of credit      (45,107)      (766,961)
Repayments of notes payable      (2,590,917)      (6,157,335)
Repayments of finance leases      (299,275)      (252,571)
Payment of debt issuance costs      (27,388)      (13,975)
Members' contributions      3,869,201      4,968,410
Members' distributions      (32,852,981)      (38,885,848)
Net cash used in financing activities      (27,709,393)      (32,708,280)
             
Net increase (decrease) in cash and cash equivalents      (559,794)      17,786,892
Cash and cash equivalents - beginning of the period      36,118,284      25,514,275
Cash and cash equivalents - end of the period   $  35,558,490      43,301,167
             
Supplemental disclosures of cash flow information:            
Cash paid for interest   $  875,355   $  974,290
Cash paid for income taxes   $  18,473   $  -
Non-cash investing and financing activities:            
Acquisition of financing leases   $  9,937,104   $  4,021,269

See accompanying notes to combined and consolidated financial statements.

 6 

 

 

NUTEX HEALTH HOLDCO, LLC AND AFFILIATES

NOTES TO COMBINED AND CONSOLIDATED FINANCIAL STATEMENTS

MARCH 31, 2022 AND 2021

(UNAUDITED)

 

Note 1 – Organization and Operations

Nutex Health Holdco, LLC (the “Company”, “Nutex”, “we” or “our”) is a holding company in the micro-hospital and hospital outpatient department formed on October 22, 2021, as a Delaware limited liability company. The Company owns and operates 21 facilities in eight states across the Southwest and Midwest United States. We employ approximately 1500 employees and partner with over 800 physicians. Our corporate headquarters is based in Houston, Texas.

Merger with Clinigence Holdings. On April 1, 2022, the Company’s merger with Clinigence Holdings, Inc., a Delaware corporation (“Clinigence”), was completed pursuant to the Agreement and Plan of Merger (the “Merger Agreement”) entered on November 23, 2021 between Clinigence, Nutex Acquisition LLC, a Delaware limited liability company and wholly-owned subsidiary of Clinigence, Nutex, Micro Hospital Holding LLC (solely for the purposes of certain sections of the Merger Agreement), Nutex Holdco LLC (solely for the purposes of certain sections of the Merger Agreement) and Thomas Vo, M.D., not individually but in his capacity as the representative of the equity holders of Nutex.

In connection with the Merger Agreement, Nutex entered into certain Contribution Agreements with holders of equity interests (“Nutex Owners”) of subsidiaries and affiliates of Nutex and MHH (the “Nutex Subsidiaries”) pursuant to which such Nutex Owners agreed to contribute certain equity interests in the Nutex Subsidiaries to Nutex in exchange for specified equity interests in Nutex (collectively, the “Contribution Transaction”). Nutex owners having ownership interests representing approximately 84% of the agreed upon equity value of the Nutex Subsidiaries agreed to contribute all or a portion of their equity interests, as applicable.

Pursuant to the Merger Agreement, each unit representing an equity interest in Nutex issued and outstanding immediately prior to the effective time of the Merger but after the Contribution Transaction (collectively, the “Nutex Membership Interests”) was converted into the right to receive 3.571428575, or aggregate of 592,791,712 shares of common stock of Clinigence.

Under the terms of the Contribution Agreements, contributing owners of the Under Development Hospitals and Ramping Hospitals are eligible to receive a one-time additional issuance of Company Common Stock based on their TTM EBITDA as determined on the 24th anniversary of the opening. Such additional shares will be issued at the greater of the price of the Company Common Stock at the time of determination and $2.80.

The Merger was accounted for as a “reverse merger,” with Nutex as the accounting acquirer in accordance with ASC 805, Business Combinations, and Clinigence as the accounting acquiree.

Basis of Presentation. These financial statements are presented for periods before the Company’s merger with Clinigence was completed and present the combined and consolidated financial statements of Nutex and the Nutex Subsidiaries, giving effect to the transactions contemplated by the Contribution Agreements. These entities include:

100% of Nutex Health, LLC (“Nutex Health”), a healthcare service provider and facility management firm;
100% of Tyvan Billing, LLC (“Tyvan”), a healthcare billing and collections company; and
Ownership interests in certain emergency room entities (“ER Entities”) as discussed below.

 7 

 

 

The Company’s ownership interest in the ER Entities is presented in the following table:

  ER Entity Location Ownership
Under development      
  ABQ Hospital, LLC Albuquerque, NM 100.00%
  Columbus ER Hospital, LLC Columbus, OH 100.00%
  Covington Hospital, LLC Mandeville, LA 64.36%
  Fort Smith Emergency Hospital, LLC Fort Smith, AR 100.00%
  Gahanna Hospital, LLC Gahanna OH 100.00%
  Breen Bay Hospital, LLC Green Bay, WI 70.00%
  Miami ER & Hospital, LLC Miami, FL 67.00%
  Milwaukee Hospital, LLC Milwaukee, WI 70.00%
  Royse City ER, LLC Royse City, TX 89.50%
  Vance Jackson Hospital, LLC San Antonio, TX 61.00%
  Starkey Hospital, LLC Trinity, FL 62.00%
  Jacksonville ER & Hospital, LLC Jacksonville, FL 60.00%
  Maricopa Hospital, LLC Maricopa, AZ 100.00%
  Medistar Micro Hospital of Portage, LLC Portage, IN 74.90%
Operating less than 2 years      
  Northwest Indiana Hospital, LLC Hammond, IN 74.90%
  Everest Real Estate Investments, LLP Humble, TX 100.00%
  Texoma ER, LLC Sherman, TX 100.00%
  Topeka ER Hospital, LLC Topeka, KS 100.00%
  East Valley Hospital, LLC Gilbert, AZ 100.00%
  NB Hospital, LLC New Braunfels, TX 61.00%
Operating more than 2 years      
  Albuquerque ER, LLC Albuquerque, NM 100.00%
  Alexandria Hospital, LLC Alexandria, LA 99.50%
  Healthcare HL Emergency Services, LLC The Colony, TX 64.17%
  Kyle ER, LLC Kyle, TX 46.32%
  Little Rock Hospital 1, LLC Cabot, AR 81.99%
  Oklahoma ER Hospital, LLC Oklahoma City, OK 68.70%
  Phoenix ER and Medical Hospital, LLC Phoenix, AZ 100.00%
  Texarkana ER, LLC Texarkana, TX 100.00%
  Tucson Hospital, LLC Tucson, AZ 100.00%
  Tulsa ER & Hospital, LLC Tulsa, AZ 79.62%
  Wylie ER, LLC Wylie, TX 80.17%

In addition, the ER Entities have financial and operating relationships with multiple professional entities (the “PLLCs”) and real estate entities (the “REEs”). The PLLCs employ the doctors who work in our emergency rooms. These entities are consolidated by the Company as variable interest entities (“VIEs”) because they do not have significant equity at risk, and the ER Entities have historically supported the PLLCs cash shortages and received the benefits of their cash surpluses.

The REEs own the land and hospital buildings which are leased to the ERs. The REEs have mortgage loans payable to third parties which are collateralized by the land and buildings. The REEs are also consolidated by the Company as VIEs because they do not have sufficient equity at risk and the ER Entities are guarantors of the outstanding mortgage loans.

 8 

 

The Company has no direct or indirect ownership interest in the PLLCs or REEs, so 100% of the equity for these entities is shown as non-controlling interest in the consolidated and combined balance sheets and statements of income. See Note 12 – Variable Interest Entities for more information concerning these entities.

All significant intercompany balances and transactions have been eliminated in consolidation.

Note 2 - Summary of Significant Accounting Policies

These unaudited combined and consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) regarding interim financial reporting Accordingly, they do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”). The unaudited combined and consolidated financial statements contained in this report include all material adjustments of a normal recurring nature that, in the opinion of management, are necessary for a fair presentation of the results of operations for the interim periods presented. These interim financial statements should be read together with the combined and consolidated financial statements and notes thereto included in our audited financial statements for the years ended December 31, 2021 and 2020.

Certain of our significant accounting policies are discussed below:

Use of Estimates. The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amount of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Significant items subject to such estimates and assumptions include (i) estimates of net revenue and accounts receivable and (ii) impairment of long-lived assets and goodwill. Actual results could differ from those estimates.

Fair Value Measurements. The estimated fair value of accounts receivable, accounts payable, accrued expenses and notes payable approximate the carrying amount due to the relatively short maturity or time to maturity of these instruments. Accounts receivable and payable with related parties may not be arms-length transactions and therefore, may not reflect fair value.

Recent Accounting Pronouncements. There are no new accounting pronouncements that are expected to have a material impact on the consolidated financial statements.

Note 3 - Net Patient Service Revenue

The Company receives payment for services rendered from federal agencies, private insurance carriers, and patients for facility services from the ER Entities’ and doctor services from the PLLC’s. On average, greater than 97% of revenues are paid by insurers, federal agencies, and other non-patient third parties. The remaining revenues are paid by our patients in the form of copays, deductibles, and self-payment.

 9 

 

Patient service revenue, net of allowances and discounts, recognized from the ER Entities and PLLCs for the three months ended March 31, 2022 and 2021 are as follows:

   2022  2021
Emergency room facilities services revenue  $66,665,156   $70,688,965 
PLLC services revenue   12,462,086    16,011,041 
Net revenue  $79,127,242   $86,700,006 

The following tables present our percentage of payments received by payor type:

    2022   2021
Insurance     96%     96%
Self pay     3%     3%
Workers compensation     1%     1%
Medicare/Medicaid     0%     0%
Total payments received     100%     100%

Note 4 - Property and Equipment

The principal categories of property and equipment are summarized as follows:

    Useful lives (Years)   March 31, 2022   December 31, 2021
Buildings     39   $  81,465,517   $  81,985,734
Land     -      21,182,949      18,201,804
Land improvements     39      808,595      808,595
Leasehold improvements     10-39      28,929,401      27,038,503
Construction in progress     -      8,065,149      4,299,614
Machinery and equipment     10      26,105,816      25,686,562
Office furniture and equipment     7      2,870,270      2,870,270
Computer hardware and software     5      1,339,258      1,288,224
Vehicles     5      161,590      161,590
Signage     10      1,164,368      1,160,195
Total cost            172,092,914      163,501,091
Less: accumulated depreciation            13,057,789      11,588,591
Total property and equipment, net         $  159,035,125   $  151,912,500

Note 5 - Debt

The Company and its affiliates have entered into private debt arrangements with banking institutions for the purposes of purchasing land, constructing new emergency room facilities, building out leasehold improvements, purchasing equipment, and to provide working capital and liquidity through cash and lines of credit (“LOC”).

 10 

 

The Company’s outstanding debt is shown in the following table:

                             
Facility   Type of Debt   Collateral/Guarantors   Maturity Date   Annual Interest rate   March 31, 2022   December 31, 2021
Kyle ER, LLC:                    
    Term Loan   Company assets and Members   04-2023   3.25%   $  145,049   $  180,564
Texarkana Emergency Center & Hospital, LLC:                    
    Term Loan   Company assets and Members   07-2025   4.75%      317,297      339,739
    Term Loan   Acquired Equipment   08-2025   4.75%      245,223      262,099
    Term Loan   Acquired Equipment   09-2025   4.90%      64,644      68,963
Texarkana Assets, LLC:                    
    Term Loan   Commercial Properties and Members   12-2024   5.75%      2,514,675      2,738,844
    Term Loan   land and building and Members   12-2024   5.75%      288,282      371,206
    Term Loan   land and building and Members   04-2032   5.25%      1,054,600      1,100,831
Alexandria Hospital, LLC:                    
    Term Loan   land and building and Members   10-2029   4.00%      -      3,303,391
    Term Loan   Acquired Equipment   07-2024   6.90%      288,276      316,506
    Term Loan   Acquired Equipment   09-2024   6.90%      135,655      143,896
    Term Loan   Company assets and Members   11-2025   4.90%      69,727      74,151
    Term Loan   Acquired Equipment   07-2025   4.62%      53,507      57,300
Alexandria Assets, LLC:                    
    Term Loan   Land and Members   10-2029   5.61%      2,867,060      2,961,579
    Term Loan   Land and Members   10-2029   3.25%      3,228,187      -
Albuquerque ER, LLC:                    
    Term Loan   Acquired Equipment   10-2024   5.18%      234,017      270,720
    Term Loan   Acquired Equipment   04-2024   5.26%      103,423      119,629
Albuquerque Assets, LLC:                    
    Term Loan   Land Construction and Members   10-2023   4.80%      4,735,283      4,893,861
Little Rock Hospital 1, LLC:                    
    Term Loan   Company assets and Members   07-2024   5.50%      127,598      315,081
    Term Loan   Commercial Properties and Members   07-2024   5.50%      769,774      846,555
    Term Loan   Acquired Equipment   07-2024   5.50%      66,974      73,918
    Term Loan   Acquired Equipment   07-2024   4.66%      87,961      97,179
    Term Loan   Acquired Equipment   10-2024   5.50%      27,730      30,300
    Term Loan   Acquired Equipment   11-2024   4.37%      206,111      224,851
    Term Loan   Acquired Equipment   11-2024   4.49%      293,529      320,171
    Term Loan   Acquired Equipment   08-2025   4.75%      63,785      68,175
Cabot Assets LLC:                    
    Term Loan   Commercial Properties and Members   01-2036   4.25%      4,232,514      4,289,290
Northwest Indiana Hospital LLC:                    
    Term Loan   Acquired Equipment   05-2025   4.75%      367,618      385,713
    Term Loan   Acquired Equipment   06-2025   4.75%      233,450      250,430
    Term Loan   Acquired Equipment   06-2025   4.75%      121,466      127,204
    Term Loan   Acquired Equipment   07-2025   4.75%      36,344      38,914
Oklahoma ER, LLC:                    
    Term Loan   Equipment and fixtures.   02-2024   4.75%      1,456,044      1,646,311
    Term Loan   Acquired Equipment   01-2024   5.73%      94,426      107,161
    Term Loan   Acquired Equipment   02-2024   5.52%      232,997      252,119
Oklahoma Assets:                    
    Term Loan   Members   03-2031   5.45%      8,012,294      8,120,072
Phoenix ER Chandler Holdings LLC:                    
    Term Loan   Members   11-2030   3.78%      6,526,754      6,586,694
Phoenix ER, LLC:                    
    Term Loan   Land Construction and Members   01-2025   5.00%   $  122,800   $  266,846
    LOC Company assets and Members   on demand   4.50%      500,000      -
Topeka ER Hospital LLC:                    
    Term Loan   Company assets and Members   07-2025   4.15%      1,027,653      1,132,571
    Term Loan   Company assets and Members   07-2021   4.75%      136,875      286,875
    Term Loan   Equipment and Members   07-2025   4.75%      386,896      414,261
    Term Loan   Equipment and Members   07-2025   4.75%      243,776      261,018
    Term Loan   Equipment and Members   07-2025   4.75%      123,168      131,880
    Term Loan   Equipment and Members   09-2025   4.75%      38,826      41,427
Tucson Hospital, LLC:                    
    Term Loan   Equipment and Members   07-2024   4.74%      266,301      294,179
    Term Loan   Equipment and Members   09-2024   4.19%      190,143      208,738
    Term Loan   Equipment and Members   10-2024   4.25%      48,171      52,713
Tucson Assets, LLC:                    
    Term Loan   Company assets and Members   03-2025   3.21%      5,749,187      5,808,525
Wylie Asset LLC:                    
    Term Loan       06-2031   3.65%      3,663,126      3,696,098
SE Texas:                    
    Term Loan   Company assets and Members       3.50%      12,850      -
SETX Assets LLC:                    
    Term Loan   Company assets and Members   08-2025   3.50%      7,542,318      7,588,234
TULSA Assets LLC:                    
    Term Loan   Company assets and Members   12-2040   4.00%      12,398,608      12,510,411
Texoma ER LLC:                    
    Term Loan   Company assets and Members   08-2023   6.00%      541,843      632,559
    Term Loan   Equipment and Members   09-2026   5.50%      483,504      507,524
    LOC   Company assets and Members   05-2022   6.50%      26,948      72,055
Gilbert Assets LLC:                    
    Vo Family LP   Company assets and Members   08-2022   2.84%      8,400,000      8,400,000
East Valley Hospital:                    
    Term Loan   Company assets and Members   06-2027   3.50%      1,600,000      838,201
    Term Loan   Company assets and Members   06-2027   3.50%      3,631,945      2,631,945
    LOC   Company assets and Members   on demand   3.75%      592,714      -
NB Hospital:                    
    Term Loan   Company assets and Members   02-2027   4.25%      2,748,042      2,595,184
    LOC   Company assets and Members   01-2023   4.50%      952,050      -
Fort Smith Building, LLC                    
    Term Loan   Company assets and Members   12-2028   3.95%      112,442      -

Fort Smith Emergency Hospital:

                   
    Term Loan   Company assets and Members   12-2028   3.95%      113,254      -
Total   $  90,955,714   $  89,354,663
Less: unamortized debt issuance costs      329,080      301,691
Less: short-term lines of credit      2,071,713      72,055
Less: current portion of long-term debt      8,181,784      10,158,932
Total debt reflected as long-term   $  80,373,137   $  78,821,985

The term loan for Kyle ER is subject to a minimum debt service coverage Ratio (“DSCR”) of 1.15:1, tested annually. The term loan to Texarkana ER is subject to a minimum DSCR of 1.25:1, tested annually. The term loan to Tucson ER and Tucson Assets are subject to a minimum DSCR of 1.25:1 and minimum fixed charge coverage ratio of 1.15:1, tested quarterly. The term loans to Alexandria ER and Alexandria Assets are subject to a minimum DSCR of 1.2:1, tested annually, and require one of the partnerships to maintain unencumbered cash and cash equivalents in excess of $5,000,000. The term loan to Phoenix ER is subject to a minimum DSCR of 1.2:1, tested semi-annually at June 30th and December 31st of each calendar year, and must maintain liquid assets of not less than $750,000 to be tested annually, and must maintain a cash reserve account with the bank containing an average balance of $250,000 or greater, tested quarterly. The term loan to Topeka ER is subject to a minimum DSCR of 1.3:1.

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Note 6 - Accrued Expenses and Other Current Liabilities

Accrued expenses and other current liabilities consisted of the following:

    March 31, 2022   December 31, 2021
Accrued wages and benefits   $  3,414,477   $  2,645,750
Accrued other      3,722,442      4,218,676
Total accrued expenses and other current liabilities   $  7,136,919   $  6,864,426

Note 7 – Leases

The Companies have entered into hospital property and equipment rental agreements with various lessors. The ER Entities have intercompany lease agreements with the REEs, which are eliminated and not shown in the tables below. The third party leases shown in the following tables represent hospital building and medical equipment leases. The hospital operating leases expire on various dates between July 2024 through June 2039.

The following tables disclose information about third-party leases as of and for the three months ended March 31, 2022 and 2021:

        March 31, 2022   March 31, 2021
Operating lease cost         $  692,669   $  351,357
Finance lease cost:                  
Amortization of right-of-use assets            927,664      556,971
Interest on lease liabilities            980,619      498,428
Total finance lease cost         $  1,908,283   $  1,055,399

 

Minimum lease payments for the next five years as of March 31, 2022 are as follows:   Operating leases   Third-party finance leases   Related party finance leases
2022   $  1,936,735   $  3,502,803   $  679,500
2023      2,617,491      4,668,310      931,635
2024      2,658,438      4,403,112      959,584
2025      2,728,898      4,235,966      988,372
2026      2,648,019      4,338,317      1,018,023
2027      2,648,049      4,443,157      1,048,563
Thereafter      13,503,978      69,998,442      26,812,661
Total minimum lease payments      28,741,607      95,590,107      32,438,338
Less interest      (6,787,431)      (36,095,035)      (15,107,632)
Total lease liabilities   $  21,954,176   $  59,495,072   $  17,330,706

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Note 8 - Employee Benefit Plans

The Company’s employees are eligible to participate in the 401(k) Savings Plan. There are no restrictions in eligibility to contribute to the 401(k) Savings Plan. Salary deferrals are allowed in amounts up to 100% of an eligible employee’s salary, not to exceed the maximum allowed by law. Texarkana Emergency Center & Hospital, LLC (“Texarkana”) is the only entity which may contribute a discretionary match up to 5% of its employees’ salaries. For the three months ended March 31, 2022 and 2021, Texarkana did not make significant discretionary contributions to the employee plan.

Note 9 - Commitments and Contingencies

Litigation. Certain of the companies in these combined and consolidated financial statements are named in various claims and legal actions in the normal course of business. Based upon counsel and management’s opinion, the outcome of such matters is not expected to have a material adverse effect on the Company’s combined and consolidated financial statements.

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Note 10 – Segment Information

Reportable segment information, including intercompany transactions, is presented below:

    For the Three Months Ended March 31, 2022
      Healthcare     Real Estate     Eliminations     Consolidated
Net revenue   $  79,127,242   $  -   $  -   $  79,127,242
Rental income      -      4,045,969      (4,045,969)      -
Selling, general and administrative expenses                        
Payroll      25,940,385      -      -      25,940,385
Contract services      11,194,920      182,512      -      11,377,432
Medical supplies      4,259,479      -      -      4,259,479
Insurance expense      2,658,549      -      -      2,658,549
Other      4,079,482      51,080      (874,999)      3,255,563
Total selling, general and administrative expenses      48,132,815      233,592      (874,999)      47,491,408
Depreciation and amortization      3,269,771      -      (872,910)      2,396,861
Operating income      27,724,656      3,812,377      (2,298,060)      29,238,973
                         
Interest expense      2,714,899      (963,568)      104,643      1,855,974
Other expense (income)      1,264,825      245,137      870,583      2,380,545
Income before taxes      23,744,932      4,530,808      (3,273,286)      25,002,454
                         
Income tax expense      167,323      9,000      -      176,323
Net income      23,577,609      4,521,808      (3,273,286)      24,826,131
                         
Less: net income attributable to noncontrolling interests      3,078,398      4,521,808      (4,216,918)      3,383,288
Net income attributable to Nutex Health Holdco members   $  20,499,211   $  -   $  943,632   $  21,442,843
                         
Capital expenditures   $  2,365,359   $  6,226,464   $  -   $  8,591,823

 

   As of March 31, 2022
Total assets  $414,175,482   $179,412,493   $(188,627,956)  $404,960,019 

 

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    For the Three Months Ended March 31, 2021
      Healthcare     Real Estate     Eliminations     Consolidated
Net revenue   $  86,700,006   $  -   $  -   $  86,700,006
Rental income      -      11,054,153      (11,054,153)      -
Selling, general and administrative expenses                        
Payroll      19,087,338      -      -      19,087,338
Contract services      5,018,469      48,504      -      5,066,973
Medical supplies      2,399,692      -      -      2,399,692
Insurance expense      2,043,529      -      -      2,043,529
Other      4,098,867      33,273      164,810      4,296,950
Total selling, general and administrative expenses      32,647,895      81,777      164,810      32,894,482
Depreciation and amortization      2,753,578      4,190      (969,812)      1,787,956
Operating income      51,298,533      10,968,186      (10,249,151)      52,017,568
                         
Interest expense      2,440,265      (1,046,051)      91,943      1,486,157
Other expense (income)      (495,445)      65,397      (74,396)      (504,444)
Income before taxes      49,353,713      11,948,840      (10,266,698)      51,035,855
                         
Income tax expense      147,853      9,000      -      156,853
Net income      49,205,860      11,939,840      (10,266,698)      50,879,002
                         
Less: net income attributable to noncontrolling interests      12,269,447      11,939,840      (11,092,422)      13,116,865
Net income attributable to Nutex Health Holdco members   $  36,936,413   $  -   $  825,724   $  37,762,137
                         
Capital expenditures   $  481,956   $  10,682,796   $  -   $  11,164,752

 

   As of December 31, 2021
Total assets  $408,958,074   $172,012,691   $(186,320,722)  $394,650,043 

Note 11 – Related Party Transactions

Certain Members of the Companies may have member interests in other entities which are not included within these combined and consolidated financial statements. Transactions with these entities or directly with members of the Companies are classified as related party transactions and are disclosed in the following tables as of March 31, 2022, and December 31, 2021, and for the nine months ended March 31, 2022 and 2021.  The income statement amounts primarily relate to Tyvan’s billing services provided to related parties.

             
Balance sheet line items containing related party amounts as of:   March 31, 2022   December 31, 2021
Accounts receivable - related party    $  125,621    $  1,993,117
Accounts payable - related party      3,539,372      4,070,438
             
Income statement line items containing related party amounts for the three months ended:   March 31, 2022   March 31, 2021
Selling, general and administrative expenses    $  390,871    $  -
Other expense (income) – with unconsolidated entities      (412,554)      (647,908)

Dr. Thomas Vo, our CEO, has made advances to SE Texas ER which are reported as accounts payable – related party. These advances have no stated maturity and bear no interest.

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Note 12 – Variable Interest Entities

The PLLCs and REEs are consolidated in these financial statements as VIEs. The following tables provide the balance sheet amounts related to the VIEs:

    March 31, 2022
    REEs     PLLCs     Total
Current assets $  8,278,425   $  19,921,958   $  28,200,383
Fixed assets    27,905,609      -      27,905,609
Long-term assets    143,228,459      4,279      143,232,738
                 
Total assets    179,412,493      19,926,237      199,338,730
                 
Current liabilities    3,423,167      5,317,978      8,741,145
Long-term liabilities    71,097,883      930,000      72,027,883
                 
Total liabilities    74,521,050      6,247,978      80,769,028
                 
Equity    104,891,443      13,678,259      118,569,702
                 
Total liabilities and equity $  179,412,493   $  19,926,237   $  199,338,730
                 

 

   December 31, 2021
   REEs  PLLCs  Total
Current assets  $10,959,090   $22,035,457   $32,994,547 
Fixed assets   32,182,902    —      32,182,902 
Long-term assets   128,870,699    4,279    128,874,978 
                
Total assets   172,012,691    22,039,737    194,052,428 
                
Current liabilities   6,666,690    5,070,706    11,737,396 
Long-term liabilities   68,850,689    930,000    69,780,689 
                
Total liabilities   75,517,379    6,000,706    81,518,085 
                
Equity   96,495,312    16,039,031    112,534,343 
                
Total liabilities and equity  $172,012,691   $22,039,737   $194,052,428 

The revenue and operating income for the REEs can be found in Note 10 – Segment Information. The revenue for the PLLCs can be found in Note 3 - Net Patient Service Revenue and the operating income (loss) for the three months ended March 31, 2022 and 2021 was $(420,460) and $6,068,008, respectively.

The assets of each of the ER Entities may only be used to settle the liabilities of that entity or its consolidated VIEs and may not be required to be used to settle the liabilities of any of the other ER Entities, other VIEs, or corporate entity. Additionally, the assets of corporate entities cannot be used to settle the liabilities of VIEs. The Company has aggregated all of the PLLCs and REEs into two categories above, because they have similar risk characteristics, and presenting distinct financial information for each VIE would not add more useful information.

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Note 13 - Subsequent Event

The Company has evaluated subsequent events through the filing of this report and determined that there have been no events that have occurred that would require adjustments to our disclosures in the combined and consolidated financial statements except for the transaction described below.

Merger with Clinigence Holdings. As discussed in Note 1, the Company’s merger with Clinigence was completed on April 1, 2022.

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