0001193125-21-138424.txt : 20210429 0001193125-21-138424.hdr.sgml : 20210429 20210429080128 ACCESSION NUMBER: 0001193125-21-138424 CONFORMED SUBMISSION TYPE: 40-F/A PUBLIC DOCUMENT COUNT: 117 CONFORMED PERIOD OF REPORT: 20201231 FILED AS OF DATE: 20210429 DATE AS OF CHANGE: 20210429 FILER: COMPANY DATA: COMPANY CONFORMED NAME: AKUMIN INC. CENTRAL INDEX KEY: 0001776197 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 000000000 STATE OF INCORPORATION: A6 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 40-F/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-39479 FILM NUMBER: 21867150 BUSINESS ADDRESS: STREET 1: 151 BLOOR STREET WEST, SUITE 603 CITY: TORONTO STATE: A6 ZIP: M5S 1S4 BUSINESS PHONE: 844-730-0050 MAIL ADDRESS: STREET 1: 151 BLOOR STREET WEST, SUITE 603 CITY: TORONTO STATE: A6 ZIP: M5S 1S4 40-F/A 1 d163944d40fa.htm 40-F/A 40-F/A

 

 

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

 

AMENDMENT NO.1 TO

FORM 40-F/A

 

☐

  

Registration statement pursuant to Section 12 of the Securities Exchange Act of 1934

    

or

   

☒

  

Annual report pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934

 

             For the fiscal year ended December 31, 2020    Commission File Number 001-39479

 

 

AKUMIN INC.

(Exact name of Registrant as specified in its charter)

 

Ontario    8071    N/A

(Province or other jurisdiction of

incorporation or organization)

   

(Primary Standard Industrial

Classification

Code)

   

(I.R.S. Employer

Identification Number)

8300 W. Sunrise Boulevard

Plantation, Florida 33322

Tel: (844) 730-0050

(Address and telephone number of Registrant’s principal executive offices)

 

 

Akumin Corp.

8300 W. Sunrise Boulevard

Plantation, Florida 33322

Tel: (844) 730-0050

(Name, address (including zip code) and telephone number (including area code) of agent for service in the United States)

 

 

Securities registered or to be registered pursuant to Section 12(b) of the Act.

 

 

Title of each class

   

 

Trading Symbol

   

 

Name of each exchange on which

registered

 

 

Common Shares, no par value

 

   

AKU

 

   

The Nasdaq Stock Market LLC

 

Securities registered or to be registered pursuant to Section 12(g) of the Act: None

Securities for which there is a reporting obligation pursuant to Section 15(d) of the Act:  None

For annual reports, indicate by check mark the information filed with this Form:

 

☒ Annual information form

   

☒ Audited annual financial statements

Indicate the number of outstanding shares of each of the Registrant’s classes of capital or common stock as of the close of the period covered by the annual report: 70,178,428

Indicate by check mark whether the Registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Exchange Act during the preceding 12 months (or for such shorter period that the Registrant was required to file such reports) and (2) has been subject to such filing requirements for the past 90 days. ☒ Yes        ☐ No

Indicate by check mark whether the Registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the Registrant was required to submit such files). ☐ Yes ☐ No

Indicate by check mark whether the Registrant is an emerging growth company as defined in Rule 12b-2 of the Exchange Act.

Emerging growth company ☒

If an emerging growth company that prepares its financial statements in accordance with U.S. GAAP, indicate by check mark if the Registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards† provided pursuant to Section 13(a) of the Exchange Act. ☐

† The term “new or revised financial accounting standard” refers to any update issued by the Financial Accounting Standards Board to its Accounting Standards Codification after April 5, 2012.

Indicate by check mark whether the Registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report.            ☐

 

 

 

 

 

EXPLANATORY NOTE

This Amendment No. 1 to Form 40-F (the “Form 40-F/A”) for the year ended December 31, 2020 is being filed to furnish the financial statements of Akumin Inc. (the “Company”) for the fiscal year ended December 31, 2020 formatted in eXtensible Business Reporting Language (“XBRL”). In accordance with the policy of the Securities and Exchange Commission (the “Commission”) stated in Release No. 33-9002, we are filing this Form 40-F/A within the 30-day period available to first-time XBRL filers following the filing of our Form 40-F, as filed with the Commission on March 31, 2021.

 

1

 

EXHIBIT INDEX

 

Exhibit

Number

    Exhibit Description
99.1*    Certification of Chief Executive Officer pursuant to Rule 13a-14(a) of the Exchange Act, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
99.2*    Certification of Chief Financial Officer pursuant to Rule 13a-14(a) of the Exchange Act, as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002
99.3*    Certification of Chief Executive Officer and Chief Financial Officer pursuant to Rule 13a-14(b) of the Exchange Act and 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002
99.4*    Annual Information Form of the Company for the year ended December 31, 2020
99.5*    Management’s Discussion and Analysis for the year ended December 31, 2020
99.6*    Audited consolidated financial statements of the Company and notes thereto as at and for the years ended December  31, 2020 and 2019, together with the report of the Independent Registered Public Accounting Firm thereon
99.7*    Condensed Interim Consolidated Financial Statements (Unaudited) of Akumin Inc. dated March 31, 2020
99.8*    Condensed Interim Consolidated Financial Statements (Unaudited) of Akumin Inc. dated June 30, 2020
99.9*    Condensed Interim Consolidated Financial Statements (Unaudited) of Akumin Inc. dated September 30, 2020
99.10*    Consent of Ernst & Young LLP
101.INS    XBRL Instance
101.SCH    XBRL Taxonomy Extension Schema
101.CAL    XBRL Taxonomy Extension Calculation Linkbase
101.DEF    XBRL Taxonomy Extension Definition Linkbase
101.LAB    XBRL Taxonomy Extension Label Linkbase
101.PRE    XBRL Taxonomy Extension Presentation Linkbase

*Previously filed.

 

2

 

SIGNATURES

Pursuant to the requirements of the Exchange Act of 1934, as amended, the Company certifies that it meets all of the requirements for filing on Form 40-F and has duly caused this Form 40-F/A to be signed on its behalf by the undersigned, thereunto duly authorized.

 

AKUMIN INC.

By:

  

/s/ Riadh Zine

 

Name: Riadh Zine

 

Title: Chief Executive Officer

Date: April 29, 2021

 

3

 

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Previously, the Company&#8217;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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">9-months</div> ended September&#160;30, 2020. On August&#160;28, 2020, the Company filed a Form <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">40-F</div> with the United States Securities and Exchange Commission pursuant to Section&#160;12 of the Securities Exchange Act of 1934. This filing resulted in the Company becoming an &#8220;SEC Issuer&#8221; for purposes of National Instrument <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">51-102</div> -- Continuous Disclosure Obligations and as such the Company is entitled to prepare and report its financial statements in GAAP as opposed to IFRS. </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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&#8217;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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">on-going</div> trends, or subsequent settlements, and realization depending on the nature and predictability of the estimates and contingencies. 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Under ASC 810, a reporting entity is considered to have a controlling financial interest in a variable interest entity (VIE) if (1)&#160;the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (2)&#160;the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-medical,</div> technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenue and expenses of the Revenue Practices are included in these consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. The Revenue Practices&#8217; assets and liabilities included in the Company&#8217;s consolidated balance sheets as at December&#160;31, 2020 were $57.0&#160;million (2019 &#8211; $58.7 million) and $2.4&#160;million (2019 &#8211; $nil), respectively. The assets of the Revenue Practices can only be used to settle their obligations. 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The Company&#8217;s reporting units generally represent individual business units below the level of the Company&#8217;s operating segment. 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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. 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ASC 606 outlines a single comprehensive model for recognizing revenue as performance obligations, defined in a contract with a customer as goods or services transferred to the customer in exchange for consideration, are satisfied. The standard also requires expanded disclosures regarding the Company&#8217;s revenue recognition policies and significant judgments used in the determination of revenue. </div><div style="font-size: 1px; margin-top: 12px; margin-bottom: 0px;"><div style="font-size: 1px; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">The Company adopted ASC 606 with a full retrospective application. 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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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">The Company reports a liability for unrecognized tax benefits resulting from uncertain tax positions taken or expected to be taken in a tax return. 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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, <div style="font-style:italic;display:inline;;font-style:italic;display:inline;">Derivatives and Hedging</div>. 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ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02</div> is effective for fiscal years, and interim periods within those years, beginning after December&#160;15, 2018. ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02</div> requires application either retrospectively to each prior reporting period presented in the financial statements or under a modified retrospective approach at the beginning of the period of adoption. The Company adopted ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02</div> using a modified retrospective approach on January&#160;1, 2019. </div><div style="font-size: 1px; margin-top: 6px; margin-bottom: 0px;"><div style="font-size: 1px; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;">On January&#160;1, 2019, the Company recorded <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets and lease liabilities of $98,912,687 and $98,912,687, respectively. Accounting for finance leases remained substantially unchanged (they continue to be recognized on the consolidated balance sheets). </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">The Company&#8217;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)&#160;combine associated lease and <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-lease</div> components into a single lease component; and (ii)&#160;exclude recording short-term leases as <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets and liabilities on the consolidated balance sheets. </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company&#8217;s leases include renewal or termination options. Calculation of operating lease <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets and liabilities includes the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. The Company&#8217;s initial real estate lease term typically varies from approximately 3 to 10 years. Including renewal options, the lease term may vary from approximately 10 to 30 years.&#160;&#160;&#160;&#160; </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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&#8217;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&#160;1, 2019. Lease liabilities will be remeasured when there is a significant change in the lease contracts. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Warrants </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Restricted share units </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">Restricted share units (RSUs) are issued in accordance with the Company&#8217;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 12). For RSUs awarded to <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-employees</div> for business services, the RSU expense would be recognized in the consolidated statements of operations and comprehensive income (loss) on vesting of such RSUs. </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Stock-based compensation </div></div></div><div style="font-size: 1px; margin-top: 6px; margin-bottom: 0px;"><div style="font-size: 1px; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">The Company&#8217;s stock-based compensation consists of stock options, which are described in note&#160;15 and RSUs, which are discussed in note 12. 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&#8217;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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Business combinations </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">In January 2019, the Company adopted FASB issued ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2017-01,</div> <div style="font-style:italic;display:inline;;font-style:italic;display:inline;">Clarifying the Definition of a Business <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">(2017-01)</div></div>. The update provides a framework for evaluating whether a transaction should be accounted for as an acquisition and/or disposal of a business versus assets. In order for a purchase to be considered an acquisition of a business, and receive business combination accounting treatment, the set of transferred assets and activities must include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create outputs. If substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, then the set of transferred assets and activities is not a business. As a result of adoption on January&#160;1, 2019, there was no impact on our consolidated financial statements, and we have applied the guidance to subsequent acquisitions.&#160;&#160;&#160;&#160; </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests in the acquired company over the net of the acquisition date fair values of the identifiable assets acquired and the liabilities assumed. Any <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests in the acquired company are measured at their fair value. Best estimates and assumptions are used in the purchase price allocation process to accurately value assets acquired and liabilities assumed at the business combination date. These estimates and assumptions are inherently uncertain and are subject to refinement. As a result, during the measurement period, which may be up to one year from the business combination date, the Company may record adjustments to the assets acquired and liabilities assumed, with the corresponding offset to goodwill. On conclusion of the measurement period or final determination of the values of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments are recorded in the consolidated statements of operations and comprehensive income (loss) in the period in which the adjustments were determined. </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-weight:bold;display:inline;">Changes in <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">The Company treats transactions with <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests that do not result in a loss of control as transactions with equity owners of the Company. A change in ownership interest results in an adjustment between the carrying amounts of the controlling and <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests to reflect their relative interests in the subsidiary. Any difference between the amount of the adjustment to <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests and any consideration paid or received is recognized in a reserve within equity attributable to owners of Akumin. </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Contingencies </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Accounts receivable </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">Accounts receivable are generally <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-interest</div> bearing, unsecured obligations due from patients and third-party payers. They are recognized initially at net realizable value and are subsequently measured at amortized cost less loss allowances. In addition to the implicit price concessions considered and recorded when the service was performed, at each reporting period, the Company estimates the expected credit losses based on a combination of probability-weighted historic and actual bad debts experience with consideration of forward-looking information including changes to economic conditions that would impact its customers (such as unemployment rate and general economic environment for <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-individual</div> payors). During the period affected by the <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">COVID-19</div> pandemic, management&#8217;s consideration of those changes to economic conditions included the impact of the <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">COVID-19</div> pandemic. &#160;&#160;&#160;&#160; </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">In the fourth quarter of 2020, due to slow down in collections of receivables, the Company changed its estimates of the implicit price concessions related to its customers, primarily based on historical experience of collections impacted by the pandemic and the integration of diagnostic imaging centers acquired in 2018 and 2019. The result of this change in estimate resulted in an increase as compared to the year ended December&#160;31, 2019 to the cumulative implicit price concessions for outstanding receivables by approximately $12.3&#160;million ($9.4&#160;million net of tax) in the year ended 2020, or $0.13 per share (basic and diluted) for the three and twelve months ended December&#160;31, 2020. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Principles of consolidation </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Variable interest entities </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">In accordance with the FASB&#8217;s ASC Topic 810, <div style="font-style:italic;display:inline;;font-style:italic;display:inline;">Consolidation</div>, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenue and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. Under ASC 810, a reporting entity is considered to have a controlling financial interest in a variable interest entity (VIE) if (1)&#160;the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (2)&#160;the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-medical,</div> technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenue and expenses of the Revenue Practices are included in these consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. The Revenue Practices&#8217; assets and liabilities included in the Company&#8217;s consolidated balance sheets as at December&#160;31, 2020 were $57.0&#160;million (2019 &#8211; $58.7 million) and $2.4&#160;million (2019 &#8211; $nil), respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the twelve month period ended December&#160;31, 2020, the Revenue Practices&#8217; net revenue was $139.1&#160;million (2019 &#8211; $151.9 million) and the net contribution to the Company&#8217;s cash flow from operations was $134.7&#160;million (2019 &#8211; $112.0 million). </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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&#8217; 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. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Functional and reporting currency and foreign currency translation </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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. <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">Non-monetary</div> assets and liabilities are translated at rates prevailing at the dates of acquisition. Revenues and expenses are translated at the average rate of exchange in effect during the month the transaction occurred. All exchange gains and losses are recognized in the current year&#8217;s earnings. </div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Cash </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">Cash includes cash on hand and cash held with banks. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; 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ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2017-04</div> simplifies the measurement of goodwill by eliminating the requirement to calculate the implied fair value of goodwill (step 2 of the current impairment test) to measure goodwill impairment charge. Instead, entities will record impairment charges based on the excess of a reporting unit&#8217;s carrying amount over its fair value. ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2017-04</div> is effective for fiscal years beginning after December&#160;15, 2019. Early adoption is permitted. The Company elected to early adopt ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2017-04</div> on January&#160;1, 2019. There was no material impact for the Company from the adoption of ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2017-04.</div> </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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&#8217;s reporting units generally represent individual business units below the level of the Company&#8217;s operating segment. 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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. 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ASC 606 outlines a single comprehensive model for recognizing revenue as performance obligations, defined in a contract with a customer as goods or services transferred to the customer in exchange for consideration, are satisfied. The standard also requires expanded disclosures regarding the Company&#8217;s revenue recognition policies and significant judgments used in the determination of revenue. </div><div style="font-size: 1px; margin-top: 12px; margin-bottom: 0px;"><div style="font-size: 1px; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. 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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. 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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. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Income taxes </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Financial instruments </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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, <div style="font-style:italic;display:inline;;font-style:italic;display:inline;">Derivatives and Hedging</div>. Please see note 16 for additional information. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Leases </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">In February 2016, the FASB issued ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02.</div> The FASB subsequently issued related clarifying ASUs on leases. ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02&#8217;s</div> core principle is to increase transparency and comparability among organizations by recognizing lease assets and liabilities on the balance sheet and disclosing key information. ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02</div> is effective for fiscal years, and interim periods within those years, beginning after December&#160;15, 2018. ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02</div> requires application either retrospectively to each prior reporting period presented in the financial statements or under a modified retrospective approach at the beginning of the period of adoption. The Company adopted ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2016-02</div> using a modified retrospective approach on January&#160;1, 2019. </div><div style="font-size: 1px; margin-top: 6px; margin-bottom: 0px;"><div style="font-size: 1px; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;">On January&#160;1, 2019, the Company recorded <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets and lease liabilities of $98,912,687 and $98,912,687, respectively. Accounting for finance leases remained substantially unchanged (they continue to be recognized on the consolidated balance sheets). </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">The Company&#8217;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)&#160;combine associated lease and <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-lease</div> components into a single lease component; and (ii)&#160;exclude recording short-term leases as <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets and liabilities on the consolidated balance sheets. </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company&#8217;s leases include renewal or termination options. Calculation of operating lease <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">right-of-use</div></div> assets and liabilities includes the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. The Company&#8217;s initial real estate lease term typically varies from approximately 3 to 10 years. Including renewal options, the lease term may vary from approximately 10 to 30 years.&#160;&#160;&#160;&#160; </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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&#8217;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&#160;1, 2019. Lease liabilities will be remeasured when there is a significant change in the lease contracts. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Warrants </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Restricted share units </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">Restricted share units (RSUs) are issued in accordance with the Company&#8217;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 12). For RSUs awarded to <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-employees</div> for business services, the RSU expense would be recognized in the consolidated statements of operations and comprehensive income (loss) on vesting of such RSUs. </div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Stock-based compensation </div></div></div><div style="font-size: 1px; margin-top: 6px; margin-bottom: 0px;"><div style="font-size: 1px; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div style="font-family: arial; font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">The Company&#8217;s stock-based compensation consists of stock options, which are described in note&#160;15 and RSUs, which are discussed in note 12. 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&#8217;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. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Business combinations </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">In January 2019, the Company adopted FASB issued ASU <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">2017-01,</div> <div style="font-style:italic;display:inline;;font-style:italic;display:inline;">Clarifying the Definition of a Business <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">(2017-01)</div></div>. The update provides a framework for evaluating whether a transaction should be accounted for as an acquisition and/or disposal of a business versus assets. In order for a purchase to be considered an acquisition of a business, and receive business combination accounting treatment, the set of transferred assets and activities must include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create outputs. If substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, then the set of transferred assets and activities is not a business. As a result of adoption on January&#160;1, 2019, there was no impact on our consolidated financial statements, and we have applied the guidance to subsequent acquisitions.&#160;&#160;&#160;&#160; </div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests in the acquired company over the net of the acquisition date fair values of the identifiable assets acquired and the liabilities assumed. Any <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests in the acquired company are measured at their fair value. Best estimates and assumptions are used in the purchase price allocation process to accurately value assets acquired and liabilities assumed at the business combination date. These estimates and assumptions are inherently uncertain and are subject to refinement. As a result, during the measurement period, which may be up to one year from the business combination date, the Company may record adjustments to the assets acquired and liabilities assumed, with the corresponding offset to goodwill. On conclusion of the measurement period or final determination of the values of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments are recorded in the consolidated statements of operations and comprehensive income (loss) in the period in which the adjustments were determined. </div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-weight:bold;display:inline;">Changes in <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">The Company treats transactions with <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests that do not result in a loss of control as transactions with equity owners of the Company. A change in ownership interest results in an adjustment between the carrying amounts of the controlling and <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests to reflect their relative interests in the subsidiary. Any difference between the amount of the adjustment to <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-controlling</div> interests and any consideration paid or received is recognized in a reserve within equity attributable to owners of Akumin. </div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Contingencies </div></div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. 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In addition to the implicit price concessions considered and recorded when the service was performed, at each reporting period, the Company estimates the expected credit losses based on a combination of probability-weighted historic and actual bad debts experience with consideration of forward-looking information including changes to economic conditions that would impact its customers (such as unemployment rate and general economic environment for <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">non-individual</div> payors). 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(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. 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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 <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">Tri-State</div> Imaging FL Holdings, LLC (FL Holdings), Akumin Imaging Texas, LLC, formerly known as Preferred Medical Imaging, LLC (PMI), SyncMed, Akumin FL, LLC (Akumin FL), Advanced Diagnostics Group, LLC (ADG), TIC Acquisition Holdings, LLC (TIC) and Akumin Health Illinois, LLC (Akumin IL) (collectively, the Subsidiaries), as well as through Delaware Open MRI Radiology Associates, LLC, Elite Imaging, LLC, Elite Radiology of Georgia, LLC, Jeanes Radiology Associates, LLC, Lebanon Diagnostic Imaging, LLC, Rittenhouse Imaging Center, LLC, Rose Radiology Centers, LLC and Wilkes-Barre Imaging, LLC (collectively, the Revenue Practices), all of which are located in the United States. </div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <table border="0" cellpadding="0" cellspacing="0" style="font-family: arial; font-size: 11pt; border-collapse: collapse; border-spacing: 0px;;width:100%;"><tr style="page-break-inside: avoid;"><td style="text-align:left;;vertical-align:top;;width:4%;"><div style="font-weight:bold;display:inline;">17</div></td><td style="text-align:left;;vertical-align:top;"><div style="font-family: arial; font-size: 11pt; margin-top: 0pt; margin-bottom: 0pt; line-height: normal;;text-align:left;"><div style="font-family: arial; font-size: 11pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Related party transactions </div></div></div></td></tr></table><div style="clear: both; max-height: 0px;"></div><div style="clear: both; max-height: 0px; background: none;"></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">On November&#160;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. 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Therefore, if one or more of these matters were resolved against the Company for amounts in excess of management&#8217;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. </div></div><div style="font-family: arial; font-size: 10pt; margin-top: 12pt; margin-bottom: 0pt; margin-left: 4%;">Commencing during Q1 2020 and continuing through the present and beyond, a pandemic relating to the novel coronavirus known as <div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">COVID-19</div> occurred causing significant financial market disruption and social dislocation. 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background-color: rgb(204, 238, 255);;vertical-align:bottom;">&#160;</td><td style="white-space: nowrap; background-color: rgb(204, 238, 255);;text-align:right;;vertical-align:bottom;">(826,566</td><td style="white-space: nowrap; background-color: rgb(204, 238, 255);;vertical-align:bottom;">)&#160;</td><td style="background-color: rgb(204, 238, 255);;vertical-align:bottom;">&#160;</td><td style="white-space: nowrap; background-color: rgb(204, 238, 255);;vertical-align:bottom;">&#160;</td><td style="white-space: nowrap; background-color: rgb(204, 238, 255);;text-align:right;;vertical-align:bottom;">(6,256,820</td><td style="white-space: nowrap; background-color: rgb(204, 238, 255);;vertical-align:bottom;">)&#160;</td></tr><tr style="font-size: 1px;"><td style="font-family: arial;;vertical-align:bottom;"></td><td style="vertical-align:bottom;">&#160;&#160;</td><td style="vertical-align:bottom;"><div style="margin-top: 0pt; margin-bottom: 0pt; border-top: 1.5pt solid rgb(0, 0, 0); line-height: normal;">&#160;</div></td><td colspan="5" style="vertical-align:bottom;"><div style="margin-top: 0pt; 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Tax years 2017-2019 and 2016-2019 remain subject to examination by the tax authorities in the US and Canada, respectively. </div></div><table border="0" style="width:100%; table-layout:fixed;" cellspacing="0" cellpadding="0"><tr><td></td></tr></table> <div style="font-family: arial; font-size: 10pt; margin-top: 10pt; margin-bottom: 0pt; margin-left: 9%;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">The reconciliation of income tax expense (benefit) computed at the Canadian federal statutory rate to income tax expense (benefit) is as follows: </div></div><div style="font-size: 10pt; margin-top: 0pt; margin-bottom: 0pt;"><div style="font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div></div><div><table border="0" cellpadding="0" cellspacing="0" style="font-family: arial; font-size: 10pt; border-collapse: collapse; border-spacing: 0px;;width:91%;"><tr style="font-size: 0px;"><td style="font-family: arial;;width:74%;"></td><td style="font-family: arial;;vertical-align:bottom;;width:2%;"></td><td style="font-family: arial;"></td><td style="font-family: arial;"></td><td style="font-family: arial;"></td><td style="font-family: arial;;vertical-align:bottom;;width:1%;"></td><td style="font-family: arial;"></td><td style="font-family: arial;"></td><td style="font-family: arial;"></td></tr><tr style="font-family: arial; 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During the period affected by the<div style="color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">COVID-19</div><div style="color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div>pandemic, management&#8217;s consideration of those changes to economic conditions included the impact of the<div style="color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div><div style="white-space: nowrap; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">COVID-19</div><div style="color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">&#160;</div>pandemic.</div> <div style="color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-top: 12pt; margin-bottom: 0pt; margin-left: 59.3056px; font-size: 10pt; font-family: arial;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Currency risk</div></div></div> <div style="color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-top: 12pt; margin-bottom: 0pt; margin-left: 59.3056px; font-size: 10pt; font-family: arial;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">Currency risk is the risk to the Company&#8217;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&#160;31, 2020 and December&#160;31, 2019, the Company did not enter into any foreign exchange contracts that would expose the Company to currency risk.</div></div> <div style="color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-top: 12pt; margin-bottom: 0pt; margin-left: 59.3056px; font-size: 10pt; font-family: arial;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;"><div style="font-weight:bold;display:inline;">Interest rate risk</div></div></div> <div style="color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-top: 12pt; margin-bottom: 0pt; margin-left: 59.3056px; font-size: 10pt; font-family: arial;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">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 10. As at December&#160;31, 2020, the Company&#8217;s variable interest rate debt only related to the 2020 Revolving Facility (note 10), which was not drawn during 2020.</div></div> <div style="color: rgb(0, 0, 0); font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; margin-top: 12pt; margin-bottom: 0pt; margin-left: 59.3056px; font-size: 10pt; font-family: arial;"><div style="font-family: arial; font-size: 10pt; color: rgb(0, 0, 0); letter-spacing: 0px; top: 0px;;display:inline;">The following table shows the Company&#8217;s exposure to interest rate risk and the effects on comprehensive income for the twelve months ended December&#160;31, 2020 and 2019 of a 1% increase or decrease in the variable interest rates.</div></div> <div style="color: rgb(0, 0, 0); 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(the &#8220;Company&#8221; or the &#8220;Registrant&#8221;) is a &#8220;foreign private issuer&#8221; as defined in Rule 3b-4 under Securities Exchange Act of 1934, as amended (the &#8220;Exchange Act&#8221;), and is a Canadian issuer eligible to file its annual report (&#8220;Annual Report&#8221;) pursuant to Section 13 of the Exchange Act on Form 40-F pursuant to the multi-jurisdictional disclosure system (the &#8220;MJDS&#8221;) adopted by the United States Securities and Exchange Commission (the &#8220;SEC&#8221;). The Company&#8217;s common shares are listed on the Toronto Stock Exchange and the Nasdaq Global Select Market (&#8220;Nasdaq&#8221;) under the trading symbol &#8220;AKU&#8221;. The Registrant is permitted under MJDS to file with this Annual Report certain reports and other information prepared in accordance with Canadian disclosure requirements, which are different from those of the United States. 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Cover Page
 12 Months Ended
Dec. 31, 2020
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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 Akumin Inc. (the “Company” or the “Registrant”) is a “foreign private issuer” as defined in Rule 3b-4 under Securities Exchange Act of 1934, as amended (the “Exchange Act”), and is a Canadian issuer eligible to file its annual report (“Annual Report”) pursuant to Section 13 of the Exchange Act on Form 40-F pursuant to the multi-jurisdictional disclosure system (the “MJDS”) adopted by the United States Securities and Exchange Commission (the “SEC”). The Company’s common shares are listed on the Toronto Stock Exchange and the Nasdaq Global Select Market (“Nasdaq”) under the trading symbol “AKU”. The Registrant is permitted under MJDS to file with this Annual Report certain reports and other information prepared in accordance with Canadian disclosure requirements, which are different from those of the United States. On October 1, 2020, the Registrant adopted United States generally accepted accounting principles (“U.S. GAAP”). The Registrant’s Audited Consolidated Financial Statements for the year ended December 31, 2020, filed as Exhibit 99.6 to this Annual Report, including required comparative information for 2019, have been prepared in accordance with U.S. GAAP. The financial information for the year ended December 31, 2020 included in the Annual Information Form of the Company for the year ended December 31, 2020 (the “AIF”), filed as Exhibit 99.4 to this Annual Report, is prepared in accordance with U.S. GAAP.
Entity Address, State or Province FL
ICFR Auditor Attestation Flag false
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Consolidated Balance Sheets - USD ($)
Dec. 31, 2020
Dec. 31, 2019
Current assets    
Cash $ 44,395,988 $ 23,388,916
Accounts receivable 91,126,923 82,867,225
Prepaid expenses and other current assets 3,942,268 3,927,949
Assets, Current 139,465,179 110,184,090
Security deposits and other assets 4,876,208 1,967,053
Property and equipment (note 4) 79,929,574 75,938,590
Operating lease right-of-use assets (note 3) 127,061,894 126,675,770
Goodwill (notes 3 and 6) 360,603,613 358,802,534
Intangible assets (note 5) 6,748,073 9,432,480
Total assets 718,684,541 683,000,517
Current liabilities    
Accounts payable and accrued liabilities (note 7) 34,233,142 26,262,225
Finance lease liabilities (note 9) 3,264,806 1,789,995
Operating lease liabilities (right-of-use) (notes 3 and 9) 9,345,656 9,276,298
Senior loans payable (note 10) 405,698 3,705,952
Earn-out liability (note 8) 4,688,553 7,529,962
Liabilities, Current 51,937,855 48,564,432
Finance lease liabilities (note 9) 12,308,780 6,625,409
Operating lease liabilities (right-of-use) (notes 3 and 9) 122,953,656 119,773,692
Senior loans payable (note 10) 389,580,046 336,276,370
Derivative financial instruments (note 10)   951,702
Subordinated notes payable – earn-out (note 11)   184,485
Earn-out liability (note 8)   7,304,105
Accrued payroll taxes (note 25) 1,346,088  
Deferred tax liability 826,566 6,256,820
Total liabilities 578,952,991 525,937,015
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 12 and 15) 160,965,034 158,881,120
Deficit (26,759,151) (6,361,767)
Equity attributable to shareholders of Akumin Inc. 134,205,883 152,519,353
Non-controlling interests (note 24) 5,525,667 4,544,149
Total shareholders' equity 139,731,550 157,063,502
Total liabilities and shareholders' equity $ 718,684,541 $ 683,000,517
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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 69,840,928
Common Stock, Shares, Outstanding 70,178,428 69,840,928
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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 $ 243,981,183 $ 244,841,400
Other revenue 7,301,666 2,594,903
Revenues 251,282,849 247,436,303
Operating expenses    
Cost of operations, excluding depreciation and amortization (note 22) 197,803,388 187,802,601
Depreciation and amortization (notes 4 and 5) 20,459,767 15,587,200
Stock-based compensation (notes 12 and 15) 2,083,914 3,554,765
Operational financial instruments revaluation and other (gains) losses (note 20) (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 income and expenses    
Interest expense (notes 9 and 10) 32,781,210 20,783,438
Other financial instruments revaluation and other (gains) losses (note 20) 22,078,745 1,805,816
Settlement costs and other (recoveries) (note 23) 2,324,151 (1,881,233)
Acquisition-related costs 1,079,255 3,403,160
Total other expenses (income) 58,263,361 24,111,181
Income (loss) before income taxes (23,419,915) 15,363,155
Income tax provision (benefit) (note 13) (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 (note 24) 2,728,539 2,199,629
Net income (loss) attributable to common shareholders $ (20,397,384) $ 9,427,978
Basic and diluted $ (0.29) $ 0.14
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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 $ 118,895,463 $ 130,577,709 $ (15,789,745) $ 4,107,499
Net income and comprehensive income 11,627,607   9,427,978 2,199,629
Acquisition consideration (note 12) 23,437,500 23,437,500    
RSUs and Warrants exercised (note 12) 1,311,146 1,311,146    
Stock-based compensation expense (notes 12 and 15) 3,554,765 3,554,765    
Payment to non-controlling interests (note 24) (1,762,979)     (1,762,979)
Ending Balance at Dec. 31, 2019 157,063,502 158,881,120 (6,361,767) 4,544,149
Net income and comprehensive income (17,668,845)   (20,397,384) 2,728,539
Stock-based compensation expense (notes 12 and 15) 2,083,914 2,083,914    
Payment to non-controlling interests (note 24) (1,747,021)     (1,747,021)
Ending Balance at Dec. 31, 2020 $ 139,731,550 $ 160,965,034 $ (26,759,151) $ 5,525,667
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Consolidated Statements of Cash Flows - USD ($)
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Operating activities    
Net income (loss) for the period $ (17,668,845) $ 11,627,607
Adjustments for:    
Depreciation and amortization 20,459,767 15,587,200
Stock-based compensation (notes 12 and 15) 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) (5,430,254) 2,092,504
Financial instruments revaluation and other (gains) losses 18,171,079 2,823,217
Changes in operating assets and liabilities    
Accounts receivable (8,259,697) (25,243,156)
Prepaid expenses, security deposits and other assets (138,395) (3,657,429)
Accounts payable and accrued liabilities 9,038,102 1,369,580
Operating lease liabilities and right-of-use assets 2,952,575 2,379,575
Net Cash Provided by (Used in) Operating Activities 26,690,553 12,581,077
Investing activities    
Purchase of property and equipment and intangible assets (13,420,375) (12,447,634)
Business acquisitions – net of cash acquired (note 3) (3,198,634) (218,659,981)
Other investments (463,789) 0
Net Cash Provided by (Used in) Investing Activities (17,082,798) (231,107,615)
Financing activities    
Loan proceeds (note 10) 406,300,000 354,114,000
Loan repayments (note 10) (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 11) (200,000) (1,500,000)
Earn-out liability (note 8) (4,688,553) 0
Common shares (note 12) 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
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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),
fluoroscopy and other related procedures.
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
Imaging FL Holdings, LLC (FL Holdings), Akumin Imaging Texas, LLC, formerly known as Preferred Medical Imaging, LLC (PMI), SyncMed, Akumin FL, LLC (Akumin FL), Advanced Diagnostics Group, LLC (ADG), TIC Acquisition Holdings, LLC (TIC) and Akumin Health Illinois, LLC (Akumin IL) (collectively, the Subsidiaries), as well as through Delaware Open MRI Radiology Associates, LLC, Elite Imaging, LLC, Elite Radiology of Georgia, LLC, Jeanes Radiology Associates, LLC, Lebanon Diagnostic Imaging, LLC, Rittenhouse Imaging Center, LLC, Rose Radiology Centers, LLC and Wilkes-Barre Imaging, LLC (collectively, the Revenue Practices), all of which are located in the United States.
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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
ended September 30, 2020. On August 28, 2020, the Company filed a Form
40-F
with the United States Securities and Exchange Commission pursuant to Section 12 of the Securities Exchange Act of 1934. This filing resulted in the Company becoming an “SEC Issuer” for purposes of National Instrument
51-102
-- Continuous Disclosure Obligations and as such the Company is entitled to prepare and report its financial statements in GAAP as opposed to IFRS.
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
trends, or subsequent settlements, and realization depending on the nature and predictability of the estimates and contingencies. Although we believe that our estimates are reasonable, actual results could differ from these estimates.
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,
income taxes, business combinations and revenue recognition.
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
, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenue and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. Under ASC 810, a reporting entity is considered to have a controlling financial interest in a variable interest entity (VIE) if (1) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (2) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE.
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,
technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenue and expenses of the Revenue Practices are included in these consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. The Revenue Practices’ assets and liabilities included in the Company’s consolidated balance sheets as at December 31, 2020 were $57.0 million (2019 – $58.7 million) and $2.4 million (2019 – $nil), respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the twelve month period ended December 31, 2020, the Revenue Practices’ net revenue was $139.1 million (2019 – $151.9 million) and the net contribution to the Company’s cash flow from operations was $134.7 million (2019 – $112.0 million).
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
assets and liabilities are translated at rates prevailing at the dates of acquisition. Revenues and expenses are translated at the average rate of exchange in effect during the month the transaction occurred. All exchange gains and losses are recognized in the current year’s earnings.
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)
. ASU
2017-04
simplifies the measurement of goodwill by eliminating the requirement to calculate the implied fair value of goodwill (step 2 of the current impairment test) to measure goodwill impairment charge. Instead, entities will record impairment charges based on the excess of a reporting unit’s carrying amount over its fair value. ASU
2017-04
is effective for fiscal years beginning after December 15, 2019. Early adoption is permitted. The Company elected to early adopt ASU
2017-04
on January 1, 2019. There was no material impact for the Company from the adoption of ASU
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)
, and related clarifying standards (ASC 606). ASC 606 outlines a single comprehensive model for recognizing revenue as performance obligations, defined in a contract with a customer as goods or services transferred to the customer in exchange for consideration, are satisfied. The standard also requires expanded disclosures regarding the Company’s revenue recognition policies and significant judgments used in the determination of revenue.
 
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 25.
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
. Please see note 16 for additional information.
Leases
In February 2016, the FASB issued ASU
2016-02.
The FASB subsequently issued related clarifying ASUs on leases. ASU
2016-02’s
core principle is to increase transparency and comparability among organizations by recognizing lease assets and liabilities on the balance sheet and disclosing key information. ASU
2016-02
is effective for fiscal years, and interim periods within those years, beginning after December 15, 2018. ASU
2016-02
requires application either retrospectively to each prior reporting period presented in the financial statements or under a modified retrospective approach at the beginning of the period of adoption. The Company adopted ASU
2016-02
using a modified retrospective approach on January 1, 2019.
 
On January 1, 2019, the Company recorded
right-of-use
assets and lease liabilities of $98,912,687 and $98,912,687, respectively. Accounting for finance leases remained substantially unchanged (they continue to be recognized on the consolidated balance sheets).
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
components into a single lease component; and (ii) exclude recording short-term leases as
right-of-use
assets and liabilities on the consolidated balance sheets.
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
assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company’s leases include renewal or termination options. Calculation of operating lease
right-of-use
assets and liabilities includes the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. The Company’s initial real estate lease term typically varies from approximately 3 to 10 years. Including renewal options, the lease term may vary from approximately 10 to 30 years.    
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 12). For RSUs awarded to
non-employees
for business services, the RSU expense would be recognized in the consolidated statements of operations and comprehensive income (loss) on vesting of such RSUs.
Stock-based compensation
 
The Company’s stock-based compensation consists of stock options, which are described in note 15 and RSUs, which are discussed in note 12. 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 update provides a framework for evaluating whether a transaction should be accounted for as an acquisition and/or disposal of a business versus assets. In order for a purchase to be considered an acquisition of a business, and receive business combination accounting treatment, the set of transferred assets and activities must include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create outputs. If substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, then the set of transferred assets and activities is not a business. As a result of adoption on January 1, 2019, there was no impact on our consolidated financial statements, and we have applied the guidance to subsequent acquisitions.    
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
interests in the acquired company over the net of the acquisition date fair values of the identifiable assets acquired and the liabilities assumed. Any
non-controlling
interests in the acquired company are measured at their fair value. Best estimates and assumptions are used in the purchase price allocation process to accurately value assets acquired and liabilities assumed at the business combination date. These estimates and assumptions are inherently uncertain and are subject to refinement. As a result, during the measurement period, which may be up to one year from the business combination date, the Company may record adjustments to the assets acquired and liabilities assumed, with the corresponding offset to goodwill. On conclusion of the measurement period or final determination of the values of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments are recorded in the consolidated statements of operations and comprehensive income (loss) in the period in which the adjustments were determined.
Changes in
non-controlling
interests
The Company treats transactions with
non-controlling
interests that do not result in a loss of control as transactions with equity owners of the Company. A change in ownership interest results in an adjustment between the carrying amounts of the controlling and
non-controlling
interests to reflect their relative interests in the subsidiary. Any difference between the amount of the adjustment to
non-controlling
interests and any consideration paid or received is recognized in a reserve within equity attributable to owners of Akumin.
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
bearing, unsecured obligations due from patients and third-party payers. They are recognized initially at net realizable value and are subsequently measured at amortized cost less loss allowances. In addition to the implicit price concessions considered and recorded when the service was performed, at each reporting period, the Company estimates the expected credit losses based on a combination of probability-weighted historic and actual bad debts experience with consideration of forward-looking information including changes to economic conditions that would impact its customers (such as unemployment rate and general economic environment for
non-individual
payors). During the period affected by the
COVID-19
pandemic, management’s consideration of those changes to economic conditions included the impact of the
COVID-19
pandemic.     
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.
In the fourth quarter of 2020, due to slow down in collections of receivables, the Company changed its estimates of the implicit price concessions related to its customers, primarily based on historical experience of collections impacted by the pandemic and the integration of diagnostic imaging centers acquired in 2018 and 2019. The result of this change in estimate resulted in an increase as compared to the year ended December 31, 2019 to the cumulative implicit price concessions for outstanding receivables by approximately $12.3 million ($9.4 million net of tax) in the year ended 2020, or $0.13 per share (basic and diluted) for the three and twelve months ended December 31, 2020.
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Business Combinations
 12 Months Ended
Dec. 31, 2020
Business Combinations [Abstract]  
Business Combinations
3
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
assets
  
Security deposits
   368,601   
Property and equipment
   412,400   
Operating lease
right-of-use
assets
           2,427,618   
  
 
 
 
   3,241,580   
  
 
 
 
Liabilities assumed
  
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   
  
 
 
 
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 $0.7 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 $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
assets
  
Security deposits
   5,799   
Property and equipment
   820,000   
Operating lease
right-of-use
assets
   554,830   
  
 
 
 
   1,380,629   
  
 
 
 
Liabilities assumed
  
Non-current
liabilities
  
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 (Davie Acquisition). In accordance with the transaction agreement, $50,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller on October 1, 2019. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows:
 
  
 
                $  
 
Assets acquired
  
Non-current
assets
  
Property and equipment
   170,000   
Operating lease
right-of-use
assets
   427,558   
  
 
 
 
   597,558   
  
 
 
 
Liabilities assumed
  
Non-current
liabilities
  
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 $0.5 million in revenue and $54 thousand in loss before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $247.6 million and $13.2 million, 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 imaging centres (Florida – 21 and Georgia – 6) operated under ADG, The Imaging Centers of West Palm and Elite Radiology of Georgia. All of these centres were managed by ADG’s management team. On May 31, 2019, the Company announced the closing of these acquisitions. Pursuant to the purchase agreements, the Company acquired all of the issued and outstanding equity interests of ADG Acquisition Holdings, Inc., TIC Acquisition Holdings, LLC and SFL Radiology Holdings, LLC (the ADG Acquisitions).
The total purchase price (excluding
earn-out)
for the ADG Acquisitions at closing (including preliminary working capital adjustments and payment for cash acquired) was approximately $216 million, of which $23.4 million was satisfied by the issuance of 6.25 million common shares of the Company at a price of $3.75 per share based on the share price at the close of May 31, 2019. The balance of this purchase price was mostly financed through the Term Loans (note 10). A portion of the purchase price payable in respect of the acquisition of SFL Radiology Holdings, LLC is subject to an
earn-out
based on annualized revenues earned in the first two quarters of 2020 less certain costs (note 8). Subsequent to the completion of the acquisition, the cash purchase price was reduced by approximately $0.2 million due to working capital adjustments in accordance with the purchase agreement.
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.
 
  
 
                $  
 
Assets acquired
  
Current assets
  
Cash
   3,585,672   
Accounts receivable
   19,418,814   
Prepaid expenses
   269,012   
  
 
 
 
   23,273,498   
  
 
 
 
Non-current
assets
  
Property and equipment
   11,508,940   
Intangible assets
   5,870,000   
Operating lease
right-of-use
assets
   16,912,896   
  
 
 
 
   34,291,836   
  
 
 
 
   57,565,334   
  
 
 
 
Liabilities assumed
  
Current liabilities
  
Accounts payable and accrued liabilities
   5,634,661   
  
 
 
 
Non-current
liabilities
  
Deferred tax liability
   422,056   
Operating lease liabilities
(right-of-use)
   16,912,896   
  
 
 
 
   17,334,952   
  
 
 
 
   22,969,613   
  
 
 
 
Net assets acquired
   34,595,721   
Goodwill
   195,937,055   
  
 
 
 
Purchase price (cash and shares)
   215,784,755   
  
 
 
 
Purchase price (ADG Acquisition –
earn-out
(note 8))
   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 income (loss) from the acquisition date. Since the acquisition date, these acquisitions contributed revenue of approximately $42.5 million and income before tax of approximately $17.4 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 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 $72.6 million in revenue and $29.7 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $277.5 million and $25.5 million, 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 (Deltona Acquisition). The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows:
 
  
 
                $  
 
Assets acquired
  
Non-current
assets
  
Property and equipment
   295,000   
Operating lease
right-of-use
assets
   154,136   
  
 
 
 
   449,136   
  
 
 
 
Liabilities assumed
  
Current liabilities
  
Accounts payable and accrued liabilities
   57,880   
Non-current
liabilities
  
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 $3.2 million in revenue and $1.0 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $248.8 million and $13.6 million, 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 million (El Paso Acquisition). The cash purchase price was decreased during 2020 by approximately $16 thousand due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete.
 
  
 
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
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   
  
 
 
   
 
 
 
   9,621,985      9,621,985   
  
 
 
   
 
 
 
Liabilities assumed
    
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   
  
 
 
   
 
 
 
   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 $14.0 million in revenue and $3.0 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $256.1 million and $15.0 million, 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 million (West Palm Beach Acquisition). The cash purchase price was decreased during 2020 by approximately $0.1 million due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete.
 
  
 
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
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   
  
 
 
   
 
 
 
   19,322,700      19,322,700   
  
 
 
   
 
 
 
Liabilities assumed
    
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   
  
 
 
   
 
 
 
           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 $19.8 million in revenue and $1.6 million in income before tax for the twelve months ended December 31, 2019, and consolidated pro forma revenue and income before tax for the same period would have been approximately $262.4 million and $14.4 million, respectively. These estimates should not be used as an indicator of past or future performance of the Company or the acquisition.
XML 17 R10.htm IDEA: XBRL DOCUMENT v3.21.1
Property and Equipment
 12 Months Ended
Dec. 31, 2020
Property, Plant and Equipment [Abstract]  
Property and Equipment
4
Property and equipment
 
   
2020
$
   
2019  
$  
 
Medical equipment
   85,588,228    75,665,771   
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
               130,048,023    109,529,144   
Less: Accumulated depreciation
   (50,118,449)    (33,590,554)   
  
 
 
 
Total property and equipment – net
   79,929,574    75,938,590   
  
 
 
 
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 $17,769,948 (2019 – $13,705,653). As part of ongoing operations, during the twelve months ended December 31, 2020, the Company had net disposals of $1,779,626 (2019 – $1,030,006). The loss on these disposals was $1,549,295 (2019 - $931,356) 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 20.
XML 18 R11.htm IDEA: XBRL DOCUMENT v3.21.1
Intangible Assets
 12 Months Ended
Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Intangible Assets
5
Intangible assets
 
   
Covenants
not to
compete
$
   
Software
costs
$
   
Trade
name
$
   
License
Arrange-
ments
$
   
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 3)
       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   
  
 
 
 
XML 19 R12.htm IDEA: XBRL DOCUMENT v3.21.1
Goodwill
 12 Months Ended
Dec. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill
6      Goodwill
 
The carrying amounts of goodwill at the beginning and end of the current and previous periods are set out below.
 
  
 

 
2020

$
 

 
  
 

 
2019  

$  
 

 
Balance – Beginning of period
           358,802,534    147,120,852   
Adjustments (note 3)
   126,315    (5,104,587)  
Business acquisitions (note 3)
   1,674,764    216,786,269   
  
 
 
 
Balance – End of period
   360,603,613    358,802,534   
  
 
 
 
The carrying amount of goodwill attributed to each reporting unit was as follows:
 
  
 

 
2020

$
 

 
  
 

 
2019  

$  
 

 
Florida
           256,270,533    255,002,971   
Northeast
   3,569,801    3,569,801   
Texas
   92,803,338    92,669,821   
Other
   7,959,941    7,559,941   
  
 
 
 
   360,603,613    358,802,534   
  
 
 
 
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 16.
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.
XML 20 R13.htm IDEA: XBRL DOCUMENT v3.21.1
Accounts Payable and Accrued Liabilities
 12 Months Ended
Dec. 31, 2020
Payables and Accruals [Abstract]  
Accounts Payable and Accrued Liabilities
7
Accounts payable and accrued liabilities
The accounts payable and accrued liabilities are as follows:
 
  
 

 
2020

$
 

 
  
 

 
2019  

$  
 

 
Accounts payable
           20,400,949    21,707,080   
Accrued other expenses
   10,034,409    2,602,292   
Accrued payroll expenses
   3,797,784    1,952,853   
  
 
 
   
 
 
 
   34,233,142    26,262,225   
  
 
 
 
XML 21 R14.htm IDEA: XBRL DOCUMENT v3.21.1
Earn-Out Liability (ADG Acquisition)
 12 Months Ended
Dec. 31, 2020
Business Combinations [Abstract]  
Earn-Out Liability (ADG Acquisition)
 
8
Earn-out
liability (ADG Acquisition)
 
  
 

 
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
portion of ADG Acquisition –
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
(the ADG Acquisition –
earn-out
liability) based on its annualized revenues earned in the first two quarters of 2020 less certain costs including certain operating expenses, capital expenditures and incremental working capital. In accordance with the purchase agreement, 50% of this liability was settled in the latter half of 2020 and the balance is expected to be settled in the first half of 2021.
The value of the ADG Acquisition –
earn-out
liability was estimated by management using a probability weighted valuation technique related to information including revenue and operating expenses; changes in the fair value of this liability are recognized in the consolidated statements of operations and comprehensive income (loss). Management estimated the fair value of the ADG Acquisition –
earn-out
liability as at May 31, 2019 at approximately $14.7 million based on a discount rate of approximately 7% and management’s estimated probability weighted range of the ADG Acquisition –
earn-out
liability (it is considered a Level 3 liability as described in note 16; this liability was subsequently settled as noted below). An increase in the discount rate by 1.0% point decreased the value of this liability by about $0.2 million and vice versa. Subsequently, the ADG Acquisition –
earn-out
liability estimate was revalued at approximately $14.8 million as at December 31, 2019. This liability was revalued at approximately $9.4 million based on a settlement reached pursuant to the terms of the purchase agreement in November 2020 with the representatives of the sellers of the Company’s Georgia business and the change in fair value was recognized in financial instruments revaluation in the consolidated statements of operations and comprehensive income (loss). Fifty percent of this liability was paid in November 2020 and the balance is to be paid in May 2021 pursuant to the process outlined in the related purchase agreement. During the twelve month period ended December 31, 2020, the Company recognized a gain of approximately $5.5 million due to changes in fair value of the ADG Acquisition –
earn-out
liability (2019 – loss of approximately $0.1 million).
XML 22 R15.htm IDEA: XBRL DOCUMENT v3.21.1
Lease liabilities
 12 Months Ended
Dec. 31, 2020
Leases [Abstract]  
Lease liabilities
9
Lease liabilities
Finance
The information pertaining to finance lease liabilities on the consolidated balance sheet 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
portion of finance lease liabilities
   12,308,780    6,625,409   
  
 
 
 
The components of finance lease cost recognized in the consolidated statement of operations and comprehensive income (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
finance lease liabilities
  
 
 
 
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
assets obtained in exchange for finance lease obligations
   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
portion of operating lease liabilities
   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
operating lease liabilities
   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
assets obtained in exchange for operating lease obligations
   13,800,876     137,301,712 
XML 23 R16.htm IDEA: XBRL DOCUMENT v3.21.1
Senior loans payable
 12 Months Ended
Dec. 31, 2020
Debt Disclosure [Abstract]  
Senior Loans Payable
10
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 million of aggregate principal amount of 7.0% senior secured notes due November 1, 2025 (the 2025 Senior Notes). The net proceeds from this offering were used to repay in full the Amended May 2019 Term Loans, Revolving Facility and net derivative financial instrument liabilities, in accordance with respective contracts, and to pay related financing fees and expenses. The balance of approximately $19 million was retained as cash. The 2025 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 secured against substantially all of the assets of the Company and the guarantors
pari passu
with the security granted in connection with the 2020 Revolving Facility. On November 2, 2020, the 2025 Senior Notes were issued at their face value of $400 million net of debt issuance costs of approximately $11.5 million (it is considered a Level 2 liability as described in note 16). As at December 31, 2020, the 2025 Senior Notes had a face value of $400 million and an amortized cost balance of approximately, $389 million.
 
   
 
 
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. Interest is accrued and payable every
six
months on May 1 and November 1, respectively.
 
 • 
Restrictive
covenants
 
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
covenants
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
for the issuance of letters of credit and for swingline loans. The 2020 Revolving Facility is secured
pari passu
with the obligations under the 2025 Senior Notes. The 2020 Revolving Facility will mature on the date that is five years after the issue date (the 2020 Revolving Facility Maturity Date); provided that, 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.
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 16). 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
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. Since no amount has been drawn under the 2020 Revolving Facility as at December 31, 2020, the annualized effective interest rate under the 2020 Revolving Credit Agreement during the twelve months ended December 31, 2020 is not applicable (2019 – nil). With respect to interest rate sensitivity as at December 31, 2020, a 1% increase in variable interest rates would have increased interest expense under the 2020 Revolving Facility for the twelve months ended December 31, 2020 by $nil (2019 – $nil).
 
 • 
Restrictive
covenants
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
covenant
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 million dollars of the Term Loan A was subject to a delayed draw, which was drawn by the Company in October 2019 to partly finance the West Palm Beach Acquisition. The term of the Amended May 2019 Loans is five years from May 31, 2019. The Amended May 2019 Loans can be increased by an additional $100,000,000 subject to certain conditions. The proceeds of the Term Loans were used during 2019 to settle in accordance with the respective contracts, the Syndicated Loans for $112,482,181, the principal outstanding under Subordinated Note and related accrued and unpaid interest for $1,596,250, partly finance the ADG Acquisitions and Deltona Acquisition in May 2019 and pay related debt issuance costs. On May 31, 2019, management determined the fair value of the Amended May 2019 Loans to be their face value of $319,300,000 net of debt issuance costs of approximately $14.8 million and a debt modification accounting adjustment of approximately $1.0 million related to the settlement of the Syndicated Loans. The fair value of the Amended May 2019 Loans 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 16). As at December 31, 2019, the Amended May 2019 Loans had a balance of approximately, $338.5 million. In June 2020, the amendment costs related to the Amended May 2019 Credit Agreement were netted against the balance of the Amended May 2019 Loans. The above-noted amendment to the senior credit agreement in June 2020 was considered debt modification for accounting purposes. On November 2, 2020, the Amended May 2019 Loans and related accrued and unpaid interest and costs were settled completely in accordance with the credit agreement, for approximately $364 million using proceeds of the 2025 Senior Notes. This settlement of the May 2019 Term Loans was considered debt extinguishment for accounting purposes and a loss of approximately $18 million was recognized in the consolidated statements of operations and comprehensive income (loss). 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 
   
 
 
 
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. The cost of this derivative financial instrument was $155,000. The Company has not designated this interest rate cap agreement as a cash flow hedge for accounting purposes. On November 2, 2020, this derivative financial instrument was terminated and settled completely for $nil consideration (2019 asset - $597) and a loss for the year-ended December 31, 2020 of $597 was recognized in the consolidated statements of operations and comprehensive income (loss).
 
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 upfront cost of this derivative financial instrument. The Company has not designated this interest rate cap agreement as a cash flow hedge for accounting purposes. On November 2, 2020, this derivative financial instrument was terminated and settled completely for $4,805,000 (2019 liability - $951,702) and a loss for the year-ended December 31, 2020 of approximately $3.9 million was recognized in the consolidated statements of operations and comprehensive income (loss) in the line “Financial instruments revaluation and other (gains) losses”. During the year ended December 31, 2020, the Company incurred interest expense of $1,301,854 (2019 - $nil) with respect to this derivative financial instrument. The interest expense was paid on a monthly basis. The settlement payment with respect to this derivative financial instrument in the cashflow statement is included in the line “Loan repayments”.
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 16). 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.
XML 24 R17.htm IDEA: XBRL DOCUMENT v3.21.1
Subordinated notes payable -&#160;earn-out
 12 Months Ended
Dec. 31, 2020
Debt Disclosure [Abstract]  
Subordinated notes payable - earn-out
11
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 years. The Subordinated Note was recognized at fair value of $1,490,932 on May 11, 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 16; this liability was subsequently settled as noted below).
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
liability (Subordinated Note –
Earn-out)
of up to $4.0 million during the three-calendar year period beginning on January 1, 2019 and ending on December 31, 2021 (the Subordinated Note –
Earn-out
Period), subject to the satisfaction of certain revenue-based milestones, as follows:
 
 a)
The Subordinated Note –
Earn-out
for any given calendar year during the Subordinated Note –
Earn-out
Period shall be equal to 50% of any positive difference calculated by subtracting the Base Revenue ($16,000,000) for such calendar year from the Subordinated Note –
Earn-out
Revenue (defined below) for such calendar year.
 
 b)
The Subordinated Note –
Earn-out
Revenue for any calendar year during the Subordinated Note –
Earn-out
Period shall be the gross revenue generated by the centres related to the Tampa Acquisition during such calendar year.
 
 c)
If Subordinated Note –
Earn-out
Revenue for any calendar year of the Subordinated Note –
Earn-out
Period is less than or equal to $16,000,000, no Subordinated Note –
Earn-out
shall be payable for such calendar year.
 
 d)
The maximum aggregate amount of the Subordinated Note –
Earn-out
that may be earned over the Subordinated Note –
Earn-out
Period is $4,000,000.
The value of Subordinated Note –
Earn-out
has been estimated by management using a probability-weighted valuation technique; changes in the fair value of this liability are recognized in the consolidated statements of operations and comprehensive income (loss). Management estimated the fair value of Subordinated Note –
Earn-out
as at May 11, 2018 of $160,790 based on a discount rate of 8.75% and management’s estimated probability-weighted range of Subordinated Note –
Earn-out
Revenue during the Subordinated Note –
Earn-out
Period (it is considered a Level 3 liability as described in note 16). The Company entered into a settlement with the holders of the Subordinated Note –
Earn-out
to fully settle and terminate the Subordinated Note –
Earn-out
for $200,000 on October 23, 2020 (2019 liability - $184,485) and recognized a loss for the year-ended December 31, 2020 of $15,515 in financial instruments revaluation in the consolidated statements of operations and comprehensive income (loss).
XML 25 R18.htm IDEA: XBRL DOCUMENT v3.21.1
Capital stock and warrants
 12 Months Ended
Dec. 31, 2020
Equity [Abstract]  
Capital stock and warrants
 
12
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 November 14, 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 26.
 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 15.
XML 26 R19.htm IDEA: XBRL DOCUMENT v3.21.1
Income Taxes
 12 Months Ended
Dec. 31, 2020
Income Tax Disclosure [Abstract]  
Income Taxes
13
Income taxes
The reconciliation of income tax expense (benefit) computed at the Canadian federal statutory rate to income tax expense (benefit) is as follows:
 
   
2020
$
   
2019
$
 
Income attributable to common shareholders before income taxes
   (26,148,454)    13,163,526 
  
 
 
 
Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%)
   (6,929,340)    3,488,334 
Increase (decrease) in income taxes resulting from
    
Stock-based compensation
   396,528    942,013 
State franchise tax, net of federal benefit
   212,684    219,538 
US tax rate differential
   603,264    (400,948) 
Return to provision adjustment
   345,299    1,389,866 
Other
   (205,656)    (164,747) 
Valuation allowance
   (173,849)    (1,738,508) 
  
 
 
 
Income tax expense (benefit)
   (5,751,070)    3,735,548 
  
 
 
 
U.S. Federal current tax expense (benefit)
    
U.S. State current tax expense (benefit)
   (320,815)    1,643,043 
Canadian current tax expense (benefit)
    
U.S. Federal deferred tax expense (benefit)
   (4,433,785)    2,688,571 
U.S. State deferred tax expense (benefit)
   (996,470)    (596,066) 
Canadian deferred tax expense (benefit)
    
  
 
 
 
Total income tax expense (benefit)
   (5,751,070)    3,735,548 
The Company’s effective tax rate for the year ended December 31, 2020 was 22.0% (2019 – (28.38%)). 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:
 
   
2020
$
  
2019
$
 
Deferred tax assets
   
Lease liabilities
   31,615,510   33,474,270 
Net operating losses
   15,745,126   3,692,446 
163(j) carryforward
   5,934,846   1,458,105 
Debt issuance costs
   2,419,687   4,412,375 
Capital acquisition costs
   2,011,450   779,367 
Other
   3,409,797   9,430,097 
  
 
 
 
Total deferred tax assets
   61,136,416   53,246,660 
Less: Valuation allowance (Canada)
   (2,634,364)   (2,800,607) 
Net deferred tax assets
   58,502,052   50,446,053 
Deferred tax liabilities
   
Right-of-use
assets
   (30,360,097)   (32,907,312) 
Fixed assets
   (14,973,077)   (12,400,551) 
Goodwill
   (10,664,325)   (8,392,326) 
Other
   (3,331,119)   (3,002,684) 
  
 
 
 
Total deferred tax liabilities
   (59,328,618)   (56,702,873) 
  
 
 
 
Net deferred tax liabilities
   (826,566)   (6,256,820) 
  
 
 
 
 
 
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 Canadian operations, as at December 31, 2020, a valuation allowance of $2,634,364 (2019 – $2,800,607) has been recorded to recognize only the portion of the deferred tax asset that is more likely than not to be realized. Management’s assessment of the future profitability of the Company’s US operations has determined that the deferred tax assets related to the US operations are more likely than not to be realized and a valuation allowance against these existing deferred tax assets should not currently be required.
The amount of the deferred tax assets is considered realizable, however, it 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 $68,755,558 (2019 – $16,226,326), of which $19,742,894 begin to expire in 2036. Of these loss-carryforwards, $49,012,664 do not expire but are subject to utilization restrictions. The Company also has a Section 163(j) interest expense carryforward of $24,670,177 (2019 - $1,007,969) 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.
XML 27 R20.htm IDEA: XBRL DOCUMENT v3.21.1
Commitments and Contingencies
 12 Months Ended
Dec. 31, 2020
Commitments and Contingencies Disclosure [Abstract]  
Commitments and contingencies
14
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
occurred causing significant financial market disruption and social dislocation. The pandemic is dynamic with various cities, counties, states and countries around the world responding or having responded in different ways to address and contain the outbreak, including the declaration of a global pandemic by the World Health Organization, a National State of Emergency in the United States and state and local executive orders and ordinances forcing the closure of non essential businesses and persons not employed in or using essential services to “stay at home” or “shelter in place”. At this stage, we have no certainty as to how long the pandemic, or a more limited epidemic, will last, what regions will be most affected or to what extent containment measures will be applied.
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
pandemic, there is potential for the Company to incur incremental credit losses beyond what is currently expected and potential future reduction in revenue and income and asset impairments.
XML 28 R21.htm IDEA: XBRL DOCUMENT v3.21.1
Stock-Based Compensation &#8211; Options
 12 Months Ended
Dec. 31, 2020
Share-based Payment Arrangement [Abstract]  
Stock-based compensation – options
15
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 26.
 
  
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).
XML 29 R22.htm IDEA: XBRL DOCUMENT v3.21.1
Risk Management Arising From Financial Instruments
 12 Months Ended
Dec. 31, 2020
Fair Value Disclosures [Abstract]  
Risk management arising from financial instruments
16
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
 
portion of leases approximates their fair value given the difference between the discount rates used to recognize the liabilities in the consolidated balance sheets and the normalized expected market rates of interest is insignificant. The estimated fair values of other
 
non-current
 
liabilities were as follows:
 
   
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
   -    951,105 
  
 
 
 
   429,826,997    378,049,987 
  
 
 
 
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,
 
and ADG Acquisition –
 
Earn-out
 
were measured at fair value under the Level 3 category on recognition. The ADG Acquisition –
 
Earn-out
 
and Subordinated Note –
 
Earn-out
 
were subsequently remeasured at fair value under the Level 3 category. The Amended May 2019 Loans and Subordinated Note –
 
Earn-out
 
were settled completely during the three months ended December 31, 2020 as discussed in notes 10 and 11. The liability related to the ADG Acquisition –
 
Earn-out
 
was determined based on execution of a settlement agreement in November 2020 as discussed in note 8.
The following table summarizes information regarding the change in carrying value of the Company’s financial instruments carried at fair value.
 
   
Derivative
financial
instruments
$
   
Subordinated
Notes
Earn-out
$
   
ADG
Acquisition
Earn-out
$
 
January 1, 2019
   (16,014)    169,642    - 
Issuance
   -    -    14,748,022 
Financial instruments revaluation loss (gain)
      
Realized
   -    -    - 
Unrealized
   967,119    14,843    86,045 
  
 
 
 
December 31, 2019
   951,105    184,485    14,834,067 
Payment
   (4,805,000)    (200,000)    (4,688,553) 
Financial instruments revaluation loss (gain)
      
Realized
   3,853,895    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:
 
   
2020
$
     
2019
$
 
Cash
   44,395,988      23,388,916 
Accounts receivable
   91,126,923      82,867,225 
  
 
 
 
Financial assets measured at amortized cost
   135,522,911      106,256,141 
  
 
 
 
Accounts payable and accrued liabilities
   34,233,142      26,262,225 
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
   572,091,784      503,709,941 
  
 
 
 
Subordinated note –
 
earn-out
   -      184,485 
ADG Acquisition –
 
earn-out
   4,688,553      14,834,067 
Derivative financial instruments
   -      951,105 
  
 
 
 
Measured at fair value through profit or loss
   4,688,553      15,969,657 
  
 
 
 
 
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 $44,395,988 (2019 – $23,388,916) and accounts receivable of $91,126,923 (2019 – $82,867,225).
Collectability of the receivables is actively monitored on an ongoing basis and an allowance or a
 
write-off
 
of allowance for bad debts is established by management. At each reporting period, the Company determines whether an allowance or
 
write-off
 
is required by estimating the expected credit losses based on a combination of probability-weighted historic and actual bad debts experience with consideration of forward-looking information including changes to economic conditions that would impact its customers (such as unemployment rate and general economic environment for
 
non-individual
 
payors). During the period affected by the
 
COVID-19
 
pandemic, management’s consideration of those changes to economic conditions included the impact of the
 
COVID-19
 
pandemic.
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 10. As at December 31, 2020, the Company’s variable interest rate debt only related to the 2020 Revolving Facility (note 10), 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) 
XML 30 R23.htm IDEA: XBRL DOCUMENT v3.21.1
Related Party Transactions
 12 Months Ended
Dec. 31, 2020
Related Party Transactions [Abstract]  
Related Party Transactions
17
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.
XML 31 R24.htm IDEA: XBRL DOCUMENT v3.21.1
New Accounting Standards
 12 Months Ended
Dec. 31, 2020
Accounting Standards Update and Change in Accounting Principle [Abstract]  
New accounting standards
18
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,
Intangibles – Goodwill and Other – Internal Use Software (Topic
350-40)
In August 2018, the FASB issued ASU
2018-15,
Intangibles – Goodwill and Other –
Internal-Use
Software (Topic
350-40)
. The ASU is intended to improve the recognition and measurement of financial instruments. The new guidance aligns the requirements for capitalizing implementation costs incurred in a hosting arrangement that is a service contract with the requirements for capitalizing implementation costs incurred to develop or obtain
internal-use
software (and hosting arrangements that include an
internal-use
software license). This ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for annual reporting periods beginning after December 15, 2020. The Company is considered an Emerging Growth Company as classified by SEC, which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company continues to evaluate the impact of the standard on its consolidated financial statements.
ASU
2016-13,
Financial Instruments – Credit Losses (Topic 326)
In June 2016, the FASB issued ASU
2016-13
, Financial Instruments – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments
, and related clarifying standards, which replaces the incurred loss impairment methodology in current GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to assess credit loss estimates. The ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. For all other entities, this ASU is effective for fiscal years beginning after December 15, 2022. The Company is considered an Emerging Growth Company as classified by SEC, which gives the Company relief in the timing of implementation of this standard by allowing the private company timing for adoption. The Company continues to evaluate the impact of the standard on its consolidated financial statements.
XML 32 R25.htm IDEA: XBRL DOCUMENT v3.21.1
Basic And Diluted Income (Loss) Per Share
 12 Months Ended
Dec. 31, 2020
Earnings Per Share [Abstract]  
Basic and diluted income (loss) per share
19
Basic and diluted income (loss) per share
 
  
 

 
2020

$
 

 
 
 

 
2019

$
 

 
Net income (loss) attributable to common shareholders
   (20,397,384)   9,427,978 
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
    2,066,938 
          
Diluted
   70,101,618   68,594,989 
Net income (loss) per share
   
Basic and diluted
   (0.29)   0.14 
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  
 
XML 33 R26.htm IDEA: XBRL DOCUMENT v3.21.1
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)
20
Financial instruments revaluation and other gains (losses)
 
 
a)
Operational Financial instruments revaluation and other gains (losses)
 
  
 

 
2020

$
 

 
 
 

 
2019

$
 

 
Gain (loss) on revaluation of ADG Acquisition –
Earn-out
(note 8)
   5,456,961   (86,045) 
Loss on disposal of property and equipment
   (1,549,295)   (931,356) 
         
   (3,907,666)   (1,017,401) 
         
 
b)
Other Financial instruments revaluation and other gains (losses)
 
  
 

 
2020

$
 

 
 
 

 
2019

$
 

 
Loss on debt revaluation (note 10)
   (18,278,845)   (829,208) 
Loss on revaluation of derivatives (note 10)
   (3,853,895)   (967,119) 
Other gains (losses)
   53,995   (9,489) 
         
   (22,078,745)   (1,805,816) 
         
XML 34 R27.htm IDEA: XBRL DOCUMENT v3.21.1
Revenue Information
 12 Months Ended
Dec. 31, 2020
Revenue from Contract with Customer [Abstract]  
Revenue information
21
Revenue information
 
  
 

 
2020

$
 

 
  
 

 
2019

$
 

 
Commercial
   163,893,988    173,056,345 
Medicare
   28,449,283    28,849,651 
Medicaid
   7,889,878    7,421,432 
Attorney
   24,271,130    14,784,804 
Workers comp
   9,960,660    10,569,156 
Other patient revenue
   9,516,244    10,160,012 
          
Service fees - net of allowances and discounts
   243,981,183    244,841,400 
Other revenue (management and ancillary fees and government grants)
   7,301,666    2,594,903 
          
   251,282,849    247,436,303 
          
XML 35 R28.htm IDEA: XBRL DOCUMENT v3.21.1
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
22
Cost of operations, excluding depreciation and amortization
 
  
 

 
2020

$
 

 
  
 

 
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
   21,706,906    19,084,397 
Administrative
   12,875,606    12,459,281 
Medical supplies and other
   11,161,702    8,783,377 
          
   197,803,388    187,802,601 
          
XML 36 R29.htm IDEA: XBRL DOCUMENT v3.21.1
Settlement Costs And Other (Recoveries)
 12 Months Ended
Dec. 31, 2020
Business Litigation Settlement Costs And Other Recoveries [Abstract]  
Settlement costs and other (recoveries)
23
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.
XML 37 R30.htm IDEA: XBRL DOCUMENT v3.21.1
Non-Controlling Interests
 12 Months Ended
Dec. 31, 2020
Noncontrolling Interest Items [Abstract]  
Non-controlling interests
24
Non-controlling
interests
As part of the Texas Acquisition in 2017, certain of PMI’s subsidiaries acquired were
non-wholly
owned. As a result of operating agreements with each of those
non-wholly
owned entities, the Company was deemed to have control over those entities and thus 100% of their financial results were included in the Company’s consolidated financial results. The acquired
non-controlling
interests were recorded in the Company’s consolidated financial statements at their estimated fair value. In May 2018, the Company purchased the
non-controlling
interests in seven Texas-based diagnostic imaging companies. During June 2018, (i) the Company purchased the
non-controlling
interests in Toggle, LLC, a transcription company, for de minimis consideration, and (ii) Preferred Imaging of Tarrant County, LLC, a holding company, distributed its assets to its shareholders and was subsequently terminated.
The Company currently holds effective ownership interests in the following
non-wholly
owned entities:
 
   
Ownership interest
 
Entity
  
2020
   
2019
 
   
%
   
%
 
Phoenix Imaging, LLC
   60    60 
Preferred Imaging of Amarillo, LLC
   57    57 
XML 38 R31.htm IDEA: XBRL DOCUMENT v3.21.1
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]
25
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 income (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”.
XML 39 R32.htm IDEA: XBRL DOCUMENT v3.21.1
Subsequent Events
 12 Months Ended
Dec. 31, 2020
Subsequent Events [Abstract]  
Subsequent Events [Text Block]
26
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
directors of the Company as part of their 2021 compensation and 50,000 RSUs were awarded as part of a signing bonus to an executive who started with the Company on March 29, 2021. Subject to and in accordance with the terms of the RSU plan, 50% of the RSUs granted will vest and settle for common shares one year after the date of grant and the remaining 50% will vest and settle for common shares two years after the date of grant. Subject to and in accordance with the stock option plan, the options were granted with an exercise price of $3.58 per share, representing the
5-day
volume weighted average price of the shares prior to the date of grant and an expiry date of 7 years after the date of grant. The options granted will vest as follows: 34% of the grant vest one year after the date of grant, 33% two years after the date of grant and the remaining 33% three years after the date of grant.
XML 40 R33.htm IDEA: XBRL DOCUMENT v3.21.1
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
, a reporting entity with a variable interest in another entity is required to include the assets and liabilities and revenue and expenses of that separate entity (i.e., consolidate with the financial statements of the reporting entity) when the variable interest is determined to be a controlling financial interest. Under ASC 810, a reporting entity is considered to have a controlling financial interest in a variable interest entity (VIE) if (1) the reporting entity has the power to direct the activities of the VIE that most significantly impacts its economic performance and (2) the reporting entity has the obligation to absorb losses of the VIE that could be potentially significant to the VIE.
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,
technical and administrative services, has the power to direct their respective activities and the obligation to absorb their gains and losses. As a result, the Company is considered the primary beneficiary of the Revenue Practices, and accordingly, the assets and liabilities and revenue and expenses of the Revenue Practices are included in these consolidated financial statements. The following information excludes any intercompany transactions and costs allocated by the Company to the Revenue Practices. The Revenue Practices’ assets and liabilities included in the Company’s consolidated balance sheets as at December 31, 2020 were $57.0 million (2019 – $58.7 million) and $2.4 million (2019 – $nil), respectively. The assets of the Revenue Practices can only be used to settle their obligations. During the twelve month period ended December 31, 2020, the Revenue Practices’ net revenue was $139.1 million (2019 – $151.9 million) and the net contribution to the Company’s cash flow from operations was $134.7 million (2019 – $112.0 million).
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
assets and liabilities are translated at rates prevailing at the dates of acquisition. Revenues and expenses are translated at the average rate of exchange in effect during the month the transaction occurred. All exchange gains and losses are recognized in the current year’s earnings.
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)
. ASU
2017-04
simplifies the measurement of goodwill by eliminating the requirement to calculate the implied fair value of goodwill (step 2 of the current impairment test) to measure goodwill impairment charge. Instead, entities will record impairment charges based on the excess of a reporting unit’s carrying amount over its fair value. ASU
2017-04
is effective for fiscal years beginning after December 15, 2019. Early adoption is permitted. The Company elected to early adopt ASU
2017-04
on January 1, 2019. There was no material impact for the Company from the adoption of ASU
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)
, and related clarifying standards (ASC 606). ASC 606 outlines a single comprehensive model for recognizing revenue as performance obligations, defined in a contract with a customer as goods or services transferred to the customer in exchange for consideration, are satisfied. The standard also requires expanded disclosures regarding the Company’s revenue recognition policies and significant judgments used in the determination of revenue.
 
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 25.
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
. Please see note 16 for additional information.
Leases
Leases
In February 2016, the FASB issued ASU
2016-02.
The FASB subsequently issued related clarifying ASUs on leases. ASU
2016-02’s
core principle is to increase transparency and comparability among organizations by recognizing lease assets and liabilities on the balance sheet and disclosing key information. ASU
2016-02
is effective for fiscal years, and interim periods within those years, beginning after December 15, 2018. ASU
2016-02
requires application either retrospectively to each prior reporting period presented in the financial statements or under a modified retrospective approach at the beginning of the period of adoption. The Company adopted ASU
2016-02
using a modified retrospective approach on January 1, 2019.
 
On January 1, 2019, the Company recorded
right-of-use
assets and lease liabilities of $98,912,687 and $98,912,687, respectively. Accounting for finance leases remained substantially unchanged (they continue to be recognized on the consolidated balance sheets).
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
components into a single lease component; and (ii) exclude recording short-term leases as
right-of-use
assets and liabilities on the consolidated balance sheets.
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
assets represent operating lease liabilities adjusted for prepayments, accrued lease payments, lease incentives and initial direct costs. Certain of the Company’s leases include renewal or termination options. Calculation of operating lease
right-of-use
assets and liabilities includes the initial lease term unless it is reasonably certain a renewal or termination option will be exercised. The Company’s initial real estate lease term typically varies from approximately 3 to 10 years. Including renewal options, the lease term may vary from approximately 10 to 30 years.    
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 12). For RSUs awarded to
non-employees
for business services, the RSU expense would be recognized in the consolidated statements of operations and comprehensive income (loss) on vesting of such RSUs.
Stock-Based Compensation
Stock-based compensation
 
The Company’s stock-based compensation consists of stock options, which are described in note 15 and RSUs, which are discussed in note 12. 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 update provides a framework for evaluating whether a transaction should be accounted for as an acquisition and/or disposal of a business versus assets. In order for a purchase to be considered an acquisition of a business, and receive business combination accounting treatment, the set of transferred assets and activities must include, at a minimum, an input and a substantive process that together significantly contribute to the ability to create outputs. If substantially all of the fair value of the gross assets acquired is concentrated in a single identifiable asset or a group of similar identifiable assets, then the set of transferred assets and activities is not a business. As a result of adoption on January 1, 2019, there was no impact on our consolidated financial statements, and we have applied the guidance to subsequent acquisitions.    
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
interests in the acquired company over the net of the acquisition date fair values of the identifiable assets acquired and the liabilities assumed. Any
non-controlling
interests in the acquired company are measured at their fair value. Best estimates and assumptions are used in the purchase price allocation process to accurately value assets acquired and liabilities assumed at the business combination date. These estimates and assumptions are inherently uncertain and are subject to refinement. As a result, during the measurement period, which may be up to one year from the business combination date, the Company may record adjustments to the assets acquired and liabilities assumed, with the corresponding offset to goodwill. On conclusion of the measurement period or final determination of the values of assets acquired or liabilities assumed, whichever comes first, any subsequent adjustments are recorded in the consolidated statements of operations and comprehensive income (loss) in the period in which the adjustments were determined.
Changes in Non-Controlling Interests
Changes in
non-controlling
interests
The Company treats transactions with
non-controlling
interests that do not result in a loss of control as transactions with equity owners of the Company. A change in ownership interest results in an adjustment between the carrying amounts of the controlling and
non-controlling
interests to reflect their relative interests in the subsidiary. Any difference between the amount of the adjustment to
non-controlling
interests and any consideration paid or received is recognized in a reserve within equity attributable to owners of Akumin.
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
bearing, unsecured obligations due from patients and third-party payers. They are recognized initially at net realizable value and are subsequently measured at amortized cost less loss allowances. In addition to the implicit price concessions considered and recorded when the service was performed, at each reporting period, the Company estimates the expected credit losses based on a combination of probability-weighted historic and actual bad debts experience with consideration of forward-looking information including changes to economic conditions that would impact its customers (such as unemployment rate and general economic environment for
non-individual
payors). During the period affected by the
COVID-19
pandemic, management’s consideration of those changes to economic conditions included the impact of the
COVID-19
pandemic.     
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.
In the fourth quarter of 2020, due to slow down in collections of receivables, the Company changed its estimates of the implicit price concessions related to its customers, primarily based on historical experience of collections impacted by the pandemic and the integration of diagnostic imaging centers acquired in 2018 and 2019. The result of this change in estimate resulted in an increase as compared to the year ended December 31, 2019 to the cumulative implicit price concessions for outstanding receivables by approximately $12.3 million ($9.4 million net of tax) in the year ended 2020, or $0.13 per share (basic and diluted) for the three and twelve months ended December 31, 2020.
XML 41 R34.htm IDEA: XBRL DOCUMENT v3.21.1
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  
XML 42 R35.htm IDEA: XBRL DOCUMENT v3.21.1
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
assets
  
Security deposits
   368,601   
Property and equipment
   412,400   
Operating lease
right-of-use
assets
           2,427,618   
  
 
 
 
   3,241,580   
  
 
 
 
Liabilities assumed
  
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]  
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
assets
  
Security deposits
   5,799   
Property and equipment
   820,000   
Operating lease
right-of-use
assets
   554,830   
  
 
 
 
   1,380,629   
  
 
 
 
Liabilities assumed
  
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]  
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 (Davie Acquisition). In accordance with the transaction agreement, $50,000 of this purchase price (Holdback Fund) was withheld as security for indemnity obligations and was released to the seller on October 1, 2019. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows:
 
  
 
                $  
 
Assets acquired
  
Non-current
assets
  
Property and equipment
   170,000   
Operating lease
right-of-use
assets
   427,558   
  
 
 
 
   597,558   
  
 
 
 
Liabilities assumed
  
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]  
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.
 
  
 
                $  
 
Assets acquired
  
Current assets
  
Cash
   3,585,672   
Accounts receivable
   19,418,814   
Prepaid expenses
   269,012   
  
 
 
 
   23,273,498   
  
 
 
 
Non-current
assets
  
Property and equipment
   11,508,940   
Intangible assets
   5,870,000   
Operating lease
right-of-use
assets
   16,912,896   
  
 
 
 
   34,291,836   
  
 
 
 
   57,565,334   
  
 
 
 
Liabilities assumed
  
Current liabilities
  
Accounts payable and accrued liabilities
   5,634,661   
  
 
 
 
Non-current
liabilities
  
Deferred tax liability
   422,056   
Operating lease liabilities
(right-of-use)
   16,912,896   
  
 
 
 
   17,334,952   
  
 
 
 
   22,969,613   
  
 
 
 
Net assets acquired
   34,595,721   
Goodwill
   195,937,055   
  
 
 
 
Purchase price (cash and shares)
   215,784,755   
  
 
 
 
Purchase price (ADG Acquisition –
earn-out
(note 8))
   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 (Deltona Acquisition). The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows:
 
  
 
                $  
 
Assets acquired
  
Non-current
assets
  
Property and equipment
   295,000   
Operating lease
right-of-use
assets
   154,136   
  
 
 
 
   449,136   
  
 
 
 
Liabilities assumed
  
Current liabilities
  
Accounts payable and accrued liabilities
   57,880   
Non-current
liabilities
  
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 million (El Paso Acquisition). The cash purchase price was decreased during 2020 by approximately $16 thousand due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete.
 
  
 
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
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   
  
 
 
   
 
 
 
   9,621,985      9,621,985   
  
 
 
   
 
 
 
Liabilities assumed
    
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   
  
 
 
   
 
 
 
   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 million (West Palm Beach Acquisition). The cash purchase price was decreased during 2020 by approximately $0.1 million due to working capital adjustments in accordance with the purchase agreement. The Company has made a fair value determination of the acquired assets and assumed liabilities as at the date of acquisition, as follows. The intangible assets consist of the trade name and covenants not to compete.
 
  
 
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
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   
  
 
 
   
 
 
 
   19,322,700      19,322,700   
  
 
 
   
 
 
 
Liabilities assumed
    
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   
  
 
 
   
 
 
 
           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   
  
 
 
   
 
 
 
XML 43 R36.htm IDEA: XBRL DOCUMENT v3.21.1
Property and Equipment (Tables)
 12 Months Ended
Dec. 31, 2020
Property, Plant and Equipment [Abstract]  
Summary of Detailed Information of Property and Equipment
   
2020
$
   
2019  
$  
 
Medical equipment
   85,588,228    75,665,771   
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
               130,048,023    109,529,144   
Less: Accumulated depreciation
   (50,118,449)    (33,590,554)   
  
 
 
 
Total property and equipment – net
   79,929,574    75,938,590   
  
 
 
 
XML 44 R37.htm IDEA: XBRL DOCUMENT v3.21.1
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-
ments
$
   
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 3)
       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   
  
 
 
 
XML 45 R38.htm IDEA: XBRL DOCUMENT v3.21.1
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.
 
  
 

 
2020

$
 

 
  
 

 
2019  

$  
 

 
Balance – Beginning of period
           358,802,534    147,120,852   
Adjustments (note 3)
   126,315    (5,104,587)  
Business acquisitions (note 3)
   1,674,764    216,786,269   
  
 
 
 
Balance – End of period
   360,603,613    358,802,534   
  
 
 
 
Schedule of Carrying amount of goodwill
The carrying amount of goodwill attributed to each reporting unit was as follows:
 
  
 

 
2020

$
 

 
  
 

 
2019  

$  
 

 
Florida
           256,270,533    255,002,971   
Northeast
   3,569,801    3,569,801   
Texas
   92,803,338    92,669,821   
Other
   7,959,941    7,559,941   
  
 
 
 
   360,603,613    358,802,534   
  
 
 
 
XML 46 R39.htm IDEA: XBRL DOCUMENT v3.21.1
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:
 
  
 

 
2020

$
 

 
  
 

 
2019  

$  
 

 
Accounts payable
           20,400,949    21,707,080   
Accrued other expenses
   10,034,409    2,602,292   
Accrued payroll expenses
   3,797,784    1,952,853   
  
 
 
   
 
 
 
   34,233,142    26,262,225   
  
 
 
 
XML 47 R40.htm IDEA: XBRL DOCUMENT v3.21.1
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
portion of ADG Acquisition –
earn-out
   -    7,304,105   
  
 
 
 
XML 48 R41.htm IDEA: XBRL DOCUMENT v3.21.1
Lease Liabilities (Tables)
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Leases [Abstract]    
Summary of Finance Lease Liabilities  
The information pertaining to finance lease liabilities on the consolidated balance sheet 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
portion of finance lease liabilities
   12,308,780    6,625,409   
  
 
 
 
Summary of Finance Lease Cost  
The components of finance lease cost recognized in the consolidated statement of operations and comprehensive income (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
finance lease liabilities
  
 
 
 
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 rat
e
-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
assets obtained in exchange for finance lease obligations
   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
portion of operating lease liabilities
   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
operating lease liabilities
   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
assets obtained in exchange for operating lease obligations
   13,800,876        137,301,712 
  
XML 49 R42.htm IDEA: XBRL DOCUMENT v3.21.1
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 million and an amortized cost balance of approximately, $389 million.
 
   
 
 
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 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 16). 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 
   
 
 
 
XML 50 R43.htm IDEA: XBRL DOCUMENT v3.21.1
Subordinated notes payable -&#160;earn-out (Tables)
 12 Months Ended
Dec. 31, 2020
Debt Disclosure [Abstract]  
Summary of subordinated debt
   
2020
$
       
2019  
$  
 
Subordinated note –
earn-out
   -      184,485   
  
 
 
 
XML 51 R44.htm IDEA: XBRL DOCUMENT v3.21.1
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 
  
 
 
 
 
XML 52 R45.htm IDEA: XBRL DOCUMENT v3.21.1
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:
 
   
2020
$
   
2019
$
 
Income attributable to common shareholders before income taxes
   (26,148,454)    13,163,526 
  
 
 
 
Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%)
   (6,929,340)    3,488,334 
Increase (decrease) in income taxes resulting from
    
Stock-based compensation
   396,528    942,013 
State franchise tax, net of federal benefit
   212,684    219,538 
US tax rate differential
   603,264    (400,948) 
Return to provision adjustment
   345,299    1,389,866 
Other
   (205,656)    (164,747) 
Valuation allowance
   (173,849)    (1,738,508) 
  
 
 
 
Income tax expense (benefit)
   (5,751,070)    3,735,548 
  
 
 
 
U.S. Federal current tax expense (benefit)
    
U.S. State current tax expense (benefit)
   (320,815)    1,643,043 
Canadian current tax expense (benefit)
    
U.S. Federal deferred tax expense (benefit)
   (4,433,785)    2,688,571 
U.S. State deferred tax expense (benefit)
   (996,470)    (596,066) 
Canadian deferred tax expense (benefit)
    
  
 
 
 
Total income tax expense (benefit)
   (5,751,070)    3,735,548 
Summary of the Company's deferred tax assets and liabilities
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:
 
   
2020
$
  
2019
$
 
Deferred tax assets
   
Lease liabilities
   31,615,510   33,474,270 
Net operating losses
   15,745,126   3,692,446 
163(j) carryforward
   5,934,846   1,458,105 
Debt issuance costs
   2,419,687   4,412,375 
Capital acquisition costs
   2,011,450   779,367 
Other
   3,409,797   9,430,097 
  
 
 
 
Total deferred tax assets
   61,136,416   53,246,660 
Less: Valuation allowance (Canada)
   (2,634,364)   (2,800,607) 
Net deferred tax assets
   58,502,052   50,446,053 
Deferred tax liabilities
   
Right-of-use
assets
   (30,360,097)   (32,907,312) 
Fixed assets
   (14,973,077)   (12,400,551) 
Goodwill
   (10,664,325)   (8,392,326) 
Other
   (3,331,119)   (3,002,684) 
  
 
 
 
Total deferred tax liabilities
   (59,328,618)   (56,702,873) 
  
 
 
 
Net deferred tax liabilities
   (826,566)   (6,256,820) 
  
 
 
 
XML 53 R46.htm IDEA: XBRL DOCUMENT v3.21.1
Stock-Based Compensation &#8211; 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% 
XML 54 R47.htm IDEA: XBRL DOCUMENT v3.21.1
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
liabilities were as follows:
   
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
   -    951,105 
   
 
 
 
   
    429,826,997    378,049,987 
   
 
 
 
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.
 
   
Derivative
financial
instruments
$
   
Subordinated
Notes
Earn-out
$
   
ADG
Acquisition
Earn-out
$
 
    
January 1, 2019
   (16,014)    169,642    - 
Issuance
   -    -    14,748,022 
Financial instruments revaluation loss (gain)
               
Realized
   -    -    - 
Unrealized
   967,119    14,843    86,045 
   
 
 
 
    
December 31, 2019
   951,105    184,485    14,834,067 
Payment
   (4,805,000)    (200,000)    (4,688,553) 
Financial instruments revaluation loss (gain)
               
Realized
   3,853,895    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:
   
2020
$
     
2019
$
 
   
Cash
   44,395,988      23,388,916 
Accounts receivable
   91,126,923      82,867,225 
   
 
 
 
   
Financial assets measured at amortized cost
   135,522,911      106,256,141 
   
 
 
 
   
Accounts payable and accrued liabilities
   34,233,142      26,262,225 
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
   572,091,784      503,709,941 
   
 
 
 
   
Subordinated note –
earn-out
   -      184,485 
ADG Acquisition –
earn-out
   4,688,553      14,834,067 
Derivative financial instruments
   -      951,105 
   
 
 
 
   
Measured at fair value through profit or loss
   4,688,553      15,969,657 
   
 
 
 
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) 
XML 55 R48.htm IDEA: XBRL DOCUMENT v3.21.1
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
  
 

 
2020

$
 

 
 
 

 
2019

$
 

 
Net income (loss) attributable to common shareholders
   (20,397,384)   9,427,978 
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
    2,066,938 
          
Diluted
   70,101,618   68,594,989 
Net income (loss) per share
   
Basic and diluted
   (0.29)   0.14 
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  
XML 56 R49.htm IDEA: XBRL DOCUMENT v3.21.1
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)
 
  
 

 
2020

$
 

 
 
 

 
2019

$
 

 
Gain (loss) on revaluation of ADG Acquisition –
Earn-out
(note 8)
   5,456,961   (86,045) 
Loss on disposal of property and equipment
   (1,549,295)   (931,356) 
         
   (3,907,666)   (1,017,401) 
         
Other Financial instruments revaluation and other gains (losses)
 
b)
Other Financial instruments revaluation and other gains (losses)
 
  
 

 
2020

$
 

 
 
 

 
2019

$
 

 
Loss on debt revaluation (note 10)
   (18,278,845)   (829,208) 
Loss on revaluation of derivatives (note 10)
   (3,853,895)   (967,119) 
Other gains (losses)
   53,995   (9,489) 
         
   (22,078,745)   (1,805,816) 
         
XML 57 R50.htm IDEA: XBRL DOCUMENT v3.21.1
Revenue Information (Tables)
 12 Months Ended
Dec. 31, 2020
Revenue from Contract with Customer [Abstract]  
Summary of Revenue Information
  
 

 
2020

$
 

 
  
 

 
2019

$
 

 
Commercial
   163,893,988    173,056,345 
Medicare
   28,449,283    28,849,651 
Medicaid
   7,889,878    7,421,432 
Attorney
   24,271,130    14,784,804 
Workers comp
   9,960,660    10,569,156 
Other patient revenue
   9,516,244    10,160,012 
          
Service fees - net of allowances and discounts
   243,981,183    244,841,400 
Other revenue (management and ancillary fees and government grants)
   7,301,666    2,594,903 
          
   251,282,849    247,436,303 
          
XML 58 R51.htm IDEA: XBRL DOCUMENT v3.21.1
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
  
 

 
2020

$
 

 
  
 

 
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
   21,706,906    19,084,397 
Administrative
   12,875,606    12,459,281 
Medical supplies and other
   11,161,702    8,783,377 
          
   197,803,388    187,802,601 
          
XML 59 R52.htm IDEA: XBRL DOCUMENT v3.21.1
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
owned entities:
 
   
Ownership interest
 
Entity
  
2020
   
2019
 
   
%
   
%
 
Phoenix Imaging, LLC
   60    60 
Preferred Imaging of Amarillo, LLC
   57    57 
XML 60 R53.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 61 R54.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 62 R55.htm IDEA: XBRL DOCUMENT v3.21.1
Summary of Significant Accounting Policies - Additional Information (Detail) - USD ($)
 3 Months Ended 12 Months Ended
Dec. 31, 2020
Dec. 31, 2020
Dec. 31, 2019
Jan. 01, 2019
Significant Accounting Policies [Line Items]        
Assets $ 718,684,541 $ 718,684,541 $ 683,000,517  
Liabilities 578,952,991 578,952,991 525,937,015  
Revenues   7,301,666 2,594,903  
Net cash provided by (used in) operating activities   26,690,553 12,581,077  
Operating lease, right-of-use asset 127,061,894 127,061,894 126,675,770 $ 98,912,687
Operating lease, liability $ 132,299,312 132,299,312 129,049,990 $ 98,912,687
Increase (decrease) in accounts receivable   $ 8,259,697 $ 25,243,156  
Earnings per share, basic and diluted   $ (0.29) $ 0.14  
Accounts Receivable [Member]        
Significant Accounting Policies [Line Items]        
Increase (decrease) in accounts receivable   $ 12,300,000 $ 9,400,000  
Earnings per share, basic and diluted $ 0.13 $ 0.13    
Minimum [Member]        
Significant Accounting Policies [Line Items]        
Lessee, operating lease, term of contract 3 years 3 years    
Lessee, operating lease, renewal term 10 years 10 years    
Maximum [Member]        
Significant Accounting Policies [Line Items]        
Lessee, operating lease, term of contract 10 years 10 years    
Lessee, operating lease, renewal term 30 years 30 years    
Variable Interest Entity, Primary Beneficiary [member]        
Significant Accounting Policies [Line Items]        
Assets $ 57,000,000 $ 57,000,000 58,700,000  
Liabilities $ 2,400,000 2,400,000 0  
Revenues   139,100,000 151,900,000  
Net cash provided by (used in) operating activities   $ 134,700,000 $ 112,000,000  
XML 63 R56.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 360,603,613 $ 358,802,534 $ 147,120,852
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    
Accounts receivable 19,418,814    
Prepaid expenses 269,012    
Current assets 23,273,498    
Non-current assets      
Property and equipment 11,508,940    
Operating lease right-of-use assets 16,912,896    
Intangible assets 5,870,000    
Non-current assets 34,291,836    
Assets 57,565,334    
Current liabilities      
Accounts payable and accrued liabilities 5,634,661    
Non-current liabilities      
Deferred tax liability 422,056    
Operating lease liabilities (right-of-use) 16,912,896    
Non-current liabilities 17,334,952    
Liabilities 22,969,613    
Net assets acquired 34,595,721    
Goodwill 195,937,055    
Purchase price (cash and shares) 215,784,755    
Purchase price (ADG Acquisition – earn-out (note 8)) 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  
XML 64 R57.htm IDEA: XBRL DOCUMENT v3.21.1
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
 1 Months Ended 12 Months Ended
Jan. 01, 2020
USD ($)
Oct. 04, 2019
USD ($)
Oct. 01, 2019
USD ($)
Aug. 16, 2019
USD ($)
May 31, 2019
USD ($)
$ / shares
shares
Apr. 15, 2019
USD ($)
Agreement
Apr. 01, 2019
USD ($)
Jun. 30, 2020
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
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        
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                 700,000 900,000
Crystal Lake [Member]                    
Business Acquisition [Line Items]                    
Business combination, consideration transferred $ 1,200,000             $ 60,000    
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                   247,600,000
Income (loss) from subsidiaries, before tax                   54,000
Revenues                   500,000
Business acquisition, pro forma income before tax                   13,200,000
ADG Acquisitions [Member]                    
Business Acquisition [Line Items]                    
Business combination, consideration transferred           $ 216,000,000        
Business acquisition, pro forma revenue                   277,500,000
Income (loss) from subsidiaries, before tax                   29,700,000
Revenues                   72,600,000
Business acquisition, pro forma income before tax                   25,500,000
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          
Deltona Acquisition [Member]                    
Business Acquisition [Line Items]                    
Business combination, consideration transferred         $ 648,387          
Business acquisition, pro forma revenue                   248,800,000
Income (loss) from subsidiaries, before tax                   1,000,000
Revenues                   3,200,000
Business acquisition, pro forma income before tax                   13,600,000
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                   256,100,000
Income (loss) from subsidiaries, before tax                   3,000,000
Revenues                   14,000,000
Business acquisition, pro forma income before tax                   15,000,000
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                   262,400,000
Income (loss) from subsidiaries, before tax                   1,600,000
Revenues                   19,800,000
Business acquisition, pro forma income before tax                   14,400,000
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                   17,400,000
Revenues                   $ 42,500,000
XML 65 R58.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 130,048,023 $ 109,529,144
Less: accumulated depreciation (50,118,449) (33,590,554)
Total property and equipment – net 79,929,574 75,938,590
Medical equipment [Member]    
Property, Plant and Equipment [Line Items]    
Total property and equipment – cost 85,588,228 75,665,771
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
XML 66 R59.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 79,929,574 $ 75,938,590
Depreciation 17,769,948 13,705,653
Property, plant and equipment, disposals 1,779,626 1,030,006
Financial instruments revaluation and other gains losses [Member]    
Property, Plant and Equipment [Line Items]    
Gain (loss) on disposition of property plant equipment (1,549,295) (931,356)
Equipment under finance leases [Member]    
Property, Plant and Equipment [Line Items]    
Property and equipment - net $ 14,981,186 $ 9,404,765
XML 67 R60.htm IDEA: XBRL DOCUMENT v3.21.1
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  
XML 68 R61.htm IDEA: XBRL DOCUMENT v3.21.1
Intangible Assets - Summary of Finite-Lived Intangible Assets Net Amortization Expense (Detail)
Dec. 31, 2020
USD ($)
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
XML 69 R62.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 358,802,534 $ 147,120,852
Adjustments (note 3) 126,315 (5,104,587)
Business acquisitions (note 3) 1,674,764 216,786,269
Balance – End of period $ 360,603,613 $ 358,802,534
XML 70 R63.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 360,603,613 $ 358,802,534 $ 147,120,852
Florida [member]      
Summary of carrying amount of goodwill as follows:      
Goodwill 256,270,533 255,002,971  
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 92,803,338 92,669,821  
Other [member]      
Summary of carrying amount of goodwill as follows:      
Goodwill $ 7,959,941 $ 7,559,941  
XML 71 R64.htm IDEA: XBRL DOCUMENT v3.21.1
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 10,034,409 2,602,292
Accrued payroll expenses 3,797,784 1,952,853
Accounts payable and accrued liabilities $ 34,233,142 $ 26,262,225
XML 72 R65.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 73 R66.htm IDEA: XBRL DOCUMENT v3.21.1
Earn-Out Liability (ADG Acquisition) - Additional Information (Detail) - ADG [Member] - Earn-out liability [Member]
 6 Months Ended 12 Months Ended
Dec. 31, 2019
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2020
USD ($)
Dec. 31, 2019
USD ($)
Nov. 30, 2020
USD ($)
May 31, 2019
USD ($)
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
XML 74 R67.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 75 R68.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 76 R69.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 77 R70.htm IDEA: XBRL DOCUMENT v3.21.1
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%
XML 78 R71.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 79 R72.htm IDEA: XBRL DOCUMENT v3.21.1
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  
XML 80 R73.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 81 R74.htm IDEA: XBRL DOCUMENT v3.21.1
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  
XML 82 R75.htm IDEA: XBRL DOCUMENT v3.21.1
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%
XML 83 R76.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 84 R77.htm IDEA: XBRL DOCUMENT v3.21.1
Senior loans payable - Summary of Maturities of Long-term Debt (Detail)
Dec. 31, 2020
USD ($)
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
XML 85 R78.htm IDEA: XBRL DOCUMENT v3.21.1
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 0 335,214,995
Amended May 2019 Loans [Member] | Term Loan A And Revolving Facility [Member]    
Debt Instrument [Line Items]    
Long-term Debt 0 87,824,000
Amended May 2019 Loans [Member] | Term Loan B [Member]    
Debt Instrument [Line Items]    
Long-term Debt 0 250,710,995
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
XML 86 R79.htm IDEA: XBRL DOCUMENT v3.21.1
Senior loans payable - Additional Information (Detail) - USD ($)
 1 Months Ended 12 Months Ended
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 fair value 429,826,997               $ 429,826,997 $ 378,049,987  
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. 01, 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. 01, 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]                      
Debt instrument description of variable rate basis the Federal Reserve Bank of New York Rate plus 0.5%                    
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               951,702  
Derivative, Gain (Loss) on Derivative                 3,900,000    
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               $ 1.0      
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  
XML 87 R80.htm IDEA: XBRL DOCUMENT v3.21.1
Subordinated notes payable -&#160;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
XML 88 R81.htm IDEA: XBRL DOCUMENT v3.21.1
Subordinated notes payable -&#160;earn-out - Additional Information (Detail) - USD ($)
 12 Months Ended
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]          
Business combination contingent consideration maximum outcome         $ 4,000,000
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] | 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)
XML 89 R82.htm IDEA: XBRL DOCUMENT v3.21.1
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   70,178,428 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
XML 90 R83.htm IDEA: XBRL DOCUMENT v3.21.1
Capital stock and warrants - Additional Information (Detail) - USD ($)
$ / shares in Units, $ in Millions
 1 Months Ended 2 Months Ended 3 Months Ended 12 Months Ended
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       $ 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                         1
Class of warrants or rights exercise price           $ 4.00 $ 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. 08, 2019                   May 02, 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    
XML 91 R84.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ (26,148,454) $ 13,163,526
Expense (recovery) of income taxes at the Canadian tax rate of 26.5% (2019– 26.5%) (6,929,340) 3,488,334
Increase (decrease) in income taxes resulting from    
Stock-based compensation 396,528 942,013
State franchise tax, net of federal benefit 212,684 219,538
US tax rate differential 603,264 (400,948)
Return to provision adjustment 345,299 1,389,866
Other (205,656) (164,747)
Valuation allowance (173,849) (1,738,508)
Income tax expense (benefit) (5,751,070) 3,735,548
U.S. State current tax expense (benefit) (320,815) 1,643,043
U.S. Federal deferred tax expense (benefit) (4,433,785) 2,688,571
U.S. State deferred tax expense (benefit) (996,470) (596,066)
Total Income Tax Expense Benefit $ (5,751,070) $ 3,735,548
XML 92 R85.htm IDEA: XBRL DOCUMENT v3.21.1
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%
XML 93 R86.htm IDEA: XBRL DOCUMENT v3.21.1
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 15,745,126 3,692,446
163(j) carryforward 5,934,846 1,458,105
Debt issuance costs 2,419,687 4,412,375
Capital acquisition costs 2,011,450 779,367
Other 3,409,797 9,430,097
Total deferred tax assets 61,136,416 53,246,660
Less: Valuation allowance (Canada) (2,634,364) (2,800,607)
Net deferred tax assets 58,502,052 50,446,053
Deferred tax liabilities    
Right-of-use assets (30,360,097) (32,907,312)
Fixed assets (14,973,077) (12,400,551)
Goodwill (10,664,325) (8,392,326)
Other (3,331,119) (3,002,684)
Total deferred tax liabilities (59,328,618) (56,702,873)
Net deferred tax liabilities $ (826,566) $ (6,256,820)
XML 94 R87.htm IDEA: XBRL DOCUMENT v3.21.1
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 22.00% (28.38%)
Deferred Tax Assets, Valuation Allowance $ 2,634,364 $ 2,800,607
Operating Loss Carryforwards 68,755,558 16,226,326
Interest expense carryforward 24,670,177 $ 1,007,969
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 $ 49,012,664  
XML 95 R88.htm IDEA: XBRL DOCUMENT v3.21.1
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 1,664,852  
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    
XML 96 R89.htm IDEA: XBRL DOCUMENT v3.21.1
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 1,664,852
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
XML 97 R90.htm IDEA: XBRL DOCUMENT v3.21.1
Stock-Based Compensation &#8211; 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%  
XML 98 R91.htm IDEA: XBRL DOCUMENT v3.21.1
Risk Management Arising From Financial Instruments - Summary of Estimated Fair Values 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 $ 378,049,987
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   $ 951,105
XML 99 R92.htm IDEA: XBRL DOCUMENT v3.21.1
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 951,105 16,014
Unrealized   967,119
Payment For Liabilities Change in Fair Value Of Financial Instruments (4,805,000)  
Realized 3,853,895  
Ending balance   951,105
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
XML 100 R93.htm IDEA: XBRL DOCUMENT v3.21.1
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 91,126,923 82,867,225  
Accounts payable and accrued liabilities 34,233,142 26,262,225  
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   951,702  
Reported Value Measurement [Member]      
Fair Value Of Assets And Liabilities Carrying Value [Line Items]      
Cash 44,395,988 23,388,916  
Accounts receivable 91,126,923 82,867,225  
Financial assets measured at amortized cost 135,522,911 106,256,141  
Accounts payable and accrued liabilities 34,233,142 26,262,225  
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 572,091,784 503,709,941  
Subordinated note – earn-out   184,485  
ADG Acquisition – earn-out 4,688,553 14,834,067  
Derivative financial instruments   951,105  
Measured at fair value through profit or loss $ 4,688,553 $ 15,969,657  
XML 101 R94.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 102 R95.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 44,395,988 $ 23,388,916
Accounts Receivable fair value disclosure 91,126,923 82,867,225
Fair value concentration of risk foreign currency contracts $ 0 $ 0
XML 103 R96.htm IDEA: XBRL DOCUMENT v3.21.1
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. 08, 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] | Z Strategies Inc [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
XML 104 R97.htm IDEA: XBRL DOCUMENT v3.21.1
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 income (loss) attributable to common shareholders $ (20,397,384) $ 9,427,978
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   2,066,938
Diluted 70,101,618 68,594,989
Net income (loss) per share    
Basic and Diluted $ (0.29) $ 0.14
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  
XML 105 R98.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ (3,907,666) $ (1,017,401)
Revaluation of Assets [Member]    
Operational Financial Instruments Revaluation And Other Gains Losses [Line Items]    
Gain (loss) on revaluation of ADG Acquisition – Earn-out (note 8) 5,456,961 (86,045)
Loss on disposal of property and equipment $ (1,549,295) $ (931,356)
XML 106 R99.htm IDEA: XBRL DOCUMENT v3.21.1
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) $ 22,078,745 $ 1,805,816
Total Other Financial Instruments Revaluation and Other Gains Losses (22,078,745) (1,805,816)
Revaluation of Liabilities [Member]    
Other Financial Instruments Revaluation And Other Gains Losses [Line Items]    
Loss on debt revaluation (18,278,845) (829,208)
Loss on revaluation of derivatives (3,853,895) (967,119)
Other gains (losses) $ 53,995 $ (9,489)
XML 107 R100.htm IDEA: XBRL DOCUMENT v3.21.1
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 $ 243,981,183 $ 244,841,400
Other revenue 7,301,666 2,594,903
Revenues 251,282,849 247,436,303
Commercial    
Disaggregation of Revenue [Line Items]    
Service fees - net of allowances and discounts 163,893,988 173,056,345
Medicare    
Disaggregation of Revenue [Line Items]    
Service fees - net of allowances and discounts 28,449,283 28,849,651
Medicaid    
Disaggregation of Revenue [Line Items]    
Service fees - net of allowances and discounts 7,889,878 7,421,432
Attorney    
Disaggregation of Revenue [Line Items]    
Service fees - net of allowances and discounts 24,271,130 14,784,804
Workers comp    
Disaggregation of Revenue [Line Items]    
Service fees - net of allowances and discounts 9,960,660 10,569,156
Other patient revenue    
Disaggregation of Revenue [Line Items]    
Service fees - net of allowances and discounts $ 9,516,244 $ 10,160,012
XML 108 R101.htm IDEA: XBRL DOCUMENT v3.21.1
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) $ 197,803,388 $ 187,802,601
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) 21,706,906 19,084,397
Administrative    
Cost Of Goods And Service Excluding Depletion Depreciation And Amortization [Line Items]    
Cost of operations, excluding depreciation and amortization (note 22) 12,875,606 12,459,281
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
XML 109 R102.htm IDEA: XBRL DOCUMENT v3.21.1
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)
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  
Loss Contingency Settlement Maturity Date Jan. 31, 2021  
XML 110 R103.htm IDEA: XBRL DOCUMENT v3.21.1
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%
XML 111 R104.htm IDEA: XBRL DOCUMENT v3.21.1
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
XML 112 R105.htm IDEA: XBRL DOCUMENT v3.21.1
Subsequent Events - Additional Information (Detail) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Mar. 09, 2021
Mar. 01, 2021
Dec. 31, 2020
Dec. 31, 2019
Feb. 11, 2021
Subsequent Event [Line Items]          
Shared based compensation arrangements by share based payments award options granted in period     0 1,664,852  
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   $ 8.0      
Payments for purchase of warrants   $ 0.4      
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] | Private Placement [Member] | Artificial Intelligence Business [Member]          
Subsequent Event [Line Items]          
Total estimated equity investments   $ 4.6      
Subsequent Event [Member] | Private Placement [Member] | Seven Percent Senior Secured Notes Due November 2025 [Member]          
Subsequent Event [Line Items]          
Debt instrument face amount         $ 75.0
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%        
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