Pay vs Performance Disclosure - USD ($)

12 Months Ended

Dec. 31, 2023

Dec. 31, 2022

Dec. 31, 2021

Dec. 31, 2020

Oct. 01, 2023

Jul. 01, 2023

Apr. 01, 2023

Oct. 01, 2022

Jul. 01, 2022

Apr. 01, 2022

Oct. 01, 2021

Jul. 01, 2021

Apr. 01, 2021

Oct. 01, 2020

Jul. 01, 2020

Apr. 01, 2020

Dec. 31, 2019

Pay vs Performance Disclosure

Pay vs Performance Disclosure, Table

Pay Versus Performance

The Company’s compensation objectives and philosophy, which are discussed above, are designed to reward the contributions of its NEOs to the Company’s financial performance and provide compensation which is sufficient to attract and retain individuals who are motivated to contribute to the Company’s financial performance. To achieve these goals, the Company has implemented incentive plans which tie a significant portion of each NEOs compensation to pre-determined financial goals.

For the year ended December 31, 2023, the most important financial performance measure used by the Company to link executive compensation actually paid to the executive officers was Adjusted EBITDA. For the years ended December 31, 2022, 2021, and 2020, the most important financial performance measure used by the Company to link executive compensation actually paid to the executive officers was Operating Results, which is described in the accompanying footnotes below.

The following table summarizes the executive compensation earned by the Company’s Principal Executive Officer (“PEO”), and other Named Executive Officers (“NEOs”), the executive compensation actually paid to the Company’s PEO and other NEOs, and certain financial performance measures of the Company for the years ended December 31, 2023, 2022, 2021, and 2020.

Year(1)	Summary Compensation Table Total for PEO(1) ($)	Compensation Actually Paid to PEO(5) ($)	Average Summary Compensation Table Total for non-PEO NEOs(1) ($)	Average Compensation Actually Paid to non-PEO NEOs(5) ($)	Value of Initial Fixed $100 Investment Based on		Net Income(2) ($)	Operating Results(3) ($)	Adjusted EBITDA(6) ($)
					Total Shareholder Return ($)	Peer Group Total Shareholder Return(4) ($)
2023	$3,372,377	3,822,626	$1,722,785	1,865,290	81	134	37,220,000	36,265,000	77,717,000
2022	2,408,584	1,859,559	1,122,465	920,090	71	130	43,407,000	35,034,000	73,661,000
2021	4,143,576	3,275,545	1,454,841	1,110,753	84	135	57,924,000	43,732,000	73,780,000
2020	2,961,147	2,446,657	1,056,375	829,949	105	111	52,491,000	38,435,000	70,017,000

1)
The PEO is Christopher J. Reading for each of the years presented. The non-PEO NEOs are Carey P. Hendrickson, Eric J. Williams, Graham D. Reeve, and Richard Binstein for the years 2023 and 2022, Carey P. Hendrickson, Eric J. Williams, Glenn D. McDowell, and Graham D. Reeve for 2021 and Carey P. Hendrickson, Lawrance W. MacAfee, Glenn D. McDowell, and Graham D. Reeve for 2020.

2)
Net income includes earnings attributable to non-controlling interests.

3)
Operating Results, a non-GAAP measure, equals net income attributable to our stockholders less non-cash asset impairment charge, changes in revaluation of put-right liability, Relief Funds, changes in fair value of contingent earn-out consideration, and any allocations to non-controlling interests, all net of taxes. For additional information regarding Operating Results, please see Item 7 in the Company’s Form 10-K filed with the SEC on February 29, 2024.

4)
Total Shareholder Return assumes that $100 was invested in our common stock and the common stock on each of the companies listed on The NYSE Heathcare Index (the Company’s Peer Group), on December 31, 2019, and that any dividends were reinvested.

5)
For a computation of compensation actually paid to PEO and average compensation actually paid to non-PE NEOs, please refer to the subsequent table.

6)
For additional information regarding Adjusted EBITDA, please see Item 7 in the Company’s Form 10-K filed with the SEC on February 29, 2024.

The following table outlines the adjustments made to the compensation earned by the Company’s PEO and other NEOs, as presented in the Summary Compensation Table on page 31, to derive the compensation actually paid to the Company’s PEO and other NEOs.

	Adjustments
Year	Summary Compensation Table Total ($)	Less: Reported Value of Stock Awards ($)(1)	Plus: Year End Fair Value of Restricted Stock Awards Granted During the Year ($)(2)(3)	Plus: Change in Fair Value of Outstanding and Unvested Restricted Stock Awards ($)(2)(3)	Plus: Changes in Fair Value of Restricted Stock in Prior Years that Vested During the Year ($)(2)(3)	Dividends paid on Unvested Restricted Stock Awards During the Fiscal Year ($)(4)	Compensation Actually Paid ($)
PEO
2023	3,372,377	1,632,482	1,508,868	288,036	235,956	49,871	3,822,626
2022	2,408,584	1,016,800	810,300	(411,395)	22,404	46,466	1,859,559
2021	4,143,576	2,120,100	1,911,000	(613,844)	(81,371)	36,284	3,275,545
2020	2,961,147	1,533,056	1,346,800	180,251	(518,261)	9,776	2,446,657
Non-PEO NEOs
2023	1,722,785	816,241	754,434	108,759	76,874	18,679	1,865,290
2022	1,122,465	444,850	354,506	(132,671)	5,768	14,872	920,090
2021	1,454,841	706,539	537,469	(157,849)	(26,493)	9,325	1,110,753
2020	1,056,375	484,122	447,571	63,051	(256,345)	3,419	829,949

(1)
Represents the grant date fair value of restricted stock awards earned and as reported in the “Stock Awards” column of the Summary Compensation Table for each applicable year. These shares were issued in March of the succeeding year.

(2)
Adjustments are equal to (i) the year-end fair value of restricted stock awards granted during the applicable year that are earned but not issued and therefore deemed outstanding and unvested as of the end of the year, (ii) the amount of the change in fair value as of the end of the applicable year (from the end of the prior fiscal year) of any restricted stock awards granted in prior years that are outstanding and unvested as of the end of the applicable year, and (iii) for restricted stock awards granted in prior years that vest in the applicable year, an amount equal to the change in fair value as of the vesting date (from the end of the prior fiscal year).

(3)
Restricted stock awards are valued using the market price of our stock. The closing market price of our stock was $93.14, $81.03, $95.55, $120.25, and $114.35 as of December 31, 2023, 2022, 2021, 2020, and 2019, respectively. The closing market price of our stock when the PEO and other NEOs’ restricted stock awards vested was $81.03 on January 1, 2023, $97.91 on April 1, 2023, $121.39 on July 1, 2023, $91.73 on October 1, 2023, $95.55 on January 1, 2022, $103.76 on April 1, 2022, $112.30 on July 1, 2022, $760.02 on October 1, 2022, $120.25 on January 1, 2021, $110.21 on April 1, 2021, $119.34 on July 1, 2021, $111.55 on October 1, 2021, $114.35 on January 1, 2020, $59.00 on April 1, 2020, $81.02 on July 1, 2020 and $86.88 on October 1, 2020.

(4)
Includes dividends paid and declared on outstanding and unvested shares as of December 31, 2023, 2022, 2021 and 2020. Dividends declared per common share were $1.72, $1.64, $1.46, and $0.32 for the fiscal years ended December 31, 2023, 2022, 2021 and 2020, respectively.

Company Selected Measure Name

Adjusted EBITDA

Named Executive Officers, Footnote

1)
The PEO is Christopher J. Reading for each of the years presented. The non-PEO NEOs are Carey P. Hendrickson, Eric J. Williams, Graham D. Reeve, and Richard Binstein for the years 2023 and 2022, Carey P. Hendrickson, Eric J. Williams, Glenn D. McDowell, and Graham D. Reeve for 2021 and Carey P. Hendrickson, Lawrance W. MacAfee, Glenn D. McDowell, and Graham D. Reeve for 2020.

Peer Group Issuers, Footnote

4)
Total Shareholder Return assumes that $100 was invested in our common stock and the common stock on each of the companies listed on The NYSE Heathcare Index (the Company’s Peer Group), on December 31, 2019, and that any dividends were reinvested.

PEO Total Compensation Amount

$ 3,372,377

$ 2,408,584

$ 4,143,576

$ 2,961,147

PEO Actually Paid Compensation Amount

$ 3,822,626

1,859,559

3,275,545

2,446,657

Adjustment To PEO Compensation, Footnote

5)
For a computation of compensation actually paid to PEO and average compensation actually paid to non-PE NEOs, please refer to the subsequent table.

The following table outlines the adjustments made to the compensation earned by the Company’s PEO and other NEOs, as presented in the Summary Compensation Table on page 31, to derive the compensation actually paid to the Company’s PEO and other NEOs.

	Adjustments
Year	Summary Compensation Table Total ($)	Less: Reported Value of Stock Awards ($)(1)	Plus: Year End Fair Value of Restricted Stock Awards Granted During the Year ($)(2)(3)	Plus: Change in Fair Value of Outstanding and Unvested Restricted Stock Awards ($)(2)(3)	Plus: Changes in Fair Value of Restricted Stock in Prior Years that Vested During the Year ($)(2)(3)	Dividends paid on Unvested Restricted Stock Awards During the Fiscal Year ($)(4)	Compensation Actually Paid ($)
PEO
2023	3,372,377	1,632,482	1,508,868	288,036	235,956	49,871	3,822,626
2022	2,408,584	1,016,800	810,300	(411,395)	22,404	46,466	1,859,559
2021	4,143,576	2,120,100	1,911,000	(613,844)	(81,371)	36,284	3,275,545
2020	2,961,147	1,533,056	1,346,800	180,251	(518,261)	9,776	2,446,657
Non-PEO NEOs
2023	1,722,785	816,241	754,434	108,759	76,874	18,679	1,865,290
2022	1,122,465	444,850	354,506	(132,671)	5,768	14,872	920,090
2021	1,454,841	706,539	537,469	(157,849)	(26,493)	9,325	1,110,753
2020	1,056,375	484,122	447,571	63,051	(256,345)	3,419	829,949

(1)
Represents the grant date fair value of restricted stock awards earned and as reported in the “Stock Awards” column of the Summary Compensation Table for each applicable year. These shares were issued in March of the succeeding year.

(2)
Adjustments are equal to (i) the year-end fair value of restricted stock awards granted during the applicable year that are earned but not issued and therefore deemed outstanding and unvested as of the end of the year, (ii) the amount of the change in fair value as of the end of the applicable year (from the end of the prior fiscal year) of any restricted stock awards granted in prior years that are outstanding and unvested as of the end of the applicable year, and (iii) for restricted stock awards granted in prior years that vest in the applicable year, an amount equal to the change in fair value as of the vesting date (from the end of the prior fiscal year).

(3)
Restricted stock awards are valued using the market price of our stock. The closing market price of our stock was $93.14, $81.03, $95.55, $120.25, and $114.35 as of December 31, 2023, 2022, 2021, 2020, and 2019, respectively. The closing market price of our stock when the PEO and other NEOs’ restricted stock awards vested was $81.03 on January 1, 2023, $97.91 on April 1, 2023, $121.39 on July 1, 2023, $91.73 on October 1, 2023, $95.55 on January 1, 2022, $103.76 on April 1, 2022, $112.30 on July 1, 2022, $760.02 on October 1, 2022, $120.25 on January 1, 2021, $110.21 on April 1, 2021, $119.34 on July 1, 2021, $111.55 on October 1, 2021, $114.35 on January 1, 2020, $59.00 on April 1, 2020, $81.02 on July 1, 2020 and $86.88 on October 1, 2020.

(4)
Includes dividends paid and declared on outstanding and unvested shares as of December 31, 2023, 2022, 2021 and 2020. Dividends declared per common share were $1.72, $1.64, $1.46, and $0.32 for the fiscal years ended December 31, 2023, 2022, 2021 and 2020, respectively.

Non-PEO NEO Average Total Compensation Amount

$ 1,722,785

1,122,465

1,454,841

1,056,375

Non-PEO NEO Average Compensation Actually Paid Amount

$ 1,865,290

920,090

1,110,753

829,949

Adjustment to Non-PEO NEO Compensation Footnote

5)
For a computation of compensation actually paid to PEO and average compensation actually paid to non-PE NEOs, please refer to the subsequent table.

The following table outlines the adjustments made to the compensation earned by the Company’s PEO and other NEOs, as presented in the Summary Compensation Table on page 31, to derive the compensation actually paid to the Company’s PEO and other NEOs.

	Adjustments
Year	Summary Compensation Table Total ($)	Less: Reported Value of Stock Awards ($)(1)	Plus: Year End Fair Value of Restricted Stock Awards Granted During the Year ($)(2)(3)	Plus: Change in Fair Value of Outstanding and Unvested Restricted Stock Awards ($)(2)(3)	Plus: Changes in Fair Value of Restricted Stock in Prior Years that Vested During the Year ($)(2)(3)	Dividends paid on Unvested Restricted Stock Awards During the Fiscal Year ($)(4)	Compensation Actually Paid ($)
PEO
2023	3,372,377	1,632,482	1,508,868	288,036	235,956	49,871	3,822,626
2022	2,408,584	1,016,800	810,300	(411,395)	22,404	46,466	1,859,559
2021	4,143,576	2,120,100	1,911,000	(613,844)	(81,371)	36,284	3,275,545
2020	2,961,147	1,533,056	1,346,800	180,251	(518,261)	9,776	2,446,657
Non-PEO NEOs
2023	1,722,785	816,241	754,434	108,759	76,874	18,679	1,865,290
2022	1,122,465	444,850	354,506	(132,671)	5,768	14,872	920,090
2021	1,454,841	706,539	537,469	(157,849)	(26,493)	9,325	1,110,753
2020	1,056,375	484,122	447,571	63,051	(256,345)	3,419	829,949

(1)
Represents the grant date fair value of restricted stock awards earned and as reported in the “Stock Awards” column of the Summary Compensation Table for each applicable year. These shares were issued in March of the succeeding year.

(2)
Adjustments are equal to (i) the year-end fair value of restricted stock awards granted during the applicable year that are earned but not issued and therefore deemed outstanding and unvested as of the end of the year, (ii) the amount of the change in fair value as of the end of the applicable year (from the end of the prior fiscal year) of any restricted stock awards granted in prior years that are outstanding and unvested as of the end of the applicable year, and (iii) for restricted stock awards granted in prior years that vest in the applicable year, an amount equal to the change in fair value as of the vesting date (from the end of the prior fiscal year).

(3)
Restricted stock awards are valued using the market price of our stock. The closing market price of our stock was $93.14, $81.03, $95.55, $120.25, and $114.35 as of December 31, 2023, 2022, 2021, 2020, and 2019, respectively. The closing market price of our stock when the PEO and other NEOs’ restricted stock awards vested was $81.03 on January 1, 2023, $97.91 on April 1, 2023, $121.39 on July 1, 2023, $91.73 on October 1, 2023, $95.55 on January 1, 2022, $103.76 on April 1, 2022, $112.30 on July 1, 2022, $760.02 on October 1, 2022, $120.25 on January 1, 2021, $110.21 on April 1, 2021, $119.34 on July 1, 2021, $111.55 on October 1, 2021, $114.35 on January 1, 2020, $59.00 on April 1, 2020, $81.02 on July 1, 2020 and $86.88 on October 1, 2020.

(4)
Includes dividends paid and declared on outstanding and unvested shares as of December 31, 2023, 2022, 2021 and 2020. Dividends declared per common share were $1.72, $1.64, $1.46, and $0.32 for the fiscal years ended December 31, 2023, 2022, 2021 and 2020, respectively.

Compensation Actually Paid vs. Total Shareholder Return

Relationship between Pay and TSR

The graph below illustrates the relationship between compensation actually paid to the Company’s PEO and other NEOs, the cumulative total stockholder return (“TSR”) on $100 invested in the Company at the close of the market on December 31, 2019, with dividends being reinvested on the date paid through December 31, 2023, and the cumulative TSR of the NYSE Health Care Index. The NYSE Health Care Index TSR is calculated in a similar manner as the Company’s TSR.

Compensation Actually Paid vs. Net Income

Relationship between Pay and Net Income

The graph below illustrates the relationship between compensation actually paid to the Company’s PEO and other NEOs and the Company’s net income.

Compensation Actually Paid vs. Company Selected Measure

Relationship between Pay and Adjusted EBITDA

The graph below illustrates the relationship between compensation actually paid to the Company’s PEO and other NEOs and the Company’s Adjusted EBITDA.

Total Shareholder Return Vs Peer Group

Relationship between Pay and TSR

The graph below illustrates the relationship between compensation actually paid to the Company’s PEO and other NEOs, the cumulative total stockholder return (“TSR”) on $100 invested in the Company at the close of the market on December 31, 2019, with dividends being reinvested on the date paid through December 31, 2023, and the cumulative TSR of the NYSE Health Care Index. The NYSE Health Care Index TSR is calculated in a similar manner as the Company’s TSR.

Tabular List, Table

For the year ended December 31, 2023, the most important financial performance measure used by the Company to link executive compensation actually paid to the executive officers was Adjusted EBITDA. For the years ended December 31, 2022, 2021, and 2020, the most important financial performance measure used by the Company to link executive compensation actually paid to the executive officers was Operating Results, which is described in the accompanying footnotes below.

Total Shareholder Return Amount

$ 81

71

84

105

Peer Group Total Shareholder Return Amount

134

130

135

111

Net Income (Loss)

$ 37,220,000

$ 43,407,000

$ 57,924,000

$ 52,491,000

Company Selected Measure Amount

77,717,000

73,661,000

73,780,000

70,017,000

PEO Name

Christopher J. Reading

Christopher J. Reading

Christopher J. Reading

Christopher J. Reading

Share Price

$ 93.14

$ 81.03

$ 95.55

$ 120.25

$ 91.73

$ 121.39

$ 97.91

$ 760.02

$ 112.3

$ 103.76

$ 111.55

$ 119.34

$ 110.21

$ 86.88

$ 81.02

$ 59

$ 114.35

Common Stock, Dividends, Per Share, Declared

$ 1.72

$ 1.64

$ 1.46

$ 0.32

Measure:: 1

Pay vs Performance Disclosure

Name

Adjusted EBITDA

Non-GAAP Measure Description

6)
For additional information regarding Adjusted EBITDA, please see Item 7 in the Company’s Form 10-K filed with the SEC on February 29, 2024.

Measure:: 2

Pay vs Performance Disclosure

Compensation Actually Paid vs. Other Measure

Relationship between Pay and Operating Results

The graph below illustrates the relationship between compensation actually paid to the Company’s PEO and other NEOs and the Company’s After-tax Operating Results.

Other Performance Measure, Amount

36,265,000

35,034,000

43,732,000

38,435,000

Name

Operating Results

Non-GAAP Measure Description

3)
Operating Results, a non-GAAP measure, equals net income attributable to our stockholders less non-cash asset impairment charge, changes in revaluation of put-right liability, Relief Funds, changes in fair value of contingent earn-out consideration, and any allocations to non-controlling interests, all net of taxes. For additional information regarding Operating Results, please see Item 7 in the Company’s Form 10-K filed with the SEC on February 29, 2024.

PEO | Reported Value of Stock Awards [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

$ (1,632,482)

$ (1,016,800)

$ (2,120,100)

$ (1,533,056)

PEO | Year End Fair Value of Restricted Stock Awards Granted During the Year [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

1,508,868

810,300

1,911,000

1,346,800

PEO | Change in Fair Value of Outstanding and Unvested Restricted Stock Awards [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

288,036

(411,395)

(613,844)

180,251

PEO | Changes in Fair Value of Restricted Stock in Prior Years that Vested During the Year [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

235,956

22,404

(81,371)

(518,261)

PEO | Dividends Paid on Unvested Restricted Stock Awards During the Fiscal Year [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

49,871

46,466

36,284

9,776

Non-PEO NEO | Reported Value of Stock Awards [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

(816,241)

(444,850)

(706,539)

(484,122)

Non-PEO NEO | Year End Fair Value of Restricted Stock Awards Granted During the Year [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

754,434

354,506

537,469

447,571

Non-PEO NEO | Change in Fair Value of Outstanding and Unvested Restricted Stock Awards [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

108,759

(132,671)

(157,849)

63,051

Non-PEO NEO | Changes in Fair Value of Restricted Stock in Prior Years that Vested During the Year [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

76,874

5,768

(26,493)

(256,345)

Non-PEO NEO | Dividends Paid on Unvested Restricted Stock Awards During the Fiscal Year [Member]

Pay vs Performance Disclosure

Adjustment to Compensation, Amount

$ 18,679

$ 14,872

$ 9,325

$ 3,419