Form 10-Q - Quarterly report [Sections 13 or 15(d)]

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

FORM 10-Q

☒ QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the quarterly period ended March 31, 2024

☐ TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934

For the transition period from ______ to ______

Commission File Number: 001-12111

Pediatrix Medical Group, Inc.

(Exact name of registrant as specified in its charter)


Florida		26-3667538
(State or other jurisdiction of Incorporation or organization)		(I.R.S. Employer Identification No.)

1301 Concord Terrace Sunrise, Florida		33323
(Address of principal executive offices)		(Zip Code)

(954) 384-0175

(Registrant's telephone number, including area code)

Not Applicable

(Former name, former address and former fiscal year, if changed since last report)

Securities registered pursuant to Section 12(b) of the Act:


Title of each class	Trading Symbol	Name of each exchange on which registered
Common Stock, par value $.01 per share	MD	New York Stock Exchange

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 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 a large accelerated filer, an accelerated filer, a non-accelerated filer, smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.


Large accelerated filer	☑	Accelerated filer	☐

Non-accelerated filer	☐	Smaller reporting company	☐

		Emerging growth company	☐

If an emerging growth company, 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. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☑

On May 3, 2024, the registrant had outstanding 84,147,224 shares of Common Stock, par value $.01 per share.

Pediatrix Medical Group, Inc.

INDEX


		Page
PART I - FINANCIAL INFORMATION

Item 1.	Financial Statements	3

	Consolidated Balance Sheets as of March 31, 2024 and December 31, 2023 (Unaudited)	3

	Consolidated Statements of Income and Comprehensive Income for the Three Months Ended March 31, 2024 and 2023 (Unaudited)	4

	Consolidated Statements of Equity for the Three Months Ended March 31, 2024 and 2023 (Unaudited)	5

	Consolidated Statements of Cash Flows for the Three Months Ended March 31, 2024 and 2023 (Unaudited)	6

	Notes to Consolidated Financial Statements (Unaudited)	7

Item 2.	Management’s Discussion and Analysis of Financial Condition and Results of Operations	13

Item 3.	Quantitative and Qualitative Disclosures About Market Risk	19

Item 4.	Controls and Procedures	19

PART II - OTHER INFORMATION

Item 1.	Legal Proceedings	20

Item 1A.	Risk Factors	20

Item 2.	Unregistered Sales of Equity Securities and Use of Proceeds	20

Item 5.	Other Information	20

Item 6.	Exhibits	21

SIGNATURES		22

Pediatrix Medical Group, Inc.

Consolidated Balance Sheets

(in thousands, except share data)

(Unaudited)


	March 31, 2024			December 31, 2023
ASSETS
Current assets:
Cash and cash equivalents	$	7,998		$	73,258
Short-term investments		107,473			104,485
Accounts receivable, net		283,749			272,313
Prepaid expenses		12,532			13,525
Income taxes receivable		5,193			7,565
Other current assets		9,578			12,308
Total current assets		426,523			483,454
Property and equipment, net		74,340			75,639
Goodwill		1,393,249			1,384,166
Intangible assets, net		18,759			21,240
Operating and finance lease right-of-use assets		70,278			70,294
Deferred income tax assets		101,942			102,852
Other assets		83,074			82,165
Total assets	$	2,168,165		$	2,219,810
LIABILITIES AND SHAREHOLDERS' EQUITY
Current liabilities:
Accounts payable and accrued expenses	$	207,035		$	350,798
Current portion of debt and finance lease liabilities, net		16,409			14,913
Current portion of operating lease liabilities		21,034			21,076
Income taxes payable		2,804			2,159
Total current liabilities		247,282			388,946
Line of credit		80,000			—
Long-term debt and finance lease liabilities, net		613,347			618,421
Long-term operating lease liabilities		47,873			47,238
Long-term professional liabilities		255,870			251,284
Deferred income tax liabilities		34,105			34,308
Other liabilities		33,492			30,552
Total liabilities		1,311,969			1,370,749
Commitments and contingencies
Shareholders’ equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued		—			—
Common stock; $.01 par value; 200,000 shares authorized; 84,008,436 and 84,018,023 shares issued and outstanding, respectively		840			840
Additional paid-in capital		1,002,946			999,906
Accumulated other comprehensive loss		(2,154	)		(2,214	)
Retained deficit		(145,436	)		(149,471	)
Total shareholders’ equity		856,196			849,061
Total liabilities and shareholders' equity	$	2,168,165		$	2,219,810

The accompanying notes are an integral part of these Consolidated Financial Statements.

Pediatrix Medical Group, Inc.

Consolidated Statements of Income and Comprehensive Income

(in thousands, except per share data)

(Unaudited)


	Three Months Ended March 31,
	2024			2023
Net revenue	$	495,101		$	491,008
Operating expenses:
Practice salaries and benefits		369,138			362,235
Practice supplies and other operating expenses		31,085			30,720
General and administrative expenses		60,198			59,059
Depreciation and amortization		10,308			8,953
Transformational and restructuring related expenses		8,480			—
Total operating expenses		479,209			460,967
Income from operations		15,892			30,041
Investment and other income		2,013			634
Interest expense		(10,599	)		(10,390	)
Equity in earnings of unconsolidated affiliate		518			427
Total non-operating expenses		(8,068	)		(9,329	)
Income before income taxes		7,824			20,712
Income tax provision		(3,789	)		(6,506	)
Net income	$	4,035		$	14,206
Other comprehensive income, net of tax
Unrealized holding gain on investments, net of tax of $20 and $227		60			604
Total comprehensive income	$	4,095		$	14,810
Per common and common equivalent share data:
Net income:
Basic	$	0.05		$	0.17
Diluted	$	0.05		$	0.17
Weighted average common shares:
Basic		82,863			81,894
Diluted		83,275			82,318

The accompanying notes are an integral part of these Consolidated Financial Statements.

Pediatrix Medical Group, Inc.

Consolidated Statements of Shareholders' Equity

(in thousands)


	Common Stock
	Number of						Additional Paid-in			Accumulated Other Comprehensive			Retained			Total Shareholders'
	Shares			Amount			Capital			Loss			Deficit			Equity
2024
Balance at January 1, 2024		84,018		$	840		$	999,906		$	(2,214	)	$	(149,471	)	$	849,061
Net income		—			—			—			—			4,035			4,035
Unrealized holding gain on investments, net of tax		—			—			—			60			—			60
Common stock issued under employee stock purchase plan		108			1			859			—			—			860
Forfeitures of restricted stock		(21	)		—			—			—			—			—
Stock-based compensation expense		—			—			3,067			—			—			3,067
Repurchased common stock		(97	)		(1	)		(886	)		—			—			(887	)
Balance at March 31, 2024		84,008		$	840		$	1,002,946		$	(2,154	)	$	(145,436	)	$	856,196
2023
Balance at January 1, 2023		82,947		$	829		$	983,601		$	(3,735	)	$	(89,063	)	$	891,632
Net income		—			—			—			—			14,206			14,206
Unrealized holding gain on investments, net of tax		—			—			—			604			—			604
Common stock issued under employee stock purchase plan		86			—			1,095			—			—			1,095
Issuance of restricted stock		871			9			(9	)		—			—			—
Forfeitures of restricted stock		(221	)		(2	)		2			—			—			—
Stock-based compensation expense		—			—			3,009			—			—			3,009
Repurchased common stock		(49	)		—			(775	)		—			—			(775	)
Balance at March 31, 2023		83,634		$	836		$	986,923		$	(3,131	)	$	(74,857	)	$	909,771

The accompanying notes are an integral part of these Consolidated Financial Statements.

Pediatrix Medical Group, Inc.

Consolidated Statements of Cash Flows

(in thousands)

(Unaudited)


	Three Months Ended March 31,
	2024			2023
Cash flows from operating activities:
Net income	$	4,035		$	14,206
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization		10,308			8,953
Amortization of premiums, discounts and issuance costs		200			393
Stock-based compensation expense		3,067			3,009
Deferred income taxes		686			2,008
Other		(1,265	)		(391	)
Changes in assets and liabilities:
Accounts receivable		(9,936	)		21,345
Prepaid expenses and other current assets		3,756			(4,470	)
Other long-term assets		5,900			952
Accounts payable and accrued expenses		(141,463	)		(150,125	)
Income taxes payable		3,017			5,299
Long-term professional liabilities		4,082			2,378
Other liabilities		(5,011	)		(4,201	)
Net cash used in operating activities – continuing operations		(122,624	)		(100,644	)
Net cash used in operating activities - discontinued operations		(2,602	)		(273	)
Net cash used in operating activities		(125,226	)		(100,917	)
Cash flows from investing activities:
Acquisition payments, net of cash acquired		(8,167	)		(1,667	)
Purchases of investments		(16,896	)		(9,549	)
Proceeds from maturities or sales of investments		14,155			6,865
Purchases of property and equipment		(5,330	)		(6,999	)
Net cash used in investing activities		(16,238	)		(11,350	)
Cash flows from financing activities:
Borrowings on line of credit		170,500			216,000
Payments on line of credit		(90,500	)		(106,000	)
Payments on term loan		(3,125	)		(3,125	)
Payments on finance lease obligations		(690	)		(703	)
Proceeds from issuance of common stock		860			1,095
Repurchases of common stock		(887	)		(775	)
Other		46			2,075
Net cash provided by financing activities		76,204			108,567
Net decrease in cash and cash equivalents		(65,260	)		(3,700	)
Cash and cash equivalents at beginning of period		73,258			9,824
Cash and cash equivalents at end of period	$	7,998		$	6,124

The accompanying notes are an integral part of these Consolidated Financial Statements.

Pediatrix Medical Group, Inc.

Notes to Consolidated Financial Statements

March 31, 2024

(Unaudited)

1. Basis of Presentation:

The accompanying unaudited Consolidated Financial Statements of the Company and the notes thereto presented in this Form 10-Q have been prepared in accordance with the rules and regulations of the Securities and Exchange Commission ("SEC") applicable to interim financial statements, and do not include all disclosures required by accounting principles generally accepted in the United States of America (“GAAP”) for complete financial statements. In the opinion of management, these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair statement of the results of interim periods. The financial statements include all the accounts of Pediatrix Medical Group, Inc. and its consolidated subsidiaries (collectively, “PMG”) together with the accounts of PMG’s affiliated business corporations or professional associations, professional corporations, limited liability companies and partnerships (the “affiliated professional contractors”). Certain subsidiaries of PMG have contractual management arrangements with its affiliated professional contractors, which are separate legal entities that provide physician services in certain states.

The Company is a party to a joint venture in which it owns a 37.5% economic interest. The Company accounts for this joint venture under the equity method of accounting because the Company exercises significant influence over, but does not control, this entity.

The consolidated results of operations for the interim periods presented are not necessarily indicative of the results to be experienced for the entire fiscal year. In addition, the accompanying unaudited Consolidated Financial Statements and the notes thereto should be read in conjunction with the Consolidated Financial Statements and the notes thereto included in the Company’s most recent Annual Report on Form 10-K (the “Form 10-K”).

2. Cash Equivalents and Investments:

As of March 31, 2024 and December 31, 2023, the Company's cash equivalents consisted entirely of money market funds totaling $0.6 million and $2.8 million, respectively.

Investments held are all classified as current and at March 31, 2024 and December 31, 2023 are summarized as follows (in thousands):


	March 31, 2024		December 31, 2023
Corporate securities	$	63,244	$	57,878
U.S. Treasury securities		20,919		22,674
Municipal debt securities		13,647		14,649
Federal home loan securities		6,485		5,670
Certificates of deposit		3,178		3,614
	$	107,473	$	104,485

3. Fair Value Measurements:

The accounting guidance establishes a fair value hierarchy that prioritizes valuation inputs into three levels based on the extent to which inputs used in measuring fair value are observable in the market. Each fair value measurement is reported in one of three levels:

Level 1 – inputs are based upon unadjusted quoted prices for identical instruments traded in active markets.

Level 2 – inputs are based upon 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.

Level 3 – inputs are generally unobservable and typically reflect management’s estimates of assumptions that market participants would use in pricing the asset or liability. The fair values are therefore determined using model-based techniques that include option pricing models, discounted cash flow models, and similar techniques.

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at March 31, 2024 and December 31, 2023 (in thousands):


		Fair Value
	Fair Value Category	March 31, 2024		December 31, 2023
Assets:
Money market funds	Level 1	$	562	$	2,814
Short-term investments	Level 2		107,473		104,485
Mutual Funds	Level 1		18,969		17,687

The following table presents information about the Company’s financial instruments that are not carried at fair value at March 31, 2024 and December 31, 2023 (in thousands):


	March 31, 2024				December 31, 2023
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2030 Notes	$	400,000	$	365,000	$	400,000	$	357,000

The carrying amounts of cash equivalents, accounts receivable and accounts payable and accrued expenses approximate fair value due to the short maturities of the respective instruments. The carrying value of the line of credit approximates fair value. If the Company’s line of credit was measured at fair value, it would be categorized as Level 2 in the fair value hierarchy.

4. Accounts Receivable and Net Revenue:

Accounts receivable, net consists of the following (in thousands):


	March 31, 2024			December 31, 2023

Gross accounts receivable	$	1,456,721		$	1,379,213
Allowance for contractual adjustments and uncollectibles		(1,172,972	)		(1,106,900	)
	$	283,749		$	272,313

Patient service revenue is recognized at the time services are provided by the Company’s affiliated physicians. The Company’s performance obligations related to the delivery of services to patients are satisfied at the time of service. Accordingly, there are no performance obligations that are unsatisfied or partially unsatisfied at the end of the reporting period with respect to patient service revenue. Almost all of the Company’s patient service revenue is reimbursed by government-sponsored healthcare programs (“GHC Programs”) and third-party insurance payors. Payments for services rendered to the Company’s patients are generally less than billed charges. The Company monitors its revenue and receivables from these sources and records an estimated contractual allowance to properly account for the anticipated differences between billed and reimbursed amounts.

Accordingly, patient service revenue is presented net of an estimated provision for contractual adjustments and uncollectibles. The Company estimates allowances for contractual adjustments and uncollectibles on accounts receivable based upon historical experience and other factors, including days sales outstanding (“DSO”) for accounts receivable, evaluation of expected adjustments and delinquency rates, past adjustments and collection experience in relation to amounts billed, an aging of accounts receivable, current contract and reimbursement terms, changes in payor mix and other relevant information. Contractual adjustments result from the difference between the physician rates for services performed and the reimbursements by GHC Programs and third-party insurance payors for such services.

Collection of patient service revenue the Company expects to receive is normally a function of providing complete and correct billing information to the GHC Programs and third-party insurance payors within the various filing deadlines and typically occurs within 30 to 60 days of billing.

Some of the Company’s hospital agreements require hospitals to pay the Company administrative fees. Some agreements provide for fees if the hospital does not generate sufficient patient volume in order to guarantee that the Company receives a specified minimum revenue level. The Company also receives fees from hospitals for administrative services performed by its affiliated physicians providing medical director or other services at the hospital.

The following table summarizes the Company’s net revenue by category (in thousands):


	Three Months Ended March 31,
	2024		2023
Net patient service revenue	$	421,831	$	423,184
Hospital contract administrative fees		71,803		65,989
Other revenue		1,467		1,835
	$	495,101	$	491,008

The approximate percentage of net patient service revenue by type of payor was as follows:


	Three Months Ended March 31,
	2024			2023
Contracted managed care		70	%		67	%
Government		25			26
Other third-parties		3			6
Private-pay patients		2			1
		100	%		100	%

5. Business Combinations

During the three months ended March 31, 2024, the Company completed the acquisition of one maternal-fetal medicine practice for total consideration of $9.7 million, of which $6.5 million was paid in cash at closing and $3.2 million is recorded as a contingent consideration liability. The acquisition expanded the Company’s national network of physician practices across women’s and children’s services. In connection with this acquisition, the Company recorded tax deductible goodwill of $9.1 million, fixed assets of $0.4 million and other intangible assets consisting primarily of physician and hospital agreements of $0.2 million.

6. Accounts Payable and Accrued Expenses:

Accounts payable and accrued expenses consist of the following (in thousands):


	March 31, 2024	December 31, 2023
Accounts payable	$31,636	$34,588
Accrued salaries and incentive compensation	65,711	193,112
Accrued payroll taxes and benefits	23,674	36,545
Accrued professional liabilities	29,034	32,039
Accrued interest	2,936	8,262
Other accrued expenses	54,044	46,252
	$207,035	$350,798

The net decrease in accrued salaries and incentive compensation of $127.4 million, from December 31, 2023 to March 31, 2024, is primarily due to the payment of performance-based incentive compensation, principally to the Company’s affiliated physicians, partially offset by performance-based incentive compensation accrued during the three months ended March 31, 2024. A majority of the Company’s payments for performance-based incentive compensation is paid annually during the first quarter.

7. Line of Credit and Long-Term Debt:

On February 11, 2022, the Company issued $400.0 million of 5.375% unsecured senior notes due 2030 (the “2030 Notes”). The Company used the net proceeds from the issuance of the 2030 Notes, together with $100.0 million drawn under the Revolving Credit Line (as defined below), $250.0 million of Term A Loan (as defined below) and approximately $308.0 million of cash on hand, to redeem (the “Redemption”) the 2027 Notes, which had an outstanding principal balance of $1.0 billion, and to pay costs, fees and expenses associated with the Redemption and the Credit Agreement Amendment (as defined below).

Interest on the 2030 Notes accrues at the rate of 5.375% per annum, or $21.5 million, and is payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022. The Company's obligations under the 2030 Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Amended Credit Agreement (as defined below). The indenture under which the 2030 Notes are issued, among other things, limits the Company's ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits the Company's ability to merge or dispose of all or substantially all of its assets, in all cases, subject to a number of customary exceptions. Although the Company is not required to make mandatory

redemption or sinking fund payments with respect to the 2030 Notes, upon the occurrence of a change in control, the Company may be required to repurchase the 2030 Notes at a purchase price equal to 101% of the aggregate principal amount of the 2030 Notes repurchased plus accrued and unpaid interest.

Also in connection with the Redemption, the Company amended its credit agreement (the “Credit Agreement”, and such amendment, the "Credit Agreement Amendment"), concurrently with the issuance of the 2030 Notes. The Credit Agreement Amendment, among other things, (i) refinanced the prior unsecured revolving credit facility with a $450 million unsecured revolving credit facility, including a $37.5 million sub-facility for the issuance of letters of credit (the “Revolving Credit Line”), and a $250 million term A loan facility (“Term A Loan”) and (ii) removed JPMorgan Chase Bank, N.A., as the administrative agent under the Credit Agreement and appointed Bank of America, N.A. as the administrative agent for the lenders.

The Credit Agreement, as amended by the Credit Agreement Amendment (the “Amended Credit Agreement”) matures on February 11, 2027 and is guaranteed on an unsecured basis by substantially all of the Company's subsidiaries and affiliated professional contractors. At the Company's option, borrowings under the Amended Credit Agreement bear interest at (i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on the Company's consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if the Company selects a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on the Company's consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line, based on the Company's consolidated net leverage ratio.

The Amended Credit Agreement contains customary covenants and restrictions, including covenants that require the Company to maintain a minimum interest coverage ratio, a maximum consolidated total consolidated net leverage ratio and to comply with laws, and restrictions on the ability to pay dividends, incur indebtedness or liens and make certain other distributions subject to baskets and exceptions, in each case, as specified therein. Failure to comply with these covenants would constitute an event of default under the Amended Credit Agreement, notwithstanding the ability of the Company to meet its debt service obligations. The Amended Credit Agreement includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Amended Credit Agreement. In addition, the Company may increase the principal amount of the Revolving Credit Line or incur additional term loans under the Amended Credit Agreement in an aggregate principal amount such that on a pro forma basis after giving effect to such increase or additional term loans, the Company would be in compliance with the financial covenants, subject to the satisfaction of specified conditions and additional caps in the event that the Amended Credit Agreement is secured.

At March 31, 2024, the Company had an outstanding principal balance on the Amended Credit Agreement of $305.0 million, composed of $225.0 million under the Term A Loan and $80.0 million under the Revolving Credit Line. The Company had $370.0 million available on its Amended Credit Agreement at March 31, 2024.

At March 31, 2024, the Company had an outstanding principal balance of $400.0 million on the 2030 Notes.

8. Common and Common Equivalent Shares:

Basic net income per common share is calculated by dividing net income by the weighted average number of common shares outstanding during the period. Diluted net income per common share is calculated by dividing net income by the weighted average number of common and potential common shares outstanding during the period. Potential common shares consist of outstanding restricted stock and stock options and is calculated using the treasury stock method.

The calculation of shares used in the basic and diluted net income per common share calculation for the three months ended March 31, 2024 and 2023 is as follows (in thousands):


	Three Months Ended March 31,
	2024		2023
Weighted average number of common shares outstanding		82,863		81,894
Weighted average number of dilutive common share equivalents		412		424
Weighted average number of common and common equivalent shares outstanding		83,275		82,318
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		406		1,377

9. Stock Incentive Plans and Stock Purchase Plans:

The Company’s Amended and Restated 2008 Incentive Compensation Plan (the “Amended and Restated 2008 Incentive Plan”) provides for grants of stock options, stock appreciation rights, restricted stock, deferred stock, and other stock-related awards and performance awards that may be settled in cash, stock or other property.

Under the Amended and Restated 2008 Incentive Plan, options to purchase shares of common stock may be granted at a price not less than the fair market value of the shares on the date of grant. The options must be exercised within 10 years from the date of grant and generally become exercisable on a pro rata basis over a three-year period from the date of grant. The Company issues new shares of its common stock upon exercise of its stock options. Restricted stock awards generally vest over periods of three years upon the fulfillment of specified service-based conditions and in certain instances performance-based conditions. Deferred stock awards generally vest upon the satisfaction of specified performance-based conditions and service-based conditions. The Company recognizes compensation expense related to its restricted stock and deferred stock awards ratably over the corresponding vesting periods. At March 31, 2024, the Company had 8.9 million shares available for future grants and awards under the Amended and Restated 2008 Incentive Plan.

Under the Company’s Amended and Restated 1996 Non-Qualified Employee Stock Purchase Plan, as amended (the “ESPP”), employees are permitted to purchase the Company's common stock at 85% of market value on January 1st, April 1st, July 1st and October 1st of each year. Under the Company’s 2015 Non-Qualified Stock Purchase Plan (the “SPP”), certain eligible non-employee service providers are permitted to purchase the Company’s common stock at 90% of market value on January 1st, April 1st, July 1st and October 1st of each year.

The Company recognizes stock-based compensation expense for the discount received by participating employees and non-employee service providers. During the three months ended March 31, 2024, approximately 0.1 million shares were issued under the ESPP. At March 31, 2024, the Company had approximately 2.0 million shares reserved for issuance under the ESPP. At March 31, 2024, the Company had approximately 61,000 shares in the aggregate reserved for issuance under the SPP. No shares have been issued under the SPP since 2020.

During the three months ended March 31, 2024 and 2023, the Company recognized stock-based compensation expense of $2.9 million and $3.0 million, respectively.

10. Common Stock Repurchase Programs:

In July 2013, the Company’s Board of Directors authorized the repurchase of shares of the Company’s common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under the Company’s equity compensation programs. The share repurchase program allows the Company to make open market purchases from time-to-time based on general economic and market conditions and trading restrictions. The repurchase program also allows for the repurchase of shares of the Company’s common stock to offset the dilutive impact from the issuance of shares, if any, related to the Company’s acquisition program. No shares were purchased under this program during the three months ended March 31, 2024.

In August 2018, the Company announced that its Board of Directors had authorized the repurchase of up to $500.0 million of the Company’s common stock in addition to its existing share repurchase program, of which $4.6 million remained available for repurchase as of December 31, 2023. Under this share repurchase program, during the three months ended March 31, 2024, the Company purchased a nominal number of shares of its common stock for $0.9 million representing shares withheld to satisfy minimum statutory withholding obligations in connection with the vesting of restricted stock, resulting in $3.7 million remaining available for repurchase under this authorization as of March 31, 2024.

The Company intends to utilize various methods to effect any future share repurchases, including, among others, open market purchases and accelerated share repurchase programs. The amount and timing of repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

11. Commitments and Contingencies:

The Company expects that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities. The Company has not included an accrual for these matters as of March 31, 2024 in its Consolidated Financial Statements, as the variables affecting any potential eventual liability depend on the currently unknown facts and circumstances that arise out of, and are specific to, any particular future audit, inquiry and investigation and cannot be reasonably estimated at this time.

In the ordinary course of business, the Company becomes involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by the Company's affiliated physicians. The Company's contracts with hospitals generally require the Company to indemnify them and their affiliates for losses resulting from the negligence of the Company's affiliated physicians. The Company may also become subject to other lawsuits which could involve large claims and significant costs. The Company believes, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on its business, financial condition, results of operations, cash flows and the trading price of its securities. The outcome of such actions and proceedings, however, cannot be

predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities.

Although the Company currently maintains liability insurance coverage intended to cover professional liability and certain other claims, the Company cannot assure that its insurance coverage will be adequate to cover liabilities arising out of claims asserted against it in the future where the outcomes of such claims are unfavorable. With respect to professional liability risk, the Company generally self-insures a portion of this risk through its wholly owned captive insurance subsidiary. Liabilities in excess of the Company's insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on the Company's business, financial condition, results of operations, cash flows and the trading price of its securities.

Item 2. Management’s Discussion and Analysis of Financial Condition and Results of Operations

The following discussion highlights the principal factors that have affected our financial condition and results of operations, as well as our liquidity and capital resources, for the periods described. This discussion should be read in conjunction with the unaudited Consolidated Financial Statements and the notes thereto included in this Quarterly Report. In addition, reference is made to our audited consolidated financial statements and notes thereto and related Management’s Discussion and Analysis of Financial Condition and Results of Operations included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2023, filed with the Securities and Exchange Commission on February 20, 2024 (the “2023 Form 10-K”). As used in this Quarterly Report, the terms “Pediatrix”, the “Company”, “we”, “us” and “our” refer to the parent company, Pediatrix Medical Group, Inc., a Florida corporation, and the consolidated subsidiaries through which its businesses are actually conducted (collectively, “PMG”), together with PMG’s affiliated business corporations or professional associations, professional corporations, limited liability companies and partnerships (“affiliated professional contractors”). Certain subsidiaries of PMG have contracts with our affiliated professional contractors, which are separate legal entities that provide physician services in certain states. The following discussion contains forward-looking statements. Please see the Company’s 2023 Form 10-K, including Item 1A, Risk Factors, for a discussion of the uncertainties, risks and assumptions associated with these forward-looking statements. In addition, please see “Caution Concerning Forward-Looking Statements” below.

Overview

Pediatrix is a leading provider of physician services including newborn, maternal-fetal, pediatric cardiology and other pediatric subspecialty care. Our national network is comprised of affiliated physicians who provide clinical care in 37 states. Our affiliated physicians provide neonatal clinical care, primarily within hospital-based neonatal intensive care units (“NICUs”), to babies born prematurely or with medical complications; and maternal-fetal and obstetrical medical care to expectant mothers experiencing complicated pregnancies, primarily in areas where our affiliated neonatal physicians practice. Our network also includes other pediatric subspecialists, including those who provide pediatric intensive care, pediatric cardiology care, hospital-based pediatric care, pediatric surgical care, pediatric ear, nose and throat, pediatric ophthalmology and pediatric urology services, among others.

General Economic Conditions and Other Factors

Our operations and performance depend significantly on economic conditions. During the three months ended March 31, 2024, the percentage of our patient service revenue being reimbursed under government-sponsored healthcare programs (“GHC Programs”) decreased as compared to the three months ended March 31, 2023. However, we could experience shifts toward GHC Programs if changes occur in economic behaviors or population demographics within geographic locations in which we provide services, including an increase in unemployment and underemployment as well as losses of commercial health insurance. Payments received from GHC Programs are substantially less for equivalent services than payments received from commercial insurance payors. In addition, costs of managed care premiums and patient responsibility amounts continue to rise, and accordingly, we may experience lower net revenue resulting from increased bad debt due to patients’ inability to pay for certain services.

“Surprise” Billing Legislation

In late 2020, Congress enacted the No Surprises Act (“NSA”) legislation intended to protect patients from “surprise” medical bills when certain services are furnished by providers who are not in-network with the patient’s insurer. Effective January 1, 2022, if the patient’s insurance plan or coverage is subject to the NSA, providers are not permitted to send patients an unexpected or “surprise” medical bill that arises from out-of-network emergency care provided at certain out-of-network facilities or at certain in-network facilities by out-of-network emergency providers, as well as nonemergency care provided at certain in-network facilities by out-of-network providers without the patient’s informed consent (as defined by the NSA). Many states have legislation on this topic and will continue to modify and review their laws pertaining to surprise billing.

For claims subject to the NSA, insurers are required to calculate the patient’s total cost-sharing amount pursuant to rules set forth in the NSA and its implementing regulations which, in some cases, can be calculated by reference to the applicable qualifying payment amount for the items or services received. The patient’s cost-sharing amount for out-of-network services covered by the NSA must be no more than the patient’s in-network cost-sharing amounts. Patient cost-sharing amounts for items and services subject to the NSA count toward the patient’s health plan deductible and out-of-pocket cost-sharing limits. For claims subject to the NSA, providers are generally not permitted to balance bill patients beyond this cost-sharing amount. An out-of-network provider is only permitted to bill a patient more than the cost-sharing amount allowed under the NSA for certain types of services if the provider satisfies all aspects of an informed consent process set forth in the NSA’s implementing regulations. Providers that violate these surprise billing prohibitions may be subject to state enforcement action or federal civil monetary penalties.

For claims subject to the NSA, including many emergency care services, out-of-network providers will be paid an amount determined by the patient’s insurer; if a provider is not satisfied with the initial amount paid for the services, the provider can pursue recourse through an independent dispute resolution process. The outcome of each IDR dispute is generally binding on both the provider and payor with respect to the particular claims at issue in that dispute but may not affect an insurer’s future offers of payment. Accordingly, we cannot predict how these IDR results will compare to the rates that our affiliated physicians customarily receive for their services. These measures could limit the amount we can charge and recover for services we furnish where we have not contracted with the patient’s insurer, and therefore could have a material adverse effect on our business, financial condition, results of operations, cash flows and the trading price of our securities.

Healthcare Reform

The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act (collectively the “ACA”) has altered how health care is delivered and reimbursed in the U.S. and contain various provisions, including the establishment of health insurance exchanges to facilitate the purchase of qualified health plans, expanded Medicaid eligibility, subsidized insurance premiums and additional requirements and incentives for businesses to provide healthcare benefits. Other provisions have expanded the scope and reach of the FCA and other healthcare fraud and abuse laws. The status of the ACA may be subject to change as a result of political, legislative, regulatory, and administrative developments, as well as judicial proceedings. As a result, we could be affected by potential changes to various aspects of the ACA, including changes to subsidies, healthcare insurance marketplaces and Medicaid expansion. We cannot say for certain whether there will be additional future challenges to the ACA or what impact, if any, such challenges may have on our business. Changes resulting from various legal proceedings, and any legislative or administrative change to the current healthcare financing system, could have a material adverse effect on our business, financial condition, results of operations, cash flows and the trading price of our securities.

In addition to the ACA, there could be changes to other GHC Programs, such as a change to the Medicaid program design or Medicaid coverage and reimbursement rates set forth under federal or state law. These changes, if implemented, could eliminate the guarantee that everyone who is eligible and applies for Medicaid benefits would receive them and could potentially give states new authority to restrict eligibility, cut benefits and/or make it more difficult for people to enroll. Moreover, the expiration of the COVID-19 national emergency and public health emergency declarations in May 2023 may impact the coverage for and access to certain services for Medicaid patients. Expiration of the national emergency and public health emergency declarations will also end waivers for the provision of certain services, and returning our services to a pre-pandemic regulatory state similarly may increase our exposure to legal, regulatory, compliance and clinical risks.

Medicaid Expansion

The ACA also allows states to expand their Medicaid programs through federal payments that fund most of the cost of increasing the Medicaid eligibility income limit from a state’s historic eligibility levels to 133% of the federal poverty level. All of the states in which we operate, however, already cover children in the first year of life and pregnant women if their household income is at or below 133% of the federal poverty level. Recently, Democrats in Congress have sought to expand Medicaid or Medicaid-like coverage in states that have not yet expanded Medicaid. They also have sought to reduce payments to certain hospitals in some of these states. Should any of these changes take effect, we cannot predict with any assurance the ultimate effect on reimbursements for our services.

Non-GAAP Measures

In our analysis of our results of operations, we use various GAAP and certain non-GAAP financial measures. We have incurred certain expenses that we do not consider representative of our underlying operations, including transformational and restructuring related expenses. Accordingly, we report adjusted earnings before interest, taxes and depreciation and amortization (“Adjusted EBITDA”), defined as net income before interest, taxes, depreciation and amortization, and transformational and restructuring related expenses. Earnings per share has also been adjusted (“Adjusted EPS”) and consists of diluted net income per common and common equivalent share adjusted for amortization expense, stock-based compensation expense, transformational and restructuring related expenses and impacts from discrete tax events.

We believe these measures, in addition to income from operations, net income and diluted net income per common and common equivalent share, provide investors with useful supplemental information to compare and understand our underlying business trends and performance across reporting periods on a consistent basis. These measures should be considered a supplement to, and not a substitute for, financial performance measures determined in accordance with GAAP. In addition, since these non-GAAP measures are not determined in accordance with GAAP, they are susceptible to varying calculations and may not be comparable to other similarly titled measures of other companies. We encourage investors to review our financial statements and publicly-filed reports in their entirety and not to rely on any single financial measure.

For a reconciliation of each of Adjusted EBITDA and Adjusted EPS to the most directly comparable GAAP measures for the three months ended March 31, 2024 and 2023, refer to the tables below (in thousands, except per share data).


	Three Months Ended March 31,
	2024		2023
Net income	$	4,035	$	14,206
Interest expense		10,599		10,390
Income tax provision		3,789		6,506
Depreciation and amortization expense		10,308		8,953
Transformational and restructuring related expenses		8,480		—
Adjusted EBITDA	$	37,211	$	40,055


	Three Months Ended March 31,
	2024				2023
Weighted average diluted shares outstanding	83,275				82,318
Net income and diluted net income per share	$	4,035	$	0.05	$	14,206	$	0.17
Adjustments (1):
Amortization (net of tax of $863 and $499)		2,589		0.03		1,496		0.02
Stock-based compensation (net of tax of $716 and $752)		2,146		0.03		2,257		0.03
Transformational and restructuring expenses (net of tax of $2,120)		6,360		0.08		—		—
Net impact from discrete tax events		1,676		0.01		720		0.01
Adjusted income and diluted EPS	$	16,806	$	0.20	$	18,679	$	0.23

(1)

A blended tax rate of 25% was used to calculate the tax effects of the adjustments for the three months ended March 31, 2024 and 2023.

Results of Operations

Three Months Ended March 31, 2024 as Compared to Three Months Ended March 31, 2023

Our net revenue was $495.1 million for the three months ended March 31, 2024, as compared to $491.0 million for the same period in 2023. The increase in net revenue of $4.1 million, or 0.8%, was primarily attributable to an increase in same-unit revenue, partially offset by a decrease in revenue from non-same unit activity. Same units are those units at which we provided services for the entire current period and the entire comparable period. Same-unit net revenue increased by $10.9 million, or 2.3%. The increase in same-unit revenue was comprised of an increase of $6.4 million, or 1.3%, related to patient service volumes and $4.5 million, or 1.0%, from net reimbursement-related factors. The increase in revenue from patient service volumes was related to increases in neonatology, maternal-fetal medicine and other pediatric subspecialty services, partially offset by a modest decline in primary and urgent care services. The net increase in revenue related to net reimbursement-related factors was primarily due to an increase in revenue resulting from an increase in administrative fees from our hospital partners.

Practice salaries and benefits increased $6.9 million, or 1.9%, to $369.1 million for the three months ended March 31, 2024, as compared to $362.2 million for the same period in 2023. The $6.9 million increase was primarily attributable to an increase of $9.2 million related to salaries, driven by increases in clinical compensation at our existing units, partially offset by a decrease of $2.3 million related to benefits and incentive compensation.

Practice supplies and other operating expenses increased $0.4 million, or 1.2%, to $31.1 million for the three months ended March 31, 2024, as compared to $30.7 million for the same period in 2023. The increase was primarily attributable to practice supply, rent and other costs related to our existing units and acquisition related activity.

General and administrative expenses primarily include all billing and collection functions and all other salaries, benefits, supplies and operating expenses not specifically related to the day-to-day operations of our affiliated physician practices and services. General and administrative expenses were $60.2 million for the three months ended March 31, 2024, as compared to $59.1 million for the same period in 2023. The net increase of $1.1 million was primarily related to salaries for enhancement of front-end revenue cycle management staffing, partially offset by decreases in other expenses, including information technology, professional services and travel. General and administrative expenses as a percentage of net revenue was 12.2% for the three months ended March 31, 2024, as compared to 12.0% for the same period in 2023.

Transformational and restructuring related expenses were $8.5 million for the three months ended March 31, 2024 and primarily related to position eliminations across various shared services and operations departments and revenue cycle management transition activities.

Depreciation and amortization expense was $10.3 million for the three months ended March 31, 2024, as compared to $9.0 million for the same period in 2023. The net increase of $1.3 million was primarily related to an increase in amortization expense related to practice disposition activities.

Income from operations decreased $14.1 million, or 47.1%, to $15.9 million for the three months ended March 31, 2024, as compared to $30.0 million for the same period in 2023. Our operating margin was 3.2% for the three months ended March 31, 2024, as compared to 6.1% for the same period in 2023. The decrease in our operating margin was primarily due to net unfavorable impacts in our same-unit results driven by higher operating expenses, including the increase in transformation and restructuring related expenses, partially offset by same-unit revenue increases. Excluding transformation and restructuring related expenses for the three months ended March 31, 2024, our income from operations was $24.4 million and our operating margin was 4.9% for such period. We believe excluding the impacts from the transformational and restructuring related activity provides a more comparable view of our operating income and operating margin.

Total non-operating expenses were $8.1 million for the three months ended March 31, 2024, as compared to $9.3 million for the same period in 2023. The net decrease in non-operating expenses was primarily related to an increase in interest income.

Our effective income tax rate (“tax rate”) was 48.4% for the three months ended March 31, 2024 as compared to 31.4% for the three months ended March 31, 2023. The first quarter 2024 and 2023 tax rates include discrete tax expenses of $1.7 million and $0.7 million,

respectively. After excluding discrete tax impacts during the three months ended March 31, 2024 and 2023, our tax rate was 27.0% and 27.9%, respectively. We believe excluding discrete tax impacts provides a more comparable view of our tax rate.

Net income was $4.0 million for the three months ended March 31, 2024, as compared to $14.2 million for the same period in 2023. Adjusted EBITDA was $37.2 million for the three months ended March 31, 2024, as compared to $40.1 million for the same period in 2023. The decrease in our Adjusted EBITDA was primarily due to net unfavorable impacts in our same-unit results, primarily from higher operating expenses.

Diluted net income per common and common equivalent share was $0.05 on weighted average shares outstanding of 83.3 million for the three months ended March 31, 2024, as compared to $0.17 per common and common equivalent share on weighted average shares outstanding of 82.3 million for the same period in 2023. Adjusted EPS was $0.20 for the three months ended March 31, 2024, as compared to $0.23 for the same period in 2023.

Liquidity and Capital Resources

As of March 31, 2024, we had $8.0 million of cash and cash equivalents as compared to $73.3 million at December 31, 2023. Additionally, we had working capital of $179.2 million at March 31, 2024, an increase of $84.7 million from working capital of $94.5 million at December 31, 2023. The net increase in working capital is primarily due to net borrowings on our line of credit.

Cash Flows from Continuing Operations

Cash (used in) provided from operating, investing and financing activities is summarized as follows (in thousands):


	Three Months Ended March 31,
	2024			2023
Operating activities	$	(122,624	)	$	(100,644	)
Investing activities		(16,238	)		(11,350	)
Financing activities		76,204			108,567

Operating Activities

During the three months ended March 31, 2024, our net cash used in operating activities for continuing operations was $122.6 million, compared to $100.6 million for the same period in 2023. The net increase in cash used of $22.0 million was primarily due to decreases in cash flow from accounts receivable, partially offset by increases in cash flow from accounts payable and accrued expenses, prepaid expenses and other current assets and other long-term assets.

During the three months ended March 31, 2024, cash outflow from accounts receivable was $9.9 million, as compared to a cash inflow of $21.3 million for the same period in 2023. The decrease in cash flow from accounts receivable for the three months ended March 31, 2024 as compared to the prior year period was primarily due to an increase in days sales outstanding ("DSO") related to higher accounts receivable balances at our existing units.

DSO is one of the key factors that we use to evaluate the condition of our accounts receivable and the related allowances for contractual adjustments and uncollectibles. DSO reflects the timeliness of cash collections on billed revenue and the level of reserves on outstanding accounts receivable. Our DSO for continuing operations was 52.2 days at March 31, 2024 as compared to 50.5 days at December 31, 2023 and 51.1 days at March 31, 2023. The change in our DSO was primarily related to a decrease in cash collections at our existing units.

Investing Activities

During the three months ended March 31, 2024, our net cash used in investing activities of $16.2 million consisted primarily of acquisition payments of $8.2 million, capital expenditures of $5.3 million and net purchases of investments of $2.7 million.

Financing Activities

During the three months ended March 31, 2024, our net cash provided by financing activities of $76.2 million primarily consisted of net borrowings on our Revolving Credit Line (as defined below) of $80.0 million, partially offset by payments on our Term A Loan (as defined below).

Liquidity

On February 11, 2022, we issued $400.0 million of 5.375% unsecured senior notes due 2030 (the “2030 Notes”). We used the net proceeds from the issuance of the 2030 Notes, together with $100.0 million drawn under our Revolving Credit Line (as defined below), $250.0 million of Term A Loan and approximately $308.0 million of cash on hand, to redeem (the “Redemption”) the 2027 Notes, which had an outstanding principal balance of $1.0 billion, and to pay costs, fees and expenses associated with the Redemption and the Credit Agreement Amendment (as defined below).

Also in connection with the Redemption, we amended and restated the Credit Agreement (the "Credit Agreement"), and such amendment and restatement (the “Credit Agreement Amendment”), concurrently with the issuance of the 2030 Notes. The Credit Agreement, as amended by the Credit Agreement Amendment (the “Amended Credit Agreement”), among other things, (i) refinanced the prior unsecured revolving credit facility with a $450.0 million unsecured revolving credit facility, including a $37.5 million sub-facility for the issuance of letters of credit (the “Revolving Credit Line”), and a new $250.0 million term A loan facility (“Term A Loan”) and (ii) removed JPMorgan Chase Bank, N.A., as the administrative agent under the Credit Agreement and appointed Bank of America, N.A. as the administrative agent for the lenders under the Amended Credit Agreement.

The Amended Credit Agreement matures on February 11, 2027 and is guaranteed on an unsecured basis by substantially all of our subsidiaries and affiliated professional contractors. At our option, borrowings under the Amended Credit Agreement bear interest at (i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on our consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if we select a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on our consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line, based on our consolidated net leverage ratio.

The Amended Credit Agreement contains customary covenants and restrictions, including covenants that require us to maintain a minimum interest coverage ratio, a maximum consolidated total consolidated net leverage ratio and to comply with laws, and restrictions on the ability to pay dividends, incur indebtedness or liens and make certain other distributions subject to baskets and exceptions, in each case, as specified therein. Failure to comply with these covenants would constitute an event of default under the Amended Credit Agreement, notwithstanding the ability of the company to meet its debt service obligations. The Amended Credit Agreement includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Amended Credit Agreement. In addition, we may increase the principal amount of the Revolving Credit Line or incur additional term loans under the Amended Credit Agreement in an aggregate principal amount such that on a pro forma basis after giving effect to such increase or additional term loans, we are in compliance with the financial covenants, subject to the satisfaction of specified conditions and additional caps in the event that the Amended Credit Agreement is secured.

At March 31, 2024, we had an outstanding principal balance on the Amended Credit Agreement of $305.0 million, composed of $225.0 million under the Term A Loan and $80.0 million under the Revolving Credit Line. We had $370.0 million available on the Amended Credit Agreement at March 31, 2024.

At March 31, 2024, we had an outstanding principal balance of $400.0 million on the 2030 Notes. Our obligations under the 2030 Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee our Amended Credit Agreement. Interest on the 2030 Notes accrues at the rate of 5.375% per annum, or $21.5 million, and is payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022.

The indenture under which the 2030 Notes are issued, among other things, limits our ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits our ability to merge or dispose of all or substantially all of our assets, in all cases, subject to a number of customary exceptions. Although we are not required to make mandatory redemption or sinking fund payments with respect to the 2030 Notes, upon the occurrence of a change in control, we may be required to repurchase the 2030 Notes at a purchase price equal to 101% of the aggregate principal amount of the 2030 Notes repurchased plus accrued and unpaid interest.

At March 31, 2024, we believe we were in compliance, in all material respects, with the financial covenants and other restrictions applicable to us under the Amended Credit Agreement and the 2030 Notes. We believe we will be in compliance with these covenants throughout 2024.

We maintain professional liability insurance policies with third-party insurers, subject to self-insured retention, exclusions and other restrictions. We self-insure our liabilities to pay self-insured retention amounts under our professional liability insurance coverage through a wholly owned captive insurance subsidiary. We record liabilities for self-insured amounts and claims incurred but not reported based on an actuarial valuation using historical loss information, claim emergence patterns and various actuarial assumptions. Our total liability related to professional liability risks at March 31, 2024 was $284.9 million, of which $29.0 million is classified as a current liability within accounts payable and accrued expenses in the Consolidated Balance Sheet. In addition, there is a corresponding insurance receivable of $33.2 million recorded as a component of other assets for certain professional liability claims that are covered by insurance policies.

We anticipate that funds generated from operations, together with our current cash on hand and funds available under our Amended Credit Agreement, will be sufficient to finance our working capital requirements, fund anticipated acquisitions and capital expenditures, fund expenses related to our transformational and restructuring activities, fund our share repurchase programs and meet our contractual obligations for at least the next 12 months from the date of issuance of this Quarterly Report on Form 10-Q.

Caution Concerning Forward-Looking Statements

Certain information included or incorporated by reference in this Quarterly Report may be deemed to be “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). Forward-looking statements may include, but are not limited to, statements relating to our objectives, plans and strategies, and all statements, other than statements of historical facts, that address activities, events or developments that we intend, expect, project, believe or anticipate will or may occur in the future are forward-looking statements. These statements are often characterized by terminology such as “believe,” “hope,” “may,” “anticipate,” “should,” “intend,” “plan,” “will,” “expect,” “estimate,” “project,” “positioned,” “strategy” and similar expressions, and are based on assumptions and assessments made by our management in light of their experience and their perception of historical trends, current conditions, expected future developments and other factors they believe to be appropriate. Any forward-looking statements in this Quarterly Report are made as of the date hereof, and we undertake no duty to update or revise any such statements, whether as a result of new information, future events or otherwise. Forward-looking statements are not guarantees of future performance and are subject to risks and uncertainties. Important factors that could cause actual results, developments and business decisions to differ materially from forward-looking statements are described in the 2023 Form 10-K, including the section entitled “Risk Factors.”

Item 3. Quantitative and Qualitative Disclosures about Market Risk

We are subject to market risk primarily from exposure to changes in interest rates based on our financing, investing and cash management activities. We intend to manage interest rate risk through the use of a combination of fixed rate and variable rate debt. We borrow under our Amended Credit Agreement at various interest rate options based on the Alternate Base Rate or SOFR rate depending on certain financial ratios. At March 31, 2024, the outstanding principal balance on our Amended Credit Agreement was $305.0 million, composed of $225.0 million under our Term A Loan and $80.0 million under our Revolving Credit Line. Considering the total outstanding balance, a 1% change in interest rates would result in an impact to income before taxes of approximately $3.1 million per year.

Item 4. Controls and Procedures

Evaluation of Disclosure Controls and Procedures

We maintain disclosure controls and procedures (as defined in Rules 13a-15(e) and 15d-15(e) under the Exchange Act) that are designed to provide reasonable assurance that information required to be disclosed by the Company in reports it files or submits under the Exchange Act is (i) recorded, processed, summarized and reported within the time periods specified in SEC rules and forms and (ii) accumulated and communicated to our management, including our principal executive officer and principal financial officer, as appropriate to allow timely decisions regarding required disclosure.

We carried out an evaluation, under the supervision and with the participation of our management, including our Chief Executive Officer and Chief Financial Officer, of the effectiveness of our disclosure controls and procedures. Based upon that evaluation, the Chief Executive Officer and Chief Financial Officer have concluded that our disclosure controls and procedures were effective at the reasonable assurance level as of March 31, 2024.

Changes in Internal Controls Over Financial Reporting

No changes in our internal control over financial reporting occurred during the three months ended March 31, 2024 that have materially affected, or are reasonably likely to materially affect, our internal control over financial reporting.

PART II - OTHER INFORMATION

Item 1. Legal Proceedings

We expect that audits, inquiries and investigations from government authorities and agencies will occur in the ordinary course of business. Such audits, inquiries and investigations and their ultimate resolutions, individually or in the aggregate, could have a material adverse effect on our business, financial condition, results of operations, cash flows and the trading price of our securities.

In the ordinary course of our business, we become involved in pending and threatened legal actions and proceedings, most of which involve claims of medical malpractice related to medical services provided by our affiliated physicians. Our contracts with hospitals generally require us to indemnify them and their affiliates for losses resulting from the negligence of our affiliated physicians and other clinicians. We may also become subject to other lawsuits, including with payors or other counterparties that could involve large claims and significant defense costs. We believe, based upon a review of pending actions and proceedings, that the outcome of such legal actions and proceedings will not have a material adverse effect on our business, financial condition, results of operations, cash flows or the trading price of our securities. The outcome of such actions and proceedings, however, cannot be predicted with certainty and an unfavorable resolution of one or more of them could have a material adverse effect on our business, financial condition, results of operations, cash flows and the trading price of our securities.

Although we currently maintain liability insurance coverage intended to cover professional liability and certain other claims, we cannot ensure that our insurance coverage will be adequate to cover liabilities arising out of claims asserted against us in the future where the outcomes of such claims are unfavorable to us. With respect to professional liability risk, we self-insure a significant portion of this risk through our wholly owned captive insurance subsidiary. Liabilities in excess of our insurance coverage, including coverage for professional liability and certain other claims, could have a material adverse effect on our business, financial condition, results of operations, cash flows and the trading price of our securities.

Item 1A. Risk Factors

There have been no material changes to the risk factors previously disclosed in our 2023 Form 10-K.

Item 2. Unregistered Sales of Equity Securities and Use of Proceeds

During the three months ended March 31, 2024, we withheld 96,996 shares of our common stock to satisfy minimum statutory withholding obligations in connection with the vesting of restricted stock.


Period	Total Number of Shares Repurchased (a)		Average Price Paid per Share		Total Number of Shares Purchased as part of the Repurchase Program		Approximate Dollar Value of Shares that May Yet Be Purchased Under the Repurchase Programs (a)
January 1 – January 31, 2024		—	$	—		—	(a)
February 1 – February 29, 2024		—		—		—	(a)
March 1 – March 31, 2024	96,996 (b)			9.15		—	(a)
Total		96,996	$	9.15		—	(a)

(a)

We have two active repurchase programs. Our July 2013 program allows us to repurchase shares of our common stock up to an amount sufficient to offset the dilutive impact from the issuance of shares under our equity compensation programs, which is estimated to be approximately 1.5 million shares for 2024. Our August 2018 repurchase program allows us to repurchase up to an additional $500.0 million of shares of our common stock, of which we repurchased $496.3 million as of March 31, 2024.

(b)

Shares withheld to satisfy minimum statutory withholding obligations of $0.9 million in connection with the vesting of restricted stock.

The amount and timing of any future repurchases will depend upon several factors, including general economic and market conditions and trading restrictions.

Item 5. Other Information

Rule 10b5-1 Trading Plans

During the three months ended March 31, 2024, none of the Company’s directors or officers adopted or terminated any Rule 10b5-1 trading arrangement or non-Rule 10b5-1 trading arrangement (as such terms are defined in Item 408 of Regulation S-K).

Item 6. Exhibits

Exhibit No. Description



31.1+	Certification of Chief Executive Officer pursuant to Securities Exchange Act Rule 13a-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
31.2+	Certification of Chief Financial Officer pursuant to Securities Exchange Act Rule 13a-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002.
32.1++	Certification pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002.
101.1+	Interactive Data File
101.INS+	XBRL Instance Document – the instance document does not appear in the Interactive Data File because its XBRL tags are embedded within the Inline XBRL document.
101.SCH+	XBRL Schema Document.
101.CAL+	XBRL Calculation Linkbase Document.
101.DEF+	XBRL Definition Linkbase Document.
101.LAB+	XBRL Label Linkbase Document.
101.PRE+	XBRL Presentation Linkbase Document.
104+	Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101).

+ Filed herewith.

++ Furnished herewith.

SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned thereunto duly authorized.


	Pediatrix Medical Group, Inc.


Date: May 7, 2024	By: /s/ James D. Swift, M.D.
	James D. Swift, M.D.
	Chief Executive Officer
	(Principal Executive Officer)

Date: May 7, 2024	By: /s/ C. Marc Richards
	C. Marc Richards
	Chief Financial Officer
	(Principal Financial Officer and Principal Accounting Officer)

Exhibit 31.1

CERTIFICATION PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, James D. Swift, M.D., certify that:

1. I have reviewed this quarterly report on Form 10-Q of Pediatrix Medical Group, Inc.;

2. Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3. Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4. The registrant’s other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) and internal control over financial reporting (as defined in Exchange Act Rules 13a-15(f) and 15d-15(f)) for the registrant and have:

(a) Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b) Designed such internal control over financial reporting, or caused such internal control over financial reporting to be designed under our supervision, to provide reasonable assurance regarding the reliability of financial reporting and the preparation of financial statements for external purposes in accordance with generally accepted accounting principles;

(c) Evaluated the effectiveness of the registrant’s disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d) Disclosed in this report any change in the registrant’s internal control over financial reporting that occurred during the registrant’s most recent fiscal quarter (the registrant’s fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant’s internal control over financial reporting; and

5. The registrant’s other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant’s auditors and the audit committee of the registrant’s board of directors (or persons performing the equivalent functions):

(a) All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant’s ability to record, process, summarize and report financial information; and

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: May 7, 2024

By: /s/ James D. Swift, M.D.

James D. Swift, M.D.

Chief Executive Officer

(Principal Executive Officer)

Exhibit 31.2

CERTIFICATION PURSUANT TO SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, C. Marc Richards, certify that:

1. I have reviewed this quarterly report on Form 10-Q of Pediatrix Medical Group, Inc.;

(b) Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant’s internal control over financial reporting.

Date: May 7, 2024

By: /s/ C. Marc Richards

C. Marc Richards

Chief Financial Officer

(Principal Financial Officer and

Principal Accounting Officer)

Exhibit 32.1

Certification Pursuant to 18 U.S.C Section 1350

(Adopted by Section 906 of the Sarbanes-Oxley Act of 2002)

In connection with the Quarterly Report of Pediatrix Medical Group, Inc. on Form 10-Q for the quarter ended March 31, 2024 (the “Report”), each of the undersigned hereby certifies, pursuant to Section 906 of the Sarbanes-Oxley Act of 2002, that (i) the Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934 and (ii) the information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of Pediatrix Medical Group, Inc.

A signed original of this written statement required by Section 906 has been provided to Pediatrix Medical Group, Inc. and will be retained by Pediatrix Medical Group, Inc. and furnished to the Securities and Exchange Commission or its staff upon request.

May 7, 2024

By: /s/ James D. Swift, M.D.

James D. Swift, M.D.

Chief Executive Officer

(Principal Executive Officer)

By: /s/ C. Marc Richards

C. Marc Richards

Chief Financial Officer

(Principal Financial Officer and

Principal Accounting Officer)

Cover Page - shares	3 Months Ended
Cover Page - shares	Mar. 31, 2024	May 03, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Transition Report	false
Amendment Flag	false
Document Period End Date	Mar. 31, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q1
Entity Registrant Name	Pediatrix Medical Group, Inc.
Entity Central Index Key	0000893949
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Title of 12(b) Security	Common Stock, par value $.01 per share
Trading Symbol	MD
Security Exchange Name	NYSE
Entity File Number	001-12111
Entity Incorporation, State or Country Code	FL
Entity Tax Identification Number	26-3667538
Entity Address, Address Line One	1301 Concord Terrace
Entity Address, City or Town	Sunrise
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33323
City Area Code	954
Local Phone Number	384-0175
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		84,147,224

Consolidated Balance Sheets (Unaudited) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 7,998	$ 73,258
Short-term investments	107,473	104,485
Accounts receivable, net	283,749	272,313
Prepaid expenses	12,532	13,525
Income taxes receivable	5,193	7,565
Other current assets	9,578	12,308
Total current assets	426,523	483,454
Property and equipment, net	74,340	75,639
Goodwill	1,393,249	1,384,166
Intangible assets, net	18,759	21,240
Operating and finance lease right-of-use assets	70,278	70,294
Deferred income tax assets	101,942	102,852
Other assets	83,074	82,165
Total assets	2,168,165	2,219,810
Current liabilities:
Accounts payable and accrued expenses	207,035	350,798
Current portion of debt and finance lease liabilities, net	16,409	14,913
Current portion of operating lease liabilities	21,034	21,076
Income taxes payable	2,804	2,159
Total current liabilities	247,282	388,946
Line of credit	80,000	0
Long-term debt and finance lease liabilities, net	613,347	618,421
Long-term operating lease liabilities	47,873	47,238
Long-term professional liabilities	255,870	251,284
Deferred income tax liabilities	34,105	34,308
Other liabilities	33,492	30,552
Total liabilities	1,311,969	1,370,749
Commitments and contingencies
Shareholders' equity:
Preferred stock; $.01 par value; 1,000 shares authorized; none issued	0	0
Common stock; $.01 par value; 200,000 shares authorized; 84,008,436 and 84,018,023 shares issued and outstanding, respectively	840	840
Additional paid-in capital	1,002,946	999,906
Accumulated other comprehensive loss	(2,154)	(2,214)
Retained deficit	(145,436)	(149,471)
Total shareholders' equity	856,196	849,061
Total liabilities and shareholders' equity	$ 2,168,165	$ 2,219,810

Consolidated Balance Sheets (Unaudited) (Parenthetical) - $ / shares	Mar. 31, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, issued	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	84,008,436	84,018,023
Common stock, shares outstanding	84,008,436	84,018,023

Consolidated Statements of Income and Comprehensive Income (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Income Statement [Abstract]
Net revenue	$ 495,101	$ 491,008
Operating expenses:
Practice salaries and benefits	369,138	362,235
Practice supplies and other operating expenses	31,085	30,720
General and administrative expenses	60,198	59,059
Depreciation and amortization	10,308	8,953
Transformational and restructuring related expenses	8,480	0
Total operating expenses	479,209	460,967
Income from operations	15,892	30,041
Investment and other income	2,013	634
Interest expense	(10,599)	(10,390)
Equity in earnings of unconsolidated affiliate	518	427
Total non-operating expenses	(8,068)	(9,329)
Income before income taxes	7,824	20,712
Income tax provision	(3,789)	(6,506)
Net Income	4,035	14,206
Unrealized holding gain on investments, net of tax of $20 and $227	60	604
Total comprehensive income	$ 4,095	$ 14,810
Net income:
Basic	$ 0.05	$ 0.17
Diluted	$ 0.05	$ 0.17
Weighted average common shares:
Basic	82,863	81,894
Diluted	83,275	82,318

Consolidated Statements of Income and Comprehensive Income (Unaudited) (Parenthetical) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Income Statement [Abstract]
Unrealized holding gain (loss) on investments, net of tax	$ 20	$ 227

Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Loss [Member]	Retained Deficit [Member]
Balance at Dec. 31, 2022	$ 891,632	$ 829	$ 983,601	$ (3,735)	$ (89,063)
Balance, Shares at Dec. 31, 2022		82,947,000
Net Income (Loss)	14,206				14,206
Unrealized holding gain on investments, net of tax	604			604
Common stock issued under employee stock purchase plan Value	1,095		1,095
Common stock issued under employee stock purchase plan shares		86,000
Issuance of restricted stock		$ 9	(9)
Issuance of restricted stock, shares		871,000
Forfeitures of restricted stock		$ (2)	2
Forfeitures of restricted stock, shares		(221,000)
Stock-based compensation expense	3,009		3,009
Repurchased common stock	(775)		(775)
Repurchased common stock, shares		(49,000)
Balance at Mar. 31, 2023	909,771	$ 836	986,923	(3,131)	(74,857)
Balance, Shares at Mar. 31, 2023		83,634,000
Balance at Dec. 31, 2023	849,061	$ 840	999,906	(2,214)	(149,471)
Balance, Shares at Dec. 31, 2023		84,018,000
Net Income (Loss)	4,035				4,035
Unrealized holding gain on investments, net of tax	60			60
Common stock issued under employee stock purchase plan Value	860	$ 1	859
Common stock issued under employee stock purchase plan shares		108,000
Forfeitures of restricted stock, shares		(21,000)
Stock-based compensation expense	3,067		3,067
Repurchased common stock	$ (887)	$ (1)	(886)
Repurchased common stock, shares	0	(97,000)
Balance at Mar. 31, 2024	$ 856,196	$ 840	$ 1,002,946	$ (2,154)	$ (145,436)
Balance, Shares at Mar. 31, 2024		84,008,000

Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Cash flows from operating activities:
Net income	$ 4,035	$ 14,206
Adjustments to reconcile net income to net cash from operating activities:
Depreciation and amortization	10,308	8,953
Amortization of premiums, discounts and issuance costs	200	393
Stock-based compensation expense	3,067	3,009
Deferred income taxes	686	2,008
Other	(1,265)	(391)
Changes in assets and liabilities:
Accounts receivable	(9,936)	21,345
Prepaid expenses and other current assets	3,756	(4,470)
Other long-term assets	5,900	952
Accounts payable and accrued expenses	(141,463)	(150,125)
Income taxes payable	3,017	5,299
Long-term professional liabilities	4,082	2,378
Other liabilities	(5,011)	(4,201)
Net cash used in operating activities - continuing operations	(122,624)	(100,644)
Net cash used in operating activities - discontinued operations	(2,602)	(273)
Net cash used in operating activities	(125,226)	(100,917)
Cash flows from investing activities:
Acquisition payments, net of cash acquired	(8,167)	(1,667)
Purchases of investments	(16,896)	(9,549)
Proceeds from maturities or sales of investments	14,155	6,865
Purchases of property and equipment	(5,330)	(6,999)
Net cash used in investing activities	(16,238)	(11,350)
Cash flows from financing activities:
Borrowings on line of credit	170,500	216,000
Payments on line of credit	(90,500)	(106,000)
Payments on term loan	(3,125)	(3,125)
Payment on finance lease obligation	(690)	(703)
Proceeds from issuance of common stock	860	1,095
Repurchases of common stock	(887)	(775)
Other	46	2,075
Net cash provided by financing activities	76,204	108,567
Net decrease in cash and cash equivalents	(65,260)	(3,700)
Cash and cash equivalents at beginning of period	73,258	9,824
Cash and cash equivalents at end of period	$ 7,998	$ 6,124

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Mar. 31, 2024	Mar. 31, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ 4,035	$ 14,206

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Mar. 31, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Basis of Presentation

3 Months Ended

Mar. 31, 2024

Accounting Policies [Abstract]

Basis of Presentation

1. Basis of Presentation:

Cash Equivalents and Investments

3 Months Ended

Mar. 31, 2024

Investments, Debt and Equity Securities [Abstract]

Cash Equivalents and Investments

2. Cash Equivalents and Investments:

As of March 31, 2024 and December 31, 2023, the Company's cash equivalents consisted entirely of money market funds totaling $0.6 million and $2.8 million, respectively.

Investments held are all classified as current and at March 31, 2024 and December 31, 2023 are summarized as follows (in thousands):


	March 31, 2024		December 31, 2023
Corporate securities	$	63,244	$	57,878
U.S. Treasury securities		20,919		22,674
Municipal debt securities		13,647		14,649
Federal home loan securities		6,485		5,670
Certificates of deposit		3,178		3,614
	$	107,473	$	104,485

Fair Value Measurements

3 Months Ended

Mar. 31, 2024

Fair Value Disclosures [Abstract]

Fair Value Measurements

3. Fair Value Measurements:

Level 1 – inputs are based upon unadjusted quoted prices for identical instruments traded in active markets.

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at March 31, 2024 and December 31, 2023 (in thousands):


		Fair Value
	Fair Value Category	March 31, 2024		December 31, 2023
Assets:
Money market funds	Level 1	$	562	$	2,814
Short-term investments	Level 2		107,473		104,485
Mutual Funds	Level 1		18,969		17,687

The following table presents information about the Company’s financial instruments that are not carried at fair value at March 31, 2024 and December 31, 2023 (in thousands):


	March 31, 2024				December 31, 2023
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2030 Notes	$	400,000	$	365,000	$	400,000	$	357,000

Accounts Receivable and Net Revenue

3 Months Ended

Mar. 31, 2024

Text Block [Abstract]

Accounts Receivable and Net Revenue

4. Accounts Receivable and Net Revenue:

Accounts receivable, net consists of the following (in thousands):


	March 31, 2024			December 31, 2023

Gross accounts receivable	$	1,456,721		$	1,379,213
Allowance for contractual adjustments and uncollectibles		(1,172,972	)		(1,106,900	)
	$	283,749		$	272,313

The following table summarizes the Company’s net revenue by category (in thousands):


	Three Months Ended March 31,
	2024		2023
Net patient service revenue	$	421,831	$	423,184
Hospital contract administrative fees		71,803		65,989
Other revenue		1,467		1,835
	$	495,101	$	491,008

The approximate percentage of net patient service revenue by type of payor was as follows:


	Three Months Ended March 31,
	2024			2023
Contracted managed care		70	%		67	%
Government		25			26
Other third-parties		3			6
Private-pay patients		2			1
		100	%		100	%

Business Combinations

3 Months Ended

Mar. 31, 2024

Business Combinations [Abstract]

Business Combinations

5. Business Combinations

Accounts Payable and Accrued Expenses

3 Months Ended

Mar. 31, 2024

Payables and Accruals [Abstract]

Accounts Payable and Accrued Expenses

6. Accounts Payable and Accrued Expenses:

Accounts payable and accrued expenses consist of the following (in thousands):


	March 31, 2024	December 31, 2023
Accounts payable	$31,636	$34,588
Accrued salaries and incentive compensation	65,711	193,112
Accrued payroll taxes and benefits	23,674	36,545
Accrued professional liabilities	29,034	32,039
Accrued interest	2,936	8,262
Other accrued expenses	54,044	46,252
	$207,035	$350,798

Line of Credit and Long Term Debt

3 Months Ended

Mar. 31, 2024

Debt Disclosure [Abstract]

Line of Credit and Long Term Debt

7. Line of Credit and Long-Term Debt:

At March 31, 2024, the Company had an outstanding principal balance of $400.0 million on the 2030 Notes.

Common and Common Equivalent Shares

3 Months Ended

Mar. 31, 2024

Earnings Per Share [Abstract]

Common and Common Equivalent Shares

8. Common and Common Equivalent Shares:

The calculation of shares used in the basic and diluted net income per common share calculation for the three months ended March 31, 2024 and 2023 is as follows (in thousands):


	Three Months Ended March 31,
	2024		2023
Weighted average number of common shares outstanding		82,863		81,894
Weighted average number of dilutive common share equivalents		412		424
Weighted average number of common and common equivalent shares outstanding		83,275		82,318
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		406		1,377

Stock Incentive Plans and Stock Purchase Plans

3 Months Ended

Mar. 31, 2024

Share-Based Payment Arrangement [Abstract]

Stock Incentive Plans and Stock Purchase Plans

9. Stock Incentive Plans and Stock Purchase Plans:

During the three months ended March 31, 2024 and 2023, the Company recognized stock-based compensation expense of $2.9 million and $3.0 million, respectively.

Common Stock Repurchase Programs

3 Months Ended

Mar. 31, 2024

Equity [Abstract]

Common Stock Repurchase Programs

10. Common Stock Repurchase Programs:

Commitments and Contingencies

3 Months Ended

Mar. 31, 2024

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

11. Commitments and Contingencies:

Cash Equivalents and Investments (Tables)

3 Months Ended

Mar. 31, 2024

Investments, Debt and Equity Securities [Abstract]

Schedule of Investments

Investments held are all classified as current and at March 31, 2024 and December 31, 2023 are summarized as follows (in thousands):


	March 31, 2024		December 31, 2023
Corporate securities	$	63,244	$	57,878
U.S. Treasury securities		20,919		22,674
Municipal debt securities		13,647		14,649
Federal home loan securities		6,485		5,670
Certificates of deposit		3,178		3,614
	$	107,473	$	104,485

Fair Value Measurements (Tables)

3 Months Ended

Mar. 31, 2024

Fair Value Disclosures [Abstract]

Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis

The following table presents information about the Company’s financial instruments that are accounted for at fair value on a recurring basis at March 31, 2024 and December 31, 2023 (in thousands):


		Fair Value
	Fair Value Category	March 31, 2024		December 31, 2023
Assets:
Money market funds	Level 1	$	562	$	2,814
Short-term investments	Level 2		107,473		104,485
Mutual Funds	Level 1		18,969		17,687

Financial Instruments Measured At Carrying Amount

The following table presents information about the Company’s financial instruments that are not carried at fair value at March 31, 2024 and December 31, 2023 (in thousands):


	March 31, 2024				December 31, 2023
	Carrying Amount		Fair Value		Carrying Amount		Fair Value
Liabilities:
2030 Notes	$	400,000	$	365,000	$	400,000	$	357,000

Accounts Receivable and Net Revenue (Tables)

3 Months Ended

Mar. 31, 2024

Text Block [Abstract]

Schedule of Accounts Receivable, Net

Accounts receivable, net consists of the following (in thousands):


	March 31, 2024			December 31, 2023

Gross accounts receivable	$	1,456,721		$	1,379,213
Allowance for contractual adjustments and uncollectibles		(1,172,972	)		(1,106,900	)
	$	283,749		$	272,313

Schedule of Net Revenue

The following table summarizes the Company’s net revenue by category (in thousands):


	Three Months Ended March 31,
	2024		2023
Net patient service revenue	$	421,831	$	423,184
Hospital contract administrative fees		71,803		65,989
Other revenue		1,467		1,835
	$	495,101	$	491,008

Schedule of Percentage of Net Revenue

The approximate percentage of net patient service revenue by type of payor was as follows:


	Three Months Ended March 31,
	2024			2023
Contracted managed care		70	%		67	%
Government		25			26
Other third-parties		3			6
Private-pay patients		2			1
		100	%		100	%

Accounts Payable and Accrued Expenses (Tables)

3 Months Ended

Mar. 31, 2024

Payables and Accruals [Abstract]

Schedule of Accounts Payable and Accrued Expenses

Accounts payable and accrued expenses consist of the following (in thousands):


	March 31, 2024	December 31, 2023
Accounts payable	$31,636	$34,588
Accrued salaries and incentive compensation	65,711	193,112
Accrued payroll taxes and benefits	23,674	36,545
Accrued professional liabilities	29,034	32,039
Accrued interest	2,936	8,262
Other accrued expenses	54,044	46,252
	$207,035	$350,798

Common and Common Equivalent Shares (Tables)

3 Months Ended

Mar. 31, 2024

Earnings Per Share [Abstract]

Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share

The calculation of shares used in the basic and diluted net income per common share calculation for the three months ended March 31, 2024 and 2023 is as follows (in thousands):


	Three Months Ended March 31,
	2024		2023
Weighted average number of common shares outstanding		82,863		81,894
Weighted average number of dilutive common share equivalents		412		424
Weighted average number of common and common equivalent shares outstanding		83,275		82,318
Antidilutive securities (restricted stock and stock options) not included in the diluted net income per common share calculation		406		1,377

Basis of Presentation - Additional Information (Detail)	Mar. 31, 2024
Unnamed Corporate Joint Venture One [Member]
Basis Of Presentation [Line Items]
Equity method ownership percentage in joint venture	37.50%

Cash Equivalents and Investments - Additional Information (Detail) - USD ($) $ in Millions	Mar. 31, 2024	Dec. 31, 2023
Cash Equivalents [Member]
Cash Equivalents And Investments [Line Items]
Cash equivalents	$ 0.6	$ 2.8

Cash Equivalents and Investments - Schedule of Investments (Detail) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Available-for-sale [Line Items]
Available-for-sale Securities	$ 107,473	$ 104,485
Corporate securities
Available-for-sale [Line Items]
Available-for-sale Securities	63,244	57,878
U.S. Treasury securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	20,919	22,674
Municipal Debt Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	13,647	14,649
Federal Home Loan Securities [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	6,485	5,670
Certificates of Deposit [Member]
Available-for-sale [Line Items]
Available-for-sale Securities	$ 3,178	$ 3,614

Fair Value Measurements - Schedule of fair value on a recurring basis (Details) - Fair Value, Recurring [Member] - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Fair Value, Inputs, Level 1 [Member]
Assets:
Money market funds	$ 562	$ 2,814
Mutual funds	18,969	17,687
Fair Value, Inputs, Level 2 [Member]
Assets:
Short-term investments	$ 107,473	$ 104,485

Fair Value Measurements - Schedule of financial instruments that are not carried at fair value (Details) - 2030 Notes [Member] - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Liabilities:
Notes Payable	$ 400,000	$ 400,000
Liabilities:
Notes Payable Fair Value Disclosure	$ 365,000	$ 357,000

Accounts Receivable and Net Revenue - Schedule of Accounts Receivable, Net (Detail) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Receivables [Abstract]
Gross accounts receivable	$ 1,456,721	$ 1,379,213
Allowance for contractual adjustments and uncollectibles	(1,172,972)	(1,106,900)
Accounts receivable, net	$ 283,749	$ 272,313

Accounts Receivable and Net Revenue - Schedule of Net Revenue (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Disaggregation of Revenue [Abstract]
Net revenue	$ 495,101	$ 491,008
Net patient service revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	421,831	423,184
Hospital contract administrative fees [Member]
Disaggregation of Revenue [Abstract]
Net revenue	71,803	65,989
Other revenue [Member]
Disaggregation of Revenue [Abstract]
Net revenue	$ 1,467	$ 1,835

Accounts Receivable and Net Revenue - Schedule of Net Patient Service Revenue by Type of Payor (Detail)	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	100.00%	100.00%
Contracted Managed Care [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	70.00%	67.00%
Government [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	25.00%	26.00%
Other Third-Parties [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	3.00%	6.00%
Private-Pay Patients [Member]
Health Care Organization, Receivable and Revenue Disclosures [Line Items]
Percentage of net patient service revenue	2.00%	1.00%

Business Combinations - Additional information (Detail) $ in Thousands	3 Months Ended
	Mar. 31, 2024 USD ($) Number	Dec. 31, 2023 USD ($)
Goodwill	$ 9,100
Other intangible assets	200
Fixed assets	400
Other non-current assets	$ 83,074	$ 82,165
Maternal Fetal Medicine Practice [Member]
Number of Maternal Fetal Medicine Practices Acquired \| Number	1
Business acquisition total consideration	$ 9,700
Business acquisition consideration paid in cash	6,500
Business combination consideration identifiable as current and long term liabilities	$ 3,200

Accounts Payable and Accrued Expenses - Schedule of Accounts Payable and Accrued Expenses (Detail) - USD ($) $ in Thousands	Mar. 31, 2024	Dec. 31, 2023
Payables and Accruals [Abstract]
Accounts payable	$ 31,636	$ 34,588
Accrued salaries and incentive compensation	65,711	193,112
Accrued payroll taxes and benefits	23,674	36,545
Accrued professional liabilities	29,034	32,039
Accrued interest	2,936	8,262
Other accrued expenses	54,044	46,252
Accounts payable and accrued expenses, total	$ 207,035	$ 350,798

Accounts Payable and Accrued Expenses - Additional Information (Detail) $ in Millions	3 Months Ended
	Mar. 31, 2024 USD ($)
Net decrease in accrued salaries and bonuses	$ 127.4

Line of Credit and Long Term Debt (Additional Information) (Details) - USD ($) $ in Thousands		3 Months Ended
	Feb. 11, 2022	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023
Debt Instrument [Line Items]
Debt instrument interest rate		5.375%
Debt Instrument, Frequency of Periodic Payment		payable semi-annually in arrears on February 15 and August 15, beginning on August 15, 2022
Debt Instrument, Description		Notes are guaranteed on an unsecured senior basis by the same subsidiaries and affiliated professional contractors that guarantee the Amended Credit Agreement (as defined below). The indenture under which the 2030 Notes are issued, among other things, limits the Company's ability to (1) incur liens and (2) enter into sale and lease-back transactions, and also limits the Company's ability to merge or dispose of all or substantially all of its assets, in all cases, subject to a number of customary exceptions
Purchase price		101.00%
Borrowings on revolving credit line		$ 170,500	$ 216,000
Line of credit		80,000		$ 0
Long-Term Debt
Debt Instrument [Line Items]
Proceeds from issuance of unsecured debt	$ 250,000
Cash on hand	308,000
Long term debt		225,000
Credit Agreement [Member]
Debt Instrument [Line Items]
Line of Credit facility, available balance		370,000
Long term debt		305,000
Revolving Credit Facility [Member]
Debt Instrument [Line Items]
Proceeds from issuance of unsecured debt	100,000
Long term debt		80,000
Borrowings on revolving credit line		37,500
Revolving Credit Facility [Member] \| Long-Term Debt
Debt Instrument [Line Items]
Proceeds from issuance of unsecured debt		250,000
Revolving Credit Facility [Member] \| Credit Agreement [Member]
Debt Instrument [Line Items]
Unsecured note issued		$ 450,000
Interest Rate, description		(i) the Alternate Base Rate (defined as the highest of (a) the prime rate as announced by Bank of America, N.A., (b) the Federal Funds Rate plus 0.50% and (c) Term Secured Overnight Financing Rate ("SOFR") for an interest period of one month plus 1.00% with a 1.00% floor) plus an applicable margin rate of 0.50% for the first two fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 0.125% to 0.750% based on the Company's consolidated net leverage ratio or (ii) Term SOFR rate (calculated as the Secured Overnight Financing Rate published on the applicable Reuters screen page plus a spread adjustment of 0.10%, 0.15% or 0.25% depending on if the Company selects a one-month, three-month or six-month interest period, respectively, for the applicable loan with a 0% floor), plus an applicable margin rate of 1.50% for the first two full fiscal quarters after the date of the Credit Agreement Amendment, and thereafter at an applicable margin rate ranging from 1.125% to 1.750% based on the Company's consolidated net leverage ratio. The Amended Credit Agreement also provides for other customary fees and charges, including an unused commitment fee with respect to the Revolving Credit Line ranging from 0.150% to 0.200% of the unused lending commitments under the Revolving Credit Line
5.375% Unsecured Senior Notes Due 2030 [Member]
Debt Instrument [Line Items]
Senior notes	$ 400,000
Debt instrument interest rate	5.375%
Debt instrument, maturity year	2030
Interest accrued periodically		$ 21,500
Long term debt		$ 400,000
2027 Notes
Debt Instrument [Line Items]
Long term debt	$ 1,000,000

Common and Common Equivalent Shares - Schedule of Calculation of Shares Used in Basic and Diluted Net Income Per Share (Detail) - shares	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Earnings Per Share [Abstract]
Weighted average number of common shares outstanding	82,863,000	81,894,000
Weighted average number of dilutive common share equivalents	412,000	424,000
Weighted average number of common and common equivalent shares outstanding	83,275,000	82,318,000
Antidilutive securities not included in the diluted net income per common share calculation	406,000	1,377,000

Stock Incentive Plans and Stock Purchase Plans - Additional Information (Detail) - USD ($) shares in Thousands, $ in Millions	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation expense	$ 2.9	$ 3.0
Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
Aggregate number Shares issued under Stock Purchase Plans	100
Employee Stock Option \| Maximum [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Vesting period of options, maximum years	10 years
Restricted Stock [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Award vesting period	3 years
1996 Non-Qualified Employee Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Aggregate number Shares issued under Stock Purchase Plans	0
Common stock, reserved for issuance	61,000
2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	90.00%
Amended and Restated 2008 Plan [Member] \| Employee Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for future grants and awards under Stock Incentive Plans	8,900
1996 Non-Qualified Employee Stock Purchase Plan and 2015 Non-Qualified Stock Purchase Plan [Member]
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Percentage of market value of common stock at which employees are permitted to purchase	85.00%
Common stock, reserved for issuance	2,000

Common Stock Repurchase Programs - Additional Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2024	Mar. 31, 2023	Dec. 31, 2023	Aug. 31, 2018
Common Stock [Line Items]
Repurchased common stock, shares	0
Common stock authorized for repurchase				$ 500,000
Company's Common stock repurchased			$ 4,600
Payments for repurchase of common stock	$ 887	$ 775
Common Stock [Member]
Common Stock [Line Items]
Repurchased common stock, shares	(97,000)	(49,000)
Payments for repurchase of common stock	$ 900
Restricted Stock [Member]
Common Stock [Line Items]
Company's Common stock repurchased	$ 3,700