0000950170-24-122748 | 10-Q | XBRL Viewer | Aveanna Healthcare Holdings INC

Derivative Financial Instruments

9 Months Ended

Sep. 28, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

7. DERIVATIVE FINANCIAL INSTRUMENTS

The Company’s earnings and cash flows are subject to fluctuations due to changes in interest rates, and the Company seeks to mitigate a portion of this risk by entering into derivative contracts. The derivatives the Company currently uses are interest rate swaps and interest rate caps. The Company recognizes derivatives as either assets or liabilities at fair value on the interim unaudited consolidated balance sheets and does not designate the derivatives as hedging instruments. Changes in the fair value of derivatives are therefore recorded in earnings throughout the terms of the respective derivatives.

The Company currently has two interest rate swap agreements intended to limit its exposure to interest rate risk on its variable rate debt. These swaps expire on June 30, 2026. Prior to the quarter ended July 1, 2023, the interest rate swap agreements paid a fixed rate of 2.08% and received the one-month LIBOR rate, subject to a 0.50% floor. During the quarter ended July 1, 2023, the Company amended its interest rate swap agreements to change the benchmark rate under the agreements from LIBOR to SOFR. Since July 1, 2023, the interest rate swap agreements have paid a fixed rate of 2.03% and received the one-month SOFR rate, subject to a 0.50% floor. The aggregate notional amount of the interest rate swaps remained unchanged at $520.0 million at September 28, 2024 and December 30, 2023, respectively. The fair value of the interest rate swaps was $12.1 million at September 28, 2024 and $23.0 million at December 30, 2023 and is included in other long-term assets in the interim unaudited consolidated balance sheets. The Company does not apply hedge accounting to these agreements and records all mark-to-market adjustments directly to other (expense) income in the consolidated statements of operations, which are included within cash flows from operating activities in the consolidated statements of cash flows. The net settlements incurred with swap counterparties under the swap agreements are recognized through cash flows from financing activities in the consolidated statements of cash flows due to an other-than-insignificant financing element on the interest rate swaps.

The Company has interest rate cap agreements with an aggregate notional amount of $880.0 million and a cap rate of 2.96%. The cap agreements have an expiration date of February 28, 2027. Prior to the quarter ended July 1, 2023, the cap agreements provided that the counterparty would pay the Company the amount by which LIBOR exceeded 3.00% in a given measurement period. During the quarter ended July 1, 2023, the Company amended its interest rate cap agreements to provide that the counterparty would pay the Company the amount by which SOFR exceeds 2.96%. The fair value of the interest rate cap agreements was $14.5

million at September 28, 2024 and $30.5 million at December 30, 2023 and is included in other long-term assets on the interim unaudited consolidated balance sheets. The Company does not apply hedge accounting to interest rate cap agreements and records all mark-to-market adjustments directly to other (expense) income in the consolidated statements of operations, which are included within cash flows from operating activities in the consolidated statement of cash flows. The proceeds received from cap counterparties under the cap agreements are recognized through cash flows from operating activities in the consolidated statements of cash flows.

The following losses and gains from these derivatives not designated as hedging instruments were recognized in the Company’s consolidated statements of operations for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively (amounts in thousands):


	Statement of Operations	For the three-month periods ended
	Classification	September 28, 2024			September 30, 2023
Interest rate cap agreements	Other (expense) income	$	(19,399	)	$	1,366
Interest rate swap agreements	Other (expense) income	$	(12,600	)	$	2,956

	Statement of Operations	For the nine-month periods ended
	Classification	September 28, 2024			September 30, 2023
Interest rate cap agreements	Other (expense) income	$	(15,969	)	$	839
Interest rate swap agreements	Other (expense) income	$	(10,900	)	$	1,745

The Company does not utilize financial instruments for trading or other speculative purposes.

Revenue (Tables)

9 Months Ended

Sep. 28, 2024

Revenue from Contract with Customer [Abstract]

Schedule of Revenue by Payer Type as a Percentage of Revenue

The following table presents revenue by payer type as a percentage of total revenue for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively:


	For the three-month periods ended						For the nine-month periods ended
	September 28, 2024			September 30, 2023			September 28, 2024			September 30, 2023
Medicaid MCO		56.7	%		56.8	%		56.3	%		55.2	%
Medicaid		25.0	%		22.0	%		23.4	%		22.0	%
Commercial		7.9	%		9.0	%		9.7	%		10.0	%
Medicare		10.3	%		12.0	%		10.5	%		12.7	%
Self-pay		0.1	%		0.2	%		0.1	%		0.1	%
Total revenue		100.0	%		100.0	%		100.0	%		100.0	%

CONSOLIDATED STATEMENTS OF CASH FLOWS (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023
Cash Flows From Operating Activities:
Net loss	$ (40,109)	$ (108,788)
Adjustments to reconcile net loss to net cash from operating activities:
Depreciation and amortization	8,332	10,494
Amortization of deferred debt issuance costs	3,797	3,983
Amortization and impairment of operating lease right of use assets	15,628	12,490
Non-cash share-based compensation	12,483	10,143
Goodwill impairment		105,136
Loss on disposal or impairment of licenses, property and equipment, and software	3,212	2,086
Fair value adjustments on interest rate derivatives	26,869	(2,584)
Deferred income taxes	527	575
Non-cash gain on acquisition		(5,090)
Changes in operating assets and liabilities, net of impact of acquisitions:
Patient accounts receivable	(28,891)	(14,431)
Prepaid expenses	5,631	5,247
Other current and long-term assets	(15,678)	(12,657)
Accounts payable and other accrued liabilities	11,919	(7,861)
Accrued payroll and employee benefits	17,823	31,752
Insurance reserves	6,942	229
Operating lease liabilities	(14,589)	(11,991)
Other current and long-term liabilities	5,335	6,944
Net cash provided by operating activities	19,231	25,677
Cash Flows From Investing Activities:
Purchase of certificates of need		(2,678)
Purchases of property and equipment, and software	(4,790)	(4,548)
Net cash used in investing activities	(4,790)	(7,226)
Cash Flows From Financing Activities:
Proceeds from employee stock purchase plan	3,088	945
Proceeds from securitization obligation	25,000	45,000
Repayment of securitization obligation	(10,000)	(30,000)
Proceeds from revolving credit facility		20,000
Repayments on revolving credit facility		(20,000)
Principal payments on term loans	(4,600)	(6,900)
Principal payments on notes payable	(4,604)	(7,293)
Principal payments on financing lease obligations	(198)	(521)
Payment of debt issuance costs	(288)	(1,047)
Settlements with interest rate swap counterparties	11,681	10,442
Net cash provided by financing activities	20,079	10,626
Net change in cash and cash equivalents	34,520	29,077
Cash and cash equivalents at beginning of period	43,942	19,217
Cash and cash equivalents at end of period	78,462	48,294
Supplemental Disclosures of Cash Flow Information:
Cash paid for interest	114,948	99,291
Cash paid for income taxes, net of refunds received	$ 5,646	$ 766

Net Loss Per Share

9 Months Ended

Sep. 28, 2024

Earnings Per Share [Abstract]

Net Loss Per Share

13. NET LOSS PER SHARE

Basic net loss per share is calculated by dividing net loss by the weighted average number of shares of common stock outstanding for the period. Diluted net loss per share is calculated by dividing net loss by the diluted weighted average number of shares of common stock outstanding for the period. For purposes of this calculation, outstanding stock options, RSUs and PSUs are considered potential dilutive shares of common stock. The following is a computation of basic and diluted net loss per share (amounts in thousands, except per share amounts):


	For the three-month periods ended						For the nine-month periods ended
	September 28, 2024			September 30, 2023			September 28, 2024			September 30, 2023
Numerator:
Net loss	$	(42,843	)	$	(102,389	)	$	(40,109	)	$	(108,788	)
Denominator:
Weighted average shares of common stock outstanding (1), basic and diluted		193,361			189,139			192,734			189,632
Net loss per share, basic and diluted	$	(0.22	)	$	(0.54	)	$	(0.21	)	$	(0.57	)

Dilutive securities outstanding not included in the computation of diluted net loss per share, as their effect is antidilutive:
RSUs		9,316			7,674			9,316			7,674
PSUs		6,113			4,059			6,113			4,059
Stock options		13,039			13,621			13,039			13,621

(1)

The calculation of weighted average shares of common stock outstanding includes all vested deferred restricted stock units.

Goodwill (Additional Information) (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023
Goodwill [Line Items]
Goodwill impairment	$ 105,136	$ 105,136

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

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+ Details

Commitments and Contingencies

9 Months Ended

Sep. 28, 2024

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

10. COMMITMENTS AND CONTINGENCIES

Insurance Reserves

As is typical in the healthcare industry, the Company is subject to claims that its services have resulted in patient injury or other adverse effects.

The accrued professional liability insurance reserves included in the interim unaudited consolidated balance sheets include estimates of the ultimate costs, including third-party legal defense costs, in the event the Company was unable to receive funds from claims made under commercial insurance policies, for claims that have been reported but not paid and claims that have been incurred but not reported at the balance sheet dates. Although substantially all reported claims are paid directly by the Company’s commercial insurance carriers (after the Company satisfies the applicable policy deductible and/or retention), the Company is ultimately responsible for payment of these claims in the event its insurance carriers become insolvent or otherwise do not honor the contractual obligations under the liability policies. The Company is required under U.S. GAAP to recognize these estimated liabilities in its consolidated financial statements on a gross basis; with a corresponding receivable from the insurance carriers reflecting the contractual indemnity provided by the carriers under the related liability policies.

Since October 1, 2023, the Company has maintained primary commercial insurance coverage on a claims-made basis for professional liability claims with a $2.0 million per claim deductible, a $1.0 million aggregate buffer retention, and $4.5 million per claim and annual aggregate limits. From and after October 1, 2024, the foregoing aggregate buffer retention increased to $2.0 million, but the other coverages have remained unchanged. Prior to October 1, 2023, the Company maintained primary commercial insurance coverage on a claims made basis for professional liability claims with varying deductibles by policy year from $0.5 million to $1.5 million on a per claim basis and $5.0 million to $6.0 million per claim and annual aggregate limits. Moreover, the Company maintains excess insurance coverage for professional liability claims to cover any claims over the aggregate limits. In addition, the Company maintains workers’ compensation insurance with a $0.5 million per claim deductible and statutory limits. The Company reimburses insurance carriers for deductible losses under these policies. The Company’s insurance carriers require collateral to secure the Company’s obligation to reimburse insurance carriers for these deductible payments. Collateral as of September 28, 2024 was comprised of $22.7 million of issued letters of credit and $0.7 million in cash collateral. Collateral as of December 30, 2023 was comprised of $22.7 million of issued letters of credit and $0.7 million in cash collateral.

As of September 28, 2024, insurance reserves totaling $106.7 million were included on the interim unaudited consolidated balance sheets, representing $46.3 million and $60.4 million of reserves for professional liability claims and workers’ compensation claims, respectively. At December 30, 2023, insurance reserves totaling $91.8 million were included on the consolidated balance sheets, representing $39.4 million and $52.4 million of reserves for professional liability claims and workers’ compensation claims, respectively.

Litigation and Other Current Liabilities

On November 23, 2022, a judgment in the amount of $19.8 million was rendered against the Company related to a civil litigation matter in Texas. In March 2023, the plaintiffs attempted to enforce the judgment by seeking a writ of garnishment, and $18.4 million was garnished from the Company’s cash accounts. The Company promptly obtained and recorded an $18.4 million cash collateralized appellate bond with the state trial court, and such court dissolved the writ of garnishment and ordered the return of the previously garnished funds. All previously garnished funds have been returned to the Company. In July 2023, the Company and the plaintiffs reached a confidential settlement agreement wherein the plaintiffs have agreed to release all claims and extinguish the aforementioned judgment in exchange for a settlement payment. The corresponding appeal of the judgment has been discontinued upon finalization of the settlement, and the Company has secured the return of the underlying collateral for the aforementioned appellate bond. The settlement did not have a material impact on the consolidated results of operations.

On January 18, 2023, an arbitration award in the amount of $7.9 million was rendered against the Company related to a claim under the Company's Texas non-subscriber benefit plan. After the trial court entered a judgment to enforce the arbitration award, the Company promptly obtained a $9.1 million collateralized appellate bond and intends to avail itself of all appellate options. The ultimate resolution of this litigated matter is not expected to have a material impact on the consolidated financial statements.

The Company is currently a party to various routine litigation incidental to the business. While management currently believes that the ultimate outcome of such proceedings, individually and in the aggregate, will not have a material adverse effect on the Company’s financial position or overall trends in results of operations, litigation is subject to inherent uncertainties. Management has established provisions within other current liabilities in the accompanying consolidated balance sheets, which in the opinion of management represents the best estimate of exposure and adequately provides for such losses that may occur from asserted claims related to the provision of professional services and which may not be covered by the Company’s insurance policies. Management believes that any additional unfavorable provisions would not be material to the Company’s results of operations or financial position; however, if an unfavorable ruling on any asserted or unasserted claim were to occur, there exists the possibility of a material adverse impact on the Company’s net earnings or financial position. The estimate of the potential impact from legal proceedings on the Company’s financial position or overall results of operations could change in the future.

Healthcare Regulatory Matters

Starting on October 30, 2019 the Company has received grand jury subpoenas issued by the U.S. Department of Justice, Antitrust Division (the “Antitrust Division”), requiring the production of documents and information pertaining to nurse wages, reimbursement rates, and hiring activities in a few of its local markets. The Company is fully cooperating with the Antitrust Division with respect to this investigation, and management believes that a loss event is not probable and that this matter will not materially impact the Company’s business, results of operations or financial condition. However, based on the information currently available to the Company, management cannot predict the timing or outcome of this investigation or predict the possible loss or range of loss, if any, associated with the resolution of this matter.

On July 19, 2023, the Company received a Civil Investigation Demand issued by the U.S. Department of Justice, United States Attorney’s Office, Middle District of Alabama (the “AUSA”), requiring the production of documents and information pertaining to Comfort Care Hospice, LLC, an indirect wholly owned subsidiary of the Company, regarding issues of (1) improper submission of claims to Medicare and other federal healthcare programs for service to patients who were ineligible or not properly certified for said healthcare services and (2) improper remuneration to medical directors and skilled nursing facilities for patient referrals in violation of certain federal regulations. The Company is fully cooperating with the AUSA with respect to this investigation, and management believes that a loss event is not probable and that this matter will not materially impact the Company’s business, results of operations or financial condition. However, based on the information currently available to the Company, management cannot predict the timing or outcome of this investigation or predict the possible loss or range of loss, if any, associated with the resolution of this matter.

Laws and regulations governing the government payer programs are complex and subject to interpretation. Compliance with such laws and regulations can be subject to future governmental review and interpretation as well as significant regulatory action. From time to time, governmental regulatory agencies conduct inquiries and audits of the Company’s practices. It is the Company’s practice to cooperate fully with such inquiries. In addition to laws and regulations governing the Medicaid, Medicaid Managed Care, and Tricare programs, there are a number of federal and state laws and regulations governing matters such as the corporate practice of medicine, fee splitting arrangements, anti-kickback statues, physician self-referral laws, false or fraudulent claims filing and patient privacy requirements. Failure to comply with any such laws or regulations could have an adverse impact on the Company’s operations and financial results. The Company believes that it is in material compliance with all applicable laws and regulations and is not aware of any pending or threatened investigations involving allegations of wrongdoing.

Derivative Financial Instruments - Schedule of Losses and Gains from Derivatives (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Derivative Instruments Gain Loss [Line Items]
Derivative gain (loss)			$ (26,869)	$ 2,584
Interest Rate Cap Agreements \| Not Designated as Hedging Instruments
Derivative Instruments Gain Loss [Line Items]
Derivative gain (loss)	$ (19,399)	$ 1,366	$ (15,969)	$ 839
Derivative, Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration]	Other Nonoperating Income (Expense)	Other Nonoperating Income (Expense)	Other Nonoperating Income (Expense)	Other Nonoperating Income (Expense)
Interest Rate Swap Agreement \| Not Designated as Hedging Instruments
Derivative Instruments Gain Loss [Line Items]
Derivative gain (loss)	$ (12,600)	$ 2,956	$ (10,900)	$ 1,745
Derivative, Gain (Loss), Statement of Income or Comprehensive Income [Extensible Enumeration]	Other Nonoperating Income (Expense)	Other Nonoperating Income (Expense)	Other Nonoperating Income (Expense)	Other Nonoperating Income (Expense)

Fair Value Measurements

9 Months Ended

Sep. 28, 2024

Fair Value Disclosures [Abstract]

Fair Value Measurements

6. FAIR VALUE MEASUREMENTS

The carrying amounts of cash and cash equivalents, patient accounts receivable, accounts payable, accrued expenses and other current liabilities approximate their fair values due to the short-term maturities of the instruments.

The Company’s other assets measured at fair value were as follows (amounts in thousands):


	Fair Value Measurements at September 28, 2024
	Level 1		Level 2		Level 3		Total
Assets:
Interest rate cap agreements	$	-	$	14,486	$	-	$	14,486
Interest rate swap agreements		-		12,122		-		12,122
Total derivative assets	$	-	$	26,608	$	-	$	26,608

	Fair Value Measurements at December 30, 2023
	Level 1		Level 2		Level 3		Total
Assets:
Interest rate cap agreements	$	-	$	30,455	$	-	$	30,455
Interest rate swap agreements		-		23,022		-		23,022
Total derivative assets	$	-	$	53,477	$	-	$	53,477

The fair values of the interest rate swap and cap agreements are based on the estimated net proceeds or costs to settle the transactions as of the respective balance sheet dates. The valuations are based on commercially reasonable industry and market practices for valuing similar financial instruments. See Note 7 – Derivative Financial Instruments for further details on the Company’s interest rate swap and cap agreements.

- Definition

The entire disclosure for the fair value of financial instruments (as defined), including financial assets and financial liabilities (collectively, as defined), and the measurements of those instruments as well as disclosures related to the fair value of non-financial assets and liabilities. Such disclosures about the financial instruments, assets, and liabilities would include: (1) the fair value of the required items together with their carrying amounts (as appropriate); (2) for items for which it is not practicable to estimate fair value, disclosure would include: (a) information pertinent to estimating fair value (including, carrying amount, effective interest rate, and maturity, and (b) the reasons why it is not practicable to estimate fair value; (3) significant concentrations of credit risk including: (a) information about the activity, region, or economic characteristics identifying a concentration, (b) the maximum amount of loss the entity is exposed to based on the gross fair value of the related item, (c) policy for requiring collateral or other security and information as to accessing such collateral or security, and (d) the nature and brief description of such collateral or security; (4) quantitative information about market risks and how such risks are managed; (5) for items measured on both a recurring and nonrecurring basis information regarding the inputs used to develop the fair value measurement; and (6) for items presented in the financial statement for which fair value measurement is elected: (a) information necessary to understand the reasons for the election, (b) discussion of the effect of fair value changes on earnings, (c) a description of [similar groups] items for which the election is made and the relation thereof to the balance sheet, the aggregate carrying value of items included in the balance sheet that are not eligible for the election; (7) all other required (as defined) and desired information.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
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-Section 55
-Paragraph 107
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-URI https://asc.fasb.org/1943274/2147482078/820-10-55-107

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+ Details

Description of Business - Additional Information (Details)	Sep. 28, 2024 State
Subsidiary, Sale of Stock [Line Items]
Number of states in which entity locations	33

Derivative Financial Instruments (Tables)

9 Months Ended

Sep. 28, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Losses and Gains from Derivatives


	Statement of Operations	For the three-month periods ended
	Classification	September 28, 2024			September 30, 2023
Interest rate cap agreements	Other (expense) income	$	(19,399	)	$	1,366
Interest rate swap agreements	Other (expense) income	$	(12,600	)	$	2,956

	Statement of Operations	For the nine-month periods ended
	Classification	September 28, 2024			September 30, 2023
Interest rate cap agreements	Other (expense) income	$	(15,969	)	$	839
Interest rate swap agreements	Other (expense) income	$	(10,900	)	$	1,745

Description of Business

9 Months Ended

Sep. 28, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Description of Business

1. DESCRIPTION OF BUSINESS

Aveanna Healthcare Holdings Inc. (together with its consolidated subsidiaries, referred to herein as the “Company”) is headquartered in Atlanta, Georgia and has locations in 33 states with concentrations in California, Texas and Pennsylvania, providing a broad range of pediatric and adult healthcare services, including nursing, hospice, rehabilitation services, occupational nursing in schools, therapy services, day treatment centers for medically fragile and chronically ill children and adults, as well as delivery of enteral nutrition and other products to patients. In addition, the Company provides respite healthcare services, which are temporary care provider services provided in relief of the patient’s normal caregiver. The Company’s services are designed to provide a high quality, lower cost alternative to prolonged hospitalization.

Commitments and Contingencies - Additional Information (Details) - USD ($) $ in Millions					1 Months Ended	9 Months Ended
	Oct. 01, 2024	Oct. 01, 2023	Jan. 18, 2023	Nov. 23, 2022	Mar. 16, 2023	Sep. 28, 2024	Dec. 30, 2023
Loss Contingencies [Line Items]
Insurance, per claims deductible		$ 2.0
Professional malpractice claims, per claim and annual aggregate limits		4.5
Insurance reserves						$ 106.7	$ 91.8
Litigation Settlement, Amount			$ 7.9
Aggregate buffer retention		$ 1.0
Texas
Loss Contingencies [Line Items]
Litigation Settlement, Amount				$ 19.8
Litigation settlement, garnishment of cash					$ 18.4
Subsequent Events
Loss Contingencies [Line Items]
Aggregate buffer retention	$ 2.0
Minimum
Loss Contingencies [Line Items]
Insurance, per claims deductible						0.5
Professional malpractice claims, per claim and annual aggregate limits						5.0
Maximum
Loss Contingencies [Line Items]
Insurance, per claims deductible						1.5
Professional malpractice claims, per claim and annual aggregate limits						6.0
Professional Malpractice Claims
Loss Contingencies [Line Items]
Insurance reserves						46.3	39.4
Cash Collateral
Loss Contingencies [Line Items]
Collaterals						0.7	0.7
Appellate Bond
Loss Contingencies [Line Items]
Cash collateralized			$ 9.1
Appellate Bond \| Texas
Loss Contingencies [Line Items]
Cash collateralized					$ 18.4
Letters of Credit
Loss Contingencies [Line Items]
Collaterals						22.7	22.7
Workers Compensation Insurance
Loss Contingencies [Line Items]
Insurance, per claims deductible						0.5
Insurance reserves						$ 60.4	$ 52.4

Long-Term Obligations - Schedule of Long-Term Obligations and Notes Payable (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 28, 2024	Dec. 30, 2023
Debt Instrument [Line Items]
Total principal amount of long-term obligations	$ 1,310,150	$ 1,314,750
Less: unamortized debt issuance costs	(25,866)	(29,209)
Total amount of long-term obligations, net of unamortized debt issuance costs	1,284,284	1,285,541
Less: current portion of long-term obligations	(9,200)	(9,200)
Total amount of long-term obligations, net of unamortized debt issuance costs, less current portion	1,275,084	1,276,341
2021 Extended Term Loan
Debt Instrument [Line Items]
Total principal amount of long-term obligations	$ 895,150	899,750
Stated Maturity Date	2028-07
Contractual Interest Rate	S + 3.75%
Interest rate margin on borrowings	3.75%
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	SOFR
Interest Rate	8.91%
Second Lien Term Loan
Debt Instrument [Line Items]
Total principal amount of long-term obligations	$ 415,000	$ 415,000
Stated Maturity Date	2029-12
Contractual Interest Rate	S + 7.00%
Interest rate margin on borrowings	7.00%
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	SOFR
Interest Rate	12.21%
Revolving Credit Facility
Debt Instrument [Line Items]
Stated Maturity Date	2026-04
Contractual Interest Rate	S + 3.75%
Interest rate margin on borrowings	3.75%
Debt Instrument, Variable Interest Rate, Type [Extensible Enumeration]	SOFR
Interest Rate	8.91%

Income Taxes - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income tax expense	$ 15,511	$ 631	$ 18,246	$ 1,387
Effective tax rate	(56.80%)	(0.60%)	(83.50%)	(1.30%)
Statutory tax rate	21.00%	21.00%	21.00%	21.00%
Recognized tax benefits	$ 1,900		$ 1,900

- Definition

Amount of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
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-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (ee)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-12

Reference 4: http://www.xbrl.org/2003/role/exampleRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 231
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482663/740-10-55-231

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-9

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SAB Topic 6.I.7)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479360/740-10-S99-1

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
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-URI https://asc.fasb.org/1943274/2147483443/250-10-50-8

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 740
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-Name Accounting Standards Codification
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482685/740-10-50-10

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
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-Paragraph 22
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477250/944-220-S99-1

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
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-Paragraph 2
-Subparagraph (a)
-SubTopic 20
-Topic 740
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-URI https://asc.fasb.org/1943274/2147482659/740-20-45-2

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
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-Paragraph 1
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-SubTopic 10
-Topic 235
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480678/235-10-S99-1

+ Details

Segment Information (Tables)

9 Months Ended

Sep. 28, 2024

Segment Reporting [Abstract]

Summary of Segment Information

The following tables summarize the Company’s segment information for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively (amounts in thousands):


	For the three-month period ended September 28, 2024
	PDS			HHH			MS			Total
Revenue	$	409,558		$	54,139		$	45,326		$	509,023
Cost of revenue, excluding depreciation and amortization		299,731			24,948			24,645			349,324
Gross margin	$	109,827		$	29,191		$	20,681		$	159,699
Gross margin percentage		26.8	%		53.9	%		45.6	%		31.4	%


	For the three-month period ended September 30, 2023
	PDS			HHH			MS			Total
Revenue	$	384,750		$	52,989		$	40,271		$	478,010
Cost of revenue, excluding depreciation and amortization		280,288			27,597		$	22,861			330,746
Gross margin	$	104,462		$	25,392		$	17,410		$	147,264
Gross margin percentage		27.2	%		47.9	%		43.2	%		30.8	%


	For the nine-month period ended September 28, 2024
	PDS			HHH			MS			Total
Revenue	$	1,212,418		$	163,382		$	128,834		$	1,504,634
Cost of revenue, excluding depreciation and amortization		891,588			75,814			73,412			1,040,814
Gross margin	$	320,830		$	87,568		$	55,422		$	463,820
Gross margin percentage		26.5	%		53.6	%		43.0	%		30.8	%


	For the nine-month period ended September 30, 2023
	PDS			HHH			MS			Total
Revenue	$	1,135,365		$	164,525		$	116,478		$	1,416,368
Cost of revenue, excluding depreciation and amortization		815,221			87,189		$	66,974			969,384
Gross margin	$	320,144		$	77,336		$	49,504		$	446,984
Gross margin percentage		28.2	%		47.0	%		42.5	%		31.6	%


	For the three-month periods ended						For the nine-month periods ended
Segment Reconciliation:	September 28, 2024			September 30, 2023			September 28, 2024			September 30, 2023
Total segment gross margin	$	159,699		$	147,264		$	463,820		$	446,984
Branch and regional administrative expenses		88,184			91,004			264,070			273,967
Corporate expenses		31,894			27,446			91,981			84,735
Goodwill impairment		-			105,136			-			105,136
Depreciation and amortization		2,587			2,962			8,332			10,494
Acquisition-related costs		150			428			150			466
Other operating expense (income)		2,860			(3,360	)		5,271			(6,593	)
Operating income (loss)		34,024			(76,352	)		94,016			(21,221	)
Interest income		100			50			297			238
Interest expense		(39,245	)		(39,599	)		(118,505	)		(113,542	)
Other (expense) income		(22,211	)		14,143			2,329			27,124
Loss before income taxes	$	(27,332	)	$	(101,758	)	$	(21,863	)	$	(107,401	)

Long-Term Obligations

9 Months Ended

Sep. 28, 2024

Debt Disclosure [Abstract]

Long-Term Obligations

4. LONG-TERM OBLIGATIONS

Long-term obligations consisted of the following as of September 28, 2024 and December 30, 2023, respectively (dollar amounts in thousands):


Instrument	Stated Maturity Date	Contractual Interest Rate	Interest Rate as of September 28, 2024	September 28, 2024			December 30, 2023
2021 Extended Term Loan (1)	07/2028	S + 3.75%	8.91%	$	895,150		$	899,750
Second Lien Term Loan (1)	12/2029	S + 7.00%	12.21%		415,000			415,000
Revolving Credit Facility (1)	04/2026	S + 3.75%	8.91%		-			-
Total principal amount of long-term obligations					1,310,150			1,314,750
Less: unamortized debt issuance costs					(25,866	)		(29,209	)
Total amount of long-term obligations, net of unamortized debt issuance costs					1,284,284			1,285,541
Less: current portion of long-term obligations					(9,200	)		(9,200	)
Total amount of long-term obligations, net of unamortized debt issuance costs, less current portion				$	1,275,084		$	1,276,341
(1) S = Greater of 0.50% or one-month SOFR, plus a credit spread adjustment

The 2021 Extended Term Loan bears interest, at the Company’s election, at a variable interest rate based on either SOFR (subject to a minimum of 0.50%), or an alternative base rate ABR (subject to a minimum of 2.00%) for the interest period relevant to such borrowing, plus a credit spread adjustment ("CSA") of 0.10% and an applicable margin of 3.75% for loans accruing interest based on SOFR, and an applicable margin of 2.75% for loans accruing interest based on ABR. The Revolving Credit Facility bears interest, at the Company’s election, at a variable interest rate based on either SOFR or ABR (subject to a minimum of 2.00%) for the interest period relevant to such borrowing, plus a CSA of 0.10% and an applicable margin of 3.75% for loans accruing interest based on SOFR, and an applicable margin of 2.75% for loans accruing interest based on ABR. As of September 28, 2024, the principal amount of the 2021 Extended Term Loan and borrowings under the Revolving Credit Facility each accrued interest at a rate of 8.91%.

The Second Lien Term Loan bears interest at a rate per annum equal to, at the Company’s election, either (1) an applicable margin (equal to 6.00%) plus a base rate determined by reference to the highest of (a) 0.50% per annum plus the Federal Funds Effective Rate, (b) the Prime Rate and (c) the SOFR rate for an interest period of one month plus a CSA depending on the interest period plus 1.00%; or (2) an applicable margin (equal to 7.00%) plus SOFR and a CSA depending on the interest period; provided that such rate is not lower than a floor of 0.50%. As of September 28, 2024, the principal amount of the Second Lien Term Loan accrued interest at a rate of 12.21%.

Debt issuance costs related to the term loans are recorded as a direct deduction from the carrying amount of the debt. The balance for debt issuance costs related to the term loans as of September 28, 2024 and December 30, 2023 was $25.9 million and $29.2 million, respectively. The Company recognized interest expense related to the amortization of debt issuance costs of $1.1 million and $3.3 million for the three and nine-month periods ended September 28, 2024, respectively, and $1.1 million and $3.6 million for the three and nine-month periods ended September 30, 2023, respectively.

Issued letters of credit as of September 28, 2024 and December 30, 2023 were $31.8 million and $31.9 million, respectively. There were no swingline loans outstanding as of September 28, 2024 or December 30, 2023. Borrowing capacity under the Company's Revolving Credit Facility was approximately $168.2 million as of September 28, 2024 and $168.1 million as of December 30, 2023. Available borrowing capacity under the Revolving Credit Facility is subject to a maintenance leverage covenant that becomes effective if more than 30% of the total commitment is utilized.

The fair value of the Company's long-term obligations was estimated using market-observable inputs from the Company’s comparable peers with public debt, including quoted prices in active markets, which are considered Level 2 inputs. The aggregate fair value of the Company's long-term obligations was $1,260.6 million at September 28, 2024.

The Company was in compliance with all financial covenants and restrictions under the foregoing instruments at September 28, 2024.

See Note 14 - Subsequent Event for disclosure of subsequent amendments to the Revolving Credit Facility.

- Definition

The entire disclosure for information about short-term and long-term debt arrangements, which includes amounts of borrowings under each line of credit, note payable, commercial paper issue, bonds indenture, debenture issue, own-share lending arrangements and any other contractual agreement to repay funds, and about the underlying arrangements, rationale for a classification as long-term, including repayment terms, interest rates, collateral provided, restrictions on use of assets and activities, whether or not in compliance with debt covenants, and other matters important to users of the financial statements, such as the effects of refinancing and noncompliance with debt covenants.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481544/470-10-50-6

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
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-Section 50
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481544/470-10-50-6

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
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-Section 50
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147477092/405-40-50-1

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
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-Name Accounting Standards Codification
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Reference 6: http://www.xbrl.org/2003/role/disclosureRef
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Reference 7: http://www.xbrl.org/2003/role/disclosureRef
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Reference 8: http://www.xbrl.org/2003/role/disclosureRef
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Reference 9: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/470/tableOfContent

Reference 11: http://www.xbrl.org/2003/role/disclosureRef
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Reference 12: http://www.xbrl.org/2003/role/disclosureRef
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Reference 13: http://www.xbrl.org/2003/role/disclosureRef
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Revenue - Additional Information (Details) - USD ($)	3 Months Ended		9 Months Ended
Revenue - Additional Information (Details) - USD ($)	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023	Dec. 30, 2023
Revenue Disclosure [Line Items]
Estimated contractual adjustments and price concessions	$ 83,600,000		$ 83,600,000		$ 62,600,000
Bad debt expense	$ 0	$ 0	$ 0	$ 0
Maximum
Revenue Disclosure [Line Items]
Revenue, performance obligation, expected timing of satisfaction, period	1 year		1 year

Segment Information - Summary of Segment Reconciliation (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Segment Reconciliation:
Total segment gross margin	$ 159,699	$ 147,264	$ 463,820	$ 446,984
Branch and regional administrative expenses	88,184	91,004	264,070	273,967
Corporate expenses	31,894	27,446	91,981	84,735
Goodwill impairment		105,136		105,136
Depreciation and amortization	2,587	2,962	8,332	10,494
Acquisition-related costs	150	428	150	466
Other operating expense (income)	2,860	(3,360)	5,271	(6,593)
Operating income (loss)	34,024	(76,352)	94,016	(21,221)
Interest income	100	50	297	238
Interest expense	(39,245)	(39,599)	(118,505)	(113,542)
Other (expense) income	(22,211)	14,143	2,329	27,124
Loss before income taxes	$ (27,332)	$ (101,758)	$ (21,863)	$ (107,401)

Subsequent Events

9 Months Ended

Sep. 28, 2024

Subsequent Events [Abstract]

Subsequent Events

14. SUBSEQUENT EVENT

On September 30, 2024, the Company entered into a tenth amendment to the First Lien Credit Agreement, amending the Revolving Credit Facility to extend the maturity date from April 29, 2026 to the earlier of (i) April 15, 2028 and (ii) May 1, 2026 if by such date the Securitization Facility has not been renewed or replaced or paid-off, in each case, in full, with a maturity date that is April 15, 2028, or later. Additionally, such amendment reduced the maximum borrowing availability under the Revolving Credit Facility from $200.0 million to $170.3 million from September 30, 2024 through April 29, 2026, and then to $148.9 million from April 29, 2026 through the amended maturity date.

CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares	Sep. 28, 2024	Dec. 30, 2023
Statement of Financial Position [Abstract]
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, authorized	5,000,000	5,000,000
Preferred stock, issued	0	0
Preferred stock,outstanding	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, authorized	1,000,000,000	1,000,000,000
Common stock, issued	193,225,177	190,733,153
Common stock, outstanding	193,225,177	190,733,153

CONSOLIDATED STATEMENTS OF OPERATIONS (Unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Income Statement [Abstract]
Revenue	$ 509,023	$ 478,010	$ 1,504,634	$ 1,416,368
Cost of revenue, excluding depreciation and amortization	349,324	330,746	1,040,814	969,384
Branch and regional administrative expenses	88,184	91,004	264,070	273,967
Corporate expenses	31,894	27,446	91,981	84,735
Goodwill impairment		105,136		105,136
Depreciation and amortization	2,587	2,962	8,332	10,494
Acquisition-related costs	150	428	150	466
Other operating expense (income)	2,860	(3,360)	5,271	(6,593)
Operating income (loss)	34,024	(76,352)	94,016	(21,221)
Interest income	100	50	297	238
Interest expense	(39,245)	(39,599)	(118,505)	(113,542)
Other (expense) income	(22,211)	14,143	2,329	27,124
Loss before income taxes	(27,332)	(101,758)	(21,863)	(107,401)
Income tax expense	(15,511)	(631)	(18,246)	(1,387)
Net loss	$ (42,843)	$ (102,389)	$ (40,109)	$ (108,788)
Net loss per share:
Net loss per share, basic	$ (0.22)	$ (0.54)	$ (0.21)	$ (0.57)
Weighted average shares of common stock outstanding, basic	193,361	189,139	192,734	189,632
Net loss per share, diluted	$ (0.22)	$ (0.54)	$ (0.21)	$ (0.57)
Weighted average shares of common stock outstanding, diluted	193,361	189,139	192,734	189,632

Segment Information - Summary of Segment Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Segment Reporting Information [Line Items]
Revenue	$ 509,023	$ 478,010	$ 1,504,634	$ 1,416,368
Cost of revenue, excluding depreciation and amortization	349,324	330,746	1,040,814	969,384
Gross margin	$ 159,699	$ 147,264	$ 463,820	$ 446,984
Gross margin percentage	31.40%	30.80%	30.80%	31.60%
PDS
Segment Reporting Information [Line Items]
Revenue	$ 409,558	$ 384,750	$ 1,212,418	$ 1,135,365
Cost of revenue, excluding depreciation and amortization	299,731	280,288	891,588	815,221
Gross margin	$ 109,827	$ 104,462	$ 320,830	$ 320,144
Gross margin percentage	26.80%	27.20%	26.50%	28.20%
HHH
Segment Reporting Information [Line Items]
Revenue	$ 54,139	$ 52,989	$ 163,382	$ 164,525
Cost of revenue, excluding depreciation and amortization	24,948	27,597	75,814	87,189
Gross margin	$ 29,191	$ 25,392	$ 87,568	$ 77,336
Gross margin percentage	53.90%	47.90%	53.60%	47.00%
MS
Segment Reporting Information [Line Items]
Revenue	$ 45,326	$ 40,271	$ 128,834	$ 116,478
Cost of revenue, excluding depreciation and amortization	24,645	22,861	73,412	66,974
Gross margin	$ 20,681	$ 17,410	$ 55,422	$ 49,504
Gross margin percentage	45.60%	43.20%	43.00%	42.50%

- Definition

Aggregate revenue less cost of goods and services sold or operating expenses directly attributable to the revenue generation activity.

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Amount, excluding tax collected from customer, of revenue from satisfaction of performance obligation by transferring promised good or service to customer. Tax collected from customer is tax assessed by governmental authority that is both imposed on and concurrent with specific revenue-producing transaction, including, but not limited to, sales, use, value added and excise.

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+ Details

Revenue - Schedule of Revenue by Payer Type as a Percentage of Revenue (Details) - Customer Concentration Risk - Total revenue	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Disaggregation Of Revenue [Line Items]
Percentage of total revenue	100.00%	100.00%	100.00%	100.00%
Medicaid MCO
Disaggregation Of Revenue [Line Items]
Percentage of total revenue	56.70%	56.80%	56.30%	55.20%
Medicaid
Disaggregation Of Revenue [Line Items]
Percentage of total revenue	25.00%	22.00%	23.40%	22.00%
Commercial
Disaggregation Of Revenue [Line Items]
Percentage of total revenue	7.90%	9.00%	9.70%	10.00%
Medicare
Disaggregation Of Revenue [Line Items]
Percentage of total revenue	10.30%	12.00%	10.50%	12.70%
Self-pay
Disaggregation Of Revenue [Line Items]
Percentage of total revenue	0.10%	0.20%	0.10%	0.10%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

Long-Term Obligations - Additional Information (Details) - USD ($)			3 Months Ended		9 Months Ended
	Dec. 10, 2021	Jul. 15, 2021	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023	Dec. 30, 2023
Debt Instrument [Line Items]
Debt issuance costs			$ 25,866,000		$ 25,866,000		$ 29,209,000
Fair value of long-term obligations			1,260,600,000		1,260,600,000
Swingline loans			0		0		0
Revolving Credit Facility
Debt Instrument [Line Items]
Line of credit facility, maximum borrowing capacity			168,200,000		$ 168,200,000		168,100,000
Interest rate margin on borrowings					3.75%
Finance leverage covenant minimum percentage utilization of commitment					30.00%
Letter of Credit
Debt Instrument [Line Items]
Issued letter of credit			31,800,000		$ 31,800,000		31,900,000
Term Loan
Debt Instrument [Line Items]
Debt issuance costs			$ 25,900,000		$ 25,900,000		$ 29,200,000
Second Lien Term Loan
Debt Instrument [Line Items]
Debt instrument, interest Rate			12.21%		12.21%
Debt instrument minimum floor rate percentage	0.50%
Interest rate margin on borrowings					7.00%
Second Lien Term Loan \| SOFR and CSA
Debt Instrument [Line Items]
Interest rate margin on borrowings	7.00%
Second Lien Term Loan \| SOFR One Month Plus CSA
Debt Instrument [Line Items]
Interest rate margin on borrowings	1.00%
Second Lien Term Loan \| Annual Base Rate
Debt Instrument [Line Items]
Interest rate margin on borrowings	6.00%
Second Lien Term Loan \| Federal Funds Effective Rate
Debt Instrument [Line Items]
Interest rate margin on borrowings	0.50%
2021 Extended Term Loan
Debt Instrument [Line Items]
Debt instrument, interest Rate			8.91%		8.91%
Interest rate margin on borrowings					3.75%
2021 Extended Term Loan and Delayed Draw Term Loan Facility \| SOFR \| Minimum
Debt Instrument [Line Items]
Debt instruments, variable interest rate		0.50%
2021 Extended Term Loan and Delayed Draw Term Loan Facility \| SOFR \| Maximum
Debt Instrument [Line Items]
Interest rate margin on borrowings		3.75%
2021 Extended Term Loan and Delayed Draw Term Loan Facility \| CSA
Debt Instrument [Line Items]
Debt instruments, variable interest rate		0.10%
2021 Extended Term Loan and Delayed Draw Term Loan Facility \| Annual Base Rate \| Minimum
Debt Instrument [Line Items]
Debt instruments, variable interest rate		2.00%
Interest rate margin on borrowings		2.75%
Amended First Lien Credit Agreement
Debt Instrument [Line Items]
Interest expense related to amortization of debt issuance costs			$ 1,100,000	$ 1,100,000	$ 3,300,000	$ 3,600,000

Subsequent Events - Additional Information (Details) - Revolving Credit Facility - USD ($)		9 Months Ended
	Sep. 30, 2024	Sep. 28, 2024	Apr. 29, 2026	Sep. 29, 2024	Dec. 30, 2023
Subsequent Event [Line Items]
Maturity date		Apr. 29, 2026
Line of credit facility, maximum borrowing capacity		$ 168,200,000			$ 168,100,000
Revolving Credit Facility from April 29, 2026 through Amended Maturity Date \| Scenario Forecast
Subsequent Event [Line Items]
Line of credit facility, maximum borrowing capacity			$ 148,900,000
Subsequent Events
Subsequent Event [Line Items]
Earliest maturity date	Apr. 15, 2028
Line of credit facility, maximum borrowing capacity				$ 200,000,000
Subsequent Events \| Revolving Credit Facility from September 30, 2024 through April 29, 2026
Subsequent Event [Line Items]
Line of credit facility, maximum borrowing capacity	$ 170,300,000

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 28, 2024	Nov. 01, 2024
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 28, 2024
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Current Fiscal Year End Date	--12-28
Entity Registrant Name	Aveanna Healthcare Holdings Inc.
Entity Central Index Key	0001832332
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Filer Category	Accelerated Filer
Entity Common Stock, Shares Outstanding		193,225,177
Entity File Number	001-40362
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	81-4717209
Entity Address, Address Line One	400 Interstate North Parkway SE
Entity Address, City or Town	Atlanta
Entity Address, State or Province	GA
Entity Address, Postal Zip Code	30339
City Area Code	770
Local Phone Number	441-1580
Title of 12(b) Security	Common Stock, par value $0.01 per share
Trading Symbol	AVAH
Security Exchange Name	NASDAQ
Document Quarterly Report	true
Document Transition Report	false

Segment Information

9 Months Ended

Sep. 28, 2024

Segment Reporting [Abstract]

Segment Information

12. SEGMENT INFORMATION

The Company’s operating segments have been identified based upon how management has organized the business by services provided to customers and how the CODM manages the business and allocates resources. The Company has three operating segments and three reportable segments, Private Duty Services, Home Health & Hospice, and Medical Solutions. The PDS segment predominantly includes private duty skilled nursing services, non-clinical and personal care services, and pediatric therapy services. The HHH segment provides home health and hospice services to predominately elderly patients. Through the MS segment, the Company provides enteral nutrition and other products to adults and children, delivered on a periodic or as-needed basis.

The CODM evaluates performance using gross margin (and gross margin percentage). Gross margin includes revenue less all costs of revenue, excluding depreciation and amortization, but excludes branch and regional administrative expenses, corporate expenses and other non-field expenses. The CODM does not evaluate a measure of assets when assessing performance.

Results shown for the three and nine-month periods ended September 28, 2024 and September 30, 2023 are not necessarily those which would be achieved if each segment was an unaffiliated business enterprise. There are no intersegment transactions.

The following tables summarize the Company’s segment information for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively (amounts in thousands):


	For the three-month period ended September 28, 2024
	PDS			HHH			MS			Total
Revenue	$	409,558		$	54,139		$	45,326		$	509,023
Cost of revenue, excluding depreciation and amortization		299,731			24,948			24,645			349,324
Gross margin	$	109,827		$	29,191		$	20,681		$	159,699
Gross margin percentage		26.8	%		53.9	%		45.6	%		31.4	%


	For the three-month period ended September 30, 2023
	PDS			HHH			MS			Total
Revenue	$	384,750		$	52,989		$	40,271		$	478,010
Cost of revenue, excluding depreciation and amortization		280,288			27,597		$	22,861			330,746
Gross margin	$	104,462		$	25,392		$	17,410		$	147,264
Gross margin percentage		27.2	%		47.9	%		43.2	%		30.8	%


	For the nine-month period ended September 28, 2024
	PDS			HHH			MS			Total
Revenue	$	1,212,418		$	163,382		$	128,834		$	1,504,634
Cost of revenue, excluding depreciation and amortization		891,588			75,814			73,412			1,040,814
Gross margin	$	320,830		$	87,568		$	55,422		$	463,820
Gross margin percentage		26.5	%		53.6	%		43.0	%		30.8	%


	For the nine-month period ended September 30, 2023
	PDS			HHH			MS			Total
Revenue	$	1,135,365		$	164,525		$	116,478		$	1,416,368
Cost of revenue, excluding depreciation and amortization		815,221			87,189		$	66,974			969,384
Gross margin	$	320,144		$	77,336		$	49,504		$	446,984
Gross margin percentage		28.2	%		47.0	%		42.5	%		31.6	%


	For the three-month periods ended						For the nine-month periods ended
Segment Reconciliation:	September 28, 2024			September 30, 2023			September 28, 2024			September 30, 2023
Total segment gross margin	$	159,699		$	147,264		$	463,820		$	446,984
Branch and regional administrative expenses		88,184			91,004			264,070			273,967
Corporate expenses		31,894			27,446			91,981			84,735
Goodwill impairment		-			105,136			-			105,136
Depreciation and amortization		2,587			2,962			8,332			10,494
Acquisition-related costs		150			428			150			466
Other operating expense (income)		2,860			(3,360	)		5,271			(6,593	)
Operating income (loss)		34,024			(76,352	)		94,016			(21,221	)
Interest income		100			50			297			238
Interest expense		(39,245	)		(39,599	)		(118,505	)		(113,542	)
Other (expense) income		(22,211	)		14,143			2,329			27,124
Loss before income taxes	$	(27,332	)	$	(101,758	)	$	(21,863	)	$	(107,401	)

- Definition

The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments.

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+ Details

Income Taxes

9 Months Ended

Sep. 28, 2024

Income Tax Disclosure [Abstract]

Income Taxes

8. INCOME TAXES

The Company records its provision for income taxes on an interim basis based upon the estimate of the annual effective income tax rate for the full year applied to “ordinary” income or loss, adjusted each quarter for discrete items.

The Company recorded income tax expense of $15.5 million and $18.2 million for the three and nine-month periods ended September 28, 2024, respectively and income tax expense of $0.6 million and $1.4 million for the three and nine-month periods ended September 30, 2023, respectively.

The Company’s effective tax rate was negative 56.8% and negative 83.5% for the three and nine-month periods ended September 28, 2024, respectively, and negative 0.6% and negative 1.3% for the three and nine-month periods ended September 30, 2023, respectively. The effective tax rates for the three and nine-month periods ended September 28, 2024 and September 30, 2023 differed from the statutory rate of 21% primarily due to increased current federal and state taxes resulting from certain non-deductible expenses, most notably interest expense, and the changes in the valuation allowance recorded against certain deferred tax assets.

For both the three and nine-month periods ended September 28, 2024, the Company recognized a benefit of $1.9 million from the reversal of acquired uncertain tax positions. There has been no change to the Company’s policy that recognizes potential interest and penalties related to uncertain tax positions in income tax expense in the accompanying consolidated statements of operations.

- Definition

The entire disclosure for income tax.

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+ Details

Summary of Significant Accounting Policies (Policies)	9 Months Ended
Summary of Significant Accounting Policies (Policies)	Sep. 28, 2024
Accounting Policies [Abstract]
Principles of Consolidation	Principles of Consolidation The accompanying interim unaudited consolidated financial statements include the accounts of Aveanna Healthcare Holdings Inc. and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in the interim unaudited consolidated financial statements, and business combinations accounted for as purchases have been included in the interim unaudited consolidated financial statements from their respective dates of acquisition.
Basis of Presentation	Basis of Presentation The accompanying interim consolidated financial statements are unaudited and have been prepared by the Company in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and in accordance with the rules and regulations of the Securities and Exchange Commission (the “SEC”). Accordingly, these interim unaudited consolidated financial statements do not include all the information and disclosures required by U.S. GAAP for complete financial statements. In the opinion of management, these interim unaudited consolidated financial statements reflect all adjustments, consisting of normal recurring adjustments, necessary to present fairly the Company’s financial position as of September 28, 2024 and the results of operations for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively. The results reported in these interim unaudited consolidated financial statements should not be regarded as indicative of results that may be expected for any future period or the year ending December 28, 2024. These interim unaudited consolidated financial statements and related notes should be read in conjunction with the audited consolidated financial statements and related notes for the fiscal year ended December 30, 2023 included in the Company’s Annual Report on Form 10-K filed with the SEC on March 14, 2024. Our fiscal year ends on the Saturday that is closest to December 31 of a given year, resulting in either a 52 or 53-week fiscal year. The interim unaudited consolidated balance sheets reflect the accounts of the Company as of September 28, 2024 and December 30, 2023. For the three-month periods ended September 28, 2024 and September 30, 2023, the interim unaudited consolidated statements of operations, stockholders' deficit, and cash flows reflect the accounts of the Company from June 30, 2024 through September 28, 2024 and July 2, 2023 through September 30, 2023, respectively. For the nine-month periods ended September 28, 2024 and September 30, 2023, the interim unaudited consolidated statements of operations, stockholders' deficit, and cash flows reflect the accounts of the Company from December 31, 2023, through September 28, 2024 and January 1, 2023 through September 30, 2023, respectively.
Use of Estimates	Use of Estimates The Company’s accounting and reporting policies conform with U.S. GAAP. In preparing the interim unaudited consolidated financial statements, the Company is required to make estimates and assumptions that impact the amounts reported in these interim unaudited consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates.
Recently Issued Accounting Pronouncements	Recently Issued Accounting Pronouncements In November 2023, the Financial Accounting Standards Board ("FASB") issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. The standard improves reportable segment disclosure requirements for public business entities primarily through enhanced disclosures about significant segment expenses that are regularly provided to the chief operating decision maker (“CODM”) and included within each reported measure of segment profit (referred to as the “significant expense principle”). The standard will become effective for the fiscal year 2024 annual financial statements and interim financial statements thereafter and will be applied retrospectively for all prior periods presented in the financial statements, with early adoption permitted. The Company plans to adopt the standard when it becomes effective, beginning with the Company's fiscal year 2024 annual financial statements, and is currently evaluating the impact this guidance will have on the disclosures included in the notes to the consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard enhances income tax disclosure requirements for all entities by requiring specified categories and greater disaggregation within the rate reconciliation table, disclosure of income taxes paid by jurisdiction, and providing clarification on uncertain tax positions and related financial statement impacts. The standard will be effective for the fiscal year 2025 annual financial statements with early adoption permitted. The Company plans to adopt the standard when it becomes effective beginning with the Company's fiscal year 2025 annual financial statements, and the Company expects the adoption of the standard will impact certain of its income tax disclosures.

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (42,843)	$ (102,389)	$ (40,109)	$ (108,788)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

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Reference 28: http://www.xbrl.org/2003/role/disclosureRef
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Reference 29: http://www.xbrl.org/2003/role/disclosureRef
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Reference 30: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Net Loss Per Share - Summary of Computation of Basic and Diluted Net Loss Per Share (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Numerator:
Net loss	$ (42,843)	$ (102,389)	$ (40,109)	$ (108,788)
Denominator:
Weighted average shares of common stock outstanding, basic	193,361	189,139	192,734	189,632
Net loss per share, basic	$ (0.22)	$ (0.54)	$ (0.21)	$ (0.57)
Weighted average shares of common stock outstanding, diluted	193,361	189,139	192,734	189,632
Net loss per share, diluted	$ (0.22)	$ (0.54)	$ (0.21)	$ (0.57)
RSUs
Denominator:
Dilutive securities outstanding not included in the computation of diluted net loss per share, as their effect is antidilutive:	9,316	7,674	9,316	7,674
PSUs
Denominator:
Dilutive securities outstanding not included in the computation of diluted net loss per share, as their effect is antidilutive:	6,113	4,059	6,113	4,059
Employee Stock Option
Denominator:
Dilutive securities outstanding not included in the computation of diluted net loss per share, as their effect is antidilutive:	13,039	13,621	13,039	13,621

Related Party Transactions - Additional Information (Details)	Sep. 28, 2024
2021 Extended Term Loan
Related Party Transaction [Line Items]
Shareholders ownership percentage	7.90%

Long-Term Obligations - Schedule of Long-Term Obligations and Notes Payable (Parenthetical) (Details)	9 Months Ended
	Sep. 28, 2024
Second Lien Term Loan
Debt Instrument [Line Items]
Debt instrument, description of contractual interest rate	S = Greater of 0.50% or one-month SOFR
2021 Extended Term Loan
Debt Instrument [Line Items]
Debt instrument, description of contractual interest rate	S = Greater of 0.50% or one-month SOFR

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 835
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Reference 14: http://www.xbrl.org/2003/role/disclosureRef
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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Reference 26: http://www.xbrl.org/2009/role/commonPracticeRef
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Reference 27: http://www.xbrl.org/2009/role/commonPracticeRef
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+ Details

Goodwill - Summary of Changes in Goodwill by Segment (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023
Goodwill [Line Items]
Impairment	$ (105,136)	$ (105,136)

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands	Sep. 28, 2024	Dec. 30, 2023
Current assets:
Cash and cash equivalents	$ 78,462	$ 43,942
Patient accounts receivable	265,449	236,558
Receivables under insured programs	12,828	9,250
Prepaid expenses	12,202	15,684
Other current assets	12,425	9,452
Total current assets	381,366	314,886
Property and equipment, net	18,038	20,548
Operating lease right of use assets	42,548	49,499
Goodwill	1,054,552	1,054,552
Intangible assets, net	89,746	94,010
Receivables under insured programs	25,712	21,315
Other long-term assets	32,204	58,175
Total assets	1,644,166	1,612,985
Current liabilities:
Accounts payable and other accrued liabilities	41,925	30,130
Accrued payroll and employee benefits	84,983	67,160
Current portion of insurance reserves - insured programs	12,828	9,250
Current portion of insurance reserves	20,567	20,918
Securitization obligations	170,000	155,000
Current portion of long-term obligations	9,200	9,200
Current portion of operating lease liabilities	15,290	14,881
Other current liabilities	51,243	48,219
Total current liabilities	406,036	354,758
Long-term obligations, less current portion	1,275,084	1,276,341
Long-term insurance reserves - insured programs	25,712	21,315
Long-term insurance reserves	47,583	40,290
Operating lease liabilities, less current portion	33,497	39,818
Deferred income taxes	5,386	4,859
Other long-term liabilities	5,849	3,039
Total liabilities	1,799,147	1,740,420
Commitments and contingencies (Note 10)
Deferred restricted stock units	1,461	2,135
Stockholders' deficit:
Preferred stock, $0.01 par value as of September 28, 2024 and December 30, 2023 5,000,000 shares authorized; none issued or outstanding
Common stock, $0.01 par value, 1,000,000,000 shares authorized; 193,225,177 and 190,733,153 issued and outstanding, respectively	1,931	1,907
Additional paid-in capital	1,252,970	1,239,757
Accumulated deficit	(1,411,343)	(1,371,234)
Total stockholders' deficit	(156,442)	(129,570)
Total liabilities, deferred restricted stock units, and stockholders' deficit	$ 1,644,166	$ 1,612,985

Share-Based Compensation - Additional Information (Details) - USD ($) $ / shares in Units, $ in Millions	1 Months Ended	3 Months Ended			9 Months Ended
	Feb. 29, 2024	Sep. 28, 2024	Mar. 30, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023
Long-Term Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense, net of forfeitures		$ 2.3		$ 1.2	$ 6.0	$ 4.4
Unrecognized compensation expense		15.7			15.7
Senior Management Retention Plan \| Management
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense		1.3		0.0	3.0	0.0
Unrecognized compensation expense		8.9			8.9
Pre-IPO Options and Management Restricted Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense		0.8		1.5	1.6	2.3
Unrecognized compensation expense		4.2			4.2
Restricted Stock Units \| Director
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense		0.2		0.3	0.7	0.9
Unrecognized compensation expense		0.2			$ 0.2
Settlement of restricted shares for share of common stock upon vesting	1
Shares awarded	331,950
Weighted average grant date fair value of options granted	$ 2.41
Vesting period	1 year
Restricted Stock Units \| Long-Term Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted			2,873,968
Fair value of shares granted			$ 2.41
Performance Stock Units \| Long-Term Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares granted			2,873,881
Fair value of shares granted			$ 2.41
Term of award					The PSUs are also subject to a three-year service-based cliff vesting schedule commencing on the date of grant
Employee Stock Purchase Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Compensation expense		$ 0.4		$ 0.3	$ 1.2	$ 0.8
ESPP shares purchased		741,274		0	1,751,909	1,565,933
Common stock weighted average price		$ 2.35			$ 2.35
Share price		$ 1.76		$ 0.6	$ 1.76	$ 0.6

Securitization Facility - Additional Information (Details) - USD ($) $ in Thousands		3 Months Ended		9 Months Ended
	Nov. 12, 2021	Sep. 28, 2024	Sep. 30, 2023	Sep. 28, 2024	Sep. 30, 2023	May 31, 2024	Dec. 30, 2023
Debt Instrument [Line Items]
Outstanding balance		$ 1,310,150		$ 1,310,150			$ 1,314,750
Securitization Facility
Debt Instrument [Line Items]
Maximum amount available under securitization facility	$ 175,000					$ 225,000
Debt issuance costs	$ 2,700
Interest expense related to amortization of debt issuance costs		200	$ 100	500	$ 400
Maturity date	Jul. 31, 2026
Outstanding balance		$ 170,000		$ 170,000			$ 155,000
Interest rate under facility				8.11%

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References

+ Details

Segment Information - Additional Information (Details)	9 Months Ended
Segment Information - Additional Information (Details)	Sep. 28, 2024 Segment
Segment Reporting [Abstract]
Number of operating segments	3
Number of reportable segments	3

Securitization Facility

9 Months Ended

Sep. 28, 2024

Securitization Facility [Abstract]

Securitization Facility

5. SECURITIZATION FACILITY

On November 12, 2021, the Company (through a wholly owned special purpose entity, Aveanna SPV I, LLC) (the “special purpose entity”) and a lending institution entered into a Receivables Financing Agreement, which, as amended, has a maturity date of July 31, 2026 (as amended, the “Securitization Facility”). On May 31, 2024, the Company amended the Securitization Facility to increase the maximum amount available thereunder from $175.0 million to $225.0 million, subject to certain borrowing base requirements. The Company incurred debt issuance costs of $2.7 million in connection with the Securitization Facility, which were capitalized and included in other long-term assets. The Company recognized interest expense related to the amortization of debt issuance costs of $0.2 million and $0.5 million for the three and nine-month periods ended September 28, 2024, respectively, and $0.1 million and $0.4 million for the three and nine-month periods ended September 30, 2023, respectively.

Pursuant to two separate sale agreements, each of which is among Aveanna Healthcare, LLC, as initial servicer, certain of the Company's subsidiaries and the special purpose entity, the subsidiaries sold substantially all of their existing and future accounts receivable balances to the special purpose entity. The special purpose entity uses the accounts receivable balances to collateralize loans made under the Securitization Facility. The Company retains the responsibility of servicing the accounts receivable balances pledged as collateral under the Securitization Facility and provides a performance guaranty.

The outstanding balance under the Securitization Facility was $170.0 million and $155.0 million at September 28, 2024 and December 30, 2023, respectively. The balance accrues interest at a rate equal to the SOFR rate, plus a CSA, plus an applicable margin. The interest rate under the Securitization Facility was 8.11% at September 28, 2024.

The Securitization Facility is accounted for as a collateralized financing activity, rather than a sale of assets; therefore: (i) accounts receivable balances pledged as collateral are presented as assets and the borrowings are presented as liabilities in the interim unaudited consolidated balance sheets; (ii) the consolidated statements of operations reflect the interest expense associated with the collateralized borrowings; and (iii) receipts from customers related to the underlying accounts receivable are reflected as operating cash flows and borrowings and repayments under the collateralized loans are reflected as financing cash flows within the consolidated statements of cash flows. The Securitization Facility is included within current liabilities on the interim unaudited

consolidated balance sheets as it is collateralized by current patient accounts receivable and not because payments are due within one year of the balance sheet date.

Fair Value Measurements (Tables)

9 Months Ended

Sep. 28, 2024

Fair Value Disclosures [Abstract]

Summary of Other Assets and Other Liabilities Measured at Fair Value

The Company’s other assets measured at fair value were as follows (amounts in thousands):


	Fair Value Measurements at September 28, 2024
	Level 1		Level 2		Level 3		Total
Assets:
Interest rate cap agreements	$	-	$	14,486	$	-	$	14,486
Interest rate swap agreements		-		12,122		-		12,122
Total derivative assets	$	-	$	26,608	$	-	$	26,608

	Fair Value Measurements at December 30, 2023
	Level 1		Level 2		Level 3		Total
Assets:
Interest rate cap agreements	$	-	$	30,455	$	-	$	30,455
Interest rate swap agreements		-		23,022		-		23,022
Total derivative assets	$	-	$	53,477	$	-	$	53,477

Fair Value Measurements - Summary of Other Assets and Other Liabilities Measured at Fair Value (Details) - USD ($) $ in Thousands	Sep. 28, 2024	Dec. 30, 2023
Assets:
Total derivative assets	$ 26,608	$ 53,477
Derivative Asset, Statement of Financial Position [Extensible Enumeration]	Other Assets, Noncurrent	Other Assets, Noncurrent
Level 2
Assets:
Total derivative assets	$ 26,608	$ 53,477
Interest Rate Cap Agreements
Assets:
Total derivative assets	14,486	30,455
Interest Rate Cap Agreements \| Level 2
Assets:
Total derivative assets	14,486	30,455
Interest Rate Swap Agreements
Assets:
Total derivative assets	12,122	23,022
Interest Rate Swap Agreements \| Level 2
Assets:
Total derivative assets	$ 12,122	$ 23,022

- Definition

Fair value, after the effects of master netting arrangements, of a financial asset or other contract with one or more underlyings, notional amount or payment provision or both, and the contract can be net settled by means outside the contract or delivery of an asset. Includes assets not subject to a master netting arrangement and not elected to be offset.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 103
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-103

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+ Details

Derivative Financial Instruments - Additional Information (Details)		1 Months Ended
	Feb. 09, 2022 USD ($)	Jul. 31, 2021	Sep. 28, 2024 USD ($)	Dec. 30, 2023 USD ($)	Jul. 01, 2023	Apr. 01, 2023	Oct. 31, 2018 Swap
Other Long-Term Assets
Derivative [Line Items]
Fair value of interest rate swaps			$ 12,100,000	$ 23,000,000
Amended Interest Rate Swap Agreements
Derivative [Line Items]
Aggregate notional amount			520,000,000	520,000,000
Derivative expiration date		Jun. 30, 2026
Derivative, fixed interest rate					2.03%	2.08%
Derivative, floor interest rate					0.50%	0.50%
Interest Rate Swap Agreements
Derivative [Line Items]
Number of interest rate swap agreement \| Swap							2
Interest Rate Cap Agreements
Derivative [Line Items]
Aggregate notional amount	$ 880,000,000
Fair value of interest rate swaps			$ 14,500,000	$ 30,500,000
Derivative expiration date	Feb. 28, 2027
Derivative, cap interest rate	2.96%				2.96%	3.00%

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 28, 2024
Trading Arrangements, by Individual
Material Terms of Trading Arrangement	During the quarter ended September 28, 2024, none of the directors or officers of the Company adopted, modified, or terminated any contract, instruction or written plan for the purchase or sale of the Company's securities that was intended to satisfy the affirmative defense conditions of Rule 10b5-1 (c) under the Exchange Act or any "non-Rule 10b5-1 trading arrangement", as defined in Item 408 of Regulation S-K.
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
Rule 10b5-1 Arrangement Modified	false
Non-Rule 10b5-1 Arrangement Modified	false

Long-Term Obligations (Tables)

9 Months Ended

Sep. 28, 2024

Debt Disclosure [Abstract]

Schedule of Long-Term Obligations

Long-term obligations consisted of the following as of September 28, 2024 and December 30, 2023, respectively (dollar amounts in thousands):


Instrument	Stated Maturity Date	Contractual Interest Rate	Interest Rate as of September 28, 2024	September 28, 2024			December 30, 2023
2021 Extended Term Loan (1)	07/2028	S + 3.75%	8.91%	$	895,150		$	899,750
Second Lien Term Loan (1)	12/2029	S + 7.00%	12.21%		415,000			415,000
Revolving Credit Facility (1)	04/2026	S + 3.75%	8.91%		-			-
Total principal amount of long-term obligations					1,310,150			1,314,750
Less: unamortized debt issuance costs					(25,866	)		(29,209	)
Total amount of long-term obligations, net of unamortized debt issuance costs					1,284,284			1,285,541
Less: current portion of long-term obligations					(9,200	)		(9,200	)
Total amount of long-term obligations, net of unamortized debt issuance costs, less current portion				$	1,275,084		$	1,276,341
(1) S = Greater of 0.50% or one-month SOFR, plus a credit spread adjustment

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

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+ Details

Related Party Transactions

9 Months Ended

Sep. 28, 2024

Related Party Transactions

11. RELATED PARTY TRANSACTIONS

As of September 28, 2024, one of the Company’s majority stockholders owned 7.9% of the 2021 Extended Term Loan.

- Definition

The entire disclosure for related party transactions. Examples of related party transactions include transactions between (a) a parent company and its subsidiary; (b) subsidiaries of a common parent; (c) and entity and its principal owners; and (d) affiliates.

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+ Details

Net Loss Per Share (Tables)

9 Months Ended

Sep. 28, 2024

Earnings Per Share [Abstract]

Summary of Computation of Basic and Diluted Net Loss Per Share

The following is a computation of basic and diluted net loss per share (amounts in thousands, except per share amounts):


	For the three-month periods ended						For the nine-month periods ended
	September 28, 2024			September 30, 2023			September 28, 2024			September 30, 2023
Numerator:
Net loss	$	(42,843	)	$	(102,389	)	$	(40,109	)	$	(108,788	)
Denominator:
Weighted average shares of common stock outstanding (1), basic and diluted		193,361			189,139			192,734			189,632
Net loss per share, basic and diluted	$	(0.22	)	$	(0.54	)	$	(0.21	)	$	(0.57	)

Dilutive securities outstanding not included in the computation of diluted net loss per share, as their effect is antidilutive:
RSUs		9,316			7,674			9,316			7,674
PSUs		6,113			4,059			6,113			4,059
Stock options		13,039			13,621			13,039			13,621

(1)

The calculation of weighted average shares of common stock outstanding includes all vested deferred restricted stock units.

CONSOLIDATED STATEMENTS OF STOCKHOLDERS' DEFICIT - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Deficit
Beginning Balance at Dec. 31, 2022	$ (6,310)	$ 1,888	$ 1,228,512	$ (1,236,710)
Beginning Balance (shares) at Dec. 31, 2022		188,859,165
Issuance of vested restricted shares		$ 3	(3)
Issuance of vested restricted shares (shares)		308,055
Employee stock purchase plan	945	$ 16	929
Employee stock purchase plan (shares)		1,565,933
Non-cash share-based compensation	8,440		8,440
Net loss	(108,788)			(108,788)
Ending Balance at Sep. 30, 2023	(105,713)	$ 1,907	1,237,878	(1,345,498)
Ending Balance (in shares) at Sep. 30, 2023		190,733,153
Beginning Balance at Jul. 01, 2023	(6,737)	$ 1,904	1,234,468	(1,243,109)
Beginning Balance (shares) at Jul. 01, 2023		190,425,098
Issuance of vested restricted shares		$ 3	(3)
Issuance of vested restricted shares (shares)		308,055
Non-cash share-based compensation	3,413		3,413
Net loss	(102,389)			(102,389)
Ending Balance at Sep. 30, 2023	(105,713)	$ 1,907	1,237,878	(1,345,498)
Ending Balance (in shares) at Sep. 30, 2023		190,733,153
Beginning Balance at Dec. 30, 2023	(129,570)	$ 1,907	1,239,757	(1,371,234)
Beginning Balance (shares) at Dec. 30, 2023		190,733,153
Issuance of vested restricted shares	675	$ 7	668
Issuance of vested restricted shares (shares)		740,115
Employee stock purchase plan	3,088	$ 17	3,071
Employee stock purchase plan (shares)		1,751,909
Non-cash share-based compensation	9,474		9,474
Net loss	(40,109)			(40,109)
Ending Balance at Sep. 28, 2024	(156,442)	$ 1,931	1,252,970	(1,411,343)
Ending Balance (in shares) at Sep. 28, 2024		193,225,177
Beginning Balance at Jun. 29, 2024	(118,968)	$ 1,924	1,247,608	(1,368,500)
Beginning Balance (shares) at Jun. 29, 2024		192,483,903
Employee stock purchase plan	1,739	$ 7	1,732
Employee stock purchase plan (shares)		741,274
Non-cash share-based compensation	3,630		3,630
Net loss	(42,843)			(42,843)
Ending Balance at Sep. 28, 2024	$ (156,442)	$ 1,931	$ 1,252,970	$ (1,411,343)
Ending Balance (in shares) at Sep. 28, 2024		193,225,177

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

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- Definition

Amount of equity (deficit) attributable to parent. Excludes temporary equity and equity attributable to noncontrolling interest.

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+ Details

Summary of Significant Accounting Policies	9 Months Ended
Summary of Significant Accounting Policies	Sep. 28, 2024
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	2. SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Principles of Consolidation The accompanying interim unaudited consolidated financial statements include the accounts of Aveanna Healthcare Holdings Inc. and its wholly owned subsidiaries. All intercompany accounts and transactions have been eliminated in the interim unaudited consolidated financial statements, and business combinations accounted for as purchases have been included in the interim unaudited consolidated financial statements from their respective dates of acquisition. Basis of Presentation The accompanying interim consolidated financial statements are unaudited and have been prepared by the Company in accordance with U.S. generally accepted accounting principles (“U.S. GAAP”) for interim financial information and in accordance with the rules and regulations of the Securities and Exchange Commission (the “SEC”). Accordingly, these interim unaudited consolidated financial statements do not include all the information and disclosures required by U.S. GAAP for complete financial statements. In the opinion of management, these interim unaudited consolidated financial statements reflect all adjustments, consisting of normal recurring adjustments, necessary to present fairly the Company’s financial position as of September 28, 2024 and the results of operations for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively. The results reported in these interim unaudited consolidated financial statements should not be regarded as indicative of results that may be expected for any future period or the year ending December 28, 2024. These interim unaudited consolidated financial statements and related notes should be read in conjunction with the audited consolidated financial statements and related notes for the fiscal year ended December 30, 2023 included in the Company’s Annual Report on Form 10-K filed with the SEC on March 14, 2024. Our fiscal year ends on the Saturday that is closest to December 31 of a given year, resulting in either a 52 or 53-week fiscal year. The interim unaudited consolidated balance sheets reflect the accounts of the Company as of September 28, 2024 and December 30, 2023. For the three-month periods ended September 28, 2024 and September 30, 2023, the interim unaudited consolidated statements of operations, stockholders' deficit, and cash flows reflect the accounts of the Company from June 30, 2024 through September 28, 2024 and July 2, 2023 through September 30, 2023, respectively. For the nine-month periods ended September 28, 2024 and September 30, 2023, the interim unaudited consolidated statements of operations, stockholders' deficit, and cash flows reflect the accounts of the Company from December 31, 2023, through September 28, 2024 and January 1, 2023 through September 30, 2023, respectively. Use of Estimates The Company’s accounting and reporting policies conform with U.S. GAAP. In preparing the interim unaudited consolidated financial statements, the Company is required to make estimates and assumptions that impact the amounts reported in these interim unaudited consolidated financial statements and accompanying notes. Actual results could materially differ from those estimates. Recently Issued Accounting Pronouncements In November 2023, the Financial Accounting Standards Board ("FASB") issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. The standard improves reportable segment disclosure requirements for public business entities primarily through enhanced disclosures about significant segment expenses that are regularly provided to the chief operating decision maker (“CODM”) and included within each reported measure of segment profit (referred to as the “significant expense principle”). The standard will become effective for the fiscal year 2024 annual financial statements and interim financial statements thereafter and will be applied retrospectively for all prior periods presented in the financial statements, with early adoption permitted. The Company plans to adopt the standard when it becomes effective, beginning with the Company's fiscal year 2024 annual financial statements, and is currently evaluating the impact this guidance will have on the disclosures included in the notes to the consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard enhances income tax disclosure requirements for all entities by requiring specified categories and greater disaggregation within the rate reconciliation table, disclosure of income taxes paid by jurisdiction, and providing clarification on uncertain tax positions and related financial statement impacts. The standard will be effective for the fiscal year 2025 annual financial statements with early adoption permitted. The Company plans to adopt the standard when it becomes effective beginning with the Company's fiscal year 2025 annual financial statements, and the Company expects the adoption of the standard will impact certain of its income tax disclosures.

Share-Based Compensation

9 Months Ended

Sep. 28, 2024

Share-Based Payment Arrangement [Abstract]

Share-Based Compensation

9. SHARE-BASED COMPENSATION

Pre-IPO Options and Management Restricted Units

The Company recorded compensation expense, net of forfeitures, of $0.8 million and $1.6 million for the three and nine-month periods ended September 28, 2024, respectively, and $1.5 million and $2.3 million for the three and nine-month periods ended September 30, 2023, respectively, which is included in corporate and branch and regional administrative expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense as of September 28, 2024 associated with these outstanding awards was $4.2 million.

Director Restricted Stock Units

In February 2024, the Compensation Committee of the Company's Board of Directors (the "Compensation Committee") approved grants of 331,950 restricted stock units, with a grant date per share fair value of $2.41, to certain independent Directors ("Director

RSUs") under the Company's 2021 Omnibus Stock Incentive Plan. Director RSUs vest over a one-year period, and each RSU settles for one share of common stock upon vesting. The Company recorded compensation expense of $0.2 million and $0.7 million for the three and nine-month periods ended September 28, 2024, respectively, and $0.3 million and $0.9 million for the three and nine-month periods ended September 30, 2023, respectively, which is included in corporate expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense as of September 28, 2024 associated with outstanding director restricted stock units was $0.2 million.

Long-Term Incentive Plan ("LTIP")

During the three-month period ended March 30, 2024, the Compensation Committee approved grants of restricted stock units ("RSUs") and performance stock units ("PSUs") under the Company's 2021 Omnibus Stock Incentive Plan. Upon vesting, each RSU and each PSU settles for one share of common stock.

The RSUs are subject to a three-year service-based cliff vesting schedule commencing on the date of grant. Compensation cost for the RSUs is measured based on the grant date fair value of each underlying share of common stock and the number of RSUs granted and is recognized over the applicable vesting period on a straight-line basis. During the three-month period ended March 30, 2024, the Company granted 2,873,968 RSUs with a grant date per share fair value of $2.41. The PSUs contain performance criteria based on an adjusted EBITDA target over a three-year performance period. The PSUs are also subject to a three-year service-based cliff vesting schedule commencing on the date of grant. The PSUs have a service and a performance condition, and compensation cost is initially measured based on the grant date fair value of each underlying share of common stock. Cumulative compensation cost is subsequently adjusted at the end of each reporting period to reflect the current estimation of achieving the performance condition. During the three-month period ended March 30, 2024, the Company granted 2,873,881 PSUs with a weighted average grant date per share fair value of $2.41.

Total compensation expense, net of forfeitures, for all outstanding awards under the LTIP was $2.3 million and $6.0 million for the three and nine-month periods ended September 28, 2024, respectively, and $1.2 million and $4.4 million for the three and nine-month periods ended September 30, 2023, respectively, which is included in corporate and branch and regional administrative expenses in the accompanying consolidated statements of operations. Unrecognized compensation expense for all awards under the LTIP was $15.7 million as of September 28, 2024.

Senior Management Retention Plan ("SMRP")

In the second quarter of 2023, the Compensation Committee approved SMRP awards to certain members of management to be paid in the form of RSUs under the 2021 Omnibus Stock Incentive Plan. The awards were granted based on a fixed dollar value for each member of senior management included in the plan. The Company recorded compensation expense, net of forfeitures, of $1.3 million and $3.0 million during the three and nine-month periods ended September 28, 2024, respectively, which is included in corporate expenses and branch and regional administrative expenses in the accompanying consolidated statements of operations. No such expense was recorded during the three and nine-month periods ended September 30, 2023. Unrecognized compensation expense as of September 28, 2024 associated with the remaining SMRP awards was $8.9 million.

Employee Stock Purchase Plan

During the three-month period ended September 28, 2024, participants in the Company's Employee Stock Purchase Plan purchased a total of 741,274 shares of common stock at a weighted average price of approximately $2.35 per share. During the nine-month period ended September 28, 2024, participants purchased a total of 1,751,909 shares of common stock at an average price of $1.76 per share. During the three-month period ended September 30, 2023, no purchase events related to the Employee Stock Purchase Plan occurred. Participants purchased a total of 1,565,933 shares of common stock at a price of $0.60 per share during the nine-month period ended September 30, 2023.

The Company recorded compensation expense of $0.4 million and $1.2 million for the three and nine-month periods ended September 28, 2024, respectively, and $0.3 million and $0.8 million for the three and nine-month periods ended September 30, 2023, respectively, which is included in corporate expenses, branch and regional administrative expenses and cost of revenue, excluding depreciation and amortization in the accompanying consolidated statements of operations.

Revenue

9 Months Ended

Sep. 28, 2024

Revenue from Contract with Customer [Abstract]

Revenue

3. REVENUE

The Company evaluates the nature, amount, timing and uncertainty of revenue and cash flows using the five-step process. The Company uses a portfolio approach to group contracts with similar characteristics and analyze historical cash collection trends.

Revenue is primarily derived from (i) pediatric healthcare services provided to patients, including private duty nursing and therapy services; (ii) adult home health and hospice services (collectively “patient revenue”); and (iii) the delivery of enteral nutrition and other products to patients (“product revenue”). The services provided by the Company have no fixed duration and can be terminated by the patient or the facility at any time; therefore, each service provided is its own stand-alone contract. Incremental costs of obtaining a contract are expensed as incurred due to the short-term nature of the contracts.

Services ordered by a healthcare provider in an episode of care are not separately identifiable and therefore have been combined into a single performance obligation for each contract. The Company recognizes revenue as its performance obligations are completed. For patient revenue, the performance obligation is satisfied over time as the customer simultaneously receives and consumes the benefits of the healthcare services provided. For product revenue, the performance obligation is satisfied at the point in time of delivery of the product to the patient. The Company recognizes patient revenue equally over the number of treatments provided in a single episode of care. Typically, patients and third-party payers are billed within several days of the service being performed, and payments are due based on contract terms.

The Company’s lines of business are generally classified into the following categories: private duty services; home health and hospice; and medical solutions.

Private Duty Services (“PDS”). The PDS business includes a broad range of pediatric and adult healthcare services, including private duty skilled nursing, non-clinical services, which include employer of record support services and personal care services, pediatric therapy services, rehabilitation services, and nursing services in schools and pediatric day healthcare centers.

Home Health & Hospice (“HHH”). The HHH business provides home health, hospice, and personal care services to predominately elderly patients.

Medical Solutions (“MS”). The MS business includes the delivery of enteral nutrition and other products to patients.

For the PDS, HHH, and MS businesses, the Company receives payments from the following sources for services rendered: (i) state governments under their respective Medicaid programs (“Medicaid”); (ii) Managed Care providers of state government Medicaid programs (“Medicaid MCO”); (iii) commercial insurers; (iv) other government programs including Medicare, Tricare and ChampVA (“Medicare”); and (v) individual patients. As the period between the time of service and time of payment is typically one year or less, the Company did not adjust for the effects of a significant financing component.

Most contracts contain variable consideration; however, it is unlikely that a significant reversal of revenue will occur when the uncertainty is resolved, and therefore, the Company has included the variable consideration in the estimated transaction price. The Company determines the transaction price based on established billing rates reduced by contractual adjustments provided to third-party payers and by implicit price concessions which are estimated based on historical collection experience. Management estimates the transaction price on a payer-specific basis given its interpretation of the applicable regulations or contract terms. Updated regulations and contract negotiations occur frequently, necessitating regular review and assessment by management.

There were no material revenue adjustments recognized from performance obligations satisfied or partially satisfied in previous periods for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively.

As of September 28, 2024 and December 30, 2023, estimated contractual adjustments and implicit price concessions of $83.6 million and $62.6 million, respectively, were recorded as reductions to patient accounts receivable balances to arrive at the estimated collectible revenue and patient accounts receivable. Subsequent changes resulting from a patient’s ability to pay are recorded as bad debt expense, which is included as a component of operating expenses in the consolidated statements of operations. The Company did not record any bad debt expense for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively.

The following table presents revenue by payer type as a percentage of total revenue for the three and nine-month periods ended September 28, 2024 and September 30, 2023, respectively:


	For the three-month periods ended						For the nine-month periods ended
	September 28, 2024			September 30, 2023			September 28, 2024			September 30, 2023
Medicaid MCO		56.7	%		56.8	%		56.3	%		55.2	%
Medicaid		25.0	%		22.0	%		23.4	%		22.0	%
Commercial		7.9	%		9.0	%		9.7	%		10.0	%
Medicare		10.3	%		12.0	%		10.5	%		12.7	%
Self-pay		0.1	%		0.2	%		0.1	%		0.1	%
Total revenue		100.0	%		100.0	%		100.0	%		100.0	%

- Definition

The entire disclosure of revenue from contract with customer to transfer good or service and to transfer nonfinancial asset. Includes, but is not limited to, disaggregation of revenue, credit loss recognized from contract with customer, judgment and change in judgment related to contract with customer, and asset recognized from cost incurred to obtain or fulfill contract with customer. Excludes insurance and lease contracts.

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+ Details