0000950170-24-123376 | 10-Q | XBRL Viewer | Lifestance Health Group INC

Business Combinations

9 Months Ended

Sep. 30, 2024

NOTE 7 BUSINESS COMBINATIONS

During the nine months ended September 30, 2023, the Company completed the acquisitions of 3 outpatient mental health practices. There were no completed acquisitions during the three and nine months ended September 30, 2024. The Company accounted for the acquisitions as business combinations using the acquisition method of accounting. The purchase price was allocated to the tangible and intangible assets acquired and liabilities assumed based on their estimated fair values as of the respective acquisition dates.

Total consideration transferred for these acquisitions consisted of the following:


	Nine Months Ended
	September 30, 2023
Cash consideration	$	20,000
Contingent consideration, at initial fair value		1,985
Total consideration transferred	$	21,985

The results of the acquired businesses have been included in the Company’s consolidated financial statements beginning as of their acquisition dates. It is impracticable to provide historical supplemental pro forma financial information along with revenue and earnings subsequent to the acquisition dates for acquisitions during the period due to a variety of factors, including access to historical information and the operations of acquirees being integrated within the Company shortly after closing and not operating as discrete entities within the Company’s organizational structure.

Fair Values of Assets Acquired and Liabilities Assumed

The following table summarizes the fair values of assets acquired and liabilities assumed as of the dates of acquisition:


	Nine Months Ended
Allocation of Purchase Price	September 30, 2023
Cash	$	181
Patient accounts receivable		372
Prepaid expenses and other current assets		138
Property and equipment		221
Right-of-use assets		368
Other noncurrent assets		22
Intangible assets		843
Goodwill		20,733
Total assets acquired		22,878
Total liabilities assumed		893
Fair value of net assets	$	21,985

The majority of the tangible assets acquired and liabilities assumed were recorded at their carrying values as of the respective dates of acquisition, as their carrying values approximated their fair values due to their short-term nature. The fair values of goodwill and other intangible assets acquired in these acquisitions were estimated primarily based on the income approach. The income approach estimates fair value based on the present value of the cash flows that the assets are expected to generate in the future. The Company developed estimates for the expected future cash flows and discount rates used in the present value calculations.

The following table summarizes the fair values of acquired intangible assets as of the dates of acquisition:


	Nine Months Ended
	September 30, 2023
Regional trade names (1)	$	435
Non-competition agreements (2)		408
Total	$	843

(1)

Useful lives for regional trade names are 5 years.

(2)

Useful lives for non-competition agreements are 5 years.

Contingent Consideration

Under the provisions of the acquisition agreements, the Company may pay additional cash consideration in the form of earnouts, contingent upon the acquirees achieving certain performance and operational targets (see Note 8).

The following table summarizes the maximum contingent consideration based on the acquisition agreements:


	Nine Months Ended
Contingent consideration	September 30, 2023
Maximum contingent consideration based on acquisition agreements	$	2,650

Goodwill

Goodwill is primarily attributable to the assembled workforce, customer and payor relationships and anticipated synergies and economies of scale expected from the integration of the businesses. The synergies include certain cost savings, operating efficiencies, and other strategic benefits projected to be achieved as a result of the acquisition. All goodwill is deductible for tax purposes.

Property and Equipment, Net (Tables)

9 Months Ended

Sep. 30, 2024

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment

Property and equipment, net consists of the following:


	September 30, 2024			December 31, 2023
Leasehold improvements	$	172,889		$	170,212
Computers and peripherals		23,471			27,302
Internal-use software		8,381			7,197
Furniture, fixtures and equipment		43,082			42,316
Medical equipment		842			842
Construction in process		6,921			9,037
Total	$	255,586		$	256,906
Less: Accumulated depreciation		(85,612	)		(68,684	)
Total property and equipment, net	$	169,974		$	188,222

Schedule of Depreciation Expense

Depreciation expense consists of the following:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Depreciation expense	$	10,409	$	9,448	$	30,559	$	27,698

Fair Value Measurements - Schedule of location of the interest rate swap (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Derivative Asset, Current, Statement of Financial Position [Extensible Enumeration]	Prepaid Expense and Other Assets, Current
Derivative Asset, Statement of Financial Position [Extensible Enumeration]	Other noncurrent assets
Interest Rate Swap \| Prepaid Expenses And Other Current Assets
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Derivative Asset	$ 1,046	$ 0
Interest Rate Swap \| Other Noncurrent Assets
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Derivative Asset	$ 0	$ 2,931

- 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.

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+ Details

Long-Term Debt - Future Principal Payments on Long Term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Debt Disclosure [Abstract]
Remainder of 2024	$ 731
2025	2,925
2026	2,925
2027	2,925
2028	277,794
Total	$ 287,300	$ 289,494

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
CASH FLOWS FROM OPERATING ACTIVITIES
Net loss	$ (50,331)	$ (141,303)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	56,279	58,220
Non-cash operating lease costs	29,431	30,225
Stock-based compensation	60,026	78,469
Amortization of discount and debt issue costs	1,264	1,592
Gain on remeasurement of contingent consideration	(1,975)	(4,443)
Other, net	998	5,105
Change in operating assets and liabilities, net of businesses acquired:
Patient accounts receivable, net	(32,757)	(48,484)
Prepaid expenses and other current assets	(3,924)	(52,293)
Accounts payable	620	(3,848)
Accrued payroll expenses	9,381	7,622
Operating lease liabilities	(34,300)	(30,109)
Other accrued expenses	10,232	65,568
Net cash provided by (used in) operating activities	44,944	(33,679)
CASH FLOWS FROM INVESTING ACTIVITIES
Purchases of property and equipment	(15,265)	(29,106)
Acquisitions of businesses, net of cash acquired	0	(19,820)
Net cash used in investing activities	(15,265)	(48,926)
CASH FLOWS FROM FINANCING ACTIVITIES
Proceeds from long-term debt	0	25,000
Payments of debt issue costs	0	(188)
Payments of long-term debt	(2,194)	(1,821)
Payments of contingent consideration	(3,694)	(6,402)
Net cash (used in) provided by financing activities	(5,888)	16,589
NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS	23,791	(66,016)
Cash and Cash Equivalents - Beginning of period	78,824	108,621
CASH AND CASH EQUIVALENTS – END OF PERIOD	102,615	42,605
SUPPLEMENTAL DISCLOSURE OF CASH FLOW INFORMATION
Cash paid for interest, net	19,023	15,424
Cash paid for taxes, net of refunds	59	416
SUPPLEMENTAL DISCLOSURES OF NON CASH INVESTING AND FINANCING ACTIVITIES
Contingent consideration incurred in acquisitions of businesses	0	1,985
Acquisition of property and equipment included in liabilities	$ 1,203	$ 5,303

Net Loss Per Share

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

Net Loss Per Share

NOTE 13 NET LOSS PER SHARE

The following table presents the calculation of basic and diluted net loss per share (“EPS”) for the Company’s common shares:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2024			2023			2024			2023
Net loss available to common stockholders'	$	(5,957	)	$	(61,583	)	$	(50,331	)	$	(141,303	)
Weighted-average shares used to compute basic and diluted net loss per share		380,359			372,476			378,713			365,556
Net loss per share, basic and diluted	$	(0.02	)	$	(0.17	)	$	(0.13	)	$	(0.39	)

The Company has issued potentially dilutive instruments in the form of RSAs, RSUs and stock options. The Company did not include any of these instruments in its calculation of diluted loss per share for the three and nine months ended September 30, 2024 and 2023 because to include them would be anti-dilutive due to the Company’s net loss during the period. See Note 10 for the issued, vested and

unvested RSAs, RSUs and stock options. The Company excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share:


	As of September 30,
	2024		2023
RSAs		2,255		5,615
RSUs		24,791		24,109
Stock options		13,476		13,476
		40,522		43,200

Fair Value Measurements - Summary of Fair Value, Assets and Liabilities Measured on Recurring Basis (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value	$ 86,882	$ 67,697
Beginning balance	8,169	17,824
Additions related to acquisitions	0	1,985
Payments of contingent consideration	(3,694)	(7,668)
Gain on remeasurement	(1,975)	(3,972)
Ending balance	2,500	8,169
Liabilities measured at fair value	2,500	8,169
Money Market Funds
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value	85,836	64,766
Interest Rate Swap
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value	1,046	2,931
Fair Value, Inputs, Level 1
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value	85,836	64,766
Fair Value, Inputs, Level 2
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Assets measured at fair value	1,046	2,931
Fair Value, Inputs, Level 3
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Liabilities measured at fair value	$ 2,500	$ 8,169

Total Revenue - Additional Information (Details)	9 Months Ended
Total Revenue - Additional Information (Details)	Sep. 30, 2024
Minimum [Member] \| Customer Concentration Risk [Member] \| Revenue Benchmark [Member]
Disaggregation of Revenue [Line Items]
Concentration Risk, Percentage	10.00%

- 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

Income Taxes - Additional Information (Details)	9 Months Ended
Income Taxes - Additional Information (Details)	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Statutory tax rate	21.00%

Stock - Based Compensation - Summary of Stock Option Activity (Details) - Employee Stock Option - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Number of shares options outstanding, Beginning Balance	13,476
Number of options, granted	0
Number of options, exercised	0
Number of options, Canceled and forfeited	0
Number of shares options outstanding, Ending Balance	13,476	13,476
Number of shares options, exercisable	2,142
Number of shares options, vested or expected to vest	13,476
Weighted average exercise price outstanding, Beginning Balance	$ 7.42
Weighted average exercise price, granted	0
Weighted average exercise price, exercised	0
Weighted average exercise price, Canceled and forfeited	0
Weighted average exercise price outstanding, Ending Balance	7.42	$ 7.42
Weighted average exercise price, exercisable	7.51
Weighted average exercise price, vested or expected to vest	$ 7.42
Weighted average remaining term in years, Outstanding, Ending	6 years 8 months 4 days	8 years 8 months 12 days
Weighted average remaining contractual life, exercisable	6 years 7 months 20 days
Weighted average remaining contractual life, vested or expected to vest	6 years 8 months 4 days
Aggregate intrinsic value outstanding, Beginning Balance	$ 5,565
Aggregate intrinsic value, exercised	0
Aggregate intrinsic value outstanding, Ending Balance	1,838	$ 5,565
Aggregate Intrinsic Value, exercisable	153
Aggregate intrinsic value, vested or expected	$ 1,838

Stock - Based Compensation

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

Stock Based Compensation

NOTE 10 STOCK-BASED COMPENSATION

2021 Equity Incentive Plan

Effective June 9, 2021, the Company’s Board of Directors (the "Board") and its stockholders as of that date adopted and approved the LifeStance Health Group, Inc. 2021 Equity Incentive Plan (the “2021 Equity Incentive Plan”). The 2021 Equity Incentive Plan permits the grant of awards or restricted or unrestricted common stock, stock options, stock appreciation rights, restricted stock units, performance awards, and other stock-based awards to employees and directors of, and consultants and advisors to, the Company and its affiliates. On January 1, 2024, the number of shares of common stock reserved and available for issuance under the 2021 Equity Incentive Plan increased by 18,936 shares.

Restricted Stock Awards ("RSA")

The following is a summary of RSA transactions as of and for the nine months ended September 30, 2024:


	Unvested Shares			Weighted-Average Grant Date Fair Value
Unvested, December 31, 2023		5,479		$	11.98
Vested		(13	)		11.98
Forfeited		(3,211	)		11.98
Unvested, September 30, 2024		2,255		$	11.98

Restricted Stock Units ("RSU")

The following is a summary of RSU transactions as of and for the nine months ended September 30, 2024:


	Unvested Shares			Weighted-Average Grant Date Fair Value
Outstanding, December 31, 2023		23,378		$	7.24
Granted		13,671			6.92
Vested		(7,126	)		8.40
Canceled and forfeited		(5,132	)		7.18
Outstanding, September 30, 2024		24,791		$	6.74

Stock Options

The following is a summary of stock option activity as of and for the nine months ended September 30, 2024:


	Number of Options		Weighted-Average Exercise Price		Weighted-Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value
Outstanding, December 31, 2023		13,476	$	7.42		8.70	$	5,565
Granted		—		—
Exercised		—		—				—
Canceled and forfeited		—		—
Outstanding, September 30, 2024		13,476	$	7.42		6.68	$	1,838
Exercisable at September 30, 2024		2,142	$	7.51		6.64	$	153
Vested or expected to vest at September 30, 2024		13,476	$	7.42		6.68	$	1,838

Stock-Based Compensation Expense

The Company recognized stock-based compensation expense related to RSAs, RSUs, and stock options within general and administrative expenses in the unaudited consolidated statements of operations and comprehensive loss as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Stock-based compensation expense	$	14,895	$	21,525	$	60,026	$	78,469

As of September 30, 2024, the Company had $134,383 in unrecognized compensation expense related to all non-vested RSUs and stock options that will be recognized over the weighted-average remaining service period of 1.6 years.

2021 Employee Stock Purchase Plan

Effective June 9, 2021, the Board and its stockholders as of that date adopted and approved the LifeStance Health Group, Inc. 2021 Employee Stock Purchase Plan (the “ESPP”). The ESPP is more fully described in Note 11 in the consolidated financial statements included in the Company's Annual Report on Form 10-K for the year ended December 31, 2023.

As of September 30, 2024, no shares of common stock have been purchased under the Company’s ESPP.

Leases - Summary of Weighted Average Remaining Lease Term and Discount Rate (Details)	Sep. 30, 2024	Dec. 31, 2023
Leases [Abstract]
Weighted-average remaining lease term (in years)	4 years 2 months 12 days	4 years 7 months 6 days
Weighted-average discount rate	7.44%	7.11%

Stock - Based Compensation - Summary of Stock Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock-based compensation expense	$ 14,895	$ 21,525	$ 60,026	$ 78,469

- 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

Goodwill and Intangible Assets

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Goodwill and Intangible Assets

NOTE 6 GOODWILL AND INTANGIBLE ASSETS

Goodwill

Goodwill was $1,293,346 as of September 30, 2024 and December 31, 2023. There have been no changes to the goodwill carrying value during the period.

Intangible Assets

Intangible assets consist of the following:


September 30, 2024	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount		Weighted Average Useful Life (Years)
Regional trade names	$	36,694	$	(34,187	)	$	2,507		4.0
LifeStance trade names		235,500		(45,873	)		189,627		22.5
Non-competition agreements		94,535		(91,317	)		3,218		4.2
Total intangible assets	$	366,729	$	(171,377	)	$	195,352


December 31, 2023	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount		Weighted Average Useful Life (Years)
Regional trade names	$	36,694	$	(26,399	)	$	10,295		5.0
LifeStance trade names		235,500		(38,024	)		197,476		22.5
Non-competition agreements		94,535		(81,234	)		13,301		4.2
Total intangible assets	$	366,729	$	(145,657	)	$	221,072

Gross carrying amount is based on the fair value of the intangible assets determined at the acquisition date. Total intangible asset amortization expense consists of the following:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Amortization expense	$	4,706	$	10,173	$	25,720	$	30,522

Fair Value Measurements - Summary of the Significant Assumptions Used for the Fair Value Measurement of the Contingent Consideration Liability (Details)	Sep. 30, 2024	Dec. 31, 2023
F T E Based Earn Outs
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0.084	0.097
Minimum \| Probability Weighted Analysis
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	0	0
Maximum \| Probability Weighted Analysis
Fair Value Assets And Liabilities Measured On Recurring And Nonrecurring Basis [Line Items]
Business Combination, Contingent Consideration, Liability, Measurement Input	1	1

Stock- Based Compensation (Tables)

9 Months Ended

Sep. 30, 2024

Share-Based Payment Arrangement [Abstract]

Summary of Restricted Stock Awards (RSA) Activity

The following is a summary of RSA transactions as of and for the nine months ended September 30, 2024:


	Unvested Shares			Weighted-Average Grant Date Fair Value
Unvested, December 31, 2023		5,479		$	11.98
Vested		(13	)		11.98
Forfeited		(3,211	)		11.98
Unvested, September 30, 2024		2,255		$	11.98

Summary of Restricted Stock Unit (RSU) Activity

The following is a summary of RSU transactions as of and for the nine months ended September 30, 2024:


	Unvested Shares			Weighted-Average Grant Date Fair Value
Outstanding, December 31, 2023		23,378		$	7.24
Granted		13,671			6.92
Vested		(7,126	)		8.40
Canceled and forfeited		(5,132	)		7.18
Outstanding, September 30, 2024		24,791		$	6.74

Summary of Stock Option Activity

The following is a summary of stock option activity as of and for the nine months ended September 30, 2024:


	Number of Options		Weighted-Average Exercise Price		Weighted-Average Remaining Contractual Term (Years)		Aggregate Intrinsic Value
Outstanding, December 31, 2023		13,476	$	7.42		8.70	$	5,565
Granted		—		—
Exercised		—		—				—
Canceled and forfeited		—		—
Outstanding, September 30, 2024		13,476	$	7.42		6.68	$	1,838
Exercisable at September 30, 2024		2,142	$	7.51		6.64	$	153
Vested or expected to vest at September 30, 2024		13,476	$	7.42		6.68	$	1,838

Summary of Stock Based Compensation Expense


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Stock-based compensation expense	$	14,895	$	21,525	$	60,026	$	78,469

Business Combinations (Tables)

9 Months Ended

Sep. 30, 2024

Business Combinations [Abstract]

Summary Of Consideration Transferred

Total consideration transferred for these acquisitions consisted of the following:


	Nine Months Ended
	September 30, 2023
Cash consideration	$	20,000
Contingent consideration, at initial fair value		1,985
Total consideration transferred	$	21,985

Schedule of Recognized Assets Acquired and Liabilities Assumed

The following table summarizes the fair values of assets acquired and liabilities assumed as of the dates of acquisition:


	Nine Months Ended
Allocation of Purchase Price	September 30, 2023
Cash	$	181
Patient accounts receivable		372
Prepaid expenses and other current assets		138
Property and equipment		221
Right-of-use assets		368
Other noncurrent assets		22
Intangible assets		843
Goodwill		20,733
Total assets acquired		22,878
Total liabilities assumed		893
Fair value of net assets	$	21,985

Schedule of Fair Values of Acquired Intangible Assets

The following table summarizes the fair values of acquired intangible assets as of the dates of acquisition:


	Nine Months Ended
	September 30, 2023
Regional trade names (1)	$	435
Non-competition agreements (2)		408
Total	$	843

(1)

Useful lives for regional trade names are 5 years.

(2)

Useful lives for non-competition agreements are 5 years.

Schedule of Maximum Contingent Consideration Based on the Acquisition Agreements

The following table summarizes the maximum contingent consideration based on the acquisition agreements:


	Nine Months Ended
Contingent consideration	September 30, 2023
Maximum contingent consideration based on acquisition agreements	$	2,650

Nature of the Business

9 Months Ended

Sep. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Nature of the Business

NOTE 1 NATURE OF THE BUSINESS

Description of Business

LifeStance Health Group, Inc. ("LifeStance" or the "Company") operates as a provider of outpatient mental health services, spanning psychiatric evaluations and treatment, psychological and neuropsychological testing, and individual, family and group therapy.

Goodwill and Intangible Assets - Additional Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill	$ 1,293,346	$ 1,293,346
Changes to goodwill carrying value	$ 0

- Definition

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

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+ Details

Stock - Based Compensation - Additional Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Jan. 01, 2024
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Share-based compensation arrangement by share-based payment award, description	On January 1, 2024, the number of shares of common stock reserved and available for issuance under the 2021 Equity Incentive Plan increased by 18,936 shares.
Unrecognized compensation expense	$ 134,383
Unrecognized compensattion expense, weighted-average period	1 year 7 months 6 days
2021 Equity Incentive Plan [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Common Stock, Capital Shares Reserved for Future Issuance		18,936,000
2021 Employee Stock Purchase Plan [Member] \| Common Stock [Member]
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Stock Issued During Period, Shares, Employee Stock Purchase Plans	0

- 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

Total Revenue - Schedule of Revenue From Patients And Third - Party Payors (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Amount	$ 312,722	$ 262,895	$ 925,490	$ 775,062
% of Total Revenue	100.00%	100.00%	100.00%	100.00%
Commercial
Disaggregation of Revenue [Line Items]
Amount	$ 283,264	$ 239,902	$ 840,943	$ 704,717
% of Total Revenue	91.00%	91.00%	91.00%	91.00%
Government
Disaggregation of Revenue [Line Items]
Amount	$ 14,850	$ 10,993	$ 43,016	$ 32,943
% of Total Revenue	5.00%	4.00%	5.00%	4.00%
Self-pay
Disaggregation of Revenue [Line Items]
Amount	$ 11,619	$ 10,229	$ 33,231	$ 30,360
% of Total Revenue	3.00%	4.00%	3.00%	4.00%
Total patient service revenue
Disaggregation of Revenue [Line Items]
Amount	$ 309,733	$ 261,124	$ 917,190	$ 768,020
% of Total Revenue	99.00%	99.00%	99.00%	99.00%
Nonpatient service revenue
Disaggregation of Revenue [Line Items]
Amount	$ 2,989	$ 1,771	$ 8,300	$ 7,042
% of Total Revenue	1.00%	1.00%	1.00%	1.00%

- 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

- Definition

Amount, including 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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-URI https://asc.fasb.org/1943274/2147482810/280-10-50-40

Reference 12: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 22
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-22

Reference 13: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-4

+ Details

Leases - Summary of Supplemental Cash Flow Information Related to Operating Leases (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$ 48,502	$ 47,356
Noncash lease activity
Right-of-use lease assets obtained in exchange for new operating lease liabilities	$ 13,752	$ 13,844

Fair Value Measurements (Tables)

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

Summary of the Significant Assumptions Used for the Fair Value Measurement of the Contingent Consideration Liability

The following is the summary of the significant assumptions used for the fair value measurement of the contingent consideration liability as of September 30, 2024 and December 31, 2023.


Valuation Technique	Range of Significant Assumptions
		September 30, 2024	December 31, 2023
Probability-weighted analysis	Probability	0% - 100%	0% - 100%
based earn-outs	Discount rate	8.4%	9.7%

Schedule of Location of the Interest Rate Swap

The following table summarizes the location of the interest rate swap in the unaudited consolidated balance sheets:


	Consolidated balance sheets location	September 30, 2024		December 31, 2023
Interest rate swap	Prepaid expenses and other current assets	$	1,046	$	—
Interest rate swap	Other noncurrent assets	$	—	$	2,931

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

The following table presents information about the Company’s assets and liabilities that are measured at fair value on a recurring basis:


	September 30, 2024			December 31, 2023
Assets Measured at Fair Value
Money market funds	$	85,836		$	64,766
Level 1	$	85,836		$	64,766
Interest rate swap asset	$	1,046		$	2,931
Level 2	$	1,046		$	2,931
Total assets measured at fair value	$	86,882		$	67,697

Liabilities Measured at Fair Value
Contingent consideration liability:
Beginning balance	$	8,169		$	17,824
Additions related to acquisitions		—			1,985
Payments of contingent consideration		(3,694	)		(7,668	)
Gain on remeasurement		(1,975	)		(3,972	)
Ending balance		2,500			8,169
Level 3	$	2,500		$	8,169
Total liabilities measured at fair value	$	2,500		$	8,169

Property and Equipment, Net

9 Months Ended

Sep. 30, 2024

Property, Plant and Equipment [Abstract]

Property and Equipment, Net

NOTE 4 PROPERTY AND EQUIPMENT, NET

Property and equipment, net consists of the following:


	September 30, 2024			December 31, 2023
Leasehold improvements	$	172,889		$	170,212
Computers and peripherals		23,471			27,302
Internal-use software		8,381			7,197
Furniture, fixtures and equipment		43,082			42,316
Medical equipment		842			842
Construction in process		6,921			9,037
Total	$	255,586		$	256,906
Less: Accumulated depreciation		(85,612	)		(68,684	)
Total property and equipment, net	$	169,974		$	188,222

Depreciation expense consists of the following:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Depreciation expense	$	10,409	$	9,448	$	30,559	$	27,698

Income Taxes (Tables)

9 Months Ended

Sep. 30, 2024

Income Tax Disclosure [Abstract]

Schedule of Provision (Benefit) for Income Taxes

The provision (benefit) for income taxes is as follows:


	Three Months Ended September 30,					Nine Months Ended September 30,
	2024		2023			2024		2023
Provision (benefit) for income taxes	$	575	$	(16,385	)	$	1,594	$	(26,964	)

Schedule of Effective Tax Rates

The effective tax rates are as follows:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2024			2023			2024			2023
Effective tax rate		(10.7	)%		21.0	%		(3.3	)%		16.0	%

Business Combinations - Summary of Consideration Transferred (Details) - Outpatient Mental Health Practices $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Business Acquisition [Line Items]
Cash consideration	$ 20,000
Contingent consideration, at initial fair value	1,985
Total consideration transferred	$ 21,985

Long-Term Debt - Summary of Interest Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Debt Disclosure [Abstract]
Interest expense, net	$ 5,413	$ 5,477	$ 17,139	$ 15,688

- Definition

Amount of interest expense classified as operating and nonoperating. Includes, but is not limited to, cost of borrowing accounted for as interest expense.

+ References + Details

Summary of Significant Accounting Policies (Policies)	9 Months Ended
Summary of Significant Accounting Policies (Policies)	Sep. 30, 2024
Accounting Policies [Abstract]
Basis of Presentation and Principles of Consolidation	Basis of Presentation and Principles of Consolidation The Company has prepared the accompanying unaudited consolidated financial statements pursuant to the rules and regulations of the SEC regarding interim financial reporting, which include the accounts of LifeStance, its wholly-owned subsidiaries and variable interest entities ("VIEs") in which LifeStance has an interest and is the primary beneficiary. Pursuant to these rules and regulations, the Company has omitted certain information and footnote disclosures it normally includes in its annual consolidated financial statements prepared in accordance with U.S. generally accepted accounting principles (“GAAP”). All intercompany balances and transactions have been eliminated in consolidation. In management’s opinion, the Company has made all adjustments (consisting only of normal, recurring adjustments, except as otherwise indicated) necessary to fairly state its consolidated financial condition, results of operations and cash flows. The Company’s interim period operating results do not necessarily indicate the results that may be expected for any other interim period or the full fiscal year. These financial statements and accompanying notes should be read in conjunction with the consolidated financial statements and notes thereto in the Company’s audited financial statements for the year ended December 31, 2023 in the Company's Annual Report on Form 10-K.
Use of Accounting Estimates	Use of Accounting Estimates The preparation of consolidated financial statements in conformity with GAAP requires management to make a number of estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.
Variable Interest Entities	Variable Interest Entities The Company evaluates its ownership, contractual and other interests in entities to determine if it has any variable interest in a VIE. These evaluations are complex, involve judgment, and the use of estimates and assumptions based on available information. If the Company determines that an entity in which it holds a contractual or ownership interest is a VIE and that the Company is the primary beneficiary, the Company consolidates such entity in its consolidated financial statements. The primary beneficiary of a VIE is the party that meets both of the following criteria: (i) has the power to make decisions that most significantly affect the economic performance of the VIE; and (ii) has the obligation to absorb losses or the right to receive benefits that in either case could potentially be significant to the VIE. The Company performs ongoing reassessments of whether changes in the facts and circumstances regarding the Company’s involvement with a VIE will cause the consolidation conclusion to change. The Company acquires and operates certain care centers which are deemed to be Friendly-Physician Entities (“FPEs”). As part of an FPE acquisition, the Company acquires 100% of the non-medical assets, however due to legal requirements the physician-owners must retain 100% of the equity interest. The Company’s agreements with FPEs generally consist of both a Management Service Agreement, which provides for various administrative and management services to be provided by the Company to the FPE, and Stock Transfer Restriction (“STR”) agreements with the physician-owners of the FPEs, which provide for the transition of ownership interests of the FPEs under certain conditions. The outstanding voting equity instruments of the FPEs are owned by the nominee shareholders appointed by the Company under the terms of the STR agreements. The Company has the right to receive income as an ongoing management fee, which effectively absorbs all of the residual interests and has also provided financial support through loans to the FPEs. The Company has exclusive responsibility for the provision of all nonmedical services including facilities, technology and intellectual property required for the day-to-day operation and management of each of the FPEs, and makes recommendations to the FPEs in establishing the guidelines for the employment and compensation of the physicians and other employees of the FPEs. In addition, the STR agreements provide that the Company has the right to designate an appropriately licensed person(s) to purchase the equity interest of the FPE for a nominal amount in the event of a succession event at the Company’s discretion. Based on the provisions of these agreements, the Company determined that the FPEs are VIEs due to the equity holder having insufficient capital at risk, and the Company has a variable interest in the FPEs. The contractual arrangements described above allow the Company to direct the activities that most significantly affect the economic performance of the FPEs. Accordingly, the Company is the primary beneficiary of the FPEs and consolidates the FPEs under the VIE model. Furthermore, as a direct result of nominal initial equity contributions by the physicians, the financial support the Company provides to the FPEs (e.g., loans) and the provisions of the contractual arrangements and nominee shareholder succession arrangements described above, the interests held by noncontrolling interest holders lack economic substance and do not provide them with the ability to participate in the residual profits or losses generated by the FPEs. Therefore, all income and expenses recognized by the FPEs are allocated to the Company. The Company does not hold interests in any VIEs for which the Company is not deemed to be the primary beneficiary. As noted previously, the Company acquires 100% of the non-medical assets of the VIEs. The aggregate carrying values of the VIEs total assets and total liabilities not purchased by the Company but included on the consolidated balance sheets were not material at September 30, 2024 and December 31, 2023.
Recent Accounting Pronouncements Not Yet Adopted	Recent Accounting Pronouncements Not Yet Adopted In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures ("ASU 2023-07"). ASU 2023-07 improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses on an interim and annual basis. ASU 2023-07 is effective for public companies for annual periods beginning on or after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. ASU 2023-07 will apply retrospectively to all prior periods presented in the financial statements. The Company is in process of evaluating the impact of adoption of ASU 2023-07 on the Company's consolidated financial statements and disclosures. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures ("ASU 2023-09"). ASU 2023-09 improves the transparency of income tax disclosures by requiring (1) consistent categories and greater disaggregation of information in the rate reconciliation and (2) income taxes paid disaggregated by jurisdiction. ASU 2023-09 is effective for public business entities for annual periods beginning after December 15, 2024. Early adoption is permitted. ASU 2023-09 will apply on a prospective basis and retrospective application is permitted. The Company is in process of evaluating the impact of adoption of ASU 2023-09 on the Company's consolidated financial statements and disclosures.

CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - $ / shares	Sep. 30, 2024	Dec. 31, 2023
Preferred Stock, par value	$ 0.01	$ 0.01
Preferred Stock, Shares Authorized	25,000,000	25,000,000
Preferred Stock, Shares Issued	0	0
Preferred Stock, Shares Outstanding	0	0
Common Stock, par value	$ 0.01	$ 0.01
Common Stock, Shares Authorized	800,000,000	800,000,000
Common Stock, Shares, Issued	382,640,000	378,725,000
Common Stock, Shares, Outstanding	382,640,000	378,725,000

Business Combinations - Schedule of Fair Values of Acquired Intangible Assets (Parenthetical) (Details)	Sep. 30, 2023
Regional Trade Names
Business Acquisition [Line Items]
Useful lives for acquired intangible assets	5 years
Non-Competition Agreements
Business Acquisition [Line Items]
Useful lives for acquired intangible assets	5 years

CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE LOSS (unaudited) - USD ($) shares in Thousands, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
TOTAL REVENUE	$ 312,722	$ 262,895	$ 925,490	$ 775,062
OPERATING EXPENSES
Center costs, excluding depreciation and amortization shown separately below	212,291	186,686	632,527	556,280
General and administrative expenses	85,269	130,945	269,356	317,425
Depreciation and amortization	15,115	19,621	56,279	58,220
Total operating expenses	312,675	337,252	958,162	931,925
INCOME (LOSS) FROM OPERATIONS	47	(74,357)	(32,672)	(156,863)
OTHER EXPENSE
Gain on remeasurement of contingent consideration	15	1,867	1,975	4,443
Transaction costs	(29)	0	(821)	(89)
Interest expense, net	(5,413)	(5,477)	(17,139)	(15,688)
Other expense	(2)	(1)	(80)	(70)
Total other expense	(5,429)	(3,611)	(16,065)	(11,404)
LOSS BEFORE INCOME TAXES	(5,382)	(77,968)	(48,737)	(168,267)
INCOME TAX (PROVISION) BENEFIT	(575)	16,385	(1,594)	26,964
NET LOSS	$ (5,957)	$ (61,583)	$ (50,331)	$ (141,303)
NET LOSS PER SHARE, BASIC	$ (0.02)	$ (0.17)	$ (0.13)	$ (0.39)
NET LOSS PER SHARE, DILUTED	$ (0.02)	$ (0.17)	$ (0.13)	$ (0.39)
Weighted-average shares used to compute basic net loss per share	380,359	372,476	378,713	365,556
Weighted-average shares used to compute diluted net loss per share	380,359	372,476	378,713	365,556
Net Income (Loss)	$ (5,957)	$ (61,583)	$ (50,331)	$ (141,303)
OTHER COMPREHENSIVE (LOSS) INCOME
Unrealized (losses) gains on cash flow hedge, net of tax	(1,872)	230	(1,532)	1,107
COMPREHENSIVE LOSS	$ (7,829)	$ (61,353)	$ (51,863)	$ (140,196)

Business Combinations - Additional Information (Details) - Facility	3 Months Ended	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2024	Sep. 30, 2023
Business Combinations [Abstract]
Acquisitions of outpatient mental health practices	0	0	3

Net Loss Per Share (Tables)

9 Months Ended

Sep. 30, 2024

Earnings Per Share [Abstract]

Schedule of Basic and Diluted Net Loss Per Share

The following table presents the calculation of basic and diluted net loss per share (“EPS”) for the Company’s common shares:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2024			2023			2024			2023
Net loss available to common stockholders'	$	(5,957	)	$	(61,583	)	$	(50,331	)	$	(141,303	)
Weighted-average shares used to compute basic and diluted net loss per share		380,359			372,476			378,713			365,556
Net loss per share, basic and diluted	$	(0.02	)	$	(0.17	)	$	(0.13	)	$	(0.39	)

Computation of Diluted Net Loss per Share

The Company excluded the following potential common shares, presented based on amounts outstanding at each period end, from the computation of diluted net loss per share:


	As of September 30,
	2024		2023
RSAs		2,255		5,615
RSUs		24,791		24,109
Stock options		13,476		13,476
		40,522		43,200

Stock - Based Compensation - Summary of Restricted Stock Unit (RSU) Activity (Details) - Restricted Stock Unit shares in Thousands	9 Months Ended
	Sep. 30, 2024 $ / shares shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding \| shares	23,378
Granted \| shares	13,671
Vested \| shares	(7,126)
Canceled and forfeited \| shares	(5,132)
Outstanding \| shares	24,791
Outstanding \| $ / shares	$ 7.24
Granted \| $ / shares	6.92
Vested \| $ / shares	8.4
Canceled and forfeited \| $ / shares	7.18
Outstanding \| $ / shares	$ 6.74

Property and Equipment, Net - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Property Plant And Equipment [Line Items]
Total	$ 255,586	$ 256,906
Less: Accumulated depreciation	(85,612)	(68,684)
Total property and equipment, net	169,974	188,222
Leasehold Improvements
Property Plant And Equipment [Line Items]
Total	172,889	170,212
Computers and Peripherals
Property Plant And Equipment [Line Items]
Total	23,471	27,302
Internal-use software
Property Plant And Equipment [Line Items]
Total	8,381	7,197
Furniture, Fixtures and Equipment
Property Plant And Equipment [Line Items]
Total	43,082	42,316
Medical Equipment
Property Plant And Equipment [Line Items]
Total	842	842
Construction in Process
Property Plant And Equipment [Line Items]
Total	$ 6,921	$ 9,037

Net Loss Per Share - Schedule 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. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Earnings Per Share [Abstract]
Net loss available to common stockholders'	$ (5,957)	$ (61,583)	$ (50,331)	$ (141,303)
Weighted-average shares used to compute basic net loss per share	380,359	372,476	378,713	365,556
Weighted-average shares used to compute diluted net loss per share	380,359	372,476	378,713	365,556
Net loss per share, basic	$ (0.02)	$ (0.17)	$ (0.13)	$ (0.39)
Net loss per share, diluted	$ (0.02)	$ (0.17)	$ (0.13)	$ (0.39)

- Definition

The amount of net income (loss) from continuing operations per each share of common stock or unit outstanding during the reporting period.

+ References

+ Details

- Definition

The amount of net income (loss) derived from continuing operations during the period available to each share of common stock or common unit outstanding during the reporting period and to each share or unit that would have been outstanding assuming the issuance of common shares or units for all dilutive potential common shares or units outstanding during the reporting period.

+ References

+ Details

- Definition

Amount, after deduction of tax, noncontrolling interests, dividends on preferred stock and participating securities; of income (loss) available to common shareholders.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 805
-SubTopic 60
-Name Accounting Standards Codification
-Section 65
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147476176/805-60-65-1

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 3
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-3

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 11
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-11

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 11
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-11

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 4
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-4

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 5
-Subparagraph (SAB Topic 6.B)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483621/220-10-S99-5

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482662/260-10-50-1

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482689/260-10-45-10

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 11
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482689/260-10-45-11

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 60B
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482689/260-10-45-60B

+ Details

Business Combinations - Schedule of Fair Values of Acquired Intangible Assets (Details)
$ in Thousands

9 Months Ended

Sep. 30, 2023

USD ($)

Business Acquisition [Line Items]

Acquired intangible assets, Fair value

$ 843

Regional Trade Names

Business Acquisition [Line Items]

Acquired intangible assets, Fair value

435

^[1]

Non-Competition Agreements

Business Acquisition [Line Items]

Acquired intangible assets, Fair value

$ 408

^[2]

[1]	Useful lives for regional trade names are 5 years.
[2]	Useful lives for non-competition agreements are 5 years.

Document and Entity Information - shares	9 Months Ended
Document and Entity Information - shares	Sep. 30, 2024	Oct. 30, 2024
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Sep. 30, 2024
Entity Registrant Name	LifeStance Health Group, Inc.
Entity Central Index Key	0001845257
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Document Quarterly Report	true
Document Transition Report	false
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Trading Symbol	LFST
Title of 12(b) Security	Common Stock, par value $0.01 per share
Security Exchange Name	NASDAQ
Entity Common Stock, Shares Outstanding		382,640,096
Entity File Number	001-40478
Entity Tax Identification Number	86-1832801
Entity Address, Address Line Two	Suite 2500
Entity Incorporation, State or Country Code	DE
Entity Address, Address Line One	4800 N. Scottsdale Road
Entity Address, City or Town	Scottsdale
Entity Address, State or Province	AZ
Entity Address, Postal Zip Code	85251
City Area Code	602
Local Phone Number	767-2100

Commitments and Contingencies

9 Months Ended

Sep. 30, 2024

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

NOTE 12 COMMITMENTS AND CONTINGENCIES

Professional Liability Insurance

The Company's medical malpractice insurance coverage is subject to a $3,000 per claim limit and an annual aggregate shared limit of $8,000. Should the claims-made policy not be renewed or replaced with equivalent insurance, claims based on occurrences during its term, but reported subsequently, would be uninsured. The Company is not aware of any unasserted claims, unreported incidents, or claims outstanding that are expected to exceed malpractice insurance coverage limits as of September 30, 2024 and December 31, 2023.

Health Care Industry

The healthcare industry is subject to numerous laws and regulations of federal, state, and local governments. These laws and regulations include, but are not necessarily limited to, matters such as licensure, accreditation, and government healthcare program participation requirements, reimbursement for patient services, and Medicare fraud and abuse. Recently, government activity has increased with respect to investigations and allegations concerning possible violations of fraud and abuse statutes and regulations by healthcare providers. Violation of these laws and regulations could result in expulsion from government healthcare programs together with imposition of significant fines and penalties, as well as significant repayments for patient services billed.

Laws and regulations concerning government programs, including Medicare and Medicaid, are complex and subject to varying interpretation. As a result of investigations by governmental agencies, various healthcare companies have received requests for information and notices regarding alleged noncompliance with those laws and regulations, which, in some instances, have resulted in companies entering into significant settlement agreements. Compliance with such laws and regulations may also be subject to future government review and interpretation as well as significant regulatory action, including fines, penalties, and potential exclusion from the related programs. There can be no assurance that regulatory authorities will not challenge the Company’s compliance with these laws and regulations, and it is not possible to determine the impact (if any) such claims or penalties would have upon the Company. In addition, the contracts the Company has with commercial payors also provide for retroactive audit and review of claims.

Management believes that the Company is in substantial compliance with fraud and abuse as well as other applicable government laws and regulations. While no regulatory inquiries have been made, compliance with such laws and regulations is subject to government review and interpretation, as well as regulatory actions unknown or unasserted at this time.

General Contingencies

The Company is exposed to various risks of loss related to torts; theft of, damage to and destruction of assets; errors and omissions, injuries to employees, and natural disasters. These risks are covered by commercial insurance purchased from independent third parties. There has been no significant reduction in insurance coverage from the previous year in any of the Company’s policies.

Litigation

The Company may be involved from time-to-time in legal actions relating to the ownership and operations of its business. Liabilities related to loss contingencies are recognized when the Company believes it is probable a liability has occurred and the amount can be reasonably estimated by management.

In the first half of 2023, two related hybrid collective/class action lawsuits, captioned Armand et al. v. LifeStance Health Group, Inc. and Jessica McAfee et al. v. LifeStance Health Group, Inc., were filed against the Company, in the United States District Court for the Middle District of Florida on January 1, 2023 and the United States District Court for the District of Arizona on June 22, 2023, respectively, by a putative collective or class representing employees of the Company related to advance on compensation and alleged underpayments for time worked. The lawsuit seeks unspecified monetary damages. The process of resolving these matters is inherently uncertain and may develop over an extended period of time; therefore, at this time, the ultimate resolution cannot be predicted. The Company has not recorded any material accruals for loss contingencies and in management's opinion no material range of loss is estimable for this matter as of September 30, 2024.

On April 26, 2023, a class action litigation captioned Strong v. LifeStance Health Group, Inc. was filed in the United States District Court for the District of Arizona against the Company by a putative class representing users of the Company's website who allege various privacy-related claims premised on the Company's use of pixel technologies on its website. The lawsuit seeks unspecified monetary damages. The Company has moved to dismiss all claims. The process of resolving these matters is inherently uncertain and may develop over an extended period of time; therefore, at this time, the ultimate resolution cannot be predicted. The Company has not recorded any material accruals for loss contingencies and in management's opinion no material range of loss is estimable for this matter as of September 30, 2024.

Net Loss Per Share - Computation of Diluted Net Loss per Share (Details) - shares shares in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Diluted net loss per share	40,522	43,200
Restricted Stock Awards RSA
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Diluted net loss per share	2,255	5,615
Restricted Stock Units RSU
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Diluted net loss per share	24,791	24,109
Employee Stock Option
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Diluted net loss per share	13,476	13,476

Fair Value Measurements

9 Months Ended

Sep. 30, 2024

Fair Value Disclosures [Abstract]

Fair Value Measurements

NOTE 8 FAIR VALUE MEASUREMENTS

Contingent Consideration

The Company measures its contingent consideration liability at fair value on a recurring basis using Level 3 inputs. The Company estimates the fair value of the contingent consideration liability based on the likelihood and timing of the contingent earn-out payments. The following is the summary of the significant assumptions used for the fair value measurement of the contingent consideration liability as of September 30, 2024 and December 31, 2023.


Valuation Technique	Range of Significant Assumptions
		September 30, 2024	December 31, 2023
Probability-weighted analysis	Probability	0% - 100%	0% - 100%
based earn-outs	Discount rate	8.4%	9.7%

As of September 30, 2024 and December 31, 2023, the Company adjusted the fair value of the contingent consideration liability due to remeasurement at the reporting date.

Hedging Activities

The Company uses derivative financial instruments, including an interest rate swap, for hedging and non-trading purposes to manage its exposure to changes in interest rates. The Company entered into a hedge transaction (interest rate swap) using a derivative financial instrument for the purpose of hedging the Company’s exposure to interest rate risks, which the contractual terms of the hedged instrument closely mirror those of the hedged item, providing a high degree of risk reduction and correlation. The objective of entering into the interest rate swap is to eliminate the variability of cash flows in the Secured Overnight Financing Rate ("SOFR") interest payments associated with the variable-rate loan over the life of the loan. In August 2022, the Company entered into an interest rate swap agreement to pay a fixed rate of 3.24% on a total notional value of $189,000 of debt. As a result of the interest rate swap, 94.5% of the term loan previously exposed to interest rate risk from changes in SOFR is now hedged against the interest rate swap at a fixed rate. The interest rate swap matures on September 30, 2025. As of September 30, 2024, the notional value was $185,220. As changes in interest rates impact the future cash flow of interest payments, the hedge provides a synthetic offset to interest rate movements.

The Company used the income approach to value the derivative for the interest rate swap using observable market data for all significant inputs and standard valuation techniques to convert future amounts to a single present value amount, assuming that participants are motivated but not compelled to transact. This derivative instrument (interest rate swap) is designated and qualifies as a cash flow hedge, with the entire gain or loss on the derivative reported as a component of other comprehensive income. Amounts recorded in accumulated other comprehensive income are released to earnings in the same period that the hedged transaction impacts consolidated earnings within interest expense, net. The cash flows from the derivative treated as a cash flow hedge is classified in the Company’s consolidated statements of cash flows in the same category as the item being hedged.

For the three and nine months ended September 30, 2024 and 2023, the Company included immaterial gains on the hedged instrument (variable-rate borrowings) in the same line item (interest expense, net) as the offsetting gain on the related interest rate swap in the unaudited consolidated statements of operations and comprehensive loss.

The following table summarizes the location of the interest rate swap in the unaudited consolidated balance sheets:


	Consolidated balance sheets location	September 30, 2024		December 31, 2023
Interest rate swap	Prepaid expenses and other current assets	$	1,046	$	—
Interest rate swap	Other noncurrent assets	$	—	$	2,931

The amount of estimated cash flow hedge unrealized gains and losses that are expected to be reclassified to earnings in the next twelve months is not material.

Fair Value Measured on a Recurring Basis

The following table presents information about the Company’s assets and liabilities that are measured at fair value on a recurring basis:


	September 30, 2024			December 31, 2023
Assets Measured at Fair Value
Money market funds	$	85,836		$	64,766
Level 1	$	85,836		$	64,766
Interest rate swap asset	$	1,046		$	2,931
Level 2	$	1,046		$	2,931
Total assets measured at fair value	$	86,882		$	67,697

Liabilities Measured at Fair Value
Contingent consideration liability:
Beginning balance	$	8,169		$	17,824
Additions related to acquisitions		—			1,985
Payments of contingent consideration		(3,694	)		(7,668	)
Gain on remeasurement		(1,975	)		(3,972	)
Ending balance		2,500			8,169
Level 3	$	2,500		$	8,169
Total liabilities measured at fair value	$	2,500		$	8,169

- 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.

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+ Details

Total Revenue (Tables)

9 Months Ended

Sep. 30, 2024

Disaggregation of Revenue [Abstract]

Schedule of revenue from patients and third - party payors

The payor mix of fee-for-service revenue from patients and third-party payors consists of the following:


	Three Months Ended September 30,										Nine Months Ended September 30,
	2024					2023					2024					2023
	Amount		% of Total Revenue			Amount		% of Total Revenue			Amount		% of Total Revenue			Amount		% of Total Revenue
Commercial	$	283,264		91	%	$	239,902		91	%	$	840,943		91	%	$	704,717		91	%
Government		14,850		5	%		10,993		4	%		43,016		5	%		32,943		4	%
Self-pay		11,619		3	%		10,229		4	%		33,231		3	%		30,360		4	%
Total patient service revenue		309,733		99	%		261,124		99	%		917,190		99	%		768,020		99	%
Nonpatient service revenue		2,989		1	%		1,771		1	%		8,300		1	%		7,042		1	%
Total	$	312,722		100	%	$	262,895		100	%	$	925,490		100	%	$	775,062		100	%

Schedule of percentage of revenue from insurance companies

Among the commercial payors, the table below represents insurance companies that individually represented 10% or more of revenue:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2024			2023			2024			2023
Payor A		16	%		19	%		17	%		19	%
Payor B		16	%		13	%		15	%		13	%

Fair Value Measurements - Additional Information (Details) - Interest Rate Swap - USD ($) $ in Thousands	Sep. 30, 2024	Aug. 31, 2022
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Derivative Percent of Debt Exposed		94.50%
Cash Flow Hedging
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Derivative, Fixed Interest Rate		3.24%
Derivative, Notional Amount	$ 185,220	$ 189,000

Income Taxes - Schedule of Provision (Benefit) for Income Taxes (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Provision (benefit) for income taxes	$ 575	$ (16,385)	$ 1,594	$ (26,964)

- Definition

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

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+ Details

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Thousands	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss)	$ (5,957)	$ (61,583)	$ (50,331)	$ (141,303)

- Definition

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

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+ Details

Business Combinations - Schedule of Fair Value Assets Acquired And Liabilities Assumed (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Business Combinations [Abstract]
Cash	$ 181
Patient accounts receivable	372
Prepaid expenses and other current assets	138
Property and equipment	221
Right-of-use assets	368
Other noncurrent assets	22
Intangible assets	843
Goodwill	20,733
Total assets acquired	22,878
Total liabilities assumed	893
Fair value of net assets	$ 21,985

Long-Term Debt - Additional Information (Details) - USD ($)		9 Months Ended
	May 04, 2022	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Long-term debt, fair value		$ 306,099,000	$ 304,955,000
Long term debt fair value		287,300,000	289,494,000
2022 Credit Agreement
Debt Instrument [Line Items]
Term loan facility	$ 200,000,000
Debt instrument, basis spread on variable rate	1.00%
2022 Credit Agreement \| Revolving Credit Facility
Debt Instrument [Line Items]
Loan withdrawal amount		0	0
Maximum borrowing capacity		$ 50,000,000
Unused revolving loan commitment fee percentage		0.005
Revolving loan outstanding amount		$ 0	0
Revolving loan,expiration date		May 16, 2027
Term Loans
Debt Instrument [Line Items]
Long-term debt, maturities, repayment terms	May 16, 2028
Long term debt fair value	$ 200,000,000	$ 196,000,000	197,500,000
Delayed Draw Term Loans
Debt Instrument [Line Items]
Long term debt fair value		$ 91,300,000	$ 91,994,000
Maximum \| 2022 Credit Agreement
Debt Instrument [Line Items]
Loan withdrawal amount	50,000,000
Revolving loan outstanding amount	50,000,000
Maximum \| Delayed Draw Term Loans \| 2022 Credit Agreement
Debt Instrument [Line Items]
Aggregate loan commitment amount	$ 100,000,000
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| 2022 Credit Agreement
Debt Instrument [Line Items]
Long-term debt, maturities, repayment terms	May 16, 2027
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Minimum \| 2022 Credit Agreement
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	0.75%
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Minimum \| 2022 Credit Agreement \| Revolving Credit Facility
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		1.00%
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Maximum \| 2022 Credit Agreement
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	3.75%
Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate \| Maximum \| 2022 Credit Agreement \| Revolving Credit Facility
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		3.25%
Federal Funds Rate \| 2022 Credit Agreement
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	0.50%
Federal Funds Rate \| 2022 Credit Agreement \| Revolving Credit Facility
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		0.50%
Base Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	2.75%
Base Rate \| 2022 Credit Agreement \| Revolving Credit Facility
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate		2.25%

Goodwill and Intangible Assets - Summary of Intangible Assets (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2024	Dec. 31, 2023
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 366,729	$ 366,729
Accumulated Amortization	(171,377)	(145,657)
Net Carrying Amount	195,352	221,072
Regional Trade Names
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	36,694	36,694
Accumulated Amortization	(34,187)	(26,399)
Net Carrying Amount	$ 2,507	$ 10,295
Weighted Average Useful Life (Years)	4 years	5 years
Life Stance Trade Names
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 235,500	$ 235,500
Accumulated Amortization	(45,873)	(38,024)
Net Carrying Amount	$ 189,627	$ 197,476
Weighted Average Useful Life (Years)	22 years 6 months	22 years 6 months
Non-Competition Agreements
Finite-Lived Intangible Assets [Line Items]
Gross Carrying Amount	$ 94,535	$ 94,535
Accumulated Amortization	(91,317)	(81,234)
Net Carrying Amount	$ 3,218	$ 13,301
Weighted Average Useful Life (Years)	4 years 2 months 12 days	4 years 2 months 12 days

- 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

Total Revenue - Schedule of Percentage Of Revenue From Insurance Companies (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
% of Total Revenue	100.00%	100.00%	100.00%	100.00%
Payor A
Disaggregation of Revenue [Line Items]
% of Total Revenue	16.00%	19.00%	17.00%	19.00%
Payor B
Disaggregation of Revenue [Line Items]
% of Total Revenue	16.00%	13.00%	15.00%	13.00%

- 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

Summary of Significant Accounting Policies - Additional Information (Details)	Sep. 30, 2024
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Acquisition of Non Medical Assets	100.00%

- 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 (unaudited) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
CURRENT ASSETS
Cash and cash equivalents	$ 102,615	$ 78,824
Patient accounts receivable, net	158,161	125,405
Prepaid expenses and other current assets	26,244	21,502
Total current assets	287,020	225,731
NONCURRENT ASSETS
Property and equipment, net	169,974	188,222
Right-of-use assets	154,835	170,703
Intangible assets, net	195,352	221,072
Goodwill	1,293,346	1,293,346
Other noncurrent assets	7,414	10,895
Total noncurrent assets	1,820,921	1,884,238
Total assets	2,107,941	2,109,969
CURRENT LIABILITIES
Accounts payable	7,282	7,051
Accrued payroll expenses	111,858	102,478
Other accrued expenses	43,291	35,012
Contingent consideration	2,500	8,169
Operating lease liabilities, current	48,959	46,475
Other current liabilities	3,624	3,688
Total current liabilities	217,514	202,873
NONCURRENT LIABILITIES
Long-term debt, net	279,055	280,285
Operating lease liabilities, noncurrent	158,679	181,357
Deferred tax liability, net	15,219	15,572
Other noncurrent liabilities	381	952
Total noncurrent liabilities	453,334	478,166
Total liabilities	670,848	681,039
COMMITMENTS AND CONTINGENCIES (see Note 12)
STOCKHOLDERS' EQUITY
Preferred stock - par value $0.01 per share; 25,000 shares authorized as of September 30, 2024 and December 31, 2023; 0 shares issued and outstanding as of September 30, 2024 and December 31, 2023	0	0
Common stock - par value $0.01 per share; 800,000 shares authorized as of September 30, 2024 and December 31, 2023; 382,640 and 378,725 shares issued and outstanding as of September 30, 2024 and December 31, 2023, respectively	3,826	3,789
Additional paid-in capital	2,243,673	2,183,684
Accumulated other comprehensive income	771	2,303
Accumulated deficit	(811,177)	(760,846)
Total stockholders' equity	1,437,093	1,428,930
Total liabilities and stockholders' equity	$ 2,107,941	$ 2,109,969

Leases - Summary of Future Minimum Lease Payments (Details) $ in Thousands	Sep. 30, 2024 USD ($)
Leases [Abstract]
Remainder of 2024	$ 12,999
2025	65,642
2026	58,771
2027	45,104
2028	32,196
Thereafter	29,043
Total lease payments	243,755
Less: imputed interest	(36,117)
Total lease liabilities	$ 207,638

Property and Equipment, Net - Schedule of Depreciation Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Property, Plant and Equipment [Abstract]
Depreciation expense	$ 10,409	$ 9,448	$ 30,559	$ 27,698

Income Taxes - Schedule of Effective Tax Rates (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Effective tax rate	(10.70%)	21.00%	(3.30%)	16.00%

Goodwill and Intangible Assets - Summary of Intangible Asset Amortization Expense (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization expense	$ 4,706	$ 10,173	$ 25,720	$ 30,522

Leases

9 Months Ended

Sep. 30, 2024

Leases [Abstract]

Leases

NOTE 5 LEASES

The Company leases its office facilities and office equipment which are accounted for as operating leases. Some leases contain clauses for renewal at the Company's option with renewal terms that generally extend the lease term from one to seven years.

The components of lease expense for the Company's operating leases in its unaudited consolidated statements of operations and comprehensive loss were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Operating lease costs	$	13,817	$	14,270	$	41,231	$	42,842

Variable lease costs and short-term lease costs were not material.

The weighted-average remaining lease term and discount rate for operating lease liabilities included in the consolidated balance sheets are as follows:


	September 30, 2024			December 31, 2023
Weighted-average remaining lease term (in years)		4.2			4.6
Weighted-average discount rate		7.44	%		7.11	%

Supplemental cash flow information related to operating leases was as follows:


	Nine Months Ended September 30,
	2024		2023
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$	48,502	$	47,356
Noncash lease activity
Right-of-use lease assets obtained in exchange for new operating lease liabilities	$	13,752	$	13,844

The future minimum lease payments under noncancellable operating leases as of September 30, 2024 are as follows:


Year Ended December 31,	Amount
Remainder of 2024	$	12,999
2025		65,642
2026		58,771
2027		45,104
2028		32,196
Thereafter		29,043
Total lease payments	$	243,755
Less: imputed interest		(36,117	)
Total lease liabilities	$	207,638

Related party lease transactions were not material as of September 30, 2024 and December 31, 2023 and for the three and nine months ended September 30, 2024 and 2023.

Real Estate Optimization and Restructuring Charges

In 2023, the Company announced a strategic re-focus, to prioritize resources and close certain centers as a direct result of changes to the Company's business model driven by a shift to more virtual visits initiated by the COVID-19 pandemic. The Company substantially completed a significant reduction in physical space and exited several underoccupied offices by both negotiating terminations of and abandoning certain real estate leases during the year ended December 31, 2023. The Company accounts for real estate optimization restructuring charges in accordance with ASC 420, Exit or Disposal Cost Obligations and ASC 360-10, Property, Plant, and Equipment. The costs are included in general and administrative expenses in the unaudited consolidated statements of operations and comprehensive loss.

During the three months ended September 30, 2023, the Company recorded $1,257 of office space reductions, including primarily $2,364 of property and equipment disposals and $1,602 of gains related to early lease terminations. During the nine months ended September 30, 2023, the Company recorded $4,977 of office space reductions, including primarily $2,339 of right-of-use asset impairment, $2,664 of property and equipment disposal and impairment costs, and $1,610 of gains related to early lease terminations. The portion of these amounts to be settled by cash disbursements was accounted for as an exit cost liability within other current liabilities and other noncurrent liabilities within the unaudited consolidated balance sheets and are not material as of September 30, 2024.

Business Combinations - Schedule of Maximum Contingent Consideration Based on the Acquisition Agreements (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2023 USD ($)
Contingent Consideration [Member]
Business Acquisition [Line Items]
Maximum contingent consideration based on acquisition agreements	$ 2,650

Long-Term Debt - Summary of Long-term Debt Instruments (Details) - USD ($)
$ in Thousands

Sep. 30, 2024

Dec. 31, 2023

May 04, 2022

Debt Instrument [Line Items]

Term loans

$ 279,055

$ 280,285

Less: Current portion of long-term debt

(2,925)

Less: Unamortized discount and debt issue costs

^[1]

(5,320)

(6,284)

Total

287,300

289,494

Term Loans

Debt Instrument [Line Items]

Total

196,000

197,500

$ 200,000

Delayed Draw Term Loans

Debt Instrument [Line Items]

Total

$ 91,300

$ 91,994

[1]

The unamortized debt issue costs related to long-term debt are presented as a reduction of the carrying amount of the corresponding liabilities on the unaudited consolidated balance sheets. Unamortized debt issue costs related to delayed draw term loan commitments and revolving loans are presented within other noncurrent assets on the unaudited consolidated balance sheets.

- 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

- Definition

Amount, after deduction of unamortized premium (discount) and debt issuance cost, of long-term debt. Excludes lease obligation.

+ References + Details

Goodwill and Intangible Assets (Tables)

9 Months Ended

Sep. 30, 2024

Goodwill and Intangible Assets Disclosure [Abstract]

Summary of Intangible Assets

Intangible assets consist of the following:


September 30, 2024	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount		Weighted Average Useful Life (Years)
Regional trade names	$	36,694	$	(34,187	)	$	2,507		4.0
LifeStance trade names		235,500		(45,873	)		189,627		22.5
Non-competition agreements		94,535		(91,317	)		3,218		4.2
Total intangible assets	$	366,729	$	(171,377	)	$	195,352


December 31, 2023	Gross Carrying Amount		Accumulated Amortization			Net Carrying Amount		Weighted Average Useful Life (Years)
Regional trade names	$	36,694	$	(26,399	)	$	10,295		5.0
LifeStance trade names		235,500		(38,024	)		197,476		22.5
Non-competition agreements		94,535		(81,234	)		13,301		4.2
Total intangible assets	$	366,729	$	(145,657	)	$	221,072

Summary of Intangible Assets Amortization Expense

Gross carrying amount is based on the fair value of the intangible assets determined at the acquisition date. Total intangible asset amortization expense consists of the following:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Amortization expense	$	4,706	$	10,173	$	25,720	$	30,522

Leases - Additional Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Lessee, Lease, Description [Line Items]
Variable lease costs		$ 0
Short-term lease costs		$ 0
Right-of-use asset, impairment			$ 2,339
Property and equipment, disposals	$ 2,364		2,664
Gain (Loss) on Contract Termination	1,602		1,610
Office Space Reductions
Lessee, Lease, Description [Line Items]
Exit or Disposal of office space	$ 1,257		$ 4,977
Maximum
Lessee, Lease, Description [Line Items]
Operating leases renewal term		7 years
Minimum
Lessee, Lease, Description [Line Items]
Operating leases renewal term		1 year

Leases - Summary of Components of Lease Expense for the Company's Operating Leases (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Leases [Abstract]
Operating lease costs	$ 13,817	$ 14,270	$ 41,231	$ 42,842

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Sep. 30, 2024 shares
Trading Arrangements, by Individual
Material Terms of Trading Arrangement	During our fiscal quarter ended September 30, 2024, one of our directors or officers (as defined in Rule 16a-1(f) under the Securities Exchange Act of 1934, as amended) entered into, modified (as to amount, price or timing of trades) or terminated (i) contracts, instructions or written plans for the purchase or sale of our securities that are intended to satisfy the conditions specified in Rule 10b5-1(c) under the Exchange Act for an affirmative defense against liability for trading in securities on the basis of material nonpublic information or (ii) non-Rule 10b5-1 trading arrangements (as defined in Item 408(c) of Regulation S-K). Robert Bessler, Director On August 28, 2024, Robert Bessler, Director, entered into a Rule 10b5-1 trading plan that provides that Mr. Bessler, acting through a broker, may sell up to an aggregate of 1,500,000 shares of our common stock, subject to adjustments for stock splits, stock combinations, stock dividends and other similar changes to our common stock. Sales of shares under the plan may only occur from November 15, 2024 to December 31, 2025. The plan is scheduled to terminate on December 31, 2025, subject to earlier termination upon the sale of all shares subject to the plan or the expiration of all sale orders under the plan, upon termination by Mr. Bessler or the broker, or as otherwise provided in the plan. In Item 5 of Part II of our Quarterly Report on Form 10-Q for the period ended March 31, 2024, we inadvertently omitted the disclosure of a new Rule 10b5-1 trading plan entered into by Kevin Mullins. The terms of this 10b5-1 trading plan are described below. Kevin Mullins, Former Chief Development Officer On March 14, 2024, Kevin Mullins, our former Chief Development Officer, entered into a Rule 10b5-1 trading plan that provided that Mr. Mullins, acting through a broker, could sell up to an aggregate of 1,500,000 shares of our common stock, subject to adjustments for stock splits, stock combinations, stock dividends and other similar changes to our common stock. Sales of shares under the plan were permitted to only occur from June 13, 2024 to November 29, 2024. The plan was scheduled to terminate on November 29, 2024, subject to earlier termination upon the sale of all shares subject to the plan or the expiration of all sale orders under the plan, upon termination by Mr. Mullins or the broker, or as otherwise provided in the plan. The plan was terminated by Mr. Mullins on August 20, 2024, following his termination from the Company.
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
Rule 10b5-1 Arrangement Modified	true
Non-Rule 10b5-1 Arrangement Modified	true
Robert Bessler [Member]
Trading Arrangements, by Individual
Name	Robert Bessler
Title	Director
Rule 10b5-1 Arrangement Adopted	true
Non-Rule 10b5-1 Arrangement Adopted	true
Adoption Date	August 28, 2024
Rule 10b5-1 Arrangement Terminated	true
Termination Date	December 31, 2025
Expiration Date	December 31, 2025
Arrangement Duration	490 days
Aggregate Available	1,500,000,000
Kevin Mullins [Member]
Trading Arrangements, by Individual
Name	Kevin Mullins
Title	former Chief Development Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	March 14, 2024
Rule 10b5-1 Arrangement Terminated	true
Termination Date	August 20, 2024
Expiration Date	November 29, 2024
Arrangement Duration	159 days
Aggregate Available	1,500,000,000

Stock - Based Compensation - Summary of Restricted Stock Awards (RSA) Activity (Details) - Restricted Stock Award shares in Thousands	9 Months Ended
	Sep. 30, 2024 $ / shares shares
Share Based Compensation Arrangement By Share Based Payment Award [Line Items]
Outstanding \| shares	5,479
Vested \| shares	(13)
Forfeited \| shares	(3,211)
Outstanding \| shares	2,255
Outstanding \| $ / shares	$ 11.98
Vested \| $ / shares	11.98
Forfeited \| $ / shares	11.98
Outstanding \| $ / shares	$ 11.98

- 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

Commitments and Contingencies - Additional Information (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Medical malpractice insurance, coverage per claim limit	$ 3,000
Medical malpractice insurance, annual coverage per clinician	$ 8,000

Leases (Tables)

9 Months Ended

Sep. 30, 2024

Leases [Abstract]

Summary of Components of Lease Expense

The components of lease expense for the Company's operating leases in its unaudited consolidated statements of operations and comprehensive loss were as follows:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Operating lease costs	$	13,817	$	14,270	$	41,231	$	42,842

Variable lease costs and short-term lease costs were not material.

The weighted-average remaining lease term and discount rate for operating lease liabilities included in the consolidated balance sheets are as follows:


	September 30, 2024			December 31, 2023
Weighted-average remaining lease term (in years)		4.2			4.6
Weighted-average discount rate		7.44	%		7.11	%

Summary of Supplemental Cash Flow Information Related to Operating Leases

Supplemental cash flow information related to operating leases was as follows:


	Nine Months Ended September 30,
	2024		2023
Cash paid for amounts included in the measurement of lease liabilities
Operating cash flows from operating leases	$	48,502	$	47,356
Noncash lease activity
Right-of-use lease assets obtained in exchange for new operating lease liabilities	$	13,752	$	13,844

Summary of Future Minimum Lease Payments

The future minimum lease payments under noncancellable operating leases as of September 30, 2024 are as follows:


Year Ended December 31,	Amount
Remainder of 2024	$	12,999
2025		65,642
2026		58,771
2027		45,104
2028		32,196
Thereafter		29,043
Total lease payments	$	243,755
Less: imputed interest		(36,117	)
Total lease liabilities	$	207,638

Income Taxes

9 Months Ended

Sep. 30, 2024

Income Tax Disclosure [Abstract]

Income Taxes

NOTE 11 INCOME TAXES

The provision (benefit) for income taxes is as follows:


	Three Months Ended September 30,					Nine Months Ended September 30,
	2024		2023			2024		2023
Provision (benefit) for income taxes	$	575	$	(16,385	)	$	1,594	$	(26,964	)

The effective tax rates are as follows:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2024			2023			2024			2023
Effective tax rate		(10.7	)%		21.0	%		(3.3	)%		16.0	%

The difference between the Company’s effective tax rate and the U.S. statutory tax rate of 21% was primarily the result of non-deductible equity awards. The Company regularly evaluates the realizability of its deferred tax assets and establishes a valuation allowance if it is more likely than not that some or all the deferred tax assets will not be realized.

- Definition

The entire disclosure for income tax.

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+ Details

Long-Term Debt (Tables)

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

Summary of Long-term Debt Instruments

Long-term debt consists of the following:


	September 30, 2024			December 31, 2023
Term loans	$	196,000		$	197,500
Delayed Draw term loans		91,300			91,994
Total long-term debt		287,300			289,494
Less: Current portion of long-term debt		(2,925	)		(2,925	)
Less: Unamortized discount and debt issue costs (1)		(5,320	)		(6,284	)
Total Long-Term Debt, Net of Current Portion and Unamortized Discount and Debt Issue Costs	$	279,055		$	280,285

(1)

Summary of Interest Expense

Interest expense, net consists of the following:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Interest expense, net	$	5,413	$	5,477	$	17,139	$	15,688

Summary of Maturities of Long-term Debt

Future principal payments on long-term debt as of September 30, 2024 are as follows:


Year Ended December 31,	Amount
Remainder of 2024	$	731
2025		2,925
2026		2,925
2027		2,925
2028		277,794
Total	$	287,300

- 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

CONSOLIDATED STATEMENTS OF CHANGES IN STOCKHOLDERS' EQUITY (unaudited) - USD ($) $ in Thousands	Total	Common Stock [Member]	Additional Paid-in Capital [Member]	Accumulated Other Comprehensive Income [Member]	Accumulated Deficit [Member]
Balance at Dec. 31, 2022	$ 1,518,723	$ 3,761	$ 2,084,324	$ 3,274	$ (572,636)
Shares, Outstanding at Dec. 31, 2022		375,964,000
Net Income (Loss)	(141,303)				(141,303)
Adoption of ASU 2016-13	(1,948)				(1,948)
Issuance of common stock upon vesting of restricted stock units		$ 47	(47)
Issuance of common stock upon vesting of restricted stock units, Shares		4,713,000
Forfeitures, value	(3,399)	$ (20)	(3,379)
Forfeitures, shares		(2,070,000)
Other comprehensive income loss	1,107			1,107
Stock-based compensation expense	81,868		81,868
Balance at Sep. 30, 2023	1,455,048	$ 3,788	2,162,766	4,381	(715,887)
Shares, Outstanding at Sep. 30, 2023		378,607,000
Balance at Jun. 30, 2023	1,494,876	$ 3,782	2,141,247	4,151	(654,304)
Shares, Outstanding at Jun. 30, 2023		378,005,000
Net Income (Loss)	(61,583)				(61,583)
Issuance of common stock upon vesting of restricted stock units		$ 7	(7)
Issuance of common stock upon vesting of restricted stock units, Shares		707,000
Forfeitures, value	0	$ (1)	1
Forfeitures, shares		(105,000)
Other comprehensive income loss	230			230
Stock-based compensation expense	21,525		21,525
Balance at Sep. 30, 2023	1,455,048	$ 3,788	2,162,766	4,381	(715,887)
Shares, Outstanding at Sep. 30, 2023		378,607,000
Balance at Dec. 31, 2023	1,428,930	$ 3,789	2,183,684	2,303	(760,846)
Shares, Outstanding at Dec. 31, 2023		378,725,000
Net Income (Loss)	(50,331)				(50,331)
Issuance of common stock upon vesting of restricted stock units		$ 70	(70)
Issuance of common stock upon vesting of restricted stock units, Shares		7,126,000
Forfeitures, value		$ (33)	33
Forfeitures, shares		(3,211,000)
Other comprehensive income loss	(1,532)			(1,532)
Stock-based compensation expense	60,026		60,026
Balance at Sep. 30, 2024	1,437,093	$ 3,826	2,243,673	771	(811,177)
Shares, Outstanding at Sep. 30, 2024		382,640,000
Balance at Jun. 30, 2024	1,430,027	$ 3,833	2,228,771	2,643	(805,220)
Shares, Outstanding at Jun. 30, 2024		383,314,000
Net Income (Loss)	(5,957)				(5,957)
Issuance of common stock upon vesting of restricted stock units, Shares		63,000
Forfeitures, value		$ (7)	7
Forfeitures, shares		(737,000)
Other comprehensive income loss	(1,872)			(1,872)
Stock-based compensation expense	14,895		14,895
Balance at Sep. 30, 2024	$ 1,437,093	$ 3,826	$ 2,243,673	$ 771	$ (811,177)
Shares, Outstanding at Sep. 30, 2024		382,640,000

Summary of Significant Accounting Policies

9 Months Ended

Sep. 30, 2024

Accounting Policies [Abstract]

Summary of Significant Accounting Policies

NOTE 2 SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES

The Company's significant accounting policies are discussed in Note 2 "Summary of Significant Accounting Policies" in Item 15 of its Annual Report on Form 10-K for the year ended December 31, 2023. During the nine months ended September 30, 2024, there have been no significant changes to these policies.

Basis of Presentation and Principles of Consolidation

The Company has prepared the accompanying unaudited consolidated financial statements pursuant to the rules and regulations of the SEC regarding interim financial reporting, which include the accounts of LifeStance, its wholly-owned subsidiaries and variable interest entities ("VIEs") in which LifeStance has an interest and is the primary beneficiary. Pursuant to these rules and regulations, the Company has omitted certain information and footnote disclosures it normally includes in its annual consolidated financial statements prepared in accordance with U.S. generally accepted accounting principles (“GAAP”). All intercompany balances and transactions have been eliminated in consolidation. In management’s opinion, the Company has made all adjustments (consisting only of normal, recurring adjustments, except as otherwise indicated) necessary to fairly state its consolidated financial condition, results of operations and cash flows. The Company’s interim period operating results do not necessarily indicate the results that may be expected for any other interim period or the full fiscal year. These financial statements and accompanying notes should be read in conjunction with the consolidated financial statements and notes thereto in the Company’s audited financial statements for the year ended December 31, 2023 in the Company's Annual Report on Form 10-K.

Use of Accounting Estimates

The preparation of consolidated financial statements in conformity with GAAP requires management to make a number of estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.

Variable Interest Entities

The Company evaluates its ownership, contractual and other interests in entities to determine if it has any variable interest in a VIE. These evaluations are complex, involve judgment, and the use of estimates and assumptions based on available information. If the Company determines that an entity in which it holds a contractual or ownership interest is a VIE and that the Company is the primary beneficiary, the Company consolidates such entity in its consolidated financial statements. The primary beneficiary of a VIE is the party that meets both of the following criteria: (i) has the power to make decisions that most significantly affect the economic performance of the VIE; and (ii) has the obligation to absorb losses or the right to receive benefits that in either case could potentially be significant to the VIE. The Company performs ongoing reassessments of whether changes in the facts and circumstances regarding the Company’s involvement with a VIE will cause the consolidation conclusion to change.

The Company acquires and operates certain care centers which are deemed to be Friendly-Physician Entities (“FPEs”). As part of an FPE acquisition, the Company acquires 100% of the non-medical assets, however due to legal requirements the physician-owners must retain 100% of the equity interest. The Company’s agreements with FPEs generally consist of both a Management Service Agreement, which provides for various administrative and management services to be provided by the Company to the FPE, and Stock Transfer Restriction (“STR”) agreements with the physician-owners of the FPEs, which provide for the transition of ownership interests of the FPEs under certain conditions. The outstanding voting equity instruments of the FPEs are owned by the nominee shareholders appointed by the Company under the terms of the STR agreements. The Company has the right to receive income as an ongoing management fee, which effectively absorbs all of the residual interests and has also provided financial support through loans to the FPEs. The Company has exclusive responsibility for the provision of all nonmedical services including facilities, technology and intellectual property required for the day-to-day operation and management of each of the FPEs, and makes recommendations to the FPEs in establishing the guidelines for the employment and compensation of the physicians and other employees of the FPEs. In addition, the STR agreements provide that the Company has the right to designate an appropriately licensed person(s) to purchase the equity interest of the FPE for a nominal amount in the event of a succession event at the Company’s discretion. Based on the

provisions of these agreements, the Company determined that the FPEs are VIEs due to the equity holder having insufficient capital at risk, and the Company has a variable interest in the FPEs.

The contractual arrangements described above allow the Company to direct the activities that most significantly affect the economic performance of the FPEs. Accordingly, the Company is the primary beneficiary of the FPEs and consolidates the FPEs under the VIE model. Furthermore, as a direct result of nominal initial equity contributions by the physicians, the financial support the Company provides to the FPEs (e.g., loans) and the provisions of the contractual arrangements and nominee shareholder succession arrangements described above, the interests held by noncontrolling interest holders lack economic substance and do not provide them with the ability to participate in the residual profits or losses generated by the FPEs. Therefore, all income and expenses recognized by the FPEs are allocated to the Company. The Company does not hold interests in any VIEs for which the Company is not deemed to be the primary beneficiary.

As noted previously, the Company acquires 100% of the non-medical assets of the VIEs. The aggregate carrying values of the VIEs total assets and total liabilities not purchased by the Company but included on the consolidated balance sheets were not material at September 30, 2024 and December 31, 2023.

Recent Accounting Pronouncements Not Yet Adopted

In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures ("ASU 2023-07"). ASU 2023-07 improves reportable segment disclosure requirements, primarily through enhanced disclosures about significant segment expenses on an interim and annual basis. ASU 2023-07 is effective for public companies for annual periods beginning on or after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. ASU 2023-07 will apply retrospectively to all prior periods presented in the financial statements. The Company is in process of evaluating the impact of adoption of ASU 2023-07 on the Company's consolidated financial statements and disclosures.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures ("ASU 2023-09"). ASU 2023-09 improves the transparency of income tax disclosures by requiring (1) consistent categories and greater disaggregation of information in the rate reconciliation and (2) income taxes paid disaggregated by jurisdiction. ASU 2023-09 is effective for public business entities for annual periods beginning after December 15, 2024. Early adoption is permitted. ASU 2023-09 will apply on a prospective basis and retrospective application is permitted. The Company is in process of evaluating the impact of adoption of ASU 2023-09 on the Company's consolidated financial statements and disclosures.

Long-Term Debt

9 Months Ended

Sep. 30, 2024

Debt Disclosure [Abstract]

Long-Term Debt

NOTE 9 LONG-TERM DEBT

On May 4, 2022, the Company entered into a credit agreement, as amended (the “2022 Credit Agreement”) among LifeStance Health Holdings, Inc., Lynnwood Intermediate Holdings, Inc., Capital One, National Association, and each lender party thereto. The 2022 Credit Agreement established commitments in respect of a term loan facility of $200,000, a revolving loan facility of up to $50,000 and a delayed draw term loan facility of up to $100,000. The commitments under the term loan facility and the revolving facility were available to be drawn on May 16, 2022. The Company borrowed $200,000 in term loans on that date, with a maturity date of May 16, 2028. The remaining commitments under the delayed draw term loan facility terminated on August 14, 2024. Once drawn upon, the delayed draw term loan facility has a maturity date of May 16, 2028. The loans under the term loan facility and the delayed draw term loan facility bear interest at a rate per annum equal to (x) adjusted term SOFR (which adjusted term SOFR is subject to a minimum of 0.75%) plus an applicable margin of 3.75% or (y) an alternate base rate (which will be the highest of (i) the prime rate, (ii) 0.50% above the federal funds effective rate and (iii) one-month adjusted term SOFR (which adjusted term SOFR is subject to a minimum of 0.75%) plus 1.00%) plus an applicable margin of 2.75%. The term loans are collateralized by substantially all of the assets of the Company. The revolving loan has interest only payments until the maturity date of May 16, 2027.

The 2022 Credit Agreement requires the Company to maintain compliance with certain restrictive financial covenants related to earnings, leverage ratios, and other financial metrics. The Company was in compliance with all debt covenants at September 30, 2024 and December 31, 2023.

Long-term debt consists of the following:


	September 30, 2024			December 31, 2023
Term loans	$	196,000		$	197,500
Delayed Draw term loans		91,300			91,994
Total long-term debt		287,300			289,494
Less: Current portion of long-term debt		(2,925	)		(2,925	)
Less: Unamortized discount and debt issue costs (1)		(5,320	)		(6,284	)
Total Long-Term Debt, Net of Current Portion and Unamortized Discount and Debt Issue Costs	$	279,055		$	280,285

(1)

The current portion of long-term debt is included within other current liabilities on the unaudited consolidated balance sheets.

Interest expense, net consists of the following:


	Three Months Ended September 30,				Nine Months Ended September 30,
	2024		2023		2024		2023
Interest expense, net	$	5,413	$	5,477	$	17,139	$	15,688

Future principal payments on long-term debt as of September 30, 2024 are as follows:


Year Ended December 31,	Amount
Remainder of 2024	$	731
2025		2,925
2026		2,925
2027		2,925
2028		277,794
Total	$	287,300

The fair value of long-term debt is based on the present value of future payments discounted by the market interest rates or the fixed rates based on current rates offered to the Company for debt with similar terms and maturities, which is a Level 2 fair value measurement. Long-term debt is presented at carrying value on the unaudited consolidated balance sheets. The fair value of long-term debt at September 30, 2024 and December 31, 2023 was $306,099 and $304,955, respectively.

Revolving Loan

Under the 2022 Credit Agreement, the Company has a revolving loan commitment from Capital One in the amount of $50,000. Any borrowing on the revolving loan under the 2022 Credit Agreement is due in full on May 16, 2027. The revolving loan bears interest at a rate per annum equal to (x) adjusted term SOFR plus an applicable margin of 3.25% or (y) an alternate base rate (which will be the highest of (i) the prime rate, (ii) 0.50% above the federal funds effective rate and (iii) one-month adjusted term SOFR plus 1.00%) plus an applicable margin of 2.25%. The unused revolving loan incurs a commitment fee of 0.50% per annum.

There are no amounts outstanding on the revolving loan as of September 30, 2024 and December 31, 2023.

Total Revenue

9 Months Ended

Sep. 30, 2024

Revenues [Abstract]

Total Revenue

NOTE 3 TOTAL REVENUE

The Company’s total revenue is dependent on a series of contracts with third-party payors, which is typical for providers in the healthcare industry. The Company has determined that the nature, amount, timing and uncertainty of revenue and cash flows are affected by the payor mix with third-party payors, which have different reimbursement rates.

The payor mix of fee-for-service revenue from patients and third-party payors consists of the following:


	Three Months Ended September 30,										Nine Months Ended September 30,
	2024					2023					2024					2023
	Amount		% of Total Revenue			Amount		% of Total Revenue			Amount		% of Total Revenue			Amount		% of Total Revenue
Commercial	$	283,264		91	%	$	239,902		91	%	$	840,943		91	%	$	704,717		91	%
Government		14,850		5	%		10,993		4	%		43,016		5	%		32,943		4	%
Self-pay		11,619		3	%		10,229		4	%		33,231		3	%		30,360		4	%
Total patient service revenue		309,733		99	%		261,124		99	%		917,190		99	%		768,020		99	%
Nonpatient service revenue		2,989		1	%		1,771		1	%		8,300		1	%		7,042		1	%
Total	$	312,722		100	%	$	262,895		100	%	$	925,490		100	%	$	775,062		100	%

Among the commercial payors, the table below represents insurance companies that individually represented 10% or more of revenue:


	Three Months Ended September 30,						Nine Months Ended September 30,
	2024			2023			2024			2023
Payor A		16	%		19	%		17	%		19	%
Payor B		16	%		13	%		15	%		13	%

- 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.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 9
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-9

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-10

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 15
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-15

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 7: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 8: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 12
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-12

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 606
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 13
-Subparagraph (b)(2)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147479806/606-10-50-13

Reference 10: http://www.xbrl.org/2003/role/disclosureRef
-Name Accounting Standards Codification
-Topic 606
-Publisher FASB
-URI https://asc.fasb.org/606/tableOfContent

+ Details