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Accounts and Notes Receivable
 6 Months Ended
Jun. 30, 2018
Receivables [Abstract]  
Accounts and Notes Receivable
Note 3— Accounts and Notes Receivable

The Company’s accounts and notes receivable balances consisted of the following as of June 30, 2018 and December 31, 2017:

 
June 30, 2018
 
December 31, 2017
 
(in thousands)
Short-term
 
 
 
Accounts and notes receivable
$
393,374

 
$
390,705

Allowance for doubtful accounts
(49,709
)
 
(11,985
)
 
$
343,665

 
$
378,720

Long-term
 
 
 
Notes receivable
$
37,386

 
$
15,476

Total accounts and notes receivable
$
381,051

 
$
394,196



Any decision to extend credit is made on a case-by-case basis and is based on a number of qualitative and quantitative factors related to the particular client, and general collection risks associated with operating within and trends in the long-term care industry.

The Company’s net current accounts and notes receivable balance decreased from December 31, 2017. Fluctuations in net accounts and notes receivable are generally attributable to a variety of factors including, but not limited to, the timing of cash receipts from customers and the inception, transition or termination of client relationships. However, the Company offset its accounts and notes receivable with an increased allowance for doubtful accounts in the first quarter 2018 related primarily to corporate restructurings of two privately-held, multi-state operators that occurred during the first quarter 2018. In addition, the Company converted approximately $24.8 million of accounts receivable to long-term notes receivable, due to the achievement of key operational and financial milestones related to the 2017 dining and nutrition expansion with Genesis HealthCare.

There are a variety of factors that impact a client’s ability to pay in accordance with the Company’s agreements. Primary among these factors is the client’s participation in programs funded by federal and state governmental agencies. Deviations in the timing or amounts of reimbursements under those programs can impact the client’s cash flows and the timing of their payments. The payment terms in the Company’s service agreements are not contingent upon the client’s cash flows and notwithstanding the Company’s efforts to minimize credit risk exposure, various factors affecting the client’s cash flows could have an indirect, yet material adverse effect on the Company’s results of operations and financial condition.

The Company deploys significant resources and has invested in tools and processes to optimize Management’s credit and collections efforts. When appropriate, the Company utilizes interest-bearing promissory notes as an alternative to accounts receivable to enhance the collectability of amounts due, by instituting a definitive repayment plan and providing a means by which to further evidence the amounts owed. As of June 30, 2018 and December 31, 2017, the Company had $59.4 million and $36.6 million, net of reserves, respectively, of such promissory notes outstanding. In addition, the Company may assist clients who are adjusting to changes in their cash flows by amending the Company’s agreements from full-service to management-only arrangements, or by modifying contractual payment terms to accommodate clients who have in good faith established clearly-defined plans for addressing cash flow issues. These efforts are intended to minimize the Company’s collections risk while maintaining relationships with the clients.