InfuSystem (INFU) 10-Q 8 Nov 22 2022 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2022	Nov. 03, 2022
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2022
Document Transition Report	false
Entity File Number	001-35020
Entity Registrant Name	INFUSYSTEM HOLDINGS, INC
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	20-3341405
Entity Address, Address Line One	3851 West Hamlin Road
Entity Address, City or Town	Rochester Hills
Entity Address, State or Province	MI
Entity Address, Postal Zip Code	48309
City Area Code	248
Local Phone Number	291-1210
Title of Each Class	Common Stock, par value $0.0001 per share
Trading Symbol(s)	INFU
Name of Each Exchange on which Registered	NYSEAMER
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding (in shares)		20,656,374
Entity Central Index Key	0001337013
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2022

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Current assets:
Cash and cash equivalents	$ 363	$ 186
Accounts receivable, net	16,112	15,405
Inventories	4,861	3,939
Other current assets	2,311	2,535
Total current assets	23,647	22,065
Medical equipment for sale or rental	2,843	1,742
Medical equipment in rental service, net of accumulated depreciation	39,202	39,871
Property & equipment, net of accumulated depreciation	4,211	4,523
Goodwill	3,710	3,710
Intangible assets, net	8,805	10,930
Operating lease right of use assets	4,441	4,241
Deferred income taxes	9,941	10,033
Other assets	2,181	471
Total assets	98,981	97,586
Current liabilities:
Accounts payable	6,648	7,862
Current portion of long-term debt	0	349
Other current liabilities	6,086	4,685
Total current liabilities	12,734	12,896
Long-term debt, net of current portion	34,461	32,748
Operating lease liabilities, net of current portion	3,979	3,670
Total liabilities	51,174	49,314
Stockholders’ equity:
Preferred stock, $0.0001 par value: authorized 1,000,000 shares; none issued	0	0
Common stock, $0.0001 par value: authorized 200,000,000 shares; 20,670,049 shares issued and outstanding as of September 30, 2022 and 20,699,546 shares issued and outstanding as of December 31, 2021	2	2
Additional paid-in capital	105,557	101,905
Accumulated other comprehensive income	1,599	268
Retained deficit	(59,351)	(53,903)
Total stockholders’ equity	47,807	48,272
Total liabilities and stockholders’ equity	$ 98,981	$ 97,586

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2022	Dec. 31, 2021
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Preferred stock, authorized (in shares)	1,000,000	1,000,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.0001	$ 0.0001
Common stock,, authorized (in shares)	200,000,000	200,000,000
Common stock, issued (in shares)	20,670,049	20,699,546
Common stock, outstanding (in shares)	20,670,049	20,699,546

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive (Loss) Income - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Income Statement [Abstract]
Net revenues	$ 27,279	$ 26,566	$ 81,084	$ 75,863
Cost of revenues	11,060	11,308	34,597	30,979
Gross profit	16,219	15,258	46,487	44,884
Selling, general and administrative expenses:
Provision for doubtful accounts	(90)	10	(84)	(99)
Amortization of intangibles	704	1,125	2,125	3,264
Selling and marketing	2,894	2,908	9,296	7,964
General and administrative	11,768	11,566	34,525	32,537
Total selling, general and administrative	15,276	15,609	45,862	43,666
Operating income (loss)	943	(351)	625	1,218
Other expense:
Interest expense	(385)	(270)	(976)	(909)
Other expense	(11)	(44)	(69)	(150)
Income (Loss) before income taxes	547	(665)	(420)	159
(Provision for) benefit from income taxes	(104)	217	331	874
Net income (loss)	$ 443	$ (448)	$ (89)	$ 1,033
Net income (loss) per share:
Basic (in dollars per share)	$ 0.02	$ (0.02)	$ 0	$ 0.05
Diluted (in dollars per share)	$ 0.02	$ (0.02)	$ 0	$ 0.05
Weighted average shares outstanding:
Basic (in shares)	20,683,366	20,577,886	20,625,826	20,468,842
Diluted (in shares)	21,452,483	20,577,886	20,625,826	21,995,216
Comprehensive income:
Net income (loss)	$ 443	$ (448)	$ (89)	$ 1,033
Other comprehensive income:
Unrealized gain on hedges	605	41	1,754	93
Provision for income tax on unrealized hedge gain	(146)	(10)	(423)	(23)
Net comprehensive income (loss)	$ 902	$ (417)	$ 1,242	$ 1,103

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid in Capital	Retained Deficit	Accumulated Other Comprehensive Income	Treasury Stock
Beginning balance (in shares) at Dec. 31, 2020		23,816,000
Beginning balance at Dec. 31, 2020	$ 40,752	$ 2	$ 84,785	$ (44,035)	$ 0	$ 0
Beginning balance (in shares) at Dec. 31, 2020						(3,518,000)
Stock-based shares issued upon vesting - gross (in shares)		334,000
Stock-based shares issued upon vesting - gross	431		431
Stock-based compensation expense	4,962		4,962
Employee stock purchase plan (in shares)		32,000
Employee stock purchase plan	348		348
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)		(57,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation	(1,141)		(1,141)
Other comprehensive income (loss)	70				70
Net (loss) income	1,033			1,033
Ending balance (in shares) at Sep. 30, 2021		24,125,000
Ending balance at Sep. 30, 2021	46,455	$ 2	89,385	(43,002)	70	$ 0
Ending balance (in shares) at Sep. 30, 2021						(3,518,000)
Beginning balance (in shares) at Jun. 30, 2021		24,084,000
Beginning balance at Jun. 30, 2021	44,700	$ 2	87,213	(42,554)	39	$ 0
Beginning balance (in shares) at Jun. 30, 2021						(3,518,000)
Stock-based shares issued upon vesting - gross (in shares)		25,000
Stock-based shares issued upon vesting - gross	38		38
Stock-based compensation expense	1,955		1,955
Employee stock purchase plan (in shares)		16,000
Employee stock purchase plan	179		179
Other comprehensive income (loss)	31				31
Net (loss) income	(448)			(448)
Ending balance (in shares) at Sep. 30, 2021		24,125,000
Ending balance at Sep. 30, 2021	$ 46,455	$ 2	89,385	(43,002)	70	$ 0
Ending balance (in shares) at Sep. 30, 2021						(3,518,000)
Beginning balance (in shares) at Dec. 31, 2021	20,699,546	20,700,000
Beginning balance at Dec. 31, 2021	$ 48,272	$ 2	101,905	(53,903)	268	$ 0
Beginning balance (in shares) at Dec. 31, 2021						0
Stock-based shares issued upon vesting - gross (in shares)		474,000
Stock-based shares issued upon vesting - gross	685		685
Stock-based compensation expense	3,236		3,236
Employee stock purchase plan (in shares)		61,000
Employee stock purchase plan	428		428
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)		(80,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation	(697)		(697)
Common stock repurchased as part of share repurchase program (in shares)		(485,000)
Common stock repurchased as part of share repurchase program	(5,359)			(5,359)
Other comprehensive income (loss)	1,331				1,331
Net (loss) income	$ (89)			(89)
Ending balance (in shares) at Sep. 30, 2022	20,670,049	20,670,000
Ending balance at Sep. 30, 2022	$ 47,807	$ 2	105,557	(59,351)	1,599	$ 0
Ending balance (in shares) at Sep. 30, 2022						0
Beginning balance (in shares) at Jun. 30, 2022		20,695,000
Beginning balance at Jun. 30, 2022	46,497	$ 2	104,146	(58,791)	1,140	$ 0
Beginning balance (in shares) at Jun. 30, 2022						0
Stock-based shares issued upon vesting - gross (in shares)		86,000
Stock-based shares issued upon vesting - gross	212		212
Stock-based compensation expense	1,066		1,066
Employee stock purchase plan (in shares)		33,000
Employee stock purchase plan	192		192
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares)		(8,000)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation	(59)		(59)
Common stock repurchased as part of share repurchase program (in shares)		(136,000)
Common stock repurchased as part of share repurchase program	(1,003)			(1,003)
Other comprehensive income (loss)	459				459
Net (loss) income	$ 443			443
Ending balance (in shares) at Sep. 30, 2022	20,670,049	20,670,000
Ending balance at Sep. 30, 2022	$ 47,807	$ 2	$ 105,557	$ (59,351)	$ 1,599	$ 0
Ending balance (in shares) at Sep. 30, 2022						0

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
OPERATING ACTIVITIES
Net (loss) income	$ (89)	$ 1,033
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Provision for doubtful accounts	(84)	(99)
Depreciation	8,131	7,705
Loss on disposal of and reserve adjustments for medical equipment	1,450	848
Gain on sale of medical equipment	(1,348)	(1,588)
Amortization of intangible assets	2,125	3,264
Amortization of deferred debt issuance costs	55	132
Stock-based compensation	3,236	4,962
Deferred income taxes	(331)	(875)
Changes in assets - (increase)/decrease:
Accounts receivable	(607)	217
Inventories	(922)	(630)
Other current assets	224	251
Other assets	(89)	(102)
Changes in liabilities - increase/(decrease):
Accounts payable and other liabilities	1,200	(513)
NET CASH PROVIDED BY OPERATING ACTIVITIES	12,951	14,605
INVESTING ACTIVITIES
Acquisition of business	0	(7,650)
Purchase of medical equipment	(10,452)	(9,645)
Purchase of property and equipment	(571)	(607)
Proceeds from sale of medical equipment, property and equipment	2,597	2,214
NET CASH USED IN INVESTING ACTIVITIES	(8,426)	(15,688)
FINANCING ACTIVITIES
Principal payments on long-term debt	(31,089)	(69,306)
Cash proceeds from long-term debt	32,398	61,654
Debt issuance costs	0	(386)
Cash payment of contingent consideration	(750)	0
Common stock repurchased to satisfy statutory withholding on employee stock-based compensation plans	(698)	(1,141)
Common stock repurchased as part of share repurchase program	(5,359)	0
Cash proceeds from stock plans	1,150	779
NET CASH USED IN FINANCING ACTIVITIES	(4,348)	(8,400)
Net change in cash and cash equivalents	177	(9,483)
Cash and cash equivalents, beginning of period	186	9,648
Cash and cash equivalents, end of period	$ 363	$ 165

Basis of Presentation, Nature o

Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2022
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies	Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies The terms “InfuSystem”, the “Company”, “we”, “our” and “us” are used herein to refer to InfuSystem Holdings, Inc. and its subsidiaries. InfuSystem is a leading provider of infusion pumps and related products and services for patients in the home, oncology clinics, ambulatory surgery centers, and other sites of care. The Company provides products and services to hospitals, oncology practices and facilities and other alternative site health care providers. Headquartered in Rochester Hills, Michigan, the Company delivers local, field-based customer support, and also operates pump service and repair Centers of Excellence in Michigan, Kansas, California, Massachusetts, Texas and Ontario, Canada. The accompanying unaudited condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) for interim financial information. Accordingly, the unaudited condensed consolidated financial statements do not include all of the information and notes required by U.S. Generally Accepted Accounting Principles (“GAAP”) for complete financial statements. The accompanying unaudited condensed consolidated financial statements include all adjustments, composed of normal recurring adjustments, considered necessary by management to fairly state the Company’s results of operations, financial position and cash flows. The operating results for the interim periods are not necessarily indicative of results that may be expected for any other interim period or for the full year. These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2021 as filed with the SEC on March 15, 2022. The unaudited condensed consolidated financial statements are prepared in conformity with GAAP, which requires the use of estimates, judgments and assumptions that affect the amounts of assets and liabilities at the reporting date and the amounts of revenue and expenses in the periods presented. The Company believes that the accounting estimates employed are appropriate and the resulting balances are reasonable; however, due to the inherent uncertainties in making estimates, actual results could differ from the original estimates, requiring adjustments to these balances in future periods.

Recent Accounting Pronouncement

Recent Accounting Pronouncements and Developments	9 Months Ended
	Sep. 30, 2022
Accounting Policies [Abstract]
Recent Accounting Pronouncements and Developments	Recent Accounting Pronouncements and DevelopmentsIn June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update No. 2016-13, “Financial Instruments (Topic 326) Credit Losses”. Topic 326 changes the impairment model for most financial assets and certain other instruments. Under the new standard, entities holding financial assets and net investment in leases that are not accounted for at fair value through net income are to be presented at the net amount expected to be collected. An allowance for credit losses will be a valuation account that will be deducted from the amortized cost basis of the financial asset to present the net carrying value at the amount expected to be collected on the financial asset. Topic 326 was originally effective as of January 1, 2020, although in November 2019, the FASB delayed the effective date until fiscal years beginning after December 15, 2022 for SEC filers eligible as of the FASB's deferral date to be smaller reporting companies under the SEC’s definition. The Company qualified as a smaller reporting company in November 2019 when the FASB delayed the effective date of Topic 326. Early adoption is permitted. The Company is currently evaluating the impact of Topic 326 on its consolidated balance sheets, statements of operations, statements of cash flows and related disclosures.

Business Combinations

Business Combinations	9 Months Ended
	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Business Combinations	Business Combinations Acquisitions Accounted for Using the Purchase Method On January 31, 2021, the Company acquired the business and the majority of the assets of FilAMed, a privately-held biomedical services company based in Bakersfield, California. In becoming part of the Company's Durable Medical Equipment Services ("DME Services") segment, this acquisition supplements the Company’s existing biomedical recertification, maintenance and repair services for acute care facilities and other alternate site settings including home care and home infusion providers, skilled nursing facilities, pain centers and others. On April 18, 2021, the Company acquired the business and substantially all of the assets of OB Healthcare Corporation (“OB Healthcare”), a privately-held biomedical services company based in Mesquite, Texas. OB Healthcare specializes in on-site repair, preventative maintenance, and device physical inventory management to hospitals and healthcare systems nationwide. The acquisition further develops and expands InfuSystem’s DME Services segment and complements the Company’s purchase of FilAMed. The results of operations for FilAMed and OB Healthcare are included in the Company’s consolidated statements of operations from the respective closing dates. Purchase Price Allocation Pursuant to FASB Accounting Standards Codification (“ASC”) Topic 805, “Business Combinations,” the purchase price for each of the acquisitions was allocated to the assets acquired and liabilities assumed based upon their estimated fair values as of the respective acquisition dates. The purchase price allocations were primarily based upon a valuation using management’s estimates and assumptions. The purchase price allocation was completed for FilAMed and OB Healthcare as of December 31, 2021. The following table summarizes the consideration paid and the allocation of the purchase price to the fair values of the assets acquired and liabilities assumed as of the respective acquisition dates for both FilAMed and OB Healthcare (in thousands): FilAMed OB Healthcare Total Consideration Cash $ 1,400 $ 6,250 $ 7,650 Working capital, paid in cash — 325 325 Contingent consideration, paid in cash — 750 750 Total - consideration $ 1,400 $ 7,325 $ 8,725 FilAMed OB Healthcare Total Acquisition Date Fair Value Accounts receivable $ — $ 725 $ 725 Inventories 74 — 74 Medical equipment held for sale or rental 40 — 40 Property and equipment 102 59 161 Intangible assets 1,015 3,000 4,015 Goodwill 169 3,541 3,710 Operating lease right of use assets 281 7 288 Operating lease liabilities (281) (7) (288) Total - purchase price $ 1,400 $ 7,325 $ 8,725 The amount of acquisition costs for both transactions was $0.2 million for the nine months ended September 30, 2021 and was included in general and administrative expenses. The Company fully paid all consideration for FilAMed as of December 31, 2021. On the OB Healthcare acquisition date, the Company made an initial cash payment of $6.1 million with subsequent cash payments of $0.4 million during the year ended December 31, 2021 and had an additional estimated amount due to the seller for contingent consideration of $0.8 million, which was recorded in the balance sheet under the heading for other current liabilities. The contingent consideration arrangement, as amended, required the Company to pay OB Healthcare $0.8 million if certain written contracts were executed. As of September 30, 2022, the requirement under the contingent consideration arrangement had been satisfied and the Company had made the required payment. The following table shows the breakdown of the identified intangible assets acquired into major intangible asset classes for both acquisitions: Acquisition Date Fair Value (Thousands) Weighted-Average Amortization Period (Years) Customer relationships $ 2,300 15 Unpatented technology 943 7 Non-competition agreements 472 5 Internal-use software 300 5 Total intangible assets (a) $ 4,015 11.2 (a) There was no residual value, renewal terms or extensions associated with any intangible assets acquired. The goodwill acquired consists of expected synergies from combining operations of FilAMed and OB Healthcare with the DME Services segment as well as their respective assembled workforce who have specialized knowledge and experience. All of the goodwill is deductible for tax purposes. Unaudited Pro Forma Financial Information The unaudited pro forma financial information in the table below summarizes the combined results of operations of the Company, FilAMed and OB Healthcare as though the companies’ businesses had been combined as of January 1, 2021. The pro forma financial information for the three and nine months ended September 30, 2021 has been adjusted by $0.1 million and $0.2 million, respectively, for the tax effected amount of acquisition costs and non-recurring expenses directly attributable to the FilAMed and OB Healthcare acquisitions. The pro forma financial information is presented for informational purposes only and is not indicative of the results of operations that would have been achieved if the acquisitions had taken place at the beginning of each period presented nor is it indicative of future results. The following pro forma financial information presented also includes the pro forma depreciation and amortization charges from acquired tangible and intangible assets for the three and nine months ended September 30, 2021 (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2021 Revenue $ 26,566 $ 76,633 Net (loss) income $ (373) $ 1,268

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition The following tables present the Company’s disaggregated revenue by offering type (in thousands): Three Months Ended 2022 2021 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues Third-Party Payer Rentals $ 14,161 51.9 % $ 13,512 50.9 % Direct Payer Rentals 7,801 28.6 % 7,136 26.9 % Product Sales 3,562 13.1 % 4,399 16.5 % Services 1,755 6.4 % 1,519 5.7 % Total $ 27,279 100.0 % $ 26,566 100.0 % Nine Months Ended 2022 2021 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues Third-Party Payer Rentals $ 41,425 51.1 % $ 39,436 52.0 % Direct Payer Rentals 23,745 29.3 % 21,787 28.7 % Product Sales 10,968 13.5 % 11,332 14.9 % Services 4,946 6.1 % 3,308 4.4 % Total $ 81,084 100.0 % $ 75,863 100.0 % Third-Party Payer Rentals are entirely attributed to revenues of the Integrated Therapy Services (“ITS”) segment. Services revenues are entirely attributed to the DME Services segment. For the three months ended September 30, 2022, $3.2 million and $4.6 million of Direct Payer Rentals were attributed to the ITS and DME Services segments, respectively. For the three months ended September 30, 2021, $3.1 million and $4.0 million of Direct Payer Rentals were attributed to the ITS and DME Services segments, respectively. For the three months ended September 30, 2022, less than $0.1 million and $3.6 million of Product Sales were attributed to the ITS and DME Services segments, respectively. For the three months ended September 30, 2021, all Product Sales were entirely attributed to the DME Services segment. For the nine months ended September 30, 2022, $9.7 million and $14.0 million of Direct Payer Rentals were attributed to the ITS and DME Services segments, respectively. For the nine months ended September 30, 2021, $9.4 million and $12.4 million of Direct Payer Rentals were attributed to the ITS and DME Services segments, respectively. For the nine months ended September 30, 2022, $0.1 million and $10.9 million of Product Sales were attributed to the ITS and DME Services segments, respectively. For the nine months ended September 30, 2021, all Product Sales were entirely attributed to the DME Services segment.

Medical Equipment

Medical Equipment	9 Months Ended
	Sep. 30, 2022
Medical Equipment [Abstract]
Medical Equipment	Medical Equipment Medical equipment consisted of the following (in thousands): September 30, December 31, 2021 Medical equipment for sale or rental $ 2,865 $ 1,788 Medical equipment for sale or rental - pump reserve (22) (46) Medical equipment for sale or rental - net 2,843 1,742 Medical equipment in rental service 97,021 91,891 Medical equipment in rental service - pump reserve (2,074) (1,074) Accumulated depreciation (55,745) (50,946) Medical equipment in rental service - net 39,202 39,871 Total $ 42,045 $ 41,613 Depreciation expense for medical equipment for the three and nine months ended September 30, 2022 was $2.4 million and $7.3 million, respectively, compared to $2.4 million and $7.0 million for the same prior year periods, respectively. This expense was recorded in “cost of revenues” for each period. The pump reserve for medical equipment in rental service represents an estimate for medical equipment that is considered to be missing. The reserve calculated is equal to the net book value of assets that have not returned from the field within a certain timeframe. During the current period, the Company changed its estimate for missing pumps by shortening the time estimate of when a pump is considered missing. As a result of this change in estimate, the Company increased the pump reserve as of September 30, 2022 and increased its cost of sales for the three and nine months ended September 30, 2022 by $0.1 million and $0.6 million, respectively.

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consisted of the following (in thousands): September 30, 2022 December 31, 2021 Gross Assets Accumulated Depreciation Total Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 5,306 $ (3,067) $ 2,239 $ 4,812 $ (2,528) $ 2,284 Automobiles 110 (105) 5 110 (103) 7 Leasehold improvements 3,448 (1,481) 1,967 3,444 (1,212) 2,232 Total $ 8,864 $ (4,653) $ 4,211 $ 8,366 $ (3,843) $ 4,523 Depreciation expense for property and equipment for the three and nine months ended September 30, 2022 was $0.3 million and $0.8 million, respectively, compared to $0.2 million and $0.7 million for the same prior year periods, respectively. This expense was recorded in “general and administrative expenses” for each period.

Goodwill & Intangible Assets

Goodwill & Intangible Assets	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill & Intangible Assets	Goodwill & Intangible Assets The changes in the carrying value of goodwill by segment for the nine months ended September 30, 2022 are as follows (in thousands): DME Services (a) Balance as of December 31, 2021 $ 3,710 Goodwill acquired — Balance as of September 30, 2022 $ 3,710 (a) The ITS segment has no recorded goodwill. The carrying amount and accumulated amortization of intangible assets consisted of the following (in thousands): September 30, 2022 December 31, 2021 Gross Assets Accumulated Amortization Net Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ — $ 2,000 $ 2,000 $ — $ 2,000 Amortizable intangible assets: Trade names 23 (23) — 23 (23) — Physician and customer relationships 38,834 (33,297) 5,537 38,834 (31,401) 7,433 Non-competition agreements 472 (138) 334 472 (67) 405 Unpatented technology 943 (224) 719 943 (123) 820 Software 11,530 (11,315) 215 11,530 (11,258) 272 Total nonamortizable and amortizable intangible assets $ 53,802 $ (44,997) $ 8,805 $ 53,802 $ (42,872) $ 10,930 Amortization expense for the three and nine months ended September 30, 2022 was $0.7 million and $2.1 million, respectively, compared to $1.1 million and $3.3 million for the same prior year periods, respectively. This expense was recorded in “amortization of intangibles expenses” for each period. Expected remaining annual amortization expense for the next five years for intangible assets recorded as of September 30, 2022 is as follows (in thousands): 2022 2023 2024 2025 2026 2027 and thereafter Total Amortization expense $ 369 $ 990 $ 990 $ 810 $ 524 $ 3,122 $ 6,805

Debt

Debt	9 Months Ended
	Sep. 30, 2022
Debt Disclosure [Abstract]
Debt	Debt On February 5, 2021 , the Company entered into a Credit Agreement (the “ 2021 Credit Agreement”) with JPMorgan Chase Bank, N.A., as administrative agent (the “Agent”), sole bookrunner and sole lead arranger, and the lenders party thereto. The borrowers under the 2021 Credit Agreement are the Company, InfuSystem Holdings USA, Inc. (“Holdings”), InfuSystem, Inc. (“ISI”), First Biomedical, Inc. (“First Biomedical”), and IFC LLC (“IFC” and, collectively with the Company, Holdings, ISI and First Biomedical, the “Borrowers”). The 2021 Credit Agreement provides for a revolving credit facility (the “Revolving Facility”) of $75.0 million, that matures on February 5, 2026. The Revolving Facility may be increased by $25.0 million, subject to certain conditions, including the consent of the Agent and obtaining necessary commitments. The lenders under the 2021 Credit Agreement may issue up to $7.0 million in letters of credit subject to the satisfaction of certain conditions. On February 5, 2021, the Borrowers made an initial borrowing of $30.0 million under the Revolving Facility. Proceeds from the loan, along with approximately $8.2 million in cash, were used to repay all amounts due under the Company’s then existing credit facility dated March 23, 2015 (the “2015 Credit Agreement”). The 2021 Credit Agreement has customary representations and warranties. The ability to borrow under the facility is subject to ongoing compliance with a number of customary affirmative and negative covenants, including limitations on indebtedness, liens, mergers, acquisitions, investments, asset sales, affiliate transactions and restricted payments, as well as financial covenants, including the following: • a minimum fixed charge coverage ratio (defined as the ratio of consolidated EBITDA (as defined in the 2021 Credit Agreement) less 50% of depreciation expense), to consolidated fixed charges (as defined in the 2021 Credit Agreement)) for the prior four most recently ended calendar quarters of 1.20 to 1.00; and • a maximum leverage ratio (defined as total indebtedness to EBITDA for the prior four most recently ended calendar quarters) of 3.50 to 1.00. The 2021 Credit Agreement includes customary events of default. The occurrence of an event of default will permit the lenders to terminate commitments to lend under the Revolving Facility and accelerate payment of all amounts outstanding thereunder. Simultaneous with the execution of the 2021 Credit Agreement, the Company entered into a Pledge and Security Agreement to secure repayment of the obligations of the Borrowers. Under the Pledge and Security Agreement, each Borrower has granted to the Agent, for the benefit of various secured parties, a first priority security interest in substantially all of the personal property assets of each of the Borrowers, including the shares of each of Holdings, ISI and First Biomedical and the equity interests of IFC. On February 5, 2021, in connection with the execution and closing of the 2021 Credit Agreement, the Company, along with its wholly owned subsidiaries as borrowers, terminated the 2015 Credit Agreement. All outstanding loans under the 2015 Credit Agreement were repaid and all liens under the 2015 Credit Agreement were released, except that a letter of credit originally issued under the 2015 Credit Agreement in the amount of approximately $0.8 million was transferred to the 2021 Credit Agreement. The 2021 Credit Agreement was accounted for as a debt modification. As of September 30, 2022, the Company was in compliance with all debt-related covenants under the 2021 Credit Agreement. On April 15, 2019, the Company sold for $2.0 million and immediately leased back certain medical equipment in rental service to a third party specializing in such transactions. The leaseback term is 36 months. Because the arrangement contains a purchase option that the Company is reasonably certain to exercise, this transaction did not qualify for the sale-leaseback accounting under ASC 842. The medical equipment remains recorded on the accompanying condensed consolidated balance sheet and the proceeds received were classified as an other financing liability. As of September 30, 2022, all amounts owed under this arrangement had been paid. As referenced above, the Company executed and closed the 2021 Credit Agreement during the first quarter of 2021, and in connection with entering into that agreement, terminated the 2015 Credit Agreement. The following table illustrates the net availability under the Revolving Facility as of the applicable balance sheet date (in thousands): September 30, December 31, Revolving Facility: Gross availability $ 75,000 $ 75,000 Outstanding draws (34,706) (32,974) Letter of credit (600) (600) Availability on Revolving Facility $ 39,694 $ 41,426 The Company had future maturities of its long-term debt as of September 30, 2022 as follows (in thousands): 2022 2023 2024 2025 2026 and thereafter Total Revolving Facility $ — $ — $ — $ — $ 34,706 $ 34,706 Total $ — $ — $ — $ — $ 34,706 $ 34,706 The following is a breakdown of the Company’s current and long-term debt (in thousands): September 30, 2022 December 31, 2021 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Revolving Facility $ — $ 34,706 $ 34,706 $ — $ 32,974 $ 32,974 Other financing — — — 423 — 423 — 34,706 34,706 423 32,974 33,397 Unamortized value of debt issuance costs — (245) (245) (74) (226) (300) Total $ — $ 34,461 $ 34,461 $ 349 $ 32,748 $ 33,097 As of September 30, 2022, amounts outstanding under the Revolving Facility provided under the 2021 Credit Agreement bear interest at a variable rate equal to, at the Company’s election, a LIBO Rate for Eurodollar loans or an Alternative Base Rate for ABR loans, as defined by the 2021 Credit Agreement, plus a spread that will vary depending upon the Company’s leverage ratio. The spread ranges from 2.00% to 3.00% for Eurodollar Loans and 1.00% to 2.00% for base rate loans. The weighted-average Eurodollar loan rate at September 30, 2022 was 5.07% (LIBO of 2.82% plus 2.25%). The actual ABR loan rate at September 30, 2022 was 7.50% (lender’s prime rate of 6.25% plus 1.25%).

Derivative Financial Instrument

Derivative Financial Instruments and Hedging Activities	9 Months Ended
	Sep. 30, 2022
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Derivative Financial Instruments and Hedging Activities	Derivative Financial Instruments and Hedging Activities In February 2021, the Company adopted a derivative investment policy which provides guidelines and objectives related to managing financial and operational exposures arising from market changes in short term interest rates. In accordance with this policy, the Company can enter into interest rate swaps or similar instruments, will endeavor to evaluate all the risks inherent in a transaction before entering into a derivative financial instrument and will not enter into derivative financial instruments for speculative or trading purposes. Hedging relationships are formally documented at the inception of the hedge and hedges must be highly effective in offsetting changes to future cash flows on hedged transactions at the inception of a hedge and on an ongoing basis to be designated for hedge accounting treatment. The Company is exposed to interest rate risk related to its variable rate debt obligations under the 2021 Credit Agreement. In order to manage the volatility in interest rate markets, in February 2021, the Company entered into two interest rate swap agreements to manage exposure arising from this risk. On a combined basis, the agreements have a constant notional amount over a five-year term that ends on February 5, 2026. The agreements both pay the Company 30-day LIBOR on the notional amount and the Company pays a fixed rate of interest equal to 0.73%. These derivative instruments are considered cash flow hedges. The Company does not have any other derivative financial instruments. The tables below present the location and gross fair value amounts of the Company's derivative financial instruments and the associated notional amounts designated as cash flow hedges as of the applicable balance sheet date (in thousands): September 30, 2022 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 2,109 December 31, 2021 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 355 The tables below present the effect of our derivative financial instruments designated as hedging instruments in AOCI (in thousands): Three Months Ended September 30, 2022 2021 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,140 $ 39 Unrealized gain/(loss) recognized in AOCI 679 9 Amounts reclassified to interest expense (a) (74) 32 Tax provision (146) (10) Ending balance $ 1,599 $ 70 (a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income for the three months ended September 30, 2022 and 2021 was $0.4 million and $0.3 million, respectively. Nine Months Ended September 30, 2022 2021 Gain on cash flow hedges - interest rate swaps Beginning balance $ 268 $ — Unrealized gain recognized in AOCI 1,802 20 Amounts reclassified to interest expense (a) (b) (48) 73 Tax provision (423) (23) Ending balance $ 1,599 $ 70 (a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income for the nine months ended September 30, 2022 and 2021 was $1.0 million and $0.9 million, respectively. (b) As of September 30, 2022, $0.7 million of income is expected to be reclassified into earnings within the next 12 months. The Company did not incur any hedge ineffectiveness during the three or nine months ended September 30, 2022.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes During the three and nine months ended September 30, 2022, the Company recorded a provision for income taxes of $0.1 million and a benefit from income taxes of $0.3 million, respectively. The income tax benefit for the nine months ended September 30, 2022, relates principally to the Company's pre-tax losses during the period and also includes a benefit from excess tax benefits on exercises of stock options and vesting of restricted stock during the period. For the three and nine months ended September 30, 2021, the Company recorded a benefit from income taxes of $0.2 million and $0.9 million, respectively. On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act was enacted in response to the COVID-19 pandemic. The CARES Act among other things, allows employers to defer the deposit and payment of the employer's share of Social Security taxes. Under the CARES Act, the Company deferred paying $0.7 million of applicable gross payroll taxes as of December 31, 2020, which was included in other liabilities. The $0.7 million balance of the deferred Social Security taxes was expected to be paid in two equal annual installments during the years ending December 31, 2021 and 2022, respectively. In December 2021, the Company made the first of these two equal annual installment payments. As of September 30, 2022, the remaining balance of approximately $0.3 million is included in other liabilities.

Commitments, Contingencies and

Commitments, Contingencies and Litigation	9 Months Ended
	Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]
Commitments, Contingencies and Litigation	Commitments, Contingencies and Litigation From time to time in the ordinary course of its business, the Company may be involved in legal and regulatory proceedings, the outcomes of which may not be determinable. The results of litigation and regulatory proceedings are inherently unpredictable. Any claims against the Company, whether meritorious or not, could be time consuming, result in costly litigation, require significant amounts of management time and result in diversion of significant resources. The Company is not able to estimate an aggregate amount or range of reasonably possible losses for those legal matters for which losses are not probable and estimable, primarily for the following reasons: (i) many of the relevant legal proceedings are in preliminary stages and, until such proceedings develop further, there is often uncertainty regarding the relevant facts and circumstances at issue and potential liability; and (ii) many of these proceedings involve matters of which the outcomes are inherently difficult to predict. The Company has insurance policies covering potential losses where such coverage is cost effective. The Company is not at this time involved in any proceedings that the Company currently believes could have a material effect on the Company’s financial condition, results of operations or cash flows.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Earnings (Loss) Per Share	Earnings (Loss) Per ShareBasic income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding during the period. Diluted income (loss) per share assumes the issuance of potentially dilutive shares of common stock during the period. The following table reconciles the numerators and denominators of the basic and diluted income (loss) per share computations: Three Months Ended September 30, Nine Months Ended September 30, Numerator (in thousands) : 2022 2021 2022 2021 Net income (loss) income: $ 443 $ (448) $ (89) $ 1,033 Denominator: Weighted average common shares outstanding: Basic 20,683,366 20,577,886 20,625,826 20,468,842 Dilutive effect of common stock equivalents 769,117 — — 1,526,374 Diluted 21,452,483 20,577,886 20,625,826 21,995,216 Net income (loss) income per share: Basic $ 0.02 $ (0.02) $ — $ 0.05 Diluted $ 0.02 $ (0.02) $ — $ 0.05 For the three months ended September 30, 2022, there were 1,143,001 outstanding options and unvested restricted stock units with an exercise price above the current market value of the Company's common stock not included in the calculation because they would have an anti-dilutive effect. For the nine months ended September 30, 2022, all outstanding options and unvested restricted stock units were anti-dilutive due to the Company's net loss for the period and therefore are not included in the calculation. For the three months ended September 30, 2021, all outstanding options and unvested restricted stock units were anti-dilutive due to the Company's net loss for the period and therefore are not included in the calculation. For the nine months ended September 30, 2021, 0.3 million of outstanding options and unvested restricted stock units with an exercise price above the current market value of the Company’s common stock were not included in the calculation because they would have an anti-dilutive effect. Share Repurchase Program On June 30, 2021, our Board of Directors approved a stock repurchase program (the “Share Repurchase Program”) that authorizes the Company to repurchase up to $20.0 million of the Company’s outstanding common stock through June 30, 2024. Repurchases under the Share Repurchase Program are subject to market conditions, the periodic capital needs of the Company’s operating activities, and the continued satisfaction of all covenants under the Company’s existing 2021 Credit Agreement. Repurchases under the Share Repurchase Program may take place in the open market or in privately negotiated transactions and may be made under a Rule 10b5-1 plan. The Share Repurchase Program does not obligate the Company to repurchase shares and may be suspended, terminated, or modified at any time. As of September 30, 2022, the Company had repurchased and retired approximately $5.9 million, or 517,672 shares, of the Company's outstanding common stock under the Share Repurchase Program.

Leases

Leases	9 Months Ended
	Sep. 30, 2022
Leases [Abstract]
Leases	Leases The Company’s operating leases are primarily for office space, service facility centers and equipment under operating lease arrangements that expire at various dates over the next ten years. The Company’s leases do not contain any restrictive covenants. The Company’s office leases generally contain renewal options for periods ranging from one Payments due under the Company’s operating leases include fixed payments as well as variable payments. For the Company’s office leases, variable payments include amounts for the Company’s proportionate share of operating expenses, utilities, property taxes, insurance, common area maintenance and other facility-related expenses. For the Company’s equipment leases, variable payments may consist of sales taxes, property taxes and other fees. The components of lease costs for the three and nine months ended September 30, 2022 and 2021 are as follows (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Operating lease cost $ 342 $ 302 $ 1,006 $ 998 Variable lease cost 77 65 231 180 Total lease cost $ 419 $ 367 $ 1,237 $ 1,178 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Nine Months Ended 2022 2021 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 946 $ 993 Right of use assets obtained in exchange for lease obligations: Operating leases $ 18 $ 288 Increases to right of use assets resulting from lease modifications: Operating leases $ 1,050 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: As of September 30, 2022 2021 Years Years Weighted average remaining lease term: 6.9 6.3 Rate Rate Weighted average discount rate: 7.1% 7.7% Future maturities of lease liabilities as of September 30, 2022 are as follows (in thousands): Operating Leases (a) 2022 $ 303 2023 1,159 2024 1,064 2025 1,033 2026 998 2027 and thereafter 2,841 Total undiscounted lease payments 7,398 Less: Imputed interest (2,451) Total lease liabilities $ 4,947 (a) Excludes $1.8 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of 7 years and is expected to commence in 2023.

Business Segment Information

Business Segment Information	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Business Segment Information	Business Segment Information The Company’s reportable segments are organized based on service platforms, with the ITS segment reflecting higher margin rental revenues that generally include payments made by third-party and direct payers and the DME Services segment reflecting lower margin product sales, direct payer rental and service revenues. Resources are allocated and performance is assessed for these segments by the Company’s Chief Executive Officer, whom the Company has determined to be its chief operating decision-maker. The Company believes that reporting performance at the gross profit level is the best indicator of segment performance. The financial information summarized below is presented by reportable segment for the three months ended September 30, 2022 and 2021: 2022 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 17,375 $ 9,904 $ — $ 27,279 Net revenues - internal — 1,610 (1,610) — Total net revenues 17,375 11,514 (1,610) 27,279 Gross profit 11,400 4,819 — 16,219 Selling, general and administrative expenses 15,276 15,276 Interest expense (385) (385) Other expense (11) (11) Provision for income taxes (104) (104) Net income $ 443 Total assets $ 61,735 $ 35,246 $ 2,000 $ 98,981 Purchases of medical equipment $ 2,088 $ 1,695 $ — $ 3,783 Depreciation and amortization of intangible assets $ 2,425 $ 1,015 $ — $ 3,440 2021 (in thousands) ITS DME Services Corporate/Eliminations Total Net revenues - external $ 16,581 $ 9,985 $ — $ 26,566 Net revenues - internal — 1,440 (1,440) — Total net revenues 16,581 11,425 (1,440) 26,566 Gross profit 10,574 4,684 — 15,258 Selling, general and administrative expenses 15,609 15,609 Interest expense (270) (270) Other expense (44) (44) Benefit from income taxes 217 217 Net loss $ (448) Total assets $ 59,312 $ 33,474 $ 2,000 $ 94,786 Purchases of medical equipment $ 4,058 $ 644 $ — $ 4,702 Depreciation and amortization of intangible assets $ 2,785 $ 955 $ — $ 3,740 The financial information summarized below is presented by reportable segment for the nine months ended September 30, 2022 and 2021: 2022 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 51,260 $ 29,824 $ — $ 81,084 Net revenues - internal — 4,860 (4,860) — Total net revenues 51,260 34,684 (4,860) 81,084 Gross profit 32,251 14,236 — 46,487 Selling, general and administrative expenses 45,862 45,862 Interest expense (976) (976) Other expense (69) (69) Benefit from income taxes 331 331 Net loss $ (89) Total assets $ 61,735 $ 35,246 $ 2,000 $ 98,981 Purchases of medical equipment $ 6,924 $ 3,528 $ — $ 10,452 Depreciation and amortization of intangible assets $ 7,194 $ 3,062 $ — $ 10,256 2021 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 48,826 $ 27,037 $ — $ 75,863 Net revenues - internal — 4,484 (4,484) — Total net revenues 48,826 31,521 (4,484) 75,863 Gross profit 31,028 13,856 — 44,884 Selling, general and administrative expenses 43,666 43,666 Interest expense (909) (909) Other expense (150) (150) Benefit from income taxes 874 874 Net income $ 1,033 Total assets $ 59,312 $ 33,474 $ 2,000 $ 94,786 Purchases of medical equipment $ 7,550 $ 2,095 $ — $ 9,645 Depreciation and amortization of intangible assets $ 8,213 $ 2,756 $ — $ 10,969

COVID-19

COVID-19	9 Months Ended
	Sep. 30, 2022
Covid-19 [Abstract]
COVID-19	COVID-19On March 11, 2020, the World Health Organization declared the outbreak of coronavirus (“COVID-19”) as a pandemic, which has spread globally and throughout the United States. During the period of the pandemic, we took a number of precautionary and preemptive steps to protect the safety and well-being of our employees while ensuring continuity of service to our clients, including, transitioning our employees to a remote work environment, suspending employee travel, canceling participation in industry events and in-person group meetings, promoting social distancing and enhanced cleaning and sanitization efforts across office locations, and implementing protocols to quarantine employees who may have been exposed to COVID-19, or showed relevant symptoms. We also undertook preparedness plans at our facilities to maintain continuity of operations, which provide for flexible work arrangements without any significant disruptions to our business or control processes. Our management team continues to actively monitor the situation and is in constant communication with our workforce, customers and vendors. Since the pandemic started, outbreaks of COVID-19, including the Delta and Omicron variants, unfavorably impacted our revenue growth initiatives in certain product lines including Pain Management and NPWT. Such impacts included scattered restrictions on elective surgeries, delayed ramp-up in treatment volumes for new customers and, mainly during 2022, reduced availability of disposable medical supplies, all of which unfavorably impacted the Pain Management business. Additionally, restricted physical access to our customers facilities unfavorably impacted revenue growth initiatives for both the Pain Management and NPWT businesses. While the COVID-19 pandemic has not had any material unfavorable effects in our financial results for the three and nine months ended September 30, 2022, beyond these delays to our revenue growth plans, the extent of any future impact will depend on future developments, which are highly uncertain, cannot be predicted and could have a material adverse impact on our financial position, operating results and cash flows.

Business Combinations (Tables)

Business Combinations (Tables)	9 Months Ended
	Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]
Schedule of Business Acquisitions, by Acquisition	The following table summarizes the consideration paid and the allocation of the purchase price to the fair values of the assets acquired and liabilities assumed as of the respective acquisition dates for both FilAMed and OB Healthcare (in thousands): FilAMed OB Healthcare Total Consideration Cash $ 1,400 $ 6,250 $ 7,650 Working capital, paid in cash — 325 325 Contingent consideration, paid in cash — 750 750 Total - consideration $ 1,400 $ 7,325 $ 8,725 FilAMed OB Healthcare Total Acquisition Date Fair Value Accounts receivable $ — $ 725 $ 725 Inventories 74 — 74 Medical equipment held for sale or rental 40 — 40 Property and equipment 102 59 161 Intangible assets 1,015 3,000 4,015 Goodwill 169 3,541 3,710 Operating lease right of use assets 281 7 288 Operating lease liabilities (281) (7) (288) Total - purchase price $ 1,400 $ 7,325 $ 8,725
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed	The following table summarizes the consideration paid and the allocation of the purchase price to the fair values of the assets acquired and liabilities assumed as of the respective acquisition dates for both FilAMed and OB Healthcare (in thousands): FilAMed OB Healthcare Total Consideration Cash $ 1,400 $ 6,250 $ 7,650 Working capital, paid in cash — 325 325 Contingent consideration, paid in cash — 750 750 Total - consideration $ 1,400 $ 7,325 $ 8,725 FilAMed OB Healthcare Total Acquisition Date Fair Value Accounts receivable $ — $ 725 $ 725 Inventories 74 — 74 Medical equipment held for sale or rental 40 — 40 Property and equipment 102 59 161 Intangible assets 1,015 3,000 4,015 Goodwill 169 3,541 3,710 Operating lease right of use assets 281 7 288 Operating lease liabilities (281) (7) (288) Total - purchase price $ 1,400 $ 7,325 $ 8,725
Finite-Lived and Indefinite-Lived Intangible Assets Acquired as Part of Business Combination	The following table shows the breakdown of the identified intangible assets acquired into major intangible asset classes for both acquisitions: Acquisition Date Fair Value (Thousands) Weighted-Average Amortization Period (Years) Customer relationships $ 2,300 15 Unpatented technology 943 7 Non-competition agreements 472 5 Internal-use software 300 5 Total intangible assets (a) $ 4,015 11.2 (a) There was no residual value, renewal terms or extensions associated with any intangible assets acquired.
Business Acquisition, Pro Forma Information	The following pro forma financial information presented also includes the pro forma depreciation and amortization charges from acquired tangible and intangible assets for the three and nine months ended September 30, 2021 (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2021 2021 Revenue $ 26,566 $ 76,633 Net (loss) income $ (373) $ 1,268

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2022
Revenue from Contract with Customer [Abstract]
Disaggregation of Revenue	The following tables present the Company’s disaggregated revenue by offering type (in thousands): Three Months Ended 2022 2021 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues Third-Party Payer Rentals $ 14,161 51.9 % $ 13,512 50.9 % Direct Payer Rentals 7,801 28.6 % 7,136 26.9 % Product Sales 3,562 13.1 % 4,399 16.5 % Services 1,755 6.4 % 1,519 5.7 % Total $ 27,279 100.0 % $ 26,566 100.0 % Nine Months Ended 2022 2021 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues Third-Party Payer Rentals $ 41,425 51.1 % $ 39,436 52.0 % Direct Payer Rentals 23,745 29.3 % 21,787 28.7 % Product Sales 10,968 13.5 % 11,332 14.9 % Services 4,946 6.1 % 3,308 4.4 % Total $ 81,084 100.0 % $ 75,863 100.0 %

Medical Equipment (Tables)

Medical Equipment (Tables)	9 Months Ended
	Sep. 30, 2022
Medical Equipment [Abstract]
Schedule of Medical Equipment	Medical equipment consisted of the following (in thousands): September 30, December 31, 2021 Medical equipment for sale or rental $ 2,865 $ 1,788 Medical equipment for sale or rental - pump reserve (22) (46) Medical equipment for sale or rental - net 2,843 1,742 Medical equipment in rental service 97,021 91,891 Medical equipment in rental service - pump reserve (2,074) (1,074) Accumulated depreciation (55,745) (50,946) Medical equipment in rental service - net 39,202 39,871 Total $ 42,045 $ 41,613

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2022
Property, Plant and Equipment [Abstract]
Property, Plant and Equipment	Property and equipment consisted of the following (in thousands): September 30, 2022 December 31, 2021 Gross Assets Accumulated Depreciation Total Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 5,306 $ (3,067) $ 2,239 $ 4,812 $ (2,528) $ 2,284 Automobiles 110 (105) 5 110 (103) 7 Leasehold improvements 3,448 (1,481) 1,967 3,444 (1,212) 2,232 Total $ 8,864 $ (4,653) $ 4,211 $ 8,366 $ (3,843) $ 4,523

Goodwill & Intangible Assets (T

Goodwill & Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	The changes in the carrying value of goodwill by segment for the nine months ended September 30, 2022 are as follows (in thousands): DME Services (a) Balance as of December 31, 2021 $ 3,710 Goodwill acquired — Balance as of September 30, 2022 $ 3,710 (a) The ITS segment has no recorded goodwill.
Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets	The carrying amount and accumulated amortization of intangible assets consisted of the following (in thousands): September 30, 2022 December 31, 2021 Gross Assets Accumulated Amortization Net Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ — $ 2,000 $ 2,000 $ — $ 2,000 Amortizable intangible assets: Trade names 23 (23) — 23 (23) — Physician and customer relationships 38,834 (33,297) 5,537 38,834 (31,401) 7,433 Non-competition agreements 472 (138) 334 472 (67) 405 Unpatented technology 943 (224) 719 943 (123) 820 Software 11,530 (11,315) 215 11,530 (11,258) 272 Total nonamortizable and amortizable intangible assets $ 53,802 $ (44,997) $ 8,805 $ 53,802 $ (42,872) $ 10,930
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense	Expected remaining annual amortization expense for the next five years for intangible assets recorded as of September 30, 2022 is as follows (in thousands): 2022 2023 2024 2025 2026 2027 and thereafter Total Amortization expense $ 369 $ 990 $ 990 $ 810 $ 524 $ 3,122 $ 6,805

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2022
Debt Disclosure [Abstract]
Schedule of Line of Credit Facilities	The following table illustrates the net availability under the Revolving Facility as of the applicable balance sheet date (in thousands): September 30, December 31, Revolving Facility: Gross availability $ 75,000 $ 75,000 Outstanding draws (34,706) (32,974) Letter of credit (600) (600) Availability on Revolving Facility $ 39,694 $ 41,426
Schedule of Maturities of Long-term Debt	The Company had future maturities of its long-term debt as of September 30, 2022 as follows (in thousands): 2022 2023 2024 2025 2026 and thereafter Total Revolving Facility $ — $ — $ — $ — $ 34,706 $ 34,706 Total $ — $ — $ — $ — $ 34,706 $ 34,706
Schedule of Debt	The following is a breakdown of the Company’s current and long-term debt (in thousands): September 30, 2022 December 31, 2021 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Revolving Facility $ — $ 34,706 $ 34,706 $ — $ 32,974 $ 32,974 Other financing — — — 423 — 423 — 34,706 34,706 423 32,974 33,397 Unamortized value of debt issuance costs — (245) (245) (74) (226) (300) Total $ — $ 34,461 $ 34,461 $ 349 $ 32,748 $ 33,097

Derivative Financial Instrume_2

Derivative Financial Instruments and Hedging Activities (Tables)	9 Months Ended
	Sep. 30, 2022
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Derivative Instruments in Statement of Financial Position, Fair Value	The tables below present the location and gross fair value amounts of the Company's derivative financial instruments and the associated notional amounts designated as cash flow hedges as of the applicable balance sheet date (in thousands): September 30, 2022 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 2,109 December 31, 2021 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 355
Schedule of Derivative Instruments, Effect on AOCI	The tables below present the effect of our derivative financial instruments designated as hedging instruments in AOCI (in thousands): Three Months Ended September 30, 2022 2021 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,140 $ 39 Unrealized gain/(loss) recognized in AOCI 679 9 Amounts reclassified to interest expense (a) (74) 32 Tax provision (146) (10) Ending balance $ 1,599 $ 70 (a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income for the three months ended September 30, 2022 and 2021 was $0.4 million and $0.3 million, respectively. Nine Months Ended September 30, 2022 2021 Gain on cash flow hedges - interest rate swaps Beginning balance $ 268 $ — Unrealized gain recognized in AOCI 1,802 20 Amounts reclassified to interest expense (a) (b) (48) 73 Tax provision (423) (23) Ending balance $ 1,599 $ 70 (a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income for the nine months ended September 30, 2022 and 2021 was $1.0 million and $0.9 million, respectively. (b) As of September 30, 2022, $0.7 million of income is expected to be reclassified into earnings within the next 12 months.

Earnings (Loss) Per Share (Tabl

Earnings (Loss) Per Share (Tables)	9 Months Ended
	Sep. 30, 2022
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table reconciles the numerators and denominators of the basic and diluted income (loss) per share computations: Three Months Ended September 30, Nine Months Ended September 30, Numerator (in thousands) : 2022 2021 2022 2021 Net income (loss) income: $ 443 $ (448) $ (89) $ 1,033 Denominator: Weighted average common shares outstanding: Basic 20,683,366 20,577,886 20,625,826 20,468,842 Dilutive effect of common stock equivalents 769,117 — — 1,526,374 Diluted 21,452,483 20,577,886 20,625,826 21,995,216 Net income (loss) income per share: Basic $ 0.02 $ (0.02) $ — $ 0.05 Diluted $ 0.02 $ (0.02) $ — $ 0.05

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2022
Leases [Abstract]
Lease, Cost	The components of lease costs for the three and nine months ended September 30, 2022 and 2021 are as follows (in thousands): Three Months Ended Nine Months Ended 2022 2021 2022 2021 Operating lease cost $ 342 $ 302 $ 1,006 $ 998 Variable lease cost 77 65 231 180 Total lease cost $ 419 $ 367 $ 1,237 $ 1,178 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Nine Months Ended 2022 2021 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 946 $ 993 Right of use assets obtained in exchange for lease obligations: Operating leases $ 18 $ 288 Increases to right of use assets resulting from lease modifications: Operating leases $ 1,050 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: As of September 30, 2022 2021 Years Years Weighted average remaining lease term: 6.9 6.3 Rate Rate Weighted average discount rate: 7.1% 7.7%
Lessee, Operating Lease, Liability, Maturity	Future maturities of lease liabilities as of September 30, 2022 are as follows (in thousands): Operating Leases (a) 2022 $ 303 2023 1,159 2024 1,064 2025 1,033 2026 998 2027 and thereafter 2,841 Total undiscounted lease payments 7,398 Less: Imputed interest (2,451) Total lease liabilities $ 4,947 (a) Excludes $1.8 million of legally binding minimum lease payments for an office lease signed but not yet commenced. This lease has an expected term of 7 years and is expected to commence in 2023.

Business Segment Information (T

Business Segment Information (Tables)	9 Months Ended
	Sep. 30, 2022
Segment Reporting [Abstract]
Schedule of Segment Reporting Information, by Segment	The financial information summarized below is presented by reportable segment for the three months ended September 30, 2022 and 2021: 2022 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 17,375 $ 9,904 $ — $ 27,279 Net revenues - internal — 1,610 (1,610) — Total net revenues 17,375 11,514 (1,610) 27,279 Gross profit 11,400 4,819 — 16,219 Selling, general and administrative expenses 15,276 15,276 Interest expense (385) (385) Other expense (11) (11) Provision for income taxes (104) (104) Net income $ 443 Total assets $ 61,735 $ 35,246 $ 2,000 $ 98,981 Purchases of medical equipment $ 2,088 $ 1,695 $ — $ 3,783 Depreciation and amortization of intangible assets $ 2,425 $ 1,015 $ — $ 3,440 2021 (in thousands) ITS DME Services Corporate/Eliminations Total Net revenues - external $ 16,581 $ 9,985 $ — $ 26,566 Net revenues - internal — 1,440 (1,440) — Total net revenues 16,581 11,425 (1,440) 26,566 Gross profit 10,574 4,684 — 15,258 Selling, general and administrative expenses 15,609 15,609 Interest expense (270) (270) Other expense (44) (44) Benefit from income taxes 217 217 Net loss $ (448) Total assets $ 59,312 $ 33,474 $ 2,000 $ 94,786 Purchases of medical equipment $ 4,058 $ 644 $ — $ 4,702 Depreciation and amortization of intangible assets $ 2,785 $ 955 $ — $ 3,740 The financial information summarized below is presented by reportable segment for the nine months ended September 30, 2022 and 2021: 2022 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 51,260 $ 29,824 $ — $ 81,084 Net revenues - internal — 4,860 (4,860) — Total net revenues 51,260 34,684 (4,860) 81,084 Gross profit 32,251 14,236 — 46,487 Selling, general and administrative expenses 45,862 45,862 Interest expense (976) (976) Other expense (69) (69) Benefit from income taxes 331 331 Net loss $ (89) Total assets $ 61,735 $ 35,246 $ 2,000 $ 98,981 Purchases of medical equipment $ 6,924 $ 3,528 $ — $ 10,452 Depreciation and amortization of intangible assets $ 7,194 $ 3,062 $ — $ 10,256 2021 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 48,826 $ 27,037 $ — $ 75,863 Net revenues - internal — 4,484 (4,484) — Total net revenues 48,826 31,521 (4,484) 75,863 Gross profit 31,028 13,856 — 44,884 Selling, general and administrative expenses 43,666 43,666 Interest expense (909) (909) Other expense (150) (150) Benefit from income taxes 874 874 Net income $ 1,033 Total assets $ 59,312 $ 33,474 $ 2,000 $ 94,786 Purchases of medical equipment $ 7,550 $ 2,095 $ — $ 9,645 Depreciation and amortization of intangible assets $ 8,213 $ 2,756 $ — $ 10,969

Business Combinations - Purchas

Business Combinations - Purchase Price Allocation (Details) - USD ($) $ in Thousands			9 Months Ended
	Dec. 31, 2021	Apr. 18, 2021	Sep. 30, 2022
Business Acquisition [Line Items]
Cash			$ 7,650
Working capital, paid in cash			325
Contingent consideration, paid in cash			750
Total - consideration			8,725
FilAMed
Business Acquisition [Line Items]
Cash			1,400
Working capital, paid in cash			0
Contingent consideration, paid in cash			0
Total - consideration			1,400
OB Healthcare
Business Acquisition [Line Items]
Cash	$ 400	$ 6,100	6,250
Working capital, paid in cash			325
Contingent consideration, paid in cash			750
Total - consideration			$ 7,325

Business Combinations - Assets

Business Combinations - Assets Acquired and Liabilities Assumed (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021	Apr. 18, 2021	Jan. 31, 2021
Business Acquisition [Line Items]
Accounts receivable	$ 725
Inventories	74
Medical equipment held for sale or rental	40
Property and equipment	161
Intangible assets	4,015
Goodwill	3,710	$ 3,710
Operating lease right of use assets	288
Operating lease liabilities	(288)
Total - purchase price	$ 8,725
FilAMed
Business Acquisition [Line Items]
Accounts receivable				$ 0
Inventories				74
Medical equipment held for sale or rental				40
Property and equipment				102
Intangible assets				1,015
Goodwill				169
Operating lease right of use assets				281
Operating lease liabilities				(281)
Total - purchase price				$ 1,400
OB Healthcare
Business Acquisition [Line Items]
Accounts receivable			$ 725
Inventories			0
Medical equipment held for sale or rental			0
Property and equipment			59
Intangible assets			3,000
Goodwill			3,541
Operating lease right of use assets			7
Operating lease liabilities			(7)
Total - purchase price			$ 7,325

Business Combinations - Narrati

Business Combinations - Narrative (Details) - USD ($) $ in Thousands			3 Months Ended	9 Months Ended
	Dec. 31, 2021	Apr. 18, 2021	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Business Acquisition [Line Items]
Acquisition costs and non-recurring expenses					$ 200
Payments to acquire businesses				$ 7,650
OB Healthcare
Business Acquisition [Line Items]
Payments to acquire businesses	$ 400	$ 6,100		$ 6,250
OB Healthcare | Other Current Liabilities
Business Acquisition [Line Items]
Contingent consideration	$ 800
General and Administrative Expense
Business Acquisition [Line Items]
Pro forma acquisition cost and non-recurring expense			$ 100		$ 200

Business Combinations - Intangi

Business Combinations - Intangible Assets Acquired (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2022 USD ($)
Business Acquisition [Line Items]
Acquisition date fair value	$ 4,015
Weighted average amortization period	11 years 2 months 12 days
Customer relationships
Business Acquisition [Line Items]
Acquisition date fair value	$ 2,300
Weighted average amortization period	15 years
Unpatented technology
Business Acquisition [Line Items]
Acquisition date fair value	$ 943
Weighted average amortization period	7 years
Non-competition agreements
Business Acquisition [Line Items]
Acquisition date fair value	$ 472
Weighted average amortization period	5 years
Software
Business Acquisition [Line Items]
Acquisition date fair value	$ 300
Weighted average amortization period	5 years

Business Combinations - Pro For

Business Combinations - Pro Forma Information (Details) - USD ($) $ in Thousands	3 Months Ended	9 Months Ended
	Sep. 30, 2021	Sep. 30, 2021
Business Combination and Asset Acquisition [Abstract]
Revenue	$ 26,566	$ 76,633
Net (loss) income	$ (373)	$ 1,268

Revenue Recognition - Disaggreg

Revenue Recognition - Disaggregated Revenue by Revenue Stream (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Disaggregation of Revenue [Line Items]
Total Net Revenues	$ 27,279	$ 26,566	$ 81,084	$ 75,863
Third-Party Payer Rentals
Disaggregation of Revenue [Line Items]
Total Net Revenues	14,161	13,512	41,425	39,436
Direct Payer Rentals
Disaggregation of Revenue [Line Items]
Total Net Revenues	7,801	7,136	23,745	21,787
Product Sales
Disaggregation of Revenue [Line Items]
Total Net Revenues	3,562	4,399	10,968	11,332
Services
Disaggregation of Revenue [Line Items]
Total Net Revenues	$ 1,755	$ 1,519	$ 4,946	$ 3,308
Revenue Benchmark | Customer Concentration Risk
Disaggregation of Revenue [Line Items]
Percentage of Total Net Revenues	100%	100%	100%	100%
Revenue Benchmark | Customer Concentration Risk | Third-Party Payer Rentals
Disaggregation of Revenue [Line Items]
Percentage of Total Net Revenues	51.90%	50.90%	51.10%	52%
Revenue Benchmark | Customer Concentration Risk | Direct Payer Rentals
Disaggregation of Revenue [Line Items]
Percentage of Total Net Revenues	28.60%	26.90%	29.30%	28.70%
Revenue Benchmark | Customer Concentration Risk | Product Sales
Disaggregation of Revenue [Line Items]
Percentage of Total Net Revenues	13.10%	16.50%	13.50%	14.90%
Revenue Benchmark | Customer Concentration Risk | Services
Disaggregation of Revenue [Line Items]
Percentage of Total Net Revenues	6.40%	5.70%	6.10%	4.40%

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Disaggregation of Revenue [Line Items]
Net revenues	$ 27,279	$ 26,566	$ 81,084	$ 75,863
ITS | Product
Disaggregation of Revenue [Line Items]
Net revenues	100		100
DME Services | Product
Disaggregation of Revenue [Line Items]
Net revenues	3,600		10,900
Direct Payer Rentals
Disaggregation of Revenue [Line Items]
Net revenues	7,801	7,136	23,745	21,787
Direct Payer Rentals | ITS
Disaggregation of Revenue [Line Items]
Net revenues	3,200	3,100	9,700	9,400
Direct Payer Rentals | DME Services
Disaggregation of Revenue [Line Items]
Net revenues	$ 4,600	$ 4,000	$ 14,000	$ 12,400

Medical Equipment - Summary of

Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Medical Equipment [Abstract]
Medical equipment for sale or rental	$ 2,865	$ 1,788
Medical equipment for sale or rental - pump reserve	(22)	(46)
Medical equipment for sale or rental - net	2,843	1,742
Medical equipment in rental service	97,021	91,891
Medical equipment in rental service - pump reserve	(2,074)	(1,074)
Accumulated depreciation	(55,745)	(50,946)
Medical equipment in rental service - net	39,202	39,871
Total	$ 42,045	$ 41,613

Medical Equipment - Narrative (

Medical Equipment - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Medical Equipment [Abstract]
Depreciation expense related to medical equipment	$ 2.4	$ 2.4	$ 7.3	$ 7
Medical equipment increase in pump reserve	$ 0.1		$ 0.6

Property and Equipment - Schedu

Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Property, Plant and Equipment [Line Items]
Gross Assets	$ 8,864	$ 8,366
Accumulated Depreciation	(4,653)	(3,843)
Total	4,211	4,523
Furniture, fixtures, and equipment
Property, Plant and Equipment [Line Items]
Gross Assets	5,306	4,812
Accumulated Depreciation	(3,067)	(2,528)
Total	2,239	2,284
Automobiles
Property, Plant and Equipment [Line Items]
Gross Assets	110	110
Accumulated Depreciation	(105)	(103)
Total	5	7
Leasehold improvements
Property, Plant and Equipment [Line Items]
Gross Assets	3,448	3,444
Accumulated Depreciation	(1,481)	(1,212)
Total	$ 1,967	$ 2,232

Property and Equipment - Narrat

Property and Equipment - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Property, Plant and Equipment [Abstract]
Depreciation	$ 0.3	$ 0.2	$ 0.8	$ 0.7

Goodwill & Intangible Assets -

Goodwill & Intangible Assets - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Goodwill and Intangible Assets Disclosure [Abstract]
Amortization of intangibles	$ 704	$ 1,125	$ 2,125	$ 3,264

Goodwill & Intangible Assets _2

Goodwill & Intangible Assets - Goodwill (Details)	9 Months Ended
	Sep. 30, 2022 USD ($)
Goodwill [Roll Forward]
Goodwill, beginning balance	$ 3,710,000
Goodwill, ending balance	3,710,000
DME Services
Goodwill [Roll Forward]
Goodwill, beginning balance	3,710,000
Goodwill acquired	0
Goodwill, ending balance	3,710,000
ITS
Goodwill [Roll Forward]
Goodwill, ending balance	$ 0

Goodwill & Intangible Assets _3

Goodwill & Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Goodwill [Line Items]
Trade names	$ 2,000	$ 2,000
Accumulated Amortization	(44,997)	(42,872)
Total	6,805
Total nonamortizable and amortizable intangible assets	53,802	53,802
Net	8,805	10,930
Trade names
Goodwill [Line Items]
Gross Assets	23	23
Accumulated Amortization	(23)	(23)
Total	0	0
Physician and customer relationships
Goodwill [Line Items]
Gross Assets	38,834	38,834
Accumulated Amortization	(33,297)	(31,401)
Total	5,537	7,433
Non-competition agreements
Goodwill [Line Items]
Gross Assets	472	472
Accumulated Amortization	(138)	(67)
Total	334	405
Unpatented technology
Goodwill [Line Items]
Gross Assets	943	943
Accumulated Amortization	(224)	(123)
Total	719	820
Software
Goodwill [Line Items]
Gross Assets	11,530	11,530
Accumulated Amortization	(11,315)	(11,258)
Total	$ 215	$ 272

Goodwill & Intangible Assets _4

Goodwill & Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
2022	$ 369
2023	990
2024	990
2025	810
2026	524
2027 and thereafter	3,122
Total	$ 6,805

Debt - Narrative (Details)

Debt - Narrative (Details) $ in Thousands			9 Months Ended
	Feb. 05, 2021 USD ($)	Apr. 15, 2019 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2021 USD ($)
Revolving Facility
Debt Instrument [Line Items]
Long-term line of credit			$ 34,706	$ 32,974
The 2021 Credit Agreement
Debt Instrument [Line Items]
Percentage of total depreciation expense	50%
Debt instrument, covenant, minimum fixed coverage ratio	1.20
Debt instrument, covenant, maximum leverage ratio	3.50
The 2021 Credit Agreement | Eurodollar Loan
Debt Instrument [Line Items]
Effective percentage			5.07%
LIBOR rate			2.82%
The 2021 Credit Agreement | ABR Loans
Debt Instrument [Line Items]
Effective percentage			7.50%
The 2021 Credit Agreement | London Interbank Offered Rate (LIBOR) | Eurodollar Loan
Debt Instrument [Line Items]
Basis spread on variable rate			2.25%
The 2021 Credit Agreement | Base Rate | ABR Loans
Debt Instrument [Line Items]
Basis spread on variable rate			1.25%
The 2021 Credit Agreement | Minimum | London Interbank Offered Rate (LIBOR) | Eurodollar Loan
Debt Instrument [Line Items]
Basis spread on variable rate			2%
The 2021 Credit Agreement | Minimum | Base Rate | ABR Loans
Debt Instrument [Line Items]
Basis spread on variable rate			1%
Lender prime rate			6.25%
The 2021 Credit Agreement | Maximum | London Interbank Offered Rate (LIBOR) | Eurodollar Loan
Debt Instrument [Line Items]
Basis spread on variable rate			3%
The 2021 Credit Agreement | Maximum | Base Rate | ABR Loans
Debt Instrument [Line Items]
Basis spread on variable rate			2%
The 2021 Credit Agreement | Revolving Facility
Debt Instrument [Line Items]
Line of credit facility	$ 75,000
Revolving credit facility	25,000
Borrowings under revolving credit facility	30,000
The 2021 Credit Agreement | Letter of credit
Debt Instrument [Line Items]
Line of credit facility	7,000
The 2015 Credit Agreement
Debt Instrument [Line Items]
Long-term line of credit	800
The 2015 Credit Agreement | Revolving Facility
Debt Instrument [Line Items]
Repayments	$ 8,200
Financing Agreement | Medical Equipment
Debt Instrument [Line Items]
Line of credit facility		$ 2,000
Debt term		36 months

Debt - Summary of Revolver Base

Debt - Summary of Revolver Based Upon Borrowers' Eligible Accounts Receivable and Inventory (Details) - Revolving Facility - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Gross availability	$ 75,000	$ 75,000
Outstanding draws	(34,706)	(32,974)
Letter of credit	(600)	(600)
Availability on Revolving Facility	$ 39,694	$ 41,426

Debt - Summary of Future Maturi

Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
2022	$ 0
2023	0
2024	0
2025	0
2026 and thereafter	34,706
Total	34,706	$ 33,397
Revolving Facility
Debt Instrument [Line Items]
2022	0
2023	0
2024	0
2025	0
2026 and thereafter	34,706
Total	$ 34,706	$ 32,974

Debt - Summary of Company's Cur

Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Debt Instrument [Line Items]
Current Portion	$ 0	$ 423
Long-Term Portion	34,706	32,974
Total	34,706	33,397
Unamortized value of the debt issuance costs, current portion of long-term debt	0	(74)
Unamortized value of the debt issuance costs, long-term debt	(245)	(226)
Unamortized value of the debt issuance costs, total	(245)	(300)
Current portion of long-term debt	0	349
Long-term debt	34,461	32,748
Total	34,461	33,097
Financing Agreement
Debt Instrument [Line Items]
Current Portion	0	423
Long-Term Portion	0	0
Total	0	423
Revolving Facility
Debt Instrument [Line Items]
Current Portion	0	0
Long-Term Portion	34,706	32,974
Total	$ 34,706	$ 32,974

Derivative Financial Instrume_3

Derivative Financial Instruments and Hedging Activities - Narrative (Details) - Interest rate swaps - Derivatives designated as hedges: - Cash flow hedges		3 Months Ended	9 Months Ended
	Feb. 05, 2021 agreement	Sep. 30, 2022 USD ($)	Sep. 30, 2022 USD ($)
Derivative [Line Items]
Interest rate swap | agreement	2
Term of contract (year)	5 years
Fixed interest rate	0.73%
Net hedge effectiveness | $		$ 0	$ 0

Derivative Financial Instrume_4

Derivative Financial Instruments and Hedging Activities - Fair Value and Notional Amounts of Cash Flow Hedges (Details) - Cash flow hedges - Interest rate swaps - Derivatives designated as hedges: - USD ($) $ in Thousands	Sep. 30, 2022	Dec. 31, 2021
Derivative [Line Items]
Notional	$ 20,000	$ 20,000
Fair Value Derivative Assets	$ 2,109	$ 355

Derivative Financial Instrume_5

Derivative Financial Instruments and Hedging Activities - Derivative Financial Instruments Designated as Hedging Instruments in AOCI (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Derivative [Line Items]
Beginning balance	$ 46,497	$ 44,700	$ 48,272	$ 40,752
Ending balance	47,807	46,455	47,807	46,455
Interest expense	385	270	976	909
Interest rate swaps | Cash flow hedges | Derivatives designated as hedges:
Derivative [Line Items]
Reclassified within twelve months			700
Gain/(loss) on cash flow hedges
Derivative [Line Items]
Beginning balance	1,140	39	268	0
Unrealized gain/(loss) recognized in AOCI	679	9	1,802	20
Amounts reclassified to interest expense	(74)	32	(48)	73
Tax provision	(146)	(10)	(423)	(23)
Ending balance	$ 1,599	$ 70	$ 1,599	$ 70

Income Taxes - Narrative (Detai

Income Taxes - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021	Dec. 31, 2020
Income Tax Contingency [Line Items]
Income tax expense (benefit)	$ 104	$ (217)	$ (331)	$ (874)
Other Liabilities
Income Tax Contingency [Line Items]
Payroll taxes	$ 300		$ 300		$ 700	$ 700

Earnings (Loss) Per Share - Cal

Earnings (Loss) Per Share - Calculation of Basic and Diluted EPS (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Earnings Per Share [Abstract]
Net income (loss)	$ 443	$ (448)	$ (89)	$ 1,033
Weighted average common shares outstanding:
Basic (in shares)	20,683,366	20,577,886	20,625,826	20,468,842
Dilutive effect of common stock equivalents (in shares)	769,117	0	0	1,526,374
Diluted (in shares)	21,452,483	20,577,886	20,625,826	21,995,216
Basic (in dollars per share)	$ 0.02	$ (0.02)	$ 0	$ 0.05
Diluted (in dollars per share)	$ 0.02	$ (0.02)	$ 0	$ 0.05

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Jun. 30, 2021
Earnings Per Share [Abstract]
Antidilutive securities excluded from computation of earnings per share, amount (in shares)	1,143,001	300,000
Stock repurchase program, authorized amount			$ 20,000,000
Cumulative shares purchased	$ 5,900,000
Cumulative shares purchased (in shares)	517,672

Leases - Narrative (Details)

Leases - Narrative (Details)	Sep. 30, 2022
Lessee, Lease, Description [Line Items]
Operating lease, term of contract	10 years
Minimum | Office Leases With Renewal Options Not Reasonably Certain to Exercise
Lessee, Lease, Description [Line Items]
Lessee, operating lease, renewal term (year)	1 year
Maximum | Office Leases With Renewal Options Not Reasonably Certain to Exercise
Lessee, Lease, Description [Line Items]
Lessee, operating lease, renewal term (year)	5 years

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021
Leases [Abstract]
Operating lease cost	$ 342	$ 302	$ 1,006	$ 998
Variable lease cost	77	65	231	180
Total lease cost	$ 419	$ 367	1,237	1,178
Operating cash flow from operating leases			946	993
Operating leases			18	288
Increases to right of use assets resulting from lease modifications, operating lease			$ 1,050	$ 0
Weighted average remaining lease term:	6 years 10 months 24 days	6 years 3 months 18 days	6 years 10 months 24 days	6 years 3 months 18 days
Weighted average discount rate:	7.10%	7.70%	7.10%	7.70%

Leases - Maturities of Lease Li

Leases - Maturities of Lease Liabilities (Details) $ in Thousands	Sep. 30, 2022 USD ($)
Leases [Abstract]
2022	$ 303
2023	1,159
2024	1,064
2025	1,033
2026	998
2027 and thereafter	2,841
Total undiscounted lease payments	7,398
Less: Imputed interest	(2,451)
Total lease liabilities	4,947
Operating lease, minimum payments	$ 1,800
Lessee, finance lease, remaining lease term	7 years

Business Segment Information (D

Business Segment Information (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021	Sep. 30, 2022	Sep. 30, 2021	Dec. 31, 2021
Segment Reporting Information [Line Items]
Net revenues - external	$ 27,279	$ 26,566	$ 81,084	$ 75,863
Net revenues - internal	0	0	0	0
Total net revenues	27,279	26,566	81,084	75,863
Gross profit	16,219	15,258	46,487	44,884
Selling, general and administrative expenses	15,276	15,609	45,862	43,666
Interest expense	(385)	(270)	(976)	(909)
Other expense	(11)	(44)	(69)	(150)
Provision for income taxes	(104)	217	331	874
Net income (loss)	443	(448)	(89)	1,033
Total assets	98,981	94,786	98,981	94,786	$ 97,586
Purchases of medical equipment	3,783	4,702	10,452	9,645
Depreciation and amortization of intangible assets	3,440	3,740	10,256	10,969
Corporate and Eliminations
Segment Reporting Information [Line Items]
Net revenues - external	0	0	0	0
Net revenues - internal	(1,610)	(1,440)	(4,860)	(4,484)
Total net revenues	(1,610)	(1,440)	(4,860)	(4,484)
Gross profit	0	0	0	0
Selling, general and administrative expenses	15,276	15,609	45,862	43,666
Interest expense	(385)	(270)	(976)	(909)
Other expense	(11)	(44)	(69)	(150)
Provision for income taxes	(104)	217	331	874
Total assets	2,000	2,000	2,000	2,000
Purchases of medical equipment	0	0	0	0
Depreciation and amortization of intangible assets	0	0	0	0
ITS | Operating Segments
Segment Reporting Information [Line Items]
Net revenues - external	17,375	16,581	51,260	48,826
Net revenues - internal	0	0	0	0
Total net revenues	17,375	16,581	51,260	48,826
Gross profit	11,400	10,574	32,251	31,028
Total assets	61,735	59,312	61,735	59,312
Purchases of medical equipment	2,088	4,058	6,924	7,550
Depreciation and amortization of intangible assets	2,425	2,785	7,194	8,213
DME Services | Operating Segments
Segment Reporting Information [Line Items]
Net revenues - external	9,904	9,985	29,824	27,037
Net revenues - internal	1,610	1,440	4,860	4,484
Total net revenues	11,514	11,425	34,684	31,521
Gross profit	4,819	4,684	14,236	13,856
Total assets	35,246	33,474	35,246	33,474
Purchases of medical equipment	1,695	644	3,528	2,095
Depreciation and amortization of intangible assets	$ 1,015	$ 955	$ 3,062	$ 2,756