Cover
Cover - shares | 3 Months Ended | |
Mar. 31, 2023 | May 05, 2023 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2023 | |
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 $0.0001 per share | |
Trading Symbol(s) | INFU | |
Name of Each Exchange on which Registered | NYSEAMER | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding (in shares) | 20,931,147 | |
Entity Central Index Key | 0001337013 | |
Amendment Flag | false | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Period Focus | Q1 | |
Document Fiscal Year Focus | 2023 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 256 | $ 165 |
Accounts receivable, net | 18,266 | 16,871 |
Inventories | 5,644 | 4,821 |
Other current assets | 3,752 | 2,922 |
Total current assets | 27,918 | 24,779 |
Medical equipment for sale or rental | 3,042 | 2,790 |
Medical equipment in rental service, net of accumulated depreciation | 38,620 | 39,450 |
Property & equipment, net of accumulated depreciation | 4,391 | 4,385 |
Goodwill | 3,710 | 3,710 |
Intangible assets, net | 8,188 | 8,436 |
Operating lease right of use assets | 4,295 | 4,168 |
Deferred income taxes | 9,989 | 9,625 |
Derivative financial instruments | 1,683 | 1,965 |
Other assets | 425 | 80 |
Total assets | 102,261 | 99,388 |
Current liabilities: | ||
Accounts payable | 7,368 | 8,341 |
Current portion of long-term debt | 0 | 0 |
Other current liabilities | 6,562 | 6,126 |
Total current liabilities | 13,930 | 14,467 |
Long-term debt, net of current portion | 36,386 | 33,157 |
Operating lease liabilities, net of current portion | 3,684 | 3,761 |
Total liabilities | 54,000 | 51,385 |
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; 20,931,147 shares issued and outstanding as of March 31, 2023 and 20,781,977 shares issued and outstanding as of December 31, 2022 | 2 | 2 |
Additional paid-in capital | 106,810 | 105,856 |
Accumulated other comprehensive income | 1,270 | 1,489 |
Retained deficit | (59,821) | (59,344) |
Total stockholders’ equity | 48,261 | 48,003 |
Total liabilities and stockholders’ equity | $ 102,261 | $ 99,388 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares | Mar. 31, 2023 | Dec. 31, 2022 |
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) | 20,931,147 | 20,781,977 |
Common stock, outstanding (in shares) | 20,931,147 | 20,781,977 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations and Comprehensive (Loss) Income - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Income Statement [Abstract] | ||
Net revenues | $ 30,370 | $ 26,763 |
Cost of revenues | 14,830 | 11,396 |
Gross profit | 15,540 | 15,367 |
Selling, general and administrative expenses: | ||
Provision for doubtful accounts | 114 | 47 |
Amortization of intangibles | 248 | 710 |
Selling and marketing | 3,224 | 3,319 |
General and administrative | 12,061 | 11,816 |
Total selling, general and administrative | 15,647 | 15,892 |
Operating loss | (107) | (525) |
Other expense: | ||
Interest expense | (484) | (277) |
Other income expense | (35) | (28) |
Loss before income taxes | (626) | (830) |
Benefit from income taxes | 302 | 462 |
Net loss | $ (324) | $ (368) |
Net loss per share: | ||
Basic (in dollars per share) | $ (0.02) | $ (0.02) |
Diluted (in dollars per share) | $ (0.02) | $ (0.02) |
Weighted average shares outstanding: | ||
Basic (in shares) | 20,853,018 | 20,609,372 |
Diluted (in shares) | 20,853,018 | 20,609,372 |
Comprehensive (loss) income: | ||
Net loss | $ (324) | $ (368) |
Other comprehensive (loss) income: | ||
Unrealized (loss) gain on hedges | (282) | 905 |
Benefit from (provision for) income tax on unrealized hedge gain | 63 | (218) |
Net comprehensive (loss) income | $ (543) | $ 319 |
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, 2021 | 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 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Stock-based shares issued upon vesting - gross (in shares) | 125,000 | |||||
Stock-based shares issued upon vesting - gross | 239 | 239 | ||||
Stock-based compensation expense | 1,047 | 1,047 | ||||
Employee stock purchase plan (in shares) | 28,000 | |||||
Employee stock purchase plan | 236 | 236 | ||||
Common stock repurchased as part of share repurchase program (in shares) | (310,000) | |||||
Common stock repurchased as part of share repurchase program | (4,006) | (4,006) | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares) | (3,000) | |||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation | (54) | (54) | ||||
Other comprehensive income (loss) | 687 | 687 | ||||
Net loss | (368) | (368) | ||||
Ending balance (in shares) at Mar. 31, 2022 | 20,540,000 | |||||
Ending balance at Mar. 31, 2022 | $ 46,053 | $ 2 | 103,373 | (58,277) | 955 | $ 0 |
Ending balance (in shares) at Mar. 31, 2022 | 0 | |||||
Beginning balance (in shares) at Dec. 31, 2022 | 20,781,977 | 20,782,000 | ||||
Beginning balance at Dec. 31, 2022 | $ 48,003 | $ 2 | 105,856 | (59,344) | 1,489 | $ 0 |
Beginning balance (in shares) at Dec. 31, 2022 | 0 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Stock-based shares issued upon vesting - gross (in shares) | 167,000 | |||||
Stock-based shares issued upon vesting - gross | 315 | 315 | ||||
Stock-based compensation expense | 720 | 720 | ||||
Employee stock purchase plan (in shares) | 41,000 | |||||
Employee stock purchase plan | 243 | 243 | ||||
Common stock repurchased as part of share repurchase program (in shares) | (22,000) | |||||
Common stock repurchased as part of share repurchase program | (153) | (153) | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares) | (37,000) | |||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation | (324) | (324) | ||||
Other comprehensive income (loss) | (219) | (219) | ||||
Net loss | $ (324) | (324) | ||||
Ending balance (in shares) at Mar. 31, 2023 | 20,931,147 | 20,931,000 | ||||
Ending balance at Mar. 31, 2023 | $ 48,261 | $ 2 | $ 106,810 | $ (59,821) | $ 1,270 | $ 0 |
Ending balance (in shares) at Mar. 31, 2023 | 0 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
OPERATING ACTIVITIES | ||
Net loss | $ (324) | $ (368) |
Adjustments to reconcile net loss to net cash provided by operating activities: | ||
Provision for doubtful accounts | 114 | 47 |
Depreciation | 2,955 | 2,706 |
Loss on disposal of and reserve adjustments for medical equipment | 450 | 275 |
Gain on sale of medical equipment | (883) | (228) |
Amortization of intangible assets | 248 | 710 |
Amortization of deferred debt issuance costs | 18 | 18 |
Stock-based compensation | 720 | 1,047 |
Deferred income taxes | (302) | (462) |
Changes in assets - (increase)/decrease: | ||
Accounts receivable | (961) | (1,278) |
Inventories | (823) | 61 |
Other current assets | (830) | (50) |
Other assets | (846) | (41) |
Changes in liabilities - increase: | ||
Accounts payable and other liabilities | 313 | 1,641 |
NET CASH (USED IN) PROVIDED BY OPERATING ACTIVITIES | (151) | 4,078 |
INVESTING ACTIVITIES | ||
Purchase of medical equipment | (3,968) | (2,931) |
Purchase of property and equipment | (317) | (178) |
Proceeds from sale of medical equipment, property and equipment | 1,234 | 966 |
NET CASH USED IN INVESTING ACTIVITIES | (3,051) | (2,143) |
FINANCING ACTIVITIES | ||
Principal payments on long-term debt | (13,683) | (10,696) |
Cash proceeds from long-term debt | 16,894 | 12,529 |
Common stock repurchased as part of share repurchase program | (153) | (4,006) |
Common stock repurchased to satisfy statutory withholding on employee stock-based compensation plans | (324) | (54) |
Cash proceeds from stock plans | 559 | 511 |
NET CASH PROVIDED BY (USED IN) FINANCING ACTIVITIES | 3,293 | (1,716) |
Net change in cash and cash equivalents | 91 | 219 |
Cash and cash equivalents, beginning of period | 165 | 186 |
Cash and cash equivalents, end of period | $ 256 | $ 405 |
Basis of Presentation, Nature o
Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies | 3 Months Ended |
Mar. 31, 2023 | |
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 Company operates in two reportable segments, Integrated Therapy Services (“ITS”) and Durable Medical Equipment Services (“DME Services”). 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, 2022 as filed with the SEC on March 16, 2023. 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 | 3 Months Ended |
Mar. 31, 2023 | |
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. The Company's adoption of this standard on January 1, 2023 did not have a material effect on its consolidated balance sheets, statements of operations, statements of cash flows or related disclosures. |
Revenue Recognition
Revenue Recognition | 3 Months Ended |
Mar. 31, 2023 | |
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 2023 2022 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues ITS Third-Party Payer Rentals $ 14,808 48.8 % $ 13,368 50.0 % DME Services Direct Payer Rentals 4,507 14.9 % 4,775 17.8 % ITS Direct Payer Rentals 3,472 11.4 % 3,187 11.9 % DME Services Product Sales 3,739 12.3 % 3,658 13.7 % DME Services - Service 3,350 11.0 % 1,689 6.3 % ITS Product Sales 494 1.6 % 86 0.3 % Total $ 30,370 100.0 % $ 26,763 100.0 % |
Medical Equipment
Medical Equipment | 3 Months Ended |
Mar. 31, 2023 | |
Medical Equipment [Abstract] | |
Medical Equipment | Medical Equipment Medical equipment consisted of the following (in thousands): March 31, December 31, 2022 Medical equipment for sale or rental $ 3,054 $ 2,802 Medical equipment for sale or rental - pump reserve (12) (12) Medical equipment for sale or rental - net 3,042 2,790 Medical equipment in rental service 100,026 99,163 Medical equipment in rental service - pump reserve (2,427) (2,270) Accumulated depreciation (58,979) (57,443) Medical equipment in rental service - net 38,620 39,450 Total $ 41,662 $ 42,240 Depreciation expense for medical equipment for the three months ended March 31, 2023 was $2.7 million, compared to $2.4 million for the same prior year period. 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 three month period ended June 30, 2022, 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 had a higher amount recorded for the pump reserve as of March 31, 2023 and higher expense included in cost of sales for the three months ended March 31, 2023 by $0.1 million as compared to the three months ended March 31, 2022. |
Property and Equipment
Property and Equipment | 3 Months Ended |
Mar. 31, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and Equipment Property and equipment consisted of the following (in thousands): March 31, 2023 December 31, 2022 Gross Assets Accumulated Depreciation Total Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 5,986 $ (3,428) $ 2,558 $ 5,710 $ (3,252) $ 2,458 Automobiles 87 (85) 2 87 (83) 4 Leasehold improvements 3,498 (1,667) 1,831 3,498 (1,575) 1,923 Total $ 9,571 $ (5,180) $ 4,391 $ 9,295 $ (4,910) $ 4,385 Depreciation expense for property and equipment for both the three months ended March 31, 2023 and 2022 was $0.3 million. This expense was recorded in “general and administrative expenses” for each period. |
Goodwill & Intangible Assets
Goodwill & Intangible Assets | 3 Months Ended |
Mar. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill & Intangible Assets | Goodwill & Intangible Assets The changes in the carrying value of goodwill by segment for the three months ended March 31, 2023 are as follows (in thousands): DME Services (a) Balance as of December 31, 2022 $ 3,710 Goodwill acquired — Balance as of March 31, 2023 $ 3,710 (a) The ITS segment had no recorded goodwill during the reported periods. The carrying amount and accumulated amortization of intangible assets consisted of the following (in thousands): March 31, 2023 December 31, 2022 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 (33,769) 5,065 38,834 (33,594) 5,240 Non-competition agreements 472 (185) 287 472 (161) 311 Unpatented technology 943 (292) 651 943 (258) 685 Software 10,300 (10,115) 185 10,300 (10,100) 200 Total nonamortizable and amortizable intangible assets $ 52,572 $ (44,384) $ 8,188 $ 52,572 $ (44,136) $ 8,436 Amortization expense for the three months ended March 31, 2023 was $0.2 million, compared to $0.7 million for the same prior year period. 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 March 31, 2023 is as follows (in thousands): 2023 2024 2025 2026 2027 2028 and thereafter Total Amortization expense $ 743 $ 990 $ 810 $ 524 $ 471 $ 2,650 $ 6,188 |
Debt
Debt | 3 Months Ended |
Mar. 31, 2023 | |
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 March 31, 2023, the Company was in compliance with all debt-related covenants under the 2021 Credit Agreement. The following table illustrates the net availability under the Revolving Facility as of the applicable balance sheet date (in thousands): March 31, December 31, Revolving Facility: Gross availability $ 75,000 $ 75,000 Outstanding draws (36,594) (33,384) Letter of credit (400) (400) Availability on Revolving Facility $ 38,006 $ 41,216 The Company had future maturities of its long-term debt as of March 31, 2023 as follows (in thousands): 2023 2024 2025 2026 2027 and thereafter Total Revolving Facility $ — $ — $ — $ 36,594 $ — $ 36,594 Total $ — $ — $ — $ 36,594 $ — $ 36,594 The following is a breakdown of the Company’s current and long-term debt (in thousands): March 31, 2023 December 31, 2022 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Revolving Facility $ — $ 36,594 $ 36,594 $ — $ 33,384 $ 33,384 Unamortized value of debt issuance costs — (208) (208) — (227) (227) Total $ — $ 36,386 $ 36,386 $ — $ 33,157 $ 33,157 As of March 31, 2023, 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, LIBOR 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 March 31, 2023 was 7.00% (LIBOR of 4.75% plus 2.25%). The actual ABR loan rate at March 31, 2023 was 9.25% (lender’s prime rate of 8.00% plus 1.25%). Subsequent Event - Amendment to Credit Facility On April 26, 2023, the Company entered into a First Amendment to the 2021 Credit Agreement (the "First Amendment") with the Agent and the lenders party thereto, which amended the 2021 Credit Agreement, to provide for, among other things: (i) an extension of the maturity date for the 2021 Credit Agreement to April 26, 2028, (ii) the replacement of LIBOR with Term SOFR as a benchmark interest rate, and (iii) an increase of the maximum dollar amount of incremental revolving loans from $25 million to $35 million. Incremental revolving loans continue to be subject to certain conditions, including the consent of the Agent and obtaining necessary commitments. |
Derivative Financial Instrument
Derivative Financial Instruments and Hedging Activities | 3 Months Ended |
Mar. 31, 2023 | |
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): March 31, 2023 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 1,683 December 31, 2022 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 1,965 The table below presents the effect of our derivative financial instruments designated as hedging instruments in AOCI (in thousands): Three Months Ended March 31, 2023 2022 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,489 $ 268 Unrealized gain recognized in AOCI (92) 877 Amounts reclassified to interest expense (a) (b) (190) 28 Tax provision 63 (218) Ending balance $ 1,270 $ 955 (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 March 31, 2023 and 2022 was $0.5 million and $0.3 million, respectively. (b) As of March 31, 2023, $0.8 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 months ended March 31, 2023. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income TaxesDuring the three months ended March 31, 2023, the Company recorded a benefit from income taxes of $0.3 million. The income tax benefit for the three months ended March 31, 2023 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 months ended March 31, 2022, the Company recorded a benefit from income taxes of $0.5 million. |
Commitments, Contingencies and
Commitments, Contingencies and Litigation | 3 Months Ended |
Mar. 31, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments, Contingencies and Litigation | Commitments, Contingencies and LitigationFrom 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. |
Loss Per Share
Loss Per Share | 3 Months Ended |
Mar. 31, 2023 | |
Earnings Per Share [Abstract] | |
Loss Per Share | Loss Per Share Basic loss per share is computed by dividing net loss by the weighted average number of common shares outstanding during the period. Diluted 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 loss per share computations: Three Months Ended March 31, Numerator (in thousands) : 2023 2022 Net loss: $ (324) $ (368) Denominator: Weighted average common shares outstanding: Basic 20,853,018 20,609,372 Dilutive effect of common stock equivalents — — Diluted 20,853,018 20,609,372 Net loss per share: Basic $ (0.02) $ (0.02) Diluted $ (0.02) $ (0.02) For both the three months ended March 31, 2023 and 2022, all outstanding options and unvested restricted stock units were anti-dilutive due to the Company's net losses for the periods and therefore not included in the calculation. 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 March 31, 2023, the Company had repurchased and retired approximately $6.2 million, or 553,149 shares, of the Company's outstanding common stock under the Share Repurchase Program. |
Leases
Leases | 3 Months Ended |
Mar. 31, 2023 | |
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 months ended March 31, 2023 and 2022 are as follows (in thousands): Three Months Ended 2023 2022 Operating lease cost $ 352 $ 329 Variable lease cost 76 74 Total lease cost $ 428 $ 403 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Three Months Ended 2023 2022 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 449 $ 359 Right of use assets obtained in exchange for lease obligations: Operating leases $ 381 $ — Increases to right of use assets resulting from lease modifications: Operating leases $ 160 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: As of March 31, 2023 2022 Years Years Weighted average remaining lease term: 6.2 6.2 Rate Rate Weighted average discount rate: 7.0% 7.6% Future maturities of lease liabilities as of March 31, 2023 are as follows (in thousands): Operating Leases (a) 2023 $ 969 2024 1,235 2025 1,172 2026 998 2027 826 2028 and thereafter 2,016 Total undiscounted lease payments 7,216 Less: Imputed interest (2,383) Total lease liabilities $ 4,833 (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 the fourth quarter of 2023. |
Business Segment Information
Business Segment Information | 3 Months Ended |
Mar. 31, 2023 | |
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 March 31, 2023 and 2022: 2023 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 18,774 $ 11,596 $ — $ 30,370 Net revenues - internal — 1,630 (1,630) — Total net revenues 18,774 13,226 (1,630) 30,370 Gross profit 11,541 3,999 — 15,540 Selling, general and administrative expenses 15,647 15,647 Interest expense (484) (484) Other expense (35) (35) Benefit from income taxes 302 302 Net loss $ (324) Total assets $ 62,769 $ 37,492 $ 2,000 $ 102,261 Purchases of medical equipment $ 2,673 $ 1,295 $ — $ 3,968 Depreciation and amortization of intangible assets $ 2,178 $ 1,025 $ — $ 3,203 2022 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 16,641 $ 10,122 $ — $ 26,763 Net revenues - internal — 1,488 (1,488) — Total net revenues 16,641 11,610 (1,488) 26,763 Gross profit 10,738 4,629 — 15,367 Selling, general and administrative expenses 15,892 15,892 Interest expense (277) (277) Other expense (28) (28) Benefit from income taxes 462 462 Net loss $ (368) Total assets $ 61,991 $ 34,246 $ 2,000 $ 98,237 Purchases of medical equipment $ 1,511 $ 1,420 $ — $ 2,931 Depreciation and amortization of intangible assets $ 2,398 $ 1,018 $ — $ 3,416 |
Revenue Recognition (Tables)
Revenue Recognition (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
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 2023 2022 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues ITS Third-Party Payer Rentals $ 14,808 48.8 % $ 13,368 50.0 % DME Services Direct Payer Rentals 4,507 14.9 % 4,775 17.8 % ITS Direct Payer Rentals 3,472 11.4 % 3,187 11.9 % DME Services Product Sales 3,739 12.3 % 3,658 13.7 % DME Services - Service 3,350 11.0 % 1,689 6.3 % ITS Product Sales 494 1.6 % 86 0.3 % Total $ 30,370 100.0 % $ 26,763 100.0 % |
Medical Equipment (Tables)
Medical Equipment (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Medical Equipment [Abstract] | |
Schedule of Medical Equipment | Medical equipment consisted of the following (in thousands): March 31, December 31, 2022 Medical equipment for sale or rental $ 3,054 $ 2,802 Medical equipment for sale or rental - pump reserve (12) (12) Medical equipment for sale or rental - net 3,042 2,790 Medical equipment in rental service 100,026 99,163 Medical equipment in rental service - pump reserve (2,427) (2,270) Accumulated depreciation (58,979) (57,443) Medical equipment in rental service - net 38,620 39,450 Total $ 41,662 $ 42,240 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property, Plant and Equipment | Property and equipment consisted of the following (in thousands): March 31, 2023 December 31, 2022 Gross Assets Accumulated Depreciation Total Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 5,986 $ (3,428) $ 2,558 $ 5,710 $ (3,252) $ 2,458 Automobiles 87 (85) 2 87 (83) 4 Leasehold improvements 3,498 (1,667) 1,831 3,498 (1,575) 1,923 Total $ 9,571 $ (5,180) $ 4,391 $ 9,295 $ (4,910) $ 4,385 |
Goodwill & Intangible Assets (T
Goodwill & Intangible Assets (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Goodwill | The changes in the carrying value of goodwill by segment for the three months ended March 31, 2023 are as follows (in thousands): DME Services (a) Balance as of December 31, 2022 $ 3,710 Goodwill acquired — Balance as of March 31, 2023 $ 3,710 (a) The ITS segment had no recorded goodwill during the reported periods. |
Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets | The carrying amount and accumulated amortization of intangible assets consisted of the following (in thousands): March 31, 2023 December 31, 2022 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 (33,769) 5,065 38,834 (33,594) 5,240 Non-competition agreements 472 (185) 287 472 (161) 311 Unpatented technology 943 (292) 651 943 (258) 685 Software 10,300 (10,115) 185 10,300 (10,100) 200 Total nonamortizable and amortizable intangible assets $ 52,572 $ (44,384) $ 8,188 $ 52,572 $ (44,136) $ 8,436 |
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 March 31, 2023 is as follows (in thousands): 2023 2024 2025 2026 2027 2028 and thereafter Total Amortization expense $ 743 $ 990 $ 810 $ 524 $ 471 $ 2,650 $ 6,188 |
Debt (Tables)
Debt (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
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): March 31, December 31, Revolving Facility: Gross availability $ 75,000 $ 75,000 Outstanding draws (36,594) (33,384) Letter of credit (400) (400) Availability on Revolving Facility $ 38,006 $ 41,216 |
Schedule of Maturities of Long-term Debt | The Company had future maturities of its long-term debt as of March 31, 2023 as follows (in thousands): 2023 2024 2025 2026 2027 and thereafter Total Revolving Facility $ — $ — $ — $ 36,594 $ — $ 36,594 Total $ — $ — $ — $ 36,594 $ — $ 36,594 |
Schedule of Debt | The following is a breakdown of the Company’s current and long-term debt (in thousands): March 31, 2023 December 31, 2022 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Revolving Facility $ — $ 36,594 $ 36,594 $ — $ 33,384 $ 33,384 Unamortized value of debt issuance costs — (208) (208) — (227) (227) Total $ — $ 36,386 $ 36,386 $ — $ 33,157 $ 33,157 |
Derivative Financial Instrume_2
Derivative Financial Instruments and Hedging Activities (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
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): March 31, 2023 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 1,683 December 31, 2022 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Other assets $ 20,000 $ 1,965 |
Schedule of Derivative Instruments, Effect on AOCI | The table below presents the effect of our derivative financial instruments designated as hedging instruments in AOCI (in thousands): Three Months Ended March 31, 2023 2022 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,489 $ 268 Unrealized gain recognized in AOCI (92) 877 Amounts reclassified to interest expense (a) (b) (190) 28 Tax provision 63 (218) Ending balance $ 1,270 $ 955 (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 March 31, 2023 and 2022 was $0.5 million and $0.3 million, respectively. (b) As of March 31, 2023, $0.8 million of income is expected to be reclassified into earnings within the next 12 months. |
Loss Per Share (Tables)
Loss Per Share (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
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 loss per share computations: Three Months Ended March 31, Numerator (in thousands) : 2023 2022 Net loss: $ (324) $ (368) Denominator: Weighted average common shares outstanding: Basic 20,853,018 20,609,372 Dilutive effect of common stock equivalents — — Diluted 20,853,018 20,609,372 Net loss per share: Basic $ (0.02) $ (0.02) Diluted $ (0.02) $ (0.02) |
Leases (Tables)
Leases (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
Leases [Abstract] | |
Lease, Cost | The components of lease costs for the three months ended March 31, 2023 and 2022 are as follows (in thousands): Three Months Ended 2023 2022 Operating lease cost $ 352 $ 329 Variable lease cost 76 74 Total lease cost $ 428 $ 403 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Three Months Ended 2023 2022 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 449 $ 359 Right of use assets obtained in exchange for lease obligations: Operating leases $ 381 $ — Increases to right of use assets resulting from lease modifications: Operating leases $ 160 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: As of March 31, 2023 2022 Years Years Weighted average remaining lease term: 6.2 6.2 Rate Rate Weighted average discount rate: 7.0% 7.6% |
Lessee, Operating Lease, Liability, Maturity | Future maturities of lease liabilities as of March 31, 2023 are as follows (in thousands): Operating Leases (a) 2023 $ 969 2024 1,235 2025 1,172 2026 998 2027 826 2028 and thereafter 2,016 Total undiscounted lease payments 7,216 Less: Imputed interest (2,383) Total lease liabilities $ 4,833 (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 the fourth quarter of 2023. |
Business Segment Information (T
Business Segment Information (Tables) | 3 Months Ended |
Mar. 31, 2023 | |
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 March 31, 2023 and 2022: 2023 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 18,774 $ 11,596 $ — $ 30,370 Net revenues - internal — 1,630 (1,630) — Total net revenues 18,774 13,226 (1,630) 30,370 Gross profit 11,541 3,999 — 15,540 Selling, general and administrative expenses 15,647 15,647 Interest expense (484) (484) Other expense (35) (35) Benefit from income taxes 302 302 Net loss $ (324) Total assets $ 62,769 $ 37,492 $ 2,000 $ 102,261 Purchases of medical equipment $ 2,673 $ 1,295 $ — $ 3,968 Depreciation and amortization of intangible assets $ 2,178 $ 1,025 $ — $ 3,203 2022 (in thousands) ITS DME Services Corporate/ Eliminations Total Net revenues - external $ 16,641 $ 10,122 $ — $ 26,763 Net revenues - internal — 1,488 (1,488) — Total net revenues 16,641 11,610 (1,488) 26,763 Gross profit 10,738 4,629 — 15,367 Selling, general and administrative expenses 15,892 15,892 Interest expense (277) (277) Other expense (28) (28) Benefit from income taxes 462 462 Net loss $ (368) Total assets $ 61,991 $ 34,246 $ 2,000 $ 98,237 Purchases of medical equipment $ 1,511 $ 1,420 $ — $ 2,931 Depreciation and amortization of intangible assets $ 2,398 $ 1,018 $ — $ 3,416 |
Basis of Presentation, Nature_2
Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies (Details) | 3 Months Ended |
Mar. 31, 2023 segment | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Number of reportable segments | 2 |
Revenue Recognition - Disaggreg
Revenue Recognition - Disaggregated Revenue by Revenue Stream (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | $ 30,370 | $ 26,763 |
ITS Third-Party Payer Rentals | ITS Segment | ||
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | 14,808 | 13,368 |
DME Services Direct Payer Rentals | ITS Segment | ||
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | 3,472 | 3,187 |
DME Services Direct Payer Rentals | DME Services Segment | ||
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | 4,507 | 4,775 |
DME Services - Service | DME Services Segment | ||
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | 3,739 | 3,658 |
DME Services - Service | DME Services Segment | ||
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | 3,350 | 1,689 |
ITS Product Sales | ITS Segment | ||
Disaggregation of Revenue [Line Items] | ||
Total Net Revenues | $ 494 | $ 86 |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 100% | 100% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | ITS Third-Party Payer Rentals | ITS Segment | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 48.80% | 50% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | DME Services Direct Payer Rentals | ITS Segment | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 11.40% | 11.90% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | DME Services Direct Payer Rentals | DME Services Segment | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 14.90% | 17.80% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | DME Services - Service | DME Services Segment | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 12.30% | 13.70% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | DME Services - Service | DME Services Segment | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 11% | 6.30% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | ITS Product Sales | ITS Segment | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of Total Net Revenues | 1.60% | 0.30% |
Medical Equipment - Summary of
Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Medical Equipment [Abstract] | ||
Medical equipment for sale or rental | $ 3,054 | $ 2,802 |
Medical equipment for sale or rental - pump reserve | (12) | (12) |
Medical equipment for sale or rental - net | 3,042 | 2,790 |
Medical equipment in rental service | 100,026 | 99,163 |
Medical equipment in rental service - pump reserve | (2,427) | (2,270) |
Accumulated depreciation | (58,979) | (57,443) |
Medical equipment in rental service - net | 38,620 | 39,450 |
Total | $ 41,662 | $ 42,240 |
Medical Equipment - Narrative (
Medical Equipment - Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Medical Equipment [Abstract] | ||
Depreciation expense related to medical equipment | $ 2.7 | $ 2.4 |
Medical equipment increase in pump reserve | $ 0.1 |
Property and Equipment - Schedu
Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Property, Plant and Equipment [Line Items] | ||
Gross Assets | $ 9,571 | $ 9,295 |
Accumulated Depreciation | (5,180) | (4,910) |
Total | 4,391 | 4,385 |
Furniture, fixtures, and equipment | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 5,986 | 5,710 |
Accumulated Depreciation | (3,428) | (3,252) |
Total | 2,558 | 2,458 |
Automobiles | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 87 | 87 |
Accumulated Depreciation | (85) | (83) |
Total | 2 | 4 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 3,498 | 3,498 |
Accumulated Depreciation | (1,667) | (1,575) |
Total | $ 1,831 | $ 1,923 |
Property and Equipment - Narrat
Property and Equipment - Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Property, Plant and Equipment [Abstract] | ||
Depreciation | $ 0.3 | $ 0.3 |
Goodwill & Intangible Assets -
Goodwill & Intangible Assets - Goodwill (Details) | 3 Months Ended |
Mar. 31, 2023 USD ($) | |
Goodwill [Roll Forward] | |
Goodwill, beginning balance | $ 3,710,000 |
Goodwill, ending balance | 3,710,000 |
DME Services Segment | |
Goodwill [Roll Forward] | |
Goodwill, beginning balance | 3,710,000 |
Goodwill acquired | 0 |
Goodwill, ending balance | 3,710,000 |
ITS Segment | |
Goodwill [Roll Forward] | |
Goodwill, ending balance | $ 0 |
Goodwill & Intangible Assets _2
Goodwill & Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Goodwill [Line Items] | ||
Trade names | $ 2,000 | $ 2,000 |
Accumulated Amortization | (44,384) | (44,136) |
Total | 6,188 | |
Total nonamortizable and amortizable intangible assets | 52,572 | 52,572 |
Net | 8,188 | 8,436 |
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 | (33,769) | (33,594) |
Total | 5,065 | 5,240 |
Non-competition agreements | ||
Goodwill [Line Items] | ||
Gross Assets | 472 | 472 |
Accumulated Amortization | (185) | (161) |
Total | 287 | 311 |
Unpatented technology | ||
Goodwill [Line Items] | ||
Gross Assets | 943 | 943 |
Accumulated Amortization | (292) | (258) |
Total | 651 | 685 |
Software | ||
Goodwill [Line Items] | ||
Gross Assets | 10,300 | 10,300 |
Accumulated Amortization | (10,115) | (10,100) |
Total | $ 185 | $ 200 |
Goodwill & Intangible Assets _3
Goodwill & Intangible Assets - Narrative (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Goodwill and Intangible Assets Disclosure [Abstract] | ||
Amortization of intangible assets | $ 248 | $ 710 |
Goodwill & Intangible Assets _4
Goodwill & Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands | Mar. 31, 2023 USD ($) |
Goodwill and Intangible Assets Disclosure [Abstract] | |
2023 | $ 743 |
2024 | 990 |
2025 | 810 |
2026 | 524 |
2027 | 471 |
2028 and thereafter | 2,650 |
Total | $ 6,188 |
Debt - Narrative (Details)
Debt - Narrative (Details) $ in Thousands | 3 Months Ended | ||||
Feb. 05, 2021 USD ($) | Mar. 31, 2023 USD ($) | Apr. 26, 2023 USD ($) | Apr. 25, 2023 USD ($) | Dec. 31, 2022 USD ($) | |
Revolving Facility | |||||
Debt Instrument [Line Items] | |||||
Long-term line of credit | $ 36,594 | $ 33,384 | |||
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 | 7% | ||||
LIBOR rate | 4.75% | ||||
The 2021 Credit Agreement | ABR Loans | |||||
Debt Instrument [Line Items] | |||||
Effective percentage | 9.25% | ||||
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 | 8% | ||||
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 | Revolving Facility | Subsequent Event | |||||
Debt Instrument [Line Items] | |||||
Revolving credit facility | $ 35,000 | $ 25,000 | |||
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 |
Debt - Summary of Revolver Base
Debt - Summary of Revolver Based Upon Borrowers' Eligible Accounts Receivable and Inventory (Details) - Revolving Facility - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Gross availability | $ 75,000 | $ 75,000 |
Outstanding draws | (36,594) | (33,384) |
Letter of credit | (400) | (400) |
Availability on Revolving Facility | $ 38,006 | $ 41,216 |
Debt - Summary of Future Maturi
Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
2023 | $ 0 | |
2024 | 0 | |
2025 | 0 | |
2026 | 36,594 | |
2027 and thereafter | 0 | |
Total | 36,594 | |
Revolving Facility | ||
Debt Instrument [Line Items] | ||
2023 | 0 | |
2024 | 0 | |
2025 | 0 | |
2026 | 36,594 | |
2027 and thereafter | 0 | |
Total | $ 36,594 | $ 33,384 |
Debt - Summary of Company's Cur
Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Total | $ 36,594 | |
Unamortized value of the debt issuance costs, current portion of long-term debt | 0 | $ 0 |
Unamortized value of the debt issuance costs, long-term debt | (208) | (227) |
Unamortized value of the debt issuance costs, total | (208) | (227) |
Current portion of long-term debt | 0 | 0 |
Long-term debt | 36,386 | 33,157 |
Total | 36,386 | 33,157 |
Revolving Facility | ||
Debt Instrument [Line Items] | ||
Current Portion | 0 | 0 |
Long-Term Portion | 36,594 | 33,384 |
Total | $ 36,594 | $ 33,384 |
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 | |
Feb. 05, 2021 agreement | Mar. 31, 2023 USD ($) | |
Derivative [Line Items] | ||
Interest rate swap | agreement | 2 | |
Term of contract (year) | 5 years | |
Fixed interest rate | 0.73% | |
Net hedge effectiveness | $ | $ 0 |
Derivative Financial Instrume_4
Derivative Financial Instruments and Hedging Activities - Fair Value and Notional Amounts of Cash Flow Hedges (Details) - USD ($) $ in Thousands | Mar. 31, 2023 | Dec. 31, 2022 |
Derivative [Line Items] | ||
Fair Value Derivative Assets | $ 1,683 | $ 1,965 |
Cash flow hedges | Interest rate swaps | Derivatives designated as hedges: | ||
Derivative [Line Items] | ||
Notional | 20,000 | 20,000 |
Fair Value Derivative Assets | $ 1,683 | $ 1,965 |
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 | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Derivative [Line Items] | ||
Beginning balance | $ 48,003 | $ 48,272 |
Ending balance | 48,261 | 46,053 |
Interest expense | 484 | 277 |
Interest rate swaps | Cash flow hedges | Derivatives designated as hedges: | ||
Derivative [Line Items] | ||
Reclassified within twelve months | 800 | |
Gain/(loss) on cash flow hedges | ||
Derivative [Line Items] | ||
Beginning balance | 1,489 | 268 |
Unrealized gain recognized in AOCI | (92) | 877 |
Amounts reclassified to interest expense | (190) | 28 |
Tax provision | 63 | (218) |
Ending balance | $ 1,270 | $ 955 |
Income Taxes - Narrative (Detai
Income Taxes - Narrative (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Income Tax Disclosure [Abstract] | ||
Benefit from income taxes | $ 302 | $ 462 |
Loss Per Share - Calculation of
Loss Per Share - Calculation of Basic and Diluted EPS (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Earnings Per Share [Abstract] | ||
Net loss | $ (324) | $ (368) |
Weighted average common shares outstanding: | ||
Basic (in shares) | 20,853,018 | 20,609,372 |
Dilutive effect of common stock equivalents (in shares) | 0 | 0 |
Diluted (in shares) | 20,853,018 | 20,609,372 |
Basic (in dollars per share) | $ (0.02) | $ (0.02) |
Diluted (in dollars per share) | $ (0.02) | $ (0.02) |
Loss Per Share - Narrative (Det
Loss Per Share - Narrative (Details) - USD ($) | Mar. 31, 2023 | Jun. 30, 2021 |
Earnings Per Share [Abstract] | ||
Stock repurchase program, authorized amount | $ 20,000,000 | |
Cumulative shares purchased | $ 6,200,000 | |
Cumulative shares purchased (in shares) | 553,149 |
Leases - Narrative (Details)
Leases - Narrative (Details) | Mar. 31, 2023 |
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 | |
Mar. 31, 2023 | Mar. 31, 2022 | |
Leases [Abstract] | ||
Operating lease cost | $ 352 | $ 329 |
Variable lease cost | 76 | 74 |
Total lease cost | 428 | 403 |
Operating cash flow from operating leases | 449 | 359 |
Operating leases | 381 | 0 |
Increases to right of use assets resulting from lease modifications, operating lease | $ 160 | $ 0 |
Weighted average remaining lease term: | 6 years 2 months 12 days | 6 years 2 months 12 days |
Weighted average discount rate: | 7% | 7.60% |
Leases - Maturities of Lease Li
Leases - Maturities of Lease Liabilities (Details) $ in Thousands | Mar. 31, 2023 USD ($) |
Leases [Abstract] | |
2023 | $ 969 |
2024 | 1,235 |
2025 | 1,172 |
2026 | 998 |
2027 | 826 |
2028 and thereafter | 2,016 |
Total undiscounted lease payments | 7,216 |
Less: Imputed interest | (2,383) |
Total lease liabilities | 4,833 |
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 | ||
Mar. 31, 2023 | Mar. 31, 2022 | Dec. 31, 2022 | |
Segment Reporting Information [Line Items] | |||
Net revenues - external | $ 30,370 | $ 26,763 | |
Net revenues - internal | 0 | 0 | |
Total net revenues | 30,370 | 26,763 | |
Gross profit | 15,540 | 15,367 | |
Selling, general and administrative expenses | 15,647 | 15,892 | |
Interest expense | (484) | (277) | |
Other income expense | (35) | (28) | |
Benefit from income taxes | 302 | 462 | |
Net loss | (324) | (368) | |
Total assets | 102,261 | 98,237 | $ 99,388 |
Purchases of medical equipment | 3,968 | 2,931 | |
Depreciation and amortization of intangible assets | 3,203 | 3,416 | |
Corporate and Eliminations | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 0 | 0 | |
Net revenues - internal | (1,630) | (1,488) | |
Total net revenues | (1,630) | (1,488) | |
Gross profit | 0 | 0 | |
Selling, general and administrative expenses | 15,647 | 15,892 | |
Interest expense | (484) | (277) | |
Other income expense | (35) | (28) | |
Benefit from income taxes | 302 | 462 | |
Total assets | 2,000 | 2,000 | |
Purchases of medical equipment | 0 | 0 | |
Depreciation and amortization of intangible assets | 0 | 0 | |
ITS Segment | Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 18,774 | 16,641 | |
Net revenues - internal | 0 | 0 | |
Total net revenues | 18,774 | 16,641 | |
Gross profit | 11,541 | 10,738 | |
Total assets | 62,769 | 61,991 | |
Purchases of medical equipment | 2,673 | 1,511 | |
Depreciation and amortization of intangible assets | 2,178 | 2,398 | |
DME Services Segment | Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 11,596 | 10,122 | |
Net revenues - internal | 1,630 | 1,488 | |
Total net revenues | 13,226 | 11,610 | |
Gross profit | 3,999 | 4,629 | |
Total assets | 37,492 | 34,246 | |
Purchases of medical equipment | 1,295 | 1,420 | |
Depreciation and amortization of intangible assets | $ 1,025 | $ 1,018 |