Cover
Cover - shares | 3 Months Ended | |
Mar. 31, 2024 | May 03, 2024 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Mar. 31, 2024 | |
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 $0.0001 per share | |
Trading Symbol(s) | INFU | |
Name of Each Exchange on which Registered | NYSEAMER | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 21,295,254 | |
Entity Central Index Key | 0001337013 | |
Amendment Flag | false | |
Current Fiscal Year End Date | --12-31 | |
Document Fiscal Period Focus | Q1 | |
Document Fiscal Year Focus | 2024 |
Condensed Consolidated Balance
Condensed Consolidated Balance Sheets - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Current assets: | ||
Cash and cash equivalents | $ 822 | $ 231 |
Accounts receivable, net | 20,543 | 19,830 |
Inventories, net | 6,249 | 6,402 |
Other current assets | 4,842 | 4,157 |
Total current assets | 32,456 | 30,620 |
Medical equipment for sale or rental | 4,084 | 3,049 |
Medical equipment in rental service, net of accumulated depreciation | 34,425 | 34,928 |
Property & equipment, net of accumulated depreciation | 4,231 | 4,321 |
Goodwill | 3,710 | 3,710 |
Intangible assets, net | 7,199 | 7,446 |
Operating lease right of use assets | 6,206 | 6,703 |
Deferred income taxes | 9,236 | 9,115 |
Derivative financial instruments | 1,716 | 1,442 |
Other assets | 1,587 | 1,581 |
Total assets | 104,850 | 102,915 |
Current liabilities: | ||
Accounts payable | 9,796 | 8,009 |
Other current liabilities | 7,516 | 7,704 |
Total current liabilities | 17,312 | 15,713 |
Long-term debt, net of current portion | 29,931 | 29,101 |
Operating lease liabilities, net of current portion | 5,331 | 5,799 |
Total liabilities | 52,574 | 50,613 |
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; 21,290,254 shares issued and outstanding as of March 31, 2024 and 21,196,851 shares issued and outstanding as of December 31, 2023 | 2 | 2 |
Additional paid-in capital | 110,715 | 109,837 |
Accumulated other comprehensive income | 1,296 | 1,088 |
Retained deficit | (59,737) | (58,625) |
Total stockholders’ equity | 52,276 | 52,302 |
Total liabilities and stockholders’ equity | $ 104,850 | $ 102,915 |
Condensed Consolidated Balanc_2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares | Mar. 31, 2024 | Dec. 31, 2023 |
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) | 21,290,254 | 21,196,851 |
Common stock, outstanding (in shares) | 21,290,254 | 21,196,851 |
Condensed Consolidated Statemen
Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Income Statement [Abstract] | ||
Net revenues | $ 31,995 | $ 30,370 |
Cost of revenues | 15,521 | 15,420 |
Gross profit | 16,474 | 14,950 |
Selling, general and administrative expenses: | ||
Amortization of intangibles | 248 | 248 |
Selling and marketing | 3,376 | 3,224 |
General and administrative | 13,695 | 11,585 |
Total selling, general and administrative | 17,319 | 15,057 |
Operating loss | (845) | (107) |
Other expense: | ||
Interest expense | (456) | (484) |
Other income (expense) | 3 | (35) |
Loss before income taxes | (1,298) | (626) |
Benefit from income taxes | 186 | 302 |
Net loss | $ (1,112) | $ (324) |
Net loss per share: | ||
Basic (in dollars per share) | $ (0.05) | $ (0.02) |
Diluted (in dollars per share) | $ (0.05) | $ (0.02) |
Weighted average shares outstanding: | ||
Basic (in shares) | 21,225,768 | 20,853,018 |
Diluted (in shares) | 21,225,768 | 20,853,018 |
Comprehensive loss: | ||
Net loss: | $ (1,112) | $ (324) |
Other comprehensive income (loss): | ||
Unrealized gain (loss) on hedges | 274 | (282) |
(Provision for) benefit from income tax on unrealized hedge gain | (66) | 63 |
Net comprehensive loss | $ (904) | $ (543) |
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 |
Beginning balance (in shares) at Dec. 31, 2022 | 20,782,000 | ||||
Beginning balance at Dec. 31, 2022 | $ 48,003 | $ 2 | $ 105,856 | $ (59,344) | $ 1,489 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||
Shares issued upon restricted stock vesting and option exercise (in shares) | 167,000 | ||||
Shares issued upon restricted stock vesting and option exercise | 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 (loss) income | (219) | (219) | |||
Net loss | (324) | (324) | |||
Ending balance (in shares) at Mar. 31, 2023 | 20,931,000 | ||||
Ending balance at Mar. 31, 2023 | $ 48,261 | $ 2 | 106,810 | (59,821) | 1,270 |
Beginning balance (in shares) at Dec. 31, 2023 | 21,196,851 | 21,197,000 | |||
Beginning balance at Dec. 31, 2023 | $ 52,302 | $ 2 | 109,837 | (58,625) | 1,088 |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||
Shares issued upon restricted stock vesting and option exercise (in shares) | 106,000 | ||||
Shares issued upon restricted stock vesting and option exercise | 0 | ||||
Stock-based compensation expense | 1,057 | 1,057 | |||
Employee stock purchase plan (in shares) | 26,000 | ||||
Employee stock purchase plan | 186 | 186 | |||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares) | (39,000) | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation | (365) | (365) | |||
Other comprehensive (loss) income | 208 | 208 | |||
Net loss | $ (1,112) | (1,112) | |||
Ending balance (in shares) at Mar. 31, 2024 | 21,290,254 | 21,290,000 | |||
Ending balance at Mar. 31, 2024 | $ 52,276 | $ 2 | $ 110,715 | $ (59,737) | $ 1,296 |
Condensed Consolidated Statem_3
Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
OPERATING ACTIVITIES | ||
Net loss: | $ (1,112) | $ (324) |
Adjustments to reconcile net loss to net cash provided by operating activities: | ||
Provision for doubtful accounts | (130) | 114 |
Depreciation | 2,652 | 2,955 |
(Gain) loss on disposal of and reserve adjustments for medical equipment | (43) | 450 |
Gain on sale of medical equipment | (629) | (883) |
Amortization of intangible assets | 248 | 248 |
Amortization of deferred debt issuance costs | 19 | 18 |
Stock-based compensation | 1,057 | 720 |
Deferred income taxes | (186) | (302) |
Changes in assets - (increase)/decrease: | ||
Accounts receivable | (237) | (961) |
Inventories | 153 | (823) |
Other current assets | (685) | (830) |
Other assets | 376 | (846) |
Changes in liabilities - (decrease)/increase: | ||
Accounts payable and other liabilities | (1,106) | 313 |
NET CASH PROVIDED BY (USED IN) OPERATING ACTIVITIES | 377 | (151) |
INVESTING ACTIVITIES | ||
Purchase of medical equipment | (1,493) | (3,968) |
Purchase of property and equipment | (182) | (317) |
Proceeds from sale of medical equipment, property and equipment | 1,257 | 1,234 |
NET CASH USED IN INVESTING ACTIVITIES | (418) | (3,051) |
FINANCING ACTIVITIES | ||
Principal payments on long-term debt | (15,258) | (13,683) |
Cash proceeds from long-term debt | 16,069 | 16,894 |
Common stock repurchased as part of share repurchase program | 0 | (153) |
Common stock repurchased to satisfy statutory withholding on employee stock-based compensation plans | (365) | (324) |
Cash proceeds from exercise of options and ESPP | 186 | 559 |
NET CASH PROVIDED BY FINANCING ACTIVITIES | 632 | 3,293 |
Net change in cash and cash equivalents | 591 | 91 |
Cash and cash equivalents, beginning of period | 231 | 165 |
Cash and cash equivalents, end of period | $ 822 | $ 256 |
Basis of Presentation and Natur
Basis of Presentation and Nature of Operations | 3 Months Ended |
Mar. 31, 2024 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation and Nature of Operations | Basis of Presentation and Nature of Operations 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, Patient Services and Device Solutions. During the fiscal year ended December 31, 2023, the Company also operated through First Biomedical, Inc., a Kansas Corporation, which was a wholly-owned subsidiary that merged into InfuSystem, Inc. on January 1, 2024. 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, 2023 as filed with the SEC on April 10, 2024. 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, 2024 | |
Accounting Policies [Abstract] | |
Recent Accounting Pronouncements and Developments | Recent Accounting Pronouncements and Developments In November 2023, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2023-07, Segment Reporting (ASC 280): Improvements to Reportable Segment Disclosures. ASU 2023-07 expands the disclosure requirements for reportable segments by requiring enhanced disclosures about significant segment expenses. Under the new standard, entities must disclose an amount for other segment items by reportable segment and a description of its composition. The other segment items category is the difference between segment revenue less the significant expenses disclosed and each reported measure of segment profit or loss. Additionally, entities must disclose at least one measure of assessing segment performance and the title and position of the chief operating decision-maker ("CODM") and an explanation of how the CODM uses the reported measure(s) of segment profit or loss in assessing segment performance. The amendments are effective for annual periods beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments are to be applied retrospectively to all prior periods presented in the financial statements. The Company is currently evaluating the impact of ASU 2023-07 on its consolidated financial statements and related disclosures. In December 2023, the FASB issued Accounting Standards Update No. 2023-09, Income Taxes (ASC 740): Improvements to Income Tax Disclosures. ASU 2023-09 enhances existing income tax disclosures primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. The amendments in this ASU requires public entities to disclose a tabular tax rate reconciliation, using both percentages and currency, with specific categories. Public entities are also required to provide a qualitative description of the states and local jurisdictions that make up the majority of the effect of the state and local income tax category and the net amount of income taxes paid, disaggregated by federal, state and foreign taxes and also disaggregated by individual jurisdictions. The amendments also remove certain disclosures that are no longer considered cost beneficial. The amendments are effective prospectively for annual periods beginning after December 15, 2024, and early adoption and retrospective application are permitted. The Company is currently evaluating the impact of ASU 2023-09 on its consolidated financial statements and related disclosures. In March 2024, the SEC issued final rules on climate-related disclosures that will require annual disclosure of material climate-related risks and material direct greenhouse gas emissions from operations owned or controlled (Scope 1) and material indirect greenhouse gas emissions from purchased energy consumed in owned or controlled operations (Scope 2). Additionally, the rules require disclosure in the notes to the financial statements of the effects of severe weather events and other natural conditions, subject to certain financial thresholds, as well as amounts related to carbon offsets and renewable energy credits or certificates. These rules also require disclosure of climate risk oversight practices of the Board of Directors and management, and the disclosure of governance, risk management and strategy related to material climate-related risks. In April 2024, the SEC voluntarily stayed the new rules pending the completion of judicial review. The disclosure requirements, if ultimately upheld as adopted, will begin phasing in for reports and registration statements including financial information with respect to annual periods beginning in our fiscal 2027. We are currently evaluating the impact of adoption of these final rules on our disclosures. |
Revenue
Revenue | 3 Months Ended |
Mar. 31, 2024 | |
Revenue from Contract with Customer [Abstract] | |
Revenue | Revenue The following table presents the Company’s disaggregated revenue by offering type (in thousands): Three Months Ended 2024 2023 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues Patient Services revenue recognized at a point in time: Direct products $ 615 1.9 % $ 579 1.9 % Third-Party Payer products 1,872 5.9 % 3,408 11.2 % Patient Services revenue recognized over time: Direct rental services 3,572 11.2 % 1,869 6.2 % Third-Party Payer rental services 10,977 34.3 % 11,020 36.3 % Total Patient Services accounted for under ASC 606 17,036 53.2 % 16,876 55.6 % Device Solutions revenue recognized at a point in time: Products 4,213 13.2 % 3,740 12.3 % Services 2,409 7.5 % 2,576 8.5 % Device Solutions revenue recognized over time: Services 1,969 6.2 % 774 2.5 % Total Device Solutions accounted for under ASC 606 8,591 26.9 % 7,090 23.3 % Total Revenue Accounted for under ASC 606 25,627 80.1 % 23,966 78.9 % Patient Services lease revenue 1,555 4.9 % 1,897 6.2 % Device Solutions lease revenue 4,813 15.0 % 4,507 14.8 % Total Revenue accounted for under ASC 842, Leases 6,368 19.9 % 6,404 21.1 % Total Net Revenue $ 31,995 100.0 % $ 30,370 100.0 % Contract Balances (dollars in thousands) As of March 31, 2024 As of December 31, 2023 $ Change Accounts receivable, net $ 20,543 $ 19,830 $ 713 Contract assets $ 1,332 $ 1,271 $ 61 The change in contract assets during the three months ended March 31, 2024 was mainly due to $2.9 million of revenue recognized for which the payment is subject to conditions other than the passage of time, partially offset by $2.8 million of contract assets reclassified to accounts receivable as our right to consideration for these contract assets became unconditional. Contract assets are included in other current assets on the Company's Condensed Consolidated Balance Sheets. |
Medical Equipment
Medical Equipment | 3 Months Ended |
Mar. 31, 2024 | |
Medical Equipment [Abstract] | |
Medical Equipment | Medical Equipment Medical equipment consisted of the following (in thousands): March 31, December 31, 2023 Medical equipment for sale or rental $ 4,113 $ 3,081 Medical equipment for sale or rental - pump reserve (29) (32) Medical equipment for sale or rental - net 4,084 3,049 Medical equipment in rental service 97,480 96,298 Medical equipment in rental service - pump reserve (2,033) (2,126) Accumulated depreciation (61,022) (59,244) Medical equipment in rental service - net 34,425 34,928 Total $ 38,509 $ 37,977 Depreciation expense for medical equipment for the three months ended March 31, 2024 was $2.3 million compared to $2.7 million for the same prior year period, 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. For the three months ended March 31, 2024 and 2023, $2.7 million and $1.1 million of current liabilities related to non-cash purchases of medical equipment and property, respectively, had not been included in investing activities in the Condensed Consolidated Statements of Cash Flows. These amounts will be included as a cash outflow from investing activities when paid. |
Property and Equipment
Property and Equipment | 3 Months Ended |
Mar. 31, 2024 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and Equipment Property and equipment consisted of the following (in thousands): March 31, 2024 December 31, 2023 Gross Assets Accumulated Depreciation Total Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 5,955 $ (4,094) $ 1,861 $ 6,611 $ (3,909) $ 2,702 Automobiles 87 (87) — 87 (87) — Leasehold improvements 4,442 (2,072) 2,370 3,570 (1,951) 1,619 Total $ 10,484 $ (6,253) $ 4,231 $ 10,268 $ (5,947) $ 4,321 Depreciation expense for property and equipment for both the three months ended March 31, 2024 and 2023 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, 2024 | |
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, 2024 are as follows (in thousands): Device Solutions (a) Balance as of December 31, 2023 $ 3,710 Goodwill acquired — Balance as of March 31, 2024 $ 3,710 (a) The Patient Services 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, 2024 December 31, 2023 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 (34,470) 4,364 38,834 (34,295) 4,539 Non-competition agreements 472 (279) 193 472 (255) 217 Unpatented technology 943 (426) 517 943 (393) 550 Software 10,300 (10,175) 125 10,300 (10,160) 140 Total nonamortizable and amortizable intangible assets $ 52,572 $ (45,373) $ 7,199 $ 52,572 $ (45,126) $ 7,446 Amortization expense for both the three months ended March 31, 2024 and 2023 was $0.2 million. 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, 2024 is as follows (in thousands): 2024 2025 2026 2027 2028 2029 and thereafter Total Amortization expense $ 743 $ 810 $ 525 $ 471 $ 348 $ 2,302 $ 5,199 |
Debt
Debt | 3 Months Ended |
Mar. 31, 2024 | |
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 InfuSystem Holdings, Inc. and its subsidiaries (collectively, 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 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 London Interbank Offered Rate (“LIBOR”) with Adjusted Term Secured Overnight Financing Rate (“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. The 2021 Credit Agreement and First Amendment were accounted for as debt modifications. As of March 31, 2024, the Company was in compliance with all debt-related covenants under the 2021 Credit Agreement, as amended. 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 (30,250) (29,439) Letter of credit (200) (200) Availability on Revolving Facility $ 44,550 $ 45,361 The Company had future maturities of its long-term debt as of March 31, 2024 as follows (in thousands): 2024 2025 2026 2027 2028 Total Revolving Facility $ — $ — $ — $ — $ 30,250 $ 30,250 Total $ — $ — $ — $ — $ 30,250 $ 30,250 The following is a breakdown of the Company’s current and long-term debt (in thousands): March 31, 2024 December 31, 2023 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Revolving Facility $ — $ 30,250 $ 30,250 $ — $ 29,439 $ 29,439 Unamortized value of debt issuance costs — (319) (319) — (338) (338) Total $ — $ 29,931 $ 29,931 $ — $ 29,101 $ 29,101 As of March 31, 2024, amounts outstanding under the Revolving Facility provided under the 2021 Credit Agreement, as amended, bear interest at a variable rate equal to, at the Company’s election, Adjusted Term SOFR for Term Benchmark loans or an Alternative Base Rate for ABR loans, as defined by the First Amendment, plus a spread that will vary depending upon the Company’s leverage ratio. The spread ranges from 2.00% to 3.00% for Term Benchmark Loans and 1.00% to 2.00% for base rate loans. The weighted-average Term Benchmark loan rate at March 31, 2024 was 7.42% (Adjusted Term SOFR of 5.42% plus 2.00%). The actual ABR loan rate at March 31, 2024 was 9.50% (lender’s prime rate of 8.50% plus 1.00%). |
Derivative Financial Instrument
Derivative Financial Instruments and Hedging Activities | 3 Months Ended |
Mar. 31, 2024 | |
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 had a constant notional amount over a five-year term that would have ended on February 5, 2026. While they were outstanding, each agreement paid the Company 30-day LIBOR on the notional amount and the Company paid a fixed rate of interest equal to 0.73%. These derivative instruments were considered cash flow hedges. On May 11, 2023, these two swaps were settled and a new swap was entered into with different terms that aligned with changes in the 2021 Credit Agreement arising from the First Amendment. The new swap has a constant notional amount over a five-year term that ends on April 26, 2028. The agreement pays the Company 30-day SOFR on the notional amount and the Company pays a fixed rate of interest equal to 1.74%. The Company does not have any other derivative financial instruments. The fair values of the Company’s derivative financial instruments are categorized as Level II of the fair value hierarchy as the values are derived using the market approach based on observable market inputs including quoted prices of similar instruments and interest rate forward curves. 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, 2024 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,716 December 31, 2023 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,442 The table below presents the effect of our derivative financial instruments designated as hedging instruments in accumulated other comprehensive income (“AOCI”) (in thousands): Three Months Ended March 31, 2024 2023 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,088 $ 1,489 Unrealized gain (loss) recognized in AOCI 456 (92) Amounts reclassified to interest expense (a) (b) (182) (190) Tax (provision) benefit (66) 63 Ending balance $ 1,296 $ 1,270 (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 loss for both the three months ended March 31, 2024 and 2023 was $0.5 million. (b) As of March 31, 2024, $0.6 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, 2024. |
Income Taxes
Income Taxes | 3 Months Ended |
Mar. 31, 2024 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes During the three months ended March 31, 2024, the Company recorded a benefit from income taxes totaling $0.2 million on pre-tax losses of $1.3 million, representing an effective tax rate of 14.3%. During the three months ended March 31, 2023, the Company recorded a benefit from income taxes totaling $0.3 million on pre-tax losses of $0.6 million, representing an effective tax rate of 48.2%. These rates differed from the U.S. statutory rate mainly due to the effects of local, state and foreign jurisdiction income taxes, limitations on the deductions of certain expenses including meals and entertainment expense and management compensation and differences between expense recognized for book purposes versus tax purposes associated with equity compensation expense. The impact of permanent differences weighs heavier on the effective tax rate when pre-tax earnings are close to break even. |
Commitments, Contingencies and
Commitments, Contingencies and Litigation | 3 Months Ended |
Mar. 31, 2024 | |
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. |
Loss Per Share
Loss Per Share | 3 Months Ended |
Mar. 31, 2024 | |
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) : 2024 2023 Net loss: $ (1,112) $ (324) Denominator: Weighted average common shares outstanding: Basic 21,225,768 20,853,018 Dilutive effect of common stock equivalents — — Diluted 21,225,768 20,853,018 Net loss per share: Basic $ (0.05) $ (0.02) Diluted $ (0.05) $ (0.02) For the three months ended March 31, 2024 and 2023, 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 calculations. 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, as amended. 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 at the discretion of the Board. As of March 31, 2024, 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. |
Share-Based Compensation
Share-Based Compensation | 3 Months Ended |
Mar. 31, 2024 | |
Share-Based Payment Arrangement [Abstract] | |
Share-Based Compensation | Share-Based Compensation The following tables summarize the activity during the period under the Company's 2014 Amended and Restated Stock Incentive Plan (the "2014 Plan") and 2021 Equity Incentive Plan (the "2021 Plan"). Restricted Stock Awards Number of Weighted Unvested at December 31, 2023 529,862 $ 11.42 Granted 88,499 9.09 Vested (67,844) 17.44 Vested shares forgone to satisfy minimum statutory withholding (38,656) 17.44 Forfeitures (3,500) 13.25 Unvested at March 31, 2024 508,361 $ 9.74 Three Months Ended March 31, 2024 2023 0 Weighted average grant date fair value of awards granted $ 9.09 $ — Total fair value of shares vested $ 641,823 $ 273,994 Total fair value of shares forgone to satisfy minimum statutory withholding $ 365,697 $ 167,251 Performance-Based Restricted Stock Units ("PSU") For the three months ended March 31, 2024, there were no grants, vesting, or forfeitures of PSUs. Stock Options 2014 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2023 657,346 $ 6.69 4.16 $ 2,983,514 Forfeitures and expirations (500) 18.44 Outstanding at March 31, 2024 656,846 $ 6.68 3.91 $ 2,099,944 Exercisable at March 31, 2024 656,846 $ 6.68 3.91 $ 2,099,944 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. 2021 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2023 1,051,673 $ 11.05 8.79 $ 1,207,118 Granted 152,927 8.97 Forfeitures and expirations (31,291) 9.73 Outstanding at March 31, 2024 (a) 1,173,309 $ 10.81 8.71 $ — Exercisable at March 31, 2024 (a) 309,597 $ 14.31 7.60 $ — (a) Aggregate Intrinsic Value - no exercisable options were in-the-money as of March 31, 2024 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. The following is the average fair value per share estimated on the date of grant and the assumptions used for options granted: Three Months Ended March 31, Stock Options: 2024 Expected volatility 50% to 51% Risk free interest rate 4.25% to 4.28% Expected lives at date of grant (in years) 4.06 Weighted average fair value of options granted $3.97 Total intrinsic value of options exercised $ — For the three months ended March 31, 2023, the Company did not grant any options, and thus that time period is excluded from the table above. |
Leases
Leases | 3 Months Ended |
Mar. 31, 2024 | |
Leases [Abstract] | |
Leases | Leases As Lessee 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 seven 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, 2024 and 2023 are as follows (in thousands): Three Months Ended 2024 2023 Operating lease cost $ 473 $ 352 Variable lease cost 75 76 Total lease cost $ 548 $ 428 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Three Months Ended 2024 2023 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 530 $ 449 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, 2024 2023 Years Years Weighted average remaining lease term: 6.0 6.2 Rate Rate Weighted average discount rate: 7.8% 7.0% Future maturities of lease liabilities as of March 31, 2024 are as follows (in thousands): Operating Leases 2024 $ 1,309 2025 1,837 2026 1,654 2027 1,478 2028 1,429 2029 and thereafter 2,424 Total undiscounted lease payments 10,131 Less: Imputed interest (3,266) Total lease liabilities $ 6,865 The long-term portion of the lease liabilities included in the amounts above is $5.3 million with the remainder included in other current liabilities in the Condensed Consolidated Balance Sheet. As Lessor: We lease medical equipment to customers, often in conjunction with arrangements to provide consumable medical products. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options, varies by customer. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The components of the Company’s lease revenues consisted of the following (in thousands): Three Months Ended March 31, 2024 2023 Net operating lease revenue $ 6,111 $ 5,910 Sales-type lease revenue 257 494 Total lease revenue $ 6,368 $ 6,404 The components of our net investment in sales-type leases as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Lease receivable $ 2,531 $ 2,583 Net investment in leases $ 2,531 $ 2,583 Our net investment in sales-type leases is classified as follows in the accompanying condensed consolidated balance sheets as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Accounts receivable, net $ 1,061 $ 1,067 Other assets 1,470 1,516 Total $ 2,531 $ 2,583 Future maturities of sales-type leases as of March 31, 2024 are as follows (in thousands): Sales-Type Leases 2024 $ 985 2025 1,292 2026 614 2027 12 2028 — Thereafter — Total undiscounted lease payments 2,903 Less: Imputed interest (372) Total lease receivables $ 2,531 |
Leases | Leases As Lessee 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 seven 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, 2024 and 2023 are as follows (in thousands): Three Months Ended 2024 2023 Operating lease cost $ 473 $ 352 Variable lease cost 75 76 Total lease cost $ 548 $ 428 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Three Months Ended 2024 2023 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 530 $ 449 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, 2024 2023 Years Years Weighted average remaining lease term: 6.0 6.2 Rate Rate Weighted average discount rate: 7.8% 7.0% Future maturities of lease liabilities as of March 31, 2024 are as follows (in thousands): Operating Leases 2024 $ 1,309 2025 1,837 2026 1,654 2027 1,478 2028 1,429 2029 and thereafter 2,424 Total undiscounted lease payments 10,131 Less: Imputed interest (3,266) Total lease liabilities $ 6,865 The long-term portion of the lease liabilities included in the amounts above is $5.3 million with the remainder included in other current liabilities in the Condensed Consolidated Balance Sheet. As Lessor: We lease medical equipment to customers, often in conjunction with arrangements to provide consumable medical products. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options, varies by customer. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The components of the Company’s lease revenues consisted of the following (in thousands): Three Months Ended March 31, 2024 2023 Net operating lease revenue $ 6,111 $ 5,910 Sales-type lease revenue 257 494 Total lease revenue $ 6,368 $ 6,404 The components of our net investment in sales-type leases as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Lease receivable $ 2,531 $ 2,583 Net investment in leases $ 2,531 $ 2,583 Our net investment in sales-type leases is classified as follows in the accompanying condensed consolidated balance sheets as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Accounts receivable, net $ 1,061 $ 1,067 Other assets 1,470 1,516 Total $ 2,531 $ 2,583 Future maturities of sales-type leases as of March 31, 2024 are as follows (in thousands): Sales-Type Leases 2024 $ 985 2025 1,292 2026 614 2027 12 2028 — Thereafter — Total undiscounted lease payments 2,903 Less: Imputed interest (372) Total lease receivables $ 2,531 |
Leases | Leases As Lessee 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 seven 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, 2024 and 2023 are as follows (in thousands): Three Months Ended 2024 2023 Operating lease cost $ 473 $ 352 Variable lease cost 75 76 Total lease cost $ 548 $ 428 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Three Months Ended 2024 2023 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 530 $ 449 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, 2024 2023 Years Years Weighted average remaining lease term: 6.0 6.2 Rate Rate Weighted average discount rate: 7.8% 7.0% Future maturities of lease liabilities as of March 31, 2024 are as follows (in thousands): Operating Leases 2024 $ 1,309 2025 1,837 2026 1,654 2027 1,478 2028 1,429 2029 and thereafter 2,424 Total undiscounted lease payments 10,131 Less: Imputed interest (3,266) Total lease liabilities $ 6,865 The long-term portion of the lease liabilities included in the amounts above is $5.3 million with the remainder included in other current liabilities in the Condensed Consolidated Balance Sheet. As Lessor: We lease medical equipment to customers, often in conjunction with arrangements to provide consumable medical products. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options, varies by customer. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The components of the Company’s lease revenues consisted of the following (in thousands): Three Months Ended March 31, 2024 2023 Net operating lease revenue $ 6,111 $ 5,910 Sales-type lease revenue 257 494 Total lease revenue $ 6,368 $ 6,404 The components of our net investment in sales-type leases as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Lease receivable $ 2,531 $ 2,583 Net investment in leases $ 2,531 $ 2,583 Our net investment in sales-type leases is classified as follows in the accompanying condensed consolidated balance sheets as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Accounts receivable, net $ 1,061 $ 1,067 Other assets 1,470 1,516 Total $ 2,531 $ 2,583 Future maturities of sales-type leases as of March 31, 2024 are as follows (in thousands): Sales-Type Leases 2024 $ 985 2025 1,292 2026 614 2027 12 2028 — Thereafter — Total undiscounted lease payments 2,903 Less: Imputed interest (372) Total lease receivables $ 2,531 |
Business Segment Information
Business Segment Information | 3 Months Ended |
Mar. 31, 2024 | |
Segment Reporting [Abstract] | |
Business Segment Information | Business Segment Information The Company’s reportable segments are organized based on service platforms, with the Patient Services segment reflecting higher margin rental revenues that generally include payments made by third-party and direct payers and the Device Solutions 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, 2024 and 2023: 2024 (in thousands) Patient Services Device Solutions Corporate/ Eliminations Total Net revenues - external $ 18,591 $ 13,404 $ — $ 31,995 Net revenues - internal — 1,713 (1,713) — Total net revenues 18,591 15,117 (1,713) 31,995 Gross profit 12,274 4,200 — 16,474 Selling, general and administrative expenses 17,319 Interest expense (456) Other income 3 Loss before income taxes $ (1,298) Total assets $ 57,996 $ 44,854 $ 2,000 $ 104,850 Purchases of medical equipment $ 350 $ 1,143 $ — $ 1,493 Depreciation and amortization of intangible assets $ 1,856 $ 1,044 $ — $ 2,900 2023 (in thousands) Patient Services Device Solutions 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 3,409 — 14,950 Selling, general and administrative expenses 15,057 Interest expense (484) Other expense (35) Loss before income taxes $ (626) 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 |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Pay vs Performance Disclosure | ||
Net Income (Loss) | $ (1,112) | $ (324) |
Insider Trading Arrangements
Insider Trading Arrangements | 3 Months Ended |
Mar. 31, 2024 | |
Trading Arrangements, by Individual | |
Rule 10b5-1 Arrangement Adopted | false |
Non-Rule 10b5-1 Arrangement Adopted | false |
Rule 10b5-1 Arrangement Terminated | false |
Non-Rule 10b5-1 Arrangement Terminated | false |
Revenue (Tables)
Revenue (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Revenue from Contract with Customer [Abstract] | |
Schedule of the Company’s Disaggregated Revenue | The following table presents the Company’s disaggregated revenue by offering type (in thousands): Three Months Ended 2024 2023 Total Net Revenues Percentage of Total Net Revenues Total Net Revenues Percentage of Total Net Revenues Patient Services revenue recognized at a point in time: Direct products $ 615 1.9 % $ 579 1.9 % Third-Party Payer products 1,872 5.9 % 3,408 11.2 % Patient Services revenue recognized over time: Direct rental services 3,572 11.2 % 1,869 6.2 % Third-Party Payer rental services 10,977 34.3 % 11,020 36.3 % Total Patient Services accounted for under ASC 606 17,036 53.2 % 16,876 55.6 % Device Solutions revenue recognized at a point in time: Products 4,213 13.2 % 3,740 12.3 % Services 2,409 7.5 % 2,576 8.5 % Device Solutions revenue recognized over time: Services 1,969 6.2 % 774 2.5 % Total Device Solutions accounted for under ASC 606 8,591 26.9 % 7,090 23.3 % Total Revenue Accounted for under ASC 606 25,627 80.1 % 23,966 78.9 % Patient Services lease revenue 1,555 4.9 % 1,897 6.2 % Device Solutions lease revenue 4,813 15.0 % 4,507 14.8 % Total Revenue accounted for under ASC 842, Leases 6,368 19.9 % 6,404 21.1 % Total Net Revenue $ 31,995 100.0 % $ 30,370 100.0 % |
Schedule of Accounts, Notes, Loans and Financing Receivable | (dollars in thousands) As of March 31, 2024 As of December 31, 2023 $ Change Accounts receivable, net $ 20,543 $ 19,830 $ 713 Contract assets $ 1,332 $ 1,271 $ 61 |
Medical Equipment (Tables)
Medical Equipment (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Medical Equipment [Abstract] | |
Schedule of Medical Equipment | Medical equipment consisted of the following (in thousands): March 31, December 31, 2023 Medical equipment for sale or rental $ 4,113 $ 3,081 Medical equipment for sale or rental - pump reserve (29) (32) Medical equipment for sale or rental - net 4,084 3,049 Medical equipment in rental service 97,480 96,298 Medical equipment in rental service - pump reserve (2,033) (2,126) Accumulated depreciation (61,022) (59,244) Medical equipment in rental service - net 34,425 34,928 Total $ 38,509 $ 37,977 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property, Plant and Equipment | Property and equipment consisted of the following (in thousands): March 31, 2024 December 31, 2023 Gross Assets Accumulated Depreciation Total Gross Assets Accumulated Depreciation Total Furniture, fixtures, and equipment $ 5,955 $ (4,094) $ 1,861 $ 6,611 $ (3,909) $ 2,702 Automobiles 87 (87) — 87 (87) — Leasehold improvements 4,442 (2,072) 2,370 3,570 (1,951) 1,619 Total $ 10,484 $ (6,253) $ 4,231 $ 10,268 $ (5,947) $ 4,321 |
Goodwill & Intangible Assets (T
Goodwill & Intangible Assets (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
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, 2024 are as follows (in thousands): Device Solutions (a) Balance as of December 31, 2023 $ 3,710 Goodwill acquired — Balance as of March 31, 2024 $ 3,710 (a) The Patient Services segment had no recorded goodwill during the reported periods. |
Schedule of 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, 2024 December 31, 2023 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 (34,470) 4,364 38,834 (34,295) 4,539 Non-competition agreements 472 (279) 193 472 (255) 217 Unpatented technology 943 (426) 517 943 (393) 550 Software 10,300 (10,175) 125 10,300 (10,160) 140 Total nonamortizable and amortizable intangible assets $ 52,572 $ (45,373) $ 7,199 $ 52,572 $ (45,126) $ 7,446 |
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, 2024 is as follows (in thousands): 2024 2025 2026 2027 2028 2029 and thereafter Total Amortization expense $ 743 $ 810 $ 525 $ 471 $ 348 $ 2,302 $ 5,199 |
Debt (Tables)
Debt (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
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 (30,250) (29,439) Letter of credit (200) (200) Availability on Revolving Facility $ 44,550 $ 45,361 |
Schedule of Maturities of Long-term Debt | The Company had future maturities of its long-term debt as of March 31, 2024 as follows (in thousands): 2024 2025 2026 2027 2028 Total Revolving Facility $ — $ — $ — $ — $ 30,250 $ 30,250 Total $ — $ — $ — $ — $ 30,250 $ 30,250 |
Schedule of Debt | The following is a breakdown of the Company’s current and long-term debt (in thousands): March 31, 2024 December 31, 2023 Current Portion Long-Term Portion Total Current Portion Long-Term Portion Total Revolving Facility $ — $ 30,250 $ 30,250 $ — $ 29,439 $ 29,439 Unamortized value of debt issuance costs — (319) (319) — (338) (338) Total $ — $ 29,931 $ 29,931 $ — $ 29,101 $ 29,101 |
Derivative Financial Instrume_2
Derivative Financial Instruments and Hedging Activities (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
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, 2024 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,716 December 31, 2023 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,442 |
Schedule of Derivative Instruments, Effect on AOCI | The table below presents the effect of our derivative financial instruments designated as hedging instruments in accumulated other comprehensive income (“AOCI”) (in thousands): Three Months Ended March 31, 2024 2023 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,088 $ 1,489 Unrealized gain (loss) recognized in AOCI 456 (92) Amounts reclassified to interest expense (a) (b) (182) (190) Tax (provision) benefit (66) 63 Ending balance $ 1,296 $ 1,270 (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 loss for both the three months ended March 31, 2024 and 2023 was $0.5 million. (b) As of March 31, 2024, $0.6 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, 2024 | |
Earnings Per Share [Abstract] | |
Schedule of Loss 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) : 2024 2023 Net loss: $ (1,112) $ (324) Denominator: Weighted average common shares outstanding: Basic 21,225,768 20,853,018 Dilutive effect of common stock equivalents — — Diluted 21,225,768 20,853,018 Net loss per share: Basic $ (0.05) $ (0.02) Diluted $ (0.05) $ (0.02) |
Share-Based Compensation (Table
Share-Based Compensation (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Restricted Share Activity, Excluding Company's Employee Stock Purchase Plan | Number of Weighted Unvested at December 31, 2023 529,862 $ 11.42 Granted 88,499 9.09 Vested (67,844) 17.44 Vested shares forgone to satisfy minimum statutory withholding (38,656) 17.44 Forfeitures (3,500) 13.25 Unvested at March 31, 2024 508,361 $ 9.74 Three Months Ended March 31, 2024 2023 0 Weighted average grant date fair value of awards granted $ 9.09 $ — Total fair value of shares vested $ 641,823 $ 273,994 Total fair value of shares forgone to satisfy minimum statutory withholding $ 365,697 $ 167,251 |
Schedule of Share-based Payment Arrangement, Option, Activity | 2014 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2023 657,346 $ 6.69 4.16 $ 2,983,514 Forfeitures and expirations (500) 18.44 Outstanding at March 31, 2024 656,846 $ 6.68 3.91 $ 2,099,944 Exercisable at March 31, 2024 656,846 $ 6.68 3.91 $ 2,099,944 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. 2021 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2023 1,051,673 $ 11.05 8.79 $ 1,207,118 Granted 152,927 8.97 Forfeitures and expirations (31,291) 9.73 Outstanding at March 31, 2024 (a) 1,173,309 $ 10.81 8.71 $ — Exercisable at March 31, 2024 (a) 309,597 $ 14.31 7.60 $ — (a) Aggregate Intrinsic Value - no exercisable options were in-the-money as of March 31, 2024 |
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions | The following is the average fair value per share estimated on the date of grant and the assumptions used for options granted: Three Months Ended March 31, Stock Options: 2024 Expected volatility 50% to 51% Risk free interest rate 4.25% to 4.28% Expected lives at date of grant (in years) 4.06 Weighted average fair value of options granted $3.97 Total intrinsic value of options exercised $ — |
Leases (Tables)
Leases (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
Leases [Abstract] | |
Schedule of the Components of Lease Costs | The components of lease costs for the three months ended March 31, 2024 and 2023 are as follows (in thousands): Three Months Ended 2024 2023 Operating lease cost $ 473 $ 352 Variable lease cost 75 76 Total lease cost $ 548 $ 428 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Three Months Ended 2024 2023 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 530 $ 449 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, 2024 2023 Years Years Weighted average remaining lease term: 6.0 6.2 Rate Rate Weighted average discount rate: 7.8% 7.0% |
Schedule of Future Maturities of Lease Liabilities | Future maturities of lease liabilities as of March 31, 2024 are as follows (in thousands): Operating Leases 2024 $ 1,309 2025 1,837 2026 1,654 2027 1,478 2028 1,429 2029 and thereafter 2,424 Total undiscounted lease payments 10,131 Less: Imputed interest (3,266) Total lease liabilities $ 6,865 |
Schedule of Leases Revenues | The components of the Company’s lease revenues consisted of the following (in thousands): Three Months Ended March 31, 2024 2023 Net operating lease revenue $ 6,111 $ 5,910 Sales-type lease revenue 257 494 Total lease revenue $ 6,368 $ 6,404 |
Schedule of Net Investment in Sales-Type Leases | The components of our net investment in sales-type leases as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Lease receivable $ 2,531 $ 2,583 Net investment in leases $ 2,531 $ 2,583 Our net investment in sales-type leases is classified as follows in the accompanying condensed consolidated balance sheets as of March 31, 2024 and December 31, 2023 were (in thousands): March 31, December 31, Accounts receivable, net $ 1,061 $ 1,067 Other assets 1,470 1,516 Total $ 2,531 $ 2,583 |
Schedule of Future Maturities of Sales-Type Leases | Future maturities of sales-type leases as of March 31, 2024 are as follows (in thousands): Sales-Type Leases 2024 $ 985 2025 1,292 2026 614 2027 12 2028 — Thereafter — Total undiscounted lease payments 2,903 Less: Imputed interest (372) Total lease receivables $ 2,531 |
Business Segment Information (T
Business Segment Information (Tables) | 3 Months Ended |
Mar. 31, 2024 | |
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, 2024 and 2023: 2024 (in thousands) Patient Services Device Solutions Corporate/ Eliminations Total Net revenues - external $ 18,591 $ 13,404 $ — $ 31,995 Net revenues - internal — 1,713 (1,713) — Total net revenues 18,591 15,117 (1,713) 31,995 Gross profit 12,274 4,200 — 16,474 Selling, general and administrative expenses 17,319 Interest expense (456) Other income 3 Loss before income taxes $ (1,298) Total assets $ 57,996 $ 44,854 $ 2,000 $ 104,850 Purchases of medical equipment $ 350 $ 1,143 $ — $ 1,493 Depreciation and amortization of intangible assets $ 1,856 $ 1,044 $ — $ 2,900 2023 (in thousands) Patient Services Device Solutions 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 3,409 — 14,950 Selling, general and administrative expenses 15,057 Interest expense (484) Other expense (35) Loss before income taxes $ (626) 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 |
Basis of Presentation and Nat_2
Basis of Presentation and Nature of Operations (Details) | 3 Months Ended |
Mar. 31, 2024 segment | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Number of reportable segments | 2 |
Number of operating segments | 2 |
Revenue - Disaggregated Revenue
Revenue - Disaggregated Revenue by Revenue Stream (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Disaggregation of Revenue [Line Items] | ||
Lease revenue | $ 6,368 | $ 6,404 |
Total net revenues | 31,995 | 30,370 |
Patient Services | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 17,036 | 16,876 |
Lease revenue | 1,555 | 1,897 |
Device Solutions | ||
Disaggregation of Revenue [Line Items] | ||
Lease revenue | 4,813 | 4,507 |
Device Solutions | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 8,591 | 7,090 |
Patient Services And Device Solutions | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 25,627 | 23,966 |
Lease revenue | 6,368 | 6,404 |
Product Sales | Patient Services | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 615 | 579 |
Product Sales | Device Solutions | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 4,213 | 3,740 |
Third-Party Payer Rentals | Patient Services | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 1,872 | 3,408 |
Third-Party Payer Rentals | Patient Services | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 10,977 | 11,020 |
Direct Payer Rentals | Patient Services | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 3,572 | 1,869 |
Service | Device Solutions | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | 2,409 | 2,576 |
Service | Device Solutions | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Revenues | $ 1,969 | $ 774 |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Patient Services | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 53.20% | 55.60% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Device Solutions | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 26.90% | 23.30% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Patient Services And Device Solutions | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 80.10% | 78.90% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Product Sales | Patient Services | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 1.90% | 1.90% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Product Sales | Device Solutions | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 13.20% | 12.30% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Third-Party Payer Rentals | Patient Services | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 5.90% | 11.20% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Third-Party Payer Rentals | Patient Services | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 34.30% | 36.30% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Direct Payer Rentals | Patient Services | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 11.20% | 6.20% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Service | Device Solutions | Transferred at Point in Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 7.50% | 8.50% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Service | Device Solutions | Transferred over Time | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 6.20% | 2.50% |
Revenue Benchmark | Customer Concentration Risk | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 100% | 100% |
Revenue Benchmark | Customer Concentration Risk | Patient Services | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 4.90% | 6.20% |
Revenue Benchmark | Customer Concentration Risk | Device Solutions | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 15% | 14.80% |
Revenue Benchmark | Customer Concentration Risk | Patient Services And Device Solutions | ||
Disaggregation of Revenue [Line Items] | ||
Percentage of total net revenues | 19.90% | 21.10% |
Revenue - Contract Balances (De
Revenue - Contract Balances (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Disaggregation of Revenue [Line Items] | ||
Accounts receivable, net | $ 20,543 | $ 19,830 |
Contract assets | 1,332 | $ 1,271 |
Revision of Prior Period, Adjustment | ||
Disaggregation of Revenue [Line Items] | ||
Accounts receivable, net | 713 | |
Contract assets | $ 61 |
Revenue - Narrative (Details)
Revenue - Narrative (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Dec. 31, 2023 | |
Disaggregation of Revenue [Line Items] | ||
Contract assets | $ 1,332 | $ 1,271 |
Other Current Assets | ||
Disaggregation of Revenue [Line Items] | ||
Contract assets partially offset amount | 2,800 | |
Revision of Prior Period, Adjustment | ||
Disaggregation of Revenue [Line Items] | ||
Contract assets | 61 | |
Revision of Prior Period, Adjustment | Other Current Assets | ||
Disaggregation of Revenue [Line Items] | ||
Contract assets | $ 2,900 |
Medical Equipment - Summary of
Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Medical Equipment [Abstract] | ||
Medical equipment for sale or rental | $ 4,113 | $ 3,081 |
Medical equipment for sale or rental - pump reserve | (29) | (32) |
Medical equipment for sale or rental - net | 4,084 | 3,049 |
Medical equipment in rental service | 97,480 | 96,298 |
Medical equipment in rental service - pump reserve | (2,033) | (2,126) |
Accumulated depreciation | (61,022) | (59,244) |
Medical equipment in rental service - net | 34,425 | 34,928 |
Total | $ 38,509 | $ 37,977 |
Medical Equipment - Narrative (
Medical Equipment - Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Medical Equipment [Abstract] | ||
Depreciation expense related to medical equipment | $ 2.3 | $ 2.7 |
Non-cash purchases of medical equipment | $ 2.7 | $ 1.1 |
Property and Equipment - Schedu
Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Property, Plant and Equipment [Line Items] | ||
Gross Assets | $ 10,484 | $ 10,268 |
Accumulated Depreciation | (6,253) | (5,947) |
Total | 4,231 | 4,321 |
Furniture, fixtures, and equipment | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 5,955 | 6,611 |
Accumulated Depreciation | (4,094) | (3,909) |
Total | 1,861 | 2,702 |
Automobiles | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 87 | 87 |
Accumulated Depreciation | (87) | (87) |
Total | 0 | 0 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 4,442 | 3,570 |
Accumulated Depreciation | (2,072) | (1,951) |
Total | $ 2,370 | $ 1,619 |
Property and Equipment - Narrat
Property and Equipment - Narrative (Details) - USD ($) $ in Millions | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Property, Plant and Equipment [Abstract] | ||
Depreciation | $ 0.3 | $ 0.3 |
Goodwill & Intangible Assets -
Goodwill & Intangible Assets - Goodwill (Details) | 3 Months Ended |
Mar. 31, 2024 USD ($) | |
Goodwill [Roll Forward] | |
Goodwill, beginning balance | $ 3,710,000 |
Goodwill, ending balance | 3,710,000 |
Device Solutions | |
Goodwill [Roll Forward] | |
Goodwill, beginning balance | 3,710,000 |
Goodwill acquired | 0 |
Goodwill, ending balance | 3,710,000 |
Patient Services | |
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, 2024 | Dec. 31, 2023 |
Goodwill [Line Items] | ||
Trade names | $ 2,000 | $ 2,000 |
Accumulated Amortization | (45,373) | (45,126) |
Total | 5,199 | |
Total nonamortizable and amortizable intangible assets | 52,572 | 52,572 |
Net | 7,199 | 7,446 |
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 | (34,470) | (34,295) |
Total | 4,364 | 4,539 |
Non-competition agreements | ||
Goodwill [Line Items] | ||
Gross Assets | 472 | 472 |
Accumulated Amortization | (279) | (255) |
Total | 193 | 217 |
Unpatented technology | ||
Goodwill [Line Items] | ||
Gross Assets | 943 | 943 |
Accumulated Amortization | (426) | (393) |
Total | 517 | 550 |
Software | ||
Goodwill [Line Items] | ||
Gross Assets | 10,300 | 10,300 |
Accumulated Amortization | (10,175) | (10,160) |
Total | $ 125 | $ 140 |
Goodwill & Intangible Assets _3
Goodwill & Intangible Assets - Narrative (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | ||
Amortization of intangible assets | $ 248 | $ 248 |
Goodwill & Intangible Assets _4
Goodwill & Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands | Mar. 31, 2024 USD ($) |
Goodwill and Intangible Assets Disclosure [Abstract] | |
2024 | $ 743 |
2025 | 810 |
2026 | 525 |
2027 | 471 |
2028 | 348 |
2029 and thereafter | 2,302 |
Total | $ 5,199 |
Debt - Narrative (Details)
Debt - Narrative (Details) | 3 Months Ended | |||
Feb. 05, 2021 USD ($) | Mar. 31, 2024 | Apr. 26, 2023 USD ($) | Apr. 25, 2023 USD ($) | |
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 | Term Benchmark Loans | ||||
Debt Instrument [Line Items] | ||||
Effective percentage | 7.42% | |||
LIBOR rate | 5.42% | |||
The 2021 Credit Agreement | ABR Loans | ||||
Debt Instrument [Line Items] | ||||
Effective percentage | 9.50% | |||
The 2021 Credit Agreement | Secured Overnight Financing Rate (SOFR) | Term Benchmark Loans | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 2% | |||
The 2021 Credit Agreement | Base Rate | ABR Loans | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 1% | |||
The 2021 Credit Agreement | Minimum | Secured Overnight Financing Rate (SOFR) | Term Benchmark Loans | ||||
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 | 8.50% | |||
The 2021 Credit Agreement | Maximum | Secured Overnight Financing Rate (SOFR) | Term Benchmark Loans | ||||
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 | $ 75,000,000 | |||
Revolving credit facility | 25,000,000 | $ 35,000,000 | $ 25,000,000 | |
Borrowings under revolving credit facility | 30,000,000 | |||
The 2021 Credit Agreement | Letter of credit | ||||
Debt Instrument [Line Items] | ||||
Line of credit facility | 7,000,000 | |||
The 2015 Credit Agreement | Revolving Facility | ||||
Debt Instrument [Line Items] | ||||
Repayments | $ 8,200,000 |
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, 2024 | Dec. 31, 2023 |
Debt Instrument [Line Items] | ||
Gross availability | $ 75,000 | $ 75,000 |
Outstanding draws | (30,250) | (29,439) |
Letter of credit | (200) | (200) |
Availability on Revolving Facility | $ 44,550 | $ 45,361 |
Debt - Summary of Future Maturi
Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Debt Instrument [Line Items] | ||
2024 | $ 0 | |
2025 | 0 | |
2026 | 0 | |
2027 | 0 | |
2028 | 30,250 | |
Total | 30,250 | |
Revolving Facility | ||
Debt Instrument [Line Items] | ||
2024 | 0 | |
2025 | 0 | |
2026 | 0 | |
2027 | 0 | |
2028 | 30,250 | |
Total | $ 30,250 | $ 29,439 |
Debt - Summary of Company's Cur
Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Debt Instrument [Line Items] | ||
Total | $ 30,250 | |
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 | (319) | (338) |
Unamortized value of the debt issuance costs, total | (319) | (338) |
Current portion of long-term debt | 0 | 0 |
Long-term debt | 29,931 | 29,101 |
Total | 29,931 | 29,101 |
Revolving Facility | ||
Debt Instrument [Line Items] | ||
Current Portion | 0 | 0 |
Long-Term Portion | 30,250 | 29,439 |
Total | $ 30,250 | $ 29,439 |
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 | ||
May 11, 2023 agreement | Feb. 05, 2021 agreement | Mar. 31, 2024 USD ($) | |
Derivative [Line Items] | |||
Interest rate swap | agreement | 2 | 2 | |
Term of contract (year) | 5 years | 5 years | |
Fixed interest rate | 1.74% | 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, 2024 | Dec. 31, 2023 |
Derivative [Line Items] | ||
Fair Value Derivative Assets | $ 1,716 | $ 1,442 |
Cash flow hedges | Interest rate swaps | Derivatives designated as hedges: | ||
Derivative [Line Items] | ||
Notional | 20,000 | 20,000 |
Fair Value Derivative Assets | $ 1,716 | $ 1,442 |
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, 2024 | Mar. 31, 2023 | |
Derivatives used in Net Investment Hedge, Net of Tax [Roll Forward] | ||
Beginning balance | $ 52,302 | $ 48,003 |
Ending balance | 52,276 | 48,261 |
Interest expense | 456 | 484 |
Interest rate swaps | Cash flow hedges | Derivatives designated as hedges: | ||
Derivatives used in Net Investment Hedge, Net of Tax [Roll Forward] | ||
Reclassified within twelve months | 600 | |
Gain/(loss) on cash flow hedges | ||
Derivatives used in Net Investment Hedge, Net of Tax [Roll Forward] | ||
Beginning balance | 1,088 | 1,489 |
Unrealized gain (loss) recognized in AOCI | 456 | (92) |
Amounts reclassified to interest expense | (182) | (190) |
Tax (provision) benefit | (66) | 63 |
Ending balance | $ 1,296 | $ 1,270 |
Income Taxes - Narrative (Detai
Income Taxes - Narrative (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Income Tax Disclosure [Abstract] | ||
Income tax expense (benefit) | $ (186) | $ (302) |
Loss before income taxes | $ (1,298) | $ (626) |
Effective income tax rate reconciliation, percent | 14.30% | 48.20% |
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, 2024 | Mar. 31, 2023 | |
Earnings Per Share [Abstract] | ||
Net loss: | $ (1,112) | $ (324) |
Weighted average common shares outstanding: | ||
Basic (in shares) | 21,225,768 | 20,853,018 |
Dilutive effect of common stock equivalents (in shares) | 0 | 0 |
Diluted (in shares) | 21,225,768 | 20,853,018 |
Basic (in dollars per share) | $ (0.05) | $ (0.02) |
Diluted (in dollars per share) | $ (0.05) | $ (0.02) |
Loss Per Share - Narrative (Det
Loss Per Share - Narrative (Details) - USD ($) | Mar. 31, 2024 | 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 |
Share-Based Compensation - Summ
Share-Based Compensation - Summary of Restricted Share Activity, Excluding Company's Employee Stock Purchase Plan (Details) - Restricted Stock - USD ($) | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Number of shares | ||
Unvested, number of shares (in shares) | 529,862 | |
Granted, number of shares (in shares) | 88,499 | |
Vested, number of shares (in shares) | (67,844) | |
Vested shares forgone to satisfy minimum statutory withholding, number of shares (in shares) | (38,656) | |
Forfeitures, number of shares (in shares) | (3,500) | |
Unvested, number of shares (in shares) | 508,361 | |
Weighted average grant date fair value | ||
Unvested, weighted average grant date fair value (usd per share) | $ 11.42 | |
Granted, weighted average grant date fair value (usd per share) | 9.09 | $ 0 |
Vested, weighted average grant date fair value (usd per share) | 17.44 | |
Vested shares forgone to satisfy minimum statutory withholding, weighted average grant date fair value (usd per share) | 17.44 | |
Forfeitures, weighted average grant date fair value (usd per share) | 13.25 | |
Unvested, weighted average grant date fair value (usd per share) | $ 9.74 | |
Total fair value of shares vested | $ 641,823 | $ 273,994 |
Total fair value of shares forgone to satisfy minimum statutory withholding | $ 365,697 | $ 167,251 |
Share-Based Compensation - Sche
Share-Based Compensation - Schedule of Share-based Payment Arrangement, Option, Activity (Details) - USD ($) | 3 Months Ended | 12 Months Ended |
Mar. 31, 2024 | Dec. 31, 2023 | |
2014 Equity Incentive Plan | ||
Number of Authorized Shares | ||
Outstanding, number of authorized shares (in shares) | 657,346 | |
Forfeitures and expirations (in shares) | (500) | |
Outstanding, number of authorized shares (in shares) | 656,846 | 657,346 |
Exercisable, number of authorized shares (in shares) | 656,846 | |
Weighted- Average Exercise Price | ||
Outstanding, weighted average exercise price (usd per share) | $ 6.69 | |
Forfeitures and expirations (usd per share) | 18.44 | |
Outstanding, weighted average exercise price (usd per share) | 6.68 | $ 6.69 |
Exercisable, weighted average exercise price (usd per share) | $ 6.68 | |
Options, Additional Disclosures | ||
Outstanding, Weighted average remaining contractual term | 3 years 10 months 28 days | 4 years 1 month 28 days |
Exercisable, Weighted average remaining contractual term | 3 years 10 months 28 days | |
Outstanding, Aggregate Intrinsic Value | $ 2,099,944 | $ 2,983,514 |
Exercisable, Aggregate Intrinsic Value | $ 2,099,944 | |
2021 Equity Incentive Plan | ||
Number of Authorized Shares | ||
Outstanding, number of authorized shares (in shares) | 1,051,673 | |
Granted (in shares) | 152,927 | |
Forfeitures and expirations (in shares) | (31,291) | |
Outstanding, number of authorized shares (in shares) | 1,173,309 | 1,051,673 |
Exercisable, number of authorized shares (in shares) | 309,597 | |
Weighted- Average Exercise Price | ||
Outstanding, weighted average exercise price (usd per share) | $ 11.05 | |
Granted (usd per share) | 8.97 | |
Forfeitures and expirations (usd per share) | 9.73 | |
Outstanding, weighted average exercise price (usd per share) | 10.81 | $ 11.05 |
Exercisable, weighted average exercise price (usd per share) | $ 14.31 | |
Options, Additional Disclosures | ||
Outstanding, Weighted average remaining contractual term | 8 years 8 months 15 days | 8 years 9 months 14 days |
Exercisable, Weighted average remaining contractual term | 7 years 7 months 6 days | |
Outstanding, Aggregate Intrinsic Value | $ 0 | $ 1,207,118 |
Exercisable, Aggregate Intrinsic Value | $ 0 |
Share-Based Compensation - Sc_2
Share-Based Compensation - Schedule of Share-based Compensation Expense Based on Fair Value of Options (Details) - Stock Options | 3 Months Ended |
Mar. 31, 2024 USD ($) $ / shares | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |
Expected volatility rate, minimum | 50% |
Expected volatility rate, maximum | 51% |
Risk free interest rate, minimum | 4.25% |
Risk free interest rate, maximum | 4.28% |
Expected lives at date of grant (in years) | 4 years 21 days |
Weighted average fair value of options granted (usd per share) | $ / shares | $ 3.97 |
Total intrinsic value of options exercised | $ | $ 0 |
Leases - Narrative (Details)
Leases - Narrative (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Lessee, Lease, Description [Line Items] | ||
Operating lease, term of contract | 7 years | |
Operating lease liabilities, net of current portion | $ 5,331 | $ 5,799 |
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, 2024 | Mar. 31, 2023 | |
Leases [Abstract] | ||
Operating lease cost | $ 473 | $ 352 |
Variable lease cost | 75 | 76 |
Total lease cost | 548 | 428 |
Operating cash flow from operating leases | 530 | 449 |
Operating leases | 0 | 381 |
Increases to right of use assets resulting from lease modifications, operating lease | $ 0 | $ 160 |
Weighted average remaining lease term: | 6 years | 6 years 2 months 12 days |
Weighted average discount rate: | 7.80% | 7% |
Leases - Maturities of Lease Li
Leases - Maturities of Lease Liabilities (Details) $ in Thousands | Mar. 31, 2024 USD ($) |
Leases [Abstract] | |
2024 | $ 1,309 |
2025 | 1,837 |
2026 | 1,654 |
2027 | 1,478 |
2028 | 1,429 |
2029 and thereafter | 2,424 |
Total undiscounted lease payments | 10,131 |
Less: Imputed interest | (3,266) |
Total lease liabilities | $ 6,865 |
Leases - Lease Revenue (Details
Leases - Lease Revenue (Details) - USD ($) $ in Thousands | 3 Months Ended | |
Mar. 31, 2024 | Mar. 31, 2023 | |
Leases [Abstract] | ||
Net operating lease revenue | $ 6,111 | $ 5,910 |
Sales-type lease revenue | 257 | 494 |
Total lease revenue | $ 6,368 | $ 6,404 |
Leases - Net Investment in Sale
Leases - Net Investment in Sales-Type Leases (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 |
Leases [Abstract] | ||
Lease receivable | $ 2,531 | $ 2,583 |
Net investment in leases | $ 2,531 | $ 2,583 |
Leases - Net Investment in Sa_2
Leases - Net Investment in Sales-Type Leases in Balance Sheet (Details) - USD ($) $ in Thousands | Mar. 31, 2024 | Dec. 31, 2023 | Mar. 31, 2023 |
Sales-Type Lease, Net Investment In Lease [Line Items] | |||
Total assets | $ 104,850 | $ 102,915 | $ 102,261 |
Sales-Type Lease, Net Investment | |||
Sales-Type Lease, Net Investment In Lease [Line Items] | |||
Accounts receivable, net | 1,061 | 1,067 | |
Other assets | 1,470 | 1,516 | |
Total assets | $ 2,531 | $ 2,583 |
Leases - Maturities of Sale-Typ
Leases - Maturities of Sale-Type Leases (Details) $ in Thousands | Mar. 31, 2024 USD ($) |
Leases [Abstract] | |
2024 | $ 985 |
2025 | 1,292 |
2026 | 614 |
2027 | 12 |
2028 | 0 |
Thereafter | 0 |
Total undiscounted lease payments | 2,903 |
Less: Imputed interest | (372) |
Total lease receivables | $ 2,531 |
Business Segment Information -
Business Segment Information - Segment Reporting Information, by Segment (Details) - USD ($) $ in Thousands | 3 Months Ended | ||
Mar. 31, 2024 | Mar. 31, 2023 | Dec. 31, 2023 | |
Segment Reporting Information [Line Items] | |||
Net revenues - external | $ 31,995 | $ 30,370 | |
Net revenues - internal | 0 | 0 | |
Total net revenues | 31,995 | 30,370 | |
Gross profit | 16,474 | 14,950 | |
Selling, general and administrative expenses | 17,319 | 15,057 | |
Interest expense | (456) | (484) | |
Other income (expense) | 3 | (35) | |
Loss before income taxes | (1,298) | (626) | |
Total assets | 104,850 | 102,261 | $ 102,915 |
Purchases of medical equipment | 1,493 | 3,968 | |
Depreciation and amortization of intangible assets | 2,900 | 3,203 | |
Corporate and Eliminations | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 0 | 0 | |
Net revenues - internal | (1,713) | (1,630) | |
Total net revenues | (1,713) | (1,630) | |
Gross profit | 0 | 0 | |
Total assets | 2,000 | 2,000 | |
Purchases of medical equipment | 0 | 0 | |
Depreciation and amortization of intangible assets | 0 | 0 | |
Patient Services | Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 18,591 | 18,774 | |
Net revenues - internal | 0 | 0 | |
Total net revenues | 18,591 | 18,774 | |
Gross profit | 12,274 | 11,541 | |
Total assets | 57,996 | 62,769 | |
Purchases of medical equipment | 350 | 2,673 | |
Depreciation and amortization of intangible assets | 1,856 | 2,178 | |
Device Solutions | Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 13,404 | 11,596 | |
Net revenues - internal | 1,713 | 1,630 | |
Total net revenues | 15,117 | 13,226 | |
Gross profit | 4,200 | 3,409 | |
Total assets | 44,854 | 37,492 | |
Purchases of medical equipment | 1,143 | 1,295 | |
Depreciation and amortization of intangible assets | $ 1,044 | $ 1,025 |