Cover
Cover - shares | 6 Months Ended | |
Jun. 30, 2023 | Jul. 20, 2023 | |
Cover [Abstract] | ||
Document Type | 10-Q | |
Document Quarterly Report | true | |
Document Period End Date | Jun. 30, 2023 | |
Document Transition Report | false | |
Entity File Number | 001-38973 | |
Entity Registrant Name | Viemed Healthcare, Inc. | |
Entity Incorporation, State or Country Code | Z4 | |
Entity Address, Address Line One | 625 E. Kaliste Saloom Rd. | |
Entity Address, City or Town | Lafayette | |
Entity Address, State or Province | LA | |
Entity Address, Postal Zip Code | 70508 | |
City Area Code | 337 | |
Local Phone Number | 504-3802 | |
Title of 12(b) Security | Common Shares, no par value | |
Trading Symbol | VMD | |
Security Exchange Name | NASDAQ | |
Entity Current Reporting Status | Yes | |
Entity Interactive Data Current | Yes | |
Entity Filer Category | Accelerated Filer | |
Entity Small Business | true | |
Entity Emerging Growth Company | true | |
Entity Ex Transition Period | false | |
Entity Shell Company | false | |
Entity Common Stock, Shares Outstanding | 38,400,422 | |
Entity Central Index Key | 0001729149 | |
Amendment Flag | false | |
Document Fiscal Year Focus | 2023 | |
Document Period Focus | Q2 | |
Current Fiscal Year End Date | --12-31 |
CONDENSED CONSOLIDATED BALANCE
CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Current assets | ||
Cash and cash equivalents | $ 10,224 | $ 16,914 |
Accounts receivable, net | 17,893 | 15,379 |
Inventory | 4,476 | 3,574 |
Income tax receivable | 1,029 | 26 |
Prepaid expenses and other assets | 2,327 | 3,849 |
Total current assets | 35,949 | 39,742 |
Long-term assets | ||
Property and equipment, net | 72,884 | 67,743 |
Finance lease right-of-use assets | 538 | 0 |
Operating lease right-of-use assets | 516 | 694 |
Equity investments | 1,942 | 2,155 |
Debt investment | 2,110 | 2,000 |
Deferred tax asset | 3,844 | 3,119 |
Identifiable intangibles, net | 688 | 0 |
Goodwill | 29,759 | 0 |
Other long-term assets | 887 | 1,590 |
Total long-term assets | 113,168 | 77,301 |
TOTAL ASSETS | 149,117 | 117,043 |
Current liabilities | ||
Trade payables | 6,167 | 2,650 |
Deferred revenue | 5,960 | 4,624 |
Accrued liabilities | 15,509 | 11,092 |
Finance lease liabilities, current portion | 375 | 0 |
Operating lease liabilities, current portion | 395 | 495 |
Current debt | 3,169 | 0 |
Total current liabilities | 31,575 | 18,861 |
Long-term liabilities | ||
Accrued liabilities | 637 | 889 |
Finance lease liabilities, less current portion | 143 | 0 |
Operating lease liabilities, less current portion | 143 | 199 |
Long-term debt | 12,114 | 0 |
Total long-term liabilities | 13,037 | 1,088 |
TOTAL LIABILITIES | 44,612 | 19,949 |
Commitments and Contingencies | 0 | 0 |
SHAREHOLDERS' EQUITY | ||
Common stock - No par value: unlimited authorized; 38,400,422 and 38,049,739 issued and outstanding as of June 30, 2023 and December 31, 2022, respectively | 17,850 | 15,123 |
Additional paid-in capital | 13,488 | 12,125 |
Retained earnings | 73,167 | 69,846 |
TOTAL SHAREHOLDERS' EQUITY | 104,505 | 97,094 |
TOTAL LIABILITIES AND SHAREHOLDERS' EQUITY | $ 149,117 | $ 117,043 |
CONDENSED CONSOLIDATED BALANC_2
CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - shares | Jun. 30, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Issued (in shares) | 38,400,422 | 38,049,739 |
Outstanding (in shares) | 38,400,422 | 38,049,739 |
CONDENSED CONSOLIDATED STATEMEN
CONDENSED CONSOLIDATED STATEMENTS OF INCOME AND COMPREHENSIVE INCOME - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Income Statement [Abstract] | ||||
Revenue | $ 43,311 | $ 33,310 | $ 82,867 | $ 65,565 |
Cost of revenue | 17,205 | 12,920 | 32,757 | 25,432 |
Gross profit | 26,106 | 20,390 | 50,110 | 40,133 |
Operating expenses | ||||
Selling, general and administrative | 20,563 | 17,536 | 40,325 | 33,312 |
Research and development | 758 | 672 | 1,538 | 1,304 |
Stock-based compensation | 1,471 | 1,271 | 2,862 | 2,576 |
Depreciation | 298 | 243 | 538 | 480 |
Loss (gain) on disposal of property and equipment | 117 | (110) | 95 | (124) |
Other (income) expense, net | (2) | (223) | (83) | (664) |
Income from operations | 2,901 | 1,001 | 4,835 | 3,249 |
Non-operating income and expenses | ||||
Income from equity method investments | 137 | 446 | 172 | 769 |
Interest income (expense), net | 20 | (59) | 69 | (123) |
Net income before taxes | 3,058 | 1,388 | 5,076 | 3,895 |
Provision for income taxes | 728 | 421 | 1,229 | 1,166 |
Net income | 2,330 | 967 | 3,847 | 2,729 |
Other comprehensive income (loss) | ||||
Change in unrealized gain/loss on derivative instruments, net of tax | 0 | 59 | 0 | 222 |
Other comprehensive income (loss) | 0 | 59 | 0 | 222 |
Comprehensive income | $ 2,330 | $ 1,026 | $ 3,847 | $ 2,951 |
Net income per share | ||||
Basic (in dollars per share) | $ 0.06 | $ 0.02 | $ 0.10 | $ 0.07 |
Diluted (in dollars per share) | $ 0.06 | $ 0.02 | $ 0.10 | $ 0.07 |
Weighted average number of common shares outstanding: | ||||
Basic (in shares) | 38,324,249 | 38,773,580 | 38,240,902 | 39,195,317 |
Diluted (in shares) | 40,676,951 | 39,752,928 | 40,383,616 | 40,056,953 |
CONDENSED CONSOLIDATED STATEM_2
CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN SHAREHOLDERS' EQUITY - USD ($) $ in Thousands | Total | Common Stock | Additional paid-in capital | Accumulated other comprehensive loss | Retained earnings |
Shareholders' equity, beginning balance (in shares) at Dec. 31, 2021 | 39,640,388 | ||||
Shareholders' equity, beginning balance at Dec. 31, 2021 | $ 94,820 | $ 14,014 | $ 7,749 | $ (278) | $ 73,335 |
Increase (Decrease) in Stockholders' Equity | |||||
Stock-based compensation - options | 820 | 820 | |||
Stock-based compensation - restricted stock units | 485 | 485 | |||
Shares issued for vesting of restricted stock units (in shares) | 67,010 | ||||
Shares issued for vesting of restricted stock units | 0 | $ 334 | (334) | ||
Shares redeemed to pay income tax (in shares) | (23,742) | ||||
Shares redeemed to pay income tax | (119) | (119) | |||
Shares repurchased under share repurchase program (in shares) | (389,878) | ||||
Shares repurchased under share repurchase program | (1,887) | (1,887) | |||
Change in accumulated other comprehensive loss, net of tax | 163 | 163 | |||
Net income | 1,762 | 1,762 | |||
Shareholders' equity, ending balance (in shares) at Mar. 31, 2022 | 39,293,778 | ||||
Shareholders' equity, ending balance at Mar. 31, 2022 | 96,044 | $ 14,348 | 8,720 | (115) | 73,091 |
Shareholders' equity, beginning balance (in shares) at Dec. 31, 2021 | 39,640,388 | ||||
Shareholders' equity, beginning balance at Dec. 31, 2021 | 94,820 | $ 14,014 | 7,749 | (278) | 73,335 |
Increase (Decrease) in Stockholders' Equity | |||||
Change in accumulated other comprehensive loss, net of tax | 222 | ||||
Net income | 2,729 | ||||
Shareholders' equity, ending balance (in shares) at Jun. 30, 2022 | 38,333,089 | ||||
Shareholders' equity, ending balance at Jun. 30, 2022 | 93,227 | $ 14,348 | 9,991 | (56) | 68,944 |
Shareholders' equity, beginning balance (in shares) at Mar. 31, 2022 | 39,293,778 | ||||
Shareholders' equity, beginning balance at Mar. 31, 2022 | 96,044 | $ 14,348 | 8,720 | (115) | 73,091 |
Increase (Decrease) in Stockholders' Equity | |||||
Stock-based compensation - options | 757 | 757 | |||
Stock-based compensation - restricted stock units | 514 | 514 | |||
Shares repurchased under share repurchase program (in shares) | (960,689) | ||||
Shares repurchased under share repurchase program | (5,114) | (5,114) | |||
Change in accumulated other comprehensive loss, net of tax | 59 | 59 | |||
Net income | 967 | 967 | |||
Shareholders' equity, ending balance (in shares) at Jun. 30, 2022 | 38,333,089 | ||||
Shareholders' equity, ending balance at Jun. 30, 2022 | $ 93,227 | $ 14,348 | 9,991 | (56) | 68,944 |
Shareholders' equity, beginning balance (in shares) at Dec. 31, 2022 | 38,049,739 | 38,049,739 | |||
Shareholders' equity, beginning balance at Dec. 31, 2022 | $ 97,094 | $ 15,123 | 12,125 | 0 | 69,846 |
Increase (Decrease) in Stockholders' Equity | |||||
Stock-based compensation - options | 348 | 348 | |||
Stock-based compensation - restricted stock units | 1,043 | 1,043 | |||
Exercise of options (in shares) | 108,370 | ||||
Exercise of options | 544 | $ 544 | |||
Shares issued for vesting of restricted stock units (in shares) | 183,036 | ||||
Shares issued for vesting of restricted stock units | 0 | $ 1,429 | (1,429) | ||
Shares redeemed to pay income tax (in shares) | (64,756) | ||||
Shares redeemed to pay income tax | (505) | (505) | |||
Net income | 1,517 | 1,517 | |||
Shareholders' equity, ending balance (in shares) at Mar. 31, 2023 | 38,276,389 | ||||
Shareholders' equity, ending balance at Mar. 31, 2023 | $ 100,041 | $ 17,096 | 12,087 | 0 | 70,858 |
Shareholders' equity, beginning balance (in shares) at Dec. 31, 2022 | 38,049,739 | 38,049,739 | |||
Shareholders' equity, beginning balance at Dec. 31, 2022 | $ 97,094 | $ 15,123 | 12,125 | 0 | 69,846 |
Increase (Decrease) in Stockholders' Equity | |||||
Exercise of options (in shares) | 228,000 | ||||
Shares redeemed to pay income tax (in shares) | (66,734) | ||||
Change in accumulated other comprehensive loss, net of tax | $ 0 | ||||
Net income | $ 3,847 | ||||
Shareholders' equity, ending balance (in shares) at Jun. 30, 2023 | 38,400,422 | 38,400,422 | |||
Shareholders' equity, ending balance at Jun. 30, 2023 | $ 104,505 | $ 17,850 | 13,488 | 0 | 73,167 |
Shareholders' equity, beginning balance (in shares) at Mar. 31, 2023 | 38,276,389 | ||||
Shareholders' equity, beginning balance at Mar. 31, 2023 | 100,041 | $ 17,096 | 12,087 | 0 | 70,858 |
Increase (Decrease) in Stockholders' Equity | |||||
Stock-based compensation - options | 301 | 301 | |||
Stock-based compensation - restricted stock units | 1,170 | 1,170 | |||
Exercise of options (in shares) | 119,356 | ||||
Exercise of options | 684 | $ 684 | |||
Shares issued for vesting of restricted stock units (in shares) | 6,655 | ||||
Shares issued for vesting of restricted stock units | 0 | $ 70 | (70) | ||
Shares redeemed to pay income tax (in shares) | (1,978) | ||||
Shares redeemed to pay income tax | (21) | (21) | |||
Change in accumulated other comprehensive loss, net of tax | 0 | ||||
Net income | $ 2,330 | 2,330 | |||
Shareholders' equity, ending balance (in shares) at Jun. 30, 2023 | 38,400,422 | 38,400,422 | |||
Shareholders' equity, ending balance at Jun. 30, 2023 | $ 104,505 | $ 17,850 | $ 13,488 | $ 0 | $ 73,167 |
CONDENSED CONSOLIDATED STATEM_3
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Cash flows from operating activities | ||
Net income | $ 3,847 | $ 2,729 |
Adjustments for: | ||
Depreciation | 9,968 | 7,136 |
Change in inventory reserve | 0 | (1,418) |
Stock-based compensation expense | 2,862 | 2,576 |
Distributions of earnings received from equity method investments | 392 | 612 |
Income from equity method investments | (172) | (769) |
Income from debt investment | (110) | 0 |
Loss (gain) on disposal of property and equipment | 95 | (124) |
Deferred income tax (benefit) expense | (725) | 745 |
Changes in working capital, net of effects from acquisitions: | ||
Accounts receivable, net | (500) | (1,464) |
Inventory | (320) | 1,022 |
Prepaid expenses and other assets | 2,076 | (634) |
Trade payables | (488) | (243) |
Deferred revenue | 604 | 649 |
Accrued liabilities | 1,593 | (87) |
Income tax payable/receivable | (1,003) | 1,362 |
Net cash provided by operating activities | 18,119 | 12,092 |
Cash flows from investing activities | ||
Purchase of property and equipment | (10,759) | (10,989) |
Investment in equity investments | (7) | (121) |
Cash paid for acquisition of HMP, net of cash acquired | (27,121) | 0 |
Proceeds from sale of property and equipment | 1,775 | 615 |
Net cash used in investing activities | (36,112) | (10,495) |
Cash flows from financing activities | ||
Proceeds from exercise of options | 1,228 | 0 |
Proceeds from term notes | 5,000 | 0 |
Principal payments on term notes | (1,357) | (78) |
Proceeds from revolving credit facilities | 8,000 | 0 |
Payments on revolving credit facilities | (1,005) | (872) |
Shares redeemed to pay income tax | (526) | (119) |
Shares repurchased under the share repurchase program | 0 | (7,001) |
Repayments of lease liabilities | (37) | (13) |
Net cash provided by (used in) financing activities | 11,303 | (8,083) |
Net decrease in cash and cash equivalents | (6,690) | (6,486) |
Cash and cash equivalents at beginning of year | 16,914 | 28,408 |
Cash and cash equivalents at end of period | 10,224 | 21,922 |
Supplemental disclosures of cash flow information | ||
Cash paid during the period for interest | 169 | 128 |
Cash paid (received) during the period for income taxes, net of refunds | 3,093 | (940) |
Supplemental disclosures of non-cash transactions | ||
Non-cash change in debt from the reclassification of debt issuance costs | $ (748) | $ 0 |
Nature of Business and Operatio
Nature of Business and Operations | 6 Months Ended |
Jun. 30, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Nature of Business and Operations | Nature of Business and Operations Viemed Healthcare, Inc. (the "Company"), through its subsidiaries, is a provider of home medical equipment ("HME") and post-acute respiratory healthcare services in the United States. The Company’s service offerings are focused on effective in-home treatment with clinical practitioners providing therapy and counseling to patients in their homes using cutting edge technology. The Company currently serves patients in 50 states of the United States. The Company was incorporated under the Business Corporations Act (British Columbia) on December 14, 2016. The Company's registered and records office is located at Suite 2800, Park Place, 666 Burrard Street, Vancouver, British Columbia V6C 2Z7 and its corporate office is located at 625 E. Kaliste Saloom Road, Lafayette, Louisiana 70508. The Company is an "emerging growth company," as defined in the Jumpstart Our Business Startups Act (the "JOBS Act") and a "smaller reporting company" under Rule 12b-2 of the Securities and Exchange Act of 1934, as amended (the "Exchange Act"), and, as such, has elected to comply with certain reduced U.S. public company reporting requirements. The Company’s common shares are traded in the U.S. on the Nasdaq Capital Market under the symbol "VMD" and in Canada on the Toronto Stock Exchange under the symbol "VMD.TO". |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 6 Months Ended |
Jun. 30, 2023 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | Summary of Significant Accounting Policies Principles of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and pursuant to the rules and regulations of the Securities and Exchange Commission (the "SEC"). Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. The accompanying condensed consolidated financial statements are unaudited, but reflect all adjustments consisting of normal recurring accruals, which, in the opinion of management, are necessary to present fairly the Company's Condensed Consolidated Balance Sheets, Condensed Consolidated Statements of Income and Comprehensive Income, Condensed Consolidated Statements of Changes in Shareholders’ Equity and Condensed Consolidated Statements of Cash Flows for the interim periods presented. The Company's fiscal year ends on December 31. The Condensed Consolidated Balance Sheet as of December 31, 2022 was derived from audited consolidated financial statements but does not include all disclosures required by GAAP. These condensed consolidated financial statements should be read in conjunction with the annual consolidated financial statements and the notes thereto and the report of the Company's independent registered public accounting firm included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022. The nature of the Company's business is such that the results of any interim period may not be indicative of the results to be expected for the entire year. Basis of Consolidation These consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. All intercompany transactions have been eliminated. Use of Estimates The preparation of consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Management bases these estimates and assumptions upon historical experience, existing and known circumstances, authoritative accounting pronouncements and other factors that management believes to be reasonable. Significant areas requiring the use of management estimates relate to revenue recognition, accounts receivable and the related allowance for doubtful accounts, income tax provisions, and fair value of financial instruments. Actual results could differ from these estimates. Segment Reporting The Company’s chief operating decision-makers ("CODMs") are its Chief Executive Officer and Chief Operating Officer, who make resource allocation decisions and assess performance based on financial information presented on an aggregate basis. There are no segment managers who are held accountable by the chief operating decision-makers, or anyone else, for any planning, strategy and key decision-making regarding operations. The corporate office is responsible for contract negotiation with vendors and payors, corporate compliance with healthcare laws and regulations, and revenue cycle management, among other corporate supporting functions. Accordingly, the Company has a single reportable segment and operating segment structure based on ASC 280, Segment Reporting . Accounts receivable Accounts receivable are regularly reviewed for collectability and an allowance is recorded to cover the estimated bad debts and billing modifications. The accounts receivable are presented on the Condensed Consolidated Balance Sheets net of the allowance for doubtful accounts. It is possible that the estimates of the allowance for doubtful accounts could change, which could have a material impact on our operations and cash flows. The Company writes off receivables when the likelihood for collection is remote, and when the Company believes collection efforts have been fully exhausted and it does not intend to devote additional resources in attempting to collect. The write-offs are charged against the allowance for doubtful accounts. For the six months ended June 30, 2023, the Company's evaluation takes into consideration such factors as historical bad debt and billing modification experience, national and local economic trends and conditions, industry and regulatory conditions, other collection indicators and information about disaggregated receivables. The complexity of many third-party billing arrangements, patient qualification for medical necessity of equipment and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. The estimates and charge-offs for the allowance for doubtful accounts for each reporting period were as follows: June 30, 2023 June 30, 2022 Balance, beginning of year $ 8,483 $ 7,031 Provision for uncollectible accounts 7,579 6,300 Amounts charged off (5,055) (3,948) Balance, end of period $ 11,007 $ 9,383 Included in accounts receivable at June 30, 2023 are amounts due from Medicare and Medicaid representing 35% and 6%, respectively, and 41% combined, of total outstanding receivables. As of December 31, 2022, 48% of total outstanding receivables were amounts due from Medicare and Medicaid. Revenues from Medicare and Medicaid as percentages of the Company's traditional revenue streams, excluding COVID-19 response sales and services, for the three and six months ended June 30, 2023 and 2022 were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Medicare revenues 44 % 46 % 45 % 47 % Medicaid revenues 9 % 9 % 9 % 9 % Total Medicare and Medicaid 53 % 55 % 54 % 56 % Inventory Inventory represents non-serialized supplies that consist of equipment parts, consumables, and associated product supplies and is expensed at the time of sale or use. The Company values inventory at the lower of cost or net realizable value. Obsolete and unserviceable inventories are valued at estimated net realizable value. Property and equipment Property and equipment is presented on the Condensed Consolidated Balance Sheets at historic cost less accumulated depreciation. Major renewals and improvements that extend the useful life of assets are capitalized to the respective property accounts, while maintenance and repairs, which do not extend the useful life of the respective assets, are expensed as incurred. Management has estimated the useful lives of equipment leased to customers. Depreciation is computed using the straight-line method over the estimated useful lives of the respective assets. Property and equipment are amortized on a straight-line basis over their estimated useful lives. Depreciation of medical equipment commences at the date of service, which represents the date that the asset has been delivered to a patient and is put in use and continues through the useful life of the asset. Property and equipment with definite useful lives are tested for impairment whenever events or changes in circumstances indicate that their carrying amount may not be recoverable. Equity investments Equity investments on the Condensed Consolidated Balance Sheets are comprised of an investment accounted for under the equity method and equity investments without readily determinable fair values accounted for under the measurement alternative described in ASC 321-10-35-2. The following table details the Company’s equity investments: June 30, 2023 December 31, 2022 Equity method investments $ 595 $ 816 Other equity investments 1,347 1,339 Balance, end of period $ 1,942 $ 2,155 The Company's equity method investments include a 49% equity interest in Solvet Services, LLC, an entity which provides health care support services to state and federal governments. Investments accounted for under the equity method are investments in unconsolidated entities over whose operating and financial policies the Company has the ability to exercise significant influence but not control. Equity method investments are initially measured at cost in the Condensed Consolidated Balance Sheets with any subsequent adjustments made to the carrying amount of the investment for the Company’s proportionate share of income or loss. Distributions received from the investee reduce the Company’s carrying value of the investment. The Company has recognized its share of income or loss on the gain (loss) from equity method investments within non-operating expenses in the Condensed Consolidated Statements of Income. Equity method investments are evaluated for impairment whenever events or changes in circumstances indicate that the carrying value of the investments may exceed the fair value. No events or changes have occurred as of June 30, 2023 that would impair the carrying value of equity method investments. Other equity investments include an equity interest in VeruStat, Inc., a remote patient monitoring entity, and an equity interest in DMEscripts, LLC, an e-prescribing platform. Other equity investments are investments without a readily determinable fair value which do not qualify for the practical expedient in ASC 820. For these investments, the Company has elected the measurement alternative which measures the investment at cost, less any impairment. ASU 2019-04 clarifies that if an entity identifies observable price changes in orderly transactions for the identical or a similar investment of the same issuer, it must measure its equity investment at fair value in accordance with ASC 820 as of the date that the observable transaction occurred. The Company was not aware of any impairment or observable price change adjustments that needed to be made as of June 30, 2023 on its investments in equity securities without a readily determinable fair value. Debt Investment The Company's debt investment is a variable rate secured convertible note issued by Healthcare DX, Inc. (d/b/a ModoHealth) on December 21, 2022, classified as an available-for-sale debt instrument. Accrued interest is due upon the 18 month maturity of the note and is included in the amortized cost basis at each reporting period. At each financial statement date until a conversion event, the debt instrument is required to be remeasured at fair value. Changes in unrealized gains and losses are included in accumulated other comprehensive income, net of tax effect, until realized. Valuation of Goodwill Goodwill resulting from business combinations is not amortized, rather, it is assessed for impairment annually and upon the occurrence of a triggering event or change in circumstances indicating a possible impairment. Such triggering events potentially warranting an annual or interim goodwill impairment assessment include, among other factors, declines in historical or projected revenue, operating income or cash flows, and sustained decreases in the Company’s stock price or market capitalization. Such changes in circumstance can include, among others, changes in the legal environment, reimbursement environment, operating performance, and/or future prospects. The Company performs its annual impairment assessment of goodwill during the fourth quarter of each year. The impairment assessment can be performed on either a quantitative or qualitative basis. The Company first assesses qualitative factors to determine whether it is necessary to perform a quantitative goodwill impairment analysis. If determined necessary, the Company applies the quantitative impairment test to identify and measure the amount of impairment, if any. Fair value determinations require considerable judgment and are sensitive to changes in underlying assumptions and factors, such as estimates of a reporting unit's fair value and judgment about impairment triggering events. As a result, there can be no assurance that the estimates and assumptions made for purposes of the annual or interim goodwill impairment test will prove to be accurate predictions of the future. During the three months ended June 30, 2023 the Company evaluated the events and changes that could indicate that goodwill might be impaired and concluded that an interim test was not necessary. Comprehensive income Comprehensive income reflects the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources. The Company's comprehensive income represents net income adjusted for unrealized gains and losses on derivative instruments, net of tax. Accumulated other comprehensive loss is presented on the accompanying Condensed Consolidated Balance Sheets as a component of shareholders' equity. Revenue recognition Revenue from a customer consists of sales and rentals of home medical equipment and patient medical services. Patient revenues are billed to and collections received from Medicare, Medicaid, third-party insurers, co-insurance and patient-pay. Patient revenue is recognized net of contractual adjustments and bad debt based on contractual arrangements with third-party payors, an evaluation of expected collections resulting from the analysis of current and past due accounts, past collection experience in relation to amounts billed and other relevant information. Contractual adjustments result from the differences between the rates charged for services and reimbursement rates paid by government-sponsored healthcare programs and insurance companies for such services. The Company's contracts with customers often include multiple products and services, and the Company evaluates these arrangements to determine the unit of accounting for revenue recognition purposes based on whether the product or service is distinct from other products or services in the arrangement and should be accounted for as a separate performance obligation. A product or service is distinct if the customer can benefit from it on its own or together with other readily available resources and the Company's ability to transfer the goods or services is separately identifiable from other promises in the contractual arrangement with the customer (e.g. patient). Revenue is then allocated to each separately identifiable good or service based on the standalone price of the items underlying the performance obligations. Most of the Company’s products fall in the Medicare Fee-for-Service (“FFS”) program which is a payment model where services are unbundled and paid for separately. These services are paid based on a Medicare determined price that is publicly available on the website for the Centers for Medicare & Medicaid Services (“CMS”). For commercial payors, HME companies must negotiate in-network pricing separately, though in general, the Company’s payors tend to benchmark their contract rates and coverage policies closely to those of Medicare. The Company considers performance obligations for sales and rentals to be met when the customer receives the equipment, and revenue for rentals is recognized over time, over the respective rental period. For revenue associated with HME rentals, the Company recognizes revenue in accordance with FASB ASC 842, “Leases,” (Topic 842). For any HME sales and services, the Company recognizes revenue under FASB ASU 2014-09, “Revenue from Contracts with Customers,” (Topic 606) and related amendments. The Company recognizes equipment rental revenue over the non-cancelable lease term, which varies based on the type of equipment rental, less estimated adjustments, in accordance with Topic 842. The Company has separate contracts with each patient that are not subject to a master lease agreement with any third-party payor. The Company would first consider the lease classification issue (sales-type lease or operating lease) and then appropriately recognize or defer rental revenue over the lease term . Revenues associated with external staffing services are accrued on an hourly basis and are recorded based on the determination of whether the Company is acting as a principal or an agent. In arrangements in which the Company manages customers' supplemental workforce needs utilizing its own network of healthcare professionals, the Company is determined to be a principal and includes the contractual gross billings in revenues with a corresponding increase to cost of revenues for worksite employee payroll costs associated with these services. Alternatively, when the Company acts as agent in the performance of workforce management, revenue is recorded based on contractually agreed upon fees or commissions with no associated cost of revenues. The revenues from each major source are summarized in the following table: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Revenue from rentals under Topic 842 Ventilator rentals, non-invasive and invasive $ 25,712 $ 22,736 $ 50,859 $ 44,254 Other durable medical equipment rentals 8,419 4,912 15,325 9,271 Revenue from sales and services under Topic 606 Equipment and supply sales 6,778 3,245 11,542 6,282 COVID-19 response sales and services — 183 — 2,278 Service revenues 2,402 2,234 5,141 3,480 Total revenues $ 43,311 $ 33,310 $ 82,867 $ 65,565 Revenue Accounting under Topic 842 The Company leases HME such as non-invasive and invasive ventilators, positive airway pressure ("PAP") machines, percussion vests, oxygen concentrator units and other small respiratory equipment to customers for a fixed monthly amount on a month-to-month basis. The customer generally has the right to cancel the lease at any time during the rental period. The Company accounts for these rentals as operating leases. Under FASB ASC Topic 842, the Company recognizes rental revenue on operating leases on a straight-line basis over the contractual lease term which varies based on the type of equipment rental. The lease term begins on the date equipment is delivered to patients, and revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including Medicare, private commercial payors, and Medicaid. Certain customer co-payments are included in revenue when considered probable of payment, which is generally when paid. Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenue and accounts receivable at their net realizable values. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes available. Specifically, the complexity of many third-party billing arrangements and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application or claim denial. Revenue Accounting under Topic 606 The Company sells HME, replacement parts and supplies to customers and recognizes revenue based on contractual payment rates as determined by the payors at the point in time where control of the good or service is transferred through delivery to the customer. The customer and, if applicable, the payors are generally charged at the time that the product is sold. For sales of equipment previously placed in service, proceeds associated with these sales are recorded to gain (loss) on disposal of property and equipment. The Company also provides sleep study services to customers and recognizes revenue when the sleep study results are complete, satisfying the performance obligation. In response to the COVID-19 pandemic, the Company began offering contact and vaccine tracing services, which revenues are recognized in the period in which the service has been provided. The transaction price on equipment sales, sleep studies and contact and vaccine tracing is the amount that the Company expects to receive in exchange for the goods and services provided. Due to the nature of the HME business, gross charges are retail charges and generally do not reflect what the Company is ultimately paid. As such, the transaction price is constrained for the difference between the gross charge and what is estimated to be collected from payors and from patients. The transaction price therefore is predominantly based on contractual payment rates as determined by the payors. The payment terms and conditions of customer contracts vary by customer type and the products and services offered. For staffing services, performance obligations in the staffing agreements are satisfied over time when the customer simultaneously receives and consumes the benefits provided. Accordingly, revenues from staffing services are recognized on an hourly basis as services are rendered by the job site employee in both principal and agent arrangements. The Company determines its estimates of contractual allowances and discounts based upon contractual agreements, its policies and historical experience. While the rates are fixed for the product or service with the customer and the payors, such amounts typically include co-payments, co-insurance and deductibles, which vary in amounts, and are due from the patient. The Company includes in the transaction price only the amount that the Company expects to be entitled, which is substantially all of the payor billings at contractual rates. The transaction price is initially constrained by the amount of customer co-payments, which are included in the transaction price when considered probable of payment and included in revenue if the product or service has already been provided to the customer. Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenue and accounts receivable at their net realizable values. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes available. Specifically, the complexity of many third-party billing arrangements and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application or claim denial. Returns and refunds are not accepted on equipment sales, sleep study services, staffing services, or contact and vaccine tracing services. The Company does not offer warranties to customers in excess of the manufacturer’s warranty. Any taxes due upon sale of the products or services are not recognized as revenue. The Company does not have any partially or unfilled performance obligations related to contracts with customers and as such, the Company has no contract liabilities as of June 30, 2023. Stock-based compensation The Company accounts for its stock-based compensation in accordance with ASC 718 , "Compensation—Stock Compensation" , which establishes accounting for share-based awards exchanged for employee services and requires companies to expense the estimated fair value of these awards over the requisite employee service period. Stock–based compensation costs for stock options are determined at the grant date using the Black-Scholes option pricing model. Stock-based compensation costs for restricted stock units ("RSUs") are determined at the grant date based on the closing stock price. The expense of such stock-based compensation awards is recognized using the graded vesting attribution method over the vesting period and the offsetting credit is recorded as an increase in additional paid-in capital. Forfeitures are recorded as incurred. Any excess tax benefit or deficiency is recognized as a component of income taxes and within operating cash flows upon vesting of the share-based award. For the Company’s phantom share units settled in cash, the Company computes the fair value of the phantom share units using the closing price of the Company's stock at the end of each period and records a liability based on the percentage of requisite service. Interest rate swaps The Company utilized an interest rate swap contract to reduce exposure to fluctuations in variable interest rates for future interest payments on the 2019 Term Note (as defined below). For determining the fair value of the interest rate swap contract, the Company uses significant other observable market data or assumptions (Level 2 inputs) that market participants would use in pricing similar assets or liabilities, including assumptions about counterparty risk. These fair value estimates reflect an income approach based on the terms of the interest rate swap contract and inputs corroborated by observable market data including interest rate curves. The Company presents a positive ending period fair value of the interest rate swap contract in other long-term assets, as a component of long-term assets, and a negative ending period fair value of the interest rate swap contract in accrued liabilities, as a component of long-term liabilities on the Condensed Consolidated Balance Sheets. The Company recognized any differences between the variable interest rate payments and the fixed interest rate settlements from its swap counterparty as an adjustment to interest expense over the life of the swap. If determined to be an effective cash flow hedge, the Company will record the changes in the estimated fair value of the swaps to accumulated other comprehensive income or loss on the Condensed Consolidated Balance Sheets. To the extent that interest rate swaps are determined to be ineffective, the Company would recognize the changes in the estimated fair value of swaps in interest and other non-operating expenses, net in its Condensed Consolidated Statements of Income. During the year ended December 31, 2022, the Company settled its interest rate swap in connection with the refinancing of its credit facilities and recognized the realized gain of $0.2 million in Other Income. Income taxes The Company is subject to income taxes in numerous U.S. jurisdictions. Significant judgment is required in determining the provision for income taxes. The Company's income tax provisions reflect management’s interpretation of country and state tax laws. There are many transactions and calculations for which the ultimate tax determination is uncertain during the ordinary course of business and may remain uncertain for several years after their occurrence. The Company recognizes assets and liabilities for taxation when it is probable that the Company will receive refunds from or pay taxes to the relevant tax authority. Where the final determination of tax assets and liabilities is different from the amounts that were initially recorded, such differences will impact the current and deferred income taxes provision in the period in which such a determination is made. Changes in tax law or changes in the way tax law is interpreted may also impact the Company's effective tax rate as well as the Company's business and operations. Deferred income tax assets and liabilities are recognized for the future income tax consequences attributable to temporary differences between the financial statement carrying value of assets and liabilities and their respective income tax bases. Deferred income tax assets or liabilities are measured using enacted income tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be settled. The calculation of current and deferred income taxes requires management to make estimates and assumptions and to exercise a certain amount of judgment concerning the carrying value of assets and liabilities. The current and deferred income tax assets and liabilities are also impacted by expectations about future operating results and the timing of reversal of temporary differences as well as possible audits of tax filings by regulatory agencies. Changes or differences in these estimates or assumptions may result in changes to the current and deferred tax assets and liabilities on the Condensed Consolidated Balance Sheets and a charge to or recovery of income tax expense. CARES Act Funds Received The Company received a general distribution payment from the Provider Relief Fund of $3.5 million in April 2020, a targeted distribution payment of $1.5 million in November 2021, and a general distribution payment of $0.4 million in January 2022. The U.S. Department of Health and Human Services ("HHS") has stated that Provider Relief Fund payments are not loans and will not need to be repaid. However, as a condition to the receipt of funds, the Company and any other providers must agree to a detailed set of terms and conditions. CMS has indicated that the terms and conditions may be subject to ongoing changes and reporting. There is no US GAAP guidance for for-profit health care entities that receive government grants that are not in the form of an income tax credit, revenue from a contract with a customer or a loan. As such, for-profit entities must determine the appropriate accounting treatment by analogy to other guidance such as International Accounting Standards (IAS) 20, Accounting for Government Grants and Disclosure of Government Assistance, in International Financial Reporting Standards. Under IAS 20, the Company determined that upon receipt of funds, it fully complied with the conditions attached to the grant. The Company recognized the distributions received from the Provider Relief Fund in the income statement in full during the period of receipt. To the extent that reporting requirements and terms and conditions are modified, it may affect the Company's ability to comply and may require the return of funds. The Company is not aware of any such modifications as of June 30, 2023 Recently adopted accounting pronouncements On January 1, 2023, the Company adopted ASU 2016-13, Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments. The standard replaces the current incurred loss impairment model that recognizes losses when a probable threshold is met with a requirement to recognize lifetime expected credit losses immediately when a financial asset is originated or purchased. Further, the FASB issued ASU 2019-04 and ASU 2019-05 to provide additional guidance on the credit losses standard. While the adoption of ASC 326 could result in a higher allowance recorded in the future for credit losses on receivables within the scope of the standard due to the prescribed measurement principles, the impact of the adoption on the Company's consolidated financials statements was not material. Recently issued accounting pronouncements The Company is an “emerging growth company” as defined by the JOBS Act. The JOBS Act provides that an emerging growth company can take advantage of the extended transition period provided in Section 7(a)(2)(B) of the Securities Act of 1933, as amended, for complying with new or revised accounting standards. In other words, an emerging growth company can selectively delay the adoption of all accounting standards until those standards would otherwise apply to private companies. The Company has elected to utilize this exemption and, as a result, the Company's condensed consolidated financial statements may not be comparable to the financial statements of issuers that are required to comply with the effective dates for new or revised accounting standards that are applicable to public companies. To date, however, the Company has not delayed the adoption of any accounting standards except as noted below. Section 107 of the JOBS Act provides that the Company can elect to opt out of the extended transition period at any time, which election is irrevocable. In September 2022, the FASB issued ASU No. 2022-04, Liabilities — Supplier Finance Programs (Subtopic 405-50): Disclosure of Supplier Finance Program Obligations, which requires entities that use supplier finance programs in connection with the purchase of goods and services to disclose the key terms of the programs and information about their obligations that are outstanding at the end of the reporting period. The amendments in this update are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years, except for the amendment on rollforward information, which is effective for fiscal years beginning after December 15, 2023. The Company does not expect the update to affect the recognition, measurement, or financial statement presentation of supplier finance program obligations, bu |
Business Combinations
Business Combinations | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Business Combinations | Business Combinations On June 1, 2023, Viemed, Inc., a wholly-owned subsidiary of the Company, completed the acquisition of Home Medical Products, Inc., (“HMP”), which operates in Tennessee, Alabama, and Mississippi. The Company acquired 100% of the equity ownership of HMP in exchange for approximately $29.4 million in cash or cash payable, subject to customary post-closing net working capital and other adjustments. Approximately $15 million of the purchase consideration was funded by cash on hand, $8 million was funded by a borrowing on the 2022 Revolving Credit Facility, and $5 million was funded by a borrowing on the 2022 Term Loan Facility. The results of HMP’s operations have been included in the consolidated financial statements since the date of acquisition. The Company expensed $254,000 of acquisition costs in conjunction with the acquisition for the six months ended June 30, 2023. These costs include system conversion and integrating operations charges, as well as legal and consulting expenses, and are included in selling, general, and administrative expense in the accompanying consolidated statements of income and comprehensive income. The following table summarizes the consideration paid and estimated fair values of the assets acquired and liabilities assumed at the acquisition date. The Company is in the process of obtaining third-party valuations of certain fixed assets and identifiable intangible assets; thus, the provisional measurements of property plant and equipment, trade names, non-compete agreements, and goodwill are subject to change. The fair value of accounts receivables acquired is $2.0 million, with the gross contractual amount being $2.9 million. The Company expects $0.9 million to be uncollectible. Purchase Price Cash paid or payable $ 29,417 Identifiable Assets Cash and cash equivalents 921 Accounts receivable 2,014 Inventory 582 Prepaid expenses and other assets 535 Property and equipment, net 4,358 Lease assets 743 Identifiable intangibles 688 Other long-term assets 25 TOTAL ASSETS 9,866 Identifiable Liabilities Trade payables 2,144 Deferred revenue 732 Accrued liabilities 1,195 Current portion of lease liabilities 536 Current debt 4,558 Long-term lease liabilities 207 Long-term debt 836 TOTAL LIABILITIES 10,208 Net assets (liabilities) acquired (342) Resulting goodwill $ 29,759 |
Property and Equipment
Property and Equipment | 6 Months Ended |
Jun. 30, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and Equipment The Company’s fixed assets consist of its medical equipment held for rental, furniture and equipment, real property and related improvements, and vehicles and other various small equipment. The following table details the Company’s fixed assets: June 30, 2023 December 31, 2022 Medical equipment $ 103,571 $ 93,893 Furniture and equipment 3,115 2,792 Land 2,566 2,566 Buildings 7,129 7,043 Leasehold improvements 344 296 Vehicles 1,129 1,052 Less: Accumulated depreciation (44,970) (39,899) Property and equipment, net of accumulated depreciation and amortization $ 72,884 $ 67,743 |
Current Liabilities
Current Liabilities | 6 Months Ended |
Jun. 30, 2023 | |
Payables and Accruals [Abstract] | |
Current Liabilities | Current Liabilities The Company’s short-term accrued liabilities are included within current liabilities and consist of the following: June 30, 2023 December 31, 2022 Accrued trade payables $ 2,735 $ 2,254 Accrued commissions payable 737 608 Accrued bonuses payable 4,329 3,708 Accrued vacation and payroll 2,450 1,484 Current portion of phantom share liability 1,483 1,704 Purchase price payable 1,376 — Accrued other liabilities 2,399 1,334 Total accrued liabilities $ 15,509 $ 11,092 |
Debt
Debt | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Debt | Debt 2018 Senior Credit Facility On February 20, 2018, the Company entered a Commercial Business Loan Agreement (the "2018 Senior Credit Facility") that provided for Term Loans and Lines of Credit with Hancock Whitney Bank. Until November 29, 2022, the Company maintained a line of credit in the amount of $10.0 million under the 2018 Senior Credit Facility. On May 30, 2019, the Company entered into a term note (“Building Term Note”) under the 2018 Senior Credit Facility in the principal amount of $4.8 million. The proceeds of the Building Term Note were used to purchase the Company's corporate headquarters. In connection with the Building Term Note, the Company entered into an interest rate swap transaction ("Interest Rate Swap Transaction") with Hancock Whitney Bank effectively fixing the interest rate for the Building Term Note at 4.68%. On September 19, 2019, the Company entered into an additional loan agreement providing for a term note (the “2019 Term Note") under the 2018 Senior Credit Facility in the principal amount of $5.0 million and bearing an annual interest rate of 4.60%. The proceeds of the 2019 Term Note were utilized for general corporate purposes. The 2019 Term Note matured on September 19, 2022 at which time the entire unpaid balance of principal and interest was repaid in full. In connection with the entry in to the 2022 Senior Credit Facilities on November 29, 2022, the Company retired the 2018 Senior Credit Facility, and repaid all outstanding interest and principal in full. 2022 Senior Credit Facilities On November 29, 2022, the Company refinanced its existing borrowings under the 2018 Senior Credit Facility and entered into a new credit agreement (the "2022 Senior Credit Facilities") with the lenders from time to time party thereto, and Regions Bank, as administrative agent (the "Administrative Agent") and collateral agent, that provides for an up to $30.0 million revolving credit facility (the "2022 Revolving Credit Facility") and an up to $30.0 million delayed draw term loan facility (the "2022 Term Loan Facility"), both maturing in November 2027. The proceeds of the 2022 Revolving Credit Facility may be used to refinance existing indebtedness, for working capital purposes, capital expenditures and other general corporate purposes (including permitted acquisitions), and to pay transaction fees, costs and expenses related to the 2022 Senior Credit Facilities. The proceeds of the 2022 Term Loan Facility and any additional term loans established in accordance with the 2022 Senior Credit Facilities may be used to finance permitted acquisitions and to pay transaction fees, costs and expenses related to such acquisitions. The interest rates per annum applicable to the 2022 Senior Credit Facilities are Term SOFR (as defined in the 2022 Senior Credit Facilities) plus an applicable margin, which ranges from 2.625% to 3.375%, or, at the option of the Company, a Base Rate (as defined in the 2022 Senior Credit Facilities) plus an applicable margin, which ranges from 1.625% to 2.375%. The 2022 Senior Credit Facilities require the Company to comply with certain affirmative, as well as certain negative covenants that, among other things, restrict, subject to certain exceptions, the ability of the Company to incur indebtedness, grant liens, make investments, engage in acquisitions, mergers or consolidations and pay dividends and other restricted payments. The 2022 Senior Credit Facilities also include certain financial covenants, which generally include, but are not limited to the following : • Consolidated Total Leverage Ratio ( defined generally as total indebtedness to adjusted EBITDA) of not greater than (i) for any fiscal quarter ending during the period from the closing date to and including December 31, 2024, 2.75 to 1.0 and (ii) for any fiscal quarter ending on and after March 31, 2025, 2.50 to 1.0, subject to certain adjustments following a material acquisition. • Consolidated Fixed Charge Coverage Ratio ( defined generally as (a) adjusted EBITDA minus capital expenditures minus cash taxes to (b) the sum of scheduled principal payments plus cash interest expense plus restricted payments) of not less than 1.25:1.0. The Company was in compliance with all covenants under the 2022 Senior Credit Facilities in effect at June 30, 2023. The 2022 Senior Credit Facilities includes provisions permitting the Company from time to time to, subject to certain terms and conditions, increase the aggregate amount of commitments under the 2022 Revolving Credit Facility and/or establish one or more additional term loans under the 2022 Term Loan Facility, in each case, with additional commitments from existing lenders or new commitments from financial institutions acceptable to the Administrative Agent in its reasonable discretion; provided, that, (a) the aggregate principal amount of any increases in the 2022 Revolving Credit Facility, and (b) the aggregate principal amount of all additional term loans under the 2022 Term Loan Facility established after the closing date will not exceed $30.0 million. Financing costs and commitment fees related to the 2022 Senior Credit Facilities are capitalized and amortized over the term of the loans using the effective interest method. The recorded balances associated with the 2022 Senior Credit Facilities are as follows: June 30, 2023 December 31, 2022 Outstanding balance $ 13,000 $ — Financing costs and commitment fees (748) — Less: Current portion of notes payable (250) — Net long-term notes payable $ 12,002 $ — Medical Equipment Financing As a result of the acquisition of HMP, the Company assumed equipment financing obligations consisting of installment payments for medical equipment which secure the financing. The financing obligations are payable in monthly installments through 2026 and include interest at rates ranging from 0% to 7.99%. As of June 30, 2023, $3 million of the outstanding medical equipment financing obligations is presented on the condensed consolidated balance sheets as short term debt and $0.1 million is presented as long term debt, based on the scheduled repayment dates. |
Fair Value Measurement
Fair Value Measurement | 6 Months Ended |
Jun. 30, 2023 | |
Fair Value Disclosures [Abstract] | |
Fair Value Measurement | Fair Value Measurement Under ASC Topic 820, fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date (i.e., an exit price). ASC Topic 820 establishes a hierarchy for inputs to valuation techniques used in measuring fair value that maximizes the use of observable inputs and minimizes the use of unobservable inputs by requiring that the most observable inputs be used when available. There are three levels to the hierarchy based on the reliability of inputs, as follows: Level 1 - Observable inputs that reflect quoted prices (unadjusted) for identical assets or liabilities in active markets. Level 2 - Inputs other than quoted prices included in Level 1 that are observable for the asset or liability, either directly or indirectly. Level 2 inputs include quoted prices for similar assets or liabilities in active markets, or quoted prices for identical or similar assets and liabilities in markets that are not active. Level 3 - Unobservable inputs for the asset or liability. The degree of judgment exercised by the Company in determining fair value is greatest for instruments categorized in Level 3. Assets Measured at Fair Value on a Recurring Basis The Company measures certain assets at fair value on a recurring basis. There were no transfers between fair value measurement levels during any presented period. The following tables summarize the Company's assets measured at fair value on a recurring basis as of June 30, 2023 and December 31, 2022: At June 30, 2023 (In thousands) Level 1 Level 2 Level 3 Total Recurring Fair Value Measurements: Money market mutual funds $ 2,078 $ — $ — $ 2,078 Available for sale debt instrument — — 2,110 2,110 Total $ 2,078 $ — $ 2,110 $ 4,188 At December 31, 2022 (In thousands) Level 1 Level 2 Level 3 Total Recurring Fair Value Measurements: Money market mutual funds $ 11,005 $ — $ — $ 11,005 Available for sale debt instrument $ — $ — $ 2,000 $ 2,000 Total $ 11,005 $ — $ 2,000 $ 13,005 Available for Sale Debt Instrument The fair value of the Company’s available for sale debt instrument approximates its amortized cost basis due to the short maturity and indexed interest rate terms. The fair value is classified within Level 3 in the fair value hierarchy as the Company evaluates adjustments using a combination of observable and unobservable inputs, such as operating results of the counterparty as well observable prices in transactions of debt and equity instruments of the issuing counterparty when available. As of June 30, 2023, the analysis resulted in no adjustments to the carrying value impacting unrealized gains or losses. All changes to measured fair value during the period were the result of accrued interest. Assets Measured at Fair Value on a Nonrecurring Basis The Company measures certain assets at fair value on a nonrecurring basis. These assets include equity method investments and other equity investments. Equity method investments are evaluated for impairment whenever events or changes in circumstances indicate that the carrying value of the investments may exceed the fair value. The Company's other equity investments are holdings in privately-held companies without a readily determinable market value. The Company remeasures equity securities without readily determinable fair value at fair value when an orderly transaction is identified for an identical or similar investment of the same issuer in accordance with the measurement alternative under Topic 820. ASU 2019-04 states that the measurement alternative is a nonrecurring fair value measurement. Accordingly, other equity investments without readily determinable fair value are classified within Level 3 in the fair value hierarchy because the Company estimates the value using a combination of observable and unobservable inputs, including valuation ascribed to the issuing company in subsequent financing rounds, volatility in the results of operations of the issuers and rights and obligations of the holdings the Company owns. The Company had no material adjustments of assets measured at fair value on a nonrecurring basis during any of the periods presented. There were no transfers between fair value measurement levels during any presented period. |
Shareholders' Equity
Shareholders' Equity | 6 Months Ended |
Jun. 30, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Shareholders' Equity | Shareholders' Equity Authorized share capital The Company’s authorized share capital consists of an unlimited number of common shares, with no stated par value . Issued and outstanding share capital The Company has only one class of stock outstanding, common shares. The authorized stock consists of an unlimited number of common shares with no stated par value, of which 38,400,422 and 38,049,739 shares were issued and outstanding as of June 30, 2023 and December 31, 2022, respectively. For the six months ended June 30, 2023, the Company acquired and cancelled 66,734 common shares at a cost of $0.5 million to satisfy employee income tax withholding associated with RSUs vesting. The Company’s retained earnings were reduced by the amount paid for the shares repurchased and cancelled. Stock-based compensation Effective June 11, 2020 (the "Effective Date"), the Company’s shareholders approved the Company's 2020 Long Term Incentive Plan (the "Omnibus Plan"). Upon approval of the Omnibus Plan, no future awards are available to be made under the Company's previous RSU and Option Plans (collectively, the "Former Plan"), and the common shares that were not settled or awarded under the Former Plan as of the Effective Date are available for awards under the Omnibus Plan. The maximum number of common shares that are available for awards under the Omnibus Plan and under any other security-based compensation arrangements adopted by the Company, including the Former Plan, may not exceed 7,758,211 shares (equal to 20% of the issued and outstanding common shares of the Company on the Effective Date). The maximum amount of the foregoing common shares that may be awarded under the Omnibus Plan as “incentive stock options” is 2,600,000 common shares. As of June 30, 2023, the Company had outstanding options of 4,244,000 and RSUs of 1,123,000 associated with common shares under the Omnibus Plan. The following table summarizes stock-based compensation expense for the three and six months ended June 30, 2023 and 2022 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Stock-based compensation - options $ 301 $ 757 $ 649 $ 1,577 Stock-based compensation - restricted stock units 1,170 514 2,213 999 Total $ 1,471 $ 1,271 $ 2,862 $ 2,576 At June 30, 2023, there was approximately $889,000 of total unrecognized pre-tax stock option expense under the Company's equity compensation plans, which is expected to be recognized over a weighted-average period of 1.32 years. As of June 30, 2023, there was approximately $4,780,000 of total unrecognized pre-tax compensation expense related to outstanding time-based restricted stock units that is expected to be recognized over a weighted-average period of 1.26 years. Options The following table summarizes stock option activity for the six months ended June 30, 2023: Number of options Weighted average exercise price (1) Weighted average remaining contractual life Aggregate intrinsic value (2) Balance December 31, 2022 4,497 $ 5.26 6.9 years $ 11,356 Issued — — Exercised (228) 5.51 Expired / Forfeited (25) 6.47 Balance June 30, 2023 4,244 $ 5.24 6.4 years $ 19,290 (1) For presentation purposes, stock options issued with a Canadian dollar exercise price have been translated to U.S. dollars based on the prevailing exchange rate on the date of grant. (2) The aggregate intrinsic value of options outstanding represents the difference between the exercise price of the option and the closing share price of the Company's common stock on the last trading day of the period ($9.78). The aggregate intrinsic value of options outstanding was $19,290,197 and options exercisable were $16,579,787 at June 30, 2023. For the six months ended June 30, 2023, 228,000 common shares were issued pursuant to the exercise of stock options. At June 30, 2023, the Company had 3,415,000 exercisable stock options outstanding with a weighted average exercise price of $4.93 and a weighted average remaining contractual life of 6.0 years. At December 31, 2022, the Company had 2,841,000 exercisable stock options outstanding with a weighted average exercise price of $4.53 and a weighted average remaining contractual life of 6.1 years. The fair value of the stock options has been charged to the Consolidated Statements of Income and Comprehensive Income and credited to additional paid-in capital over the vesting period, using the grant date fair value based on the Black-Scholes option pricing model. The assumptions used to determine the grant date fair value of stock options include exercise price, risk-free interest rates, expected volatility, and average life of an option. The risk-free interest rates are based on the rates available at the time of the grant for zero-coupon U.S. government issues with a remaining term equal to the option’s expected life. The average life of an option is based on both historical and projected exercise and lapsing data. Expected volatility is based on implied volatilities from traded options on the Company's common shares and historical volatility of the Company's common shares over the expected life of the option. There were no issuances of options during the six months ended June 30, 2023. Restricted stock units The Company accounts for RSUs using fair value. The fair value of the RSUs has been charged to the Condensed Consolidated Statements of Income and Comprehensive Income and credited to additional paid-in capital over the vesting period, based on the stock price on the date of grant. RSUs vest generally over a one three The following table summarizes RSU activity for the six months ended June 30, 2023: Number of RSUs (000's) Weighted average grant price Weighted average remaining contractual life Aggregate intrinsic value (1) Balance December 31, 2022 629 $ 5.62 0.88 years $ 4,755 Issued 702 7.87 Vested (190) 5.56 Expired / Forfeited (18) 6.70 Balance June 30, 2023 1,123 $ 7.02 1.26 years $ 10,986 (1) The aggregate intrinsic value of time-based RSUs outstanding was based on the Company's closing stock price on the last trading day of the period ($9.78). During the six months ended June 30, 2023, the Company issued 702,206 RSUs with a vesting term of three years and a fair value of $5.6 million. During the three months ended June 30, 2023, the Company issued no RSUs. Phantom share units The Company has a phantom share unit plan, which it uses for grants to directors, officers, and employees. Phantom share units granted under the plan are non-assignable and are settled in cash at vesting based on the fair value of the Company's common stock on the vesting date. Phantom share units vest annually over a three-year period. The cash-settled phantom share units are accounted for as liability awards and are re-measured at fair value each reporting period until they become vested with accrued liability and related expense being recognized over the requisite service period. The following table summarizes phantom share unit activity for the six months ended June 30, 2023: Number of phantom share units (000's) Value of share equivalents (1) Balance December 31, 2022 513 $ 3,878 Issued 176 1,401 Vested (239) (578) Expired / Forfeited (20) (196) Balance June 30, 2023 430 $ 4,200 (1) The value of outstanding share equivalents at the beginning of the period is based on the market price of the Company’s stock at that time, the value of issued share equivalents is based on the market price of the Company’s stock at issuance, the value of vested share equivalents is based on the cash paid at the time of vesting, and the values of expired/forfeited share equivalents and outstanding share equivalents at the end of the period are based on the market price of the Company's stock at the end of the period. The market price of the Company's stock was $9.78 on June 30, 2023. The change in fair value of the phantom share units has been charged to the Condensed Consolidated Statements of Income and Comprehensive Income and recorded as a liability included in accrued liabilities and long-term accrued liabilities. The total liability associated with phantom share units at June 30, 2023 is $2,120,000, with $1,483,000 of this amount included in current accrued liabilities and the remaining portion of $637,000 included in long-term accrued liabilities. The impact associated with the fair value re-measurement of phantom share units is recorded in selling, general and administrative expenses within the unaudited Condensed Consolidated Statements of Income and Comprehensive Income. The following table summarizes expense (benefit) associated with the phantom share units for the three and six months ended June 30, 2023 and 2022 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Selling, general, and administrative $ 687 $ 538 $ 1,837 $ 949 The Company paid cash settlements of $2,309,000 and $1,389,000 during the six months ended June 30, 2023 and 2022, respectively, pertaining to vestings of cash-settled phantom share units. |
Commitments and Contingencies
Commitments and Contingencies | 6 Months Ended |
Jun. 30, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies The Company accrues estimates for resolution of any legal and other contingencies when losses are probable and reasonably estimable in accordance with ASC 450, Contingencies (“ASC 450”). No less than quarterly, the Company reviews the status of each significant matter underlying a legal proceeding or claim and assess our potential financial exposure. The Company accrues a liability for an estimated loss if the potential loss from any legal proceeding or claim is considered probable and the amount can be reasonably estimated. Significant judgment is required in both the determination of probability and the determination as to whether the amount of an exposure is reasonably estimable, and accruals are based only on the information available to the Company at the time the judgment is made, which may prove to be incomplete or inaccurate or unanticipated events and circumstances may occur that might cause us to change those estimates and assumptions. Furthermore, the outcome of legal proceedings is inherently uncertain, and we may incur substantial defense costs and expenses defending any of these matters. Legal Proceedings As previously disclosed, the Company (through its subsidiary Sleep Management LLC) submitted a purchase order (the “Purchase Order”) in March 2020 to Vyaire Medical, Inc. d/b/a CareFusion Respiratory Technologies (“Vyaire”) for respiratory equipment. The Company ultimately prepaid $1.4 million towards the delivery of such respiratory equipment. Vyaire was unable or unwilling to deliver the vast majority of the respiratory equipment referenced in the Purchase Order, and also refused to refund the prepayment amount (less the amounts paid for equipment actually received). On July 29, 2020, the Company (through its subsidiary Sleep Management LLC) filed a lawsuit against Vyaire in the United States District Court for the Western District of Louisiana (the “Court”). This lawsuit was dismissed on December 8, 2020 in connection with the commencement of the lawsuit filed by the Company (through its subsidiary Sleep Management) on November 5, 2020, against Vyaire in the 15th Judicial District Court for the Parish of Lafayette, Louisiana (the “State Court”) seeking damages for breach of contract and seeking a declaratory judgment that the Company is not required to pay any further funds to Vyaire. On December 28, 2020, Vyaire filed its Answer, Affirmative Defenses, and Reconventional Demand (“Reconventional Demand”) with the State Court alleging breach of contract and seeking damages of $4.7 million, purportedly for the improper cancellation of the Purchase Order. The Company filed its Answer to the Reconventional Demand on February 12, 2021 and the parties completed discovery on July 17, 2023. The Company filed a Motion for Summary Judgment on June 9, 2023. The Court has set an August 28, 2023 hearing on that motion and has set a date for a non-jury trial on October 30, 2023. The Company continues to believe that it has valid legal and equitable grounds to recover its outstanding prepayment as a result of Vyaire’s failure to deliver the vast majority of the respiratory equipment referenced in the Purchase Order. The Company has determined that a loss related to the Reconventional Demand is not probable, and thus has not accrued a liability related to this claim. Although a loss may be reasonably possible, the Company does not have sufficient information to determine the amount or range of reasonably possible loss with respect to the Reconventional Demand given that the dispute is in the early stages of the legal process. As of June 30, 2023, outstanding funds in the amount of $0.9 million related to undelivered respiratory equipment are included within other long-term assets. Governmental and Regulatory Matters From time to time the Company is involved in various external governmental investigations, audits and reviews. Reviews, audits and investigations of this sort can lead to government actions, which can result in the assessment of recoupment of reimbursement, civil or criminal fines or penalties, or other sanctions, including restrictions or changes in the way the Company conducts business, loss of licensure or exclusion from participation in government healthcare programs. In May of 2021, a final report and recommendation (“Report”) was issued by the OIG regarding an audit by OIG of claims relating to 100 of the Company’s non-invasive ventilation at home (“NIVH”) patients. The OIG asserted that most of the sampled Medicare claims submitted for the monthly rental of non-invasive ventilators did not comply with Medicare requirements. The Company firmly believed that the Report ignored each patient’s diagnosis and supporting documentation of that diagnosis from treating and prescribing physicians and applied clinical guidelines that were contrary to CMS’s accepted standard of care. In late June of 2021, the Company received initial request letters from DME Medicare Administrative Contractors ("MACs") referencing the Report and requesting repayment of purported overpayments. The Company responded to each initial request by submitting a rebuttal and by filing a redetermination appeal as prescribed by the initial request letters and by statute. In September 2021, the MACs informed the Company of unfavorable decisions with respect to the redetermination appeals. In November 2021, the Company filed Reconsideration Appeals with CMS's designated Qualified Independent Contractor ("QIC"). Based on its review, the QIC determined that approximately 77% of the claims it reviewed were medically necessary and properly payable under Medicare rules and regulations, overturning OIG’s and the MACs' initial recommendations and determinations. As a result of the QIC's reconsideration findings, reduced and recalculated principal overpayment requests totaling $1.1 million were issued by the MACs. In order to limit the assessment of interest during the appeals period, the Company remitted the associated funds to the MACs. In December 2022, an Administrative Law Judge overturned all of the remaining appealed claims and instructed the MACs to refund all funds previously remitted by the Company. Accordingly, the funds remitted to the MACs are recorded in Prepaid expenses and other assets at December 31, 2022 and were received during the six months ended June 30, 2023. |
Income Taxes
Income Taxes | 6 Months Ended |
Jun. 30, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes For the six months ended June 30, 2023, the Company recorded income tax expense of $1.2 million, which includes a discrete tax benefit of $0.1 million associated with stock-based compensation arrangements. Excluding the impact of the discrete taxes, the effective rate for the six months ended June 30, 2023 is 28.6%. The effective rate differs from the amount computed by applying the statutory federal and state income tax rates to ordinary income before the provision for income taxes due to permanent non-deductible differences. The Company's effective tax rate is based on forecasted annual results which may fluctuate significantly through the rest of the year. At June 30, 2023 and 2022, the Company had no amounts recorded for uncertain tax positions and does not expect any material changes in uncertain tax benefits during the next 12 months. The Company recognizes interest and penalties related to income tax matters in income tax expense. The Company is subject to U.S. federal income tax as well as income tax in various states. The Company is generally not subject to examination by taxing authorities for years prior to 2019. The Company recognizes deferred tax assets to the extent that the Company believes that these assets are more likely than not to be realized. In making such a determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax-planning strategies, and results of recent operations. |
Earnings Per Share
Earnings Per Share | 6 Months Ended |
Jun. 30, 2023 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | Earnings Per Share Income per common share is calculated using earnings for the year divided by the weighted average number of shares outstanding during the year . Using the treasury stock method, diluted income per share amounts are calculated giving effect to the potential dilution that would occur if securities or other contracts to issue common shares were exercised or converted to common shares by assuming the proceeds received from the exercise of stock options and the vesting of RSUs are used to purchase common shares at the prevailing market rate. The following reflects the earnings and share data used in the basic and diluted earnings per share computations: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Numerator - basic and diluted: Net income attributable to shareholders $ 2,330 $ 967 $ 3,847 $ 2,729 Denominator: Basic weighted-average number of common shares 38,324,249 38,773,580 38,240,902 39,195,317 Diluted weighted-average number of shares 40,676,951 39,752,928 40,383,616 40,056,953 Basic earnings per share $ 0.06 $ 0.02 $ 0.10 $ 0.07 Diluted earnings per share $ 0.06 $ 0.02 $ 0.10 $ 0.07 Denominator calculation from basic to diluted: Basic weighted-average number of common shares 38,324,249 38,773,580 38,240,902 39,195,317 Stock options and other dilutive securities 2,352,702 979,348 2,142,714 861,636 Diluted weighted-average number of shares 40,676,951 39,752,928 40,383,616 40,056,953 Anti-dilutive shares excluded from the calculation consisted of dilutive employee stock options and RSUs that were de minimis in all periods presented. |
Pay vs Performance Disclosure
Pay vs Performance Disclosure - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||||
Jun. 30, 2023 | Mar. 31, 2023 | Jun. 30, 2022 | Mar. 31, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Pay vs Performance Disclosure | ||||||
Net income attributable to shareholders | $ 2,330 | $ 1,517 | $ 967 | $ 1,762 | $ 3,847 | $ 2,729 |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 6 Months Ended |
Jun. 30, 2023 | |
Accounting Policies [Abstract] | |
Principles of Presentation | Principles of Presentation The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”) for interim financial information and pursuant to the rules and regulations of the Securities and Exchange Commission (the "SEC"). Accordingly, they do not include all of the information and footnotes required by GAAP for complete financial statements. The accompanying condensed consolidated financial statements are unaudited, but reflect all adjustments consisting of normal recurring accruals, which, in the opinion of management, are necessary to present fairly the Company's Condensed Consolidated Balance Sheets, Condensed Consolidated Statements of Income and Comprehensive Income, Condensed Consolidated Statements of Changes in Shareholders’ Equity and Condensed Consolidated Statements of Cash Flows for the interim periods presented. The Company's fiscal year ends on December 31. The Condensed Consolidated Balance Sheet as of December 31, 2022 was derived from audited consolidated financial statements but does not include all disclosures required by GAAP. These condensed consolidated financial statements should be read in conjunction with the annual consolidated financial statements and the notes thereto and the report of the Company's independent registered public accounting firm included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022. The nature of the Company's business is such that the results of any interim period may not be indicative of the results to be expected for the entire year. |
Basis of Consolidation | Basis of ConsolidationThese consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries. All intercompany transactions have been eliminated. |
Use of Estimates | Use of EstimatesThe preparation of consolidated financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenues and expenses during the reporting period. Management bases these estimates and assumptions upon historical experience, existing and known circumstances, authoritative accounting pronouncements and other factors that management believes to be reasonable. Significant areas requiring the use of management estimates relate to revenue recognition, accounts receivable and the related allowance for doubtful accounts, income tax provisions, and fair value of financial instruments. Actual results could differ from these estimates. |
Segment Reporting | Segment Reporting The Company’s chief operating decision-makers ("CODMs") are its Chief Executive Officer and Chief Operating Officer, who make resource allocation decisions and assess performance based on financial information presented on an aggregate basis. There are no segment managers who are held accountable by the chief operating decision-makers, or anyone else, for any planning, strategy and key decision-making regarding operations. The corporate office is responsible for contract negotiation with vendors and payors, corporate compliance with healthcare laws and regulations, and revenue cycle management, among other corporate supporting functions. Accordingly, the Company has a single reportable segment and operating segment structure based on ASC 280, Segment Reporting . |
Accounts receivable | Accounts receivable Accounts receivable are regularly reviewed for collectability and an allowance is recorded to cover the estimated bad debts and billing modifications. The accounts receivable are presented on the Condensed Consolidated Balance Sheets net of the allowance for doubtful accounts. It is possible that the estimates of the allowance for doubtful accounts could change, which could have a material impact on our operations and cash flows. The Company writes off receivables when the likelihood for collection is remote, and when the Company believes collection efforts have been fully exhausted and it does not intend to devote additional resources in attempting to collect. The write-offs are charged against the allowance for doubtful accounts. For the six months ended June 30, 2023, the Company's evaluation takes into consideration such factors as historical bad debt and billing modification experience, national and local economic trends and conditions, industry and regulatory conditions, other collection indicators and information about disaggregated receivables. The complexity of many third-party billing arrangements, patient qualification for medical necessity of equipment and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. |
Inventory | InventoryInventory represents non-serialized supplies that consist of equipment parts, consumables, and associated product supplies and is expensed at the time of sale or use. The Company values inventory at the lower of cost or net realizable value. Obsolete and unserviceable inventories are valued at estimated net realizable value. |
Property and equipment | Property and equipment Property and equipment is presented on the Condensed Consolidated Balance Sheets at historic cost less accumulated depreciation. Major renewals and improvements that extend the useful life of assets are capitalized to the respective property accounts, while maintenance and repairs, which do not extend the useful life of the respective assets, are expensed as incurred. Management has estimated the useful lives of equipment leased to customers. Depreciation is computed using the straight-line method over the estimated useful lives of the respective assets. Property and equipment are amortized on a straight-line basis over their estimated useful lives. |
Equity investments | Equity investments Equity investments on the Condensed Consolidated Balance Sheets are comprised of an investment accounted for under the equity method and equity investments without readily determinable fair values accounted for under the measurement alternative described in ASC 321-10-35-2. The Company's equity method investments include a 49% equity interest in Solvet Services, LLC, an entity which provides health care support services to state and federal governments. Investments accounted for under the equity method are investments in unconsolidated entities over whose operating and financial policies the Company has the ability to exercise significant influence but not control. Equity method investments are initially measured at cost in the Condensed Consolidated Balance Sheets with any subsequent adjustments made to the carrying amount of the investment for the Company’s proportionate share of income or loss. Distributions received from the investee reduce the Company’s carrying value of the investment. The Company has recognized its share of income or loss on the gain (loss) from equity method investments within non-operating expenses in the Condensed Consolidated Statements of Income. Equity method investments are evaluated for impairment whenever events or changes in circumstances indicate that the carrying value of the investments may exceed the fair value. No events or changes have occurred as of June 30, 2023 that would impair the carrying value of equity method investments. Other equity investments include an equity interest in VeruStat, Inc., a remote patient monitoring entity, and an equity interest in DMEscripts, LLC, an e-prescribing platform. Other equity investments are investments without a readily determinable fair value which do not qualify for the practical expedient in ASC 820. For these investments, the Company has elected the measurement alternative which measures the investment at cost, less any impairment. ASU 2019-04 clarifies that if an entity identifies observable price changes in orderly transactions for the identical or a similar investment of the same issuer, it must measure its equity investment at fair value in accordance with ASC 820 as of the date that the observable transaction occurred. The Company was not aware of any impairment or observable price change adjustments that needed to be made as of June 30, 2023 on its investments in equity securities without a readily determinable fair value. |
Debt Investment | Debt InvestmentThe Company's debt investment is a variable rate secured convertible note issued by Healthcare DX, Inc. (d/b/a ModoHealth) on December 21, 2022, classified as an available-for-sale debt instrument. Accrued interest is due upon the 18 month maturity of the note and is included in the amortized cost basis at each reporting period. At each financial statement date until a conversion event, the debt instrument is required to be remeasured at fair value. Changes in unrealized gains and losses are included in accumulated other comprehensive income, net of tax effect, until realized. |
Valuation of Goodwill | Valuation of Goodwill Goodwill resulting from business combinations is not amortized, rather, it is assessed for impairment annually and upon the occurrence of a triggering event or change in circumstances indicating a possible impairment. Such triggering events potentially warranting an annual or interim goodwill impairment assessment include, among other factors, declines in historical or projected revenue, operating income or cash flows, and sustained decreases in the Company’s stock price or market capitalization. Such changes in circumstance can include, among others, changes in the legal environment, reimbursement environment, operating performance, and/or future prospects. The Company performs its annual impairment assessment of goodwill during the fourth quarter of each year. The impairment assessment can be performed on either a quantitative or qualitative basis. The Company first assesses qualitative factors to determine whether it is necessary to perform a quantitative goodwill impairment analysis. If determined necessary, the Company applies the quantitative impairment test to identify and measure the amount of impairment, if any. Fair value determinations require considerable judgment and are sensitive to changes in underlying assumptions and factors, such as estimates of a reporting unit's fair value and judgment about impairment triggering events. As a result, there can be no assurance that the estimates and assumptions made for purposes of the annual or interim goodwill impairment test will prove to be accurate predictions of the future. During the three months ended June 30, 2023 the Company evaluated the events and changes that could indicate that goodwill might be impaired and concluded that an interim test was not necessary. |
Comprehensive income | Comprehensive incomeComprehensive income reflects the change in equity of a business enterprise during a period from transactions and other events and circumstances from non-owner sources. The Company's comprehensive income represents net income adjusted for unrealized gains and losses on derivative instruments, net of tax. Accumulated other comprehensive loss is presented on the accompanying Condensed Consolidated Balance Sheets as a component of shareholders' equity. |
Revenue recognition | Revenue recognition Revenue from a customer consists of sales and rentals of home medical equipment and patient medical services. Patient revenues are billed to and collections received from Medicare, Medicaid, third-party insurers, co-insurance and patient-pay. Patient revenue is recognized net of contractual adjustments and bad debt based on contractual arrangements with third-party payors, an evaluation of expected collections resulting from the analysis of current and past due accounts, past collection experience in relation to amounts billed and other relevant information. Contractual adjustments result from the differences between the rates charged for services and reimbursement rates paid by government-sponsored healthcare programs and insurance companies for such services. The Company's contracts with customers often include multiple products and services, and the Company evaluates these arrangements to determine the unit of accounting for revenue recognition purposes based on whether the product or service is distinct from other products or services in the arrangement and should be accounted for as a separate performance obligation. A product or service is distinct if the customer can benefit from it on its own or together with other readily available resources and the Company's ability to transfer the goods or services is separately identifiable from other promises in the contractual arrangement with the customer (e.g. patient). Revenue is then allocated to each separately identifiable good or service based on the standalone price of the items underlying the performance obligations. Most of the Company’s products fall in the Medicare Fee-for-Service (“FFS”) program which is a payment model where services are unbundled and paid for separately. These services are paid based on a Medicare determined price that is publicly available on the website for the Centers for Medicare & Medicaid Services (“CMS”). For commercial payors, HME companies must negotiate in-network pricing separately, though in general, the Company’s payors tend to benchmark their contract rates and coverage policies closely to those of Medicare. The Company considers performance obligations for sales and rentals to be met when the customer receives the equipment, and revenue for rentals is recognized over time, over the respective rental period. For revenue associated with HME rentals, the Company recognizes revenue in accordance with FASB ASC 842, “Leases,” (Topic 842). For any HME sales and services, the Company recognizes revenue under FASB ASU 2014-09, “Revenue from Contracts with Customers,” (Topic 606) and related amendments. The Company recognizes equipment rental revenue over the non-cancelable lease term, which varies based on the type of equipment rental, less estimated adjustments, in accordance with Topic 842. The Company has separate contracts with each patient that are not subject to a master lease agreement with any third-party payor. The Company would first consider the lease classification issue (sales-type lease or operating lease) and then appropriately recognize or defer rental revenue over the lease term . |
Revenue Accounting under Topic 842 | Revenue Accounting under Topic 842 The Company leases HME such as non-invasive and invasive ventilators, positive airway pressure ("PAP") machines, percussion vests, oxygen concentrator units and other small respiratory equipment to customers for a fixed monthly amount on a month-to-month basis. The customer generally has the right to cancel the lease at any time during the rental period. The Company accounts for these rentals as operating leases. Under FASB ASC Topic 842, the Company recognizes rental revenue on operating leases on a straight-line basis over the contractual lease term which varies based on the type of equipment rental. The lease term begins on the date equipment is delivered to patients, and revenues are recorded at amounts estimated to be received under reimbursement arrangements with third-party payors, including Medicare, private commercial payors, and Medicaid. Certain customer co-payments are included in revenue when considered probable of payment, which is generally when paid. |
Revenue Accounting under Topic 606 | Revenue Accounting under Topic 606 The Company sells HME, replacement parts and supplies to customers and recognizes revenue based on contractual payment rates as determined by the payors at the point in time where control of the good or service is transferred through delivery to the customer. The customer and, if applicable, the payors are generally charged at the time that the product is sold. For sales of equipment previously placed in service, proceeds associated with these sales are recorded to gain (loss) on disposal of property and equipment. The Company also provides sleep study services to customers and recognizes revenue when the sleep study results are complete, satisfying the performance obligation. In response to the COVID-19 pandemic, the Company began offering contact and vaccine tracing services, which revenues are recognized in the period in which the service has been provided. The transaction price on equipment sales, sleep studies and contact and vaccine tracing is the amount that the Company expects to receive in exchange for the goods and services provided. Due to the nature of the HME business, gross charges are retail charges and generally do not reflect what the Company is ultimately paid. As such, the transaction price is constrained for the difference between the gross charge and what is estimated to be collected from payors and from patients. The transaction price therefore is predominantly based on contractual payment rates as determined by the payors. The payment terms and conditions of customer contracts vary by customer type and the products and services offered. For staffing services, performance obligations in the staffing agreements are satisfied over time when the customer simultaneously receives and consumes the benefits provided. Accordingly, revenues from staffing services are recognized on an hourly basis as services are rendered by the job site employee in both principal and agent arrangements. The Company determines its estimates of contractual allowances and discounts based upon contractual agreements, its policies and historical experience. While the rates are fixed for the product or service with the customer and the payors, such amounts typically include co-payments, co-insurance and deductibles, which vary in amounts, and are due from the patient. The Company includes in the transaction price only the amount that the Company expects to be entitled, which is substantially all of the payor billings at contractual rates. The transaction price is initially constrained by the amount of customer co-payments, which are included in the transaction price when considered probable of payment and included in revenue if the product or service has already been provided to the customer. Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates are required to record net revenue and accounts receivable at their net realizable values. Inherent in these estimates is the risk that they will have to be revised or updated as additional information becomes available. Specifically, the complexity of many third-party billing arrangements and the uncertainty of reimbursement amounts for certain services from certain payors may result in adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application or claim denial. Returns and refunds are not accepted on equipment sales, sleep study services, staffing services, or contact and vaccine tracing services. The Company does not offer warranties to customers in excess of the manufacturer’s warranty. Any taxes due upon sale of the products or services are not recognized as revenue. The Company does not have any partially or unfilled performance obligations related to contracts with customers and as such, the Company has no contract liabilities as of June 30, 2023. |
Stock-based compensation | Stock-based compensation The Company accounts for its stock-based compensation in accordance with ASC 718 , "Compensation—Stock Compensation" , which establishes accounting for share-based awards exchanged for employee services and requires companies to expense the estimated fair value of these awards over the requisite employee service period. Stock–based compensation costs for stock options are determined at the grant date using the Black-Scholes option pricing model. Stock-based compensation costs for restricted stock units ("RSUs") are determined at the grant date based on the closing stock price. The expense of such stock-based compensation awards is recognized using the graded vesting attribution method over the vesting period and the offsetting credit is recorded as an increase in additional paid-in capital. Forfeitures are recorded as incurred. Any excess tax benefit or deficiency is recognized as a component of income taxes and within operating cash flows upon vesting of the share-based award. For the Company’s phantom share units settled in cash, the Company computes the fair value of the phantom share units using the closing price of the Company's stock at the end of each period and records a liability based on the percentage of requisite service. |
Interest rate swaps | Interest rate swaps The Company utilized an interest rate swap contract to reduce exposure to fluctuations in variable interest rates for future interest payments on the 2019 Term Note (as defined below). For determining the fair value of the interest rate swap contract, the Company uses significant other observable market data or assumptions (Level 2 inputs) that market participants would use in pricing similar assets or liabilities, including assumptions about counterparty risk. These fair value estimates reflect an income approach based on the terms of the interest rate swap contract and inputs corroborated by observable market data including interest rate curves. The Company presents a positive ending period fair value of the interest rate swap contract in other long-term assets, as a component of long-term assets, and a negative ending period fair value of the interest rate swap contract in accrued liabilities, as a component of long-term liabilities on the Condensed Consolidated Balance Sheets. The Company recognized any differences between the variable interest rate payments and the fixed interest rate settlements from its swap counterparty as an adjustment to interest expense over the life of the swap. If determined to be an effective cash flow hedge, the Company will record the changes in the estimated fair value of the swaps to accumulated other comprehensive income or loss on the Condensed Consolidated Balance Sheets. To the extent that interest rate swaps are determined to be ineffective, the Company would recognize the changes in the estimated fair value of swaps in interest and other non-operating expenses, net in its Condensed Consolidated Statements of Income. |
Income taxes | Income taxes The Company is subject to income taxes in numerous U.S. jurisdictions. Significant judgment is required in determining the provision for income taxes. The Company's income tax provisions reflect management’s interpretation of country and state tax laws. There are many transactions and calculations for which the ultimate tax determination is uncertain during the ordinary course of business and may remain uncertain for several years after their occurrence. The Company recognizes assets and liabilities for taxation when it is probable that the Company will receive refunds from or pay taxes to the relevant tax authority. Where the final determination of tax assets and liabilities is different from the amounts that were initially recorded, such differences will impact the current and deferred income taxes provision in the period in which such a determination is made. Changes in tax law or changes in the way tax law is interpreted may also impact the Company's effective tax rate as well as the Company's business and operations. Deferred income tax assets and liabilities are recognized for the future income tax consequences attributable to temporary differences between the financial statement carrying value of assets and liabilities and their respective income tax bases. Deferred income tax assets or liabilities are measured using enacted income tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be settled. The calculation of current and deferred income taxes requires management to make estimates and assumptions and to exercise a certain amount of judgment concerning the carrying value of assets and liabilities. The current and deferred income tax assets and liabilities are also impacted by expectations about future operating results and the timing of reversal of temporary differences as well as possible audits of tax filings by regulatory agencies. Changes or differences in these estimates or assumptions may result in changes to the current and deferred tax assets and liabilities on the Condensed Consolidated Balance Sheets and a charge to or recovery of income tax expense. |
CARES Act Funds Received | CARES Act Funds Received The Company received a general distribution payment from the Provider Relief Fund of $3.5 million in April 2020, a targeted distribution payment of $1.5 million in November 2021, and a general distribution payment of $0.4 million in January 2022. The U.S. Department of Health and Human Services ("HHS") has stated that Provider Relief Fund payments are not loans and will not need to be repaid. However, as a condition to the receipt of funds, the Company and any other providers must agree to a detailed set of terms and conditions. CMS has indicated that the terms and conditions may be subject to ongoing changes and reporting. There is no US GAAP guidance for for-profit health care entities that receive government grants that are not in the form of an income tax credit, revenue from a contract with a customer or a loan. As such, for-profit entities must determine the appropriate accounting treatment by analogy to other guidance such as International Accounting Standards (IAS) 20, Accounting for Government Grants and Disclosure of Government Assistance, in International Financial Reporting Standards. Under IAS 20, the Company determined that upon receipt of funds, it fully complied with the conditions attached to the grant. The Company recognized the distributions received from the Provider Relief Fund in the income statement in full during the period of receipt. To the extent that reporting requirements and terms and conditions are modified, it may affect the Company's ability to comply and may require the return of funds. The Company is not aware of any such modifications as of June 30, 2023 |
Recently adopted accounting pronouncements and Recently issued accounting pronouncements | Recently adopted accounting pronouncements On January 1, 2023, the Company adopted ASU 2016-13, Financial Instruments - Credit Losses: Measurement of Credit Losses on Financial Instruments. The standard replaces the current incurred loss impairment model that recognizes losses when a probable threshold is met with a requirement to recognize lifetime expected credit losses immediately when a financial asset is originated or purchased. Further, the FASB issued ASU 2019-04 and ASU 2019-05 to provide additional guidance on the credit losses standard. While the adoption of ASC 326 could result in a higher allowance recorded in the future for credit losses on receivables within the scope of the standard due to the prescribed measurement principles, the impact of the adoption on the Company's consolidated financials statements was not material. Recently issued accounting pronouncements The Company is an “emerging growth company” as defined by the JOBS Act. The JOBS Act provides that an emerging growth company can take advantage of the extended transition period provided in Section 7(a)(2)(B) of the Securities Act of 1933, as amended, for complying with new or revised accounting standards. In other words, an emerging growth company can selectively delay the adoption of all accounting standards until those standards would otherwise apply to private companies. The Company has elected to utilize this exemption and, as a result, the Company's condensed consolidated financial statements may not be comparable to the financial statements of issuers that are required to comply with the effective dates for new or revised accounting standards that are applicable to public companies. To date, however, the Company has not delayed the adoption of any accounting standards except as noted below. Section 107 of the JOBS Act provides that the Company can elect to opt out of the extended transition period at any time, which election is irrevocable. In September 2022, the FASB issued ASU No. 2022-04, Liabilities — Supplier Finance Programs (Subtopic 405-50): Disclosure of Supplier Finance Program Obligations, which requires entities that use supplier finance programs in connection with the purchase of goods and services to disclose the key terms of the programs and information about their obligations that are outstanding at the end of the reporting period. The amendments in this update are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years, except for the amendment on rollforward information, which is effective for fiscal years beginning after December 15, 2023. The Company does not expect the update to affect the recognition, measurement, or financial statement presentation of supplier finance program obligations, but is evaluating the impact of the update on related disclosures upon adoption. |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Accounting Policies [Abstract] | |
Accounts Receivable, Allowance for Doubtful Accounts | The estimates and charge-offs for the allowance for doubtful accounts for each reporting period were as follows: June 30, 2023 June 30, 2022 Balance, beginning of year $ 8,483 $ 7,031 Provision for uncollectible accounts 7,579 6,300 Amounts charged off (5,055) (3,948) Balance, end of period $ 11,007 $ 9,383 |
Schedules of Revenue by Customer | Revenues from Medicare and Medicaid as percentages of the Company's traditional revenue streams, excluding COVID-19 response sales and services, for the three and six months ended June 30, 2023 and 2022 were as follows: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Medicare revenues 44 % 46 % 45 % 47 % Medicaid revenues 9 % 9 % 9 % 9 % Total Medicare and Medicaid 53 % 55 % 54 % 56 % |
Schedule of Equity Method Investments | The following table details the Company’s equity investments: June 30, 2023 December 31, 2022 Equity method investments $ 595 $ 816 Other equity investments 1,347 1,339 Balance, end of period $ 1,942 $ 2,155 |
Schedule of Revenue by Source | The revenues from each major source are summarized in the following table: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Revenue from rentals under Topic 842 Ventilator rentals, non-invasive and invasive $ 25,712 $ 22,736 $ 50,859 $ 44,254 Other durable medical equipment rentals 8,419 4,912 15,325 9,271 Revenue from sales and services under Topic 606 Equipment and supply sales 6,778 3,245 11,542 6,282 COVID-19 response sales and services — 183 — 2,278 Service revenues 2,402 2,234 5,141 3,480 Total revenues $ 43,311 $ 33,310 $ 82,867 $ 65,565 |
Business Combinations (Tables)
Business Combinations (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Business Combination and Asset Acquisition [Abstract] | |
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed | The following table summarizes the consideration paid and estimated fair values of the assets acquired and liabilities assumed at the acquisition date. The Company is in the process of obtaining third-party valuations of certain fixed assets and identifiable intangible assets; thus, the provisional measurements of property plant and equipment, trade names, non-compete agreements, and goodwill are subject to change. The fair value of accounts receivables acquired is $2.0 million, with the gross contractual amount being $2.9 million. The Company expects $0.9 million to be uncollectible. Purchase Price Cash paid or payable $ 29,417 Identifiable Assets Cash and cash equivalents 921 Accounts receivable 2,014 Inventory 582 Prepaid expenses and other assets 535 Property and equipment, net 4,358 Lease assets 743 Identifiable intangibles 688 Other long-term assets 25 TOTAL ASSETS 9,866 Identifiable Liabilities Trade payables 2,144 Deferred revenue 732 Accrued liabilities 1,195 Current portion of lease liabilities 536 Current debt 4,558 Long-term lease liabilities 207 Long-term debt 836 TOTAL LIABILITIES 10,208 Net assets (liabilities) acquired (342) Resulting goodwill $ 29,759 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property and Equipment | The following table details the Company’s fixed assets: June 30, 2023 December 31, 2022 Medical equipment $ 103,571 $ 93,893 Furniture and equipment 3,115 2,792 Land 2,566 2,566 Buildings 7,129 7,043 Leasehold improvements 344 296 Vehicles 1,129 1,052 Less: Accumulated depreciation (44,970) (39,899) Property and equipment, net of accumulated depreciation and amortization $ 72,884 $ 67,743 |
Current Liabilities (Tables)
Current Liabilities (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Payables and Accruals [Abstract] | |
Schedule of Current Liabilities | The Company’s short-term accrued liabilities are included within current liabilities and consist of the following: June 30, 2023 December 31, 2022 Accrued trade payables $ 2,735 $ 2,254 Accrued commissions payable 737 608 Accrued bonuses payable 4,329 3,708 Accrued vacation and payroll 2,450 1,484 Current portion of phantom share liability 1,483 1,704 Purchase price payable 1,376 — Accrued other liabilities 2,399 1,334 Total accrued liabilities $ 15,509 $ 11,092 |
Debt (Tables)
Debt (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Notes Payable | The recorded balances associated with the 2022 Senior Credit Facilities are as follows: June 30, 2023 December 31, 2022 Outstanding balance $ 13,000 $ — Financing costs and commitment fees (748) — Less: Current portion of notes payable (250) — Net long-term notes payable $ 12,002 $ — |
Fair Value Measurement (Tables)
Fair Value Measurement (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Fair Value Disclosures [Abstract] | |
Schedule of Assets and Liabilities Measured on Recurring Basis | The following tables summarize the Company's assets measured at fair value on a recurring basis as of June 30, 2023 and December 31, 2022: At June 30, 2023 (In thousands) Level 1 Level 2 Level 3 Total Recurring Fair Value Measurements: Money market mutual funds $ 2,078 $ — $ — $ 2,078 Available for sale debt instrument — — 2,110 2,110 Total $ 2,078 $ — $ 2,110 $ 4,188 At December 31, 2022 (In thousands) Level 1 Level 2 Level 3 Total Recurring Fair Value Measurements: Money market mutual funds $ 11,005 $ — $ — $ 11,005 Available for sale debt instrument $ — $ — $ 2,000 $ 2,000 Total $ 11,005 $ — $ 2,000 $ 13,005 |
Shareholders' Equity (Tables)
Shareholders' Equity (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Stock-based Compensation Expense | The following table summarizes stock-based compensation expense for the three and six months ended June 30, 2023 and 2022 (in thousands): Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Stock-based compensation - options $ 301 $ 757 $ 649 $ 1,577 Stock-based compensation - restricted stock units 1,170 514 2,213 999 Total $ 1,471 $ 1,271 $ 2,862 $ 2,576 Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Selling, general, and administrative $ 687 $ 538 $ 1,837 $ 949 |
Schedule of Option Activity | The following table summarizes stock option activity for the six months ended June 30, 2023: Number of options Weighted average exercise price (1) Weighted average remaining contractual life Aggregate intrinsic value (2) Balance December 31, 2022 4,497 $ 5.26 6.9 years $ 11,356 Issued — — Exercised (228) 5.51 Expired / Forfeited (25) 6.47 Balance June 30, 2023 4,244 $ 5.24 6.4 years $ 19,290 (1) For presentation purposes, stock options issued with a Canadian dollar exercise price have been translated to U.S. dollars based on the prevailing exchange rate on the date of grant. (2) The aggregate intrinsic value of options outstanding represents the difference between the exercise price of the option and the closing share price of the Company's common stock on the last trading day of the period ($9.78). |
Schedule of Restricted Stock Units | The following table summarizes RSU activity for the six months ended June 30, 2023: Number of RSUs (000's) Weighted average grant price Weighted average remaining contractual life Aggregate intrinsic value (1) Balance December 31, 2022 629 $ 5.62 0.88 years $ 4,755 Issued 702 7.87 Vested (190) 5.56 Expired / Forfeited (18) 6.70 Balance June 30, 2023 1,123 $ 7.02 1.26 years $ 10,986 (1) The aggregate intrinsic value of time-based RSUs outstanding was based on the Company's closing stock price on the last trading day of the period ($9.78). |
Schedule of Phantom Share Units | The following table summarizes phantom share unit activity for the six months ended June 30, 2023: Number of phantom share units (000's) Value of share equivalents (1) Balance December 31, 2022 513 $ 3,878 Issued 176 1,401 Vested (239) (578) Expired / Forfeited (20) (196) Balance June 30, 2023 430 $ 4,200 (1) The value of outstanding share equivalents at the beginning of the period is based on the market price of the Company’s stock at that time, the value of issued share equivalents is based on the market price of the Company’s stock at issuance, the value of vested share equivalents is based on the cash paid at the time of vesting, and the values of expired/forfeited share equivalents and outstanding share equivalents at the end of the period are based on the market price of the Company's stock at the end of the period. The market price of the Company's stock was $9.78 on June 30, 2023. |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 6 Months Ended |
Jun. 30, 2023 | |
Earnings Per Share [Abstract] | |
Schedule of Earnings Per Share | The following reflects the earnings and share data used in the basic and diluted earnings per share computations: Three Months Ended June 30, Six Months Ended June 30, 2023 2022 2023 2022 Numerator - basic and diluted: Net income attributable to shareholders $ 2,330 $ 967 $ 3,847 $ 2,729 Denominator: Basic weighted-average number of common shares 38,324,249 38,773,580 38,240,902 39,195,317 Diluted weighted-average number of shares 40,676,951 39,752,928 40,383,616 40,056,953 Basic earnings per share $ 0.06 $ 0.02 $ 0.10 $ 0.07 Diluted earnings per share $ 0.06 $ 0.02 $ 0.10 $ 0.07 Denominator calculation from basic to diluted: Basic weighted-average number of common shares 38,324,249 38,773,580 38,240,902 39,195,317 Stock options and other dilutive securities 2,352,702 979,348 2,142,714 861,636 Diluted weighted-average number of shares 40,676,951 39,752,928 40,383,616 40,056,953 |
Nature of Business and Operat_2
Nature of Business and Operations (Details) | Jun. 30, 2023 state |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Number of states in which entity provides DME and health care solutions | 50 |
Summary of Significant Accoun_4
Summary of Significant Accounting Policies (Accounts Receivable, Allowance for Doubtful Accounts) (Details) - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 30, 2023 | Jun. 30, 2022 | |
Accounts Receivable, Allowance for Credit Loss [Roll Forward] | ||
Balance, beginning of year | $ 8,483 | $ 7,031 |
Provision for uncollectible accounts | 7,579 | 6,300 |
Amounts charged off | (5,055) | (3,948) |
Balance, end of period | $ 11,007 | $ 9,383 |
Summary of Significant Accoun_5
Summary of Significant Accounting Policies (Customer Percentages) (Details) - Customer Concentration | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Total Medicare and Medicaid | Accounts Receivable | |||||
Concentration Risk [Line Items] | |||||
Concentration risk, percentage | 41% | 48% | |||
Total Medicare and Medicaid | Revenue | |||||
Concentration Risk [Line Items] | |||||
Concentration risk, percentage | 53% | 55% | 54% | 56% | |
Medicare revenues | Accounts Receivable | |||||
Concentration Risk [Line Items] | |||||
Concentration risk, percentage | 35% | ||||
Medicare revenues | Revenue | |||||
Concentration Risk [Line Items] | |||||
Concentration risk, percentage | 44% | 46% | 45% | 47% | |
Medicaid revenues | Accounts Receivable | |||||
Concentration Risk [Line Items] | |||||
Concentration risk, percentage | 6% | ||||
Medicaid revenues | Revenue | |||||
Concentration Risk [Line Items] | |||||
Concentration risk, percentage | 9% | 9% | 9% | 9% |
Summary of Significant Accoun_6
Summary of Significant Accounting Policies (Equity Investments) (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Accounting Policies [Abstract] | ||
Equity investments | $ 595 | $ 816 |
Other equity investments | 1,347 | 1,339 |
Balance, end of period | $ 1,942 | $ 2,155 |
Solvet Services LLC | ||
Schedule of Investments [Line Items] | ||
Equity method investment, ownership percentage | 49% |
Summary of Significant Accoun_7
Summary of Significant Accounting Policies (Revenue Recognition) (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Disaggregation of Revenue [Line Items] | ||||
Total revenues | $ 43,311 | $ 33,310 | $ 82,867 | $ 65,565 |
Ventilator rentals, non-invasive and invasive | ||||
Disaggregation of Revenue [Line Items] | ||||
Revenue from rentals under Topic 842 | 25,712 | 22,736 | 50,859 | 44,254 |
Other durable medical equipment rentals | ||||
Disaggregation of Revenue [Line Items] | ||||
Revenue from rentals under Topic 842 | 8,419 | 4,912 | 15,325 | 9,271 |
Equipment and supply sales | ||||
Disaggregation of Revenue [Line Items] | ||||
Revenue from sales and services under Topic 606 | 6,778 | 3,245 | 11,542 | 6,282 |
COVID-19 response sales and services | ||||
Disaggregation of Revenue [Line Items] | ||||
Revenue from sales and services under Topic 606 | 0 | 183 | 0 | 2,278 |
Service revenues | ||||
Disaggregation of Revenue [Line Items] | ||||
Revenue from sales and services under Topic 606 | $ 2,402 | $ 2,234 | $ 5,141 | $ 3,480 |
Summary of Significant Accoun_8
Summary of Significant Accounting Policies (Interest Rate Swaps) (Details) $ in Millions | 12 Months Ended |
Dec. 31, 2022 USD ($) | |
Interest Rate | |
New Accounting Pronouncements or Change in Accounting Principle [Line Items] | |
Derivative, gain on derivative | $ 0.2 |
Summary of Significant Accoun_9
Summary of Significant Accounting Policies (CARES Act Funds Received) (Details) - USD ($) $ in Millions | 1 Months Ended | ||
Jan. 31, 2022 | Nov. 30, 2021 | Apr. 30, 2020 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||
Government grant received | $ 3.5 | ||
Proceeds from targeted distribution payment | $ 1.5 | ||
Proceeds from general distribution payment | $ 0.4 |
Business Combinations - Narrati
Business Combinations - Narrative (Details) - Home Medical Products Inc - USD ($) $ in Thousands | 6 Months Ended | |
Jun. 01, 2023 | Jun. 30, 2023 | |
Business Acquisition [Line Items] | ||
Business acquisition, percentage of voting interests acquired | 100% | |
Cash paid or payable | $ 29,417 | |
Purchase consideration funded by cash on hand | 15,000 | |
Acquisition related costs expensed | $ 254 | |
Fair value of accounts receivables acquired | 2,000 | |
Gross contractual amount | 2,900 | |
Estimate of uncollectible receivables | 900 | |
Revolving Credit Facility | Line of Credit | 5 Year Revolving Credit Facility | ||
Business Acquisition [Line Items] | ||
Consideration funded by borrowings | 8,000 | |
Term Loan Facility | Line of Credit | Delayed Draw Term Loan Facility | ||
Business Acquisition [Line Items] | ||
Consideration funded by borrowings | $ 5,000 |
Business Combinations - Summari
Business Combinations - Summarizes the Consideration Paid and Estimated Fair Values of the Assets Acquired and Liabilities (Details) - USD ($) $ in Thousands | Jun. 01, 2023 | Jun. 30, 2023 | Dec. 31, 2022 |
Identifiable Liabilities | |||
Goodwill | $ 29,759 | $ 0 | |
Home Medical Products Inc | |||
Business Acquisition [Line Items] | |||
Cash paid or payable | $ 29,417 | ||
Identifiable Assets | |||
Cash and cash equivalents | 921 | ||
Accounts receivable | 2,014 | ||
Inventory | 582 | ||
Prepaid expenses and other assets | 535 | ||
Property and equipment, net | 4,358 | ||
Lease assets | 743 | ||
Identifiable intangibles, net | 688 | ||
Other long-term assets | 25 | ||
TOTAL ASSETS | 9,866 | ||
Identifiable Liabilities | |||
Trade payables | 2,144 | ||
Deferred revenue | 732 | ||
Accrued liabilities | 1,195 | ||
Current portion of lease liabilities | 536 | ||
Current debt | 4,558 | ||
Long-term lease liabilities | 207 | ||
Long-term debt | 836 | ||
TOTAL LIABILITIES | 10,208 | ||
Net assets (liabilities) acquired | (342) | ||
Goodwill | $ 29,759 |
Property and Equipment (Schedul
Property and Equipment (Schedule of Fixed Assets) (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Property, Plant and Equipment [Line Items] | ||
Less: Accumulated depreciation | $ (44,970) | $ (39,899) |
Property and equipment, net of accumulated depreciation and amortization | 72,884 | 67,743 |
Medical equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 103,571 | 93,893 |
Furniture and equipment | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 3,115 | 2,792 |
Land | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 2,566 | 2,566 |
Buildings | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 7,129 | 7,043 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | 344 | 296 |
Vehicles | ||
Property, Plant and Equipment [Line Items] | ||
Property and equipment, gross | $ 1,129 | $ 1,052 |
Property and Equipment (Narrati
Property and Equipment (Narrative) (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Property, Plant and Equipment [Line Items] | |||||
Depreciation | $ 4,908 | $ 3,497 | $ 9,430 | $ 6,656 | |
Medical equipment | |||||
Property, Plant and Equipment [Line Items] | |||||
Accounts payable | $ 2,526 | $ 738 |
Current Liabilities (Details)
Current Liabilities (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Payables and Accruals [Abstract] | ||
Accrued trade payables | $ 2,735 | $ 2,254 |
Accrued commissions payable | 737 | 608 |
Accrued bonuses payable | 4,329 | 3,708 |
Accrued vacation and payroll | 2,450 | 1,484 |
Current portion of phantom share liability | 1,483 | 1,704 |
Purchase price payable | 1,376 | 0 |
Accrued other liabilities | 2,399 | 1,334 |
Total accrued liabilities | $ 15,509 | $ 11,092 |
Debt (Senior Credit Facilities)
Debt (Senior Credit Facilities) (Details) | 6 Months Ended | ||||
Nov. 29, 2022 USD ($) | Jun. 30, 2023 USD ($) | Jun. 01, 2023 | Sep. 19, 2019 USD ($) | May 30, 2019 USD ($) | |
Building Term Note | Notes Payable | |||||
Debt Instrument [Line Items] | |||||
Principal amount | $ 4,800,000 | ||||
Building Term Note | Notes Payable | Interest Rate | |||||
Debt Instrument [Line Items] | |||||
Fixed interest rate (percent) | 4.68% | ||||
2019 Term Note | Notes Payable | |||||
Debt Instrument [Line Items] | |||||
Principal amount | $ 5,000,000 | ||||
Stated interest rate (percent) | 4.60% | ||||
Equipment Financing Obligations | |||||
Debt Instrument [Line Items] | |||||
Short-term debt | $ 3,000,000 | ||||
Long-term debt | $ 100,000 | ||||
Equipment Financing Obligations | Minimum | |||||
Debt Instrument [Line Items] | |||||
Stated interest rate (percent) | 0% | ||||
Equipment Financing Obligations | Maximum | |||||
Debt Instrument [Line Items] | |||||
Stated interest rate (percent) | 7.99% | ||||
Line of Credit | 2018 Senior Credit Facility | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 10,000,000 | ||||
Revolving Credit Facility | 2019 Term Note | Line of Credit | |||||
Debt Instrument [Line Items] | |||||
Fixed charge coverage ratio | 1.25 | ||||
Revolving Credit Facility | 2022 Senior Credit Facilities | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 30,000,000 | ||||
Revolving Credit Facility | 2022 Senior Credit Facilities | Line of Credit | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | 30,000,000 | ||||
Revolving Credit Facility | 2022 Senior Credit Facilities | Line of Credit | 2022 Senior Credit Facilities Closing Date Of December 31 2024 | |||||
Debt Instrument [Line Items] | |||||
Total leverage ratio | 2.75 | ||||
Revolving Credit Facility | 2022 Senior Credit Facilities | Line of Credit | 2022 Senior Credit Facilities Closing Date Of March 31 2025 | |||||
Debt Instrument [Line Items] | |||||
Total leverage ratio | 2.50 | ||||
Revolving Credit Facility | 2022 Senior Credit Facilities | Notes Payable | |||||
Debt Instrument [Line Items] | |||||
Maximum borrowing capacity | $ 30,000,000 | ||||
Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | 2022 Senior Credit Facilities | Line of Credit | Minimum | |||||
Debt Instrument [Line Items] | |||||
Basis spread on variable rate (percent) | 2.625% | ||||
Revolving Credit Facility | Secured Overnight Financing Rate (SOFR) Overnight Index Swap Rate | 2022 Senior Credit Facilities | Line of Credit | Maximum | |||||
Debt Instrument [Line Items] | |||||
Basis spread on variable rate (percent) | 3.375% | ||||
Revolving Credit Facility | Base Rate | 2022 Senior Credit Facilities | Line of Credit | Minimum | |||||
Debt Instrument [Line Items] | |||||
Basis spread on variable rate (percent) | 1.625% | ||||
Revolving Credit Facility | Base Rate | 2022 Senior Credit Facilities | Line of Credit | Maximum | |||||
Debt Instrument [Line Items] | |||||
Basis spread on variable rate (percent) | 2.375% |
Debt (Schedule of Notes Payable
Debt (Schedule of Notes Payable) (Details) - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Current portion of notes payable | $ (3,169) | $ 0 |
Net long-term notes payable | 12,114 | 0 |
Notes Payable | ||
Debt Instrument [Line Items] | ||
Outstanding balance | 13,000 | 0 |
Financing costs and commitment fees | (748) | 0 |
Current portion of notes payable | (250) | 0 |
Net long-term notes payable | $ 12,002 | $ 0 |
Fair Value Measurement (Recurri
Fair Value Measurement (Recurring Basis) (Details) - Fair Value, Recurring - USD ($) $ in Thousands | Jun. 30, 2023 | Dec. 31, 2022 |
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Available for sale debt instrument | $ 2,110 | $ 2,000 |
Total | 4,188 | 13,005 |
Money Market Funds | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Money market mutual funds | 2,078 | 11,005 |
Fair Value, Inputs, Level 1 | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Available for sale debt instrument | 0 | 0 |
Total | 2,078 | 11,005 |
Fair Value, Inputs, Level 1 | Money Market Funds | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Money market mutual funds | 2,078 | 11,005 |
Fair Value, Inputs, Level 2 | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Available for sale debt instrument | 0 | 0 |
Total | 0 | 0 |
Fair Value, Inputs, Level 2 | Money Market Funds | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Money market mutual funds | 0 | 0 |
Fair Value, Inputs, Level 3 | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Available for sale debt instrument | 2,110 | 2,000 |
Total | 2,110 | 2,000 |
Fair Value, Inputs, Level 3 | Money Market Funds | ||
Fair Value Measurement Inputs and Valuation Techniques [Line Items] | ||
Money market mutual funds | $ 0 | $ 0 |
Shareholders' Equity (Issued an
Shareholders' Equity (Issued and Outstanding Share Capital) (Details) - USD ($) $ in Millions | 3 Months Ended | 6 Months Ended | |||||
Jun. 30, 2023 | Mar. 31, 2023 | Mar. 31, 2022 | Jun. 30, 2023 | Dec. 31, 2022 | Jun. 30, 2022 | Dec. 31, 2021 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Issued (in shares) | 38,400,422 | 38,400,422 | 38,049,739 | ||||
Shares outstanding (in shares) | 38,400,422 | 38,400,422 | 38,049,739 | ||||
Common Stock | |||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||
Shares outstanding (in shares) | 38,400,422 | 38,276,389 | 39,293,778 | 38,400,422 | 38,049,739 | 38,333,089 | 39,640,388 |
Shares redeemed to pay income tax (in shares) | 1,978 | 64,756 | 23,742 | 66,734 | |||
Shares redeemed to pay income tax | $ 0.5 |
Shareholders' Equity (Stock-bas
Shareholders' Equity (Stock-based Compensation) (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||||
Jun. 11, 2020 | Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||||
Options outstanding (in shares) | 4,244,000 | 4,244,000 | 4,497,000 | |||
Stock-based compensation, expense | $ 1,471 | $ 1,271 | $ 2,862 | $ 2,576 | ||
Unrecognized pre-tax stock option expense | 889 | $ 889 | ||||
Weighted-average period of recognition | 1 year 3 months 25 days | |||||
Omnibus Plan | ||||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||||
Maximum shares in Plan (in shares) | 7,758,211 | |||||
Percent of issued and outstanding shares | 20% | |||||
Omnibus Plan | Common Stock | ||||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||||
Maximum shares in Plan (in shares) | 2,600,000 | |||||
Options | ||||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||||
Stock-based compensation, expense | $ 301 | 757 | $ 649 | 1,577 | ||
Restricted Stock Units | ||||||
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items] | ||||||
RSUs outstanding (in shares) | 1,123,000 | 1,123,000 | 629,000 | |||
Stock-based compensation, expense | $ 1,170 | $ 514 | $ 2,213 | $ 999 | ||
Weighted-average period of recognition | 1 year 3 months 3 days | |||||
Unrecognized pre-tax compensation expense, restricted stock units | $ 4,780 | $ 4,780 |
Shareholders' Equity (Options,
Shareholders' Equity (Options, Stock Option Activity) (Details) | 6 Months Ended | 12 Months Ended |
Jun. 30, 2023 USD ($) $ / shares shares | Dec. 31, 2022 USD ($) $ / shares shares | |
Number of options (000's) | ||
Beginning balance (in shares) | shares | 4,497,000 | |
Issued (in shares) | shares | 0 | |
Exercised (in shares) | shares | (228,000) | |
Expired / Forfeited (in shares) | shares | (25,000) | |
Ending balance (in shares) | shares | 4,244,000 | 4,497,000 |
Weighted average exercise price | ||
Beginning balance (USD per share) | $ 5.26 | |
Issued (USD per share) | 0 | |
Exercised (USD per share) | 5.51 | |
Expired / Forfeited (USD per share) | 6.47 | |
Ending balance (USD per share) | $ 5.24 | $ 5.26 |
Weighted average remaining contractual life | ||
Weighted average remaining contractual life | 6 years 4 months 24 days | 6 years 10 months 24 days |
Aggregate Intrinsic Value | ||
Aggregate intrinsic value | $ | $ 19,290,197 | $ 11,356,000 |
Share price (USD per share) | $ 9.78 |
Shareholders' Equity (Options_2
Shareholders' Equity (Options, Narrative) (Details) - USD ($) | 6 Months Ended | 12 Months Ended |
Jun. 30, 2023 | Dec. 31, 2022 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Aggregate intrinsic value, outstanding | $ 19,290,197 | $ 11,356,000 |
Aggregate intrinsic value, exercisable | $ 16,579,787 | |
Common stock issued pursuant to stock options (in shares) | 228,000 | |
Exercisable (in shares) | 3,415,000 | 2,841,000 |
Weighted average exercise price (USD per share) | $ 4.93 | $ 4.53 |
Weighted average remaining contractual term | 6 years | 6 years 1 month 6 days |
Issued (in shares) | 0 | |
Common Stock | ||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||
Common stock issued pursuant to stock options (in shares) | 228,000 |
Shareholders' Equity (Restricte
Shareholders' Equity (Restricted Stock Units) (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended |
Jun. 30, 2023 | Jun. 30, 2023 | Dec. 31, 2022 | |
Aggregate Intrinsic Value | |||
Share price (USD per share) | $ 9.78 | $ 9.78 | |
Restricted Stock Units | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Vesting period | 3 years | ||
Number of RSUs (000's) | |||
Beginning balance (in shares) | 629,000 | ||
Issued (in shares) | 0 | 702,206 | |
Vested (in shares) | (190,000) | ||
Expired / Forfeited (in shares) | (18,000) | ||
Ending balance (in shares) | 1,123,000 | 1,123,000 | 629,000 |
Weighted average grant price | |||
Beginning balance (USD per share) | $ 5.62 | ||
Issued (USD per share) | 7.87 | ||
Vested (USD per share) | 5.56 | ||
Expired / Forfeited (USD per share) | 6.70 | ||
Ending balance (USD per share) | $ 7.02 | $ 7.02 | $ 5.62 |
Weighted average remaining contractual life | |||
Weighted average remaining contractual life | 1 year 3 months 3 days | 10 months 17 days | |
Aggregate Intrinsic Value | |||
Aggregate Intrinsic Value | $ 10,986 | $ 10,986 | $ 4,755 |
Fair value | $ 5,600 | ||
Restricted Stock Units | Minimum | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Vesting period | 1 year | ||
Phantom Share Units | |||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Vesting period | 3 years | ||
Number of RSUs (000's) | |||
Beginning balance (in shares) | 513,000 | ||
Issued (in shares) | 176,000 | ||
Vested (in shares) | (239,000) | ||
Expired / Forfeited (in shares) | (20,000) | ||
Ending balance (in shares) | 430,000 | 430,000 | 513,000 |
Aggregate Intrinsic Value | |||
Aggregate Intrinsic Value | $ 4,200 | $ 4,200 | $ 3,878 |
Shareholders' Equity (Phantom S
Shareholders' Equity (Phantom Share Units) (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands | 3 Months Ended | 6 Months Ended | |||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | Dec. 31, 2022 | |
Value of share equivalents | |||||
Share price (USD per share) | $ 9.78 | $ 9.78 | |||
Current accrued liabilities | $ 1,483 | $ 1,483 | $ 1,704 | ||
Stock-based compensation | $ 1,471 | $ 1,271 | $ 2,862 | $ 2,576 | |
Phantom Share Units | |||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||
Vesting period | 3 years | ||||
Number of phantom share units (000's) | |||||
Beginning balance (in shares) | 513 | ||||
Issued (in shares) | 176 | ||||
Vested (in shares) | (239) | ||||
Expired / Forfeited (in shares) | (20) | ||||
Ending balance (in shares) | 430 | 430 | |||
Value of share equivalents | |||||
Beginning balance | $ 3,878 | ||||
Issued | 1,401 | ||||
Vested | (578) | ||||
Expired / Forfeited | (196) | ||||
Ending balance | $ 4,200 | 4,200 | |||
Total liability | 2,120 | 2,120 | |||
Current accrued liabilities | 1,483 | 1,483 | |||
Long-term accrued liabilities | 637 | 637 | |||
Cash settlement | 2,309 | 1,389 | |||
Phantom Share Units | Selling, general, and administrative | |||||
Value of share equivalents | |||||
Stock-based compensation | $ 687 | $ 538 | $ 1,837 | $ 949 |
Commitments and Contingencies (
Commitments and Contingencies (Details) $ in Millions | Dec. 28, 2020 USD ($) | Jun. 30, 2023 USD ($) | Nov. 30, 2021 USD ($) | May 31, 2021 patient | Mar. 31, 2020 USD ($) |
Commitments and Contingencies Disclosure [Abstract] | |||||
Purchase obligation | $ 1.4 | ||||
Damages sought | $ 4.7 | ||||
Outstanding deposit | $ 0.9 | ||||
Number of patients | patient | 100 | ||||
Necessary claims reviewed and payable (percent) | 77% | ||||
Recalculated principal overpayment request | $ 1.1 |
Income Taxes (Details)
Income Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | ||
Jun. 30, 2023 | Jun. 30, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Income Tax Disclosure [Abstract] | ||||
Provision for income taxes | $ 728 | $ 421 | $ 1,229 | $ 1,166 |
Discrete income tax benefit | $ 100 | |||
Effective tax rate | 28.60% |
Earnings Per Share (Details)
Earnings Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 6 Months Ended | ||||
Jun. 30, 2023 | Mar. 31, 2023 | Jun. 30, 2022 | Mar. 31, 2022 | Jun. 30, 2023 | Jun. 30, 2022 | |
Earnings Per Share [Abstract] | ||||||
Net income attributable to shareholders | $ 2,330 | $ 1,517 | $ 967 | $ 1,762 | $ 3,847 | $ 2,729 |
Denominator: | ||||||
Basic weighted-average number of common shares (in shares) | 38,324,249 | 38,773,580 | 38,240,902 | 39,195,317 | ||
Diluted weighted-average number of shares (in shares) | 40,676,951 | 39,752,928 | 40,383,616 | 40,056,953 | ||
Basic earnings per share (in dollars per share) | $ 0.06 | $ 0.02 | $ 0.10 | $ 0.07 | ||
Diluted earnings per share (in dollars per share) | $ 0.06 | $ 0.02 | $ 0.10 | $ 0.07 | ||
Denominator calculation from basic to diluted: | ||||||
Basic weighted-average number of common shares (in shares) | 38,324,249 | 38,773,580 | 38,240,902 | 39,195,317 | ||
Stock options and other dilutive securities (in shares) | 2,352,702 | 979,348 | 2,142,714 | 861,636 | ||
Diluted weighted-average number of shares (in shares) | 40,676,951 | 39,752,928 | 40,383,616 | 40,056,953 |