Cover
Cover - USD ($) | 12 Months Ended | ||
Dec. 31, 2023 | Apr. 04, 2024 | Jun. 30, 2023 | |
Cover [Abstract] | |||
Document Type | 10-K | ||
Document Annual Report | true | ||
Document Period End Date | Dec. 31, 2023 | ||
Current Fiscal Year End Date | --12-31 | ||
Document Transition Report | false | ||
Entity File Number | 001-35020 | ||
Entity Registrant Name | INFUSYSTEM HOLDINGS, INC. | ||
Entity Incorporation, State or Country Code | DE | ||
Entity Tax Identification Number | 20-3341405 | ||
Entity Address, Address Line One | 3851 West Hamlin Road | ||
Entity Address, City or Town | Rochester Hills | ||
Entity Address, State or Province | MI | ||
Entity Address, Postal Zip Code | 48309 | ||
City Area Code | (248) | ||
Local Phone Number | 291-1210 | ||
Title of 12(b) Security | Common Stock, par value $0.0001 per share | ||
Trading Symbol | INFU | ||
Security Exchange Name | NYSEAMER | ||
Entity Well-known Seasoned Issuer | No | ||
Entity Voluntary Filers | No | ||
Entity Current Reporting Status | Yes | ||
Entity Interactive Data Current | Yes | ||
Entity Filer Category | Accelerated Filer | ||
Entity Small Business | true | ||
Entity Emerging Growth Company | false | ||
ICFR Auditor Attestation Flag | true | ||
Document Financial Statement Error Correction | true | ||
Document Financial Statement Restatement Recovery Analysis | false | ||
Entity Shell Company | false | ||
Entity Public Float | $ 190,572,924 | ||
Entity Common Stock, Shares Outstanding | 21,264,695 | ||
Documents Incorporated by Reference | Portions of the registrant’s definitive proxy statement to be filed with the Securities and Exchange Commission in connection with the solicitation of proxies for its 2024 Annual Meeting of Stockholders are incorporated by reference in Part III of this Form 10-K. | ||
Entity Central Index Key | 0001337013 | ||
Document Fiscal Year Focus | 2023 | ||
Document Fiscal Period Focus | FY | ||
Amendment Flag | false |
Audit Information
Audit Information | 12 Months Ended | |
Dec. 31, 2023 | Dec. 31, 2022 | |
Audit Information [Abstract] | ||
Auditor Firm ID | 34 | 243 |
Auditor Name | Deloitte & Touche LLP | BDO USA, LLP |
Auditor Location | Detroit, Michigan | Troy, Michigan |
Consolidated Balance Sheets
Consolidated Balance Sheets - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Current assets: | ||
Cash and cash equivalents | $ 231 | $ 165 |
Accounts receivable, net | 19,830 | 16,871 |
Inventories, net | 6,402 | 4,821 |
Other current assets | 4,157 | 2,922 |
Total current assets | 30,620 | 24,779 |
Medical equipment for sale or rental | 3,049 | 2,790 |
Medical equipment in rental service, net of accumulated depreciation | 34,928 | 39,450 |
Property & equipment, net of accumulated depreciation | 4,321 | 4,385 |
Goodwill | 3,710 | 3,710 |
Intangible assets, net | 7,446 | 8,436 |
Operating lease right of use assets | 6,703 | 4,168 |
Deferred income taxes | 9,115 | 9,625 |
Derivative financial instruments | 1,442 | 1,965 |
Other assets | 1,581 | 80 |
Total assets | 102,915 | 99,388 |
Current liabilities: | ||
Accounts payable | 8,009 | 8,341 |
Other current liabilities | 7,704 | 6,126 |
Total current liabilities | 15,713 | 14,467 |
Long-term debt, net of current portion | 29,101 | 33,157 |
Operating lease liabilities, net of current portion | 5,799 | 3,761 |
Total liabilities | 50,613 | 51,385 |
Stockholders’ equity: | ||
Preferred stock, $0.0001 par value: authorized 1,000,000 shares; none issued | 0 | 0 |
Common stock, $0.0001 par value: authorized 200,000,000 shares; 21,196,851 shares issued and outstanding as of December 31, 2023 and 20,781,977 shares issued and outstanding as of December 31, 2022 | 2 | 2 |
Additional paid-in capital | 109,837 | 105,856 |
Accumulated other comprehensive income | 1,088 | 1,489 |
Retained deficit | (58,625) | (59,344) |
Total stockholders’ equity | 52,302 | 48,003 |
Total liabilities and stockholders’ equity | $ 102,915 | $ 99,388 |
Consolidated Balance Sheets (Pa
Consolidated Balance Sheets (Parenthetical) - $ / shares | Dec. 31, 2023 | Dec. 31, 2022 |
Statement of Financial Position [Abstract] | ||
Preferred stock, par value (usd per share) | $ 0.0001 | $ 0.0001 |
Preferred stock, authorized (in shares) | 1,000,000 | 1,000,000 |
Preferred stock, issued (in shares) | 0 | 0 |
Common stock, par value (usd per share) | $ 0.0001 | $ 0.0001 |
Common stock,, authorized (in shares) | 200,000,000 | 200,000,000 |
Common stock, issued (in shares) | 21,196,851 | 20,781,977 |
Common stock, outstanding (in shares) | 21,196,851 | 20,781,977 |
Consolidated Statements of Oper
Consolidated Statements of Operations and Comprehensive Income - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Statement [Abstract] | |||
Net revenues | $ 125,785 | $ 109,914 | $ 102,382 |
Cost of revenues | 62,676 | 49,354 | 43,846 |
Gross profit | 63,109 | 60,560 | 58,536 |
Selling, general and administrative expenses: | |||
Amortization of intangibles | 990 | 2,494 | 4,262 |
Selling and marketing | 12,654 | 12,259 | 10,777 |
General and administrative | 45,377 | 44,153 | 40,677 |
Total selling, general and administrative | 59,021 | 58,906 | 55,716 |
Operating income | 4,088 | 1,654 | 2,820 |
Other expense: | |||
Interest expense | (2,170) | (1,402) | (1,377) |
Other expense | (67) | (122) | (186) |
Income before income taxes | 1,851 | 130 | 1,257 |
(Provision for) benefit from income taxes | (979) | (112) | 163 |
Net income | $ 872 | $ 18 | $ 1,420 |
Net income per share | |||
Basic (in dollars per share) | $ 0.04 | $ 0 | $ 0.07 |
Diluted (in dollars per share) | $ 0.04 | $ 0 | $ 0.06 |
Weighted average shares outstanding: | |||
Basic (in shares) | 21,024,382 | 20,648,818 | 20,519,958 |
Diluted (in shares) | 21,646,079 | 21,547,306 | 22,049,659 |
Comprehensive income: | |||
Net income | $ 872 | $ 18 | $ 1,420 |
Other comprehensive (loss) income: | |||
Unrealized (loss) gain on hedges | (523) | 1,609 | 355 |
Benefit from (provision for) income tax on unrealized hedge (loss) gain | 122 | (388) | (87) |
Other comprehensive income (loss) | (401) | 1,221 | 268 |
Net comprehensive income | $ 471 | $ 1,239 | $ 1,688 |
Consolidated Statements of Stoc
Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands | Total | Common Stock | Additional Paid in Capital | Retained Deficit | Other Comprehensive Income | Treasury Stock |
Beginning balance (in shares) at Dec. 31, 2020 | 23,816,000 | |||||
Beginning balance at Dec. 31, 2020 | $ 40,752 | $ 2 | $ 84,785 | $ (44,035) | $ 0 | $ 0 |
Beginning balance (in shares) at Dec. 31, 2020 | (3,518,000) | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Shares issued upon restricted stock vesting and option exercise (in shares) | 462,000 | |||||
Shares issued upon restricted stock vesting and option exercise | 812 | 812 | ||||
Stock-based compensation expense | $ 6,404 | 6,404 | ||||
Employee stock purchase plan (in shares) | 31,624 | 32,000 | ||||
Employee stock purchase plan | $ 348 | 348 | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares) | (57,067) | (59,000) | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation | $ (1,172) | (1,172) | ||||
Retirement of treasury stock (in shares) | (3,500,000) | (3,518,000) | 3,518,000 | |||
Retirement of treasury stock | $ 0 | 10,728 | (10,728) | |||
Common stock repurchased as part of share repurchase program (in shares) | (33,000) | |||||
Common stock repurchased as part of share repurchase program | (560) | (560) | ||||
Other comprehensive income (loss) | 268 | 268 | ||||
Net income | 1,420 | 1,420 | ||||
Ending balance (in shares) at Dec. 31, 2021 | 20,700,000 | |||||
Ending balance at Dec. 31, 2021 | 48,272 | $ 2 | 101,905 | (53,903) | 268 | $ 0 |
Ending balance (in shares) at Dec. 31, 2021 | 0 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Shares issued upon restricted stock vesting and option exercise (in shares) | 657,000 | |||||
Shares issued upon restricted stock vesting and option exercise | 891 | 891 | ||||
Stock-based compensation expense | $ 3,825 | 3,825 | ||||
Employee stock purchase plan (in shares) | 60,673 | 61,000 | ||||
Employee stock purchase plan | $ 428 | 428 | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares) | (136,718) | (137,000) | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation | $ (1,193) | (1,193) | ||||
Retirement of treasury stock (in shares) | 0 | |||||
Common stock repurchased as part of share repurchase program (in shares) | (499,000) | |||||
Common stock repurchased as part of share repurchase program | $ (5,459) | (5,459) | ||||
Other comprehensive income (loss) | 1,221 | 1,221 | ||||
Net income | $ 18 | 18 | ||||
Ending balance (in shares) at Dec. 31, 2022 | 20,781,977 | 20,782,000 | ||||
Ending balance at Dec. 31, 2022 | $ 48,003 | $ 2 | 105,856 | (59,344) | 1,489 | $ 0 |
Ending balance (in shares) at Dec. 31, 2022 | 0 | |||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | ||||||
Shares issued upon restricted stock vesting and option exercise (in shares) | 481,000 | |||||
Shares issued upon restricted stock vesting and option exercise | 618 | 618 | ||||
Stock-based compensation expense | $ 4,074 | 4,074 | ||||
Employee stock purchase plan (in shares) | 71,623 | 72,000 | ||||
Employee stock purchase plan | $ 446 | 446 | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation (in shares) | (115,979) | (116,000) | ||||
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation | $ (1,157) | (1,157) | ||||
Retirement of treasury stock (in shares) | 0 | |||||
Common stock repurchased as part of share repurchase program (in shares) | (22,000) | |||||
Common stock repurchased as part of share repurchase program | $ (153) | (153) | ||||
Other comprehensive income (loss) | (401) | (401) | ||||
Net income | $ 872 | 872 | ||||
Ending balance (in shares) at Dec. 31, 2023 | 21,196,851 | 21,197,000 | ||||
Ending balance at Dec. 31, 2023 | $ 52,302 | $ 2 | $ 109,837 | $ (58,625) | $ 1,088 | $ 0 |
Ending balance (in shares) at Dec. 31, 2023 | 0 |
Consolidated Statements of Cash
Consolidated Statements of Cash Flows - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | ||
OPERATING ACTIVITIES | ||||
Net income | $ 872 | $ 18 | $ 1,420 | |
Adjustments to reconcile net income to net cash provided by operating activities: | ||||
Provision for doubtful accounts | (261) | 87 | 77 | |
Depreciation | 11,518 | 10,866 | 10,363 | |
Loss on disposal of and reserve adjustments for medical equipment | 1,726 | 1,933 | 1,029 | |
Gain on sale of medical equipment | (2,887) | (2,183) | (2,545) | |
Amortization of intangible assets | 990 | 2,494 | 4,262 | |
Amortization of deferred debt issuance costs | 120 | 73 | 151 | |
Stock-based compensation | 4,074 | 3,825 | 6,404 | |
Deferred income taxes | 633 | 19 | (153) | |
Changes in assets - (increase)/decrease: | ||||
Accounts receivable | (2,363) | (1,153) | 829 | |
Inventories | (1,581) | (882) | (864) | |
Other current assets | (1,235) | (387) | (133) | |
Other assets | (2,798) | (135) | (161) | |
Changes in liabilities - increase/(decrease): | ||||
Accounts payable and other liabilities | 2,415 | 2,942 | (2,363) | |
NET CASH PROVIDED BY OPERATING ACTIVITIES | 11,223 | 17,517 | 18,316 | |
INVESTING ACTIVITIES | ||||
Acquisition of business | 0 | 0 | (7,976) | |
Purchase of medical equipment | (10,093) | (14,094) | (15,676) | |
Purchase of property and equipment | (1,024) | (982) | (980) | |
Proceeds from sale of medical equipment, property and equipment | 4,383 | 3,598 | 3,317 | |
NET CASH USED IN INVESTING ACTIVITIES | (6,734) | (11,478) | (21,315) | |
FINANCING ACTIVITIES | ||||
Principal payments on long-term debt | (55,499) | (42,035) | (81,660) | |
Cash proceeds from long-term debt | 51,552 | 42,022 | 76,191 | |
Debt issuance costs | (229) | 0 | (386) | |
Cash payment of contingent consideration | 0 | (750) | 0 | |
Common stock repurchased as part of share repurchase program | (153) | (5,459) | (560) | |
Common stock repurchased to satisfy statutory withholding on employee stock-based compensation plans | (1,158) | (1,193) | (1,172) | |
Cash proceeds from exercise of options and ESPP | 1,064 | 1,355 | 1,124 | |
NET CASH USED IN FINANCING ACTIVITIES | (4,423) | (6,060) | (6,463) | |
Net change in cash and cash equivalents | 66 | (21) | (9,462) | |
Cash and cash equivalents, beginning of period | 165 | 186 | 9,648 | |
Cash and cash equivalents, end of period | 231 | 165 | 186 | |
SUPPLEMENTAL DISCLOSURES | ||||
Cash paid for interest | 2,052 | 1,310 | 1,113 | |
Cash paid for income taxes | 213 | 153 | 171 | |
NON-CASH TRANSACTIONS | ||||
Additions to medical equipment and property | [1] | 249 | 1,902 | 1,590 |
Additions to contingent consideration | [2] | 0 | 0 | 750 |
Additions to cash proceeds from stock plans | [3] | $ 0 | $ 0 | $ 36 |
[1]Amounts consist of current liabilities for medical equipment and property that have not been included in investing activities. These amounts have not been paid for as of December 31, 2023, 2022 and 2021, respectively, but will be included as a cash outflow from investing activities for purchases of medical equipment and property when paid.[2]Amount consists of current liabilities for contingent consideration that have not been included in financing activities. These amounts have not been paid for as of December 31, 2021, but was included as a cash outflow from financing activities for contingent consideration when paid.[3]Amount consists of receivables for cash proceeds from stock plans that have not been included in financing activities. These amounts have not been received as of December 31, 2021, but was included as a cash inflow from financing activities for cash proceeds from stock plans when received. |
Basis of Presentation and Natur
Basis of Presentation and Nature of Operations | 12 Months Ended |
Dec. 31, 2023 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Basis of Presentation and Nature of Operations | Basis of Presentation and Nature of Operations InfuSystem Holdings, Inc. and its consolidated subsidiaries (collectively, the “Company”) are a leading national provider of infusion pumps and related products and services for patients in the home, oncology clinics, ambulatory surgery centers, and other sites of care from seven locations in the United States ("U.S.") and Canada. The Company provides products and services to hospitals, oncology practices and facilities and other alternate site health care providers. Headquartered in Rochester Hills, Michigan, the Company delivers local, field-based customer support, and also operates pump service and repair Centers of Excellence in Michigan, Kansas, California, Massachusetts, Texas and Ontario, Canada. InfuSystem, Inc. and First Biomedical, Inc. are both operating subsidiaries of the Company. The Company’s core service is supplying electronic ambulatory infusion pumps and associated disposable supply kits to oncology clinics, infusion clinics and hospital outpatient chemotherapy clinics to be utilized in the treatment of a variety of cancers including colorectal cancer, pain management and other disease states. The majority of the Company’s pumps are electronic infusion pumps. Smiths Medical, Inc., a division of ICU Medical, Inc., supplied more than 60% of the ambulatory pumps purchased by the Company in 2023. The Company has a supply agreement in place with this supplier. Certain “spot” purchases are made on the open market subject to individual negotiation. The Company also supplies Negative Pressure Wound Therapy (“NPWT”) medical equipment, as well as related disposables and ancillary supplies. In addition, the Company sells or rents new and pre-owned pole-mounted and ambulatory infusion pumps to, and provides biomedical recertification, maintenance and repair services for oncology practices, as well as other alternate site settings including home care and home infusion providers, skilled nursing and acute care facilities, pain centers and others. The Company purchases new and pre-owned pole-mounted and ambulatory infusion pumps from a variety of sources on a non-exclusive basis. The Company repairs, refurbishes and provides biomedical certification for the devices as needed. The pumps are then available for sale, rental or to be used within the Company’s ambulatory infusion pump management service. |
Summary of Significant Accounti
Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Summary of Significant Accounting Policies | Summary of Significant Accounting Policies Principles of Consolidation The consolidated financial statements include the accounts of the Company and all wholly owned organizations. All intercompany transactions and account balances have been eliminated in consolidation. Segments The Company operates in two reportable segments, Patient Services and Device Solutions based on management's view of its business for purpose of evaluating performance and making operating decisions. The Company’s approach is to make operational decisions and assess performance based on delivering products and services that together provide solutions to its customer base utilizing a functional management structure. Based upon this business model, the Company’s Chief Executive Officer, whom the Company has determined to be its chief operating decision-maker ("CODM") , reviews segment financial information. See Note 1 3 for segment disclosures. Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates, assumptions and judgements that affect amounts reported therein. Due to the inherent uncertainty involved in making estimates, actual results reported in future periods may differ from those estimates. Business Combinations The Company accounts for all business combinations using the acquisition method of accounting, which allocates the fair value of the purchase consideration to the tangible and intangible assets acquired and liabilities assumed based on their estimated fair values. The excess of the purchase consideration over the fair values of these identifiable assets and liabilities is recorded as goodwill. When determining the fair values of assets acquired and liabilities assumed, management makes significant estimates and assumptions. For intangible assets, the Company typically uses the income approach to determine their estimated fair values. Key estimates and assumptions in that approach include the amount and timing of projected future cash flow, the discount rate selected to measure the risks inherent in those cash flows and the assessment of the asset's useful life. Initial purchase price allocations are subject to revision within the measurement period, not to exceed one year from the date of acquisition. Acquisition-related expenses and transaction costs associated with business combinations are expensed as incurred. Cash and Cash Equivalents The Company considers all highly liquid investments with original maturities of three months or less to be cash equivalents. The Company maintains substantially all of its cash and cash equivalents primarily with two financial institutions that are insured with the Federal Deposit Insurance Corporation (“FDIC”). At times throughout the year, cash and cash equivalents balances might exceed FDIC insurance limits. Accounts at banks with an aggregate excess of the amount of outstanding checks over the cash balances are included in accounts payable in current liabilities in the consolidated balance sheet. At December 31, 2023, and 2022, the Company did not have any cash equivalents. Revenue Recognition The Company generates revenues from multiple sources including from the sale and rental of our products as well as service contracts. Financial Accounting Standards Board ("FASB") Accounting Standards Codification ("ASC") Topic 606 - Revenue from Contracts with Customers ("ASC 606") stipulates revenue recognition at the time and in an amount that reflects the consideration expected to be entitled for the performance obligations that have been provided. ASC 606 defines contracts as creating enforceable rights and may be established through written contracts, oral agreements and through customary business practice. Under this definition, the Company considers contracts to be created at the time that the service is authorized or an order to purchase product is agreed upon regardless of whether or not there is a written contract. The Company has three separate and distinct performance obligations offered to its customers: a rental service performance obligation, a product sale performance obligation and a service performance obligation. A performance obligation is a promise in a contract to transfer a distinct good or service to the customer and is defined as the unit of account for revenue recognition under ASC 606. The Company's customers include medical facilities or patients, depending on the arrangement, and payments are received from different sources which include commercial payers, government insurance payers, medical facilities and patients. The Company generates a significant amount of its revenues that are accounted for under ASC 606 from the rental service of infusion pumps to its customers and the remainder of its revenue from product sales and services. For the rental service performance obligation revenue is based on its standalone price, determined using reimbursement rates established by third-party payer or other contracts. Revenue is recognized over the contract term in the period in which the related performance obligation is satisfied. The Company’s revenues related to product sales are recognized at the time that control of the product has been transferred to the customer; either at the time the product is shipped or the time the product has been received by the customer, depending on the delivery terms, or when the customer uses the products in the case of when our products are stored at a customer's location. The Company does not commit to long-term contracts to sell customers a certain minimum quantity of products. The Company's revenues related to services are recognized as the service work is completed. The Company employs certain significant judgments to estimate the dollar amount of revenue, and related concessions, allocated to the rental service and product performance obligations. These judgments include, among others, the estimation of variable consideration. The Company allocates variable consideration using standalone selling price when appropriate and available. When an appropriate standalone selling price is not available, the Company allocates based on a best estimate approach using the relative fair market value. Variable factors include differences in transaction price and changes in the expected total volume of services during the contract period. In calculating the variable amount of revenue for these performance obligations, variable consideration is estimated as price concessions resulting from differences between the rates charged for services performed and the expected reimbursements for commercial payers and other customer concessions. The contract period starts at contract inception and typically extends 30 days past the end of each reporting period representing the non-cancelable period of each agreement. These estimates for variable consideration are based on historical service volumes with our customers and prices with similar payers, aged accounts receivable by payer class and payer correspondence using the portfolio approach, which provide a reasonable basis for estimating the variable portion of a transaction. The Company doesn’t believe it is probable that a significant reversal of revenue will occur in future periods because (i) there is no significant uncertainty about the amount of considerations that is expected to be collected based on collection history and (ii) the large number of sufficiently similar contracts allows the Company to adequately estimate the components of variable consideration. Net revenues are adjusted when changes in estimates of variable consideration occur. Changes in estimates typically arise as a result of new information obtained, such as changes in volume and actual payment receipt or denial, or pricing adjustments by payers. Subsequent changes to estimates of transaction prices are recorded as adjustments to net revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payer’s ability to pay are recorded as an adjustment to the allowance for credit losses. Lease Arrangements The Company also generates its revenues from the rental of infusion pumps to its customers as leases. Under ASC 842, Leases ("ASC 842"), leases may be classified as either financing, sales-type, or operating, and the Company is required to disclose key information about leasing arrangements. The classification determines the pattern of revenue recognition and classification within the statement of operations. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The Company's customers include medical facilities or patients, depending on the arrangement, and payments are received from different sources which include commercial insurance payers, government insurance payers, medical facilities and patients. The Company primarily participates in operating leases as a lessor, and determined, and will continue to determine, whether an arrangement is a lease at inception. The Company’s operating leases are primarily for medical equipment under operating lease arrangements that expire at various dates over the next twelve months. The Company’s leases do not contain any restrictive covenants. Most of the Company’s equipment leases do not contain any material residual value guarantees. For the agreements that have guarantees, the residual value reflects management's best estimate of the expected sales price for the equipment at lease termination based on sales history adjusted for recent trends in the expected exit markets. The Company’s equipment leases may contain renewal options which range from one week to one year. Lease payments receivable reflect contractual lease payments adjusted for renewal or termination options that the Company believe the customer is reasonably certain to exercise. As of December 31, 2023, the Company did not have any operating leases that contained renewal options with increasing rental amounts. Many of the Company's leases allow the customer to extend the lease at prevailing market terms. The Company's operating leased assets are not protected against casualty loss through third-party insurance. Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates, including management's assessment of probability of collection, are required to record revenue and accounts receivable at their net realizable values, otherwise, if probability of collection is not met, the Company records revenue for such leases on a cash basis. 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 arrangements and the uncertainty of reimbursement amounts for certain services from certain payers may result in variable lease payments that require adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application, claim denial or account review. The Company adjusts revenue for historical trends on revenue adjustments due to timely filings, deaths, and other types of analyzable adjustments on a monthly basis to record rental revenue at the expected collectible amounts. Consistent with ASC 450, Contingencies, for contracts where collection is considered probable, accounts receivable is reduced by an allowance for credit losses which provides for those accounts from which payment is not expected to be received although product was delivered and revenue was earned. The Company records an allowance for credit losses based upon an analysis of historical collections. The Company has elected to record the adjustments to accounts receivables in net revenues on the Consolidated Statements of Operations and Comprehensive Income The Company also participates in sales-type leases as a lessor, and determined, and will continue to determine, whether an arrangement is a lease at inception. In a sales-type lease, lessors are required to recognize a lease receivable, selling profit, initial indirect costs, and residual asset values for all of these types of leases, and to disclose key information about leasing arrangements. The Company’s sales-type leases are primarily for medical equipment under sales-type lease arrangements that expire at various dates over the next three years. The Company’s leases do not contain any restrictive covenants. The Company’s equipment leases do not contain any material residual value guarantees or renewal options. Lease revenue for leased assets is recognized in net revenue. The Company further recognizes any variable lease payments that are not included in the net investment in the lease as income in profit or loss in the period when the changes in facts and circumstances on which the variable lease payments are based occur. Accounts Receivable and Allowance for Credit Losses, and Contingencies Amounts billed that have not yet been collected that also meet the conditions for unconditional right to payment are presented as accounts receivable. Accounts receivable related to rental service and delivery of products are reported at net realizable value, inclusive of adjustments for variable consideration. These adjustments reflect the amounts expected to be collected from payers based on an analysis of historical collections. The Company writes off accounts receivable once collection efforts have been exhausted and an account is deemed to be uncollectible. An allowance for credit losses, and contingencies, is established as a result of an adverse change in the Company’s payers’ ability to pay outstanding billings. The allowance for credit losses was $0.6 million and $1.1 million as of December 31, 2023 and 2022, respectively. Inventories The Company’s inventories consist of disposable medical supplies, replacement parts and other supplies used in conjunction with medical equipment and are stated at the lower of cost (first-in, first-out basis) or net realizable value. Cost primarily represents the purchase price paid for the items on hand. The Company periodically performs an analysis of slow-moving inventory and records an adjustment to reflect the recoverable amount. Medical Equipment Medical Equipment (“Equipment”) consists of equipment that the Company purchases from third-parties and is (1) held for sale or rent, and (2) used in service to generate rental revenue. Equipment, once placed into service, is depreciated using the straight-line method over the estimated useful lives of the equipment which is typically seven years. The Company does not depreciate Equipment held for sale or rent. When Equipment in rental service assets are sold, or otherwise disposed, the cost and related accumulated depreciation are removed from the accounts and a gain or loss is recorded in the current period. The Company periodically performs an analysis to identify potentially missing Equipment and records a reserve equal to the underlying net book value, which was $2.1 million and $2.3 million as of December 31, 2023 and 2022, respectively. This amount approximates the accelerated depreciation the Company would recognize over the remaining useful lives of the assets determined to be missing. The Company performs a similar analysis of slow-moving Equipment for sale or rent and records a reserve, which was less than $0.1 million as of both December 31, 2023 and 2022. Presentation of Medical Equipment in the Consolidated Statements The Company purchases medical equipment directly for sale as well as medical equipment that is purchased for either rental or sale and that is unallocated at the time of purchase (“Unallocated Assets”). Management believes that the predominant source of revenues and cash flows from the Unallocated Assets is from rentals and most equipment purchased is likely to be rented prior to being sold. The Company concluded that (i) the assets specifically supporting its two primary revenue streams should be separately disclosed on the balance sheet; (ii) the purchase and sale of Unallocated Assets should be classified solely in investing cash flows based on their predominant source while medical equipment purchased specifically for sales activity should be classified in operating cash flows; and (iii) other activities ancillary to the rental process should be consistently classified. Property and Equipment Property and equipment is stated at acquired cost and depreciated using the straight-line method over the estimated useful lives of the related assets, ranging from three three Goodwill Goodwill is tested for impairment annually or more frequently when certain events or circumstances trigger a review. Management has the option to first assess qualitative factors such as current performance and overall economic conditions to determine whether or not it is necessary to perform a quantitative goodwill impairment test. If the Company chooses that option, then the Company would not be required to perform a quantitative goodwill impairment test unless the Company determines that, based on a qualitative assessment, it is more likely than not that the fair value of a reporting unit is less than its carrying value. If the Company determines that an impairment is more likely than not, or if the Company chooses not to perform a qualitative assessment, the Company will then proceed with the quantitative assessment. Under the quantitative test, if the fair value of a reporting unit exceeds its carrying amount, then goodwill of the reporting unit is considered to not be impaired. If the carrying amount of the reporting unit exceeds its fair value, then an impairment loss is recognized in an amount equal to the excess, up to the value of the goodwill. The Company performed its annual impairment analysis by using a quantitative assessment as of October 31, 2023 and determined that there was no impairment. Intangible Assets Intangible assets consist of trade names, physician and customer relationships, unpatented technology, non-competition agreements and software. The Company amortizes the value assigned to the physician and customer relationships on a straight-line basis over the period of expected benefit, which ranges from fifteen three Management tests indefinite life trade names for impairment annually or more frequently if deemed necessary. Management has the option of first performing the impairment test for intangible assets with indefinite lives on a qualitative basis, by evaluating factors to determine whether it is more likely than not that an impairment exists. If it is more likely than not that an impairment exists, or if the Company chooses not to perform a qualitative assessment, then a quantitative impairment test is performed. Impairment exists when the carrying amount of the intangible asset exceeds its fair value. If the carrying value of the intangible assets exceeds the fair value, an impairment loss is recognized in an amount equal to that excess. The Company performed its annual impairment analysis by using a quantitative assessment as of October 31, 2023 and determined that the fair value of the trade names with indefinite lives was greater than their carrying value, resulting in no impairment. Software Capitalization and Depreciation The Company capitalizes certain costs incurred in connection with obtaining or developing internal-use software, including payroll and payroll-related costs for employees who are directly associated with the internal-use software project, external direct costs of materials and services and interest costs while developing the software. Capitalized software costs are included in intangible assets, net and are amortized using the straight-line method over the estimated useful life of three The Company assesses impairment indicators related to its internally-developed, internal-use software, specifically looking at the effectiveness and useful lives of each project and sub-project to determine if impairment indicators are present. For the year ended December 31, 2023, the Company assessed the impairment indicators and found none to be present. Impairment of Long-Lived Assets Long-lived assets held for use, which includes medical equipment in rental service, property and equipment and amortizable intangible assets, are reviewed for impairment when events or changes in circumstances indicate that their carrying value may not be recoverable. If an impairment indicator exists, the Company assesses the asset or asset group for recoverability. Recoverability of these assets is determined based upon the expected undiscounted future net cash flows from the operations to which the assets relate, utilizing management’s best estimates, appropriate assumptions and projections at the time. If the carrying value is determined not to be recoverable from future operating cash flows, the asset is deemed impaired and an impairment loss would be recognized to the extent the carrying value exceeded the estimated fair market value of the asset or asset group. For the years ended December 31, 2023, 2022 and 2021, respectively, the Company assessed the impairment indicators and found none to be present. Leases For policies related to the Company acting as a lessor, refer to the "Lease Arrangements" policy section above. With respect to the policies related to the Company as lessee, under ASC 842, lessees are required to recognize a lease liability and right-of-use asset (“ROU asset”) for all leases and to disclose key information about leasing arrangements. Additionally, leases are classified as either financing or operating; the classification determines the pattern of expense recognition and classification within the statement of operations. The Company elected to apply its lease accounting policy only to leases with a term greater than twelve months. ASC 842 provides practical expedients for an entity’s ongoing accounting. The Company elected the “combining lease and non-lease components” practical expedient. The company also elected to apply the short-term lease recognition exemption to certain leases; therefore, the Company did not recognize ROU assets and lease liabilities for these leases. In adopting ASC 842, the Company determined and will continue to determine whether an arrangement is a lease at inception. The Company’s operating leases are primarily for office space, service facility centers and equipment under operating lease arrangements that expire at various dates over the next eight years. The Company’s leases do not contain any restrictive covenants. The Company’s office leases generally contain renewal options for periods ranging from one For the Company’s equipment leases, the Company used and will use the implicit rate in the lease as the discount rate, when available. Otherwise, the Company uses its incremental borrowing rate as the discount rate. For the Company’s office leases, the implicit rate is typically not available, so the Company used and will use its incremental borrowing rate as the discount rate. The incremental borrowing rate is estimated to approximate the interest rate on a collateralized basis with similar terms and payments. Payments due under the Company’s operating leases include fixed payments as well as variable payments. For the Company’s office leases, variable payments include amounts for the Company’s proportionate share of operating expenses, utilities, property taxes, insurance, common area maintenance and other facility-related expenses. For the Company’s equipment leases, variable payments may consist of sales taxes, property taxes and other fees. Cost of Revenues Cost of revenues include the costs of servicing and maintaining pumps, products and services sold, shipping, depreciation of medical equipment, and other direct and indirect costs related to net revenues, and these expenses are expensed as incurred. Shipping and handling costs incurred after control over a product has transferred to a customer are accounted for as a fulfillment cost. Customer Concentration As of December 31, 2023 and 2022, the Company had contracts with nearly 820 and 800 third-party payer networks, respectively. Material terms of contracts with third-party payer organizations are typically a pre-negotiated fee schedule rate or a then-current proprietary fee schedule rate for equipment and supplies provided. The majority of these contracts generally provide for a term of one year, with automatic one-year renewals, unless the Company or the contracted payer elect not to renew. The Company also contracts with various other third-party payer organizations, Medicaid, commercial Medicare replacement plans, self-insured plans, facilities of its Medicare patients and numerous other insurance carriers. No single payer or customer represented more than 10% of the Company's net revenue in 2023, 2022 or 2021. Income Taxes The Company recognizes deferred income tax liabilities and assets based on (i) the differences between the financial statement carrying amounts and the tax basis of assets and liabilities, using enacted tax rates in effect in the years the differences are expected to reverse and (ii) the tax credit carryforwards. Deferred income tax (expense) benefit results from the change in net deferred tax assets or deferred tax liabilities. A valuation allowance is recorded when it is more likely than not that some or all of any deferred tax assets will not be realized. Provisions for federal, state and foreign taxes are calculated based on reported pre-tax earnings based on current tax law and include the cumulative effect of any changes in tax rates from those used previously in determining deferred tax assets and liabilities. Certain items of income and expense are recognized in different time periods for financial reporting than for income tax purposes; thus, such provisions differ from the amounts currently receivable or payable. The Company follows a two-step approach for recognizing uncertain tax positions. First, it evaluates the tax position for recognition by determining if the weight of available evidence indicates it is more-likely-than-not that the position will be sustained upon examination. Second, for positions that are determined are more-likely-than-not to be sustained, it recognizes the tax benefits as the largest benefit that has a greater than 50% likelihood of being sustained. The Company establishes a reserve for uncertain tax positions liability that is comprised of unrecognized tax benefits and related interest and penalties. The Company adjusts this liability in the period in which an uncertain tax position is effectively settled, the statute of limitations expires for the relevant taxing authority to examine the tax position, or more information becomes available. Treasury Stock The Company periodically repurchases shares of its common stock. These repurchases take place either as part of a board-authorized program, which may include open market transactions or privately negotiated transactions and may be made under a Rule 10b5-1 plan, or in targeted stock purchase agreements approved by the Board. Treasury stock is accounted for using the par value method. In 2021, the Company retired the approximately 3,500,000 shares that were previously held in treasury. As of December 31, 2023 and 2022, respectively, the Company did not have any shares being held in treasury. Share-Based Payments The Company determines the fair value of stock option awards, restricted stock awards and stock appreciation rights (collectively, “Share-Based Awards”) on the date of grant using either the grant date price of the Company's common stock or option-pricing models which are affected by the Company’s stock price, as well as assumptions regarding a number of other inputs using the Black-Scholes pricing model. These variables include the Company’s expected stock price volatility over the expected term of the Share-Based Awards, actual and projected employee stock option exercise behaviors, risk-free interest rates and expected dividends. The expected volatility is based on the historical volatility. The expected term represents the period over which the Share-Based Awards are expected to be outstanding. The dividend yield is an estimate of the expected dividend yield on the Company’s stock. The risk-free rate is based on U.S. Treasury yields in effect at the time of the grant for the expected term of the Share-Based Awards. Forfeitures are recognized as they occur. All Share-Based Awards are amortized based on their graded vesting over the requisite service period of the awards. Compensation costs are recognized over the requisite service period using the accelerated method and included in general and administrative expenses. Additionally, the Company also determines the fair value of performance-based restricted stock units (“PSUs”) based upon the type of performance measure. These awards typically vest after the Company’s achievement of either a specific Company performance metric or when the market value of the Company’s stock meets a specific metric such as when the closing price of the Company's stock reaches a target value for a minimum number of consecutive trading days. Under FASB ASC 718, the provisions of the PSUs that vest upon achievement of a target market value are considered a market condition, and therefore the effect of that market condition is reflected in the grant date fair value for this type of award. A third-party valuation expert was engaged to prepare a “Monte Carlo simulation” to account for the market condition to assist management in its conclusion of fair value. That simulation takes into account the beginning stock price of the Company’s common stock, the expected volatilities for the Company’s stock price and the expected risk-free rate of return. The single grant-date fair value computed by this valuation method is recognized by the Company in accounting for the awards regardless of the actual future outcome of the market condition. Compensation costs are accelerated if the market condition is satisfied prior to the end of the service period derived under the Monte Carlo simulation. The grant date fair value of the other PSUs is calculated as the closing price of the Company’s common stock on the grant date multiplied by the number of shares estimated to be delivered subject to the award terms. Company performance measure goals are considered a performance condition and the timing and amount of compensation cost for those PSUs corresponds with management’s expectation of the probable outcome of the performance conditions as of the grant date and during the vesting period. Deferred Debt Issuance Costs Capitalized debt issuance costs as of December 31, 2023 and 2022 relate to the Company’s credit facility. The costs related to the agreement are netted against current and non-current debt and is recognized in Interest expense. The Company amortizes these costs using the interest method through the maturity date of the underlying debt. Earnings Per Share The Company reports its earnings per share which includes the presentation of both basic and diluted earnings per share on the statements of operations. The diluted weighted average common shares include adjustments for the potential effects of outstanding stock options but only in the periods in which such effect is dilutive under the treasury stock method. Included in our basic and diluted weighted average common shares are those stock options and restricted stock awards due to participants granted from the 2014 and 2021 stock incentive plans. Anti-dilutive stock awards are comprised of stock options and unvested restricted stock awards, which would have been anti-dilutive in the application of the treasury stock method. In periods where the Company records a net loss, the diluted per share amount is the same as the basic per share amount. In accordance with this topic, the following table reconciles income and share amounts utilized to calculate basic and diluted net income per common share: Years Ended December 31, 2023 2022 2021 Numerator (in thousands): Net income: $ 872 $ 18 $ 1,420 Denominator: Weighted average common shares outstanding: Basic 21,024,382 20,648,818 20,519,958 Dilutive effect of common stock equivalents 621,697 898,488 1,529,701 Diluted 21,646,079 21,547,306 22,049,659 Stock options of 1,007,394, 1,085,855 and 368,056 shares were not included in the calculation for the years ended December 31, 2023, 2022 and 2021, respectively, because they would have an anti-dilutive effect. Derivatives The Com |
Revenue Recognition
Revenue Recognition | 12 Months Ended |
Dec. 31, 2023 | |
Revenue Recognition [Abstract] | |
Revenue Recognition | Revenue Disaggregated Revenue The following table presents the Company’s disaggregated revenue by offering type (in thousands): Years Ended December 31, 2023 2022 2021 Total Net Revenues % of Total Net Revenues Total Net Revenues % of Total Net Revenues Total Net Revenues % of Total Net Revenues Patient Services revenue recognized at a point in time: Direct products $ 2,294 1.8 % $ 2,236 2.0 % $ 2,480 2.4 % Third-Party Payer products 13,821 11.0 % 12,573 11.4 % 12,112 11.8 % Patient Services revenue recognized over time: Direct rental services 7,388 5.9 % 7,246 6.6 % 7,333 7.2 % Third-Party Payer rental services 44,475 35.4 % 40,948 37.3 % 38,765 37.9 % Total Patient Services accounted for under ASC 606 67,978 54.1 % 63,003 57.3 % 60,690 59.3 % Device Solutions revenue recognized at a point in time: Products 14,877 11.8 % 15,359 14.0 % 15,296 14.9 % Services 9,844 7.8 % 6,434 5.9 % 4,718 4.6 % Device Solutions revenue recognized over time: Services 6,038 4.8 % 633 0.6 % — — % Total Device Solutions accounted for under ASC 606 30,759 24.4 % 22,426 20.5 % 20,014 19.5 % Total Revenue Accounted for under ASC 606 98,737 78.5 % 85,429 77.8 % 80,704 78.8 % Patient Services Lease Revenue 8,563 6.8 % 5,878 5.3 % 4,908 4.8 % Device Solutions Lease Revenue 18,485 14.7 % 18,607 16.9 % 16,770 16.4 % Total Revenue accounted for under ASC 842, Leases 27,048 21.5 % 24,485 22.2 % 21,678 21.2 % Total Net Revenue $ 125,785 100.0 % $ 109,914 100.0 % $ 102,382 100.0 % Contract Balances 2023 2022 2021 Change in 2023 Change in 2022 Accounts receivable, net $ 19,830 $ 16,871 $ 15,405 $ 2,959 $ 1,466 Contract assets $ 1,271 $ 360 $ — $ 911 $ 360 The change in contract assets during the fiscal year ended December 31, 2023 was mainly due to $9.2 million of revenue recognized for which the payment is subject to conditions other than the passage of time, partially offset by $8.3 million of contract assets reclassified to accounts receivable as our right to consideration for these contract assets became unconditional. Contract assets are included in other current assets on the Company's Consolidated Balance Sheets. |
Medical Equipment
Medical Equipment | 12 Months Ended |
Dec. 31, 2023 | |
Medical Equipment [Abstract] | |
Medical Equipment | Medical Equipment Medical equipment consisted of the following (in thousands): December 31, 2023 December 31, 2022 Medical Equipment for sale or rental $ 3,081 $ 2,802 Medical Equipment for sale or rental - pump reserve (32) (12) Medical Equipment for sale or rental - net 3,049 2,790 Medical Equipment in rental service 96,298 99,163 Medical Equipment in rental service - pump reserve (2,126) (2,270) Accumulated depreciation (59,244) (57,443) Medical Equipment in rental service - net 34,928 39,450 Total $ 37,977 $ 42,240 Depreciation expense for medical equipment for the years ended December 31, 2023, 2022 and 2021 was $10.4 million, $9.8 million and $9.4 million, respectively, which were recorded in “cost of revenues” for each period. The pump reserve for medical equipment in rental service represents an estimate for medical equipment that is considered to be missing. The reserve calculated is equal to the net book value of assets that have not returned from the field within a certain timeframe. Sales of the Company's medical equipment are included in net revenue. |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2023 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and Equipment Property and equipment consisted of the following (in thousands): December 31, 2023 December 31, 2022 Gross Assets Accumulated Total Gross Assets Accumulated Total Furniture, fixtures, and equipment $ 6,611 $ (3,909) $ 2,702 $ 5,710 $ (3,252) $ 2,458 Automobiles 87 (87) — 87 (83) 4 Leasehold improvements 3,570 (1,951) 1,619 3,498 (1,575) 1,923 Total $ 10,268 $ (5,947) $ 4,321 $ 9,295 $ (4,910) $ 4,385 Depreciation expense for property and equipment for each of the years ended December 31, 2023, 2022 and 2021 was $1.1 million, $1.1 million and $0.9 million, respectively. This expense was recorded in “general and administrative expenses” for each period. |
Goodwill and Intangible Assets
Goodwill and Intangible Assets | 12 Months Ended |
Dec. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill and Intangible Assets | Goodwill and Intangible Assets The changes in the carrying value of goodwill by segment are as follows (in thousands): Device Solutions (a) Balance as of December 31, 2021 $ 3,710 Goodwill acquired — Balance as of December 31, 2022 3,710 Goodwill acquired — Balance as of December 31, 2023 $ 3,710 (a) The Patient Services segment has no recorded goodwill. The carrying amount and accumulated amortization of intangible assets were as follows (in thousands): December 31, 2023 December 31, 2022 Gross Assets Accumulated Amortization Net Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ — $ 2,000 $ 2,000 $ — $ 2,000 Amortizable intangible assets Trade names 23 (23) — 23 (23) — Physician and customer relationships 38,834 (34,295) 4,539 38,834 (33,594) 5,240 Unpatented technology 943 (393) 550 943 (258) 685 Non-competition agreements 472 (255) 217 472 (161) 311 Software 10,300 (10,160) 140 10,300 (10,100) 200 Total nonamortizable and amortizable intangible assets $ 52,572 $ (45,126) $ 7,446 $ 52,572 $ (44,136) $ 8,436 Amortization expense for intangible assets for the years ended December 31, 2023, 2022 and 2021 was $1.0 million, $2.5 million and $4.3 million, respectively, which was recorded in "amortization of intangibles expenses" for each period. Expected remaining annual amortization expense for the next five years for intangible assets recorded as of December 31, 2023 is as follows (in thousands): 2024 2025 2026 2027 2028 2029 and Amortization expense $ 990 $ 810 $ 525 $ 471 $ 348 $ 2,302 |
Debt
Debt | 12 Months Ended |
Dec. 31, 2023 | |
Debt Disclosure [Abstract] | |
Debt | Debt On February 5, 2021 , the Company entered into a Credit Agreement (the “ 2021 Credit Agreement”) with JPMorgan Chase Bank, N.A., as administrative agent (the “Agent”), sole bookrunner and sole lead arranger, and the lenders party thereto. The borrowers under the 2021 Credit Agreement are the Company, InfuSystem Holdings USA, Inc. (“Holdings”), ISI, First Biomedical, and IFC LLC (“IFC” and, collectively with the Company, Holdings, ISI and First Biomedical, the “Borrowers”). The 2021 Credit Agreement provides for a revolving credit facility (the “Revolving Facility”) of $75.0 million, maturing on February 5, 2026. The Revolving Facility may be increased by $25.0 million, subject to certain conditions, including the consent of the Agent and obtaining necessary commitments. The lenders under the 2021 Credit Agreement may issue up to $7.0 million in letters of credit subject to the satisfaction of certain conditions. On February 5, 2021, the Borrowers made an initial borrowing of $30.0 million under the Revolving Facility. Proceeds from the loan, along with approximately $8.2 million in cash, were used to repay all amounts due under the Company’s then existing credit facility dated March 23, 2015 (the “2015 Credit Agreement”). The 2021 Credit Agreement has customary representations and warranties. The ability to borrow under the facility is subject to ongoing compliance with a number of customary affirmative and negative covenants, including limitations on indebtedness, liens, mergers, acquisitions, investments, asset sales, affiliate transactions and restricted payments, as well as financial covenants, including the following: • a minimum fixed charge coverage ratio (defined as the ratio of consolidated EBITDA (as defined in the 2021 Credit Agreement) less 50% of depreciation expense), to consolidated fixed charges (as defined in the 2021 Credit Agreement)) for the prior four most recently ended calendar quarters of 1.20 to 1.00; and • a maximum leverage ratio (defined as total indebtedness to EBITDA for the prior four most recently ended calendar quarters) of 3.50 to 1.00. The 2021 Credit Agreement includes customary events of default. The occurrence of an event of default will permit the lenders to terminate commitments to lend under the Revolving Facility and accelerate payment of all amounts outstanding thereunder. Simultaneous with the execution of the 2021 Credit Agreement, the Company entered into a Pledge and Security Agreement to secure repayment of the obligations of the Borrowers. Under the Pledge and Security Agreement, each Borrower has granted to the Agent, for the benefit of various secured parties, a first priority security interest in substantially all of the personal property assets of each of the Borrowers, including the shares of each of Holdings, ISI and First Biomedical and the equity interests of IFC. On April 26, 2023, the Company entered into a First Amendment to the 2021 Credit Agreement (the “First Amendment”) with the Agent and the lenders party thereto, which amended the 2021 Credit Agreement, to provide for, among other things: (i) an extension of the maturity date for the 2021 Credit Agreement to April 26, 2028, (ii) the replacement of London Interbank Offered Rate (“LIBOR”) with Adjusted Term Secured Overnight Financing Rate (“SOFR”) as a benchmark interest rate, and (iii) an increase of the maximum dollar amount of incremental revolving loans from $25 million to $35 million. Incremental revolving loans continue to be subject to certain conditions, including the consent of the Agent and obtaining necessary commitments. The 2021 Credit Agreement and First Amendment was accounted for as debt modifications that resulted in a small increase to deferred debt issuance costs. As of December 31, 2023, the Company was in compliance with all debt-related covenants under the 2021 Credit Agreement, as amended. The following table illustrates the net availability under the Revolving Facility as of the applicable balance sheet date (in thousands): December 31, 2023 December 31, 2022 Revolving Facility: Gross availability $ 75,000 $ 75,000 Outstanding draws (29,439) (33,384) Letters of credit (200) (400) Availability on Revolving Facility $ 45,361 $ 41,216 The Company had future maturities of its long-term debt as of December 31, 2023 as follows (in thousands): 2024 2025 2026 2027 2028 2029 and Total Revolving Facility $ — $ — $ — $ — $ 29,439 $ — $ 29,439 Total $ — $ — $ — $ — $ 29,439 $ — $ 29,439 The following is a breakdown of the Company’s current and long-term debt (in thousands): December 31, 2023 December 31, 2022 Current Long-Term Total Current Long-Term Total Revolving Facility $ — $ 29,439 $ 29,439 $ — $ 33,384 $ 33,384 Unamortized value of debt issuance costs — (338) (338) — (227) (227) Total $ — $ 29,101 $ 29,101 $ — $ 33,157 $ 33,157 As of December 31, 2023, amounts outstanding under the Revolving Facility provided under the 2021 Credit Agreement bear interest at a variable rate equal to, at the Company’s election, Adjusted Term SOFR for Term Benchmark loans or an Alternative Base Rate for ABR loans, as defined by the First Amendment plus a spread that will vary depending upon the Company’s leverage ratio. The spread ranges from 2.00% to 3.00% for Term Benchmark Loans and 1.00% to 2.00% for base rate loans. The weighted-average Term Benchmark loan rate at December 31, 2023 was 7.71% (Adjusted Term SOFR of 5.46% plus 2.25%). The actual ABR loan rate at December 31, 2023 was 9.75% (lender’s prime rate of 8.50% plus 1.25%). |
Derivative Financial Instrument
Derivative Financial Instruments and Hedging Activities | 12 Months Ended |
Dec. 31, 2023 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Derivative Financial Instruments and Hedging Activities | Derivative Financial Instruments and Hedging Activities In February 2021, the Company adopted a derivative investment policy which provides guidelines and objectives related to managing financial and operational exposures arising from market changes in short term interest rates. In accordance with this policy, the Company can enter into interest rate swaps or similar instruments, will endeavor to evaluate all the risks inherent in a transaction before entering into a derivative financial instrument and will not enter into derivative financial instruments for speculative or trading purposes. Hedging relationships are formally documented at the inception of the hedge and hedges must be highly effective in offsetting changes to future cash flows on hedged transactions at the inception of a hedge and on an ongoing basis to be designated for hedge accounting treatment. The Company is exposed to interest rate risk related to its variable rate debt obligations under the 2021 Credit Agreement. In order to manage the volatility in interest rate markets, in February 2021, the Company entered into two interest rate swap agreements to manage exposure arising from this risk. On a combined basis, the agreements had a constant notional amount over a 5-year term that would have ended on February 5, 2026. While they were outstanding, each agreement paid the Company 30-day LIBOR on the notional amount and the Company paid a fixed rate of interest equal to 0.73%. These derivative instruments were considered cash flow hedges. On May 11, 2023, these two swaps were settled and a new swap was entered into with different terms that aligned with changes in the 2021 Credit Agreement arising from the First Amendment. The new swap has a constant notional amount over a five-year term that ends on April 26, 2028. The agreement pays the Company 30-day SOFR on the notional amount and the Company pays a fixed rate of interest equal to 1.74%. The Company does not have any other derivative financial instruments. The table below presents the location and gross fair value amounts of the Company's derivative financial instruments and the associated notional amounts designated as cash flow hedges (in thousands): December 31, 2023 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,442 December 31, 2022 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,965 The table below presents the effect of our derivative financial instruments designated as hedging instruments in AOCI (in thousands): Years Ended December 31, 2023 December 31, 2022 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,489 $ 268 Unrealized gain recognized in AOCI 214 1,807 Amounts reclassified to interest expense (a)(b) (737) (198) Tax benefit (provision) 122 (388) Ending balance $ 1,088 $ 1,489 (a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the consolidated statement of operations for the years ended December 31, 2023, 2022 and 2021 was $2.2 million, $1.4 million and $1.4 million, respectively. (b) As of December 31, 2023, $0.6 million of income is expected to be reclassified into earnings within the next 12 months. The Company did not incur any hedge ineffectiveness during the years ended December 31, 2023, 2022 and 2021, respectively. |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | Income Taxes The following table summarizes the Company’s income before income taxes (in thousands): Years Ended December 31, 2023 2022 2021 U.S income $ 1,566 $ 63 $ 1,033 Non-U.S. income 285 67 224 Income before income taxes $ 1,851 $ 130 $ 1,257 The following table summarizes the Company’s components of the consolidated (provision for) benefit from income taxes (in thousands): Years Ended December 31, 2023 2022 2021 U.S Federal income tax (expense) benefit Current $ — $ — $ — Deferred (568) 44 150 Total U.S. Federal income tax (expense) benefit (568) 44 150 State and local income tax (expense) benefit Current (245) (99) (167) Deferred (65) (65) 3 Total state and local income tax expense (310) (164) (164) Foreign income tax (expense) benefit Current (101) 8 177 Total income tax (expense) benefit $ (979) $ (112) $ 163 The following table summarizes a reconciliation of the Company’s income tax (expense) benefit from the effective income tax rate to the U.S. federal statutory rate (in thousands): Years Ended December 31, 2023 2022 2021 Income tax expense at the statutory rate $ (389) $ (27) $ (264) State and local income tax expense (245) (130) (130) Foreign income tax (16) (4) (12) Share-Based compensation and other permanent differences (260) (58) 462 Credits (39) 79 34 Other adjustments (30) 28 73 Income tax (expense) benefit at effective income tax rate $ (979) $ (112) $ 163 The following table summarizes the temporary differences and carryforwards that give rise to deferred tax assets and liabilities (in thousands): December 31, 2023 December 31, 2022 Deferred Federal, state and local tax assets – Bad debt reserves $ 3,318 $ 2,603 Stock-based compensation 1,812 1,668 Net operating loss (a) 6,400 8,680 Operating lease liabilities 1,864 1,210 Accrued compensation 792 552 Inventories 626 639 Research & development credits 555 555 Other credits 102 141 Other 616 432 Total deferred Federal, state and local tax assets 16,085 16,480 Deferred Federal, state and local tax liabilities – Depreciation and asset basis differences (4,131) (4,505) Goodwill and intangible assets (768) (800) Right-of-use assets (1,718) (1,075) Derivative financial instruments (353) (475) Total deferred Federal, state and local tax liabilities (6,970) (6,855) Net deferred tax assets $ 9,115 $ 9,625 (a) At December 31, 2023 and 2022, this includes state and local net operating losses of $0.8 million and $1.2 million, respectively. The Company’s U.S. federal net operating loss carryforward for tax purposes was $26.6 million at December 31, 2023, resulting in a federal deferred tax asset of $5.6 million. Approximately $20.0 million of the Company’s U.S. federal net operating loss carryforwards will begin to expire in various years beginning in 2034. U.S. federal net operating loss carryforwards of $6.6 million have an indefinite life. The Company’s state net operating loss carryforward of approximately $0.8 million is comprised of various jurisdictions. These state net operating losses can be used for a period of 5 to 20 years and vary by state, and if unused, begin to expire in 2024, though a substantial portion expires beyond 2024. Approximately $0.1 million of the state net operating loss carryforwards have an indefinite life. Tax benefits of operating loss and tax credit carryforwards are evaluated on an ongoing basis, including a review of historical and projected future operating results, the eligible carryforward period, and other circumstances. The Company continues to monitor shifts in past ownership (as defined under Section 382 of the Code). The Company had no uncertain tax positions for the years ended December 31, 2023 and 2022. The Company is subject to taxation for Federal and various state jurisdictions in the U.S. and Canada. The Federal income tax returns of the Company for the years 2020 through 2023 are open to examination by the Internal Revenue Service. The Company was under audit with the Internal Revenue Service in relation to the Company’s 2018 federal income tax return and the audit was closed on December 15, 2021. The state income tax returns and other state tax filings of the Company are subject to examination by the state taxing authorities, for various periods generally up to four years after they are filed. Canadian income tax returns of the Company for the years 2019 through 2023 are subject to examination by the Canada Revenue Agency. On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security ("CARES") Act was enacted in response to the COVID-19 pandemic. The CARES Act among other things, allows employers to defer the deposit and payment of the employer's share of Social Security taxes. The Company, under the CARES Act, deferred paying $0.7 million of applicable gross payroll taxes as of December 31, 2020, which was included in other liabilities. The $0.7 million balance of the deferred Social Security taxes was paid in two annual installments during the years ending December 31, 2021 and 2022, respectively. |
Commitments and Contingencies
Commitments and Contingencies | 12 Months Ended |
Dec. 31, 2023 | |
Commitments and Contingencies Disclosure [Abstract] | |
Commitments and Contingencies | Commitments and Contingencies From time to time in the ordinary course of its business, the Company may be involved in legal and regulatory proceedings, the outcomes of which may not be determinable. The results of litigation and regulatory proceedings are inherently unpredictable. Any claims against the Company, whether meritorious or not, could be time consuming, result in costly litigation, require significant amounts of management time and result in diversion of significant resources. The Company is not able to estimate an aggregate amount or range of reasonably possible losses for those legal matters for which losses are not probable and estimable, primarily for the following reasons: (i) many of the relevant legal proceedings are in preliminary stages, and until such proceedings develop further, there is often uncertainty regarding the relevant facts and circumstances at issue and potential liability; and (ii) many of these proceedings involve matters of which the outcomes are inherently difficult to predict. The Company has insurance policies covering potential losses where such coverage is cost effective. The Company is not at this time involved in any proceedings that the Company currently believes could have a material effect on the Company’s financial condition, results of operations or cash flows. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2023 | |
Leases [Abstract] | |
Leases | Leases As Lessee: The Company has historically entered into a number of lease agreements under which the Company is the lessee for equipment and office leases. The components of the Company’s operating lease costs consisted of the following (in thousands): Years Ended December 31, 2023 2022 2021 Operating lease cost $ 1,504 $ 1,333 $ 1,316 Variable lease cost 336 301 243 Total lease cost $ 1,840 $ 1,634 $ 1,559 Lease costs for the year ended December 31, 2023 of approximately $1.8 million were recorded to G&A expenses. Lease costs for the year ended December 31, 2022 of approximately $1.6 million were recorded to G&A expenses. Lease costs for the year ended December 31, 2021 of approximately $1.5 million and $0.1 million, were recorded to G&A expenses and cost of revenues, respectively. Expense related to short-term leases, which are not recorded on the Consolidated Balance Sheets, was not material for the fiscal years ended December 31, 2023, 2022 and 2021. Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Years Ended December 31, 2023 2022 2021 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 1,441 $ 1,241 $ 1,271 Right of use assets obtained in exchange for lease obligations: Operating leases $ 3,356 $ 18 $ 926 Increases to right of use assets resulting from lease modifications: Operating leases $ 552 $ 1,050 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: 2023 2022 Years Years Weighted average remaining lease term: 6.2 6.7 Rate Rate Weighted average discount rate: 7.7% 7.1% Future maturities of lease liabilities as of December 31, 2023 are as follows (in thousands): Operating Leases 2024 $ 1,796 2025 1,837 2026 1,654 2027 1,478 2028 1,429 Thereafter 2,424 Total undiscounted lease payments 10,618 Less: Imputed interest (3,345) Total lease liabilities $ 7,273 The long-term portion of the lease liabilities included in the amounts above is $5.8 million with the remainder included in other current liabilities in the Consolidated Balance Sheet. As Lessor We lease medical equipment to customers, often in conjunction with arrangements to provide consumable medical products. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options, varies by customer. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The components of the Company’s lease revenues consisted of the following (in thousands): Years Ended December 31, 2023 2022 2021 Net operating lease revenue $ 23,797 $ 24,413 $ 21,678 Sales-type lease revenue 3,250 72 — Total lease revenue $ 27,047 $ 24,485 $ 21,678 The components of our net investment in sales-type leases as of December 31, 2023 and 2022 were (in thousands): 2023 2022 Lease receivable $ 2,583 $ 45 Net investment in leases $ 2,583 $ 45 Our net investment in sales-type leases is classified as follows in the accompanying consolidated balance sheets as of December 31, 2023 and 2022 (in thousands): 2023 2022 Accounts receivable, net $ 1,067 $ 45 Other assets 1,516 — Total $ 2,583 $ 45 Future maturities of sales-type leases as of December 31, 2023 are as follows (in thousands): Sales-Type Leases 2024 $ 1,238 2025 1,217 2026 539 Total undiscounted lease payments 2,994 Less: Imputed interest (411) Total lease receivables $ 2,583 |
Leases | Leases As Lessee: The Company has historically entered into a number of lease agreements under which the Company is the lessee for equipment and office leases. The components of the Company’s operating lease costs consisted of the following (in thousands): Years Ended December 31, 2023 2022 2021 Operating lease cost $ 1,504 $ 1,333 $ 1,316 Variable lease cost 336 301 243 Total lease cost $ 1,840 $ 1,634 $ 1,559 Lease costs for the year ended December 31, 2023 of approximately $1.8 million were recorded to G&A expenses. Lease costs for the year ended December 31, 2022 of approximately $1.6 million were recorded to G&A expenses. Lease costs for the year ended December 31, 2021 of approximately $1.5 million and $0.1 million, were recorded to G&A expenses and cost of revenues, respectively. Expense related to short-term leases, which are not recorded on the Consolidated Balance Sheets, was not material for the fiscal years ended December 31, 2023, 2022 and 2021. Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Years Ended December 31, 2023 2022 2021 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 1,441 $ 1,241 $ 1,271 Right of use assets obtained in exchange for lease obligations: Operating leases $ 3,356 $ 18 $ 926 Increases to right of use assets resulting from lease modifications: Operating leases $ 552 $ 1,050 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: 2023 2022 Years Years Weighted average remaining lease term: 6.2 6.7 Rate Rate Weighted average discount rate: 7.7% 7.1% Future maturities of lease liabilities as of December 31, 2023 are as follows (in thousands): Operating Leases 2024 $ 1,796 2025 1,837 2026 1,654 2027 1,478 2028 1,429 Thereafter 2,424 Total undiscounted lease payments 10,618 Less: Imputed interest (3,345) Total lease liabilities $ 7,273 The long-term portion of the lease liabilities included in the amounts above is $5.8 million with the remainder included in other current liabilities in the Consolidated Balance Sheet. As Lessor We lease medical equipment to customers, often in conjunction with arrangements to provide consumable medical products. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options, varies by customer. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The components of the Company’s lease revenues consisted of the following (in thousands): Years Ended December 31, 2023 2022 2021 Net operating lease revenue $ 23,797 $ 24,413 $ 21,678 Sales-type lease revenue 3,250 72 — Total lease revenue $ 27,047 $ 24,485 $ 21,678 The components of our net investment in sales-type leases as of December 31, 2023 and 2022 were (in thousands): 2023 2022 Lease receivable $ 2,583 $ 45 Net investment in leases $ 2,583 $ 45 Our net investment in sales-type leases is classified as follows in the accompanying consolidated balance sheets as of December 31, 2023 and 2022 (in thousands): 2023 2022 Accounts receivable, net $ 1,067 $ 45 Other assets 1,516 — Total $ 2,583 $ 45 Future maturities of sales-type leases as of December 31, 2023 are as follows (in thousands): Sales-Type Leases 2024 $ 1,238 2025 1,217 2026 539 Total undiscounted lease payments 2,994 Less: Imputed interest (411) Total lease receivables $ 2,583 |
Share-Based Compensation
Share-Based Compensation | 12 Months Ended |
Dec. 31, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Share-Based Compensation | Share-Based Compensation Stock Incentive Plan The Company has various stock option and stock-based incentive plans and agreements whereby equity based awards are granted to certain employees, directors and others approved by the Company’s Board of Directors (the “Board”) or Compensation Committee. Grants may be made in the form of stock options, restricted stock awards ("RSUs" or "RSAs"), performance-based restricted stock units ("PSU's), unrestricted common stock in addition to other award types. Stock options are granted with an exercise price at, or above, fair market value on the date of grant, generally expire in 5 to 10 years from the grant date and generally become exercisable over a period of up to 3 years. RSUs generally become vested over a period of up to three years. PSUs generally become vested over a period of up to three years based on the performance of a specific achievement. Awards typically vest and are issued only if the participants remain employed by the Company through the vesting date. Common stock issued under these awards are issued from shares reserved under the Company’s plan described below. On May 18, 2021, the Company’s Board adopted the 2021 Equity Incentive Plan (the “2021 Plan”). The 2021 Plan was approved by the Company’s shareholders at the 2021 Annual Meeting on May 18, 2021 and became effective at that time. The 2021 plan supersedes the 2014 Amended and Restated Stock Incentive Plan (the "2014 Plan"). The 2021 Plan provided for the issuance of a maximum of 2,500,000 shares of common stock in connection with the grant of stock-based or stock-denominated awards, plus the number of shares of the Company's common stock underlying any outstanding award granted under the 2014 Plan that expires or is cancelled, forfeited, or terminated under the terms of the 2014 Plan. On May 16, 2023 at the 2023 Annual Meeting, the Company's shareholders approved the First Amendment (the "First Amendment") to the 2021 Plan. The First Amendment increased the maximum number of shares of the Company's common stock reserved for issuance under the 2021 Plan by 2,500,000 shares to 5,000,000 shares, plus the number of shares of the Company's common stock underlying any outstanding award granted under the 2014 Plan that expires or is cancelled, forfeited, or terminated under the terms of the 2014 Plan. Reductions in the available share limit associated with these grants are based on a fungible ratio of 1:1 for stock options and stock appreciation rights and 2:1 for all other types of awards. Any shares subject to an award that expires or is cancelled, forfeited, or terminated without issuance of the full number of shares of stock to which the award related again become available for issuance under the limit. As of December 31, 2023, a total of 2,374,089 common shares remained available for future grant under the 2021 Plan. This amount reflects reductions from the original limit for grants reflective of the respective fungible ratios. The available amount also reflects the maximum potential share issuance potential in the case of performance grants that provide for variable share payouts. On April 23, 2014, the Company’s Board adopted the 2014 Plan. The 2014 Plan was approved by the Company’s shareholders at the 2014 Annual Meeting and became effective as of the date it was adopted by the Board of Directors. The 2014 Plan provided for the issuance of a maximum of 2,000,000 shares of common stock in connection with the grant of stock-based or stock-denominated awards. On July 19, 2018, the Company’s stockholders approved the reservation of an additional 1,000,000 shares to be issued under the 2014 Plan. On May 15, 2019, the Company’s stockholders approved the reservation of an additional 1,000,000 shares to be issued under the 2014 Plan. The 2021 Plan replaces and supersedes the 2014 Plan, so as of the adoption date of the 2021 Plan, no common shares remained available for future grant under the 2014 Plan. Stock-Based Compensation Expense All stock option awards are amortized based on their graded vesting over the requisite service period of the awards. Compensation costs are recognized over the requisite service period using the accelerated method and included in general and administrative expenses. The following table presents the total stock-based compensation expense, which is included in selling, general and administrative expenses (in thousands): Years Ended December 31, 2023 2022 2021 Restricted share expense $ 2,584 $ 2,683 $ 4,491 Stock option expense 1,490 1,142 1,913 Total stock-based compensation expense $ 4,074 $ 3,825 $ 6,404 Tax benefit related to stock-based compensation $ 1,045 $ 857 $ 2,234 Shares Forgone to Satisfy Minimum Statutory Withholdings During the years ended December 31, 2023, 2022 and 2021, shares of common stock were issued to employees and directors as their restricted stock awards vested or stock options were exercised. Under the terms of the Company’s stock plans, at the election of each employee, the Company can authorize a net settlement of distributable shares to employees in order to satisfy an individual employees' tax withholding obligations. For the years ended December 31, 2023, 2022 and 2021, the Company received 115,979 shares, 136,718 shares and 57,067 shares, respectively, from employees for tax withholding obligations. Restricted Stock Awards Restricted stock awards entitle the holder to receive, upon meeting certain time-based vesting criteria, a specified number of shares of the Company’s common stock. Stock-based compensation cost of restricted stock awards is measured by the market value of the Company’s common stock on the date of grant. The following table summarizes the Company’s restricted share activity, excluding the Company’s employee stock purchase plan: Number of Weighted Unvested at December 31, 2022 534,080 $ 11.85 Granted 149,859 9.37 Vested (74,040) 10.81 Vested shares forgone to satisfy minimum statutory withholding (41,558) 10.81 Forfeitures (38,479) 11.17 Unvested at December 31, 2023 529,862 $ 11.42 Year Ended December 31, 2023 2022 2021 Weighted average grant date fair value of awards granted $ 9.37 $ 9.44 $ 18.85 Total fair value of shares vested $ 649,700 $ 260,112 $ 920,125 Total fair value of shares forgone to satisfy minimum statutory withholding $ 364,670 $ 172,662 $ 32,282 As of December 31, 2023, there was $2.2 million of pre-tax total unrecognized compensation cost related to non-vested restricted stock awards, which will be adjusted for future forfeitures, if any. The Company expects to recognize such cost over a weighted average period of one year. Performance-Based Restricted Stock Units During the year ended December 31, 2023, the Company granted approximately 71,639 PSUs and during the year ended December 31, 2022, the Company granted approximately 53,864 PSUs. PSUs entitle the holder to receive, upon meeting certain performance-based vesting criteria, a specified number of shares of the Company’s common stock. These awards typically vest after the Company’s achievement of either a Company-based performance metric, such as the achievement of a certain amount of net revenue during a specified period, coupled with a time-based vesting criteria or a market-based metric of the Company’s stock, such as when the trading price reaches a target value for a minimum number of consecutive trading days or based on the Company's relative total shareholder return ("TSR") compared on a percentile rank basis to the TSR for a benchmark group of other companies. Approximately two-thirds of the PSUs granted in 2023 are earned based on a market based metric, while the other one-third are earned based on a specified Company-based performance measure condition. All of the PSUs granted in 2022 are earned based on specified Company-based performance measure conditions. In the case of the market-based awards having a trading price metric, awards are paid in stock either immediately upon achievement of the performance condition or expire without any payment after the third anniversary of the grant date. In the case of the market-based awards having a TSR metric, awards can be earned at an amount of 50% of the target number of shares for achieving a minimum threshold below the target or up to 200% of the target number of shares for exceeding the target, with a linear adjustment between the threshold and target or between target and maximum performance achievement. The TSR awards also have a time-based vesting criteria. In the case of the specified Company-based performance measure, awards can be earned at an amount that varies by award between 93% to 100% of the target number of shares for achieving a minimum threshold below the target or up to 200% of the target number of shares for exceeding the target, with a linear adjustment between threshold and target or between target and stretch performance goals. The following table summarizes the Company’s PSU activity: Number of shares Weighted Unvested at December 31, 2022 125,117 $ 9.51 Granted 71,639 11.59 Forfeitures (83,980) 9.97 Unvested at December 31, 2023 112,776 $ 10.49 Year Ended December 31, 2023 2022 2021 Weighted average grant date fair value of awards granted $ 11.59 $ 8.58 $ 19.50 Total fair value of shares vested $ — $ 680,026 $ 1,335,053 Total fair value of shares forgone to satisfy minimum statutory withholding $ — $ 506,036 $ 1,078,747 As of December 31, 2023, there was $0.6 million of pre-tax total unrecognized compensation cost related to non-vested PSUs, which will be adjusted for changes to management’s expectations of the probable outcomes of the performance conditions, if any. The Company expects to recognize such cost over a weighted average period of one year. Employee Stock Purchase Plan At the 2023 Annual Meeting of Stockholders held on May 16, 2023, the Company's stockholders approved the InfuSystem Holdings, Inc. 2023 Employee Stock Purchase Plan (the "2023 ESPP"), which was previously approved by the Company's Board. In connection with the adoption of the 2023 ESPP, the Company's Board terminated the InfuSystem Holdings, Inc. Employee Stock Purchase Plan (the "Original ESPP"). Following termination of the Original ESPP, all rights the Company intends to grant under an "employee stock purchase plan" as such term is defined in section 423 of the Internal Revenue Code of 1986, as amended, will be granted under the 2023 ESPP. The 2023 ESPP provides that a maximum of 300,000 shares of Common Stock, plus any shares remaining under the Original ESPP after the close of its final offering period, are available for sale under the 2023 ESPP. The terms of the 2023 ESPP provides eligible participants electing to participate in the plan with an option to acquire shares of Common Stock during specified offering periods. The per share option exercise price at which shares of Common Stock will be sold under the 2023 ESPP will be equal to the lesser of (i) 85% of the closing price of a share of Common Stock on the NYSE American (or such other exchange on which the shares of Common Stock are traded) on the first day of an offering period or (ii) 85% of the closing price of a share of Common Stock on the purchase date. The 2023 ESPP is administered by the Board's Compensation Committee. Eligible participants under the plan include all full-time employees and certain part-time employees of the Company who meet certain eligibility requirements set forth in the 2023 ESPP. Participation in the 2023 ESPP for any eligible employee is voluntary. In May 2014, the Company received approval from stockholders to adopt the Original ESPP effective October 2014. Under the Original ESPP, 200,000 shares of common stock were authorized for purchase by eligible employees at a 15% discount through payroll deductions during the six-month offering periods. Shares were purchased in whole numbers and generally would be the last day of the offering period. In September 2016, the Company received approval from shareholders for an additional 350,000 shares. No employee may purchase more than $25,000 worth of fair market value shares in any calendar year. As allowed under the ESPP, a participant may elect to withdraw from the plan, effective for the purchase period in progress at the time of the election with all accumulated payroll deductions returned to the participant at the time of withdrawal. As of December 31, 2023, there were 323,756 shares remaining available for future issuance. The following table summarizes the activity relating to the Company’s ESPP program: Years Ended December 31, 2023 2022 2021 Compensation expense $ 179,595 $ 229,064 $ 173,561 Shares of stock sold to employees 71,623 60,673 31,624 Weighted average fair value per ESPP award $ 7.32 $ 11.53 $ 16.95 Stock Options The Company calculates the fair value of stock option awards using the Black-Scholes option pricing model, which incorporates various assumptions including volatility, expected term, risk-free interest rates and dividend yields. The expected volatility assumption is based on historical volatility of the Company’s common stock over the most recent period commensurate with the expected life of the stock option granted. The Company uses historical volatility because management believes such volatility is representative of prospective trends. The risk-free interest rate assumption is based upon observed interest rates appropriate for the expected life of the stock option awarded. The Company uses historical exercise data to determine the expected lives. Dividend yields have not been a factor in determining fair value of stock options granted as the Company has never issued cash dividends and does not anticipate issuing cash dividends in the future. The following tables detail the various stock option activity: 2014 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2022 1,174,727 $ 5.76 3.95 $ 4,463,307 Exercised (262,724) 3.58 Exercised shares forgone to satisfy minimum statutory withholding (74,421) 3.40 Shares tendered for cashless exercise (116,236) 3.62 Forfeitures and expirations (64,000) 11.72 Outstanding at December 31, 2023 657,346 $ 6.69 4.16 $ 2,983,514 Exercisable at December 31, 2023 643,509 $ 6.44 4.10 $ 2,983,514 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. 2021 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2022 544,799 $ 13.41 8.93 $ 27,396 Granted 624,628 9.25 Exercised (28,289) 8.58 Cashless exercise (21,711) 8.58 Forfeitures and expirations (67,754) 15.24 Outstanding at December 31, 2023 1,051,673 $ 11.05 8.79 $ 1,207,118 Exercisable at December 31, 2023 296,982 $ 14.46 7.84 $ 247,280 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. The following is the average fair value per share estimated on the date of grant and the assumptions used for options granted: Years Ended December 31, Stock Options: 2023 2022 2021 Expected volatility 52% to 53% 51% to 53% 43% to 46% Risk free interest rate 3.71% to 4.83% 1.71% to 3.01% 0.31% to 0.54% Expected lives at date of grant (in years) 3.99 3.73 3.62 Weighted average fair value of options granted $4.10 $3.67 $6.56 Total intrinsic value of options exercised $ 3,155,770 $ 3,762,978 $ 4,248,401 Share Repurchase Program On June 30, 2021, the Company's Board of Directors approved a stock repurchase program (the “Share Repurchase Program”) that authorizes the Company to repurchase up to $20.0 million of the Company’s outstanding common stock through June 30, 2024. The Share Repurchase Program will be subject to market conditions, the periodic capital needs of the Company’s operating activities, and the continued satisfaction of all covenants under the Company’s existing 2021 Credit Agreement, as amended. Repurchases under the Share Repurchase Program may take place in the open market or in privately negotiated transactions and may be made under a Rule 10b5-1 plan. The Share Repurchase program does not obligate the Company to repurchase shares and may be suspended, terminated, or modified at any time at the discretion of the Board. As of December 31, 2023, the Company had repurchased approximately $6.2 million, or 553,149 shares, of the Company's outstanding common stock under the Share Repurchase Program. |
Business Segment Information
Business Segment Information | 12 Months Ended |
Dec. 31, 2023 | |
Segment Reporting [Abstract] | |
Business Segment Information | Business Segment Information The Company’s reportable segments are organized based on service platforms, with the Patient Services segment reflecting higher margin rental revenues that generally include payments made by third-party and direct payers and the Device Solutions segment reflecting lower margin product sales, direct payer rental and services revenues. Resources are allocated and performance is assessed for these segments by the Company’s Chief Executive Officer, whom the Company has determined to be its CODM. The Company believes that reporting performance at the gross profit level is the best indicator of segment performance. The financial information summarized below is presented by reportable segment: 2023 (in thousands) Patient Services Device Solutions Corporate/ Total Net revenues - external $ 76,541 $ 49,244 $ — $ 125,785 Net revenues - internal — 6,581 (6,581) $ — Total net revenues 76,541 55,825 (6,581) 125,785 Gross profit 47,800 15,309 — 63,109 Selling, general and administrative expenses 59,021 Interest expense (2,170) Other expense (67) Income before income taxes $ 1,851 Total assets $ 55,412 $ 45,503 $ 2,000 $ 102,915 Purchases of medical equipment $ 5,167 $ 4,926 $ — $ 10,093 Depreciation and amortization of intangible assets $ 8,401 $ 4,107 $ — $ 12,508 2022 (in thousands) Patient Services Device Solutions Corporate/ Total Net revenues - external $ 68,881 $ 41,033 $ — $ 109,914 Net revenues - internal — 6,473 (6,473) — Total net revenues 68,881 47,506 (6,473) 109,914 Gross profit 43,433 17,127 — 60,560 Selling, general and administrative expenses 58,906 Interest expense (1,402) Other expense (122) Income before income taxes $ 130 Total assets $ 60,886 $ 36,502 $ 2,000 $ 99,388 Purchases of medical equipment $ 8,825 $ 5,269 $ — $ 14,094 Depreciation and amortization of intangible assets $ 9,266 $ 4,094 $ — $ 13,360 2021 (in thousands) Patient Services Device Solutions Corporate/ Total Net revenues - external $ 65,598 $ 36,784 $ — $ 102,382 Net revenues - internal — 5,753 (5,753) — Total net revenues 65,598 42,537 (5,753) 102,382 Gross profit 42,046 16,490 — 58,536 Selling, general and administrative expenses 55,716 Interest expense (1,377) Other expense (186) Income before income taxes $ 1,257 Total assets $ 60,970 $ 34,616 $ 2,000 $ 97,586 Purchases of medical equipment $ 10,533 $ 5,143 $ — $ 15,676 Depreciation and amortization of intangible assets $ 10,886 $ 3,739 $ — $ 14,625 |
Employee Benefit Plans and Othe
Employee Benefit Plans and Other | 12 Months Ended |
Dec. 31, 2023 | |
Retirement Benefits [Abstract] | |
Employee Benefit Plans and Other | Employee Benefit Plans and Other The Company has a defined contribution plan in which the Company makes discretionary matching contributions for a certain percentage of employee contributions. For the years ended December 31, 2023, 2022 and 2021, the Company’s matching contributions were $1.3 million, $1.2 million and $0.9 million, respectively. The Company does not provide other post-retirement or post-employment benefits to its employees. As of December 31, 2023 and 2022, accrued payroll liabilities included in Other current liabilities were $4.6 million and $3.3 million, respectively. |
Correction of Immaterial Errors
Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements | 12 Months Ended |
Dec. 31, 2023 | |
Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements [Abstract] | |
Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements | Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements S ubsequent to the issuance of the December 31, 2022 financial statements the Company identified an error in the implementation of ASC 842. The Company inappropriately applied ASC 606 to certain rental agreements that were originally considered service contracts but contained attributes consistent with rental agreements governed by ASC 842. The required disclosures to be included within the Notes to the Consolidated Financial Statements have been revised to reflect the conclusions regarding the accounting guidance that governs that Company’s rental revenues. The Company previously reported revenues from contracts with customers recognized under ASC 606 of $109.9 million and $102.4 million for the years ended December 31, 2022 and 2021, respectively. The Company corrected this error in the current period to disclose $85.5 million and $80.7 million of revenue from contracts with customers recognized under ASC 606 for the years ended December 31, 2022 and 2021, respectively, and $24.4 million and $21.7 million of rental revenues recognized under ASC 842 for the years ended December 31, 2022 and 2021, respectively. The accounting for these rental agreements under ASC 842 (as opposed to ASC 606) had no impact on amounts reported as net revenues, cost of revenues, gross profit, operating income, net income, or earnings per share in prior years, and there is no prior year impact on any caption or amount reported in any prior year Consolidated Financial Statements (Consolidated Balance Sheets, Consolidated Statements of Operations and Comprehensive Income, Consolidated Statements of Stockholders’ Equity or Consolidated Statements of Cash Flows). Additionally, the Company identified an error in the cost classifications related to pumps, pump parts, accessories, and services that were originally classified as general and administrative expenses and should have been recorded as cost of revenues. As a result, the Company has reclassified certain of these costs within its Consolidated Statements of Operations and Comprehensive Income for the years ended December 31, 2022 and 2021, respectively. This error also impacted the Company’s disclosure of business segment information for the Device Solutions segment. Gross profit of Device Solutions decreased by $2.0 million and $1.7 million for the years ended December 31, 2022 and 2021, respectively. The reclassification did not impact net revenues, operating income, net income, or earnings per share. The table below sets forth the Company’s Consolidated Statements of Operations and Comprehensive Income that were impacted by the error described above, including as previously reported, the adjustments resulting from the error, and the as revised balances for the years ended December 31, 2022 and 2021, respectively. The Company evaluated the impact of these errors on its previously issued consolidated financial statements and concluded the errors are not material. December 31, 2022 (in thousands) As previously reported Adjustment As revised Cost of revenues $ 47,343 $ 2,011 $ 49,354 Gross profit 62,571 (2,011) 60,560 General and administrative (inclusive of provision for doubtful accounts) 46,164 (2,011) 44,153 Total selling, general and administrative $ 60,917 $ (2,011) $ 58,906 December 31, 2021 (in thousands) As previously reported Adjustment As revised Cost of revenues $ 42,185 $ 1,661 $ 43,846 Gross profit 60,197 (1,661) 58,536 General and administrative (inclusive of provision for doubtful accounts) 42,338 (1,661) 40,677 Total selling, general and administrative $ 57,377 $ (1,661) $ 55,716 |
Summary of Significant Accoun_2
Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Principles of Consolidation | Principles of Consolidation The consolidated financial statements include the accounts of the Company and all wholly owned organizations. All intercompany transactions and account balances have been eliminated in consolidation. |
Segments | Segments The Company operates in two reportable segments, Patient Services and Device Solutions based on management's view of its business for purpose of evaluating performance and making operating decisions. The Company’s approach is to make operational decisions and assess performance based on delivering products and services that together provide solutions to its customer base utilizing a functional management structure. Based upon this business model, the Company’s Chief Executive Officer, whom the Company has determined to be its chief operating decision-maker ("CODM") , reviews segment financial information. See Note 1 3 for segment disclosures. |
Use of Estimates | Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates, assumptions and judgements that affect amounts reported therein. Due to the inherent uncertainty involved in making estimates, actual results reported in future periods may differ from those estimates. |
Business Combinations | Business Combinations The Company accounts for all business combinations using the acquisition method of accounting, which allocates the fair value of the purchase consideration to the tangible and intangible assets acquired and liabilities assumed based on their estimated fair values. The excess of the purchase consideration over the fair values of these identifiable assets and liabilities is recorded as goodwill. When determining the fair values of assets acquired and liabilities assumed, management makes significant estimates and assumptions. For intangible assets, the Company typically uses the income approach to determine their estimated fair values. Key estimates and assumptions in that approach include the amount and timing of projected future cash flow, the discount rate selected to measure the risks inherent in those cash flows and the assessment of the asset's useful life. Initial purchase price allocations are subject to revision within the measurement period, not to exceed one year from the date of acquisition. Acquisition-related expenses and transaction costs associated with business combinations are expensed as incurred. |
Cash and Cash Equivalents | Cash and Cash Equivalents The Company considers all highly liquid investments with original maturities of three months or less to be cash equivalents. The Company maintains substantially all of its cash and cash equivalents primarily with two financial institutions that are insured with the Federal Deposit Insurance Corporation (“FDIC”). At times throughout the year, cash and cash equivalents balances might exceed FDIC insurance limits. Accounts at banks with an aggregate excess of the amount of outstanding checks over the cash balances are included in accounts payable in current liabilities in the consolidated balance sheet. At December 31, 2023, and 2022, the Company did not have any cash equivalents. |
Revenue Recognition | Revenue Recognition The Company generates revenues from multiple sources including from the sale and rental of our products as well as service contracts. Financial Accounting Standards Board ("FASB") Accounting Standards Codification ("ASC") Topic 606 - Revenue from Contracts with Customers ("ASC 606") stipulates revenue recognition at the time and in an amount that reflects the consideration expected to be entitled for the performance obligations that have been provided. ASC 606 defines contracts as creating enforceable rights and may be established through written contracts, oral agreements and through customary business practice. Under this definition, the Company considers contracts to be created at the time that the service is authorized or an order to purchase product is agreed upon regardless of whether or not there is a written contract. The Company has three separate and distinct performance obligations offered to its customers: a rental service performance obligation, a product sale performance obligation and a service performance obligation. A performance obligation is a promise in a contract to transfer a distinct good or service to the customer and is defined as the unit of account for revenue recognition under ASC 606. The Company's customers include medical facilities or patients, depending on the arrangement, and payments are received from different sources which include commercial payers, government insurance payers, medical facilities and patients. The Company generates a significant amount of its revenues that are accounted for under ASC 606 from the rental service of infusion pumps to its customers and the remainder of its revenue from product sales and services. For the rental service performance obligation revenue is based on its standalone price, determined using reimbursement rates established by third-party payer or other contracts. Revenue is recognized over the contract term in the period in which the related performance obligation is satisfied. The Company’s revenues related to product sales are recognized at the time that control of the product has been transferred to the customer; either at the time the product is shipped or the time the product has been received by the customer, depending on the delivery terms, or when the customer uses the products in the case of when our products are stored at a customer's location. The Company does not commit to long-term contracts to sell customers a certain minimum quantity of products. The Company's revenues related to services are recognized as the service work is completed. The Company employs certain significant judgments to estimate the dollar amount of revenue, and related concessions, allocated to the rental service and product performance obligations. These judgments include, among others, the estimation of variable consideration. The Company allocates variable consideration using standalone selling price when appropriate and available. When an appropriate standalone selling price is not available, the Company allocates based on a best estimate approach using the relative fair market value. Variable factors include differences in transaction price and changes in the expected total volume of services during the contract period. In calculating the variable amount of revenue for these performance obligations, variable consideration is estimated as price concessions resulting from differences between the rates charged for services performed and the expected reimbursements for commercial payers and other customer concessions. The contract period starts at contract inception and typically extends 30 days past the end of each reporting period representing the non-cancelable period of each agreement. These estimates for variable consideration are based on historical service volumes with our customers and prices with similar payers, aged accounts receivable by payer class and payer correspondence using the portfolio approach, which provide a reasonable basis for estimating the variable portion of a transaction. The Company doesn’t believe it is probable that a significant reversal of revenue will occur in future periods because (i) there is no significant uncertainty about the amount of considerations that is expected to be collected based on collection history and (ii) the large number of sufficiently similar contracts allows the Company to adequately estimate the components of variable consideration. Net revenues are adjusted when changes in estimates of variable consideration occur. Changes in estimates typically arise as a result of new information obtained, such as changes in volume and actual payment receipt or denial, or pricing adjustments by payers. Subsequent changes to estimates of transaction prices are recorded as adjustments to net revenue in the period of the change. Subsequent changes that are determined to be the result of an adverse change in the payer’s ability to pay are recorded as an adjustment to the allowance for credit losses. |
Lease Arrangements | Lease Arrangements The Company also generates its revenues from the rental of infusion pumps to its customers as leases. Under ASC 842, Leases ("ASC 842"), leases may be classified as either financing, sales-type, or operating, and the Company is required to disclose key information about leasing arrangements. The classification determines the pattern of revenue recognition and classification within the statement of operations. The Company elected the “combining lease and non-lease components” practical expedient for all qualifying non-lease components. The Company's customers include medical facilities or patients, depending on the arrangement, and payments are received from different sources which include commercial insurance payers, government insurance payers, medical facilities and patients. The Company primarily participates in operating leases as a lessor, and determined, and will continue to determine, whether an arrangement is a lease at inception. The Company’s operating leases are primarily for medical equipment under operating lease arrangements that expire at various dates over the next twelve months. The Company’s leases do not contain any restrictive covenants. Most of the Company’s equipment leases do not contain any material residual value guarantees. For the agreements that have guarantees, the residual value reflects management's best estimate of the expected sales price for the equipment at lease termination based on sales history adjusted for recent trends in the expected exit markets. The Company’s equipment leases may contain renewal options which range from one week to one year. Lease payments receivable reflect contractual lease payments adjusted for renewal or termination options that the Company believe the customer is reasonably certain to exercise. As of December 31, 2023, the Company did not have any operating leases that contained renewal options with increasing rental amounts. Many of the Company's leases allow the customer to extend the lease at prevailing market terms. The Company's operating leased assets are not protected against casualty loss through third-party insurance. Due to the nature of the industry and the reimbursement environment in which the Company operates, certain estimates, including management's assessment of probability of collection, are required to record revenue and accounts receivable at their net realizable values, otherwise, if probability of collection is not met, the Company records revenue for such leases on a cash basis. 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 arrangements and the uncertainty of reimbursement amounts for certain services from certain payers may result in variable lease payments that require adjustments to amounts originally recorded. Such adjustments are typically identified and recorded at the point of cash application, claim denial or account review. The Company adjusts revenue for historical trends on revenue adjustments due to timely filings, deaths, and other types of analyzable adjustments on a monthly basis to record rental revenue at the expected collectible amounts. Consistent with ASC 450, Contingencies, for contracts where collection is considered probable, accounts receivable is reduced by an allowance for credit losses which provides for those accounts from which payment is not expected to be received although product was delivered and revenue was earned. The Company records an allowance for credit losses based upon an analysis of historical collections. The Company has elected to record the adjustments to accounts receivables in net revenues on the Consolidated Statements of Operations and Comprehensive Income The Company also participates in sales-type leases as a lessor, and determined, and will continue to determine, whether an arrangement is a lease at inception. In a sales-type lease, lessors are required to recognize a lease receivable, selling profit, initial indirect costs, and residual asset values for all of these types of leases, and to disclose key information about leasing arrangements. The Company’s sales-type leases are primarily for medical equipment under sales-type lease arrangements that expire at various dates over the next three years. The Company’s leases do not contain any restrictive covenants. The Company’s equipment leases do not contain any material residual value guarantees or renewal options. Lease revenue for leased assets is recognized in net revenue. The Company further recognizes any variable lease payments that are not included in the net investment in the lease as income in profit or loss in the period when the changes in facts and circumstances on which the variable lease payments are based occur. |
Accounts Receivable and Allowance for Credit Losses | Accounts Receivable and Allowance for Credit Losses, and Contingencies Amounts billed that have not yet been collected that also meet the conditions for unconditional right to payment are presented as accounts receivable. Accounts receivable related to rental service and delivery of products are reported at net |
Inventories | Inventories The Company’s inventories consist of disposable medical supplies, replacement parts and other supplies used in conjunction with medical equipment and are stated at the lower of cost (first-in, first-out basis) or net realizable value. Cost primarily represents the purchase price paid for the items on hand. The Company periodically performs an analysis of slow-moving inventory and records an adjustment to reflect the recoverable amount. |
Medical Equipment | Medical Equipment Medical Equipment (“Equipment”) consists of equipment that the Company purchases from third-parties and is (1) held for sale or rent, and (2) used in service to generate rental revenue. Equipment, once placed into service, is depreciated using the straight-line method over the estimated useful lives of the equipment which is typically seven years. The Company does not depreciate Equipment held for sale or rent. When Equipment in rental service assets are sold, or otherwise disposed, the cost and related accumulated depreciation are removed from the accounts and a gain or loss is recorded in the current period. The Company periodically performs an analysis to identify potentially missing Equipment and records a reserve equal to the underlying net book value, which was $2.1 million and $2.3 million as of December 31, 2023 and 2022, respectively. This amount approximates the accelerated depreciation the Company would recognize over the remaining useful lives of the assets determined to be missing. The Company performs a similar analysis of slow-moving Equipment for sale or rent and records a reserve, which was less than $0.1 million as of both December 31, 2023 and 2022. Presentation of Medical Equipment in the Consolidated Statements The Company purchases medical equipment directly for sale as well as medical equipment that is purchased for either rental or sale and that is unallocated at the time of purchase (“Unallocated Assets”). Management believes that the predominant source of revenues and cash flows from the Unallocated Assets is from rentals and most equipment purchased is likely to be rented prior to being sold. The Company concluded that (i) the assets specifically supporting its two primary revenue streams should be separately disclosed on the balance sheet; (ii) the purchase and sale of Unallocated Assets should be classified solely in investing cash flows based on their predominant source while medical equipment purchased specifically for sales activity should be classified in operating cash flows; and (iii) other activities ancillary to the rental process should be consistently classified. |
Property and Equipment | Property and Equipment Property and equipment is stated at acquired cost and depreciated using the straight-line method over the estimated useful lives of the related assets, ranging from three three |
Goodwill | Goodwill |
Intangible Assets | Intangible Assets Intangible assets consist of trade names, physician and customer relationships, unpatented technology, non-competition agreements and software. The Company amortizes the value assigned to the physician and customer relationships on a straight-line basis over the period of expected benefit, which ranges from fifteen three Management tests indefinite life trade names for impairment annually or more frequently if deemed necessary. Management has the option of first performing the impairment test for intangible assets with indefinite lives on a qualitative basis, by evaluating factors to determine whether it is more likely than not that an impairment exists. If it is more likely than not that an impairment exists, or if the Company chooses not to perform a qualitative assessment, then a quantitative impairment test is performed. Impairment exists when the carrying amount of the intangible asset exceeds its fair value. If the carrying value of the intangible assets exceeds the fair value, an impairment loss is recognized in an amount equal to that excess. The Company performed its annual impairment analysis by using a quantitative assessment as of October 31, 2023 and determined that the fair value of the trade names with indefinite lives was greater than their carrying value, resulting in no impairment. |
Software Capitalization and Depreciation | Software Capitalization and Depreciation three |
Impairment of Long-Lived Assets | Impairment of Long-Lived Assets |
Leases | Leases For policies related to the Company acting as a lessor, refer to the "Lease Arrangements" policy section above. With respect to the policies related to the Company as lessee, under ASC 842, lessees are required to recognize a lease liability and right-of-use asset (“ROU asset”) for all leases and to disclose key information about leasing arrangements. Additionally, leases are classified as either financing or operating; the classification determines the pattern of expense recognition and classification within the statement of operations. The Company elected to apply its lease accounting policy only to leases with a term greater than twelve months. ASC 842 provides practical expedients for an entity’s ongoing accounting. The Company elected the “combining lease and non-lease components” practical expedient. The company also elected to apply the short-term lease recognition exemption to certain leases; therefore, the Company did not recognize ROU assets and lease liabilities for these leases. In adopting ASC 842, the Company determined and will continue to determine whether an arrangement is a lease at inception. The Company’s operating leases are primarily for office space, service facility centers and equipment under operating lease arrangements that expire at various dates over the next eight years. The Company’s leases do not contain any restrictive covenants. The Company’s office leases generally contain renewal options for periods ranging from one For the Company’s equipment leases, the Company used and will use the implicit rate in the lease as the discount rate, when available. Otherwise, the Company uses its incremental borrowing rate as the discount rate. For the Company’s office leases, the implicit rate is typically not available, so the Company used and will use its incremental borrowing rate as the discount rate. The incremental borrowing rate is estimated to approximate the interest rate on a collateralized basis with similar terms and payments. Payments due under the Company’s operating leases include fixed payments as well as variable payments. For the Company’s office leases, variable payments include amounts for the Company’s proportionate share of operating expenses, utilities, property taxes, insurance, common area maintenance and other facility-related expenses. For the Company’s equipment leases, variable payments may consist of sales taxes, property taxes and other fees. |
Cost of Revenues | Cost of Revenues Cost of revenues include the costs of servicing and maintaining pumps, products and services sold, shipping, depreciation of medical equipment, and other direct and indirect costs related to net revenues, and these expenses are expensed as incurred. Shipping and handling costs incurred after control over a product has transferred to a customer are accounted for as a fulfillment cost. |
Customer Concentration | Customer Concentration As of December 31, 2023 and 2022, the Company had contracts with nearly 820 and 800 third-party payer networks, respectively. Material terms of contracts with third-party payer organizations are typically a pre-negotiated fee schedule rate or a then-current proprietary fee schedule rate for equipment and supplies provided. The majority of these contracts generally provide for a term of one year, with automatic one-year renewals, unless the Company or the contracted payer elect not to renew. The Company also contracts with various other third-party payer organizations, Medicaid, commercial Medicare replacement plans, self-insured plans, facilities of its Medicare patients and numerous other insurance carriers. No single payer or customer represented more than 10% of the Company's net revenue in 2023, 2022 or 2021. |
Income Taxes | Income Taxes The Company recognizes deferred income tax liabilities and assets based on (i) the differences between the financial statement carrying amounts and the tax basis of assets and liabilities, using enacted tax rates in effect in the years the differences are expected to reverse and (ii) the tax credit carryforwards. Deferred income tax (expense) benefit results from the change in net deferred tax assets or deferred tax liabilities. A valuation allowance is recorded when it is more likely than not that some or all of any deferred tax assets will not be realized. Provisions for federal, state and foreign taxes are calculated based on reported pre-tax earnings based on current tax law and include the cumulative effect of any changes in tax rates from those used previously in determining deferred tax assets and liabilities. Certain items of income and expense are recognized in different time periods for financial reporting than for income tax purposes; thus, such provisions differ from the amounts currently receivable or payable. The Company follows a two-step approach for recognizing uncertain tax positions. First, it evaluates the tax position for recognition by determining if the weight of available evidence indicates it is more-likely-than-not that the position will be sustained upon examination. Second, for positions that are determined are more-likely-than-not to be sustained, it recognizes the tax benefits as the largest benefit that has a greater than 50% likelihood of being sustained. The Company establishes a reserve for uncertain tax positions liability that is comprised of unrecognized tax benefits and related interest and penalties. The Company adjusts this liability in the period in which an uncertain tax position is effectively settled, the statute of limitations expires for the relevant taxing authority to examine the tax position, or more information becomes available. |
Treasury Stock | Treasury Stock |
Share-Based Payments | Share-Based Payments The Company determines the fair value of stock option awards, restricted stock awards and stock appreciation rights (collectively, “Share-Based Awards”) on the date of grant using either the grant date price of the Company's common stock or option-pricing models which are affected by the Company’s stock price, as well as assumptions regarding a number of other inputs using the Black-Scholes pricing model. These variables include the Company’s expected stock price volatility over the expected term of the Share-Based Awards, actual and projected employee stock option exercise behaviors, risk-free interest rates and expected dividends. The expected volatility is based on the historical volatility. The expected term represents the period over which the Share-Based Awards are expected to be outstanding. The dividend yield is an estimate of the expected dividend yield on the Company’s stock. The risk-free rate is based on U.S. Treasury yields in effect at the time of the grant for the expected term of the Share-Based Awards. Forfeitures are recognized as they occur. All Share-Based Awards are amortized based on their graded vesting over the requisite service period of the awards. Compensation costs are recognized over the requisite service period using the accelerated method and included in general and administrative expenses. Additionally, the Company also determines the fair value of performance-based restricted stock units (“PSUs”) based upon the type of performance measure. These awards typically vest after the Company’s achievement of either a specific Company performance metric or when the market value of the Company’s stock meets a specific metric such as when the closing price of the Company's stock reaches a target value for a minimum number of consecutive trading days. Under FASB ASC 718, the provisions of the PSUs that vest upon achievement of a target market value are considered a market condition, and therefore the effect of that market condition is reflected in the grant date fair value for this type of award. A third-party valuation expert was engaged to prepare a “Monte Carlo simulation” to account for the market condition to assist management in its conclusion of fair value. That simulation takes into account the beginning stock price of the Company’s common stock, the expected volatilities for the Company’s stock price and the expected risk-free rate of return. The single grant-date fair value computed by this valuation method is recognized by the Company in accounting for the awards regardless of the actual future outcome of the market condition. Compensation costs are accelerated if the market condition is satisfied prior to the end of the service period derived under the Monte Carlo simulation. The grant date fair value of the other PSUs is calculated as the closing price of the Company’s common stock on the grant date multiplied by the number of shares estimated to be delivered subject to the award terms. Company performance measure goals are considered a performance condition and the timing and amount of compensation cost for those PSUs corresponds with management’s expectation of the probable outcome of the performance conditions as of the grant date and during the vesting period. |
Deferred Debt Issuance Costs | Deferred Debt Issuance Costs Capitalized debt issuance costs as of December 31, 2023 and 2022 relate to the Company’s credit facility. The costs related to the agreement are netted against current and non-current debt and is recognized in Interest expense. The Company amortizes these costs using the interest method through the maturity date of the underlying debt. |
Earnings Per Share | Earnings Per Share The Company reports its earnings per share which includes the presentation of both basic and diluted earnings per share on the statements of operations. The diluted weighted average common shares include adjustments for the potential effects of outstanding stock options but only in the periods in which such effect is dilutive under the treasury stock method. Included in our basic and diluted weighted average common shares are those stock options and restricted stock awards due to participants granted from the 2014 and 2021 stock incentive plans. Anti-dilutive stock awards are comprised of stock options and unvested restricted stock awards, which would have been anti-dilutive in the application of the treasury stock method. In periods where the Company records a net loss, the diluted per share amount is the same as the basic per share amount. |
Derivatives | Derivatives The Company recognizes all derivative financial instruments as cash flow hedges which are shown as either assets or liabilities on the Company’s consolidated balance sheets at fair value. For derivative contracts which can be classified as a cash flow hedge, the effective portion of the change in fair value of the derivative is recorded to accumulated other comprehensive income (“AOCI”) in the consolidated balance sheets. The underlying hedge transaction is realized when the interest payments on debt are accrued; the applicable amount of gain or loss included in AOCI is reclassified into earnings in the consolidated statements of operations on the same line as the gain or loss on the hedged item attributable to the hedged risk. The cash flows from derivatives are classified as operating activities. The Company maintains a policy of requiring that all derivative instruments be governed by an International Swaps and Derivatives Association Master Agreement and settles on a net basis. The fair values of the Company’s derivative financial instruments are categorized as Level 2 of the fair value hierarchy as the values are derived using the market approach based on observable market inputs including quoted prices of similar instruments and interest rate forward curves. |
Fair Value of Financial Instruments | Fair Value of Financial Instruments The carrying amounts reported in the consolidated balance sheets as of December 31, 2023 and 2022 for cash, accounts receivable, accounts payable and other current liabilities approximate fair value because of the short-term nature of these instruments (Level I). The carrying value of the Company’s long-term debt with variable interest rates approximates fair value based on instruments with similar terms (Level II). The Company has adopted ASC 820, Fair Value Measurements, which defines fair value, establishes a framework for assets and liabilities being measured and reported at fair value and appends disclosures about fair value measurements. For financial assets and liabilities measured at fair value on a recurring basis, fair value is the price the Company would receive to sell an asset or pay to transfer a liability in an orderly transaction with a market participant at the measurement date. A three-level fair value hierarchy prioritizes the inputs used to measure fair value as follows: Level I : quoted prices in active markets for identical instruments; Level II : quoted prices in active markets for similar instruments, quoted prices for identical instruments in markets that are not active, or other inputs that are observable or can be corroborated by observable data for substantially the full term of the instrument; and Level III : significant inputs to the valuation model are unobservable. |
Recent Accounting Pronouncements and Developments | Recent Accounting Pronouncements and Developments In June 2016, the FASB issued Accounting Standards Update No. 2016-13, “Financial Instruments (ASC 326) Credit Losses”. ASC 326 changes the impairment model for most financial assets and certain other instruments. Under the new standard, entities holding financial assets and net investment in leases that are not accounted for at fair value through net income are to be presented at the net amount expected to be collected. An allowance for credit losses will be a valuation account that will be deducted from the amortized cost basis of the financial asset to present the net carrying value at the amount expected to be collected on the financial asset. The Company's adoption of this standard on January 1, 2023 did not have a material effect on its consolidated balance sheets, statements of operations, statements of cash flows or related disclosures. In November 2023, the FASB issued Accounting Standards Update No. 2023-07, “Segment Reporting (ASC 280): Improvements To Reportable Segment Disclosures.” ASU 2023-07 expands the disclosure requirements for reportable segments by requiring enhanced disclosures about significant segment expenses. Under the new standard, entities must disclose an amount for other segment items by reportable segment and a description of its composition. The other segment items category is the difference between segment revenue less the significant expenses disclosed and each reported measure of segment profit or loss. Additionally, entities must disclose at least one measure of assessing segment performance and the title and position of the CODM and an explanation of how the CODM uses the reported measure(s) of segment profit or loss in assessing segment performance. The amendments are effective for annual periods beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments are to be applied retrospectively to all prior periods presented in the financial statements. The Company is currently evaluating the impact of ASU 2023-07 on its consolidated financial statements and related disclosures. In December 2023, the FASB issued Accounting Standards Update No. 2023-09, “Income Taxes (ASC 740): Improvements To Income Tax Disclosures.” ASU 2023-09 which is intended to enhance the transparency, decision usefulness and effectiveness of income tax disclosures. The amendments in this ASU require a public entity to disclose a tabular tax rate reconciliation, using both percentages and currency, with specific categories. A public entity is also required to provide a qualitative description of the states and local jurisdictions that make up the majority of the effect of the state and local income tax category and the net amount of income taxes paid, disaggregated by federal, state and foreign taxes and also disaggregated by individual jurisdictions. The amendments also remove certain disclosures that are no longer considered cost beneficial. The amendments are effective prospectively for annual periods beginning after December 15, 2024, and early adoption and retrospective application are permitted. The Company is currently evaluating the impact of ASU 2023-09 on its consolidated financial statements and related disclosures. |
Summary of Significant Accoun_3
Summary of Significant Accounting Policies - Earnings Per Share (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Accounting Policies [Abstract] | |
Schedule of Earnings Per Share, Basic and Diluted | In accordance with this topic, the following table reconciles income and share amounts utilized to calculate basic and diluted net income per common share: Years Ended December 31, 2023 2022 2021 Numerator (in thousands): Net income: $ 872 $ 18 $ 1,420 Denominator: Weighted average common shares outstanding: Basic 21,024,382 20,648,818 20,519,958 Dilutive effect of common stock equivalents 621,697 898,488 1,529,701 Diluted 21,646,079 21,547,306 22,049,659 |
Revenue Recognition (Tables)
Revenue Recognition (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Revenue Recognition [Abstract] | |
Schedule of Disaggregation of Revenue | The following table presents the Company’s disaggregated revenue by offering type (in thousands): Years Ended December 31, 2023 2022 2021 Total Net Revenues % of Total Net Revenues Total Net Revenues % of Total Net Revenues Total Net Revenues % of Total Net Revenues Patient Services revenue recognized at a point in time: Direct products $ 2,294 1.8 % $ 2,236 2.0 % $ 2,480 2.4 % Third-Party Payer products 13,821 11.0 % 12,573 11.4 % 12,112 11.8 % Patient Services revenue recognized over time: Direct rental services 7,388 5.9 % 7,246 6.6 % 7,333 7.2 % Third-Party Payer rental services 44,475 35.4 % 40,948 37.3 % 38,765 37.9 % Total Patient Services accounted for under ASC 606 67,978 54.1 % 63,003 57.3 % 60,690 59.3 % Device Solutions revenue recognized at a point in time: Products 14,877 11.8 % 15,359 14.0 % 15,296 14.9 % Services 9,844 7.8 % 6,434 5.9 % 4,718 4.6 % Device Solutions revenue recognized over time: Services 6,038 4.8 % 633 0.6 % — — % Total Device Solutions accounted for under ASC 606 30,759 24.4 % 22,426 20.5 % 20,014 19.5 % Total Revenue Accounted for under ASC 606 98,737 78.5 % 85,429 77.8 % 80,704 78.8 % Patient Services Lease Revenue 8,563 6.8 % 5,878 5.3 % 4,908 4.8 % Device Solutions Lease Revenue 18,485 14.7 % 18,607 16.9 % 16,770 16.4 % Total Revenue accounted for under ASC 842, Leases 27,048 21.5 % 24,485 22.2 % 21,678 21.2 % Total Net Revenue $ 125,785 100.0 % $ 109,914 100.0 % $ 102,382 100.0 % |
Schedule of Accounts, Notes, Loans and Financing Receivable | 2023 2022 2021 Change in 2023 Change in 2022 Accounts receivable, net $ 19,830 $ 16,871 $ 15,405 $ 2,959 $ 1,466 Contract assets $ 1,271 $ 360 $ — $ 911 $ 360 |
Medical Equipment (Tables)
Medical Equipment (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Medical Equipment [Abstract] | |
Schedule of Medical Equipment | Medical equipment consisted of the following (in thousands): December 31, 2023 December 31, 2022 Medical Equipment for sale or rental $ 3,081 $ 2,802 Medical Equipment for sale or rental - pump reserve (32) (12) Medical Equipment for sale or rental - net 3,049 2,790 Medical Equipment in rental service 96,298 99,163 Medical Equipment in rental service - pump reserve (2,126) (2,270) Accumulated depreciation (59,244) (57,443) Medical Equipment in rental service - net 34,928 39,450 Total $ 37,977 $ 42,240 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Property, Plant and Equipment [Abstract] | |
Schedule of Property and Equipment | Property and equipment consisted of the following (in thousands): December 31, 2023 December 31, 2022 Gross Assets Accumulated Total Gross Assets Accumulated Total Furniture, fixtures, and equipment $ 6,611 $ (3,909) $ 2,702 $ 5,710 $ (3,252) $ 2,458 Automobiles 87 (87) — 87 (83) 4 Leasehold improvements 3,570 (1,951) 1,619 3,498 (1,575) 1,923 Total $ 10,268 $ (5,947) $ 4,321 $ 9,295 $ (4,910) $ 4,385 |
Goodwill and Intangible Assets
Goodwill and Intangible Assets (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Goodwill | The changes in the carrying value of goodwill by segment are as follows (in thousands): Device Solutions (a) Balance as of December 31, 2021 $ 3,710 Goodwill acquired — Balance as of December 31, 2022 3,710 Goodwill acquired — Balance as of December 31, 2023 $ 3,710 (a) The Patient Services segment has no recorded goodwill. |
Schedule of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets | The carrying amount and accumulated amortization of intangible assets were as follows (in thousands): December 31, 2023 December 31, 2022 Gross Assets Accumulated Amortization Net Gross Assets Accumulated Amortization Net Nonamortizable intangible assets Trade names $ 2,000 $ — $ 2,000 $ 2,000 $ — $ 2,000 Amortizable intangible assets Trade names 23 (23) — 23 (23) — Physician and customer relationships 38,834 (34,295) 4,539 38,834 (33,594) 5,240 Unpatented technology 943 (393) 550 943 (258) 685 Non-competition agreements 472 (255) 217 472 (161) 311 Software 10,300 (10,160) 140 10,300 (10,100) 200 Total nonamortizable and amortizable intangible assets $ 52,572 $ (45,126) $ 7,446 $ 52,572 $ (44,136) $ 8,436 |
Schedule of Finite-Lived Intangible Assets, Future Amortization Expense | Expected remaining annual amortization expense for the next five years for intangible assets recorded as of December 31, 2023 is as follows (in thousands): 2024 2025 2026 2027 2028 2029 and Amortization expense $ 990 $ 810 $ 525 $ 471 $ 348 $ 2,302 |
Debt (Tables)
Debt (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Debt Disclosure [Abstract] | |
Schedule of Line of Credit Facilities | The following table illustrates the net availability under the Revolving Facility as of the applicable balance sheet date (in thousands): December 31, 2023 December 31, 2022 Revolving Facility: Gross availability $ 75,000 $ 75,000 Outstanding draws (29,439) (33,384) Letters of credit (200) (400) Availability on Revolving Facility $ 45,361 $ 41,216 |
Schedule of Maturities of Long-term Debt | The Company had future maturities of its long-term debt as of December 31, 2023 as follows (in thousands): 2024 2025 2026 2027 2028 2029 and Total Revolving Facility $ — $ — $ — $ — $ 29,439 $ — $ 29,439 Total $ — $ — $ — $ — $ 29,439 $ — $ 29,439 |
Schedule of Debt | The following is a breakdown of the Company’s current and long-term debt (in thousands): December 31, 2023 December 31, 2022 Current Long-Term Total Current Long-Term Total Revolving Facility $ — $ 29,439 $ 29,439 $ — $ 33,384 $ 33,384 Unamortized value of debt issuance costs — (338) (338) — (227) (227) Total $ — $ 29,101 $ 29,101 $ — $ 33,157 $ 33,157 |
Derivative Financial Instrume_2
Derivative Financial Instruments and Hedging Activities (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Derivative Instruments and Hedging Activities Disclosure [Abstract] | |
Schedule of Derivative Instruments in Statement of Financial Position, Fair Value | The table below presents the location and gross fair value amounts of the Company's derivative financial instruments and the associated notional amounts designated as cash flow hedges (in thousands): December 31, 2023 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,442 December 31, 2022 Balance Sheet Location Notional Fair Value Derivative Assets Derivatives designated as hedges: Cash flow hedges Interest rate swaps Derivative financial instruments $ 20,000 $ 1,965 |
Schedule of Designated as Hedging Instruments in AOCI | The table below presents the effect of our derivative financial instruments designated as hedging instruments in AOCI (in thousands): Years Ended December 31, 2023 December 31, 2022 Gain on cash flow hedges - interest rate swaps Beginning balance $ 1,489 $ 268 Unrealized gain recognized in AOCI 214 1,807 Amounts reclassified to interest expense (a)(b) (737) (198) Tax benefit (provision) 122 (388) Ending balance $ 1,088 $ 1,489 (a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the consolidated statement of operations for the years ended December 31, 2023, 2022 and 2021 was $2.2 million, $1.4 million and $1.4 million, respectively. (b) As of December 31, 2023, $0.6 million of income is expected to be reclassified into earnings within the next 12 months. |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Income Tax Disclosure [Abstract] | |
Schedule of Income Before Income Tax, Domestic and Foreign | The following table summarizes the Company’s income before income taxes (in thousands): Years Ended December 31, 2023 2022 2021 U.S income $ 1,566 $ 63 $ 1,033 Non-U.S. income 285 67 224 Income before income taxes $ 1,851 $ 130 $ 1,257 |
Schedule of Components of Income Tax Expense (Benefit) | The following table summarizes the Company’s components of the consolidated (provision for) benefit from income taxes (in thousands): Years Ended December 31, 2023 2022 2021 U.S Federal income tax (expense) benefit Current $ — $ — $ — Deferred (568) 44 150 Total U.S. Federal income tax (expense) benefit (568) 44 150 State and local income tax (expense) benefit Current (245) (99) (167) Deferred (65) (65) 3 Total state and local income tax expense (310) (164) (164) Foreign income tax (expense) benefit Current (101) 8 177 Total income tax (expense) benefit $ (979) $ (112) $ 163 |
Schedule of Effective Income Tax Rate Reconciliation | The following table summarizes a reconciliation of the Company’s income tax (expense) benefit from the effective income tax rate to the U.S. federal statutory rate (in thousands): Years Ended December 31, 2023 2022 2021 Income tax expense at the statutory rate $ (389) $ (27) $ (264) State and local income tax expense (245) (130) (130) Foreign income tax (16) (4) (12) Share-Based compensation and other permanent differences (260) (58) 462 Credits (39) 79 34 Other adjustments (30) 28 73 Income tax (expense) benefit at effective income tax rate $ (979) $ (112) $ 163 |
Schedule of Deferred Tax Assets and Liabilities | The following table summarizes the temporary differences and carryforwards that give rise to deferred tax assets and liabilities (in thousands): December 31, 2023 December 31, 2022 Deferred Federal, state and local tax assets – Bad debt reserves $ 3,318 $ 2,603 Stock-based compensation 1,812 1,668 Net operating loss (a) 6,400 8,680 Operating lease liabilities 1,864 1,210 Accrued compensation 792 552 Inventories 626 639 Research & development credits 555 555 Other credits 102 141 Other 616 432 Total deferred Federal, state and local tax assets 16,085 16,480 Deferred Federal, state and local tax liabilities – Depreciation and asset basis differences (4,131) (4,505) Goodwill and intangible assets (768) (800) Right-of-use assets (1,718) (1,075) Derivative financial instruments (353) (475) Total deferred Federal, state and local tax liabilities (6,970) (6,855) Net deferred tax assets $ 9,115 $ 9,625 (a) At December 31, 2023 and 2022, this includes state and local net operating losses of $0.8 million and $1.2 million, respectively. |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Leases [Abstract] | |
Schedule of the Components of Lease Costs | The components of the Company’s operating lease costs consisted of the following (in thousands): Years Ended December 31, 2023 2022 2021 Operating lease cost $ 1,504 $ 1,333 $ 1,316 Variable lease cost 336 301 243 Total lease cost $ 1,840 $ 1,634 $ 1,559 Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands): Years Ended December 31, 2023 2022 2021 Cash paid for amounts included in the measurement of lease liabilities and right of use assets: Operating cash flow from operating leases $ 1,441 $ 1,241 $ 1,271 Right of use assets obtained in exchange for lease obligations: Operating leases $ 3,356 $ 18 $ 926 Increases to right of use assets resulting from lease modifications: Operating leases $ 552 $ 1,050 $ — Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows: 2023 2022 Years Years Weighted average remaining lease term: 6.2 6.7 Rate Rate Weighted average discount rate: 7.7% 7.1% |
Schedule of Future Maturities of Lease Liabilities | Future maturities of lease liabilities as of December 31, 2023 are as follows (in thousands): Operating Leases 2024 $ 1,796 2025 1,837 2026 1,654 2027 1,478 2028 1,429 Thereafter 2,424 Total undiscounted lease payments 10,618 Less: Imputed interest (3,345) Total lease liabilities $ 7,273 |
Schedule of Leases Revenues | The components of the Company’s lease revenues consisted of the following (in thousands): Years Ended December 31, 2023 2022 2021 Net operating lease revenue $ 23,797 $ 24,413 $ 21,678 Sales-type lease revenue 3,250 72 — Total lease revenue $ 27,047 $ 24,485 $ 21,678 |
Schedule of Net Investment in Sales-type Leases | The components of our net investment in sales-type leases as of December 31, 2023 and 2022 were (in thousands): 2023 2022 Lease receivable $ 2,583 $ 45 Net investment in leases $ 2,583 $ 45 Our net investment in sales-type leases is classified as follows in the accompanying consolidated balance sheets as of December 31, 2023 and 2022 (in thousands): 2023 2022 Accounts receivable, net $ 1,067 $ 45 Other assets 1,516 — Total $ 2,583 $ 45 |
Schedule of Future Maturities of Sales-type Leases | Future maturities of sales-type leases as of December 31, 2023 are as follows (in thousands): Sales-Type Leases 2024 $ 1,238 2025 1,217 2026 539 Total undiscounted lease payments 2,994 Less: Imputed interest (411) Total lease receivables $ 2,583 |
Share-Based Compensation (Table
Share-Based Compensation (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Share-Based Payment Arrangement [Abstract] | |
Schedule of Stock-Based Compensation Expense | The following table presents the total stock-based compensation expense, which is included in selling, general and administrative expenses (in thousands): Years Ended December 31, 2023 2022 2021 Restricted share expense $ 2,584 $ 2,683 $ 4,491 Stock option expense 1,490 1,142 1,913 Total stock-based compensation expense $ 4,074 $ 3,825 $ 6,404 Tax benefit related to stock-based compensation $ 1,045 $ 857 $ 2,234 |
Schedule of Restricted Share Activity, Excluding Company's Employee Stock Purchase Plan | The following table summarizes the Company’s restricted share activity, excluding the Company’s employee stock purchase plan: Number of Weighted Unvested at December 31, 2022 534,080 $ 11.85 Granted 149,859 9.37 Vested (74,040) 10.81 Vested shares forgone to satisfy minimum statutory withholding (41,558) 10.81 Forfeitures (38,479) 11.17 Unvested at December 31, 2023 529,862 $ 11.42 Year Ended December 31, 2023 2022 2021 Weighted average grant date fair value of awards granted $ 9.37 $ 9.44 $ 18.85 Total fair value of shares vested $ 649,700 $ 260,112 $ 920,125 Total fair value of shares forgone to satisfy minimum statutory withholding $ 364,670 $ 172,662 $ 32,282 |
Schedule of PSU Activity | The following table summarizes the Company’s PSU activity: Number of shares Weighted Unvested at December 31, 2022 125,117 $ 9.51 Granted 71,639 11.59 Forfeitures (83,980) 9.97 Unvested at December 31, 2023 112,776 $ 10.49 Year Ended December 31, 2023 2022 2021 Weighted average grant date fair value of awards granted $ 11.59 $ 8.58 $ 19.50 Total fair value of shares vested $ — $ 680,026 $ 1,335,053 Total fair value of shares forgone to satisfy minimum statutory withholding $ — $ 506,036 $ 1,078,747 |
Schedule of Share-based Compensation, Employee Stock Purchase Plan, Activity | The following table summarizes the activity relating to the Company’s ESPP program: Years Ended December 31, 2023 2022 2021 Compensation expense $ 179,595 $ 229,064 $ 173,561 Shares of stock sold to employees 71,623 60,673 31,624 Weighted average fair value per ESPP award $ 7.32 $ 11.53 $ 16.95 |
Schedule of Share-based Payment Arrangement, Option, Activity | The following tables detail the various stock option activity: 2014 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2022 1,174,727 $ 5.76 3.95 $ 4,463,307 Exercised (262,724) 3.58 Exercised shares forgone to satisfy minimum statutory withholding (74,421) 3.40 Shares tendered for cashless exercise (116,236) 3.62 Forfeitures and expirations (64,000) 11.72 Outstanding at December 31, 2023 657,346 $ 6.69 4.16 $ 2,983,514 Exercisable at December 31, 2023 643,509 $ 6.44 4.10 $ 2,983,514 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. 2021 Plan (Options) Number Weighted- Weighted- Aggregate Outstanding at December 31, 2022 544,799 $ 13.41 8.93 $ 27,396 Granted 624,628 9.25 Exercised (28,289) 8.58 Cashless exercise (21,711) 8.58 Forfeitures and expirations (67,754) 15.24 Outstanding at December 31, 2023 1,051,673 $ 11.05 8.79 $ 1,207,118 Exercisable at December 31, 2023 296,982 $ 14.46 7.84 $ 247,280 Aggregate Intrinsic Value = Excess of market value over the option exercise price of all in-the-money stock options. |
Schedule of Share-based Payment Award, Stock Options, Valuation Assumptions | The following is the average fair value per share estimated on the date of grant and the assumptions used for options granted: Years Ended December 31, Stock Options: 2023 2022 2021 Expected volatility 52% to 53% 51% to 53% 43% to 46% Risk free interest rate 3.71% to 4.83% 1.71% to 3.01% 0.31% to 0.54% Expected lives at date of grant (in years) 3.99 3.73 3.62 Weighted average fair value of options granted $4.10 $3.67 $6.56 Total intrinsic value of options exercised $ 3,155,770 $ 3,762,978 $ 4,248,401 |
Business Segment Information (T
Business Segment Information (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Segment Reporting [Abstract] | |
Schedule of Segment Reporting Information, by Segment | The financial information summarized below is presented by reportable segment: 2023 (in thousands) Patient Services Device Solutions Corporate/ Total Net revenues - external $ 76,541 $ 49,244 $ — $ 125,785 Net revenues - internal — 6,581 (6,581) $ — Total net revenues 76,541 55,825 (6,581) 125,785 Gross profit 47,800 15,309 — 63,109 Selling, general and administrative expenses 59,021 Interest expense (2,170) Other expense (67) Income before income taxes $ 1,851 Total assets $ 55,412 $ 45,503 $ 2,000 $ 102,915 Purchases of medical equipment $ 5,167 $ 4,926 $ — $ 10,093 Depreciation and amortization of intangible assets $ 8,401 $ 4,107 $ — $ 12,508 2022 (in thousands) Patient Services Device Solutions Corporate/ Total Net revenues - external $ 68,881 $ 41,033 $ — $ 109,914 Net revenues - internal — 6,473 (6,473) — Total net revenues 68,881 47,506 (6,473) 109,914 Gross profit 43,433 17,127 — 60,560 Selling, general and administrative expenses 58,906 Interest expense (1,402) Other expense (122) Income before income taxes $ 130 Total assets $ 60,886 $ 36,502 $ 2,000 $ 99,388 Purchases of medical equipment $ 8,825 $ 5,269 $ — $ 14,094 Depreciation and amortization of intangible assets $ 9,266 $ 4,094 $ — $ 13,360 2021 (in thousands) Patient Services Device Solutions Corporate/ Total Net revenues - external $ 65,598 $ 36,784 $ — $ 102,382 Net revenues - internal — 5,753 (5,753) — Total net revenues 65,598 42,537 (5,753) 102,382 Gross profit 42,046 16,490 — 58,536 Selling, general and administrative expenses 55,716 Interest expense (1,377) Other expense (186) Income before income taxes $ 1,257 Total assets $ 60,970 $ 34,616 $ 2,000 $ 97,586 Purchases of medical equipment $ 10,533 $ 5,143 $ — $ 15,676 Depreciation and amortization of intangible assets $ 10,886 $ 3,739 $ — $ 14,625 |
Correction of Immaterial Erro_2
Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements (Tables) | 12 Months Ended |
Dec. 31, 2023 | |
Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements [Abstract] | |
Schedule of Restatement of Previously Issued Consolidated Financial Statements | The table below sets forth the Company’s Consolidated Statements of Operations and Comprehensive Income that were impacted by the error described above, including as previously reported, the adjustments resulting from the error, and the as revised balances for the years ended December 31, 2022 and 2021, respectively. The Company evaluated the impact of these errors on its previously issued consolidated financial statements and concluded the errors are not material. December 31, 2022 (in thousands) As previously reported Adjustment As revised Cost of revenues $ 47,343 $ 2,011 $ 49,354 Gross profit 62,571 (2,011) 60,560 General and administrative (inclusive of provision for doubtful accounts) 46,164 (2,011) 44,153 Total selling, general and administrative $ 60,917 $ (2,011) $ 58,906 December 31, 2021 (in thousands) As previously reported Adjustment As revised Cost of revenues $ 42,185 $ 1,661 $ 43,846 Gross profit 60,197 (1,661) 58,536 General and administrative (inclusive of provision for doubtful accounts) 42,338 (1,661) 40,677 Total selling, general and administrative $ 57,377 $ (1,661) $ 55,716 |
Basis of Presentation and Nat_2
Basis of Presentation and Nature of Operations (Details) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 USD ($) location | Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | |
Product Information [Line Items] | |||
Number of locations | location | 7 | ||
Cost of revenues | $ 62,676 | $ 49,354 | $ 43,846 |
General and administrative | $ 45,377 | 44,153 | 40,677 |
Revision of Prior Period, Adjustment | |||
Product Information [Line Items] | |||
General and administrative | $ (2,011) | $ (1,661) | |
Ambulatory Pumps | Minimum | Cost of Goods and Service, Product and Service Benchmark | Supplier Concentration Risk | Smiths Medical, Inc. | |||
Product Information [Line Items] | |||
Concentration risk, percentage | 60% |
Summary of Significant Accoun_4
Summary of Significant Accounting Policies - Narrative (Details) | 1 Months Ended | 12 Months Ended | ||
Oct. 31, 2023 USD ($) | Dec. 31, 2023 USD ($) financial_institution network segment shares | Dec. 31, 2022 USD ($) network shares | Dec. 31, 2021 USD ($) shares | |
Segment Reporting Information [Line Items] | ||||
Number of reportable segments | segment | 2 | |||
Number of financial institutions | financial_institution | 2 | |||
Accounts receivable, allowance for credit loss, current | $ 600,000 | $ 1,100,000 | ||
Medical equipment in rental services, useful life | 7 years | |||
Medical equipment in rental services reserve | $ 2,126,000 | 2,270,000 | ||
Medical equipment for sale or rental, reserve | 32,000 | 12,000 | ||
Capitalized computer software | 0 | 0 | ||
Capitalized computer software, amortization | $ 100,000 | $ 100,000 | $ 1,600,000 | |
Lessee, operating lease, expiration | 8 years | |||
Operating Lease, Lease Income, Statement of Income or Comprehensive Income [Extensible Enumeration] | Revenues | |||
Sales-Type Lease, Lease Income, Statement of Income or Comprehensive Income [Extensible Enumeration] | Revenues | |||
Number of contracts with third parties | network | 820 | 800 | ||
Term of contract | 1 year | |||
Term of renewal | 1 year | |||
Treasury stock, shares, retired (in shares) | shares | 0 | 0 | 3,500,000 | |
Stock Options | ||||
Segment Reporting Information [Line Items] | ||||
Antidilutive securities excluded from computation of earnings per share, amount (in shares) | shares | 1,007,394 | 1,085,855 | 368,056 | |
Software | ||||
Segment Reporting Information [Line Items] | ||||
Impairment of long-lived assets held-for-use | $ 0 | $ 0 | $ 0 | $ 0 |
Unpatented Technology | ||||
Segment Reporting Information [Line Items] | ||||
Finite-lived intangible asset, useful life | 7 years | |||
Non-competition agreements | ||||
Segment Reporting Information [Line Items] | ||||
Finite-lived intangible asset, useful life | 5 years | |||
Information Technology Software | ||||
Segment Reporting Information [Line Items] | ||||
Property, plant and equipment, useful life | 3 years | |||
Computer Equipment | ||||
Segment Reporting Information [Line Items] | ||||
Property, plant and equipment, useful life | 5 years | |||
Minimum | ||||
Segment Reporting Information [Line Items] | ||||
Property, plant and equipment, useful life | 3 years | |||
Lessee, operating lease, renewal term | 1 year | |||
Minimum | Physician and customer relationships | ||||
Segment Reporting Information [Line Items] | ||||
Finite-lived intangible asset, useful life | 15 years | |||
Minimum | Software | ||||
Segment Reporting Information [Line Items] | ||||
Finite-lived intangible asset, useful life | 3 years | |||
Maximum | ||||
Segment Reporting Information [Line Items] | ||||
Medical equipment for sale or rental, reserve | $ 100,000 | $ 100,000 | ||
Property, plant and equipment, useful life | 7 years | |||
Lessee, operating lease, renewal term | 5 years | |||
Maximum | Physician and customer relationships | ||||
Segment Reporting Information [Line Items] | ||||
Finite-lived intangible asset, useful life | 20 years | |||
Maximum | Software | ||||
Segment Reporting Information [Line Items] | ||||
Finite-lived intangible asset, useful life | 5 years |
Summary of Significant Accoun_5
Summary of Significant Accounting Policies - Summary of Income and Share Amounts Utilized to Calculate Basic and Diluted Net Income Per Common Share (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Accounting Policies [Abstract] | |||
Net income | $ 872 | $ 18 | $ 1,420 |
Weighted average common shares outstanding: | |||
Basic (in shares) | 21,024,382 | 20,648,818 | 20,519,958 |
Dilutive effect of common stock equivalents (in shares) | 621,697 | 898,488 | 1,529,701 |
Diluted (in shares) | 21,646,079 | 21,547,306 | 22,049,659 |
Revenue Recognition - Disaggreg
Revenue Recognition - Disaggregated Revenue by Revenue Stream (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Disaggregation of Revenue [Line Items] | |||
Lease revenue | $ 27,047 | $ 24,485 | $ 21,678 |
Total net revenues | 125,785 | 109,914 | 102,382 |
Patient Services and Device Solutions | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 98,737 | 85,429 | 80,704 |
Lease revenue | 27,048 | 24,485 | 21,678 |
Patient Services | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 67,978 | 63,003 | 60,690 |
Lease revenue | 8,563 | 5,878 | 4,908 |
Device Solutions | |||
Disaggregation of Revenue [Line Items] | |||
Lease revenue | 18,485 | 18,607 | 16,770 |
Device Solutions | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 30,759 | 22,426 | 20,014 |
Third-Party Payer Rentals | Patient Services | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 13,821 | 12,573 | 12,112 |
Third-Party Payer Rentals | Patient Services | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 44,475 | 40,948 | 38,765 |
Direct Payer Rentals | Patient Services | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 7,388 | 7,246 | 7,333 |
Products | Patient Services | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 2,294 | 2,236 | 2,480 |
Products | Device Solutions | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 14,877 | 15,359 | 15,296 |
Service | Device Solutions | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 9,844 | 6,434 | 4,718 |
Service | Device Solutions | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | $ 6,038 | $ 633 | $ 0 |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Patient Services and Device Solutions | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 78.50% | 77.80% | 78.80% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Patient Services | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 54.10% | 57.30% | 59.30% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Device Solutions | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 24.40% | 20.50% | 19.50% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Third-Party Payer Rentals | Patient Services | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 11% | 11.40% | 11.80% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Third-Party Payer Rentals | Patient Services | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 35.40% | 37.30% | 37.90% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Direct Payer Rentals | Patient Services | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 5.90% | 6.60% | 7.20% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Products | Patient Services | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 1.80% | 2% | 2.40% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Products | Device Solutions | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 11.80% | 14% | 14.90% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Service | Device Solutions | Transferred at Point in Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 7.80% | 5.90% | 4.60% |
Revenue from Contract with Customer Benchmark | Customer Concentration Risk | Service | Device Solutions | Transferred over Time | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 4.80% | 0.60% | 0% |
Revenue Benchmark | Customer Concentration Risk | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 100% | 100% | 100% |
Revenue Benchmark | Customer Concentration Risk | Patient Services and Device Solutions | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 21.50% | 22.20% | 21.20% |
Revenue Benchmark | Customer Concentration Risk | Patient Services | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 6.80% | 5.30% | 4.80% |
Revenue Benchmark | Customer Concentration Risk | Device Solutions | |||
Disaggregation of Revenue [Line Items] | |||
Concentration risk, percentage | 14.70% | 16.90% | 16.40% |
Revenue Recognition - Contract
Revenue Recognition - Contract Balances (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 |
Disaggregation of Revenue [Line Items] | |||
Accounts receivable, net | $ 19,830 | $ 16,871 | $ 15,405 |
Contract assets | 1,271 | 360 | $ 0 |
Revision of Prior Period, Adjustment | |||
Disaggregation of Revenue [Line Items] | |||
Accounts receivable, net | 2,959 | 1,466 | |
Contract assets | $ 911 | $ 360 |
Revenue Recognition - Narrative
Revenue Recognition - Narrative (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Disaggregation of Revenue [Line Items] | |||
Contract assets | $ 1,271 | $ 360 | $ 0 |
Revision of Prior Period, Adjustment | |||
Disaggregation of Revenue [Line Items] | |||
Contract assets | 911 | $ 360 | |
Other Current Assets | |||
Disaggregation of Revenue [Line Items] | |||
Contract assets partially offset amount | 8,300 | ||
Other Current Assets | Revision of Prior Period, Adjustment | |||
Disaggregation of Revenue [Line Items] | |||
Contract assets | $ 9,200 |
Medical Equipment - Summary of
Medical Equipment - Summary of Medical Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Medical Equipment [Abstract] | ||
Medical Equipment for sale or rental | $ 3,081 | $ 2,802 |
Medical Equipment for sale or rental - pump reserve | (32) | (12) |
Medical Equipment for sale or rental - net | 3,049 | 2,790 |
Medical Equipment in rental service | 96,298 | 99,163 |
Medical Equipment in rental service - pump reserve | (2,126) | (2,270) |
Accumulated depreciation | (59,244) | (57,443) |
Medical Equipment in rental service - net | 34,928 | 39,450 |
Total | $ 37,977 | $ 42,240 |
Medical Equipment - Narrative (
Medical Equipment - Narrative (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Medical Equipment [Abstract] | |||
Depreciation expense related to medical equipment | $ 10.4 | $ 9.8 | $ 9.4 |
Property and Equipment - Schedu
Property and Equipment - Schedule of Property and Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Property, Plant and Equipment [Line Items] | ||
Gross Assets | $ 10,268 | $ 9,295 |
Accumulated Depreciation | (5,947) | (4,910) |
Total | 4,321 | 4,385 |
Furniture, fixtures, and equipment | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 6,611 | 5,710 |
Accumulated Depreciation | (3,909) | (3,252) |
Total | 2,702 | 2,458 |
Automobiles | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 87 | 87 |
Accumulated Depreciation | (87) | (83) |
Total | 0 | 4 |
Leasehold improvements | ||
Property, Plant and Equipment [Line Items] | ||
Gross Assets | 3,570 | 3,498 |
Accumulated Depreciation | (1,951) | (1,575) |
Total | $ 1,619 | $ 1,923 |
Property and Equipment - Narrat
Property and Equipment - Narrative (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Property, Plant and Equipment [Abstract] | |||
Depreciation, nonproduction | $ 1.1 | $ 1.1 | $ 0.9 |
Goodwill and Intangible Asset_2
Goodwill and Intangible Assets - Goodwill (Details) - USD ($) | 12 Months Ended | |
Dec. 31, 2023 | Dec. 31, 2022 | |
Goodwill [Roll Forward] | ||
Goodwill, beginning balance | $ 3,710,000 | |
Goodwill, ending balance | 3,710,000 | $ 3,710,000 |
Device Solutions | ||
Goodwill [Roll Forward] | ||
Goodwill, beginning balance | 3,710,000 | 3,710,000 |
Goodwill acquired | 0 | 0 |
Goodwill, ending balance | 3,710,000 | $ 3,710,000 |
Patient Services | ||
Goodwill [Roll Forward] | ||
Goodwill, ending balance | $ 0 |
Goodwill and Intangible Asset_3
Goodwill and Intangible Assets - Summary of Carrying Amount and Accumulated Amortization of Identifiable Intangible Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Finite-Lived Intangible Assets [Line Items] | ||
Trade names | $ 2,000 | $ 2,000 |
Accumulated Amortization | (45,126) | (44,136) |
Total nonamortizable and amortizable intangible assets, gross | 52,572 | 52,572 |
Total nonamortizable and amortizable intangible assets, net | 7,446 | 8,436 |
Trade names | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Assets | 23 | 23 |
Accumulated Amortization | (23) | (23) |
Net | 0 | 0 |
Physician and customer relationships | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Assets | 38,834 | 38,834 |
Accumulated Amortization | (34,295) | (33,594) |
Net | 4,539 | 5,240 |
Unpatented technology | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Assets | 943 | 943 |
Accumulated Amortization | (393) | (258) |
Net | 550 | 685 |
Non-competition agreements | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Assets | 472 | 472 |
Accumulated Amortization | (255) | (161) |
Net | 217 | 311 |
Software | ||
Finite-Lived Intangible Assets [Line Items] | ||
Gross Assets | 10,300 | 10,300 |
Accumulated Amortization | (10,160) | (10,100) |
Net | $ 140 | $ 200 |
Goodwill & Intangible Assets -
Goodwill & Intangible Assets - Narrative (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |||
Amortization of intangibles | $ 990 | $ 2,494 | $ 4,262 |
Goodwill and Intangible Asset_4
Goodwill and Intangible Assets - Expected Annual Amortization Expense for Intangible Assets (Details) $ in Thousands | Dec. 31, 2023 USD ($) |
Goodwill and Intangible Assets Disclosure [Abstract] | |
2024 | $ 990 |
2025 | 810 |
2026 | 525 |
2027 | 471 |
2028 | 348 |
2028 and thereafter | $ 2,302 |
Debt - Narrative (Details)
Debt - Narrative (Details) | 12 Months Ended | |||
Feb. 05, 2021 USD ($) | Dec. 31, 2023 | Apr. 26, 2023 USD ($) | Apr. 25, 2023 USD ($) | |
The 2021 Credit Agreement | ||||
Debt Instrument [Line Items] | ||||
Percentage of total depreciation expense | 50% | |||
Debt instrument, covenant, minimum fixed coverage ratio | 1.20 | |||
Debt instrument, covenant, maximum leverage ratio | 3.50 | |||
The 2021 Credit Agreement | Eurodollar Loan | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, interest rate, effective percentage | 7.71% | |||
SOFR Rate | 5.46% | |||
The 2021 Credit Agreement | ABR Loans | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, interest rate, effective percentage | 9.75% | |||
Lender prime rate | 1.25% | |||
The 2021 Credit Agreement | Secured Overnight Financing Rate (SOFR) | Eurodollar Loan | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 2.25% | |||
The 2021 Credit Agreement | Base Rate | ABR Loans | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 8.50% | |||
The 2021 Credit Agreement | Minimum | Secured Overnight Financing Rate (SOFR) | Eurodollar Loan | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 2% | |||
The 2021 Credit Agreement | Minimum | Base Rate | ABR Loans | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 1% | |||
The 2021 Credit Agreement | Maximum | Secured Overnight Financing Rate (SOFR) | Eurodollar Loan | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 3% | |||
The 2021 Credit Agreement | Maximum | Base Rate | ABR Loans | ||||
Debt Instrument [Line Items] | ||||
Basis spread on variable rate | 2% | |||
The 2021 Credit Agreement | Revolving Facility | ||||
Debt Instrument [Line Items] | ||||
Line of credit facility, maximum borrowing capacity | $ 75,000,000 | |||
Revolving credit facility | 25,000,000 | $ 35,000,000 | $ 25,000,000 | |
Borrowings under revolving credit facility | 30,000,000 | |||
The 2021 Credit Agreement | Letter of Credit | ||||
Debt Instrument [Line Items] | ||||
Line of credit facility, maximum borrowing capacity | 7,000,000 | |||
The 2015 Credit Agreement | Revolving Facility | ||||
Debt Instrument [Line Items] | ||||
Repayments | $ 8,200,000 |
Debt - Summary of Revolver Base
Debt - Summary of Revolver Based Upon Borrowers' Eligible Accounts Receivable and Inventory (Details) - Revolving Facility - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Gross availability | $ 75,000 | $ 75,000 |
Outstanding draws | (29,439) | (33,384) |
Letters of credit | (200) | (400) |
Availability on Revolving Facility | $ 45,361 | $ 41,216 |
Debt - Summary of Future Maturi
Debt - Summary of Future Maturities of Loans (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
2024 | $ 0 | |
2025 | 0 | |
2026 | 0 | |
2027 | 0 | |
2028 | 29,439 | |
2028 thereafter | 0 | |
Total | 29,439 | |
Revolving Facility | ||
Debt Instrument [Line Items] | ||
2024 | 0 | |
2025 | 0 | |
2026 | 0 | |
2027 | 0 | |
2028 | 29,439 | |
2028 thereafter | 0 | |
Total | $ 29,439 | $ 33,384 |
Debt - Summary of Company's Cur
Debt - Summary of Company's Current and Long-term Debt (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Debt Instrument [Line Items] | ||
Total | $ 29,439 | |
Unamortized value of debt issuance costs | 0 | $ 0 |
Unamortized value of the debt issuance costs, long-term debt | (338) | (227) |
Unamortized value of the debt issuance costs, total | (338) | (227) |
Current portion of long-term debt | 0 | 0 |
Long-term debt | 29,101 | 33,157 |
Total | 29,101 | 33,157 |
Revolving Facility | ||
Debt Instrument [Line Items] | ||
Current Portion | 0 | 0 |
Long-Term Portion | 29,439 | 33,384 |
Total | $ 29,439 | $ 33,384 |
Derivative Financial Instrume_3
Derivative Financial Instruments and Hedging Activities - Narrative (Details) - Interest Rate Swap - Designated as Hedging Instrument - Cash Flow Hedging | 12 Months Ended | ||||
May 11, 2023 agreement | Feb. 05, 2021 agreement | Dec. 31, 2023 USD ($) | Dec. 31, 2022 USD ($) | Dec. 31, 2021 USD ($) | |
Derivative [Line Items] | |||||
Interest rate swap | agreement | 2 | 2 | |||
Term of contract | 5 years | 5 years | |||
Fixed interest rate | 1.74% | 0.73% | |||
Net hedge effectiveness | $ | $ 0 | $ 0 | $ 0 |
Derivative Financial Instrume_4
Derivative Financial Instruments and Hedging Activities - Fair Value and Notional Amounts of Cash Flow Hedges (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Derivative [Line Items] | ||
Fair value derivative assets | $ 1,442 | $ 1,965 |
Cash Flow Hedging | Interest Rate Swap | Designated as Hedging Instrument | ||
Derivative [Line Items] | ||
Notional | 20,000 | 20,000 |
Fair value derivative assets | $ 1,442 | $ 1,965 |
Derivative Financial Instrume_5
Derivative Financial Instruments and Hedging Activities - Designated as Hedging Instruments in AOCI (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||
Beginning balance | $ 48,003 | $ 48,272 | $ 40,752 |
Ending balance | 52,302 | 48,003 | 48,272 |
Interest expense | 2,170 | 1,402 | 1,377 |
Interest Rate Swap | Cash Flow Hedging | Designated as Hedging Instrument | |||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||
Cash flow hedge gain (loss) to be reclassified within 12 months | 600 | ||
Gain/(Loss) on Cash Flow Hedges | |||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||
Beginning balance | 1,489 | 268 | |
Unrealized gain recognized in AOCI | 214 | 1,807 | |
Amounts reclassified to interest expense | (737) | (198) | |
Tax benefit (provision) | 122 | (388) | |
Ending balance | $ 1,088 | $ 1,489 | $ 268 |
Income Taxes - Income Before In
Income Taxes - Income Before Income Taxes (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |||
U.S income | $ 1,566 | $ 63 | $ 1,033 |
Non-U.S. income | 285 | 67 | 224 |
Income before income taxes | $ 1,851 | $ 130 | $ 1,257 |
Income Taxes - Components (Deta
Income Taxes - Components (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
U.S Federal income tax (expense) benefit | |||
Current | $ 0 | $ 0 | $ 0 |
Deferred | (568) | 44 | 150 |
Total U.S. Federal income tax (expense) benefit | (568) | 44 | 150 |
State and local income tax (expense) benefit | |||
Current | (245) | (99) | (167) |
Deferred | (65) | (65) | 3 |
Total state and local income tax expense | (310) | (164) | (164) |
Foreign income tax (expense) benefit | |||
Current | (101) | 8 | 177 |
Provision for income taxes | $ (979) | $ (112) | $ 163 |
Income Taxes - Effective Tax Ra
Income Taxes - Effective Tax Rate (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Income Tax Disclosure [Abstract] | |||
Income tax expense at the statutory rate | $ (389) | $ (27) | $ (264) |
State and local income tax expense | (245) | (130) | (130) |
Foreign income tax | (16) | (4) | (12) |
Share-Based compensation and other permanent differences | (260) | (58) | 462 |
Credits | (39) | 79 | 34 |
Other adjustments | (30) | 28 | 73 |
Provision for income taxes | $ (979) | $ (112) | $ 163 |
Income Taxes - Carry Forwards (
Income Taxes - Carry Forwards (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Operating Loss Carryforwards [Line Items] | ||
Bad debt reserves | $ 3,318 | $ 2,603 |
Stock-based compensation | 1,812 | 1,668 |
Net operating loss | 6,400 | 8,680 |
Operating lease liabilities | 1,864 | 1,210 |
Accrued compensation | 792 | 552 |
Inventories | 626 | 639 |
Research & development credits | 555 | 555 |
Other credits | 102 | 141 |
Other | 616 | 432 |
Total deferred Federal, state and local tax assets | 16,085 | 16,480 |
Depreciation and asset basis differences | (4,131) | (4,505) |
Goodwill and intangible assets | (768) | (800) |
Right-of-use assets | (1,718) | (1,075) |
Derivative financial instruments | (353) | (475) |
Total deferred Federal, state and local tax liabilities | (6,970) | (6,855) |
Net deferred tax assets | 9,115 | 9,625 |
State and Local Jurisdiction | ||
Operating Loss Carryforwards [Line Items] | ||
Operating loss carryforwards, total | $ 800 | $ 1,200 |
Income Taxes - Narrative (Detai
Income Taxes - Narrative (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2020 | |
Income Tax Contingency [Line Items] | ||||
Net operating loss | $ 6,400 | $ 8,680 | ||
Unrecognized tax benefits, ending balance | 0 | 0 | ||
Domestic Tax Authority | ||||
Income Tax Contingency [Line Items] | ||||
Operating loss carryforwards, total | 26,600 | |||
Net operating loss | 5,600 | |||
Operating loss carryforwards with a definite life | 20,000 | |||
Operating loss carryforwards with indefinite life | 6,600 | |||
State and Local Jurisdiction | ||||
Income Tax Contingency [Line Items] | ||||
Operating loss carryforwards, total | 800 | 1,200 | ||
Operating loss carryforwards with a definite life | $ 100 | |||
Other Liabilities | ||||
Income Tax Contingency [Line Items] | ||||
Accrued payroll taxes | $ 700 | $ 700 | $ 700 | |
Minimum | State and Local Jurisdiction | ||||
Income Tax Contingency [Line Items] | ||||
Operating loss carryforwards expiration periods | 5 years | |||
Maximum | State and Local Jurisdiction | ||||
Income Tax Contingency [Line Items] | ||||
Operating loss carryforwards expiration periods | 20 years |
Leases - Lease Cost (Details)
Leases - Lease Cost (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Leases [Abstract] | |||
Operating lease cost | $ 1,504 | $ 1,333 | $ 1,316 |
Variable lease cost | 336 | 301 | 243 |
Total lease cost | $ 1,840 | $ 1,634 | $ 1,559 |
Leases - Narrative (Details)
Leases - Narrative (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Lessee, Lease, Description [Line Items] | |||
Lease, cost, total | $ 1,840 | $ 1,634 | $ 1,559 |
Operating lease liabilities, net of current portion | 5,799 | 3,761 | |
General and Administrative Expense | |||
Lessee, Lease, Description [Line Items] | |||
Lease, cost, total | $ 1,800 | $ 1,600 | 1,500 |
Cost of Sales | |||
Lessee, Lease, Description [Line Items] | |||
Lease, cost, total | $ 100 |
Leases - Supplemental Cash Flow
Leases - Supplemental Cash Flow (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Leases [Abstract] | |||
Operating cash flow from operating leases | $ 1,441 | $ 1,241 | $ 1,271 |
Operating leases | 3,356 | 18 | 926 |
Operating leases | $ 552 | $ 1,050 | $ 0 |
Leases - Weighted Average Table
Leases - Weighted Average Table (Details) | Dec. 31, 2023 | Dec. 31, 2022 |
Leases [Abstract] | ||
Weighted average remaining lease term: | 6 years 2 months 12 days | 6 years 8 months 12 days |
Weighted average discount rate: | 7.70% | 7.10% |
Leases - Maturities of Lease Li
Leases - Maturities of Lease Liabilities (Details) $ in Thousands | Dec. 31, 2023 USD ($) |
Leases [Abstract] | |
2024 | $ 1,796 |
2025 | 1,837 |
2026 | 1,654 |
2027 | 1,478 |
2028 | 1,429 |
Thereafter | 2,424 |
Total undiscounted lease payments | 10,618 |
Less: Imputed interest | (3,345) |
Total lease liabilities | $ 7,273 |
Leases - Lease Revenue (Details
Leases - Lease Revenue (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Leases [Abstract] | |||
Net operating lease revenue | $ 23,797 | $ 24,413 | $ 21,678 |
Sales-type lease revenue | 3,250 | 72 | 0 |
Total lease revenue | $ 27,047 | $ 24,485 | $ 21,678 |
Leases - Net Investment in Sale
Leases - Net Investment in Sales-Type Leases (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 |
Leases [Abstract] | ||
Lease receivable | $ 2,583 | $ 45 |
Net investment in leases | $ 2,583 | $ 45 |
Leases - Net Investment in Sa_2
Leases - Net Investment in Sales-Type Leases in Balance Sheet (Details) - USD ($) $ in Thousands | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 |
Sales-Type Lease, Net Investment In Lease [Line Items] | |||
Total assets | $ 102,915 | $ 99,388 | $ 97,586 |
Sales-Type Lease, Net Investment | |||
Sales-Type Lease, Net Investment In Lease [Line Items] | |||
Accounts receivable, net | 1,067 | 45 | |
Other assets | 1,516 | 0 | |
Total assets | $ 2,583 | $ 45 |
Leases - Maturities of Sale-Typ
Leases - Maturities of Sale-Type Leases (Details) $ in Thousands | Dec. 31, 2023 USD ($) |
Leases [Abstract] | |
2024 | $ 1,238 |
2025 | 1,217 |
2026 | 539 |
Total undiscounted lease payments | 2,994 |
Less: Imputed interest | (411) |
Total lease receivables | $ 2,583 |
Share-Based Compensation - Narr
Share-Based Compensation - Narrative (Details) | 1 Months Ended | 12 Months Ended | 30 Months Ended | |||||||||
May 16, 2023 shares | May 15, 2019 shares | Jul. 19, 2018 shares | Sep. 30, 2016 shares | May 31, 2014 USD ($) shares | Dec. 31, 2023 USD ($) shares | Dec. 31, 2022 USD ($) shares | Dec. 31, 2021 USD ($) shares | Dec. 31, 2023 USD ($) shares | Jun. 30, 2021 USD ($) | May 18, 2021 shares | Apr. 23, 2014 shares | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Options, reduction ratio | 1 | |||||||||||
Other types of awards, reduction ratio | 2 | |||||||||||
Number of additional shares authorized (in shares) | 350,000 | |||||||||||
Shares withheld for tax withholding obligation (in shares) | 115,979 | 136,718 | 57,067 | |||||||||
Cost not yet recognized, period for recognition | 1 year | |||||||||||
Employee stock ownership plan (ESOP) (in shares) | 200,000 | 300,000 | ||||||||||
Employee stock purchase plan discount rate | 15% | |||||||||||
Offering period | 6 months | |||||||||||
ESOP purchase per employee maximum | $ | $ 25,000 | |||||||||||
Stock issued during period shares employee stock ownership plan number of remaining shares available for future issuance (in shares) | 323,756 | 323,756 | ||||||||||
Stock repurchase program, authorized amount | $ | $ 20,000,000 | |||||||||||
Stock repurchased during period | $ | $ 153,000 | $ 5,459,000 | $ 560,000 | $ 6,200,000 | ||||||||
Stock repurchased during period (in shares) | 553,149 | |||||||||||
2021 Equity Incentive Plan | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based payment award, shares allowed for issuance (in shares) | 2,500,000 | |||||||||||
Number of shares available for grant (in shares) | 2,374,089 | 2,374,089 | ||||||||||
2021 Equity Incentive Plan | Minimum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based payment award, increase in shares allowed for issuance (in shares) | 2,500,000 | |||||||||||
2021 Equity Incentive Plan | Maximum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based payment award, shares allowed for issuance (in shares) | 5,000,000 | |||||||||||
2014 Equity Incentive Plan | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Number of shares available for grant (in shares) | 2,000,000 | |||||||||||
Number of additional shares authorized (in shares) | 1,000,000 | 1,000,000 | ||||||||||
Stock Options | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Exercisable period | 3 years | |||||||||||
Stock Options | Minimum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based payment award, expiration period | 5 years | |||||||||||
Stock Options | Maximum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based payment award, expiration period | 10 years | |||||||||||
Restricted Stock | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Nonvested award, excluding option, cost not yet recognized, amount | $ | $ 2,200,000 | $ 2,200,000 | ||||||||||
Share-based compensation arrangement, equity instruments other than options, grants in period (in shares) | 149,859 | |||||||||||
Restricted Stock | Maximum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Award vesting period | 3 years | |||||||||||
Performance Shares | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Nonvested award, excluding option, cost not yet recognized, amount | $ | $ 600,000 | $ 600,000 | ||||||||||
Cost not yet recognized, period for recognition | 1 year | |||||||||||
Share-based compensation arrangement, equity instruments other than options, grants in period (in shares) | 71,639 | 53,864 | ||||||||||
Performance Shares | Maximum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Award vesting period | 3 years | |||||||||||
Performance Shares | Share-based Payment Arrangement, Exceeding Minimum Threshold | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based compensation arrangement by share-based payment award percentage of target number of shares to be earned | 200% | |||||||||||
Performance Shares | Share-based Payment Arrangement, Achieving Minimum Threshold | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based compensation arrangement by share-based payment award percentage of target number of shares to be earned | 50% | |||||||||||
Performance Shares | Share-based Payment Arrangement, Achieving Minimum Threshold | Minimum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based compensation arrangement by share-based payment award percentage of target number of shares to be earned | 93% | |||||||||||
Performance Shares | Share-based Payment Arrangement, Achieving Minimum Threshold | Maximum | ||||||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | ||||||||||||
Share-based compensation arrangement by share-based payment award percentage of target number of shares to be earned | 100% |
Share-Based Compensation - Stoc
Share-Based Compensation - Stock-based Compensation (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Share-Based Payment Arrangement [Abstract] | |||
Restricted share expense | $ 2,584 | $ 2,683 | $ 4,491 |
Stock option expense | 1,490 | 1,142 | 1,913 |
Total stock-based compensation expense | 4,074 | 3,825 | 6,404 |
Tax benefit related to stock-based compensation | $ 1,045 | $ 857 | $ 2,234 |
Share-Based Compensation - Summ
Share-Based Compensation - Summary of Restricted Share Activity, Excluding Company's Employee Stock Purchase Plan (Details) - Restricted Stock - USD ($) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Number of shares | |||
Unvested, number of shares (in shares) | 534,080 | ||
Share-based compensation arrangement, equity instruments other than options, grants in period (in shares) | 149,859 | ||
Vested, number of shares (in shares) | (74,040) | ||
Vested shares forgone to satisfy minimum statutory withholding, number of shares (in shares) | (41,558) | ||
Forfeitures, number of shares (in shares) | (38,479) | ||
Unvested, number of shares (in shares) | 529,862 | 534,080 | |
Weighted average grant date fair value | |||
Unvested, weighted average grant date fair value (usd per share) | $ 11.85 | ||
Granted, weighted average grant date fair value (usd per share) | 9.37 | $ 9.44 | $ 18.85 |
Vested, weighted average grant date fair value (usd per share) | 10.81 | ||
Vested shares forgone to satisfy minimum statutory withholding, weighted average grant date fair value (usd per share) | 10.81 | ||
Forfeitures, weighted average grant date fair value (usd per share) | 11.17 | ||
Unvested, weighted average grant date fair value (usd per share) | $ 11.42 | $ 11.85 | |
Total fair value of shares vested | $ 649,700 | $ 260,112 | $ 920,125 |
Total fair value of shares forgone to satisfy minimum statutory withholding | $ 364,670 | $ 172,662 | $ 32,282 |
Share-Based Compensation - PSU
Share-Based Compensation - PSU Activity (Details) - Performance Shares - USD ($) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Number of shares | |||
Unvested, number of shares (in shares) | 125,117 | ||
Granted (in shares) | 71,639 | 53,864 | |
Forfeitures, number of shares (in shares) | (83,980) | ||
Unvested, number of shares (in shares) | 112,776 | 125,117 | |
Weighted average grant date fair value | |||
Unvested, weighted average grant date fair value (usd per share) | $ 9.51 | ||
Granted, weighted average grant date fair value (usd per share) | 11.59 | $ 8.58 | $ 19.50 |
Forfeitures, weighted average grant date fair value (usd per share) | 9.97 | ||
Unvested, weighted average grant date fair value (usd per share) | $ 10.49 | $ 9.51 | |
Total fair value of shares vested | $ 0 | $ 680,026 | $ 1,335,053 |
Total fair value of shares forgone to satisfy minimum statutory withholding | 0 | 506,036 | 1,078,747 |
Share-Based Compensation - Su_2
Share-Based Compensation - Summary of Activity Relating to Company's ESPP Program (Details) - USD ($) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Share-Based Payment Arrangement [Abstract] | |||
Compensation expense | $ 179,595 | $ 229,064 | $ 173,561 |
Shares of stock sold to employees (in shares) | 71,623 | 60,673 | 31,624 |
Weighted average fair value per ESPP award (usd per share) | $ 7.32 | $ 11.53 | $ 16.95 |
Share-Based Compensation - 2014
Share-Based Compensation - 2014 and 2021 Plan Activity (Details) - USD ($) | 12 Months Ended | |
Dec. 31, 2023 | Dec. 31, 2022 | |
2014 Equity Incentive Plan | ||
Number of Authorized Shares | ||
Outstanding, number of authorized shares (in shares) | 1,174,727 | |
Exercised, number of authorized shares (in shares) | (262,724) | |
Exercised shares forgone to satisfy minimum statutory withholding, number of authorized shares (in shares) | (74,421) | |
Cashless exercise, number of authorized shares (in shares) | (116,236) | |
Forfeited and expirations, number of authorized shares (in shares) | (64,000) | |
Outstanding, number of authorized shares (in shares) | 657,346 | 1,174,727 |
Share-based compensation arrangement, options, exercisable, number (in shares) | 643,509 | |
Weighted- Average Exercise Price | ||
Outstanding, weighted average exercise price (usd per share) | $ 5.76 | |
Share-based compensation arrangements, options, exercises in period, weighted average exercise price (usd per share) | 3.58 | |
Share-based compensation arrangements, options, expirations in period, weighted average exercise price (usd per share) | 3.40 | |
Cashless exercise, weighted average exercise price (usd per share) | 3.62 | |
Forfeitures and expirations (usd per share) | 11.72 | |
Outstanding, weighted average exercise price (usd per share) | 6.69 | $ 5.76 |
Share-based compensation arrangement, options, exercisable, weighted average exercise price (usd per share) | $ 6.44 | |
Options, Additional Disclosures | ||
Outstanding, Weighted average remaining contractual term | 4 years 1 month 28 days | 3 years 11 months 12 days |
Exercisable, Weighted average remaining contractual term | 4 years 1 month 6 days | |
Outstanding, Aggregate Intrinsic Value | $ 2,983,514 | $ 4,463,307 |
Exercisable, Aggregate Intrinsic Value | $ 2,983,514 | |
2021 Equity Incentive Plan | ||
Number of Authorized Shares | ||
Outstanding, number of authorized shares (in shares) | 544,799 | |
Share-based compensation arrangement, options, grants in period (in shares) | 624,628 | |
Exercised, number of authorized shares (in shares) | (28,289) | |
Cashless exercise, number of authorized shares (in shares) | (21,711) | |
Forfeited and expirations, number of authorized shares (in shares) | (67,754) | |
Outstanding, number of authorized shares (in shares) | 1,051,673 | 544,799 |
Share-based compensation arrangement, options, exercisable, number (in shares) | 296,982 | |
Weighted- Average Exercise Price | ||
Outstanding, weighted average exercise price (usd per share) | $ 13.41 | |
Share-based compensation arrangements, options, grants in period, weighted average exercise price (usd per share) | 9.25 | |
Share-based compensation arrangements, options, exercises in period, weighted average exercise price (usd per share) | 8.58 | |
Cashless exercise, weighted average exercise price (usd per share) | 8.58 | |
Forfeitures and expirations (usd per share) | 15.24 | |
Outstanding, weighted average exercise price (usd per share) | 11.05 | $ 13.41 |
Share-based compensation arrangement, options, exercisable, weighted average exercise price (usd per share) | $ 14.46 | |
Options, Additional Disclosures | ||
Outstanding, Weighted average remaining contractual term | 8 years 9 months 14 days | 8 years 11 months 4 days |
Exercisable, Weighted average remaining contractual term | 7 years 10 months 2 days | |
Outstanding, Aggregate Intrinsic Value | $ 1,207,118 | $ 27,396 |
Exercisable, Aggregate Intrinsic Value | $ 247,280 |
Share-Based Compensation - Sche
Share-Based Compensation - Schedule of Share-based Compensation Expense Based on Fair Value of Options (Details) - Stock Options - USD ($) | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Expected volatility rate, minimum | 52% | 51% | 43% |
Expected volatility rate, maximum | 53% | 53% | 46% |
Risk free interest rate, minimum | 3.71% | 1.71% | 0.31% |
Risk free interest rate, maximum | 4.83% | 3.01% | 0.54% |
Expected lives at date of grant (in years) | 3 years 11 months 26 days | 3 years 8 months 23 days | 3 years 7 months 13 days |
Weighted average fair value of options granted (usd per share) | $ 4.10 | $ 3.67 | $ 6.56 |
Total intrinsic value of options exercised | $ 3,155,770 | $ 3,762,978 | $ 4,248,401,000 |
Business Segment Information (D
Business Segment Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Segment Reporting Information [Line Items] | |||
Net revenues - external | $ 125,785 | $ 109,914 | $ 102,382 |
Net revenues - internal | 0 | 0 | 0 |
Total net revenues | 125,785 | 109,914 | 102,382 |
Gross profit | 63,109 | 60,560 | 58,536 |
Selling, general and administrative expenses | 59,021 | 58,906 | 55,716 |
Interest expense | (2,170) | (1,402) | (1,377) |
Other expense | (67) | (122) | (186) |
Income before income taxes | 1,851 | 130 | 1,257 |
Provision for income taxes | (979) | (112) | 163 |
Net income | 872 | 18 | 1,420 |
Total assets | 102,915 | 99,388 | 97,586 |
Purchases of medical equipment | 10,093 | 14,094 | 15,676 |
Depreciation and amortization of intangible assets | 12,508 | 13,360 | 14,625 |
Corporate/Eliminations | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 0 | 0 | 0 |
Net revenues - internal | (6,581) | (6,473) | (5,753) |
Total net revenues | (6,581) | (6,473) | (5,753) |
Gross profit | 0 | 0 | 0 |
Total assets | 2,000 | 2,000 | 2,000 |
Purchases of medical equipment | 0 | 0 | 0 |
Depreciation and amortization of intangible assets | 0 | 0 | 0 |
Patient Services | Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 76,541 | 68,881 | 65,598 |
Net revenues - internal | 0 | 0 | 0 |
Total net revenues | 76,541 | 68,881 | 65,598 |
Gross profit | 47,800 | 43,433 | 42,046 |
Total assets | 55,412 | 60,886 | 60,970 |
Purchases of medical equipment | 5,167 | 8,825 | 10,533 |
Depreciation and amortization of intangible assets | 8,401 | 9,266 | 10,886 |
Device Solutions | Operating Segments | |||
Segment Reporting Information [Line Items] | |||
Net revenues - external | 49,244 | 41,033 | 36,784 |
Net revenues - internal | 6,581 | 6,473 | 5,753 |
Total net revenues | 55,825 | 47,506 | 42,537 |
Gross profit | 15,309 | 17,127 | 16,490 |
Total assets | 45,503 | 36,502 | 34,616 |
Purchases of medical equipment | 4,926 | 5,269 | 5,143 |
Depreciation and amortization of intangible assets | $ 4,107 | $ 4,094 | $ 3,739 |
Employee Benefit Plans and Ot_2
Employee Benefit Plans and Other (Details) - USD ($) $ in Millions | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Retirement Benefits [Abstract] | |||
Contributions by employer | $ 1.3 | $ 1.2 | $ 0.9 |
Employee-related liabilities, current | $ 4.6 | $ 3.3 |
Correction of Immaterial Erro_3
Correction of Immaterial Errors to Previously Issued Consolidated Financial Statements (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | |
Disaggregation of Revenue [Line Items] | |||
Revenues | $ 125,785 | $ 109,914 | $ 102,382 |
Rental agreement revenue | 24,400 | 21,700 | |
Cost of revenues | 62,676 | 49,354 | 43,846 |
Gross profit | 63,109 | 60,560 | 58,536 |
General and administrative (inclusive of provision for doubtful accounts) | 45,377 | 44,153 | 40,677 |
Selling, general and administrative expenses | $ 59,021 | 58,906 | 55,716 |
Previously Reported | |||
Disaggregation of Revenue [Line Items] | |||
Cost of revenues | 47,343 | 42,185 | |
Gross profit | 62,571 | 60,197 | |
General and administrative (inclusive of provision for doubtful accounts) | 46,164 | 42,338 | |
Selling, general and administrative expenses | 60,917 | 57,377 | |
Revision of Prior Period, Adjustment | |||
Disaggregation of Revenue [Line Items] | |||
Revenues | 85,500 | 80,700 | |
Gross profit | (2,011) | (1,661) | |
General and administrative (inclusive of provision for doubtful accounts) | (2,011) | (1,661) | |
Selling, general and administrative expenses | (2,011) | (1,661) | |
Device Solutions | Revision of Prior Period, Adjustment | |||
Disaggregation of Revenue [Line Items] | |||
Cost of revenues | $ 2,011 | $ 1,661 |