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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
FORM 10-Q
x    Quarterly Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
for the quarterly period ended June 30, 2024
or
¨     Transition Report Pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934
for the transition period from _____ to _____
Commission File Number: 001-35020
InfuSystem_SAFE.SMART.TRUSTED._PMSC_Stacked_10-19.jpg
INFUSYSTEM HOLDINGS, INC.
(Exact name of registrant as specified in its charter)
Delaware20-3341405
(State or Other Jurisdiction of
 Incorporation or Organization)
(I.R.S. Employer
 Identification No.)
3851 West Hamlin Road
Rochester Hills, Michigan 48309
(Address of Principal Executive Offices)
Registrant’s Telephone Number, including Area Code: (248) 291-1210
Securities Registered Pursuant to Section 12(b) of the Act:
Title of Each ClassTrading Symbol(s)Name of Each Exchange on which Registered
Common Stock, par value $0.0001 per shareINFUNYSE American LLC
Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports) and (2) has been subject to such filing requirements for the past 90 days. Yes x No ¨
Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes x No ¨
Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act.
Large accelerated filer ¨Accelerated filerxNon-accelerated filer ¨Smaller reporting companyx
Emerging growth company¨   
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ¨
Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ¨ No x
As of August 5, 2024, 21,315,428 shares of the registrant’s common stock, par value $0.0001 per share, were outstanding.

INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
Index to Form 10-Q
  
PAGE
 
   
   
 
 
 
 
 
   
   
   
   
 
   
  
  
  
  
  
  
  
2
PART I—FINANCIAL INFORMATION
Item 1. Financial Statements
INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED BALANCE SHEETS
(UNAUDITED)
 
As of
(in thousands, except par value and share data)
June 30, 2024December 31, 2023
ASSETS  
Current assets:  
Cash and cash equivalents$146$231
Accounts receivable, net21,32519,830
Inventories, net6,8396,402
Other current assets4,6034,157
Total current assets32,91330,620
Medical equipment for sale or rental6,9803,049
Medical equipment in rental service, net of accumulated depreciation36,26234,928
Property & equipment, net of accumulated depreciation4,1744,321
Goodwill3,7103,710
Intangible assets, net6,9517,446
Operating lease right of use assets5,8456,703
Deferred income taxes8,6449,115
Derivative financial instruments1,7141,442
Other assets1,3341,581
Total assets$108,527$102,915
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable$9,940$8,009
Other current liabilities5,9407,704
Total current liabilities15,88015,713
Long-term debt, net of current portion34,16529,101
Operating lease liabilities, net of current portion4,9955,799
Total liabilities55,04050,613
Stockholders’ equity:
Preferred stock, $0.0001 par value: authorized 1,000,000 shares; none issued
——
Common stock, $0.0001 par value: authorized 200,000,000 shares; 21,315,046 shares issued and outstanding as of June 30, 2024 and 21,196,851 shares issued and outstanding as of December 31, 2023
22
Additional paid-in capital111,493109,837
Accumulated other comprehensive income1,2951,088
Retained deficit(59,303)(58,625)
Total stockholders’ equity53,48752,302
Total liabilities and stockholders’ equity$108,527$102,915

See accompanying notes to unaudited condensed consolidated financial statements.
3
INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (LOSS)
(UNAUDITED)
(in thousands, except share and per share data)
Three Months Ended
June 30,		Six Months Ended
June 30,
 2024202320242023
Net revenues$33,698$31,735$65,693$62,105
Cost of revenues17,03015,90332,55131,323
Gross profit16,66815,83233,14230,782
Selling, general and administrative expenses:
Amortization of intangibles247247495495
Selling and marketing3,0422,9856,4186,209
General and administrative11,52411,35225,21922,937
 
Total selling, general and administrative14,81314,58432,13229,641
 
Operating income1,8551,2481,0101,141
Other expense:
Interest expense(484)(620)(940)(1,104)
Other (expense) income(63)2(60)(33)
 
Income before income taxes1,308630104
(Provision for) benefit from income taxes(591)(195)(405)107
Net income (loss)$717$435$(395)$111
Net income (loss) per share:
Basic$0.03$0.02$(0.02)$0.01
Diluted$0.03$0.02$(0.02)$0.01
Weighted average shares outstanding:
Basic21,299,08920,955,04821,262,42920,904,315
Diluted21,711,19821,600,34621,262,42921,565,667
 
Comprehensive income (loss):
Net income (loss)$717$435$(395)$111
Other comprehensive (loss) income:
Unrealized (loss) gain on hedges(1)228273(54)
(Provision for) benefit from income tax on unrealized hedge gain (loss) —(56)(66)7
Net comprehensive income (loss)$716$607$(188)$64
See accompanying notes to unaudited condensed consolidated financial statements.
4
INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF
STOCKHOLDERS’ EQUITY
(UNAUDITED)

 Common Stock
Additional Paid in Capital
Retained Deficit
Accumulated Other Comprehensive Income
Total Stockholders’ Equity
(in thousands)
Shares
Par Value Amount
Balances at March 31, 202320,931$2$106,810$(59,821)$1,270$48,261
Shares issued upon restricted stock vesting and option exercise142—271——271
Stock-based compensation expense——1,016——1,016
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(22)—(199)——(199)
Other comprehensive income————172172
Net income———435—435
Balances at June 30, 202321,051$2$107,898$(59,386)$1,442$49,956
 
Balances at March 31, 202421,290$2$110,715$(59,737)$1,296$52,276
Shares issued upon restricted stock vesting and option exercise105—39——39
Stock-based compensation expense——998——998
Common stock repurchased as part of share repurchase program(41)——(283)—(283)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(39)—(259)——(259)
Other comprehensive loss————(1)(1)
Net income———717—717
Balances at June 30, 202421,315$2$111,493$(59,303)$1,295$53,487
 
Balances at December 31, 202220,782$2$105,856$(59,344)$1,489$48,003
Shares issued upon restricted stock vesting and option exercise309—586——586
Stock-based compensation expense——1,736——1,736
Employee stock purchase plan41—243——243
Common stock repurchased as part of share repurchase program(22)——(153)—(153)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(59)—(523)——(523)
Other comprehensive loss————(47)(47)
Net income———111—111
Balances at June 30, 202321,051$2$107,898$(59,386)$1,442$49,956
 
Balances at December 31, 202321,197$2$109,837$(58,625)$1,088$52,302
Shares issued upon restricted stock vesting and option exercise211—39——39
Stock-based compensation expense——2,055——2,055
Employee stock purchase plan26—186——186
Common stock repurchased as part of share repurchase program(41)——(283)—(283)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(78)—(624)——(624)
Other comprehensive income————207207
Net loss———(395)—(395)
Balances at June 30, 202421,315$2$111,493$(59,303)$1,295$53,487
See accompanying notes to unaudited condensed consolidated financial statements.
5
INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
Six Months Ended June 30,
(in thousands)20242023
OPERATING ACTIVITIES
Net (loss) income$(395)$111
Adjustments to reconcile net (loss) income to net cash provided by operating activities:
Provision for doubtful accounts(194)47
Depreciation5,4385,801
Loss on disposal of and reserve adjustments for medical equipment316828
Gain on sale of medical equipment(1,036)(1,402)
Amortization of intangible assets495495
Amortization of deferred debt issuance costs3978
Stock-based compensation2,0551,736
Deferred income taxes405(106)
Changes in assets - (increase)/decrease:
Accounts receivable(1,203)(506)
Inventories(437)(885)
Other current assets(446)(994)
Other assets914(1,719)
Changes in liabilities - (decrease)/increase:
Accounts payable and other liabilities(3,265)(1,183)
NET CASH PROVIDED BY OPERATING ACTIVITIES2,6862,301
INVESTING ACTIVITIES
Purchase of medical equipment(8,796)(6,994)
Purchase of property and equipment(519)(494)
Proceeds from sale of medical equipment, property and equipment2,2012,098
NET CASH USED IN INVESTING ACTIVITIES(7,114)(5,390)
 
FINANCING ACTIVITIES
Principal payments on long-term debt(26,744)(29,451)
Cash proceeds from long-term debt31,76932,585
Debt issuance costs—(229)
Common stock repurchased as part of share repurchase program(283)(153)
Common stock repurchased to satisfy statutory withholding on employee stock-based compensation plans(624)(523)
Cash proceeds from exercise of options and ESPP225829
NET CASH PROVIDED BY FINANCING ACTIVITIES4,3433,058
Net change in cash and cash equivalents(85)(31)
Cash and cash equivalents, beginning of period231165
Cash and cash equivalents, end of period$146$134
See accompanying notes to unaudited condensed consolidated financial statements.

6
INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
NOTES TO THE UNAUDITED CONDENSED CONSOLIDATED FINANCIAL STATEMENTS
1.Basis of Presentation, Nature of Operations and Summary of Significant Accounting Policies
The terms "InfuSystem", the "Company", "we", "our" and "us" are used herein to refer to InfuSystem Holdings, Inc. and its subsidiaries. InfuSystem is a leading provider of infusion pumps and related products and services for patients in the home, oncology clinics, ambulatory surgery centers, and other sites of care. The Company provides products and services to hospitals, oncology practices and facilities and other alternative site health care providers. Headquartered in Rochester Hills, Michigan, the Company delivers local, field-based customer support, and also operates pump service and repair Centers of Excellence in Michigan, Kansas, California, Massachusetts, Texas and Ontario, Canada. The Company operates in two reportable segments, Patient Services and Device Solutions. During the fiscal year ended December 31, 2023, the Company also operated through First Biomedical, Inc., a Kansas Corporation, which was a wholly-owned subsidiary that merged into InfuSystem, Inc. on January 1, 2024.
The accompanying unaudited condensed consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission ("SEC") for interim financial information. Accordingly, the unaudited condensed consolidated financial statements do not include all of the information and notes required by U.S. Generally Accepted Accounting Principles ("GAAP") for complete financial statements. The accompanying unaudited condensed consolidated financial statements include all adjustments, composed of normal recurring adjustments, considered necessary by management to fairly state the Company’s results of operations, financial position and cash flows. The operating results for the interim periods are not necessarily indicative of results that may be expected for any other interim period or for the full year. These unaudited condensed consolidated financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023 as filed with the SEC on April 10, 2024.
The unaudited condensed consolidated financial statements are prepared in conformity with GAAP, which requires the use of estimates, judgments and assumptions that affect the amounts of assets and liabilities at the reporting date and the amounts of revenue and expenses in the periods presented. The Company believes that the accounting estimates employed are appropriate and the resulting balances are reasonable; however, due to the inherent uncertainties in making estimates, actual results could differ from the original estimates, requiring adjustments to these balances in future periods.
2.Recent Accounting Pronouncements and Developments
In November 2023, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2023-07, Segment Reporting (ASC 280): Improvements to Reportable Segment Disclosures. ASU 2023-07 expands the disclosure requirements for reportable segments by requiring enhanced disclosures about significant segment expenses. Under the new standard, entities must disclose an amount for other segment items by reportable segment and a description of its composition. The other segment items category is the difference between segment revenue less the significant expenses disclosed and each reported measure of segment profit or loss. Additionally, entities must disclose at least one measure of assessing segment performance and the title and position of the chief operating decision maker ("CODM") and an explanation of how the CODM uses the reported measure(s) of segment profit or loss in assessing segment performance. The amendments are effective for annual periods beginning after December 15, 2023, and interim periods within fiscal years beginning after December 15, 2024. Early adoption is permitted. The amendments are to be applied retrospectively to all prior periods presented in the financial statements. The Company is currently evaluating the impact of ASU 2023-07 on its consolidated financial statements and related disclosures.
In December 2023, the FASB issued Accounting Standards Update No. 2023-09, Income Taxes (ASC 740): Improvements to Income Tax Disclosures. ASU 2023-09 enhances existing income tax disclosures primarily through standardization and disaggregation of rate reconciliation categories and income taxes paid by jurisdiction. The amendments in this ASU requires public entities to disclose a tabular tax rate reconciliation, using both percentages and currency, with specific categories. Public entities are also required to provide a qualitative description of the states and local jurisdictions that make up the majority of the effect of the state and local income tax category and the net amount of income taxes paid, disaggregated by federal, state and foreign taxes and also disaggregated by individual jurisdictions. The amendments also remove certain disclosures that are no longer considered cost beneficial. The amendments are effective prospectively for annual periods beginning after December 15, 2024, and early adoption and retrospective application are permitted. The Company is currently evaluating the impact of ASU 2023-09 on its consolidated financial statements and related disclosures.
7
In March 2024, the SEC issued final rules on climate-related disclosures that will require annual disclosure of material climate-related risks and material direct greenhouse gas emissions from operations owned or controlled (Scope 1) and material indirect greenhouse gas emissions from purchased energy consumed in owned or controlled operations (Scope 2). Additionally, the rules require disclosure in the notes to the financial statements of the effects of severe weather events and other natural conditions, subject to certain financial thresholds, as well as amounts related to carbon offsets and renewable energy credits or certificates. These rules also require disclosure of climate risk oversight practices of the Board of Directors and management, and the disclosure of governance, risk management and strategy related to material climate-related risks. In April 2024, the SEC voluntarily stayed the new rules pending the completion of judicial review. The disclosure requirements, if ultimately upheld as adopted, will begin phasing in for reports and registration statements including financial information with respect to annual periods beginning in our fiscal 2027. We are currently evaluating the impact of adoption of these final rules on our disclosures.
3.Revenue
The following table presents the Company’s disaggregated revenue by offering type (in thousands):
 Three Months Ended
June 30,
 20242023
 
Total Net
Revenues
Percentage of
Total Net
Revenues
Total Net
Revenues
Percentage of
Total Net
Revenues
Patient Services revenue recognized at a point in time:
Direct products$730 2.2 %$578 1.8 %
Third-Party Payer products3,695 11.0 %3,365 10.6 %
Patient Services revenue recognized over time:
Direct rental services1,928 5.7 %1,865 5.9 %
Third-Party Payer rental services11,889 35.3 %10,889 34.3 %
Total Patient Services accounted for under ASC 60618,242 54.1 %16,697 52.6 %
Device Solutions revenue recognized at a point in time:
Products3,943 11.7 %3,866 12.2 %
Services
2,457 7.3 %2,459 7.7 %
Device Solutions revenue recognized over time:
Services
2,040 6.1 %1,499 4.7 %
Total Device Solutions accounted for under ASC 6068,440 25.0 %7,824 24.7 %
Total Revenue Accounted for under ASC 60626,682 79.2 %24,521 77.3 %
Patient Services lease revenue
2,004 5.9 %2,622 8.3 %
Device Solutions lease revenue
5,012 14.9 %4,592 14.5 %
Total Revenue accounted for under ASC 842, Leases7,016 20.8 %7,214 22.7 %
Total Net Revenue$33,698 100.0 %$31,735100.0 %
8
 Six Months Ended
June 30,
 20242023
 
Total Net
Revenues
Percentage of
Total Net
Revenues
Total Net
Revenues
Percentage of
Total Net
Revenues
Patient Services revenue recognized at a point in time:
Direct products$1,345 2.0 %$1,157 1.9 %
Third-Party Payer products7,267 11.1 %6,773 10.9 %
Patient Services revenue recognized over time:
Direct rental services3,800 5.8 %3,734 6.0 %
Third-Party Payer rental services22,866 34.8 %21,910 35.3 %
Total Patient Services accounted for under ASC 60635,278 53.7 %33,574 54.1 %
Device Solutions revenue recognized at a point in time:
Products8,155 12.4 %7,606 12.2 %
Services4,867 7.4 %5,035 8.1 %
Device Solutions revenue recognized over time:
Services4,009 6.1 %2,272 3.7 %
Total Device Solutions accounted for under ASC 60617,031 25.9 %14,913 24.0 %
Total Revenue Accounted for under ASC 60652,309 79.6 %48,487 78.1 %
Patient Services Lease Revenue3,559 5.4 %4,519 7.3 %
Device Solutions Lease Revenue9,825 15.0 %9,099 14.7 %
Total Revenue accounted for under ASC 842, Leases13,384 20.4 %13,618 21.9 %
Total Net Revenue$65,693 100.0 %$62,105100.0 %
Contract Balances
(dollars in thousands)
As of June 30, 2024
As of December 31, 2023
$ Change
Accounts receivable, net$21,325 $19,830 $1,495 
Contract assets$1,271 $1,271 $— 
There was no change in the balance for contract assets during the six months ended June 30, 2024. The activity related to the contract assets during the six months ended June 30, 2024 included $5.6 million of revenue recognized for which the payment is subject to conditions other than the passage of time, which was fully offset by $5.6 million of contract assets reclassified to accounts receivable as our right to consideration for these contract assets became unconditional. Contract assets are included in other current assets on the Company's Condensed Consolidated Balance Sheets.
9
4.Medical Equipment
Medical equipment consisted of the following (in thousands):
 June 30,
2024		December 31, 2023
Medical equipment for sale or rental$7,007$3,081
Medical equipment for sale or rental - pump reserve(27)(32)
Medical equipment for sale or rental - net6,9803,049
 
Medical equipment in rental service101,39896,298
Medical equipment in rental service - pump reserve(2,239)(2,126)
Accumulated depreciation(62,897)(59,244)
Medical equipment in rental service - net36,26234,928
 
Total$43,242$37,977
Depreciation expense for medical equipment for the three and six months ended June 30, 2024 was $2.5 million and $4.8 million compared to $2.6 million and $5.3 million for the same prior year periods, respectively. This expense was recorded in "cost of revenues" for each period. The pump reserve for medical equipment in rental service represents an estimate for medical equipment that is considered to be missing. The reserve calculated is equal to the net book value of assets that have not returned from the field within a certain timeframe. For the six months ended June 30, 2024 and 2023, $3.1 million and $1.6 million of current liabilities related to non-cash purchases of medical equipment and property, respectively, had not been included in investing activities in the Condensed Consolidated Statements of Cash Flows. These amounts will be included as a cash outflow from investing activities when paid.
5.Property and Equipment
Property and equipment consisted of the following (in thousands):
 June 30, 2024December 31, 2023
 Gross Assets
Accumulated
Depreciation
TotalGross Assets
Accumulated Depreciation
Total
Furniture, fixtures, and equipment$6,049$(4,238)$1,811$6,611$(3,909)$2,702
Automobiles87(87)—87(87)—
Leasehold improvements4,558(2,195)2,3633,570(1,951)1,619
 
Total$10,694$(6,520)$4,174$10,268$(5,947)$4,321
Depreciation expense for property and equipment for the three and six months ended June 30, 2024 was $0.3 million and $0.6 million compared to $0.2 million and $0.5 million for the same prior year periods, respectively. This expense was recorded in "general and administrative expenses" for each period.
10
6.Goodwill & Intangible Assets
The changes in the carrying value of goodwill by segment for the six months ended June 30, 2024 are as follows (in thousands):
 Device Solutions (a)
Balance as of December 31, 2023$3,710
Goodwill acquired—
Balance as of June 30, 2024$3,710
(a) The Patient Services segment had no recorded goodwill during the reported periods.
The carrying amount and accumulated amortization of intangible assets consisted of the following (in thousands):
 June 30, 2024December 31, 2023
 
Gross
Assets
Accumulated
Amortization
Net
Gross
Assets
Accumulated
Amortization
Net
Nonamortizable intangible assets      
Trade names$2,000$—$2,000$2,000$—$2,000
Amortizable intangible assets:
Trade names23(23)—23(23)—
Physician and customer relationships38,834(34,645)4,18938,834(34,295)4,539
Non-competition agreements472(303)169472(255)217
Unpatented technology943(460)483943(393)550
Software10,300(10,190)11010,300(10,160)140
 
Total nonamortizable and amortizable intangible assets$52,572$(45,621)$6,951$52,572$(45,126)$7,446
Amortization expense for both the three and six months ended June 30, 2024 and 2023 was $0.2 million and $0.5 million, respectively. This expense was recorded in "amortization of intangibles expenses" for each period. Expected remaining annual amortization expense for the next five years for intangible assets recorded as of June 30, 2024 is as follows (in thousands):
 20242025202620272028
2029 and thereafter
Total
        
Amortization expense$495$810$525$471$348$2,302$4,951
7.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.
11
The borrowers under the 2021 Credit Agreement are InfuSystem Holdings, Inc. and its subsidiaries (collectively, the "Borrowers").
The 2021 Credit Agreement provides for a revolving credit facility (the "Revolving Facility") of $75.0 million, that matures on February 5, 2026. The Revolving Facility may be increased by $25.0 million, subject to certain conditions, including the consent of the Agent and obtaining necessary commitments. The lenders under the 2021 Credit Agreement may issue up to $7.0 million in letters of credit subject to the satisfaction of certain conditions. On February 5, 2021, the Borrowers made an initial borrowing of $30.0 million under the Revolving Facility. Proceeds from the loan, along with approximately $8.2 million in cash, were used to repay all amounts due under the Company’s then existing credit facility dated March 23, 2015 (the "2015 Credit Agreement").
The 2021 Credit Agreement has customary representations and warranties. The ability to borrow under the facility is subject to ongoing compliance with a number of customary affirmative and negative covenants, including limitations on indebtedness, liens, mergers, acquisitions, investments, asset sales, affiliate transactions and restricted payments, as well as financial covenants, including the following:
•a minimum fixed charge coverage ratio (defined as the ratio of consolidated EBITDA (as defined in the 2021 Credit Agreement) less 50% of depreciation expense), to consolidated fixed charges (as defined in the 2021 Credit Agreement)) for the prior four most recently ended calendar quarters of 1.20 to 1.00; and
•a maximum leverage ratio (defined as total indebtedness to EBITDA for the prior four most recently ended calendar quarters) of 3.50 to 1.00.
The 2021 Credit Agreement includes customary events of default. The occurrence of an event of default will permit the lenders to terminate commitments to lend under the Revolving Facility and accelerate payment of all amounts outstanding thereunder.
Simultaneous with the execution of the 2021 Credit Agreement, the Company entered into a Pledge and Security Agreement to secure repayment of the obligations of the Borrowers. Under the Pledge and Security Agreement, each Borrower has granted to the Agent, for the benefit of various secured parties, a first priority security interest in substantially all of the personal property assets and shares of each of the Borrowers.
On April 26, 2023, the Company entered into a First Amendment to the 2021 Credit Agreement (the "First Amendment") with the Agent and the lenders party thereto, which amended the 2021 Credit Agreement, to provide for, among other things: (i) an extension of the maturity date for the 2021 Credit Agreement to April 26, 2028, (ii) the replacement of London Interbank Offered Rate ("LIBOR") with Adjusted Term Secured Overnight Financing Rate ("SOFR") as a benchmark interest rate, and (iii) an increase of the maximum dollar amount of incremental revolving loans from $25 million to $35 million. Incremental revolving loans continue to be subject to certain conditions, including the consent of the Agent and obtaining necessary commitments.
The 2021 Credit Agreement and First Amendment were accounted for as debt modifications. As of June 30, 2024, the Company was in compliance with all debt-related covenants under the 2021 Credit Agreement, as amended.
The following table illustrates the net availability under the Revolving Facility as of the applicable balance sheet date (in thousands):
 June 30,
2024		December 31,
2023
Revolving Facility:
Gross availability$75,000$75,000
Outstanding draws(34,464)(29,439)
Letter of credit(200)(200)
Availability on Revolving Facility$40,336$45,361
12
The Company had future maturities of its long-term debt as of June 30, 2024 as follows (in thousands):
 2024202520262027
2028
Total
Revolving Facility$—$—$—$—$34,464$34,464
Total$—$—$—$—$34,464$34,464
The following is a breakdown of the Company’s current and long-term debt (in thousands):
 June 30, 2024December 31, 2023
 
Current
Portion
Long-Term
Portion
Total
Current
Portion
Long-Term
Portion
Total
Revolving Facility$—$34,464$34,464$—$29,439$29,439
Unamortized value of debt issuance costs—(299)(299)—(338)(338)
Total$—$34,165$34,165$—$29,101$29,101
As of June 30, 2024, amounts outstanding under the Revolving Facility provided under the 2021 Credit Agreement, as amended, bear interest at a variable rate equal to, at the Company’s election, Adjusted Term SOFR for Term Benchmark loans or an Alternative Base Rate for ABR loans, as defined by the First Amendment, plus a spread that will vary depending upon the Company’s leverage ratio. The spread ranges from 2.00% to 3.00% for Term Benchmark Loans and 1.00% to 2.00% for base rate loans. The weighted-average Term Benchmark loan rate at June 30, 2024 was 7.43% (Adjusted Term SOFR of 5.43% plus 2.00%). The actual ABR loan rate at June 30, 2024 was 9.50% (lender’s prime rate of 8.50% plus 1.00%).

8.Derivative Financial Instruments and Hedging Activities
In February 2021, the Company adopted a derivative investment policy, which provides guidelines and objectives related to managing financial and operational exposures arising from market changes in short term interest rates. In accordance with this policy, the Company can enter into interest rate swaps or similar instruments, will endeavor to evaluate all the risks inherent in a transaction before entering into a derivative financial instrument and will not enter into derivative financial instruments for speculative or trading purposes. Hedging relationships are formally documented at the inception of the hedge and hedges must be highly effective in offsetting changes to future cash flows on hedged transactions at the inception of a hedge and on an ongoing basis to be designated for hedge accounting treatment.
The Company is exposed to interest rate risk related to its variable rate debt obligations under the 2021 Credit Agreement. In order to manage the volatility in interest rate markets, in February 2021, the Company entered into two interest rate swap agreements to manage exposure arising from this risk. On a combined basis, the agreements had a constant notional amount over a five-year term that would have ended on February 5, 2026. While they were outstanding, each agreement paid the Company 30-day LIBOR on the notional amount and the Company paid a fixed rate of interest equal to 0.73%. These derivative instruments were considered cash flow hedges. On May 11, 2023, these two swaps were settled and a new swap was entered into with different terms that aligned with changes in the 2021 Credit Agreement arising from the First Amendment. The new swap has a constant notional amount over a five-year term that ends on April 26, 2028. The agreement pays the Company 30-day SOFR on the notional amount and the Company pays a fixed rate of interest equal to 1.74%. The Company does not have any other derivative financial instruments.
The fair values of the Company’s derivative financial instruments are categorized as Level II of the fair value hierarchy as the values are derived using the market approach based on observable market inputs including quoted prices of similar instruments and interest rate forward curves.
The tables below present the location and gross fair value amounts of the Company's derivative financial instruments and the associated notional amounts designated as cash flow hedges as of the applicable balance sheet date (in thousands):
13
 
June 30, 2024
 Balance Sheet LocationNotionalFair Value Derivative Assets
Derivatives designated as hedges:
Cash flow hedges
Interest rate swapsDerivative financial instruments$20,000$1,714

 
December 31, 2023
 Balance Sheet LocationNotionalFair Value Derivative Assets
Derivatives designated as hedges:
Cash flow hedges
Interest rate swapsDerivative financial instruments$20,000$1,442
The table below presents the effect of our derivative financial instruments designated as hedging instruments in accumulated other comprehensive income ("AOCI") (in thousands):
 Three Months Ended June 30,
20242023
Gain on cash flow hedges - interest rate swaps  
Beginning balance$1,296$1,270
Unrealized gain recognized in AOCI179412
Amounts reclassified to interest expense (a)(180)(184)
Tax provision—(56)
Ending balance$1,295$1,442
(a) Negative amounts represent interest income. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income (loss) for the three months ended June 30, 2024 and 2023 was $0.5 million and $0.6 million, respectively.
 Six Months Ended June 30,
20242023
Gain on cash flow hedges - interest rate swaps  
Beginning balance$1,088$1,489
Unrealized gain recognized in AOCI635320
Amounts reclassified to interest expense (a) (b)(362)(374)
Tax (provision) benefit
(66)7
Ending balance$1,295$1,442
(a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income (loss) for the six months ended June 30, 2024 and 2023 was $0.9 million and $1.1 million, respectively.
(b) As of June 30, 2024, $0.6 million of income is expected to be reclassified into earnings within the next 12 months.
The Company did not incur any hedge ineffectiveness during the six months ended June 30, 2024.
14
9.Income Taxes
During both the three months ended June 30, 2024 and 2023, the Company recorded a provision for income taxes totaling $0.6 million and $0.2 million on pre-tax income of $1.3 million and $0.6 million, respectively, representing effective tax rates of 45.2% and 30.9%, respectively. During both the six months ended June 30, 2024 and 2023, the Company recorded a provision for income taxes totaling $0.4 million and a benefit from income taxes totaling $0.1 million, respectively, on pre-tax income of less than $0.1 million for both periods, respectively. The effective tax rates differed from the U.S. statutory rate mainly due to the effects of local, state and foreign jurisdiction income taxes, limitations on the deductions of certain expenses including meals and entertainment expense and management compensation and differences between expense recognized for book purposes versus tax purposes associated with equity compensation expense. The impact of permanent differences weighs heavier on the effective tax rate when pre-tax earnings are close to break even.
10.Commitments, Contingencies and Litigation
From time to time in the ordinary course of its business, the Company may be involved in legal and regulatory proceedings, the outcomes of which may not be determinable. The results of litigation and regulatory proceedings are inherently unpredictable. Any claims against the Company, whether meritorious or not, could be time consuming, result in costly litigation, require significant amounts of management time and result in diversion of significant resources. The Company is not able to estimate an aggregate amount or range of reasonably possible losses for those legal matters for which losses are not probable and estimable, primarily for the following reasons: (i) many of the relevant legal proceedings are in preliminary stages and, until such proceedings develop further, there is often uncertainty regarding the relevant facts and circumstances at issue and potential liability; and (ii) many of these proceedings involve matters of which the outcomes are inherently difficult to predict. The Company has insurance policies covering potential losses where such coverage is cost effective.
The Company is not at this time involved in any proceedings that the Company currently believes could have a material effect on the Company’s financial condition, results of operations or cash flows.
11.Earnings (Loss) Per Share
Basic income (loss) per share is computed by dividing net income (loss) by the weighted average number of common shares outstanding during the period. Diluted income (loss) per share assumes the issuance of potentially dilutive shares of common stock during the period. The following table reconciles the numerators and denominators of the basic and diluted income (loss) per share computations:
 Three Months Ended June 30,Six Months Ended June 30,
Numerator (in thousands):
2024202320242023
Net income (loss):$717$435$(395)$111
Denominator:
Weighted average common shares outstanding:
Basic21,299,08920,955,04821,262,42920,904,315
Dilutive effect of common stock equivalents412,109645,298—661,352
Diluted21,711,19821,600,34621,262,42921,565,667
Net income (loss) per share:
Basic$0.03$0.02$(0.02)$0.01
Diluted$0.03$0.02$(0.02)$0.01
For the three months ended June 30, 2024 and 2023, respectively, there were 1,917,188 and 901,995 of outstanding options and unvested restricted stock units with an exercise price above the current market value of the Company's common stock that were not included in the calculation because they would have an anti-dilutive effect. For the six months ended June 30, 2024, all outstanding options and unvested restricted stock units, which totaled 2,530,571 shares, were anti-dilutive due to the Company's net loss for the period and therefore not included in the calculation. For the six months ended June 30, 2023, there were 755,234 of outstanding options and unvested restricted stock units with an exercise price above the current market value of the Company's common stock that were not included in the calculation because they would have an anti-dilutive effect.
15
Share Repurchase Program
On May 16, 2024, our Board of Directors approved a stock repurchase program (the "Share Repurchase Program") that authorizes the Company to repurchase up to $20.0 million of the Company’s outstanding common stock through June 30, 2026. The Share Repurchase Program supersedes the previous authorization, which was set to expire on June 30, 2024. Repurchases under the Share Repurchase Program are subject to market conditions, the periodic capital needs of the Company’s operating activities, and the continued satisfaction of all covenants under the Company’s existing 2021 Credit Agreement, as amended. Repurchases under the Share Repurchase Program may take place in the open market or in privately negotiated transactions and may be made under a Rule 10b5-1 plan. The Share Repurchase Program does not obligate the Company to repurchase shares and may be suspended, terminated, or modified at any time at the discretion of the Board. As of June 30, 2024, the Company had repurchased and retired approximately $0.3 million, or 41,139 shares, of the Company's outstanding common stock under the Share Repurchase Program. The Company had repurchased and retired approximately $6.2 million, or 553,149 shares under the previous authorization.
12.Share-Based Compensation
The following tables summarize the activity during the period under the Company's 2014 Amended and Restated Stock Incentive Plan (the "2014 Plan") and 2021 Equity Incentive Plan (the "2021 Plan").
Restricted Stock Awards
Number of
shares		Weighted
average
grant
date fair
value
Unvested at December 31, 2023529,862 $11.42 
Granted214,054 7.52 
Vested(85,266)17.91 
Vested shares forgone to satisfy minimum statutory withholding(52,965)17.91 
Forfeitures(13,250)11.70 
Unvested at June 30, 2024592,435 $8.49 
Three Months Ended June 30,Six Months Ended June 30,
2024202320242023
Weighted average grant date fair value of awards granted$6.41 $9.18 $7.52 $9.18 
Total fair value of shares vested$112,198 $297,792 $747,525 $571,105 
Total fair value of shares forgone to satisfy minimum statutory withholding$92,150 $161,018 $464,343 $328,950 
Performance-Based Restricted Stock Units ("PSU")
16
Number of
shares		Weighted
average
grant
date fair
value
Unvested at December 31, 2023112,776 $10.49 
Granted117,582 5.69 
Performance adjustment upon vesting(17,690)8.58 
Vested(13,022)8.58 
Vested shares forgone to satisfy minimum statutory withholding(10,425)8.58 
Unvested at June 30, 2024189,221 $7.92 
Three Months Ended June 30,Six Months Ended June 30,
2024202320242023
Weighted average grant date fair value of awards granted$5.69 $11.05 $5.69 $11.05 
Total fair value of shares vested$83,862 $— $83,862 $— 
Total fair value of shares forgone to satisfy minimum statutory withholding$67,137 $— $67,137 $— 
Stock Options
2014 Plan (Options)Number
of Authorized
Shares		Weighted-
Average Exercise
Price		Weighted-
Average
Remaining
Contractual Term (in Years)		Aggregate
Intrinsic Value
Outstanding at December 31, 2023657,346 $6.69 4.16$2,983,514 
Exercised(35,487)3.62 312,195 
Exercised shares forgone to satisfy minimum statutory withholding(14,654)2.69 
Shares tendered for cashless exercise(43,193)3.78 
Forfeitures and expirations(1,500)18.44 
Outstanding at June 30, 2024562,512 $7.17 4.16$1,054,630 
Exercisable at June 30, 2024562,512 $7.17 4.16$1,054,630 
Aggregate Intrinsic Value is equal to the excess of market value over the option exercise price of all in-the-money stock options.
17
2021 Plan (Options)Number
of Authorized
Shares		Weighted-
Average Exercise
Price		Weighted-
Average
Remaining
Contractual Term (in Years)		Aggregate
Intrinsic Value
Outstanding at December 31, 20231,051,673 $11.05 8.79$1,207,118 
Granted866,147 6.80 
Forfeitures and expirations(36,541)11.01 
Outstanding at June 30, 2024 (a)1,881,279 $9.10 9.00$349,478 
Exercisable at June 30, 2024 (a)609,822 $12.25 7.94$— 
(a) Aggregate Intrinsic Value - no exercisable options were in-the-money as of June 30, 2024
Aggregate Intrinsic Value is equal to the excess of market value over the option exercise price of all in-the-money stock options.

The following is the average fair value per share estimated on the date of grant and the assumptions used for options granted:
Three Months Ended June 30,Six Months Ended June 30,
Stock Options:2024202320242023
Expected volatility
46%
53%
46% to 51%
53%
Risk free interest rate
4.60%
3.71% to 4.11%
4.25% to 4.60%
3.71% to 4.11%
Expected lives at date of grant (in years)4.083.984.083.98
Weighted average fair value of options granted$2.73$4.06$2.95$4.06
Total intrinsic value of options exercised$312,195 $600,113 $312,195 $1,421,213 

13.Leases
As Lessee
The Company’s operating leases are primarily for office space, service facility centers and equipment under operating lease arrangements that expire at various dates over the next six 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 to five years. Because the Company is not reasonably certain to exercise these renewal options, the options are not considered in determining the lease term, and payments associated with the option years are excluded from lease payments. The Company’s office leases do not contain any material residual value guarantees. The Company’s equipment leases generally do not contain renewal options.
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.
18
The components of lease costs for the three and six months ended June 30, 2024 and 2023 are as follows (in thousands):
 Three Months Ended
June 30,		Six Months Ended
June 30,
 2024202320242023
Operating lease cost$472 $369 $945 $721 
Variable lease cost97 87 172 163 
Total lease cost$569 $456 $1,117 $884 
Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands):
 Six Months Ended
June 30,
20242023
Cash paid for amounts included in the measurement of lease liabilities and right of use assets:  
Operating cash flow from operating leases$965 $773 
 
Right of use assets obtained in exchange for lease obligations:
Operating leases$— $406 
Increases to right of use assets resulting from lease modifications:
Operating leases$— $552 
Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows:
 As of June 30,
 20242023
 
 
Years
Years
Weighted average remaining lease term:5.85.6
 RateRate
Weighted average discount rate:7.8%6.9%
Future maturities of lease liabilities as of June 30, 2024 are as follows (in thousands):
 
Operating
Leases
2024$880 
20251,846 
20261,654 
20271,478 
20281,429 
2029 and thereafter
2,424 
Total undiscounted lease payments9,711 
Less: Imputed interest(3,205)
Total lease liabilities$6,506 
19
The long-term portion of the lease liabilities included in the amounts above is $5.0 million with the remainder included in other current liabilities in the Condensed Consolidated Balance Sheet.
As Lessor:
We lease medical equipment to customers, often in conjunction with arrangements to provide consumable medical products. Certain of our equipment leases are classified as sales-type leases and the remainder are operating leases. The terms of the related contracts, including the proportion of fixed versus variable payments and any options, varies by customer. The Company elected the "combining lease and non-lease components" practical expedient for all qualifying non-lease components.
The components of the Company’s lease revenues consisted of the following (in thousands ) for the three and six months ended June 30, 2024 and 2023:
Three Months Ended June 30,
Six Months Ended June 30,
2024202320242023
Net operating lease revenue$6,872 $5,885 $12,983 $11,795 
Sales-type lease revenue144 1,329 401 1,823 
Total lease revenue$7,016 $7,214 $13,384 $13,618 

The components of our net investment in sales-type leases as of June 30, 2024 and December 31, 2023 were (in thousands):
June 30,
2024		December 31,
2023
Lease receivable$2,326 $2,583 
Net investment in leases$2,326 $2,583 
Our net investment in sales-type leases is classified as follows in the accompanying condensed consolidated balance sheets as of June 30, 2024 and December 31, 2023 were (in thousands):
June 30,
2024		December 31,
2023
Accounts receivable, net$1,103 $1,067 
Other assets1,223 1,516 
Total$2,326 $2,583 
Future maturities of sales-type leases as of June 30, 2024 are as follows (in thousands):
Sales-Type Leases
2024$668 
20251,313 
2026