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Table of Contents
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 September 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 November 6, 2024, 21,263,597 shares of the registrant’s common stock, par value $0.0001 per share, were outstanding.

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INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
Index to Form 10-Q
  
PAGE
 
   
   
 
 
 
 -Unaudited Condensed Consolidated Statements of Stockholders’ Equity for the three and nine months ended September 30, 2024 and 2023
 
 
   
   
   
   
 
   
  
  
  
  
  
  
  
2
Table of Contents
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)
September 30, 2024December 31, 2023
ASSETS  
Current assets:  
Cash and cash equivalents$380$231
Accounts receivable, net22,76119,830
Inventories, net6,7006,402
Other current assets3,7724,157
Total current assets33,61330,620
Medical equipment for sale or rental4,6993,049
Medical equipment in rental service, net of accumulated depreciation37,00134,928
Property & equipment, net of accumulated depreciation3,9104,321
Goodwill3,7103,710
Intangible assets, net6,7047,446
Operating lease right of use assets5,7356,703
Deferred income taxes7,8159,115
Derivative financial instruments1,1071,442
Other assets1,0091,581
Total assets$105,303$102,915
LIABILITIES AND STOCKHOLDERS’ EQUITY
Current liabilities:
Accounts payable$8,908$8,009
Other current liabilities8,0287,704
Total current liabilities16,93615,713
Long-term debt, net of current portion27,97529,101
Operating lease liabilities, net of current portion4,8795,799
Total liabilities49,79050,613
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; 21,234,303 shares issued and outstanding as of September 30, 2024 and 21,196,851 shares issued and outstanding as of December 31, 2023
22
Additional paid-in capital112,869109,837
Accumulated other comprehensive income8361,088
Retained deficit(58,194)(58,625)
Total stockholders’ equity55,51352,302
Total liabilities and stockholders’ equity$105,303$102,915

See accompanying notes to unaudited condensed consolidated financial statements.
3
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INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS AND COMPREHENSIVE INCOME (UNAUDITED)
(in thousands, except share and per share data)
Three Months Ended
September 30,		Nine Months Ended
September 30,
 2024202320242023
Net revenues$35,320$31,909$101,013$94,014
Cost of revenues16,27516,29348,82647,616
Gross profit19,04515,61652,18746,398
Selling, general and administrative expenses:
Amortization of intangibles248248743743
Selling and marketing2,7552,7289,1738,937
General and administrative12,77710,94337,99633,880
 
Total selling, general and administrative15,78013,91947,91243,560
 
Operating income3,2651,6974,2752,838
Other expense:
Interest expense(476)(563)(1,416)(1,667)
Other expense(4)(14)(64)(47)
 
Income before income taxes2,7851,1202,7951,124
Provision for income taxes(978)(431)(1,383)(324)
Net income$1,807$689$1,412$800
Net income per share:
Basic$0.08$0.03$0.07$0.04
Diluted$0.08$0.03$0.07$0.04
Weighted average shares outstanding:
Basic21,290,51221,095,40421,271,85820,968,711
Diluted21,652,45721,719,40421,707,83521,615,706
 
Comprehensive income:
Net income$1,807$689$1,412$800
Other comprehensive (loss) income:
Unrealized (loss) gain on hedges(608)254(335)200
Benefit from (provision for) income tax on unrealized hedge gain149(62)83(55)
Net comprehensive income$1,348$881$1,160$945
See accompanying notes to unaudited condensed consolidated financial statements.
4
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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 June 30, 202321,051$2$107,898$(59,386)$1,442$49,956
Shares issued upon restricted stock vesting and option exercise159—————
Stock-based compensation expense——1,063——1,063
Employee stock purchase plan31—203——203
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(57)—(634)——(634)
Other comprehensive income————192192
Net income———689—689
Balances at September 30, 202321,184$2$108,530$(58,697)$1,634$51,469
 
Balances at June 30, 202421,315$2$111,493$(59,303)$1,295$53,487
Shares issued upon restricted stock vesting and option exercise1—————
Stock-based compensation expense——1,221——1,221
Employee stock purchase plan27—156——156
Common stock repurchased as part of share repurchase program(109)——(698)—(698)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation——(1)——(1)
Other comprehensive loss————(459)(459)
Net income———1,807—1,807
Balances at September 30, 202421,234$2$112,869$(58,194)$836$55,513
 
Balances at December 31, 202220,782$2$105,856$(59,344)$1,489$48,003
Shares issued upon restricted stock vesting and option exercise468—586——586
Stock-based compensation expense——2,799——2,799
Employee stock purchase plan72—446——446
Common stock repurchased as part of share repurchase program(22)——(153)—(153)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(116)—(1,157)——(1,157)
Other comprehensive loss————145145
Net income———800—800
Balances at September 30, 202321,184$2$108,530$(58,697)$1,634$51,469
 
Balances at December 31, 202321,197$2$109,837$(58,625)$1,088$52,302
Shares issued upon restricted stock vesting and option exercise212—39——39
Stock-based compensation expense——3,276——3,276
Employee stock purchase plan53—342——342
Common stock repurchased as part of share repurchase program(150)——(981)—(981)
Common stock repurchased to satisfy minimum statutory withholding on stock-based compensation(78)—(625)——(625)
Other comprehensive loss————(252)(252)
Net income———1,412—1,412
Balances at September 30, 202421,234$2$112,869$(58,194)$836$55,513
See accompanying notes to unaudited condensed consolidated financial statements.
5
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INFUSYSTEM HOLDINGS, INC. AND SUBSIDIARIES
CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS
(UNAUDITED)
Nine Months Ended September 30,
(in thousands)20242023
OPERATING ACTIVITIES
Net income$1,412$800
Adjustments to reconcile net income to net cash provided by operating activities:
Provision for doubtful accounts(141)(122)
Depreciation8,3358,621
Loss on disposal of and reserve adjustments for medical equipment6781,278
Gain on sale of medical equipment(1,863)(1,990)
Amortization of intangible assets743743
Amortization of deferred debt issuance costs5899
Stock-based compensation3,2762,799
Deferred income taxes1,383325
Changes in assets - (increase)/decrease:
Accounts receivable(1,348)(1,035)
Inventories(298)(1,270)
Other current assets385(1,090)
Other assets1,137(2,304)
Changes in liabilities - (decrease)/increase:
Accounts payable and other liabilities(1,229)(289)
NET CASH PROVIDED BY OPERATING ACTIVITIES12,5286,565
INVESTING ACTIVITIES
Purchase of medical equipment(12,162)(8,503)
Purchase of property and equipment(562)(616)
Proceeds from sale of medical equipment, property and equipment2,7543,429
NET CASH USED IN INVESTING ACTIVITIES(9,970)(5,690)
 
FINANCING ACTIVITIES
Principal payments on long-term debt(40,415)(43,160)
Cash proceeds from long-term debt39,23142,788
Debt issuance costs—(229)
Common stock repurchased as part of share repurchase program(981)(153)
Common stock repurchased to satisfy statutory withholding on employee stock-based compensation plans(625)(1,157)
Cash proceeds from exercise of options and ESPP3811,032
NET CASH USED IN FINANCING ACTIVITIES(2,409)(879)
Net change in cash and cash equivalents149(4)
Cash and cash equivalents, beginning of period231165
Cash and cash equivalents, end of period$380$161
See accompanying notes to unaudited condensed consolidated financial statements.
6
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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.

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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
September 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$685 1.9 %$570 1.8 %
Third-Party Payer products3,917 11.1 %3,425 10.7 %
Patient Services revenue recognized over time:
Direct rental services1,923 5.4 %1,840 5.8 %
Third-Party Payer rental services12,277 34.8 %11,003 34.5 %
Total Patient Services accounted for under ASC 60618,802 53.2 %16,838 52.8 %
Device Solutions revenue recognized at a point in time:
Products4,731 13.4 %3,593 11.3 %
Services
2,575 7.3 %2,573 8.1 %
Device Solutions revenue recognized over time:
Services
1,841 5.2 %1,807 5.7 %
Total Device Solutions accounted for under ASC 6069,147 25.9 %7,973 25.0 %
Total Revenue Accounted for under ASC 60627,949 79.1 %24,811 77.8 %
Patient Services lease revenue
1,978 5.6 %2,451 7.7 %
Device Solutions lease revenue
5,393 15.3 %4,647 14.6 %
Total Revenue accounted for under ASC 842, Leases7,371 20.9 %7,098 22.2 %
Total Net Revenue$35,320 100.0 %$31,909100.0 %

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 Nine Months Ended
September 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$2,030 2.0 %$1,727 1.8 %
Third-Party Payer products11,182 11.1 %10,198 10.8 %
Patient Services revenue recognized over time:
Direct rental services5,724 5.7 %5,574 5.9 %
Third-Party Payer rental services35,144 34.8 %32,913 35.0 %
Total Patient Services accounted for under ASC 60654,080 53.5 %50,412 53.6 %
Device Solutions revenue recognized at a point in time:
Products12,886 12.8 %11,199 11.9 %
Services7,442 7.4 %7,608 8.1 %
Device Solutions revenue recognized over time:
Services5,850 5.8 %4,079 4.3 %
Total Device Solutions accounted for under ASC 60626,178 25.9 %22,886 24.3 %
Total Revenue Accounted for under ASC 60680,258 79.5 %73,298 78.0 %
Patient Services Lease Revenue5,537 5.5 %6,970 7.4 %
Device Solutions Lease Revenue15,218 15.1 %13,746 14.6 %
Total Revenue accounted for under ASC 842, Leases20,755 20.5 %20,716 22.0 %
Total Net Revenue$101,013 100.0 %$94,014100.0 %
Contract Balances
(dollars in thousands)
As of September 30, 2024
As of December 31, 2023
$ Change
Accounts receivable, net$22,761 $19,830 $2,931 
Contract assets$980 $1,271 $(291)
The change in contract assets during the nine months ended September 30, 2024 included $8.2 million of revenue recognized for which the payment is subject to conditions other than the passage of time, which was fully offset by $8.5 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.

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4.Medical Equipment
Medical equipment consisted of the following (in thousands):
 September 30,
2024		December 31, 2023
Medical equipment for sale or rental$4,726$3,081
Medical equipment for sale or rental - pump reserve(27)(32)
Medical equipment for sale or rental - net4,6993,049
 
Medical equipment in rental service103,05296,298
Medical equipment in rental service - pump reserve(2,456)(2,126)
Accumulated depreciation(63,595)(59,244)
Medical equipment in rental service - net37,00134,928
 
Total$41,700$37,977
Depreciation expense for medical equipment for the three and nine months ended September 30, 2024 was $2.6 million and $7.4 million compared to $2.5 million and $7.8 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 nine months ended September 30, 2024 and 2023, $2.2 million and $1.9 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):
 September 30, 2024December 31, 2023
 Gross Assets
Accumulated
Depreciation
TotalGross Assets
Accumulated Depreciation
Total
Furniture, fixtures, and equipment$6,077$(4,429)$1,648$6,611$(3,909)$2,702
Automobiles87(87)—87(87)—
Leasehold improvements4,584(2,322)2,2623,570(1,951)1,619
 
Total$10,748$(6,838)$3,910$10,268$(5,947)$4,321
Depreciation expense for property and equipment for the three and nine months ended September 30, 2024 was $0.3 million and $0.9 million compared to $0.3 million and $0.8 million for the same prior year periods, respectively. This expense was recorded in "general and administrative expenses" for each period.

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6.Goodwill & Intangible Assets
The changes in the carrying value of goodwill by segment for the nine months ended September 30, 2024 are as follows (in thousands):
 Device Solutions (a)
Balance as of December 31, 2023$3,710
Goodwill acquired—
Balance as of September 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):
 September 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(34,820)4,01438,834(34,295)4,539
Non-competition agreements472(326)146472(255)217
Unpatented technology943(494)449943(393)550
Software10,300(10,205)9510,300(10,160)140
 
Total nonamortizable and amortizable intangible assets$52,572$(45,868)$6,704$52,572$(45,126)$7,446
Amortization expense for both the three and nine months ended September 30, 2024 and 2023 was $0.2 million and $0.7 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 September 30, 2024 is as follows (in thousands):
 20242025202620272028
2029 and thereafter
Total
        
Amortization expense$248$810$525$471$348$2,302$4,704
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.

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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 September 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):
 September 30,
2024		December 31,
2023
Revolving Facility:
Gross availability$75,000$75,000
Outstanding draws(28,255)(29,439)
Letter of credit(200)(200)
Availability on Revolving Facility$46,545$45,361

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The Company had future maturities of its long-term debt as of September 30, 2024 as follows (in thousands):
 2024202520262027
2028
Total
Revolving Facility$—$—$—$—$28,255$28,255
Total$—$—$—$—$28,255$28,255
The following is a breakdown of the Company’s current and long-term debt (in thousands):
 September 30, 2024December 31, 2023
 
Current
Portion
Long-Term
Portion
Total
Current
Portion
Long-Term
Portion
Total
Revolving Facility$—$28,255$28,255$—$29,439$29,439
Unamortized value of debt issuance costs—(280)(280)—(338)(338)
Total$—$27,975$27,975$—$29,101$29,101
As of September 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 September 30, 2024 was 7.43% (Adjusted Term SOFR of 5.08% plus 2.35%). The actual ABR loan rate at September 30, 2024 was 9.25% (lender’s prime rate of 8.00% plus 1.25%).

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):

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September 30, 2024
 Balance Sheet LocationNotionalFair Value Derivative Assets
Derivatives designated as hedges:
Cash flow hedges
Interest rate swapsDerivative financial instruments$20,000$1,107

 
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 September 30,
20242023
Gain on cash flow hedges - interest rate swaps  
Beginning balance$1,295$1,442
Unrealized (loss) gain recognized in AOCI(427)434
Amounts reclassified to interest expense (a)(181)(180)
Tax benefit (provision)149(62)
Ending balance$836$1,634
(a) Negative amounts represent interest income. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income for the three months ended September 30, 2024 and 2023 was $0.5 million and $0.6 million, respectively.
 Nine Months Ended September 30,
20242023
Gain on cash flow hedges - interest rate swaps  
Beginning balance$1,088$1,489
Unrealized gain recognized in AOCI208754
Amounts reclassified to interest expense (a) (b)(543)(554)
Tax benefit (provision)83(55)
Ending balance$836$1,634
(a) Negative amounts represent interest income and positive amounts represent interest expense. Interest expense as presented in the condensed consolidated statement of operations and comprehensive income for the nine months ended September 30, 2024 and 2023 was $1.4 million and $1.7 million, respectively.
(b) As of September 30, 2024, $0.4 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 nine months ended September 30, 2024.

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9.Income Taxes
During both the three months ended September 30, 2024 and 2023, the Company recorded a provision for income taxes totaling $1.0 million and $0.4 million on pre-tax income of $2.8 million and $1.1 million, respectively, representing effective tax rates of 35.1% and 38.5%, respectively. During both the nine months ended September 30, 2024 and 2023, the Company recorded a provision for income taxes totaling $1.4 million and $0.3 million on pre-tax income $2.8 million and $1.1 million, respectively, representing effective tax rates of 49.5% and 28.8%, 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 Per Share
Basic income per share is computed by dividing net income by the weighted average number of common shares outstanding during the period. Diluted income 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 per share computations:
 Three Months Ended September 30,Nine Months Ended September 30,
Numerator (in thousands):
2024202320242023
Net income:$1,807$689$1,412$800
Denominator:
Weighted average common shares outstanding:
Basic21,290,51221,095,40421,271,85820,968,711
Dilutive effect of common stock equivalents361,945624,000435,977646,995
Diluted21,652,45721,719,40421,707,83521,615,706
Net income per share:
Basic$0.08$0.03$0.07$0.04
Diluted$0.08$0.03$0.07$0.04
For the three months ended September 30, 2024 and 2023, respectively, there were 2,220,823 and 1,073,143 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 nine months ended September 30, 2024 and 2023, respectively, there were 1,877,878 and 912,833 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.

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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 September 30, 2024, the Company had repurchased and retired approximately $1.0 million, or 149,670 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 
Granted215,481 7.51 
Vested(85,648)17.88 
Vested shares forgone to satisfy minimum statutory withholding(53,083)17.88 
Forfeitures(14,750)11.61 
Unvested at September 30, 2024591,862 $8.48 
Three Months Ended September 30,Nine Months Ended September 30,
2024202320242023
Weighted average grant date fair value of awards granted$6.90 $10.68 $7.51 $9.25 
Total fair value of shares vested$2,636 $79,944 $750,298 $649,612 
Total fair value of shares forgone to satisfy minimum statutory withholding$814 $34,371 $465,020 $364,758 
Performance-Based Restricted Stock Units ("PSU")

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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 September 30, 2024189,221 $7.92 
Nine Months Ended September 30,
20242023
Weighted average grant date fair value of awards granted$5.69 $11.05 
Total fair value of shares vested$83,862 $— 
Total fair value of shares forgone to satisfy minimum statutory withholding$67,137 $— 
    There were no PSU's granted or that vested during the three months ended September 30, 2024 or 2023, respectively.
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(26,500)11.49 
Outstanding at September 30, 2024537,512 $6.98 3.83$1,017,157 
Exercisable at September 30, 2024537,512 $6.98 3.83$1,017,157 
Aggregate Intrinsic Value is equal to the excess of market value over the option exercise price of all in-the-money stock options.

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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(89,965)13.14 
Outstanding at September 30, 2024 (a)1,827,855 $8.93 8.78$256,759 
Exercisable at September 30, 2024 (a)560,647 $12.01 7.71$— 
(a) Aggregate Intrinsic Value - no exercisable options were in-the-money as of September 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 September 30,Nine Months Ended September 30,
Stock Options:2024202320242023
Expected volatility
—%
53%
46% to 51%
53%
Risk free interest rate
—%
4.43% to 4.45%
4.25% to 4.60%
3.71% to 4.45%
Expected lives at date of grant (in years)0.004.044.083.98
Weighted average fair value of options granted$—$4.90$2.95$4.07
Total intrinsic value of options exercised$— $1,646,254 $312,195 $3,067,467 
There were no stock options granted or exercised during the three months ended September 30, 2024.

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.

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The components of lease costs for the three and nine months ended September 30, 2024 and 2023 are as follows (in thousands):
 Three Months Ended
September 30,		Nine Months Ended
September 30,
 2024202320242023
Operating lease cost$478 $378 $1,423 $1,099 
Variable lease cost94 97 266 260 
Total lease cost$572 $475 $1,689 $1,359 
Supplemental cash flow information and non-cash activity related to the Company’s leases are as follows (in thousands):
 Nine Months Ended
September 30,
20242023
Cash paid for amounts included in the measurement of lease liabilities and right of use assets:  
Operating cash flow from operating leases$1,400 $1,111 
 
Right of use assets obtained in exchange for lease obligations:
Operating leases$250 $586 
Increases to right of use assets resulting from lease modifications:
Operating leases$— $552 
Weighted average remaining lease terms and discount rates for the Company’s operating leases are as follows:
 As of September 30,
 20242023
 
 
Years
Years
Weighted average remaining lease term:5.65.7
 RateRate
Weighted average discount rate:7.8%6.8%

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Future maturities of lease liabilities as of September 30, 2024 are as follows (in thousands):
 
Operating
Leases
2024$455 
20251,905 
20261,715 
20271,542 
20281,495 
2029 and thereafter
2,474 
Total undiscounted lease payments9,586 
Less: Imputed interest(3,185)
Total lease liabilities$6,401 
The long-term portion of the lease liabilities included in the amounts above is $4.9 million with the remainder included in other current liabilities in the condensed consolidated balance sheets.
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 nine months ended September 30, 2024 and 2023:
Three Months Ended September 30,
Nine Months Ended September 30,
2024202320242023
Net operating lease revenue$7,242 $5,972 $20,225 $17,767 
Sales-type lease revenue129 1,126 530 2,949 
Total lease revenue$7,371 $7,098 $20,755 $20,716 

The components of our net investment in sales-type leases as of September 30, 2024 and December 31, 2023 were (in thousands):
September 30,
2024		December 31,
2023
Lease receivable$2,097 $2,583 
Net investment in leases$2,097 $2,583 
Our net investment in sales-type leases is classified as follows in the accompanying condensed consolidated balance sheets as of September 30, 2024 and December 31, 2023 were (in thousands):
September 30,
2024		December 31,
2023
Accounts receivable, net$1,142 $1,067 
Other assets955 1,516 
Total$2,097 $2,583 
Future maturities of sales-type leases as of September 30, 2024 are as follows (in thousands):

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Sales-Type Leases
2024$338 
20251,329 
2026652 
202728 
2028— 
Thereafter— 
Total undiscounted lease payments2,347 
Less: Imputed interest(250)
Total lease receivables$2,097 
14.Business Segment Information
The Company’s reportable segments are organized based on service platforms, with the Patient Services segment reflecting higher margin rental revenues that generally include payments made by third-party and direct payers and the Device Solutions segment reflecting lower margin product sales, direct payer rental and service revenues. Resources are allocated and performance is assessed for these segments by the Company’s Chief Executive Officer, whom the Company has determined to be its chief operating decision-maker. The Company believes that reporting performance at the gross profit level is the best indicator of segment performance.
The financial information summarized below is presented by reportable segment for the three months ended September 30, 2024 and 2023:
2024
(in thousands)Patient ServicesDevice Solutions
Corporate/
Eliminations
Total
 
Net revenues - external$20,780$14,540$—$35,320
Net revenues - internal—1,992(1,992)—
Total net revenues20,78016,532(1,992)35,320
Gross profit13,7105,335—19,045
Selling, general and administrative expenses15,780
Interest expense